Diabetology International最新文献

{"title":"Anthropometry-adjusted TyG indices improve insulin resistance estimation: an exploratory euglycemic-hyperinsulinemic clamp study in Japanese adults without diabetes.","authors":"Natsu Otowa-Suematsu, Tomoaki Nakamura, Hiroshi Miura, Tomoko Yamada, Marika Nishisaka, Hayato Fukumitsu, Yukari Katsura, Yasuko Morita, Shun-Ichiro Asahara, Kazuhiko Sakaguchi","doi":"10.1007/s13340-026-00883-9","DOIUrl":"https://doi.org/10.1007/s13340-026-00883-9","url":null,"abstract":"<p><strong>Background: </strong>We evaluated the diagnostic performance of anthropometry-adjusted triglyceride-glucose (TyG)-derived indices for assessing insulin resistance (IR) in Japanese adults without diabetes, using the euglycemic-hyperinsulinemic clamp (EHC) as the reference standard.</p><p><strong>Methods: </strong>A total of 61 Japanese individuals without diabetes underwent insulin sensitivity assessment using the gold standard EHC. IR was defined as an insulin sensitivity index (ISI) below the 25th percentile. Surrogate IR indices, including Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), the original TyG index, and anthropometry-adjusted TyG-derived indices (TyG-BMI, TyG-WC, TyG-WHtR), were calculated. Correlations between these indices and the ISI were evaluated using Spearman's rank correlation. Receiver operating characteristic (ROC) analysis and linear regression were used to compare diagnostic accuracy and predictive ability. Pairwise DeLong tests were used to assess differences in the area under the curve (AUC) values.</p><p><strong>Results: </strong>TyG-BMI and TyG-WHtR showed the stronger associations with ISI (ρ = - 0.544 and - 0.546, respectively) than both HOMA-IR and the original TyG index. TyG-BMI and TyG-WHtR had the highest AUCs (0.810 and 0.829, respectively) for identifying clamp-defined IR. The optimal cutoff value for HOMA-IR was approximately 2.5. The optimal cutoff for TyG-BMI was 203.7. Pairwise DeLong tests supported the higher diagnostic performance of selected anthropometry-adjusted TyG-derived indices compared with conventional markers.</p><p><strong>Conclusions: </strong>Anthropometry-adjusted TyG-derived indices, particularly TyG-BMI and TyG-WHtR, showed strong associations with IR as assessed by the gold standard EHC in Japanese adults without diabetes. These findings suggest that these indices may serve as practical surrogate markers for IR in settings where direct clamp measurements are not feasible.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s13340-026-00883-9.</p>","PeriodicalId":11340,"journal":{"name":"Diabetology International","volume":"17 2","pages":"35"},"PeriodicalIF":1.2,"publicationDate":"2026-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13050668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute onset of neovascular age-related macular degeneration after initiation of tirzepatide.","authors":"Kohzo Takebayashi, Yurina Iemura, Mototaka Yamauchi, Kenji Hara, Takafumi Tsuchiya, Shigeki Machida, Koshi Hashimoto","doi":"10.1007/s13340-026-00885-7","DOIUrl":"https://doi.org/10.1007/s13340-026-00885-7","url":null,"abstract":"<p><p>Recent retrospective cohort studies showed that use of glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1RAs) increased the incident risk of diabetic retinopathy and nonarteritic anterior ischemic optic neuropathy (NAION). Furthermore, it was recently reported that use of GLP-1RAs for more than 6 months increased the risk of neovascular age-related macular degeneration (nAMD) by about twofold, although the association between a gastric inhibitory polypeptide (GIP)/GLP-1 receptor dual agonist (GIP/GLP-1RA) and nAMD is not clearly established. We describe the case of a middle-aged male patient with type 2 diabetes without apparent diabetic retinopathy. Due to poor glycemic control, tirzepatide (a GIP/GLP-1RA) was started instead of sitagliptin (a dipeptidyl peptidase-4 inhibitor). After switching from sitagliptin to tirzepatide, glycemic control rapidly improved, but the patient felt haziness with distortion of the central part of the left eye. A diagnosis of neovascular age-related degeneration (nAMD) was made by ophthalmologists in our hospital. The basis for the possible association of tirzepatide administration with onset of nAMD is unknown. However, clinicians should pay attention to potential visual impairments after achieving acute glycemic control with incretin-related drugs, including tirzepatide.</p>","PeriodicalId":11340,"journal":{"name":"Diabetology International","volume":"17 2","pages":"37"},"PeriodicalIF":1.2,"publicationDate":"2026-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13050665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical impact of a rapid-acting insulin bolus at the initiation of continuous insulin infusion therapy in patients with hyperglycemic crisis: a propensity score-matched analysis.","authors":"Yuichiro Iwamoto, Tomohiko Kimura, Takashi Itoh, Toshitomo Sugisaki, Kazunori Dan, Hideyuki Iwamoto, Yoshiro Fushimi, Junpei Sanada, Masashi Shimoda, Shuhei Nakanishi, Kohei Kaku, Hideaki Kaneto","doi":"10.1007/s13340-026-00892-8","DOIUrl":"https://doi.org/10.1007/s13340-026-00892-8","url":null,"abstract":"<p><strong>Background: </strong>The use of insulin bolus at the initiation of continuous intravenous insulin infusion (CII) in hyperglycemic emergencies remains controversial, with limited real-world data in patients with severe presentations. Although some guidelines discourage its routine use, there are many variations in clinical practice and its clinical benefit remains uncertain.</p><p><strong>Methods: </strong>We conducted a retrospective single-center study using propensity score matching to evaluate the impact of rapid bolus insulin administration at the start of CII in diabetic patients with hyperglycemic emergencies. Among 99 patients treated with CII between April 2010 and December 2024, 21 pairs of patients with and without bolus insulin were matched based on clinical and biochemical severity indicators. Clinical outcomes and glycemic control parameters were compared using Wilcoxon rank-sum and chi-square tests.</p><p><strong>Results: </strong>Rapid bolus insulin administration did not improve the length of hospital period, time to CII withdrawal, or glycemic control in the short and long term. However, the bolus group showed significantly higher insulin use during the treatment and greater fluctuations in serum potassium levels (Δpotassium: 1.2 (0.8-1.9) vs. 1.0 (0.4-1.3) mmol/L, <i>p</i> = 0.049). No significant differences were observed in rates of hypokalemia, mortality, or other adverse events.</p><p><strong>Conclusion: </strong>Rapid bolus insulin administration at the initiation of CII was not associated with the improvement of clinical outcomes or faster glycemic recovery. It was associated with the increase of insulin use and potassium variability. These findings suggest that a more conservative approach without an initial bolus of insulin is sufficient in managing hyperglycemic emergencies.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s13340-026-00892-8.</p>","PeriodicalId":11340,"journal":{"name":"Diabetology International","volume":"17 2","pages":"38"},"PeriodicalIF":1.2,"publicationDate":"2026-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13050670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional category, physical frailty, and sarcopenia in older adults with diabetes mellitus: a cross-sectional study.","authors":"Takuya Omura, Taiki Sugimoto, Ayumi Sugie, Mariko Ban, Ayano Toda, Seiya Tanaka, Tomoyasu Kinoshita, Naoki Yamauchi, Makio Tanabashi, Yoshiharu Ohshima, Naoki Takashi, Shosuke Ohtera, Takahiro Kamihara","doi":"10.1007/s13340-026-00890-w","DOIUrl":"https://doi.org/10.1007/s13340-026-00890-w","url":null,"abstract":"<p><strong>Aims: </strong>To describe how a three-level functional category (DAFS-8; lower categories indicating better function) overlaps with physical frailty and sarcopenia in older outpatients with diabetes, and to explore whether their combination provides clinically interpretable risk stratification for prioritizing care.</p><p><strong>Methods: </strong>We conducted a cross-sectional study of 122 outpatients aged ≥ 65 years. Physical frailty was defined by the revised Japanese Cardiovascular Health Study (J-CHS) phenotype, and sarcopenia/possible sarcopenia by the AWGS 2019 criteria. Discriminative performance was evaluated using receiver operating characteristic (ROC) analyses and rule-based performance metrics.</p><p><strong>Results: </strong>Prefrailty/frailty, sarcopenia, and possible sarcopenia were present in 70.5%, 23.8%, and 64.8% of participants, respectively. Sarcopenia was almost exclusively concentrated among those classified as prefrail or frail (96.6%). The intersection of prefrailty/frailty and functional category II/III captured 48.3% of sarcopenia cases. While frailty alone showed high sensitivity (96.6%) but limited specificity (37.6%), this intersection-based condition showed higher specificity (80.6%) and positive predictive value (43.8%). ROC analyses <i>showed a numerically higher AUC when functional category was added to frailty (0.733 vs. 0.671)</i>, <i>although the confidence intervals overlapped.</i></p><p><strong>Conclusions: </strong>Functional category and physical frailty capture complementary aspects of vulnerability. Sarcopenia in older adults with diabetes was not uniformly distributed across frailty states but was specifically concentrated within the prefrail-to-frail spectrum. Their overlap identifies subgroups where sarcopenia is disproportionately enriched, supporting a <i>potential</i> triage perspective for prioritizing interventions in routine outpatient care. These findings illustrate how multiple geriatric \"measuring sticks\" capture distinct but overlapping segments of this heterogeneous population.</p>","PeriodicalId":11340,"journal":{"name":"Diabetology International","volume":"17 2","pages":"36"},"PeriodicalIF":1.2,"publicationDate":"2026-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13050666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heat shock protein 72 (HSP72) modulates glucagon secretion via JNK inhibition in pancreatic α-cells.","authors":"Takuro Watanabe, Tatsuya Kondo, Rintaro Yoshizumi, Nobukazu Miyakawa, Sayaka Kitano, Mary Ann Suico, Miki Sato, Masaji Sakaguchi, Motoyuki Igata, Takeshi Matsumura, Hirofumi Kai, Eiichi Araki, Naoto Kubota","doi":"10.1007/s13340-026-00886-6","DOIUrl":"10.1007/s13340-026-00886-6","url":null,"abstract":"<p><p>Heat shock protein 72 (HSP72) plays a protective role against metabolic stress through suppression of c-Jun N-terminal kinase (JNK). While HSP72 has been extensively studied in insulin-sensitive tissues and pancreatic β-cells, its role in regulating glucagon secretion in α-cells remains unclear. Because glucagon secretion is enhanced by stress-responsive kinases including JNK, we hypothesized that HSP72 may negatively regulate glucagon secretion. To evaluate the effects of HSP72 on glucagon regulation, HSP72 induction was achieved using a combination of heat shock (HS) and mild electrical stimulation (MES) in <i>db/db</i> mice. In vitro, αTC cells were treated with HS + MES, transfected with HSP72 overexpression plasmids, or subjected to HSP72 knockdown. Glucagon secretion, JNK phosphorylation, insulin signaling, and expression of glucagon-related transcription factors were analyzed. Pancreatic islets were isolated from wild-type (WT) and HSP72-knockout (KO) mice to assess glucagon secretion under basal, inflammatory, and metabolic stress conditions. HS + MES-treated <i>db/db</i> mice showed reduced fasting and random glucagon levels, accompanied by increased pancreatic HSP72 expression and decreased glucagon-positive islet area. In αTC cells, HSP72 induction suppressed TNF-α-induced glucagon secretion and JNK phosphorylation while restoring insulin-induced Akt phosphorylation. HSP72 knockdown abolished these protective effects. Islets from KO mice secreted significantly more glucagon under inflammatory (TNF-α) and metabolic (high-fat diet) stress. HSP72 overexpression decreased Pax6 and MafB mRNA levels, indicating transcriptional suppression of proglucagon expression. HSP72 suppresses glucagon secretion by inhibiting JNK activation, improving insulin signaling, and downregulating key glucagon transcription factors in α-cells. These findings identify HSP72 as a novel regulator of α-cell stress responses and a potential therapeutic target for glucagon dysregulation in diabetes.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s13340-026-00886-6.</p>","PeriodicalId":11340,"journal":{"name":"Diabetology International","volume":"17 2","pages":"34"},"PeriodicalIF":1.2,"publicationDate":"2026-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13033473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147590570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teleguidance by physiotherapists maintains the quality of life in older patients with diabetic polyneuropathy: subanalysis of the TelePhysioT2D trial.","authors":"Takuo Nomura, Hiroaki Kataoka, Hiroyuki Oka, Yukio Ikeda","doi":"10.1007/s13340-026-00884-8","DOIUrl":"10.1007/s13340-026-00884-8","url":null,"abstract":"<p><strong>Objectives: </strong>Diabetic polyneuropathy (DPN) decreases health-related quality of life (HRQOL) and physical function. Exercise therapy improves the physical function of patients with DPN; however, its effect on HRQOL remains unknown. Therefore, we subanalyzed the effect that teleguidance for exercise therapy by physiotherapists has on HRQOL in older patients with DPN by using our previously obtained data.</p><p><strong>Methods: </strong>The physiotherapist who participated in this study is a specialist in exercise therapy for diabetes. Participants with DPN were categorized into the teleguidance for exercise therapy by physiotherapists (TelePhysio) and control groups (<i>n</i> = 18 and 19, respectively). Both groups underwent the same moderate-intensity exercise therapy program. In the TelePhysio group, teleguidance for exercise therapy was provided for 30 min once a week for six months. In the control group, no telephone intervention was provided, and patients were interviewed at the hospital only at 3 months after discharge.</p><p><strong>Results: </strong>For the comparison between parameters at baseline and six months later, in the TelePhysio group, the EuroQol 5-dimensional (EQ-5D) score and knee extension force (KEF) did not decrease, whereas the Diabetes Treatment Satisfaction Questionnaire (DTSQ) score significantly improved (24.2 ± 5.7 to 26.7 ± 6.0; <i>P</i> < 0.05). In contrast, in the control group, the EQ-5D score and KEF were significantly decreased, whereas the DTSQ score remained unchanged.</p><p><strong>Conclusions: </strong>TelePhysio is effective in improving treatment satisfaction and may help prevent decline in HRQOL and physical function in older patients with DPN. Our findings suggest that TelePhysio may be a treatment option for older patients with DPN.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s13340-026-00884-8.</p>","PeriodicalId":11340,"journal":{"name":"Diabetology International","volume":"17 2","pages":"33"},"PeriodicalIF":1.2,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147510412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical utility of the MAF-5 score for assessing MAFLD/MASLD in a Japanese population with obesity.","authors":"Hayato Fukumitsu, Kazuhiko Sakaguchi, Marika Nishisaka, Yukari Katsura, Yasuko Morita, Natsu Otowa-Suematsu, Tomoko Yamada, Yoshihiko Yano, Michiko Takahashi, Shun-Ichiro Asahara, Wataru Ogawa","doi":"10.1007/s13340-025-00874-2","DOIUrl":"10.1007/s13340-025-00874-2","url":null,"abstract":"<p><strong>Background: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) coexists with type 2 diabetes and is rising in Japan. Liver fibrosis progression in MASLD causes adverse outcomes, highlighting the need for early risk stratification. The utility of the Metabolic Dysfunction-Associated Fibrosis 5 (MAF-5) score has not been assessed in Japanese populations, especially among individuals with type 2 diabetes. Herein, the clinical relevance of the MAF-5 score was assessed in Japanese patients with MASLD.</p><p><strong>Methods: </strong>This prespecified secondary analysis used data from a study titled \"A Study to Estimate the Severity of MAFLD Using Continuous Glucose Monitoring.\" Sixty-six patients diagnosed with metabolic dysfunction-associated fatty liver disease (MAFLD) underwent vibration-controlled transient elastography. All participants were subsequently confirmed to meet the revised diagnostic criteria for MASLD. The MAF-5 score and FIB-4 index were calculated for each participant. Correlations between these scores and liver stiffness measurement (LSM) were assessed using Spearman's rank correlation coefficient. Significant fibrosis was defined as LSM ≥ 8.0 kPa. The predictive performance of each score was evaluated using the area under the receiver operating characteristic curve (AUROC).</p><p><strong>Results: </strong>The final analysis included 57 participants (28 with type 2 diabetes). The MAF-5 score significantly correlated with LSM, whereas the FIB-4 index did not. These associations were consistent regardless of diabetes status. The AUROC for the MAF-5 score was higher than that for the FIB-4 index.</p><p><strong>Conclusion: </strong>The MAF-5 score may serve as a useful noninvasive marker for predicting liver fibrosis in Japanese patients with MASLD, regardless of diabetes status.</p>","PeriodicalId":11340,"journal":{"name":"Diabetology International","volume":"17 1","pages":"19"},"PeriodicalIF":1.2,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12824083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146050793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Molecular mechanism for pancreatic β-cell dysfunction and atherosclerosis.","authors":"Hideaki Kaneto","doi":"10.1007/s13340-025-00871-5","DOIUrl":"10.1007/s13340-025-00871-5","url":null,"abstract":"<p><p>It is well known in clinical practice that when pancreatic β-cells are chronically exposed to hyperglycemia, β-cell function is gradually deteriorated. It has been revealed that under diabetic conditions oxidative stress is provoked and expression levels of insulin gene transcription factors and incretin receptors are down-regulated which are closely associated with β-cell glucose toxicity. We showed that expression levels of these factors were preserved by reducing glucose toxicity with SGLT2 inhibitor. In addition, we showed that it was more beneficial to use incretin-based drugs at an early stage of diabetes when incretin receptor expression was preserved in β-cells. Similarly, we showed that expression levels of incretin receptors in arterial cells were down-regulated which seemed to be associated with the progression of atherosclerosis. Imeglimin is a relatively new anti-diabetic drug and has been used in clinical practice. Recently we have reported that imeglimin exerts beneficial effects on mitochondria morphology in β-cells and/or number and quality of insulin granules. In addition, we have reported that imeglimin shows favorable effects against the development of atherosclerosis independently of glycemic and lipid control. Taken together, it is likely that augmentation of oxidative stress and decreased expression levels of insulin gene transcription factors and incretin receptors are closely associated with pancreatic β-cell glucose toxicity. In addition, incretin-based drugs and imeglimin are expected to exert favorable effects against β-cell glucose toxicity and the development of atherosclerosis when they are appropriately introduced.</p>","PeriodicalId":11340,"journal":{"name":"Diabetology International","volume":"17 1","pages":"20"},"PeriodicalIF":1.2,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12824046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146046290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart rate variability analysis using electrocardiograms during cardio-ankle vascular index measurement shows good agreement with resting electrocardiogram-based analysis in patients with diabetes: a retrospective cross-sectional study.","authors":"Yuka Shibata, Toshiki Kiyose, Tatsuhito Himeno, Masahiro Shimoda, Hirohiko Ando, Ayako Ito, Atsuo Itani, Toru Shimizu, Rion Miura, Mika Matsuoka, Kento Tsuzuki, Takahiro Shinozaki, Mikio Motegi, Tomohide Hayami, Hiromi Nakai-Shimoda, Makoto Kato, Emiri Miura-Yura, Takayuki Nakayama, Yoshiaki Morishita, Masaki Kondo, Shin Tsunekawa, Jiro Nakamura, Tetsuya Amano, Hideki Kamiya","doi":"10.1007/s13340-025-00869-z","DOIUrl":"10.1007/s13340-025-00869-z","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular autonomic neuropathy (CAN) is a common but underrecognized diabetic complication. Although heart rate variability (HRV) analysis is a less invasive alternative to cardiovascular autonomic reflex tests, it is not routinely performed due to time and equipment constraints. This study aimed to assess whether HRV analysis using electrocardiograms (ECG) recorded during cardio-ankle vascular index (CAVI) measurement can serve as a practical substitute for conventional resting ECG-based HRV assessment.</p><p><strong>Methods and results: </strong>This cross-sectional study enrolled 48 patients with diabetes and 20 healthy controls. HRV spectral indices were calculated from ECG recorded during both resting (3-min HRV) and CAVI measurement (CAVI-HRV). Agreement between HRV indices obtained under different conditions was evaluated by intraclass correlation coefficients and Bland-Altman analyses. Correlations between HRV parameters and clinical indices were examined. Participants with diabetes showed significantly lower HRV (especially high-frequency power), and reduced coefficient of variation of RR intervals. HF power of CAVI-HRV showed good agreement with 3-min HRV, whereas LF power showed only moderate concordance. HRV spectral parameters did not significantly correlate with severity of sensorimotor polyneuropathy.</p><p><strong>Conclusions: </strong>HRV analysis performed during CAVI measurement reliably assesses parasympathetic function in diabetes. This approach may provide a convenient, accessible strategy for early CAN screening.</p>","PeriodicalId":11340,"journal":{"name":"Diabetology International","volume":"17 1","pages":"18"},"PeriodicalIF":1.2,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12824053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146050876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood glucose variability in early-onset adrenocorticotropic hormone deficiency induced by immune checkpoint inhibitor therapy with continuous blood glucose monitoring: a case report.","authors":"Yuta Nanao, Gentaro Egusa, Ryuta Baba, Takaya Kodama, Tsuguka Matsuda, Gaku Nagano, Haruya Ohno","doi":"10.1007/s13340-025-00870-6","DOIUrl":"10.1007/s13340-025-00870-6","url":null,"abstract":"<p><p>Early diagnosis and treatment of immune-related adverse events (irAEs) associated with immune checkpoint inhibitors (ICIs) are essential because they directly impact patient quality of life. This report describes the case of an 85-year-old woman with type 2 diabetes on insulin therapy, whose glycemic fluctuations became highly unstable following irAE development. During treatment for refractory hepatocellular carcinoma with tremelimumab and durvalumab, she developed hyperglycemia and was hospitalized. Endogenous insulin secretion remained intact, and hyperglycemia improved after admission. Continuous glucose monitoring (CGM) revealed nocturnal and early-morning hypoglycemia from the fourth day of admission. Insulin requirements were tapered off; however, persistent anorexia and dyspnea led to the diagnosis of hypopituitarism through endocrine testing. For patients with diabetes who experience abnormal blood glucose fluctuations after ICI therapy, clinicians should monitor changes in endogenous insulin secretion and consider the possibility of hypoadrenocorticism. CGM may be valuable for detecting these endocrine abnormalities.</p>","PeriodicalId":11340,"journal":{"name":"Diabetology International","volume":"17 1","pages":"16"},"PeriodicalIF":1.2,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12796047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145970671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}