Unique pathological changes in the pancreas of fulminant type 1 diabetes
AbstractDistinct features of the pancreas of fulminant type 1 diabetes (FT1DM) include (1) enterovirus infection of the islets and exocrine acinar tissue. (2) Activated innate immune responses: MDA5 and RIG-I expression and TLR4 and TLR9 expression in the islets of FT1DM. (3) Combined activation of the STAT/JNK and NFkB pathways, resulting in Type I interferon (IFN) and proinflammatory cytokine (i.e., IFN γ) expression in islet beta cells and MHC class I hyper-expression. (4) Activation of dendritic cells followed by effector cell infiltration of CD8+ T cells and CD68+ macrophages, resulting in apoptosis and neurosis of i...
Source: Diabetology International - August 28, 2020 Category: Endocrinology Source Type: research
Twenty years since the discovery of fulminant type 1 diabetes
(Source: Diabetology International)
Source: Diabetology International - August 27, 2020 Category: Endocrinology Source Type: research
Possible involvement of autoimmunity in fulminant type 1 diabetes
AbstractFulminant type 1 diabetes (FT1D) is characterized by a relatively low HbA1c level at the onset, despite the abrupt occurrence of marked hyperglycemia with ketosis or ketoacidosis. The initial symptoms/findings are flu-like, absence of islet-associated autoantibodies, and a drastic decrease in β-cells and α-cells, which strongly suggest the involvement of a viral infection. In fact, we successfully demonstrated that a FT1D-like phenotype can be reproduced in encephalomyocarditis virus-induced diabetes murine model. However, there is a discussion on the possible involvement of autoimmuni ty rather than viral infect...
Source: Diabetology International - August 26, 2020 Category: Endocrinology Source Type: research
Case of slowly progressive type 1 diabetes mellitus with drastically reduced insulin secretory capacity after immune checkpoint inhibitor treatment for advanced renal cell carcinoma
AbstractWe encountered a 55-year-old Japanese man with advanced renal cell carcinoma and slowly progressive type 1 diabetes mellitus (SPT1DM), whose insulin secretory capacity was drastically reduced for a brief period after only one cycle of immune checkpoint inhibitor (ICI) treatment. The patient had been diagnosed with type 2 diabetes at the age of 53 years and was treated using oral hypoglycemic agents. However, 2 years later, he was diagnosed with SPT1DM and autoimmune thyroiditis, based on the presence of anti-glutamic acid decarboxylase antibodies (GADA) and thyroid autoantibodies, which was accompanied by advanc...
Source: Diabetology International - August 23, 2020 Category: Endocrinology Source Type: research
Fulminant type 1 diabetes: 20 years of discovery and development
AbstractTwenty years have passed since the first article on fulminant type 1 diabetes (FT1D) was published. FT1D is characterized by an extremely rapid onset of ketoacidosis, high plasma glucose and, conversely, a near-normal glycosylated hemoglobin level. Digestive or flu-like symptoms frequently precede the onset of ketoacidosis. Patients are usually negative for islet-related autoantibodies, with near-complete destruction of pancreatic β-cells, even at the onset of disease. Massive infiltration of immunocytes (insulitis) can be seen in the islets of patients with new-onset FT1D, but this subsides within a few weeks. Ea...
Source: Diabetology International - August 23, 2020 Category: Endocrinology Source Type: research
Basal insulin ameliorates post-breakfast hyperglycemia via suppression of post-breakfast proinsulin/C-peptide ratio and fasting serum free fatty acid levels in patients with type 2 diabetes
ConclusionOur results suggest that basal insulin with either degludec or glargine decreases the incidence of post-breakfast hyperglycemia accompanied by decreasing the post-breakfast PI/CPR ratio and fasting FFA levels in patients with type 2 diabetes. (Source: Diabetology International)
Source: Diabetology International - August 2, 2020 Category: Endocrinology Source Type: research
Medical nutrition therapy and dietary counseling for patients with diabetes-energy, carbohydrates, protein intake and dietary counseling
(Source: Diabetology International)
Source: Diabetology International - July 24, 2020 Category: Endocrinology Source Type: research
Japanese Clinical Practice Guideline for Diabetes 2019
(Source: Diabetology International)
Source: Diabetology International - July 23, 2020 Category: Endocrinology Source Type: research
Insulin resistance and exaggerated insulin sensitivity triggered by single-gene mutations in the insulin signaling pathway
AbstractWhereas the genetic basis of insulin sensitivity is determined by variation in multiple genes, mutations of single genes can give rise to profound changes in such sensitivity. Mutations of the insulin receptor gene (INSR) —which trigger type A insulin resistance, Rabson–Mendenhall, or Donohue syndromes—and those of the gene for the p85α regulatory subunit of phosphoinositide 3-kinase (PIK3R1), which give rise to SHORT syndrome, are the most common and second most common causes, respectively, of single-gene insulin resistance. Loss-of-function mutations of the genes for the protein kinase Akt2 (AKT2) or for T...
Source: Diabetology International - July 14, 2020 Category: Endocrinology Source Type: research
Hereditary spherocytosis diagnosed with extremely low glycated hemoglobin compared to plasma glucose levels
AbstractGlycated hemoglobin (HbA1c) is an important indicator of glycemic control in patients with diabetes. High-performance liquid chromatography (HPLC) is the most commonly used method for measuring HbA1c levels; as HPLC measures all hemoglobin types, the values can be influenced by hemoglobin variants. Moreover, as HPLC-HbA1c levels are low in some diseases, including hemolytic anemia, it may be difficult to differentiate hemoglobin variants from these diseases based on HPLC-HbA1c levels alone. Similar HbA1c values using both HPLC and immunoassays (IAs) are noted for these diseases, while discrepancies are noted in the...
Source: Diabetology International - July 11, 2020 Category: Endocrinology Source Type: research
FIB-4 index-based surveillance for advanced liver fibrosis in diabetes patients
AbstractLiver fibrosis is associated with lifestyle-related diseases, including diabetes. The identification of diabetic patients with severe liver fibrosis is important, but a simple and reliable diagnostic procedure remains to be determined. We conducted an observational study to evaluate the performance of a FIB-4 index-based screening strategy for the diagnosis of advanced liver fibrosis in patients with diabetes or prediabetes. Two hundred and forty-two patients underwent abdominal imaging in our Study. According to the abdominal imaging findings, fatty liver, liver cirrhosis, and hepatocellular carcinoma were defined...
Source: Diabetology International - July 8, 2020 Category: Endocrinology Source Type: research
Impact of dietary counseling on the perception of diet in patients with gestational diabetes mellitus
ConclusionDietary counseling was regarded as helpful and acceptable to most patients with GDM in our hospital, and many suggestions were recognized as informative for modification of previous dietary habits. By providing the results of the questionnaire survey to the dieticians, they can improve the quality of their counseling, which is expected to result in better individual care of the patients. (Source: Diabetology International)
Source: Diabetology International - July 8, 2020 Category: Endocrinology Source Type: research
A case of an elderly patient with insulin-dependent diabetes and dementia receiving one basal insulin plus one bolus insulin injections a day for 6 months
AbstractMultiple daily injections of insulin, referred to basal –bolus regimen, are generally essential in achieving glycemic control and preventing ketosis in insulin-dependent diabetes, such as type 1 diabetes (T1D). A 75-year-old man with T1D receiving basal–bolus insulin therapy exhibited symptoms of dementia after hospitalization due to pyelonephritis a nd failed to continue insulin self-injection. Given that his social and familial circumstances allowed insulin injection once a day during the morning, bolus insulin injections needed to be discontinued. Ketonuria was observed the day following discontinuation of b...
Source: Diabetology International - July 1, 2020 Category: Endocrinology Source Type: research
A review of the current evidence on the sensitivity and specificity of the Ipswich touch test for the screening of loss of protective sensation in patients with diabetes mellitus
ConclusionsThe Ipswich touch test has a high specificity in screening for loss of protective sensation in the feet of patients with diabetes mellitus. It is a useful test to be included in diabetic foot screenings, especially when other sensory tools are not available. However, more rigorous studies need to be conducted as there is currently only a limited pool of research evidence to substantiate it as a screening tool for loss of protective sensation in the diabetic foot. (Source: Diabetology International)
Source: Diabetology International - June 28, 2020 Category: Endocrinology Source Type: research
Evaluation of some oxidative markers in diabetes and diabetic retinopathy
ConclusionThis study concluded that higher levels of uric acid and malondialdehyde were associated with increase in the risk of diabetes and DR development, while bilirubin wasn ’t associated with decreasing the risk of diabetes or DR. However, the combination of malondialdehyde, uric acid and bilirubin may be a valuable addition to the current options for the prognosis of DR. In addition, malondialdehyde may be independent predictor of diabetes and DR as well as uric aci d may be used as independent biomarker to predict the risk of DR. (Source: Diabetology International)
Source: Diabetology International - June 26, 2020 Category: Endocrinology Source Type: research
