ARTICLES IN PRESS | YEAR-2025 | VOLUME-6

During recent diabetic practice, continuous glucose monitoring (CGM) has become prevalent. The current case was a 70-year-old male with type 2 diabetes (T2D). He has used CGM for a long time and recently began using the novel FreeStyle Libre 3 system, which includes a sensor and an app for a smartphone. The benefits include painless, affordable, discreet, accurate, and real-time glucose readings at a glance. He successfully measured glucose variability for one month, which was associated with an average glucose of 148 mg/dL, a time in range (TIR) of 80%, and a time above range (TAR) of 20%. This apparatus would be convenient for beneficial clinical diabetic research.

Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) have their origins in phlorizin, which was discovered in apple bark in 1835. SGLT-2i has been effective in treating type 2 diabetes (T2D), chronic kidney disease (CKD), and cardiovascular disease (CVD). In heart failure, cardiac tissue becomes less able to metabolize glucose and fatty acids, and begins to rely more on ketone bodies. Subjects with heart failure with reduced ejection fraction showed higher cardiac output at rest and lower filling pressures, cardiac volumes, and NT-proBNP levels when treated with ketone esters. As an adverse effect of SGLT-2i, euglycemic ketoacidosis (eKA) has been reported and requires careful attention.

The patient was a 51-year-old male with metabolic syndrome (Met-S). Actually, he showed several problems of obesity as BMI 35.0 kg/m², type 2 diabetes (T2D), fatty liver, chronic kidney disease (CKD), hyperuricemia, and dyslipidemia. Positive biochemistry data included AST 126 U/L, ALT 143 U/L, UA 8.2 mg/dL, Cre 1.02 mg/dL, LDL 129 mg/dL, and HbA1c 6.3%, with a normal range of pulse wave velocity (PWV). He was treated by a low-carbohydrate diet (LCD) as diet therapy, continuing weight control by LCD, oral hypoglycemic agents (OHAs), and oral semaglutide (Rybelsus) as GLP-1RA. Then, his weight decreased 5 kg, and his general status has remained stable for 7 years.

In the global fight against diabetes and metabolic disorders, dietary interventions such as low-carbohydrate diets (LCDs) have gained traction for their ability to stabilize blood glucose (BG) levels and improve insulin sensitivity. The Japan Low Carbohydrate Diet Promotion Association promotes three levels of carbohydrate restriction: super, standard, and petite LCDs, which contain 12%, 26%, and 40% of total calories from carbohydrates, respectively. Whey protein consumed as a premeal supplement can diminish postprandial BG elevations and could serve as an excellent adjunct to meals containing higher levels of carbohydrates, such as the petite and standard LCDs.

Recently, health and medical problems related to carbohydrates, sugar, and sweets have been under discussion. Historically, wall paintings in the Altamira Cave in Spain depict people harvesting honey, suggesting honey as the earliest natural sweetener. White sugar originated from India before the Common Era by boiling down sugarcane juice. Since the Industrial Revolution, people have been able to obtain enough sugar at low cost. The widespread use of sugar has had a profound impact on food culture, tastes, and society around the world. Current issues regarding carbohydrates in modern society include the development of alternative sweeteners such as aspartame, sucralose, stevia, and erythritol.

Diabetes has been studied and managed internationally by the American Diabetes Association (ADA), the European Association for the Study of Diabetes (EASD), the Japan Diabetes Association (JDA), and so on. The International Diabetes Federation (IDF) proposed “type 5 diabetes (T5D)” in April 2025. T5D mainly develops due to chronic malnutrition during childhood, particularly in low-income countries, affecting an estimated 20 to 25 million people. It shows low body weight and insulin deficiency, previously known as malnutrition-related diabetes (MNRD). Its novel perspective typing will contribute to more awareness and discussion for medicine, education, public health, the economy, and social factors such as poverty and nutritional disparities.