It is well-known that when pancreatic β-cells are chronically exposed to hyperglycemia under diabetic conditions, β-cell function is gradually deteriorating. Although such phenomena were well-known as β-cell glucose toxicity in clinical practice, its molecular mechanism remained unknown.
It has been revealed that expression levels of insulin gene transcription factors and incretin receptors are downregulated, which is closely associated with β-cell glucose toxicity. In addition, we have reported that it is more beneficial to use incretin-based drugs at an early stage of diabetes when incretin receptor expression in β-cells is preserved. Furthermore, we have reported that it is more beneficial for the prevention of atherosclerosis to use incretin-based drugs at an early stage when incretin receptor expression in arterial cells is preserved. On the other hand, although clinical trials with imeglimin in human subjects clearly indicated its efficacy and safety, its precise mechanism on β-cells remained unknown. However, to address this clinical question, we performed some basic experiments and confirmed the beneficial effects of imeglimin on mitochondrial morphology in β-cells and/or the number and quality of insulin granules, which can explain the effects of imeglimin on β-cells observed in clinical practice. In addition, we demonstrated that imeglimin exerted favorable effects on the development of atherosclerosis.
In this review article, we would like to show the importance of translational research bridging clinical practice and basic research, especially focusing on the molecular mechanism for pancreatic β-cell dysfunction and atherosclerosis and on the protective effects of imeglimin against β-cell dysfunction and atherosclerosis.
The link between obesity and metabolic dysfunction is well-established. However, the choice of an anthropometric index best reflective of risk remains debatable. This study aimed to evaluate the predictive performance of several indices for diabetes and hypertension in a population at risk for cardiovascular disease.
Data from 1,537 participants was analyzed. The predictive value of 19 indices for diabetes and hypertension was evaluated via area under the receiver operating characteristic curve (AUC) analysis. Analyses were adjusted for major risk factors to evaluate the independent utility of each index. Modified versions of the American Diabetes Association (ADA) diabetes risk assessment tool were examined, where body mass index (BMI) was substituted for indices demonstrating strong or independent predictive values.
The Deurenberg formula was the best predictor of diabetes in both male (AUC = 0.67; 95% CI 0.62–0.73) and female (AUC = 0.77; 95% CI 0.73–0.82) participants, and significantly better than BMI. Body roundness index (BRI; aAUC = 0.63; 95% CI 0.56–0.70), waist-to-height ratio (WHtR; aAUC = 0.63; 95% CI 0.57–0.70), and waist-to-height1/2 ratio (WHT.5R; aAUC = 0.63; 95% CI 0.57–0.70) showed independent predictive values for diabetes in female participants. The risk assessment tool's performance was improved when BMI was substituted for these indices. BMI (aAUC = 0.66; 95% CI 0.61–0.70), Deurenberg (aAUC = 0.66; 95% CI 0.61–0.70), and Gallagher (aAUC = 0.66; 95% CI 0.62–0.70) formulas were independent predictors of hypertension in male participants.
Several indices showed promising performances for use in diabetes screening. Future research should focus on incorporating these indices in screening tools.
This study aimed to assess the longitudinal changes in cognitive function and associated factors in older patients with type 1 diabetes mellitus without dementia.
Older patients above 65 years of age with type 1 diabetes mellitus and without dementia were included in this study. They were assessed using the Mini-Mental State Examination and Montreal Cognitive Assessment, Japanese version, at baseline and 3 years after. Cognitive decline was defined as a reduction of two or more points in the total Montreal Cognitive Assessment score over 3 years. Baseline diabetes-related factors were compared between the cognitive decrement and non-decrement groups to identify risk factors associated with cognitive impairment.
Twenty-eight patients aged 71.5 ± 4.0 years were included. Total scores for the Mini-Mental State Examination and the Montreal Cognitive Assessment (Japanese version) at baseline and after 3 years of follow-up showed no significant changes (P = 0.38, P = 0.26). Delayed recall sub-scores of both tests were significantly lower after 3 years compared to their corresponding levels at baseline (P = 0.007, P = 0.04); 32% experienced impaired cognition after 3 years compared to baseline examination. Decline in total Montreal Cognitive Assessment score was significantly associated with the onset age (β = 0.54, P = 0.026) and duration of type-1 diabetes mellitus (β = −4.77, P = 0.026).
Patients with type-1 diabetes mellitus without dementia experience a progressive decline in memory over time. Long durations of type-1 diabetes mellitus are associated with cognitive decline even without dementia.
Dear Editor,
In conclusion, this study makes a significant contribution by highlighting sex-specific disparities in depression among individuals with type 2 diabetes in South Asia. Addressing limitations such as study design, unmeasured psychosocial factors, and clinical comorbidities in future research will strengthen the validity and applicability of these findings.
The authors declare no conflicts of interest.
Approval of the research protocol: No ethics approval was required for this study.
Informed consent: N/A.
Approval date of Registry and the Registration No. of the study/trial: N/A.
Animal Studies: N/A.
The authors declare that no funds, grants, or other support was received during the preparation of this manuscript.
Data sharing not applicable to this article as no datasets were generated or analysed during the current study.
Red blood cell distribution width (RDW) is a parameter of erythrocyte volume heterogeneity that has been traditionally used as an indicator of anemia and other hematopoietic abnormalities. Although the RDW-coefficient of variation (RDW-CV) increases in individuals with diabetes, its clinical significance in diabetic kidney disease (DKD), including glomerular and tubular injury, is unclear. Therefore, we aimed to clarify the relationship between RDW-CV and DKD indices in individuals with type 2 diabetes.
This was a multicenter, retrospective, cross-sectional study. In 490 Japanese individuals with type 2 diabetes (309 men and 181 women), multiple regression analysis was performed to examine the degree of association between DKD indices (estimated glomerular filtration rate (eGFR), urinary albumin-to-creatinine ratio (uACR), log-transformed uACR (Log-uACR), urinary liver-type fatty acid-binding protein (uL-FABP)-to-creatinine ratio (uL-FABPCR), and log-transformed uL-FABPCR (Log-uL-FABPCR)) and clinical confounding factors, including RDW-CV.
No significant associations were identified between RDW-CV and eGFR, uACR, or Log-uACR in either the simple or multiple linear regression analyses. However, significant and independent positive associations between RDW-CV and both uL-FABPCR and Log-uL-FABPCR were identified in multiple regression analyses (P = 0.002 and P = 0.034, respectively). Additionally, logistic regression analysis showed that RDW-CV was an aggravating factor for the incidence of advanced tubular injury [odds ratio, 1.241 (95% confidence interval: 1.010–1.520), P = 0.037].
RDW-CV was independently and positively correlated with urinary excretion of L-FABP. Therefore, RDW-CV may be a simple and useful biomarker for detecting renal tubular injury in individuals with type 2 diabetes.
This study aimed to investigate whether non-invasive fingertip autofluorescence can evaluate micro- and macrovascular complications in patients with type 2 diabetes.
This multicenter cross-sectional study recruited 452 patients with type 2 diabetes between August 2017 and January 2023. Fingertip autofluorescence levels were measured using AGEs Sensor (Air Water Biodesign, Kobe, Japan).
Fingertip autofluorescence correlated with body mass index, glycated hemoglobin, estimated glomerular filtration rate, and duration of diabetes. Fingertip autofluorescence was increased in parallel with the number of micro- and macrovascular complications. A significant relationship was noted between fingertip autofluorescence as a dependent variable and sex, serum albumin, history of diabetic nephropathy, and coronary arterial disease as independent variables. Logistic regression analysis indicated the association of fingertip autofluorescence as a dichotomous variable with diabetic nephropathy as a significant predictor variable adjusted for age, sex, duration of diabetes, smoking status, and serum albumin. The receiver operating characteristic curve revealed that fingertip autofluorescence could be used to identify the presence of macrovascular complications (area under the curve: 0.65, 95% confidence interval: 0.585–0.707, P < 0.001).
Fingertip autofluorescence may be a convenient and non-invasive potential marker for evaluating micro- and macrovascular complications in patients with type 2 diabetes.
Social stigma related to diabetes affects self-care and psychological well-being. In Taiwan, negative perceptions of “diabetes mellitus” may contribute to this stigma. This study explores public attitudes toward people with diabetes and the unpleasantness linked to the disease name.
A household telephone survey in Taiwan was conducted using stratified random sampling. Social distance was measured with the Diabetes Social Distance Scale, and the unpleasantness of disease names was recorded on an 11-point scale.
Among the 982 subjects recruited (mean age 54.3 years), the Taiwanese public showed a high willingness to interact with individuals with diabetes, except in marriage contexts (43.3% expressed reluctance). Compared with a report from Singapore, social distance was higher in Taiwan (mean score 12.4 vs 10.8, P < 0.001). Younger age, female gender, higher education, and northern residence correlated with lower social distance scores. Additionally, 15.2% rated “diabetes mellitus” as unpleasant, which was higher than “metabolic syndrome” (10.7%) and “hypertension” (7.3%), but lower than the former name of schizophrenia (42.1%).
While stigma toward diabetes in Taiwan is generally low, specific demographic groups may benefit from targeted education. Renaming “diabetes mellitus” may have a limited impact on reducing stigma, emphasizing the need for broader awareness efforts.
To investigate the association between time in range (TIR) and mild cognitive impairment (MCI) in older adult patients with type 2 diabetes mellitus (T2DM) and the contributions of various indicators to MCI.
Two hundred and three participants received continuous glucose monitoring and cognitive assessments. Relative weight analysis assessed TIR and other factors’ contributions to MCI. Binary logistic analysis explored TIR-MCI associations across the sample and by age and sex.
TIR showed a stronger association with MCI than diabetes duration, education, systolic blood pressure (SBP), urinary albumin–creatinine ratio (UACR), and C-peptide (25.59% relative weight). Multivariable-adjusted odds ratios (ORs) for MCI declined with increasing TIR quartile (Q) (Q1 [reference group], ≤40%; Q2, 40.3–51.1%, OR 0.402, 95% confidence interval [CI] 0.094–1.717; Q3, 51.2–61.2%, OR 0.113, 95% CI 0.023–0.565; Q4, ≥61.3%, OR 0.050, 95% CI 0.007–0.343). This protective association remained when TIR was treated as a continuous variable and adjusted for covariates (OR 0.917, 95% CI 0.867–0.969, P = 0.002). Women with TIR ≥61.3% had lower MCI risk. Men with TIR 51.2–61.2% had lower MCI risk.
Besides hemoglobin A1c, clinicians should consider low TIR as a risk factor for MCI in older T2DM patients. Women potentially require a higher TIR target to prevent MCI.
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