Adjunct Therapy with Ipragliflozin Exerts Limited Effects on Kidney Protection in Type 1 Diabetes: A Retrospective Study Conducted at 25 Centers in Japan (IPRA-CKD).2025 · Background/Objectives: While sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated additional non-glycemic benefits for renal protection in individuals with type 2 diabetes, less evidence is available for those with type 1 diabetes (T1D). To determine whether the adjunctive use of the SGLT2 inhibitor ipragliflozin confers kidney protection in individuals with T1D, we retrospectively analyzed data from a real-world cohort examined at 25 centers in Japan. Methods: We enrolled 359 subjects aged 20-74 years with T1D (IPRA group: 159 ipragliflozin users; control [CTRL] group: 200 non-users). The primary outcome was changes in the estimated glomerular filtration rate (eGFR) from baseline to 24 months after the initiation of ipragliflozin. The secondary outcomes were all other changes, including the urinary albumin-creatinine ratio (UACR) and urinary protein-creatinine ratio (UPCR). Results: The IPRA group's eGFR decline slopes were 0.79 mL/min/1.73 m2/year milder than the CTRL group's after propensity score matching, but this difference was not significant. The subjects complicated by chronic kidney disease (CKD) defined as UACR ≥ 30 mg/g and/or UPCR ≥ 0.5 g/g and/or eGFR < 60 mL/min/1.73 m2 showed changes in UPCR (g/g) from baseline to 24 months that were significantly lower in the IPRA group (-0.27 ± 1.63) versus the CTRL group (0.18 ± 0.36) (p = 0.016). No significant increase in adverse events (including severe hypoglycemia and hospitalization due to ketosis/ketoacidosis or cardiovascular diseases) was observed in the IPRA group. Conclusions: Adjunctive treatment with ipragliflozin exerted potential renal benefits by decreasing proteinuria in T1D subjects with CKD. Further investigations are required to determine whether its additional benefits exceed the increased risk of ketoacidosis.
Extranodal natural killer/T-cell lymphoma with lung involvement in a young adult with suspected mosquito bite hypersensitivity: A case report.2025 · A young adult with suspected pulmonary lymphoma was diagnosed with extranodal natural killer/T-cell lymphoma (ENKTL). The patient had a history of possible mosquito bite hypersensitivity (MBH), suggesting a potential association between MBH and ENKTL. Although ENKTL typically affects middle-aged adults, it has rarely been reported in children with MBH or chronic active Epstein-Barr virus (EBV) disease. This case highlights the challenges of obtaining pathological confirmation from small biopsy samples of pulmonary ENKTL. Detailed history taking and EBV DNA testing may aid in diagnosis, particularly in younger patients.
Unequal distribution of plasma glucagon levels among clustering-based diabetes subtypes: a Japanese cohort.2025 · Abstract Context Hyperglucagonemia contributes to disturbances in glucose metabolism. Data-driven diabetes clustering reflects risk of diabetic complications better than classical classification, type 1 diabetes (T1D) vs. type 2 diabetes (T2D); however, the pathophysiological features have not been clarified. Objective To assess the distribution of plasma glucagon levels among clustering-based diabetes subtypes. Methods A total of 546 Japanese participants with T1D or T2D were categorized into five diabetes subtypes. Plasma glucagon levels were compared across subtypes and factors associated with hyperglucagonemia were evaluated using logistic regression analyses. Results Plasma glucagon levels differed significantly among diabetes subtypes. Among the five subtypes, plasma glucagon levels and the frequency of hyperglucagonemia were highest in the severe insulin-resistant diabetes (SIRD) subtype (45.6%). The SIRD subtype was an independent risk factor for hyperglucagonemia (adjusted odds ratio 2.17, 95%CI 1.03–4.54, P=0.041), even after adjusting for other risk factors, such as body mass index, HbA1c, and metabolic dysfunction-associated steatotic liver disease. Conclusion The distribution of plasma glucagon levels differed among the clustering-based diabetes subtypes. SIRD is a subtype of diabetes with a hyperglucagonemic phenotype. Elucidating the reason for hyperglucagonemia in SIRD may help to clarify the mechanisms underlying the unfavorable clinical phenotype.