We assessed the possibility that the glycated albumin (GA) level measured eight years previously can be used to predict the present glycohemoglobin (HbA1c) level. Two hundred and thirty patients referred to our hospital for a general health checkup both this year and eight years earlier were selected. The average age was 56.6 years. A multiple regression analysis was performed using the present HbA1c level as the dependent factor. Independent factors used for the analysis included the levels of GA, fasting blood glucose and 1- and 2-hour blood glucose after 75-g glucose oral loading, as well as body mass index and age, all of which were measured eight years previously. The coefficient of determination for the analysis was 0.575, thus implying that the equation did not fit perfectly. The most stable levels of HbA1c predicted from the level of GA measured eight years earlier were 5.8 %, 5.9 % and 6.0 %; the GA levels predicting these HbA1c levels were 13.9 %, 15.6 % and 16.4 %, respectively. The proportion of patients whose present HbA1c level was over 5.8 % was 20.3 % greater than that observed for patients whose GA level measured eight years earlier was over 13.9 %. A GA level of 15.6 % and 16.4 % predicted an HbA1c level that was 10.6 % and 11.4 % less, respectively. A GA level of 15.6 % or 16.4 % may be therefore used to identify patients who may develop diabetes eight years later.

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The aim of this study was to investigate the long-term efficacy and safety of sitagliptin (S), a DPP-4 inhibitor, in Japanese patients with type 2 diabetes. Among 181 patients, the HbA1c levels were significantly reduced at 24 months after the initiation of S therapy (7.54±0.99→6.77±0.8 %, P<0.0001). The change in the HbA1c level at 24 months as an outcome variable was evaluated in relation to other clinical factors as predictive variables. The reduction in the HbA1c level at 24 months was significantly more prominent in the patients with a higher initial HbA1c level (P<0.0001) and shorter duration of diabetes (P<0.05). Forty-four (24 %) patients exhibited a decrease followed by re-elevation in the HbA1c level by more than 0.5 % compared to that observed after six months. Re-elevation of HbA1c was found to be significantly related to the degree of weight gain after six months (P<0.01) and a lower level of endogenous insulin secretion (P<0.05). Although 12 patients complained of mild hypoglycemia and six reported mild gastrointestinal symptoms, none were obliged to cease the administration of S due to adverse effects. Providing more careful and strict education regarding lifestyle modification is required in patients who exhibit weight gain and lower levels of endogenous insulin secretion in order to prevent re-elevation of the HbA1c level following the initiation of S therapy.

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A 55-year-old man with a history of alcoholism was admitted to our hospital due to diabetic ketosis in May 2011. Chronic pancreatitis was diagnosed based on the patient's history, radiological findings on CT imaging and decreased exocrine function. His diabetes was attributed to pancreatic diabetes, and he was started on insulin therapy. Chronic diarrhea and body weight loss (7 kg within six months) began to develop in July 2012. He was subsequently referred to our hospital due to leg weakness associated with a marked hypokalemia (K 1.4 mEq/l) on December, 2012. The FEK (fractional excretion of potassium) and TTKG (trans-tubular potassium gradient) values were 2.15 % and 3.34, respectively. His serum potassium level normalized to 3.5 mEq/l by the second day of admission following the intravenous administration of potassium chloride. The total potassium dose of intravenous treatment was approximately 872 mEq. The patient's chronic diarrhea with steatorrhea was treated with a fat-restricted diet, pancreatic enzyme replacement and proton pump inhibitor. The marked hypokalemia was attributed to his low potassium intake associated with alcoholism and the intestinal loss of potassium due to chronic diarrhea. This case illustrates the necessity to monitor the electrolyte levels in the decompensated stage of chronic pancreatitis, as malabsorption due to an insufficient exocrine function associated with chronic diarrhea may result in serious complications.

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The Committee on Diabetic Nephropathy revised the classification of diabetic nephropathy in view of the current status of eGFR and CKD in Japan. To make revisions for the classification of diabetic nephropathy 2014, the Committee carefully evaluated the report of the Research Group on Diabetic Nephropathy, Ministry of Health, Labour, and Welfare of Japan. The major revisions made were as follows: 1. eGFR can be used for the evaluation of GFR; 2. In stage 3 (overt nephropathy), A and B were combined; 3. Stage 4 (renal failure) was defined as GFR less than 30 ml/min/1.73 m², regardless of albuminuria; and 4. The importance of differential diagnosis was stressed in all stages.

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