Eun Young Lee

To evaluate the efficacy and safety of JP-2266, a novel dual sodium-glucose co-transporter 1 (SGLT1)/SGLT2 inhibitor, in patients with type 2 diabetes mellitus (T2DM) inadequately controlled with diet and exercise. In this 12-week, randomized, double-blind, placebo-controlled phase 2 trial, 156 patients with T2DM were randomly assigned (1:1:1) to receive once-daily JP-2266 5 mg (n=51), 10 mg (n=53), or placebo (n=52). The primary endpoint was the change in glycosylated hemoglobin (HbA1c) from baseline to week 12 (ClinicalTrials.gov identifier: NCT06144788). JP-2266 treatment led to significant, placebo-adjusted reductions in HbA1c of -0.94% (95% confidence interval [CI], -1.24 to -0.65; P<0.0001) for the 5 mg dose and -0.97% (95% CI, -1.26 to -0.68; P<0.0001) for the 10 mg dose. Significant reductions were also observed in fasting plasma glucose (-36.22 mg/dL [95% CI, -47.62 to -24.83] with 5 mg and -39.38 mg/dL [95% CI, -50.71 to -28.05] with 10 mg), and postprandial glucose (-62.30 mg/dL [95% CI, -84.97 to -39.64] with 5 mg and -66.89 mg/dL [95% CI, -89.71 to -44.07] with 10 mg) (all P<0.0001). JP-2266 also reduced body weight of -2.0 to -2.1 kg and systolic blood pressure (-3.6 mm Hg with 10 mg). Improvements in insulin resistance and β-cell function were also observed, as assessed by homeostasis model assessment. Adverse event rates were similar to placebo. In patients with T2DM inadequately controlled by lifestyle alone, JP-2266 significantly improved glycemic control, reduced body weight and blood pressure, and was well tolerated over 12 weeks. These findings support further investigation of JP-2266 as a potential therapeutic option for T2DM.

Lee J, et al. J Korean Med Sci. 2025 Dec;41:e44. https://doi.org/10.3346/jkms.2026.41.e44

Background: This study investigated the association between the triglyceride-glucose (TyG) index, a marker of insulin resistance, and the risk of end-stage renal disease (ESRD) in individuals with type 2 diabetes mellitus (T2DM), focusing on variations by diabetes duration.Methods: We analyzed 1,219,148 Korean adults with T2DM from National Health Insurance Service data who underwent biennial health evaluations (2015 to 2016). ESRD was defined using specific procedural codes (V codes), and Cox proportional hazard models were employed to estimate hazard ratios (HRs) for ESRD across TyG index quartiles and diabetes duration categories, adjusting for various confounders.Results: Over 6,967,381 person-years of follow-up, 7,548 participants developed ESRD. Higher TyG index quartiles were independently associated with increased risk of ESRD, which was more pronounced with longer diabetes duration. The adjusted HR for ESRD in the highest TyG quartile (Q4) compared to the lowest quartile (Q1) was 1.235 (95% confidence interval [CI], 0.995 to 1.533) in new-onset diabetes, and 1.592 (95% CI, 1.465 to 1.730) in those with diabetes for ≥10 years. Compared to the lowest TyG quartile in new-onset diabetes, the adjusted HR for ESRD in the highest quartile with diabetes duration ≥10 years increased to 10.239 (95% CI, 8.440 to 12.422). Subgroup analysis revealed that a higher TyG index consistently increased the risk of ESRD, with stronger associations observed in younger individuals and those without comorbidities.Conclusion: The TyG index is a significant predictor of ESRD in T2DM, particularly in those with prolonged diabetes duration. Targeting insulin resistance early may mitigate the risk of ESRD in this population.

Background: The digital education platform Doctorvice (iKooB Inc.) offers face-to-face physician-patient education during outpatient clinic visits, remote glucose monitoring, and the delivery of educational messages, and is expected to be effective for personalized diabetes care. Objective: This study aims to evaluate the effectiveness of the digital education platform for diabetes care by comparing cases that included both face-to-face education and remote monitoring with those that included only face-to-face education. Methods: This was a randomized clinical study conducted at the Diabetes Center of Seoul St. Mary’s Hospital. Participants were aged ≥19 years and had glycated hemoglobin (HbA1c) levels between 7.5% and 9.5%. In the intervention group, physicians used the digital education platform to provide face-to-face education at enrollment and at the 3- and 6-month visits, along with remote monitoring during the first 3 months of the 6-month study period. The control group received conventional outpatient education. Both groups completed questionnaires—assessing satisfaction with diabetes treatment, diabetes-related stress, and adherence to diabetes medication—at the beginning and end of the study. The primary endpoint was the change in HbA1c levels. Results: A total of 66 participants were enrolled between August 1, 2022, and August 31, 2023. Of these, 26 in the intervention group and 30 in the control group were analyzed, excluding 10 participants who dropped out of the study. The mean baseline HbA1c levels were 8.3% (SD 0.6%) in the intervention group and 8.0% (SD 0.5%) in the control group. At the 3-month follow-up, mean HbA1c decreased by 0.5%-7.8% (SD 0.9%; P=.01) in the intervention group and by 0.2%-7.8% (SD 0.7%) in the control group. HbA1c levels substantially improved during the first 3 months with both face-to-face education and remote glucose monitoring. However, HbA1c tended to increase during the 3- to 6-month follow-up in the intervention group without the remote monitoring service. Satisfaction with diabetes treatment significantly improved at the end of the study compared with baseline in the intervention group (mean change +3.6 points; P=.006). Medication adherence improved in both groups, with no significant difference at 6 months (P=.59), although the intervention group showed a greater increase from baseline. Subgroup analysis indicated that the reduction in HbA1c was greater for patients with baseline HbA1c levels ≥8.0%, those aged ≥65 years, smokers, drinkers, and those with obesity in the intervention group. Conclusions: The digital education platform for personalized diabetes management may be beneficial for glycemic control in type 2 diabetes mellitus. Its effectiveness appears to be enhanced when physicians provide personalized face-to-face education combined with remote feedback. Trial Registration: Clinical Research Information Service (CRiS) of Republic of Korea KCT0007953; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=23507&search_page=L

Background/Objectives: Cancer survivors increasingly face cardiovascular disease (CVD), with diabetes as a major risk factor. This study investigates the relationship between adherence to antidiabetic medications and cardiovascular (CV) outcomes in cancer patients. Methods: Using data from the Korean National Health Insurance Service—National Sample Cohort, we assessed the clinical outcomes of adult cancer patients prescribed antidiabetic medications. The study population was categorized based on medication adherence, as determined by the medication possession ratio (MPR): good (MPR ≥ 0.8), moderate (0.5 ≤ MPR < 0.8), and poor (MPR < 0.5) adherence. The primary outcomes included overall and CV mortality, with secondary outcomes encompassing hospitalization for major CVDs and healthcare costs. Results: Among the 7928 cancer patients with diabetes, 59.7% were nonadherent (22.1% with moderate and 37.6% with poor adherence). Over a median follow-up of 5.7 years, 1462 deaths and 2897 CV events were confirmed. Multivariable adjusted analyses showed a 1.70-fold and 2.11-fold higher risk of overall mortality for the moderate and poor adherence groups, respectively, compared to the good adherence group. For CV mortality, moderate adherence was associated with a 1.51-fold higher risk, and poor adherence with a 2.10-fold higher risk. The risk for new-onset CV events increased by 1.32-fold in the moderate adherence group and 1.44-fold in the poor adherence group. The good adherence group also showed significantly lower total healthcare costs compared to the nonadherence group. Conclusions: The present study underscores the importance of adherence to antidiabetic medications in cancer patients, revealing significant associations with decreased mortality, CV events, and healthcare costs.

One of the notable adverse effects of sodium-glucose cotransporter 2 (SGLT2) inhibitor is diabetic ketoacidosis (DKA) often characterized by euglycemia. In this retrospective review of patients with DKA from 2015 to 2023, 21 cases of SGLT2 inhibitorassociated DKA were identified. Twelve (57.1%) exhibited euglycemic DKA (euDKA) while nine (42.9%) had hyperglycemic DKA (hyDKA). More than 90% of these cases were patients with type 2 diabetes mellitus. Despite similar age, sex, body mass index, and diabetes duration, individuals with hyDKA showed poorer glycemic control and lower C-peptide levels compared with euDKA. Renal impairment and acidosis were worse in the hyDKA group, requiring hemodialysis in two patients. Approximately one-half of hyDKA patients had concurrent hyperosmolar hyperglycemic state. Common symptoms included nausea, vomiting, general weakness, and dyspnea. Seizure was the initial manifestation of DKA in two cases. Infection and volume depletion were major contributors, while carbohydrate restriction and inadequate insulin treatment also contributed to SGLT2 inhibitor-associated DKA. Despite their beneficial effects, clinicians should be vigilant for SGLT2 inhibitor risk associated with DKA.

BACKGROUND The Digital Education platform, DoctorviceⓇ (iKooB Inc., Seoul, South Korea), offers both physicians' face-to-face education and remote glucose monitoring, which is expected to be effective for personalized diabetes care. OBJECTIVE To evaluate the effectiveness of the digital education platform for diabetes care and compare cases where both face-to-face education and remote monitoring were provided with cases where only education was provided. METHODS Sixty-six patients with type 2 diabetes mellitus who visited the Diabetes Center of Seoul St. Mary’s Hospital were enrolled in this randomized clinical study. Participants were aged ≥19 years and had hemoglobin A1C (HbA1C) levels of 7.5–9.5%. Of the 66 participants, 26 in the intervention group and 30 in the control group were analyzed, excluding 10 who dropped out of the study. In the intervention group, physicians used the digital education platform to provide face-to-face education at enrollment and at the 3- and 6-month visits, along with remote monitoring during the first 3 months of the 6-month study period. The control group received conventional outpatient education. The primary endpoint was the change in the HbA1c levels. RESULTS The baseline HbA1c levels were 8.3±0.6% in the intervention group and 8.0±0.5% in the control group. At the 3-month follow-up, HbA1c decreased by 0.5% to 7.8±0.9% (P=.010) in the intervention group and by 0.2% to 7.8±0.7% in the control group. HbA1c levels significantly improved during the first 3 months with both face-to-face education and remote glucose monitoring; however, HbA1c tended to increase without the remote monitoring service during the 3 to 6-month follow-up in the intervention group. Subgroup analysis indicated that the effect of reducing HbA1c was greater for patients with baseline HbA1c levels≥8.0%, those aged≥65 years, smokers, drinkers, and those with obesity in the intervention group. CONCLUSIONS The digital education platform for personalized diabetes management appears beneficial for glycemic control in type 2 diabetes mellitus. It was especially effective when physicians provided personalized face-to-face education and remote feedback together. CLINICALTRIAL KCT0007953

Aims/Introduction: To investigate the long‐term efficacy of various encapsulated xenogeneic islet transplantation, and to explore the impact of different donor porcine genetic traits on islet transplantation outcomes.Materials and Methods: Donor porcine islets were obtained from wild‐type, α1,3‐galactosyltransferase knockout (GTKO) and GTKO with overexpression of membrane cofactor protein genotype. Naked, alginate, alginate‐chitosan (AC), alginate‐perfluorodecalin (A‐PFD) and AC‐perfluorodecalin (AC‐PFD) encapsulated porcine islets were transplanted into diabetic mice.Results: In vitro assessments showed no differences in the viability and function of islets across encapsulation types and donor porcine islet genotypes. Xenogeneic encapsulated islet transplantation with AC‐PFD capsules showed the most favorable long‐term outcomes, maintaining normal blood glucose levels for 180 days. A‐PFD capsules showed comparable results to AC‐PFD capsules, followed by AC capsules and alginate capsules. Conversely, blood glucose levels in naked islet transplantation increased to >300 mg/dL within a week after transplantation. Naked islet transplantation outcomes showed no improvement based on donor islet genotype. However, alginate or AC capsules showed delayed increases in blood glucose levels for GTKO and GTKO with overexpression of membrane cofactor protein porcine islets compared with wild‐type porcine islets.Conclusion: The AC‐PFD capsule, designed to ameliorate both hypoxia and inflammation, showed the highest long‐term efficacy in xenogeneic islet transplantation. Genetic modifications of porcine islets with GTKO or GTKO with overexpression of membrane cofactor protein did not influence naked islet transplantation outcomes, but did delay graft failure when encapsulated.