Neonatal diabetes mellitus (NDM), defined as diabetes with an onset during the first 6 months of life, is a rare form of monogenic diabetes. The initial publications on this condition began appearing in the second half of the 1990s and quite surprisingly, the search for new NDM genes is still ongoing with great vigor. Between 2018 and early 2024, six brand new NDM-genes have been discovered (CNOT1, FICD, ONECUT1, PDIA6, YIPF5, ZNF808) and three genes known to cause different diseases were identified as NDM-genes (EIF2B1, NARS2, KCNMA1). In addition, NDM cases carrying mutations in three other genes known to give rise to diabetes during childhood have been also identified (AGPAT2, BSCL2, PIK3R1). As a consequence, the list of NDM genes now exceeds 40. This genetic heterogeneity translates into many different mechanism(s) of disease that are being investigated with state-of-the-art methodologies, such as induced pluripotent stem cells (iPSC) and human embryonic stem cells (hESC) manipulated with the CRISPR technique of genome editing. This diversity in genetic causes and the pathophysiology of diabetes dictate the need for a variety of therapeutic approaches. The aim of this paper is to provide an overview on recent achievements in all aspects of this area of research.
{"title":"Neonatal diabetes mellitus around the world: Update 2024","authors":"Fabrizio Barbetti, Asma Deeb, Shigeru Suzuki","doi":"10.1111/jdi.14312","DOIUrl":"10.1111/jdi.14312","url":null,"abstract":"<p>Neonatal diabetes mellitus (NDM), defined as diabetes with an onset during the first 6 months of life, is a rare form of monogenic diabetes. The initial publications on this condition began appearing in the second half of the 1990s and quite surprisingly, the search for new NDM genes is still ongoing with great vigor. Between 2018 and early 2024, six brand new NDM-genes have been discovered (<i>CNOT1</i>, <i>FICD</i>, <i>ONECUT1</i>, <i>PDIA6</i>, <i>YIPF5</i>, <i>ZNF808</i>) and three genes known to cause different diseases were identified as NDM-genes (<i>EIF2B1</i>, <i>NARS2</i>, <i>KCNMA1</i>). In addition, NDM cases carrying mutations in three other genes known to give rise to diabetes during childhood have been also identified (<i>AGPAT2</i>, <i>BSCL2</i>, <i>PIK3R1</i>). As a consequence, the list of NDM genes now exceeds 40. This genetic heterogeneity translates into many different mechanism(s) of disease that are being investigated with state-of-the-art methodologies, such as induced pluripotent stem cells (iPSC) and human embryonic stem cells (hESC) manipulated with the CRISPR technique of genome editing. This diversity in genetic causes and the pathophysiology of diabetes dictate the need for a variety of therapeutic approaches. The aim of this paper is to provide an overview on recent achievements in all aspects of this area of research.</p>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"15 12","pages":"1711-1724"},"PeriodicalIF":3.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.14312","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142337881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To assess the risk of difference between 2 h post-load plasma glucose (2 h-PG) and fasting plasma glucose (FPG) on incident prediabetes/type 2 diabetes (T2DM) among normoglycemic individuals.
Methods
Among 4,971 individuals aged ≥20 years, the associations of the difference between 2 h-PG and FPG with outcomes were examined using multivariable-adjusted Cox regression analysis. Participants were categorized into three groups: a low post-load group (2 h-PG ≤ FPG, as the reference group); a high post-load group (2 h-PG > FPG and ≥75th percentile of the difference); and a medium post-load group (2 h-PG > FPG and <75th percentile of the difference), which was further categorized into three groups by equal ranges.
Results
Over a median of 11.5 years of follow-up, 2,331 new cases of prediabetes/type 2 diabetes and 360 cases of type 2 diabetes occurred. Greater risks of incident prediabetes/type 2 diabetes in second (9–16 mg/dL) and third (17–24 mg/dL) medium post-load, as well as high post-load (≥25 mg/dL) categories, were found, with hazard ratios (95% confidence intervals) of 1.26 (1.11–1.44), 1.32 (1.15–1.51), and 1.69 (1.51–1.90), respectively; the issue was more prominent among women (P for interaction = 0.005). The risk of incident type 2 diabetes was also higher for these categories. After further adjustment for the homeostasis model assessment of insulin resistance, result remained essentially unchanged. Even among individuals with low normal FPG (i.e., <90 mg/dL), ≥9 mg/dL difference between 2 h-PG and FPG increased the risk of composite prediabetes/ type 2 diabetes.
Conclusions
Greater levels of 2 h-PG as low as 9 mg/dL than FPG among normoglycemic individuals is a harbinger of prediabetes/type 2 diabetes development.
{"title":"Linking extent of return to fasting state after oral glucose tolerance test to future risk of prediabetes and type 2 diabetes: Insights from the TLGS","authors":"Soroush Masrouri, Seyed Saeed Tamehri Zadeh, Maryam Tohidi, Fereidoun Azizi, Farzad Hadaegh","doi":"10.1111/jdi.14308","DOIUrl":"10.1111/jdi.14308","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To assess the risk of difference between 2 h post-load plasma glucose (2 h-PG) and fasting plasma glucose (FPG) on incident prediabetes/type 2 diabetes (T2DM) among normoglycemic individuals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Among 4,971 individuals aged ≥20 years, the associations of the difference between 2 h-PG and FPG with outcomes were examined using multivariable-adjusted Cox regression analysis. Participants were categorized into three groups: a low post-load group (2 h-PG ≤ FPG, as the reference group); a high post-load group (2 h-PG > FPG and ≥75th percentile of the difference); and a medium post-load group (2 h-PG > FPG and <75th percentile of the difference), which was further categorized into three groups by equal ranges.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Over a median of 11.5 years of follow-up, 2,331 new cases of prediabetes/type 2 diabetes and 360 cases of type 2 diabetes occurred. Greater risks of incident prediabetes/type 2 diabetes in second (9–16 mg/dL) and third (17–24 mg/dL) medium post-load, as well as high post-load (≥25 mg/dL) categories, were found, with hazard ratios (95% confidence intervals) of 1.26 (1.11–1.44), 1.32 (1.15–1.51), and 1.69 (1.51–1.90), respectively; the issue was more prominent among women (<i>P</i> for interaction = 0.005). The risk of incident type 2 diabetes was also higher for these categories. After further adjustment for the homeostasis model assessment of insulin resistance, result remained essentially unchanged. Even among individuals with low normal FPG (i.e., <90 mg/dL), ≥9 mg/dL difference between 2 h-PG and FPG increased the risk of composite prediabetes/ type 2 diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Greater levels of 2 h-PG as low as 9 mg/dL than FPG among normoglycemic individuals is a harbinger of prediabetes/type 2 diabetes development.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"15 12","pages":"1743-1752"},"PeriodicalIF":3.1,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.14308","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142337879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Given the contemporary understanding of diabetes genetics, the term “maturity-onset diabetes of the young (MODY)” warrants renaming. I propose adopting the term “monogenic diabetes” in conjunction with the specific gene name.
{"title":"Maturity-onset diabetes of the young: A proposal for updated nomenclature","authors":"Mustafa Tosur","doi":"10.1111/jdi.14320","DOIUrl":"10.1111/jdi.14320","url":null,"abstract":"<p>Given the contemporary understanding of diabetes genetics, the term “maturity-onset diabetes of the young (MODY)” warrants renaming. I propose adopting the term “monogenic diabetes” in conjunction with the specific gene name.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"15 12","pages":"1818-1819"},"PeriodicalIF":3.1,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.14320","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142337880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Imai D, Ushigome E., Sakai R., Kitagawa N., Hamaguchi M., Yamazaki M., Fukui M. Association between variation in hemoglobin A1c levels and diabetes therapy-related quality of life in patients with diabetes. J Diabetes Investig. 2024 Aug;15:1042–1046.
In the Data collection paragraph of the Method, VIM (variability independent of mean) is corrected to be MAD (mean absolute deviation). In addition, the calculation results of ARV were incorrect. The contents of Tables 1 and 2 have been partially revised accordingly.
We apologize for this error.
Imai D、Ushigome E.、Sakai R.、Kitagawa N.、Hamaguchi M.、Yamazaki M.、Fukui M. 糖尿病患者血红蛋白 A1c 水平变化与糖尿病治疗相关生活质量之间的关系。J Diabetes Investig.2024 Aug;15:1042-1046.In the Data collection paragraph of the Method, VIM (variability independent of mean) is corrected to be MAD (mean absolute deviation).此外，ARV 的计算结果有误。表 1 和表 2 的内容也做了相应的部分修改。
{"title":"Correction to “Association between variation in hemoglobin A1c levels and diabetes therapy-related quality of life in patients with diabetes”","authors":"","doi":"10.1111/jdi.14321","DOIUrl":"10.1111/jdi.14321","url":null,"abstract":"<p>Imai D, Ushigome E., Sakai R., Kitagawa N., Hamaguchi M., Yamazaki M., Fukui M. Association between variation in hemoglobin A1c levels and diabetes therapy-related quality of life in patients with diabetes. J Diabetes Investig. 2024 Aug;15:1042–1046.</p><p>In the Data collection paragraph of the Method, VIM (variability independent of mean) is corrected to be MAD (mean absolute deviation). In addition, the calculation results of ARV were incorrect. The contents of Tables 1 and 2 have been partially revised accordingly.</p><p>We apologize for this error.</p>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"15 11","pages":"1702"},"PeriodicalIF":3.1,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.14321","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142337878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The Gs receptor in pancreatic α cells promotes glucagon transcription and secretion via increasing cAMP. The Gi receptor in pancreatic α cells suppresses glucagon secretion via decreasing cAMP. The Gq receptor in pancreatic α cells promotes glucagon secretion via releasing Ca++ from ER to cytoplasm.
胰腺α细胞中的Gs受体通过增加cAMP促进胰高血糖素的转录和分泌。胰腺α细胞中的 Gi 受体通过降低 cAMP 抑制胰高血糖素的分泌。胰腺α细胞中的 Gq 受体通过从 ER 向细胞质释放 Ca++ 来促进胰高血糖素的分泌。
{"title":"Commentary on “Intra-islet α-cell Gs signaling promotes glucagon release”","authors":"Tadahiro Kitamura","doi":"10.1111/jdi.14317","DOIUrl":"10.1111/jdi.14317","url":null,"abstract":"<p>The Gs receptor in pancreatic α cells promotes glucagon transcription and secretion via increasing cAMP. The Gi receptor in pancreatic α cells suppresses glucagon secretion via decreasing cAMP. The Gq receptor in pancreatic α cells promotes glucagon secretion via releasing Ca<sup>++</sup> from ER to cytoplasm.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"15 12","pages":"1727-1728"},"PeriodicalIF":3.1,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.14317","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142337877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study<span><sup>1</sup></span> and subsequently follow-up studies<span><sup>2-4</sup></span> have reported that gestational diabetes mellitus (GDM) is associated with various adverse pregnancy outcomes, which increases the mother's susceptibility to developing type 2 diabetes, and the child's susceptibility to developing obesity and impaired glucose tolerance in the future<span><sup>3-5</sup></span>.</p><p>GDM is diagnosed based on the presence of at least one of the following criteria: pre-load, 1- and 2-h values of the 75-g oral glucose tolerance test (75-g OGTT) of 92, 180 and 153 mg/dL, respectively, at 24–28 weeks' gestation<span><sup>6</sup></span>. These cutoff values were established and recommended by the International Association of Diabetes and Pregnancy Study Groups (IADPSG)<span><sup>6</sup></span>, based on the results of the HAPO study<span><sup>1</sup></span>.</p><p>The diagnostic criteria in Japan are the same as those of the IADPSG<span><sup>7</sup></span>. Although Japan did not participate in the HAPO study, a separate Japanese epidemiological study showed that GDM diagnosed during the second half of pregnancy using these diagnostic criteria was associated with a significantly higher risk of premature birth (<37 weeks), birthweight >90th percentile, hypertensive disorders of pregnancy and cesarean section<span><sup>8</sup></span>. These findings show that the perinatal prognosis of GDM in the second half of pregnancy, as defined by these diagnostic criteria, is poor among Japanese women. Furthermore, Japan uses similar diagnostic cutoff values as the GDM diagnostic criteria in the first half of pregnancy as in the second half of pregnancy. This policy has led to an increase in the incidence of GDM in Japan, as well as other countries<span><sup>8, 9</sup></span>. Incidentally, one study on the prognosis of GDM in the first half of pregnancy in Japan reported that women diagnosed with GDM during the first half of pregnancy had a higher incidence of pre-eclampsia and cesarean section<span><sup>10</sup></span>. We also previously showed that a GDM diagnosis in early pregnancy was associated with adverse pregnancy outcomes compared with a GDM diagnosis in late pregnancy using a previous diagnostic criteria in Japan<span><sup>11</sup></span>. Indeed, it should also be noted that Australia, USA and the UK do not apply these criteria for GDM during early pregnancy so far.</p><p>An important point is that the HAPO study, which formed the basis of the diagnostic criteria for GDM, was based on the 75-g OGTT from 24 to 32 weeks of pregnancy, and not on the blood glucose levels identified during 75-g OGTT in the first half of pregnancy. Indeed, our research has shown that blood glucose levels during 75-g OGTT differ between early and late pregnancy<span><sup>12</sup></span>. As such, the diagnostic criteria for GDM during early pregnancy based on epidemiological and clinical s
高血糖和不良妊娠结局（HAPO）研究1和随后的随访研究2-4报道，妊娠期糖尿病（GDM）与多种不良妊娠结局相关，这增加了母亲患2型糖尿病的易感性，并增加了儿童未来患肥胖和糖耐量受损的易感性3-5。GDM的诊断基于以下标准中的至少一项：妊娠24-28周时，负荷前、1- h和2-h 75-g口服葡萄糖耐量试验（75-g OGTT）值分别为92、180和153 mg/dL 6。这些临界值是由国际糖尿病和妊娠研究小组协会（IADPSG）根据HAPO研究的结果建立和推荐的。日本的诊断标准与IADPSG7的诊断标准相同。虽然日本没有参与HAPO的研究，但另一项日本流行病学研究显示，使用这些诊断标准在妊娠后半期诊断的GDM与早产（37周）、出生体重第90个百分点、妊娠高血压疾病和剖宫产的风险显著升高相关8。这些发现表明，根据这些诊断标准，妊娠后半期GDM的围产期预后在日本妇女中较差。此外，日本在妊娠前半期和妊娠后半期使用了类似的诊断截止值作为GDM诊断标准。这一政策导致GDM在日本以及其他国家的发病率增加8,9。顺便提一下，日本一项关于妊娠前半期GDM预后的研究报告称，妊娠前半期诊断为GDM的妇女先兆子痫和剖宫产的发生率较高10。我们之前也发现，与使用日本先前诊断标准的妊娠晚期GDM诊断相比，妊娠早期GDM诊断与不良妊娠结局相关11。的确，值得注意的是，到目前为止，澳大利亚、美国和英国并没有将这些标准应用于妊娠早期的GDM。重要的一点是，HAPO研究，作为GDM诊断标准的基础，是基于妊娠24 - 32周的75 g OGTT，而不是基于妊娠前半期75 g OGTT期间确定的血糖水平。事实上，我们的研究表明，在75克OGTT期间，妊娠早期和晚期的血糖水平是不同的。因此，应考虑基于流行病学和临床研究的妊娠早期GDM的诊断标准。尽管GDM的诊断标准不同，但几项随机对照试验（RCTs）已经提供了证据，证明妊娠后半期GDM的围产期结局有所改善。其中一个例子是澳大利亚孕妇碳水化合物不耐受研究（ACHOIS）试验。在该RCT中，妊娠24 - 34周期间进行75 g OGTT， GDM定义为预负荷值为140 mg/dL， 2小时负荷值为140 - 198 mg/dL。在ACHOIS的GDM病例中，干预组新生儿并发症的风险明显低于非干预组13。然而，该RCT研究并不是基于GDM的IADPSG标准。一项回顾性队列研究显示，基于IADPSG标准的GDM与妊娠结局改善相关，尽管它增加了GDM14的发生率。相比之下，一份报告显示妊娠前半期治疗GDM的有效性。妊娠期妊娠糖尿病的治疗（TOBOGM）研究是一项在17家医院进行的随机对照试验，纳入了怀孕前半期的妇女。在该随机对照试验中，具有GDM危险因素的孕妇在妊娠4-19周时接受75 g OGTT治疗。因此，满足以下任何一项标准（负荷前值≥92 mg/dL， 1小时负荷值≥180 mg/dL， 2小时负荷值≥153 mg/dL）的女性可诊断为早期GDM。TOBOGM的研究结果包括新生儿不良事件、妊娠高血压疾病和新生儿瘦体重。在妊娠前半期患有GDM的个体中，干预组与对照组相比，新生儿不良事件的风险显著降低。此外，妊娠期高血压疾病与新生儿瘦体重之间无统计学差异。在TOBOGM研究中，进行了亚组分析，将前半期GDM分类为75 g OGTT值15。在HAPO研究中，75 g OGTT预负荷值为92 mg/dL， 1 h负荷值为180 mg/dL， 2 h负荷值为153 mg/dL，婴儿出生体重90百分位数、脐带血c肽90百分位数和婴儿体脂质量90百分位数的比值比为1.75。比值比为2。 75-g OGTT预载95 mg/dL， 1 h 191 mg/dL, 2 h 162 mg/dL。研究人员将达到95,191或162 mg/dL限制中的任何一个的患者定义为高阈值组，而未达到这些值的患者被归类为低阈值组，以便进行比较研究。当结果是出生体重时，高阈值组的干预与婴儿胎龄大或胎龄小的风险之间没有明显的关联。相比之下，低阈值组的干预降低了大胎龄婴儿的风险，但增加了小胎龄婴儿的风险。这些差异被认为反映了干预造成的婴儿营养不良。此外，TOBOGM研究的二次分析表明，与妊娠后半段诊断的GDM相比，妊娠前半期诊断的GDM的不良围产期结局增加，尽管在妊娠24至28周进行了治疗。本报告建议妊娠早期GDM应予以治疗。如上所述，TOBOGM研究中使用的妊娠前半期GDM的诊断标准与日本使用的标准相同；因此，这些发现可以被认为是有用的。然而，应该指出的是，在TOBOGM研究中，许多被研究的女性符合日本对肥胖的定义。GDM的围产期预后较差，在妊娠的后半期和前半期都是如此。虽然有证据表明妊娠后半期干预GDM可改善围产儿预后，但很少有直接证据表明GDM严格定义为预负荷值≥92 mg/dL、1 h负荷值≥180 mg/dL和2 h负荷值≥153 mg/dL；因此，在日本进行进一步的干预研究是必要的。一项名为“母婴糖尿病与妊娠结局研究”的注册研究目前正在日本进行，进一步的分析结果正在等待中（图1）。作者声明无利益冲突。研究方案的批准：无。知情同意：无。注册表及注册编号研究/试验：无。动物研究：无。
{"title":"Clinical challenges in early pregnancy in Japan: An update on gestational diabetes","authors":"Takashi Sugiyama, Maki Kawasaki, Naoko Arata","doi":"10.1111/jdi.14319","DOIUrl":"10.1111/jdi.14319","url":null,"abstract":"<p>The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study<span><sup>1</sup></span> and subsequently follow-up studies<span><sup>2-4</sup></span> have reported that gestational diabetes mellitus (GDM) is associated with various adverse pregnancy outcomes, which increases the mother's susceptibility to developing type 2 diabetes, and the child's susceptibility to developing obesity and impaired glucose tolerance in the future<span><sup>3-5</sup></span>.</p><p>GDM is diagnosed based on the presence of at least one of the following criteria: pre-load, 1- and 2-h values of the 75-g oral glucose tolerance test (75-g OGTT) of 92, 180 and 153 mg/dL, respectively, at 24–28 weeks' gestation<span><sup>6</sup></span>. These cutoff values were established and recommended by the International Association of Diabetes and Pregnancy Study Groups (IADPSG)<span><sup>6</sup></span>, based on the results of the HAPO study<span><sup>1</sup></span>.</p><p>The diagnostic criteria in Japan are the same as those of the IADPSG<span><sup>7</sup></span>. Although Japan did not participate in the HAPO study, a separate Japanese epidemiological study showed that GDM diagnosed during the second half of pregnancy using these diagnostic criteria was associated with a significantly higher risk of premature birth (<37 weeks), birthweight >90th percentile, hypertensive disorders of pregnancy and cesarean section<span><sup>8</sup></span>. These findings show that the perinatal prognosis of GDM in the second half of pregnancy, as defined by these diagnostic criteria, is poor among Japanese women. Furthermore, Japan uses similar diagnostic cutoff values as the GDM diagnostic criteria in the first half of pregnancy as in the second half of pregnancy. This policy has led to an increase in the incidence of GDM in Japan, as well as other countries<span><sup>8, 9</sup></span>. Incidentally, one study on the prognosis of GDM in the first half of pregnancy in Japan reported that women diagnosed with GDM during the first half of pregnancy had a higher incidence of pre-eclampsia and cesarean section<span><sup>10</sup></span>. We also previously showed that a GDM diagnosis in early pregnancy was associated with adverse pregnancy outcomes compared with a GDM diagnosis in late pregnancy using a previous diagnostic criteria in Japan<span><sup>11</sup></span>. Indeed, it should also be noted that Australia, USA and the UK do not apply these criteria for GDM during early pregnancy so far.</p><p>An important point is that the HAPO study, which formed the basis of the diagnostic criteria for GDM, was based on the 75-g OGTT from 24 to 32 weeks of pregnancy, and not on the blood glucose levels identified during 75-g OGTT in the first half of pregnancy. Indeed, our research has shown that blood glucose levels during 75-g OGTT differ between early and late pregnancy<span><sup>12</sup></span>. As such, the diagnostic criteria for GDM during early pregnancy based on epidemiological and clinical s","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"15 12","pages":"1729-1731"},"PeriodicalIF":3.1,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.14319","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142337875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Dear Sir,</p><p>Sato <i>et al</i>.<span><sup>1</sup></span> published in the August issue a study titled “Coexistence of high visceral fat area and sarcopenia is associated with atherosclerotic markers in old-old patients with diabetes: A cross-sectional study”. The authors aimed to investigate whether there is an association between sarcopenic obesity and the progression of atherosclerotic lesions in older patients<span><sup>1</sup></span>. In their cross-section study, 118 participants were included, “50 (42.4%) were men and 68 (57.6%) were women, with a median age of 80 years, and 6 (5%) had type 1 diabetes. The median body mass index (BMI) was 24.0 kg/m<sup>2</sup>, the median HbA1c level was 9.1%, and the median duration of diabetes mellitus was 18 years”<span><sup>1</sup></span>. As surrogate marker for preclinical atherosclerosis, the carotid intima-media thickness (cIMT) was used, measured by sonography<span><sup>1</sup></span>. The authors measured cIMT bilaterally at the common carotid artery (CCA<span><sup>1</sup></span>). The study showed that the cIMT “in the group showing sarcopenia with a high visceral fat area was significantly higher than that in the control group (<i>P</i> = 0.012)”<span><sup>1</sup></span>. The authors concluded, “Although further research is needed to clarify whether sarcopenic obesity should be treated as a risk factor for atherosclerosis, this study suggests that evaluation of both sarcopenia and visceral fat mass is important in the evaluation of older patients with diabetes mellitus because they may serve as markers of atherosclerosis”<span><sup>1</sup></span>. Some comments are here needed to evaluate the cIMT results of this study in a more balanced way. The authors measured only in one segment of the carotid tree, namely the CCA<span><sup>1</sup></span>. A single location cIMT measurement is performed by some authors for technical reasons, namely a higher spatial resolution of the far wall of the CCA<span><sup>2</sup></span>. The disadvantage of a single-site CCA measurement however, given the asymmetric presentation of atherosclerosis, is that it may coincide with a normal segment but of an atherosclerotic affected vessel, providing an inaccurate cIMT measure. Other authors perform therefore a multi-site cIMT data acquisition that considers several sections of the CA tree, for example, far/near walls of CCA, bifurcation, and/or internal CA<span><sup>3</sup></span>. Sato <i>et al</i>.<span><sup>1</sup></span> did not report further, if cIMT measurement was synchronized with the cardiac cycle (the end-diastolic phase). CIMT values differ during the cardiac cycle, due to changes in vessel diameter with reported mean differences of 0.041 mm<span><sup>4</sup></span>. In summary: If cIMT is used as surrogate marker for preclinical atherosclerosis importantly to mind that submillimetric differences are sufficient to categorize subjects into different cIMT groups. Authors need to have a meticulous measure
尊敬的先生，Sato et al.1在8月号发表了一篇题为“高内脏脂肪区和肌肉减少共存与老年糖尿病患者动脉粥样硬化标志物相关：横断面研究”的研究。作者的目的是研究老年患者中肌肉减少型肥胖与动脉粥样硬化病变进展之间是否存在关联。在他们的横断面研究中，包括118名参与者，“50名（42.4%）男性，68名（57.6%）女性，中位年龄为80岁，6名（5%）患有1型糖尿病。”中位体重指数（BMI）为24.0 kg/m2，中位糖化血红蛋白（HbA1c）水平为9.1%，中位糖尿病病程为18年。作为临床前动脉粥样硬化的替代指标，采用超声测量颈动脉内膜-中膜厚度（cIMT） 1。作者测量了双侧颈总动脉（CCA1）的cIMT。研究表明，“高内脏脂肪面积肌少症组的cIMT显著高于对照组（P = 0.012）”。作者总结道：“虽然还需要进一步的研究来明确肌肉减少型肥胖是否应该作为动脉粥样硬化的危险因素，但这项研究表明，评估肌肉减少症和内脏脂肪量对于评估老年糖尿病患者很重要，因为它们可能作为动脉粥样硬化的标志。”这里需要一些评论，以更平衡的方式评估本研究的cIMT结果。作者只测量了颈动脉树的一段，即CCA1。由于技术原因，一些作者进行了单位置cIMT测量，即CCA2远壁的空间分辨率更高。然而，考虑到动脉粥样硬化的不对称表现，单位点CCA测量的缺点是，它可能与动脉粥样硬化影响血管的正常段相吻合，从而提供不准确的cIMT测量。因此，其他作者执行多站点cIMT数据采集，考虑CA树的几个部分，例如，CCA的远/近壁、分支和/或内部CA3。Sato等人1没有进一步报道cIMT测量是否与心脏周期（舒张末期）同步。在心脏周期中，由于血管直径的变化，CIMT值不同，报道的平均差异为0.041 mm4。总之：如果cIMT被用作临床前动脉粥样硬化的替代标志物，重要的是要记住，亚毫米的差异足以将受试者分为不同的cIMT组。作者需要有一个细致的测量方案，在科学报告的严谨性方面解释他们应用的cIMT方法，以便读者对获得的结果有一个平衡和充分的理解。Sato等人1得出的cIMT数据和结论应该在上述方法学局限性的背景下进行分析，并谨慎考虑。作者声明不存在利益冲突。
{"title":"Coexistence of high visceral fat area and sarcopenia and atherosclerotic markers in older patients with diabetes: Is there an association?","authors":"Christian Saleh","doi":"10.1111/jdi.14322","DOIUrl":"10.1111/jdi.14322","url":null,"abstract":"<p>Dear Sir,</p><p>Sato <i>et al</i>.<span><sup>1</sup></span> published in the August issue a study titled “Coexistence of high visceral fat area and sarcopenia is associated with atherosclerotic markers in old-old patients with diabetes: A cross-sectional study”. The authors aimed to investigate whether there is an association between sarcopenic obesity and the progression of atherosclerotic lesions in older patients<span><sup>1</sup></span>. In their cross-section study, 118 participants were included, “50 (42.4%) were men and 68 (57.6%) were women, with a median age of 80 years, and 6 (5%) had type 1 diabetes. The median body mass index (BMI) was 24.0 kg/m<sup>2</sup>, the median HbA1c level was 9.1%, and the median duration of diabetes mellitus was 18 years”<span><sup>1</sup></span>. As surrogate marker for preclinical atherosclerosis, the carotid intima-media thickness (cIMT) was used, measured by sonography<span><sup>1</sup></span>. The authors measured cIMT bilaterally at the common carotid artery (CCA<span><sup>1</sup></span>). The study showed that the cIMT “in the group showing sarcopenia with a high visceral fat area was significantly higher than that in the control group (<i>P</i> = 0.012)”<span><sup>1</sup></span>. The authors concluded, “Although further research is needed to clarify whether sarcopenic obesity should be treated as a risk factor for atherosclerosis, this study suggests that evaluation of both sarcopenia and visceral fat mass is important in the evaluation of older patients with diabetes mellitus because they may serve as markers of atherosclerosis”<span><sup>1</sup></span>. Some comments are here needed to evaluate the cIMT results of this study in a more balanced way. The authors measured only in one segment of the carotid tree, namely the CCA<span><sup>1</sup></span>. A single location cIMT measurement is performed by some authors for technical reasons, namely a higher spatial resolution of the far wall of the CCA<span><sup>2</sup></span>. The disadvantage of a single-site CCA measurement however, given the asymmetric presentation of atherosclerosis, is that it may coincide with a normal segment but of an atherosclerotic affected vessel, providing an inaccurate cIMT measure. Other authors perform therefore a multi-site cIMT data acquisition that considers several sections of the CA tree, for example, far/near walls of CCA, bifurcation, and/or internal CA<span><sup>3</sup></span>. Sato <i>et al</i>.<span><sup>1</sup></span> did not report further, if cIMT measurement was synchronized with the cardiac cycle (the end-diastolic phase). CIMT values differ during the cardiac cycle, due to changes in vessel diameter with reported mean differences of 0.041 mm<span><sup>4</sup></span>. In summary: If cIMT is used as surrogate marker for preclinical atherosclerosis importantly to mind that submillimetric differences are sufficient to categorize subjects into different cIMT groups. Authors need to have a meticulous measure","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"15 12","pages":"1820"},"PeriodicalIF":3.1,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.14322","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142337876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We previously showed that glucokinase haploinsufficiency improves the glucose tolerance of db/db mice by preserving pancreatic β-cell mass and function. In the present study, we aimed to determine the effects of glucokinase haploinsufficiency on the β-cell mass and function of long-term high-fat, high-sucrose (HFHS) diet-fed mice.
Materials and Methods
Four-week-old male glucokinase haploinsufficient (Gck+/−) mice and 4-week-old male wild-type (Gck+/+) mice (controls) were each divided into two groups: an HFHS diet-fed group and a normal chow-fed group, and the four groups were followed until 16, 40 or 60 weeks-of-age. Their glucose tolerance, glucose-stimulated insulin secretion and β-cell mass were evaluated. In addition, islets were isolated from 40-week-old mice, and the expression of key genes was compared.
Results
Gck+/−HFHS mice had smaller compensatory increases in β-cell mass and glucose-stimulated insulin secretion than Gck+/+HFHS mice, and their glucose tolerance deteriorated from 16 to 40 weeks-of-age. However, their β-cell mass and glucose-stimulated insulin secretion did not decrease between 40 and 60 weeks-of-age, but rather, tended to increase, and there was no progressive deterioration in glucose tolerance. The expression of Aldh1a3 in pancreatic islets, which is high in several models of diabetes and is associated with an impairment in β-cell function, was high in Gck+/+HFHS mice, but not in Gck+/−HFHS mice.
Conclusions
Glucokinase haploinsufficiency prevents the progressive deterioration of pancreatic β-cell mass/function and glucose tolerance in long-term HFHS diet-fed mice.
{"title":"Effects of glucokinase haploinsufficiency on the pancreatic β-cell mass and function of long-term high-fat, high-sucrose diet-fed mice","authors":"Ikumi Shigesawa, Akinobu Nakamura, Yuki Yamauchi, Shinichiro Kawata, Asuka Miyazaki, Hiroshi Nomoto, Hiraku Kameda, Yasuo Terauchi, Tatsuya Atsumi","doi":"10.1111/jdi.14307","DOIUrl":"10.1111/jdi.14307","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims/Introduction</h3>\u0000 \u0000 <p>We previously showed that glucokinase haploinsufficiency improves the glucose tolerance of <i>db/db</i> mice by preserving pancreatic β-cell mass and function. In the present study, we aimed to determine the effects of glucokinase haploinsufficiency on the β-cell mass and function of long-term high-fat, high-sucrose (HFHS) diet-fed mice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Four-week-old male glucokinase haploinsufficient (<i>Gck</i><sup><i>+/−</i></sup>) mice and 4-week-old male wild-type (<i>Gck</i><sup><i>+/+</i></sup>) mice (controls) were each divided into two groups: an HFHS diet-fed group and a normal chow-fed group, and the four groups were followed until 16, 40 or 60 weeks-of-age. Their glucose tolerance, glucose-stimulated insulin secretion and β-cell mass were evaluated. In addition, islets were isolated from 40-week-old mice, and the expression of key genes was compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p><i>Gck</i><sup><i>+/−</i></sup>HFHS mice had smaller compensatory increases in β-cell mass and glucose-stimulated insulin secretion than <i>Gck</i><sup><i>+/+</i></sup>HFHS mice, and their glucose tolerance deteriorated from 16 to 40 weeks-of-age. However, their β-cell mass and glucose-stimulated insulin secretion did not decrease between 40 and 60 weeks-of-age, but rather, tended to increase, and there was no progressive deterioration in glucose tolerance. The expression of <i>Aldh1a3</i> in pancreatic islets, which is high in several models of diabetes and is associated with an impairment in β-cell function, was high in <i>Gck</i><sup><i>+/+</i></sup>HFHS mice, but not in <i>Gck</i><sup><i>+/−</i></sup>HFHS mice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Glucokinase haploinsufficiency prevents the progressive deterioration of pancreatic β-cell mass/function and glucose tolerance in long-term HFHS diet-fed mice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"15 12","pages":"1732-1742"},"PeriodicalIF":3.1,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.14307","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142277668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study evaluated the risk factors for insulin therapy before 24 gestational weeks (early insulin therapy) in pregnant women with gestational diabetes diagnosed before 24 gestational weeks (E-GDM).
Materials and Methods
This study included 530 singleton mothers with E-GDM who underwent a 75 g oral glucose tolerance test (OGTT) in the first trimester at Keio University Hospital between January 2013 and December 2021. E-GDM can be classified according to its management into only diet therapy until delivery (Diet E-GDM), insulin therapy started before 24 gestational weeks (EarlyIns E-GDM), and insulin therapy started after 24 gestational weeks (LateIns E-GDM). We analyzed the risk factors for EarlyIns E-GDM.
Results
Patients with EarlyIns E-GDM had a significantly higher maternal age at delivery, pre-pregnancy BMI, first trimester hemoglobin A1c, 1 h plasma glucose levels (1 h-PG), and 2 h-PG, as well as a more pronounced initial increase and subsequent decrease, compared with those in the Diet E-GDM group. However, the Apgar scores at both 1 and 5 min were significantly lower in patients with EarlyIns E-GDM than in those with Diet E-GDM. The number of abnormal values in the OGTT showed the largest area under the receiver operating characteristic curve (AUC) for predicting EarlyIns E-GDM (0.83, 95% confidence interval [CI]: 0.79–0.86), followed by the 1 h-PG value (AUC: 0.81, 95% CI: 0.77–0.85). The initial increase showed the third largest AUC (0.78, 95% CI: 0.74–0.82).
Conclusions
Although further research is needed, our data suggest the importance of early insulin therapy in cases of E-GDM with multiple abnormal OGTT values, especially with high 1 h-PG levels and initial increase.
{"title":"Multiple positive points during the 75 g oral glucose tolerance test are good predictors for early insulin therapy in gestational diabetes mellitus diagnosed before 24 gestational weeks","authors":"Yoshifumi Kasuga, Marina Takahashi, Kaoru Kajikawa, Keisuke Akita, Junko Tamai, Yuka Fukuma, Yuya Tanaka, Keita Hasegawa, Toshimitsu Otani, Satoru Ikenoue, Mamoru Tanaka","doi":"10.1111/jdi.14318","DOIUrl":"10.1111/jdi.14318","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims/Introduction</h3>\u0000 \u0000 <p>This study evaluated the risk factors for insulin therapy before 24 gestational weeks (early insulin therapy) in pregnant women with gestational diabetes diagnosed before 24 gestational weeks (E-GDM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>This study included 530 singleton mothers with E-GDM who underwent a 75 g oral glucose tolerance test (OGTT) in the first trimester at Keio University Hospital between January 2013 and December 2021. E-GDM can be classified according to its management into only diet therapy until delivery (Diet E-GDM), insulin therapy started before 24 gestational weeks (EarlyIns E-GDM), and insulin therapy started after 24 gestational weeks (LateIns E-GDM). We analyzed the risk factors for EarlyIns E-GDM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients with EarlyIns E-GDM had a significantly higher maternal age at delivery, pre-pregnancy BMI, first trimester hemoglobin A1c, 1 h plasma glucose levels (1 h-PG), and 2 h-PG, as well as a more pronounced initial increase and subsequent decrease, compared with those in the Diet E-GDM group. However, the Apgar scores at both 1 and 5 min were significantly lower in patients with EarlyIns E-GDM than in those with Diet E-GDM. The number of abnormal values in the OGTT showed the largest area under the receiver operating characteristic curve (AUC) for predicting EarlyIns E-GDM (0.83, 95% confidence interval [CI]: 0.79–0.86), followed by the 1 h-PG value (AUC: 0.81, 95% CI: 0.77–0.85). The initial increase showed the third largest AUC (0.78, 95% CI: 0.74–0.82).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although further research is needed, our data suggest the importance of early insulin therapy in cases of E-GDM with multiple abnormal OGTT values, especially with high 1 h-PG levels and initial increase.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"15 12","pages":"1803-1808"},"PeriodicalIF":3.1,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.14318","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142277670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nocturia impairs the quality of life in patients with type 2 diabetes mellitus. Although sodium glucose co-transporter 2 inhibitors (SGLT2i) such as tofogliflozin increase urine volume, their impact on nocturia, in conjunction with dietary salt restriction, is less clear.
Materials and Methods
This multicenter, open-label, randomized, parallel-group trial included 80 subjects with type 2 diabetes and nocturia. The patients were divided into two groups: one receiving tofogliflozin, the shortest half-life, without salt restriction, and the other receiving both tofogliflozin and dietary salt restriction. The primary endpoint was nocturia frequency at 12 weeks. The secondary outcomes included changes in daytime urination frequency, urine volume, and home blood pressure.
Results
At 12 weeks, there were no significant differences in nocturia changes between both groups. Nocturia frequency did not change in the tofogliflozin without salt restriction group from 1.5 ± 0.8 to 1.3 ± 1.1 times per night (P = 0.297), and significantly decreased from 1.6 ± 1.0 to 1.3 ± 0.7 times per night in the tofogliflozin and dietary salt restriction group (P = 0.049). There was a trend toward increased urine volume and frequency during the daytime in the group with salt restriction, indicating a time-shift effect of the short half-life tofogliflozin and salt restriction on urinary time.
Conclusions
The frequency of nocturia after tofogliflozin did not increase. Tofogliflozin reduced nocturia when combined with salt restriction. Furthermore, daytime urine volume and frequency showed an increasing trend, suggesting a shift in urine production to daytime hours due to the short half-life of tofogliflozin. Dietary modifications can enhance the therapeutic benefits of tofogliflozin in managing nocturia in people with type 2 diabetes.
{"title":"Multicenter, open label, randomized controlled superiority trial for availability to reduce nocturnal urination frequency: The TOP-STAR study","authors":"Hanako Nakajima, Hiroshi Okada, Akinori Kogure, Takafumi Osaka, Takeshi Tsutsumi, Masayoshi Onishi, Kazuteru Mitsuhashi, Noriyuki Kitagawa, Shinichi Mogami, Akane Kitamura, Michiyo Ishii, Naoto Nakamura, Akio Kishi, Sato Eiko, Masahide Hamaguchi, Michiaki Fukui","doi":"10.1111/jdi.14314","DOIUrl":"10.1111/jdi.14314","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Nocturia impairs the quality of life in patients with type 2 diabetes mellitus. Although sodium glucose co-transporter 2 inhibitors (SGLT2i) such as tofogliflozin increase urine volume, their impact on nocturia, in conjunction with dietary salt restriction, is less clear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>This multicenter, open-label, randomized, parallel-group trial included 80 subjects with type 2 diabetes and nocturia. The patients were divided into two groups: one receiving tofogliflozin, the shortest half-life, without salt restriction, and the other receiving both tofogliflozin and dietary salt restriction. The primary endpoint was nocturia frequency at 12 weeks. The secondary outcomes included changes in daytime urination frequency, urine volume, and home blood pressure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At 12 weeks, there were no significant differences in nocturia changes between both groups. Nocturia frequency did not change in the tofogliflozin without salt restriction group from 1.5 ± 0.8 to 1.3 ± 1.1 times per night (<i>P</i> = 0.297), and significantly decreased from 1.6 ± 1.0 to 1.3 ± 0.7 times per night in the tofogliflozin and dietary salt restriction group (<i>P</i> = 0.049). There was a trend toward increased urine volume and frequency during the daytime in the group with salt restriction, indicating a time-shift effect of the short half-life tofogliflozin and salt restriction on urinary time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The frequency of nocturia after tofogliflozin did not increase. Tofogliflozin reduced nocturia when combined with salt restriction. Furthermore, daytime urine volume and frequency showed an increasing trend, suggesting a shift in urine production to daytime hours due to the short half-life of tofogliflozin. Dietary modifications can enhance the therapeutic benefits of tofogliflozin in managing nocturia in people with type 2 diabetes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51250,"journal":{"name":"Journal of Diabetes Investigation","volume":"15 12","pages":"1809-1817"},"PeriodicalIF":3.1,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.14314","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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