To determine the efforts being made to provide foot care to patients with diabetes, a mail-distributed questionnaire survey was conducted. Questionnaires were sent via the postal service to 624 institutions certified as training or teaching institutions by the Japan Diabetes Society (June 2012) (October to December 2012). Responses were received from 143 institutions. Foot care was provided by most hospitals that had more than 500 beds, a nurse-to-patient ratio of 1:7, and those employing diabetes nurse specialists. Specialist outpatient clinics for diabetic foot care were provided by 89 (62.2 %) institutions. These clinics offered foot care to a total of 29.5±52.5 individuals per month, for 17.4±28.2 h per month. The survey covered the provision of specialist outpatient foot care clinics and details of foot care (foot ulcer risk assessment, foot care intervention, and foot care assessment). The rates of implementation of foot ulcer risk assessment and foot care assessment were lower than the rate of implementation of foot care interventions. In conclusion, the availability of outpatient foot care and the implementation of appropriate foot care for patients with diabetes are not yet adequate. Thus, the establishment and implementation of systems for preventing diabetic foot lesions are required.

We analyzed the data from the Japan Tuberculosis Surveillance to gain an overview of diabetes mellitus (DM) among pulmonary tuberculosis (PTB) patients in Japan. Of the cumulative total 141,598 PTB patients newly identified between 2007 and 2014, 13.7 % were registered as being co-infected with DM. Recent trends have pointed to high and increasing proportions of co-infected cases among elderly female patients. PTB patients with DM were significantly more likely to be at a progressed stage when diagnosed. After adjusting for age, DM co-infection was associated with a poor TB treatment outcome, including death, treatment failure, and prolonged treatment. Although DM under the current TB Surveillance is not clinically defined, and thus the true burden of DM co-infection among PTB patients may be underestimated, our study nevertheless provides major insight into the general trends and an overview of the state of this dual epidemic in Japan.

A 52-year-old man who had undergone steroid therapy at 27 years of age presented to our emergency unit complaining of poor appetite, abdominal pain, and disturbance of consciousness in mid-January 2015. An examination at presentation revealed diabetic ketoacidosis with pH of 7.021, urine ketone body of 2+, blood glucose of 1111 mg/dL, and HbA1c of 6.3 %. Continuous intravenous insulin infusion with adequate fluid therapy was started. Based on the findings of an increase in the levels of pancreatic exocrine enzymes with a subsequently confirmed absence of islet-specific autoantibodies and depletion of endogenous insulin secretion as evidenced by fasting blood CPR of 0.1 ng/dL, 2-h postprandial blood CPR of 0.1 ng/dL, and urinary CPR of 8.2 μg/day, fulminant type 1 diabetes mellitus was diagnosed. The patient had an HLA haplotype of DRB1*04:05-DQB1*04:01, which is a common susceptibility factor for Harada disease and fulminant type 1 diabetes mellitus. There was also a change in the antibody titer against enterovirus (type B1 Coxsackie virus) after admission. He was suspected of having developed fulminant type 1 diabetes mellitus triggered by a new infection with enterovirus 25 years after the development of Harada disease.