Five questionnaire surveys have been conducted at ten-year intervals since 1972 to assess the status of diabetes treatment in Japan. The survey results were evaluated in this study. The last survey was conducted in 2,030 medical institutions providing a high level of diabetes treatment, using the same approach as that of the previous 4 surveys. Most institutions diagnosed diabetes in accordance with the Guidelines for Diagnosis of Diabetes Mellitus of the Japan Diabetes Society, including the criteria for a 75 g oral glucose tolerance test (OGTT), similarly to 30 years previously. Blood glucose self-monitoring increased due to revised medical fees. A continuous subcutaneous insulin infusion was introduced in less than 40 % of the institutions. Education and training of diabetic patients have been common in diabetologist clinics for 40 years. In the last survey, general practitioners provided less training than physicians in university and general hospitals. The last survey suggested that medical institutions were encouraging diabetic patients to participate in the activities of the Japan Association for Diabetes Education and Care to improve educational activities. This is because the provision of these activities has become difficult due to a lack of diabetologists certified by the Japan Diabetes Society, despite the promotion of cooperation among medical institutions.

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A 78-year-old woman with no history of diabetes mellitus, who had been treated with allopurinol for a month, was hospitalized to examine the cause of general malaise, loss of appetite and skin rash that appeared on both thighs. She had a sudden onset of a high fever after admission, and meropenem was administered. An erythema-like rash was noted on her left forearm two days thereafter. All medication was discontinued due to the suspicion of a drug eruption. We suspected DIHS and initiated steroid pulse therapy followed by oral administration of prednisolone (40 mg). The patient's HHV-6 IgG titer increased from 20 to 5,120 within three weeks, thus she was diagnosed with DIHS. One month after discharge, the patient developed fulminant type 1 diabetes mellitus. After medical treatment, she developed viral encephalitis and died due to multiple organ failure. In this paper, we described a case that developed fulminant type 1 diabetes mellitus after remission of DIHS due to allopurinol use. Similar cases have been reported regarding the development of fulminant type 1 diabetes 2 to 3 weeks after DIHS remission. In such cases, we should be careful not to delay the diagnosis of fulminant type 1 diabetes.

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We invented a collaborative computer system that uses a summary sheet for collecting diabetes care data, including the disease duration, physiological test results, biochemical data, diabetic complications and treatments. This practical system is useful for obtaining an overview of the disease and may be completed in four steps: 1) Developing the basic summary sheet, 2) Entering the data into the electronic medical recording system, 3) Collaborating with other medical staff when making each data sheet and 4) Converting the data sheet to the popular form of diabetic communication notes. The introduction of an automatic downloading system and the capacity for premanipulation by medical staff, including medical assistants, may make each step faster. The shorter the process, the more patients can be assessed. This system is very useful for developing diabetic community medicine via the use of electronic summary sheets adapted to conventional communication notes.

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This study was conducted to investigate the efficacy and safety of a SGLT2 inhibitor, ipragliflozin, in Japanese patients with type 2 diabetes. Ipragliflozin was administered to a total of 89 out-patients treated with or without other oral hypoglycemic agents, insulin, or GLP-1 receptor agonists for 12 weeks. Significant decreases were observed in the HbA1c value from 7.46±1.12 % to 7.02±0.99 % (p<0.001), body weight from 76.4±14.4 kg to 74.5±14.2 kg (p<0.001), visceral fat mass from 100.4±39.5 cm² to 93.2±33.7 cm² (p=0.011), systolic and diastolic blood pressure, waist circumference and the eGFR. As adverse events of ipragliflozin treatment, whole body eruption, cystitis and vaginal candidiasis in one case and non-severe hypoglycemia in 2 cases were observed. Ipragliflozin is relatively well-tolerated and effective for the treatment of Japanese obese patients with type 2 diabetes.

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A 62-year-old man became aware of his high blood glucose level during a health checkup in 2002, but the condition was left untreated. In July 2013, with the appearance of thirst, polydipsia and polyuria, he was drinking more than 3 l of water and soft drinks a day. When he consulted a neighborhood doctor, he was diagnosed with diabetes mellitus (DM) according to the results of a fasting plasma glucose of 150 mg/dl and HbA1c of 7.5 %. He was medicated with an antidiabetic drug, however, his symptoms remained. He was admitted to our hospital for further examination. He was finally diagnosed with central idiopathic diabetes insipidus (DI). The patient's serum IgG4 was high (433 mg/dl), and DI was suspected to be associated with IgG4-related disease. His symptoms improved by the oral administration of desmopressin. However, although his plasma glucose level improved, the patient continued to have impaired glucose tolerance. The complication of central DI and type 2 DM is very rare, and in most reported cases, the diabetes state improved after treatment for central DI. Multiple factors including dehydration, hyperosmolarity, dysfunction of the V1 receptors and increased soft drink consumption may be associated with the aggravation of glycemic control.

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A 67-year-old man was diagnosed with type 2 diabetes 10 years previously, and insulin therapy with biphasic insulin aspart was introduced 5 years previously, leading to a decrease in the HbA1c level to 7.0 %. However, his HbA1c level began to increase (8.0～9.0 %) in July 2013, and he often experienced hypoglycemia at midnight or early-morning. When a high titer of insulin antibodies was detected (binding rate: 90 %), insulin therapy was terminated, after which hypoglycemia was not detected by the patient. However, hyperglycemia persisted throughout the day. When combination therapy using GLP-1 mimetics (liraglutide) and an SGLT2 inhibitor (ipragliflozin) was introduced, the patient's blood glucose levels dropped and no hypoglycemia occurred. Furthermore, his HbA1c level was decreased (approximately 7.5 %). Previous case studies have reported that GLP-1 mimetics are useful for the treatment of type 2 diabetic patients who have unstable glycemic control due to insulin antibodies. However, there is no report on the effect of combination therapy using GLP-1 mimetics and an SGLT2 inhibitor on glucose control. This case shows that this combination therapy is useful for patients who have unstable insulin antibodies because it may improve glucose levels without insulin action.

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A 71-year-old woman with type 2 diabetes mellitus and hypertension was admitted to our hospital due to physical immobility, a fever and hyperglycemia. No typical finding of miliary tuberculosis was observed on chest computed tomography on this admission. She was first diagnosed with a biliary tract infection according to an elevated C-reactive protein concentration, a liver enzyme test and wall thickening of the gall bladder on abdominal computed tomography and ultrasound, and antibiotics were administered. During two weeks of antibiotic therapy, the C-reactive protein level decreased by quinolone antibiotic therapy, however, her fever and liver dysfunction persisted. A liver and bone marrow biopsy showed Langhans giant cell and epithelioid granuloma without caseous necrosis and miliary tuberculosis was consequently suspected. When she developed acute lung injury on day 22, anti-tuberculous therapy was initiated and her general status and liver dysfunction thereafter rapidly improved.

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A 64-year-old man with type 2 diabetes presented with epigastric pain, nausea, vomiting and diarrhea the day after his 11th administration of exenatide once weekly. His serum amylase concentration was 1,201 IU/l, and serum lipase was 3,097 IU/l. Serum levels of hepatobiliary enzymes were also elevated, resembling acute pancreatitis. However, tenderness in the upper abdomen was not observed. Neither pancreatic swelling nor gallbladder stones were detected by computed tomography (CT). The patient's symptoms ceased under conservative therapy within 3 hours. The serum amylase concentration was 92 IU/l on hospital day 4. According to these findings, weekly exenatide treatment was discontinued. Four weeks after discharge, the patient presented with a new onset of abdominal pain, nausea and vomiting. He exhibited tenderness in the upper abdomen, as well as elevated serum amylase and lipase levels. Acute pancreatitis was diagnosed. One day later, magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) data were obtained, and pancreaticobiliary maljunction (PBM) was diagnosed. Acute pancreatitis is the most frequent complication in patients with PBM. In this case, the sphincter of Oddi might be contracted by the suppression of the vagus nerve caused by the administration of exenatide once weekly.

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We herein describe a case with a falsely high HbA1c level due to modified hemoglobin. A 72-year-old man visited our clinic to evaluate his diabetes status. Although an OGTT revealed impaired glucose tolerance and a glycated albumin level of 16.4 %, the HbA1c value measured by high-performance liquid chromatography (HPLC) was high (8.1 %) and an abnormal peak on its chromatogram was observed. On the other hand, the HbA1c values measured by an immunoassay and enzyme assay were 2.4 % and 4.0 %, respectively. An analysis by high-resolution HPLC (KO500) showed two abnormal peaks at near labile HbA1c and between HbA and HbA1c. However, an analysis of the globin gene including α-chain and β-chain showed no mutation. The two abnormal peaks observed in KO500 were analyzed using mass spectrometry. Consequently, both were revealed to be β-globin with a modified molecule of 88 Da. Although the nature of this molecule is unknown, it differs from known modified hemoglobin due to its molecular weight. This may be a new condition with a falsely high HbA1c level.

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