CURRENT ISSUE

The American Diabetes Association (ADA) has presented the Standards of Medical Care in Diabetes-2024, introducing some impressive changes in description. The 2024 edition closely follows the ADA/EASD Consensus Statement. To evaluate various complications, BNP, NT-proBNP, ankle-brachial index (ABI), and the FIB-4 index are measured. The administration of SGLT2 inhibitors, GLP-1 receptor agonists, and tirzepatide is recommended for T2D adults with cardiovascular disease, heart failure (including HFrEF/HFpEF), and chronic kidney disease (CKD). For lipid control, bempedoic acid and inclisiran have been introduced. FreeStyle Libre 2 is now available, automatically sending data to the smartphone in real-time every minute.

Among oral hypoglycemic agents (OHAs), imeglimin (Twymeeg) has been evaluated in clinical practice with Trials of Imeglimin for Efficacy and Safety (TIMES) 1-3 international studies. However, its gastrointestinal adverse effect (GIAE) would be an actual problem. Recently, imeglimin electrospinning nanofibers have been reported as a potential buccal antidiabetic therapeutic approach, which shows absorption not via the gastrointestinal (GI) tract. Imeglimin nanofibers have a diameter of 361 ± 54 nm and a drug-loading (DL) of 23.5 ± 0.2 μg/mg of fibers. The solid nanofibers disintegration takes only 2 ± 1 seconds. This novel medicine is expected to lead to optimal therapeutic outcomes with better patient compliance.

Recently, sub-classifications for adult-onset diabetes have been presented based on cluster analysis. There are 5 exclusive subtypes, with clusters ranging from 1 to 5: severe autoimmune diabetes (SAID), severe insulin-deficient diabetes (SIDD), severe insulin-resistant diabetes (SIRD), mild obesity-related diabetes (MOD), and mild age-related diabetes (MARD), respectively. The related variables known include GAD antibody, age at diagnosis, BMI, HbA1c, and HOMA2-B and HOMA2-IR. From the Outcome Reduction with an Initial Glargine Intervention (ORIGIN) trial, the numerical numbers of the 5 subtypes are 241-1594-914-1595-2673, respectively. The prevalence percentages for the 5 subtypes in 3 countries are as follows: Japan: 5.4-19.0-7.2-28.9-39.5, Germany: 22.0-3.0-11.0-29.0-35.0, and Finland: 9.9-8.9-11.2-22.8-47.3, respectively.

As a novel oral hypoglycemic agent (OHA), imeglimin (Twymeeg) has recently been introduced into clinical practice. It has shown improved glucose variability via a mitochondrial mechanism. Adequate daily doses identified in several investigations are 1000 mg or 1500 mg twice a day (BID). Consequently, 1000 mg BID seems to be recommended in light of tolerability, safety, and gastrointestinal adverse effects (GI-AEs). For hemodialysis (HD) patients, 500 mg/day was tried with clinical effect. To minimize GI-AEs, novel research has explored the adaptation of nanofiber disintegration for the drug delivery system (DDS). This method takes only 2 +/- 1 seconds via buccal route administration.

Semaglutide has been widely used in the treatment of type 2 diabetes (T2D) and obesity within medical and healthcare settings. Among its formulations, Ozempic has drawn attention for potential adverse effects (AEs). In a study involving 3,962 cases of obesity, the average data showed a weight reduction of 11.8%, a BMI decrease of 4.5 kg/m², and a reduction in waist circumference of 9.4 cm. One notable effect, termed “Ozempic tongue,” is characterized by altered taste sensitivity—such as sour, metallic, or bitter tastes—reported in approximately 6% of cases. These effects are not only considered AEs but are also linked to beneficial outcomes in weight reduction. Additionally, some users have reported changes in the appearance of the breasts, buttocks, and lips with Ozempic administration.