Diabetology International最新文献

Introduction: Existing studies mostly focus on the separate impacts of diabetes distress, depression, and anxiety on glycemic control, leaving a gap in understanding their combined influence within primary care settings. This study aims to explore this interaction among patients with type 2 diabetes mellitus (T2DM) in Egyptian primary healthcare.

Methods: The study was conducted in rural primary healthcare settings in Egypt from September 2020 to June 2021, included 354 patients with T2DM. Sociodemographic, lifestyle, and clinical characteristics were assessed through patient interviews. Diabetes distress was measured using the 5-item Problem Areas in Diabetes Scale (PAID-5 scale), and symptoms of depression and anxiety were evaluated using the Patient Health Questionnaire 9 (PHQ-9) and the Generalized Anxiety Disorder 7 Scale (GAD-7), respectively. Glycated hemoglobin (HbA1c) measurements indicated glycemic control.

Results: Participants experienced varying mental health symptoms: 24.9% had one symptom, 8.2% had two, and 4.5% had all three (diabetes distress, depression, and anxiety symptoms). In multiple linear regression, not working status (β = -0.203, p = 0.015), dyslipidemia (β = 0.258, p = 0.021), increased BMI (β = 0.022, p < 0.001), and more mental health symptoms (β = 0.267, p < 0.001) predicted higher HbA1c levels. Ordinal regression found that higher educational levels (OR = 2.385, p = 0.021), sufficient income (OR = 2.360, p = 0.007), and higher HbA1c (OR = 3.103, p < 0.001) predicted more mental health symptoms.

Conclusion: Mental health symptoms were common, and there were reciprocal associations between elevated HbA1c levels and increased mental health symptoms.

Supplementary information: The online version contains supplementary material available at 10.1007/s13340-025-00793-2.

Objective: Stress and working environments are risk factors for diabetes mellitus. A new occupational health policy called the Stress Check Program was started in Japan in 2015. Therefore, we clarified whether the presence or absence of high job stress (HJS) as determined using the Brief Job Stress Questionnaire (BJSQ) is related to the comorbidity of diabetes.

Methods: The results of a single year's BJSQ and medical examinations were investigated for 30,694 Japanese active office workers who were 30 to 59 years old. Presence or absence of HJS was assessed using the BJSQ and investigated using a personal computer in a medical interview. Furthermore, the relationships between HJS and diabetes comorbidity were analyzed.

Results: The mean age of the subjects was 43.8 ± 10.5 years old, and the proportion of subjects with HJS was 10%. After adjustment for age and sex, HJS was associated with a risk of diabetes comorbidity (odds ratio, 1.30; 95% confidence interval 1.13-1.49). HJS was not a significant diabetic comorbidity factor when adjusted for lifestyle habits in addition to age and sex.

Conclusion: HJS measured using the BJSQ and unhealthy lifestyles synergistically contributed to diabetes comorbidity.

Gestational diabetes mellitus (GDM) is a known risk factor for both maternal and fatal complications. Glycemic control in pregnant women is important for preventing these complications. However, the need for insulin therapy in pregnant women is difficult to determine. This study focuses on glucagon, which provides new prospects due to advancement in the measurement assay method for type 2 diabetes. Investigating the dynamics of glucagon in pregnant women will help in the diagnosis of GDM and in identifying those requiring insulin treatment. A total of 58 pregnant women between 24 and 31 weeks of gestation underwent a 75-g glucose tolerance test at our institution between 2013 and 2015. The results showed differences in post-glucose and insulin levels between patients with and without GDM, but not in glucagon levels. However, differences were observed in fasting plasma glucose (79.2 ± 4.2 vs. 85.7 ± 8.5 mg/dL, P = 0.006) and in the glucagon change rates at 15, 30, and 60 min after glucose loading between patients with GDM requiring insulin treatment and those who did not. Using a cutoff value of -0.4566 for the glucagon change rate at 60 min as the predictor for insulin treatment, the sensitivity and specificity were 63.16% and 92.31%, respectively. Overall, the measurement of glucagon during the early post-glucose load period may be useful in predicting insulin therapy requirements in pregnant Asian women with GDM.

Supplementary information: The online version contains supplementary material available at 10.1007/s13340-025-00797-y.

Aim: The objective of this cross-sectional study was to clarify the relationship between the type of first-degree family history of diabetes (FHD) and the presence and age at onset of diabetes (AOD) in the Japanese general population.

Material and methods: Using anonymized processed data collected from community-based health checkups, we classified 10,691 subjects into 5 groups according to the type of FHD as follows: (1) no FHD; (2) diabetes only in a sibling (sFHD); (3) diabetes only in the mother (mFHD); (4) diabetes only in the father (pFHD); and (5) diabetes in ≥ 2 family members, e.g., one parent plus a sibling or both parents (FHD in ≥ 2 family members).

Result: Results of multivariate logistic regression analysis performed using the no FHD group as reference revealed a significant association between a positive FHD and the presence of diabetes (odds ratio: sFHD, 3.67; mFHD, 3.70; pFHD, 2.88; FHD in ≥ 2 family members, 6.35; P < 0.0001 for all). Moreover, the AOD was significantly younger in all the four groups with FHD than in the group without FHD (P < 0.01), being the youngest in the group of FHD in ≥ 2 family members.

Conclusion: Our results revealed that the degree of associations between a positive FHD and the presence of diabetes and AOD differ according to the type of FHD. In particular, FHD in ≥ 2 family members appears to be especially strongly associated with a high risk of diabetes and a younger AOD.

Sodium glucose cotransporter-2 (SGLT2) inhibitors improve glycemic control and reduce body weight (BW) in individuals with type 2 diabetes. However, there are still concerns that compensatory hyperphagia may affect their effects. Here, we performed an exploratory prospective study to investigate whether dietary intake and/or eating behaviors affect glycemic control and BW under long-term treatment with dapagliflozin. Fifty-three Japanese individuals with type 2 diabetes received dapagliflozin 5 mg daily for 104 weeks, with frequent assessments of HbA1c, BW, body composition, dietary intake, and eating behaviors. Dietary intake was evaluated using a brief self-administered diet history questionnaire, and eating behavior was evaluated using the Dutch Eating Behavior Questionnaire. The study was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000019192). At 104 weeks, HbA1c decreased by 0.5% and BW decreased by 2.8 kg (both p < 0.001), with a dominant decrease in body fat mass by 2.2 kg (p < 0.001). No significant change was observed in calorie intake or the proportion of carbohydrates, protein, and fat. The change (∆) in HbA1c was significantly correlated with basal HbA1c, basal triglyceride levels, ∆BMI (body mass index), ∆BFP (body fat percentage), and ∆ferritin levels. The ∆BMI was significantly correlated with only the ∆BFP. Neither the ∆HbA1c nor ∆BMI was significantly correlated with dietary intake, any type of eating behavior, or changes in these parameters during this study. In conclusion, dapagliflozin treatment improved glycemic control and reduced BW without being affected by any changes in dietary intake or eating behavior over 104 weeks.

Supplementary information: The online version contains supplementary material available at 10.1007/s13340-025-00794-1.

Background: Precision medicine in diabetes care requires a dedicated focus on hypoglycemic symptoms. This study explored the associations between clustering of hypoglycemic symptoms, psychological characteristics, and problem-solving capabilities in adults with type 1 diabetes (T1D).

Methods: A total of 251 adults with T1D participated in this survey. Hierarchical clustering was used to analyze 11 hypoglycemic symptoms (Edinburgh scale). The data included diabetic complications, fear of hypoglycemia, depressive symptoms, hypoglycemia problem-solving scale (HPSS), and treatment details. For predicting clusters and identifying feature importance, we utilized a machine learning approach.

Results: Three distinct clusters were observed; individuals not sensitive to autonomic or neuroglycopenic symptoms (cluster 1, n = 138), those sensitive to both autonomic and neuroglycopenic symptoms (cluster 2, n = 19), and those sensitive to autonomic but not neuroglycopenic symptoms (cluster 3, n = 94). Compared to cluster 1, individuals from clusters 2 and 3 were of younger age, had higher fear of hypoglycemia, increased depressive symptoms, and greater use of continuous subcutaneous insulin infusion. Cluster 2 displayed enhanced HPSS scores, indicating better detection control and a more proactive approach to seeking preventive strategies than cluster 1. The accuracy for classifying into 3 clusters using machine learning was 88.2%. The feature importance of random forest model indicated that hunger, shaking, palpitation, sweating, and confusion were the top five important factors for predicting clusters.

Conclusion: This study identified three distinct clusters of adults with T1D. These findings may provide valuable insights for diabetes professionals seeking to educate these individuals on how to manage hypoglycemia effectively.

Trial registration: University Hospital Medical Information Network (UMIN) Center: UMIN000039475); approval date: February 13, 2020.

Aims: Diabetic foot ulcers are a leading cause of lower extremity amputations, significantly affecting the quality of life. Excessive plantar surface pressure and shear stress are key factors in ulcer development and aggravation. This study aimed to determine the association of these forces with the progression of diabetic peripheral neuropathy to help in foot-ulcer treatment and prevention.

Methods: Participants were categorized into four groups: individuals with no diabetes (NS), people with diabetes without peripheral neuropathy or foot-ulcer history (DM), those with diabetes with peripheral neuropathy but no foot-ulcer history (DPN), and people with diabetes with active or past foot ulcers (DFU). Plantar pressure and shear stress were measured during walking.

Results: The study included 47 participants. The DFU group demonstrated significantly higher pressure peak value and plantar pressure time integral value at the fifth metatarsal head compared to the DPN and DM groups. The DPN group exhibited significantly higher shear-stress time integral and shear stress time compared to the NS group.

Conclusions: In the DPN group, an increase in shear stress was observed. In the DFU group, an increase in plantar pressure and a tendency for an increase in shear stress were noted. Further research is needed to understand how these changes trigger the onset of foot ulcers.

Supplementary information: The online version contains supplementary material available at 10.1007/s13340-024-00789-4.

It is rare for a patient to have minimal change nephrotic syndrome, slowly progressive insulin-dependent diabetes mellitus, and Graves' disease in combination. In this case, a patient developed idiopathic nephrotic syndrome at the age of 11 years. She was diagnosed with frequently relapsing nephrotic syndrome and steroid-dependent nephrotic syndrome after repeated increases in urinary protein levels with prednisolone reduction. At the age of 14 years, steroid-induced diabetes was suspected because she was negative for anti-glutamic acid decarboxylase (GAD) antibody, and her glycemic control improved after medication. At the age of 16 years, her nephrotic syndrome was in remission, but even after discontinuation of cyclosporine, her glycemic control did not improve. Decreased insulin secretion and positive anti-insulinoma-associated protein-2 (IA2) antibody were found, and therefore she was diagnosed as having slowly progressive insulin-dependent diabetes mellitus (SPIDDM). Although her glycemic control was stable with insulin therapy, she was diagnosed with asymptomatic Graves' disease at the age of 28 years and started treatment. Human leukocyte antigen testing (HLA) was performed to evaluate the etiology of the disease, which revealed A*02:01, B*35:01, DQA1*03:01, DQB1*03:02, DQB1*04:01, DRB1*04:05, DRB1*08:02, and DPB1*05:01, suggesting genetic involvement of HLA for each disease susceptibility.

Aims/instruction: We previously demonstrated that sitagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor, slowed down the progression of carotid atherosclerosis in type 2 diabetes participants who were treated with insulin and had no history of cardiovascular disease in the Sitagliptin Preventive study of Intima-Media Thickness Evaluation (SPIKE) trial. This was an extension of the SPIKE trial that examined if early sitagliptin initiation improved long-term cardiovascular outcomes.

Materials and methods: In the SPIKE trial, 282 participants were randomized to either sitagliptin or conventional treatment to examine the effects of sitagliptin on carotid atherosclerosis. All participants who completed the SPIKE trial were recruited to this prospective, observational, cohort study and followed for up to 520 weeks. The primary endpoint was the first occurrence of a major cardiovascular event, which included acute myocardial infarction, stroke, or total mortality.

Results: Events of composite primary outcome occurred in only a few participants in each group (15 [12.6%] in the sitagliptin group and eight in the conventional treatment group [6.7%]). The incidence rate of the primary outcome did not differ significantly between two groups. In post hoc Poisson regression analysis, there were no significant between-group differences in the incidence rates of composite recurrence events for the same outcomes as the primary endpoint.

Conclusions: Early initiation of sitagliptin as add-on therapy to insulin was not linked to reduced risk of composite cardiovascular disease. This may be due to low event numbers in both groups and/or relatively lower continuation rates of DPP-4 inhibitors in the sitagliptin group during the follow-up period.

Supplementary information: The online version contains supplementary material available at 10.1007/s13340-024-00786-7.

Type 2 diabetes (T2D) is a polygenic disease, and the development of animal models by selective breeding is crucial for understanding its etiology, pathophysiology, complications, and treatments. We recently developed a new T2D model, the Oikawa-Nagao (ON) mouse, by selectively breeding mice with inferior glucose tolerance [diabetes-prone (ON mouse DP®; ON-DP) strain] and superior glucose tolerance [diabetes-resistant (ON mouse DR®; ON-DR) strain] on a high-fat diet. ON-DP mice are predisposed to develop diabetes and obesity after being fed a high-fat diet, compared to ON-DR mice. These phenotypes provide valuable insights into the genetic and environmental interactions for the etiology of T2D. Our studies revealed that the emergence of these phenotypes is associated with novel pathophysiological mechanisms, such as low insulin secretion capacity associated with high CD36 expression in pancreatic β-cells and hypoleptinemia preceding obesity due to low leptin secretion capacity in adipocytes. In addition, ON-DP mice fed an atherogenic diet exhibit accelerated atherosclerosis, likely related to blood glucose fluctuations. These findings provide new perspectives on the pathogenesis of T2D and suggest potential prevention and treatment strategies. This review will present the development strategy of the ON mouse strain, representative metabolic phenotypes, and discuss the mechanisms driving these traits, and explore their relevance to human T2D and obesity.