Impact of prediabetes with a high risk of diabetes stratified by glycated hemoglobin level on the severity of coronavirus disease 2019 during admission.

Objective: Prediabetes with a glycated hemoglobin (HbA1c) level of 5.7 - 6.4% is associated with a poor prognosis of coronavirus disease 2019 (COVID-19), but whether the degree of glycemic control is associated with COVID-19 severity is unknown. The aim of this study was to evaluate the association between the degree of glycemic control and COVID-19 severity in patients with prediabetes. Materials and methods: We reviewed 254 patients with COVID-19 admitted to our hospital between April 2020 and September 2021. Based on their HbA1c level, patients were classified into low (HbA1c level < 5.7%), moderate (HbA1c level, 5.7 - 5.9%), and high risk of diabetes (HbA1c level, 6.0 - 6.4%). The association between risk of diabetes and the worst COVID-19 symptom in terms of severity during admission was evaluated using binary logistic regression analysis. Results: Seventy-one and 88 patients had moderate and high risks of diabetes, respectively. Sixty-three and seven patients presented severe (requiring non-invasive oxygen therapy) or critical (intensive care unit admission or artificial respiratory management) COVID-19. The multivariate logistic regression analysis showed that a high risk of diabetes was correlated with severe COVID-19 (P = 0.01) after adjusting for baseline characteristics, whereas a moderate risk of diabetes was not (P = 0.17). Conclusion: Prediabetes with a high risk of diabetes is associated with the worst COVID-19 symptom in terms of severity during admission. Our findings could aid in more efficient allocation of healthcare resources to a narrower population of prediabetic patients. Supplementary Information: The online version contains supplementary material available at 10.1007/s13340-023-00643-z.

Clinical Characteristics Associated with the Development of Diabetic Ketoacidosis in Patients with Type 2 Diabetes.

Objective This study analyzed the clinical and laboratory parameters that might influence the clinical outcomes of patients with type 2 diabetes who develop diabetic ketoacidosis (DKA), which has not been well investigated. Methods We reviewed the clinical and laboratory data of 158 patients who were hospitalized due to DKA between January 2006 and June 2019 and compared the data of patients stratified by the type of diabetes. In addition, the patients with type 2 diabetes were subdivided according to age, and their clinical and laboratory findings were evaluated. Results Patients with type 2 diabetes had a longer symptom duration associated with DKA, higher body mass index (BMI), and higher C-peptide levels than those with type 1 diabetes (p<0.05). Among patients with type 2 diabetes, elderly patients (≥65 years old) had a longer duration of diabetes, higher frequency of DKA onset under diabetes treatment, higher effective osmolarity, lower BMI, and lower urinary C-peptide levels than nonelderly patients (<65 years old) (p<0.05). A correlation analysis showed that age was significantly negatively correlated with the index of insulin secretory capacity. Conclusion Patients with DKA and type 2 diabetes had a higher BMI and insulin secretion capacity than those with type 1 diabetes. However, elderly patients with type 2 diabetes, unlike younger patients, were characterized by a lean body, impaired insulin secretion, and more frequent DKA development while undergoing treatment for diabetes.

A case of generalized lipodystrophy-associated progeroid syndrome treated by leptin replacement with short and long-term monitoring of the metabolic and endocrine profiles.

We herein report a case of a 28-year-old man with generalized lipodystrophy-associated progeroid syndrome treated by leptin replacement. He showed symptoms of generalized lipodystrophy around onset of puberty. His body mass index was 11.9 kg/m2, and he had a short stature, birdlike facies, dental crowding due to micrognathia, partial graying and loss of hair, and a high-pitched voice, all of which are typical features of the progeroid syndrome. Laboratory examinations and abdominal ultrasonography revealed diabetes mellitus, insulin-resistance, dyslipidemia, decreased serum leptin levels (2.2 ng/mL), elevated serum hepatobiliary enzyme levels and fatty liver. Whole exome sequencing revealed de novo heterozygous LMNA p.T10I mutation, indicating generalized lipodystrophy-associated progeroid syndrome, which is a newly identified subtype of atypical progeroid syndrome characterized by severe metabolic abnormalities. Daily injection of metreleptin [1.2 mg (0.04 mg/kg)/day] was started. Metreleptin treatment significantly improved his diabetes from HbA1c 11.0% to 5.4% in six months. It also elevated serum testosterone levels. Elevated serum testosterone levels persisted even 1 year after the initiation of metreleptin treatment. To the best of our knowledge, this is the first Japanese case report of generalized lipodystrophy-associated progeroid syndrome. Furthermore, we evaluated short and long-term effectiveness of leptin replacement on generalized lipodystrophy by monitoring metabolic and endocrine profiles.

Repeated Hypoglycemic Episodes with Postprandial Hyperinsulinemia after the Recovery from Acute Weight Loss Revealed by Continuous Glucose Monitoring and the Oral Glucose Tolerance Test.

We herein report a case of a 20-year-old woman who experienced hypoglycemia in parallel with acute weight loss confirmed by continuous glucose motoring (CGM). When she recovered from the acute weight loss, CGM revealed nocturnal and postprandial hypoglycemia. Six months were required to resolve the hypoglycemia and hyperinsulinemia after the recovery of her weight. Our case suggests that the adaption of insulin secretion to the rapid loss of weight and to the recovery of weight may require a long period of time, leading to the excessive secretion of insulin relative to the glucose level and repeated hypoglycemic episodes with postprandial hyperinsulinemia.

Suppression of Extrapancreatic Glucagon by Octreotide May Reduce the Fasting and Postprandial Glucose Levels in a Diabetic Patient after Total Pancreatectomy.

A 52-year-old woman was treated with sensor augmented pump therapy after undergoing total pancreatectomy for a nonfunctional pancreatic neuroendocrine tumor (NET). The secretion of both endogenous insulin and pancreatic glucagon were completely depleted. Octreotide long acting repeatable (Oct-LAR) was administered for the treatment of liver metastasis of NET. Both the fasting and postprandial glucagon levels decreased immediately after the administration of Oct-LAR. In a continuous glucose monitoring analysis, episodes of nocturnal hypoglycemia was found to increase and an improvement of postprandial hyperglycemia was observed. This case suggests that octreotide may reduce the glucose level in both the fasting and postprandial states, in part by the suppression of extrapancreatic glucagon.