Diabetology International最新文献

We report two cases of diabetes mellitus treated with sacubitril/valsartan, whose urinary C-peptide dynamics exhibited significant difference. The first case is an 84-year-old Japanese man with type 2 diabetes and hypertension who exhibited significantly elevated urinary C-peptide levels during treatment with sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNi). Despite normal serum C-peptide levels, his urinary C-peptide excretion was disproportionately high, suggesting that sacubitril/valsartan may have altered C-peptide clearance through neprilysin inhibition. The discontinuation of sacubitril/valsartan demonstrated gradual decline of urinary C-peptide levels, although they remained elevated compared to serum ones. Daily longitudinal monitoring of urinary C-peptide revealed marked fluctuations of its levels, indicating a prolonged and potentially complex effect of neprilysin inhibition on C-peptide excretion. Additionally, we observed a corresponding decrease in atrial natriuretic peptide (ANP) levels after discontinuation of sacubitril/valsartan, further supporting the role of neprilysin inhibition in altering peptide metabolism. In contrast, the second case involves a 78-year-old Japanese woman with insulin-dependent type 1 diabetes and undetectable serum C-peptide levels. In her case, urinary C-peptide levels remained undetectable despite ARNi therapy. These cases highlight the need for careful clinical interpretation of urinary C-peptide levels in patients receiving neprilysin inhibitors. When evaluating pancreatic β-cell function using urinary C-peptide levels under ARNi therapy, it is crucial to consider extended monitoring of urinary C-peptide levels, the duration of drug withdrawal, and serum C-peptide levels to ensure accurate assessment.

Aims/introduction: This study assessed the association between periodontal disease and the development of diabetes mellitus, as well as the effects of sex differences and obesity on this association.

Materials and methods: The study included 4051 employees (2497 men and 1554 women) aged 35-55 years at a metal product manufacturing company in Japan. Periodontal disease was assessed using the Community Periodontal Index. Diabetes mellitus was determined based on annual health checkups.

Results: The prevalence of periodontal disease was 36.9% (41.9% in men and 29.5% in women). During the 12-year follow-up, 229 participants developed diabetes. The cumulative incidence rates (per 1000 person-years) were 10.1 for all participants, 7.8 for those without periodontal disease, and 14.5 for those with periodontal disease. The multivariate-adjusted hazard ratio (HR) for diabetes incidence in the periodontal disease group was 1.36 (95% confidence interval: 1.04-1.78); this was significantly higher than in the non-periodontal disease group. In men, the multivariate-adjusted HR for diabetes incidence was significantly higher in the periodontal disease group, at 1.37 (1.02-1.83), than in the non-periodontal disease group. No significant association was detected in women. When stratified according to sex and obesity status, the non-obese male group showed a significantly higher HR for diabetes incidence in the periodontal disease group (1.75 [1.15-2.66]) compared with the non-periodontal disease group.

Conclusions: This 12-year prospective cohort study demonstrated that periodontal disease significantly increased the risk of diabetes; the association was more pronounced in men, particularly non-obese men.

Supplementary information: The online version contains supplementary material available at 10.1007/s13340-025-00815-z.

Aim: In patients with diabetes, autonomic neuropathy leads to reduced sweating, which can lead to dry skin, and if the condition worsens, these can progress from foot fissures to ulcers. Although foot skin care is important in patients with diabetes to prevent diabetes-related foot ulcers, there are no detailed guidelines that provide specific methodology for achieving this goal. This scoping review aimed to clarify what is known in the literature regarding foot skin care for dry skin for patients with diabetes and propose optimal foot skin care to help prevent diabetes-related foot ulcers.

Methods: Literature databases were searched and two independent researchers screened the articles according to the inclusion criteria and then extracted the data. To be included in the analysis, all reports had to be original articles/case studies, studies involving human subjects, and studies on foot skin care for dry skin for patients with diabetes.

Results: Seven studies met the inclusion criteria. Findings showed that application of a moisturizer, especially a cream containing urea or a cream containing 15% glycerol, liquid, and 10% soft paraffin twice a day for at least two weeks, could help relieve dry feet.

Conclusion: Establishing optimal foot skin care for patients with diabetes may require further studies that examine the frequency and long-term effects of foot skin care interventions, with the ultimate outcome focused on the development of diabetes-related foot ulcers.

Introduction: Older adults with diabetes often experience a decline in locomotor functions, such as stair climbing and walking, which are important for activities of daily living (ADL). Furthermore, individuals with low Self-Efficacy for Locomotor Function (SELF) are at a higher risk of requiring locomotor assistance. This study explored the relationship between diabetes and SELF in older females.

Methods: This study included 45 females (15 non-diabetes, 30 diabetes) aged 65 years and over without ADL impairment in our clinic. SELF was measured by walking and stair climbing. Physical function was measured by hand grip strength, knee extension force (KEF), and KEF divided by bodyweight (%KEF).

Results: The SELF of stair climbing was significantly lower in the diabetes mellitus group than in the non-diabetes mellitus group (p = 0.009), whereas the SELF of walking was not significantly different (p = 0.351). Diabetes status remained a significant factor in the SELF of stair climbing after adjusting for body mass index, orthopedic disease, and %KEF.

Discussion: Stair climbing is one of the most vigorous ADLs performed by older adults, and this result may be due to the fact that stair climbing is a more vigorous activity than walking. Furthermore, the results of this study suggest that other factors (physical function other than %KEF and handgrip strength, psychological factors) related to diabetes may be more important than %KEF in older females.

Conclusions: SELF for stair climbing in older females was lower in those with diabetes, indicating that diabetes status significantly influenced their perceived ability to perform this task.

Supplementary information: The online version contains supplementary material available at 10.1007/s13340-025-00813-1.

Aim/introduction: This study investigated if immediately post-lunch exercise may improve postprandial hyperglycemia in individuals with prediabetes.

Materials and methods: The study consisted of a control phase involving no exercise and an exercise phase involving exercise. During both phases, participants were assessed for their AUC, RCMC and %TITR using CGM-derived postprandial data; they were also assessed for physical activity using a physical activity tracker and for energy intake using a dietary management application.

Results: Of the 43 males included, 23 were available for analysis. Their AUC values were significantly lower at post-lunch 1 h in the exercise phase than in the control phase with their %TITR values being significantly higher in the exercise phase than in the control phase. Their cumulative AUC values were significantly lower for post-lunch 2, 3, and 4 h in the exercise phase, with the cumulative %TITR values being also significantly higher. Their RCMC values were significantly lower for post-lunch 0-1 and 3-4 h, and significantly higher for post-lunch 1-2 h, in the exercise phase than in the control phase, with no difference for post-lunch 2-3 h between the phases. They exhibited monophasic or biphasic glucose profiles in the exercise phase with significantly different AUC and %TITR values for post-lunch 0-4 h, but no difference in HR reserve (HRR), energy intake or its composition.

Conclusion: In those with prediabetes, postprandial hyperglycemia improved with immediately post-lunch exercise, with significant improvements in cumulative AUC and %TITR values. Further study is required to clarify why they exhibited disparate glucose profiles.

Objective: Recently, the Japan Diabetes Society changed its nutrition recommendations and now recognizes a low-carbohydrate diet as an effective dietary approach. There has been controversy regarding low-carbohydrate diets in relation to renal function. That is, high protein intake may lead to renal damage through hyperfiltration. Global nutritional therapy for diabetic kidney disease (DKD) recommends a protein intake of 0.8 g/kg body weight (BW)/day. In Japan, the recommended protein intake is precisely determined based on the chronic kidney disease stage. However, evidence supporting the positive health impact of such protein restriction is scarce. Therefore, we aimed to investigate the effect of a low-carbohydrate diet without protein restriction on the estimated glomerular filtration rate (eGFR) decline rate.

Methods: Clinical data of patients with DKD in Tokyo Saiseikai Central Hospital and Kitasato Institute Hospital in Japan were retrospectively analyzed between February 2019 and December 2023. Sixty-eight participants were classified into two groups based on their diet: the energy-restricted and low-carbohydrate groups.

Results: The protein intake of the low-carbohydrate group was significantly higher than that of the energy-restricted group (1.2 ± 0.4 and 1.0 ± 0.2 g/kg BW/day, respectively). No significant differences were observed in the baseline, endpoint, or slope of eGFR between the two groups.

Conclusions: This study suggests that among Japanese adults with DKD, the protein intake difference between energy-restricted and low-carbohydrate diets does not form any gap in eGFR decline rates.

Supplementary information: The online version contains supplementary material available at 10.1007/s13340-025-00808-y.

Aim: This study investigated the effects of minocycline on proinflammatory cytokines, oxidative stress marker levels in the spinal cord and sciatic nerve morphology in Type 2 diabetic (T2DM) neuropathy rats.

Methods: Male Sprague Dawley rats were randomly assigned to six groups (n = 14 per groups): Control (C), T2DM control (STZ), T2DM treated with minocycline 40 mg/kg (STZ + M40) and 80 mg/kg (STZ + M80), T2DM treated with gabapentin (STZ + G10) and non-painful T2DM neuropathy (NPDN). T2DM was induced in obese rats using a combination of high fat diet (HFD) and low-dose streptozotocin (STZ) (40 mg/kg) injection. Then, the neuropathic pain behaviour, body weight and blood biochemical analysis were performed. Rats were sacrificed and the spinal cord and sciatic nerve were collected for ELISA and histology examination.

Results: T2DM rat groups were significantly increased body weight after 6 weeks but significantly reduced from 8 until 9 weeks compared to control group (p < 0.05). The fasting blood glucose (FBG) level in all T2DM groups were significantly higher on day 3, day 14, and day 22 compared to control group (p < 0.05) consistent with HbA1c levels. T2DM groups also significantly increased MDA, TNF-α, IL-1β and C-Reactive Protein (CRP) but decreased SOD and Catalase levels in the spinal cord compared to control group (p < 0.05). T2DM groups also showed significant abnormal morphology changes in the sciatic nerve compared to control group (p < 0.05). Minocycline dependent on doses and gabapentin in T2DM rat significantly alleviated all these effects.

Conclusion: These findings suggest the neuroprotective effects of minocycline on T2DM neuropathy.

Purpose: Maturity-onset diabetes of the young (MODY) is a transformative factor in today's pattern of diabetes care. The definition of its genetic basis brings insight into the diabetes processes, opening up possibilities for its early detection through public health strategies and improvement in precision medicine. Current knowledge on MODY has been brought together in this review.

Methods: Extensive literature review on PubMed and Google Scholar databases was conducted. Studies encompassing (1) genetic underpinnings and their types, (2) the significance of its biomarkers, and (3) diagnostic techniques and treatment modalities were focused upon.

Results: The disease accounts for 1-2% of all cases of diabetes and is usually misdiagnosed as either Type 1 or Type 2 diabetes. Several genes are involved in the appropriate functioning of pancreatic β-cells and mutations in these genes lead to an impairment in glucose metabolism and insulin secretion. A mild degree of hyperglycaemia, but without ketosis, is typical of MODY, seen mostly in adolescents and young adults. Treatment varies, including sulfonylureas for HNF1A and HNF4A mutations, lifestyle management for GCK mutations, and emerging therapies like GLP1 receptor agonists.

Conclusion: Proper genetic diagnosis is cardinal to the best management of MODY. Genetic and clinical advances have been impressive in monogenic diabetes, but further research in novel therapies is needed to optimise outcomes with precision medicine.

Background: This study aimed to investigate the association between postpartum glucose intolerance and the timing of gestational diabetes mellitus (GDM) diagnosis according to criteria from the International Association of Diabetes and Pregnancy Study Groups (IADPSG).

Methods: A single-center retrospective case-control study involving patients diagnosed with GDM according to IADPSG criteria was conducted. Patients underwent a postpartum 75 g oral glucose tolerance test (OGTT) and were divided into 2 groups: normal (control) and abnormal glucose tolerance (AGT). Gestational age at GDM diagnosis and the maternal and neonatal outcomes were compared between the groups.

Results: Data from 177 controls and 102 patients diagnosed with AGT were analyzed. The AGT group exhibited a higher pre-pregnancy body mass index, family history of diabetes, glycated hemoglobin level at the initial visit, and total daily insulin dose, but a lower rate of GDM diagnosis at 24-32 weeks' gestation. GDM diagnosed before 24 weeks' gestation was independently associated with AGT (adjusted odds ratio 2.18 [95% confidence interval 1.28-3.73]; p < 0.01]). Additionally, a higher proportion of patients diagnosed with GDM before 24 weeks' gestation had a lower disposition index (27.1% versus 14.8%; p = 0.01).

Conclusions: Patients diagnosed with GDM at < 24 weeks' gestation were at higher risk for postpartum glucose intolerance than those diagnosed at 24-32 weeks. The lower disposition index in patients early diagnosed highlights the need for tailored postpartum follow-up to address their specific risks.

Aim: Although diabetes is associated with the risk of tooth loss, there are no large-scale studies examining the reality and the effectiveness of dental maintenance visits in preventing tooth loss. We aimed to investigate the associations among the number of teeth, dental maintenance visits and diabetic status.

Methods: This is a cross-sectional study: a database comprising employment-based health insurance claim and medical check-up data between April 2015 and March 2016. From the dental receipts for a total of 705,542 individuals aged 20-74 years, we calculated dental visits ratio. After excluding missing data on the number of teeth and HbA1c, the association between dental maintenance visits and the number of teeth was further examined in 185,820 individuals aged 40-69 years visited a dentist by diabetes status.

Results: The percentage of dental visits was 46% overall, particularly low among younger subjects (34% in 20 s, 43% in 30 s), and increased with age. The maintenance-included group had a higher number of teeth than the treatment-only group, even at older ages, and this association was observed regardless of diabetes or glycemic control status. Furthermore, even with diabetes, the number of teeth in the group with good glycemic control was like that of non-diabetic.

Conclusion: Dental visits ratio was particularly low among younger subjects and those who receive dental maintenance had a higher number of teeth, regardless of diabetes or not. Adequate glycemic control and dental maintenance were associated with the number of teeth in the people with diabetes. The results suggest that it is important for physicians to work closely with dentists to promote patient-centered care and encourage both maintenance visits and better glycemic control.

Supplementary information: The online version contains supplementary material available at 10.1007/s13340-025-00805-1.