Journal of Diabetes Investigation最新文献

Diabetes is one of the most common chronic diseases at present, and insulin pen injection therapy plays an important role in the treatment of diabetes. However, the majority of patients might reuse disposable insulin pen needles for various reasons, which leads to related complications. As far as we know, this article is the first to describe a patient whose needle remained in the right upper limb while reusing a disposable insulin injection needle for subcutaneous insulin injection with the non-dominant hand. The patient went to the doctor 1 week later. The needle moved from the lateral area of the proximal upper arm (the injection site) to the posterolateral area of the distal upper arm. The needle was then successfully removed by surgery. The reuse of disposable insulin pen needles might lead to serious complications. It is suggested to strengthen the education of people living with diabetes to help them use insulin pen needles safely.

The decline in β-cell mass due to the failure of β-cell compensation is one cause of the development of type 2 diabetes. Therefore, elucidation of the mechanism by which an adaptive increase in β-cell mass occurs in vivo will lead to the development of a cure for diabetes. Insulin and insulin receptor (IR)-mediated signaling pathways play an important role in the mechanism that increases β-cell mass by compensatory β-cell proliferation in response to chronic insulin resistance. However, whether IR is required for compensatory β-cell proliferation remains controversial in some situations. It might be possible that IR acts as a scaffold for the signaling complex independent of its ligand. It has also been reported that the forkhead box protein M1/polo-like kinase 1/centromere protein A pathway plays a central role in adaptive β-cell proliferation during diet-induced obesity, hyperglycemia, pregnancy, aging and acute insulin resistance. We recently reported that the cross-talk of islets with fat tissue, in addition to the liver, through humoral factors is involved in adaptive β-cell proliferation. This accommodative response of β-cell proliferation through adipocytes was observed particularly under an acute insulin resistance state in an IR/insulin signal-independent and forkhead box protein M1/polo-like kinase 1/centromere protein A pathway-dependent manner. A remaining barrier for the treatment of human diabetes using β-cells is the differences between human and rodent islets. In this review, the focus is on signaling pathways that regulate adaptive β-cell proliferation for the treatment of diabetes considering the abovementioned issues.

Pancreatic islet transplantation is a β-cell replacement therapy for people with insulin-deficient diabetes who have difficulty in glycemic control and suffer from frequent severe hypoglycemia. However, the number of islet transplantations carried out is still limited in Asia. We report a case of allogeneic islet transplantation in a 45-year-old Japanese man with type 1 diabetes. Although the islet transplantation was successfully carried out, graft loss was observed on the 18th day. Immunosuppressants were used in accordance with the protocol, and donor-specific anti-human leukocyte antigen antibodies were not detected. Autoimmunity relapse was also not observed. However, the patient had a high titer of anti-glutamic acid decarboxylase antibody from before the islet transplantation, and autoimmunity might thus have affected the β-cells in the transplanted islet. The evidence is still scarce to reach conclusions, and further data accumulation is required to enable proper patient selection before islet transplantation.

The predicted structures of major proteins involved in the insulin signaling pathway obtained from the AlphaFold Protein Structure Database.

Approximately 40 years ago, I was fortunate enough to step into the field of diabetes. When I had my fellowship training in the USA, I learned how to ask a good scientific question and conduct clinical research. With collaboration with my mentors, Prof. Gerald R Reaven and Prof. Ida Chen, we participated in many clinical trials. We established the Taiwan Diabetes Registry (TDR) to track long-term changes in diabetes profiles. The ultimate purpose of medical research is to provide benefits to patients. Using electronic medical records and point-of-care glucometers, we reduced inpatients’ hyperglycemia and hypoglycemia greatly, which was also reflected by the reduction in hospital stays and readmission rates. With the advent of new technology and medications, we have to ponder where we are on the journey toward better diabetes care. We rigorously advocate diabetes care, hold many symposia and publish updated guidelines. We successfully hosted the congress of the 11th International Diabetes Federation Western Pacific Region & 8th Asian Association for the Study of Diabetes Scientific Meeting 2016 at Taipei, Taiwan. As the era of precision medicine is coming, Taiwan could be considered as one of the best places to run precision medicine. The Taiwan Precision Medicine Initiative has enrolled more than half a million residents, and is currently conducting genotyping and data analysis. In conclusion. I witnessed the early days of simple and few choices for diabetes management to the current various modalities in diabetes care. As these new technologies have become available, patients will always remain at the center of the care model with warmth and humility.

Diabetic eye disease remains a major cause of visual impairment and blindness in many countries, and presents a significant public health challenge worldwide. The global prevalence of retinopathy among people with diabetes is approximately 22%, including 6% of vision-threatening diabetic retinopathy, and 4% of macular edema cases, and the burden is expected to remain high until 2045¹. Similar to other complications of diabetes mellitus, numerous studies have been conducted worldwide to assess the risk factors for diabetic eye disease. Several major factors have been identified, as well as validated in a recent study². The two factors, glycemic control and diabetes duration, are commonly reported in most studies.

In terms of glycemic control, most previous studies have used the levels of fasting plasma glucose or glycosylated hemoglobin as indices. However, recent advances in continuous glucose monitoring have made it possible to analyze the daily trajectory of glucose levels, including postprandial and nocturnal glucose levels. Standardized ‘time in range’³ and glycemic variability⁴ have been previously associated with retinopathy. However, since the influence of glycemia depends on both the duration and the glucose levels, indices that reflect both variables are expected to predict retinopathy better than the conventional glycemic indices. A recent attempt using the ‘area under the curve in range’ was unable to demonstrate a significant association with retinopathy⁵. Nevertheless, further research of similar indices for detailed glycemic status using the new technology is expected.

Factors related to the duration of diabetes should also be further detailed, including the effects of aging. A recent study that divided participants into early- or late-onset diabetes demonstrated that an earlier onset of diabetes is more predictive of microvascular complications, including retinopathy, than late-onset diabetes⁶. In addition to the age of diabetes onset, aging of the entire population is also related to the phenotype and the pathophysiology of diabetic retinopathy. In particular, diabetic macular edema is becoming increasingly prevalent in the older population of many developed countries; however, its treatment in clinical settings is insufficient⁷, which needs to be addressed in the future.

The association between diabetic retinopathy and other diabetic complications, as well as other morbidities and mortality, has been widely investigated⁸. Interestingly, a recent meta-analysis⁹ revealed a lack of significant association between non-alcoholic fatty liver disease (NAFLD) and retinopathy, despite sharing common pathophysiological backgrounds, such as insulin resistance. Recent studies on NAFLD and metabolic dysfunctio