Do the benefits of sodium-glucose cotransporter 2 inhibitors exceed the risks in patients with type 1 diabetes?

Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are well-established means of improving glycemia and preventing cardio-renal events in patients with type 2 diabetes. However, their efficacy and safety have yet to be fully characterized in patients with type 1 diabetes (T1D). We studied patients with T1D who regularly attended one of five diabetes centers and treated with an SGLT2i (ipragliflozin or dapagliflozin) for >52 weeks, and the changes in HbA1c, body mass, insulin dose, and laboratory data were retrospectively evaluated and adverse events (AEs) recorded during December 2018 to April 2021. A total of 216 patients with T1D were enrolled during the period. Of these, 42 were excluded owing to short treatment periods and 15 discontinued their SGLT2i. The mean changes in glycated hemoglobin (HbA1c), body mass, and insulin dose were -0.4%, -2.1 kg, and -9.0%, respectively. The change in HbA1c was closely associated with the baseline HbA1c (p < 0.001), but not with the baseline body mass or renal function. The basal and bolus insulin doses decreased by 18.2% and 12.6%, respectively, in participants with a baseline HbA1c <8%. The most frequent AE was genital infection (2.8%), followed by diabetic ketoacidosis (DKA; 1.4%). None of the participants experienced severe hypoglycemic events. In conclusion, the administration of an SGLT2i in addition to intensive insulin treatment in patients with T1D improves glycemic control and body mass, without increasing the incidence of hypoglycemia or DKA.

Cross-cultural adaptation of the Chronic Illness Resources Survey in Japanese patients with diabetes.

AIM: The Chronic Illness Resources Survey (CIRS) is a tool for assessing multiple levels of resources for self-management in people with chronic illnesses. This study aimed to examine the reliability and validity of the Japanese version of the CIRS (CIRS-J) among patients with diabetes. METHODS: This study included 102 Japanese patients with diabetes. Patients completed the CIRS-J on two occasions with additional measurements, including the multidimensional scale of perceived social support (MSPSS), the summary of diabetes self-care activities (SDSCA), and the perceived health competence scale (PHCS). The construct validity, internal consistency reliability, and test-retest reliability were evaluated. RESULTS: Factor analysis resulted in six factors. The Cronbach's α coefficient was 0.82, indicating a high internal consistency. The intraclass correlation coefficient was 0.87, indicating that the CIRS-J is stable over time. The CIRS-J showed a positive moderate association with MSPSS, SDSCA, and PHCS, with a correlation coefficient value ranging from .34 to .44. CONCLUSION: This study showed preliminary support for the reliability and validity of the CIRS-J. The availability of this instrument will help identify the spectrum of resources available for Japanese people with diabetes in both research and practical settings.

[A case of maternally inherited diabetes with deafness (MIDD) occurring at an advanced age].

We report an elderly patient with maternally inherited diabetes with deafness (MIDD). A 69-year-old woman was found to be diabetic for the first time when she visited her local medical doctor for the symptoms of a common cold. Her casual plasma glucose level was 311 mg/dl and HbA1c was 8.3%. She had been aware of muscle atrophy of the lower extremities and hearing disturbance since age 66. As for her family history, her mother, older sister and younger brother were diabetic with hearing difficulty and all of them had died suddenly in their middle age. Her 45-year-old daughter was also diabetic with some difficulty in hearing. Therefore, we suspected both the patient and her daughter had MIDD, and found alterations in mitochondrial DNA3243A-G. MIDD is a condition that needs to be diagnosed accurately and treated at an early stage, since diabetic complications can progress rapidly and could cause myocardial complications and mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS). According to a report of 115 cases of MIDD in Japan, MIDD had been diagnosed at the age of 32.8 on average and our case was strikingly old for the age of onset of the disease.

Glycemic/metabolic responses to identical meal tolerance tests at breakfast, lunch and dinner in Japanese patients with type 2 diabetes mellitus treated with a dipeptidyl peptidase-4 inhibitor and the effects of adding a mitiglinide/voglibose fixed-dose combination.

BACKGROUND: The effects of the mitiglinide/voglibose fixed-dose combination on postprandial glycemic/metabolic responses in patients with type 2 diabetes mellitus (T2DM) treated with dipeptidyl peptidase-4 (DPP-4) inhibitors are unknown. METHODS: Twelve T2DM patients treated with a DPP-4 inhibitor underwent identical meal tolerance tests (MTTs) at breakfast, lunch and dinner, before and 2 - 3 weeks after treatment with a fixed-dose combination of mitiglinide 10 mg and voglibose 0.2 mg (combination). Patients were randomized in a cross-over fashion to administer the combination either three-times-daily before each meal or twice-daily before breakfast and dinner. Glycemic/metabolic responses were evaluated at 0, 30, 60 and 120 min in each MTT. RESULTS: Three-times-daily administration of the combination significantly suppressed postprandial hyperglycemia after each meal, particularly after lunch and dinner. Active glucagon-like peptide-1 levels increased significantly after each meal, as did early-phase insulin secretion without excessive insulin secretion. Postprandial hyperglycemia after lunch was significantly greater after twice-daily than three-times-daily administration, but there were no clinically relevant differences in other metabolic responses. CONCLUSION: This study revealed that adding the mitiglinide/voglibose combination to a DPP-4 inhibitor elicited additive improvements in postprandial glycemic/metabolic responses assessed using MTTs at breakfast, lunch and dinner with identical meal compositions.