Journal of Diabetes Investigation最新文献

Aims: To compare the prevalence of GDM and pregnancy outcomes between the one-step and two-step methods of universal screening among Thai pregnant women.

Methods: A randomized controlled trial was conducted on singleton Thai pregnant women at a gestational age of 24-28 weeks. They were randomly assigned to either the one-step method group (a universal 75-gm 2-h oral glucose tolerance test: OGTT) or the two-step method group (a universal 50-gm oral glucose challenge test followed by a 100-gm 3-h OGTT). The women received standard antenatal care. The prevalence of GDM and obstetric outcomes were compared.

Results: A total of 143 women meeting the inclusion criteria were randomly allocated into the one-step group (72 cases) and the two-step group (71 cases). The prevalence of GDM was significantly higher in the one-step group than in the two-step group, with rates of 24/73 (33.3%) vs 8/70 (11.3%); P value 0.002; relative risk of 2.96, 95% CI: 1.43-6.14, respectively. Demographic data and maternal and neonatal outcomes were comparable between the two groups.

Conclusions: The one-step method can markedly increase the prevalence of GDM to nearly three times that of the two-step method, leading to a substantial increase in care costs and burdens without clear benefits. Convincingly, the one-step method as a new approach may not be suitable for universal screening in a busy antenatal care setting, especially in low-resource health centers in developing countries or among populations with a high prevalence of GDM.

The goal of diabetes management is to achieve longevity and quality of life equivalent to those of people without diabetes, and for that, it is now deemed important to pay close attention not only to diabetic vascular complications but also to diabetic comorbidities, as is recommended by the Japan Diabetes Society. In this editorial, we focus on sarcopenia as an important diabetic comorbidity which is an aging-related phenomenon in skeletal muscle. Taking our recent report on a sarcopenia mouse model and other accumulated evidence into account, we propose the existence of a skeletal muscle-centered inter-tissue network that regulates frailty and systemic aging. Sarcopenia is deemed to be a state in which skeletal muscle serving as a protective mighty armor against frailty and systemic aging is lost, and it is vitally important to establish how to recover it and keep it in good shape, so that the goal of diabetes management can be achieved.

The FreeStyle Libre Flash Glucose Monitoring System allows users to obtain sensor glucose values by scanning with the reader or their mobile phone. We report a case of a 59-year-old man with type 1 diabetes mellitus who developed diabetic ketoacidosis due to a sensor defect. After replacing the sensor with a new one, the glucose value shown in the device was much lower than usual, which made him consider that he was hypoglycemic. Accordingly, he reduced his insulin dose and eventually developed diabetic ketoacidosis. He was unaware of the discrepancy due to the lack of self-monitoring of his blood glucose, although he was educated to do. In sum, glucose monitoring with the FreeStyle Libre is helpful; however, it is necessary to remind the patient that a sensor defect leading to a severe complication frequently happens.

We aimed to compare the effects of cardiovascular disease risk in Japanese patients with type 2 diabetes on sodium–glucose cotransporter 2 inhibitors (SGLT2Is) or metformin. This retrospective, real-world cohort study was carried out using a claims database and propensity score matching; 58,402 eligible patients (29,201 per group) were included. The outcomes included nonfatal myocardial infarction, angina pectoris, nonfatal stroke, hospitalization for heart failure and composite end-points. The hazard ratio (HR) for the composite end-point was 0.79, which was lower for SGLT2Is than for metformin. For male patients (HR 0.76), patients aged <65 years (HR 0.94), patients aged ≥75 years (HR 0.78) and patients with body mass index ≥25 kg/m² (HR 0.76), the HRs for the composite end-point were significantly lower in the SGLT2I group than in the metformin group. SGLT2Is might be superior to metformin in reducing the composite risk of cardiovascular disease in patients with type 2 diabetes.

Needle phobia is a specific phobia classified as an anxiety disorder in the Diagnostic and Statistical Manual of Mental Disorders-5, and can be a serious problem for patients requiring insulin injections. However, there have been few reports to date on the management of adults with diabetes and needle phobia. We here report a case of a woman with pancreatic diabetes who developed needle phobia and could no longer perform self-injections. She started to use a sensor-augmented pump (SAP), and was able to perform a puncture for the insulin pump and the continuous glucose monitoring sensor by herself. The SAP treatment achieved self-management, better glycemic control, and high treatment satisfaction quantified using the Diabetes Treatment Satisfaction Questionnaire in this patient. Our case suggests the therapeutic potential of SAP in adults with needle phobia and diabetes requiring insulin therapy.

Impaired insulin secretion from pancreatic islet β-cells is a major cause of metabolic dysregulation and type 2 diabetes mellitus. Complete transcriptomic characterization of islets in patients with type 2 diabetes mellitus has yet to be completed, and it remains challenging to link insulin secretion dysfunction with precise changes in gene expression. There are several ongoing initiatives aimed at enabling the discovery of regulatory molecules that might contribute to insulin secretion dysfunction and whole-body glucose homeostasis impairment. In one such line of research, Bacos et al.¹ obtained evidence suggesting that the gene PAX5 might play an important role in impaired insulin secretion in human islets (Figure 1).

Given the established differences between mouse and human islets, type 2 diabetes mellitus candidate genes that were identified in mice might not have the same regulative effects on human islets. There is an unmet need for powerful transcriptomic analyses that can be applied to human islets isolated from individuals with type 2 diabetes mellitus and nondiabetic controls. Due to the difficulties associated with obtaining human islets, most human islet transcriptomic studies thus far have involved small cohorts and have lacked functional validation. Bacos et al.¹ generated a ribonucleic acid sequencing (RNA-Seq) resource bank from the large Lund University Diabetes Center pancreatic islet cohort. It is one of the largest existing type 2 diabetes mellitus human islet cohorts in existence, providing an extensive gene expression resource based on 309 islet preparations in total from individuals with type 2 diabetes mellitus and nondiabetic controls. They then identified 395 differentially expressed genes (DEGs) from the Lund University Diabetes Center cohort, and further performed some functional validation of DEGs in vitro.

The utility of transcriptomic resources can be affirmed by robust replication of DEGs across studies and databases. To date, few DEG replication studies in type 2 diabetes mellitus human islets have been reported, and the various studies in the literature showing replication have been relatively small, including the work by Bacos et al.¹ Unsurprisingly, the variance in demographic and pathophysiological profiles among sample donors affects DEG overlap across study cohorts. There remains a need to analyze human islets from a more diverse donor pool, and larger cohorts to clarify whether islet gene expression differs among individuals with type 2 diabetes mellitus in relation to demographic and pathophysiological variables. Another important factor affecting DEG overlap is the particular screen technology applied. RNA-Seq, microarray analysis and other screening technologies have been used to identify genes with altered expression in type 2 diabetes mellitus human islets, generating transcriptiona