The onset of non-communicable diseases (NCDs) in adults is influenced by undernourishment in the prenatal period in addition to a genetic predisposition and environmental factors. We examined the association between neonatal growth and current metabolic marker levels among the subjects of health checkup program for metabolic syndrome. The study group was 733 subjects (297 males, mean age 68.9±11.1 years old). We detected a relationship between the responses to our three questions and undernourishment in childhood, a low birth weight, and a short stature in elementary school. HbA1c decreased with an increasing birth weight. The odds ratio for HbAlc ≥5.8 % was significantly different between the subjects with a birth weight ≤2.5 kg and those with a birth weight ≥3.5 kg according to a multivariate logistic regression model adjusted for age and body mass index (odds ratio=4.03; 95 % confidence interval: 1.20-13.6; P<0.024). These findings suggest that undernourishment in the prenatal period is associated with the onset of NCDs. At the very least, we can conclude that achieving a high birth weight is important as a preemptive measure against diabetes.

This study was conducted to investigate the effect of the SGLT2 inhibitor ipragliflozin on the liver function in patients with type 2 diabetes. Of 150 patients with type 2 diabetes who started therapy with ipragliflozin, 94 patients who could be closely followed were analyzed to track the changes in their liver function during the initial 6-month treatment with ipragliflozin. Significant decreases were observed in the body weight, HbA1c and blood glucose levels (all, p<0.05). Regarding the liver function, there were significant decreases in the serum levels of AST, ALT and γGTP (all, p<0.05). We then divided the patients into tertiles based on the percentage change in the body weight from baseline. No significant differences were observed in the baseline clinical characteristics among these three groups. Although the serum levels of AST, ALT and γGTP decreased in all three groups, there were no significant differences in the degree of improvement in the liver function among the three groups. These findings suggest that ipragliflozin may improve liver dysfunction in patients with type 2 diabetes without dependence on body weight reduction.

In this study, we evaluated the items related to the body functions and structures that deteriorate due to diabetic polyneuropathy (DP) using a binomial logistic regression analysis. The subjects included 100 DM patients. The items regarding the body functions and structures included the walking speed (10 m forward and backward), standing on one foot with the eyes open, the Timed Up & Go Test, the 30-second chair stand test, and the calf circumference (CC). The "Proposal for the simple diagnosis standards for diabetic polyneuropathy" was used to confirm the presence of DP. CC atrophy and a decrease in the backward walking speed were extracted based on the findings of a binomial logistic regression analysis. According to the ROC curve, the cutoff value was 33.75 cm for CC and 0.905 m/s for the backward walking speed. In addition, after classifying all of the patients as either elderly or non-elderly, a decrease in the CS-30 value was found in the non-elderly patients while a decrease in the backward walking speed was identified in the elderly patients. Muscle weakness in the lower limbs occurred in non-elderly patients due to the development of DP, thereby revealing that CC atrophy occurred with aging. Elderly patients who developed DP therefore suffered from TUG and backwards dynamic balance disorders, which were associated with the decrease in their backward walking speed.

A 77-year-old man who had regularly visited our hospital for the treatment of diabetes mellitus since 71 years of age showed an improved glycemic control (HbA1c 7.0 %) until April 2011. Because his glycemic control worsened to HbA1c 9.8 % in May 2011 for 1 month, insulin injections were initiated. After some improvement, his glycemic control worsened again in April 2012, and he was admitted to our hospital for education on diabetes mellitus; abdominal plain computed tomography at this point showed no abnormal findings in the pancreas. In February 2013, however, a medical checkup revealed atrophy from the pancreas body to the tail and main pancreatic duct dilatation. His serum IgG4 level increased to 1410 mg/dL, and in March 2013, he was admitted to our hospital under clinical suspicion of autoimmune pancreatitis (AIP) when his glycemic control was not good (HbA1c 8.4 %). After a careful examination, he was diagnosed with AIP, and treatment with systemic prednisolone was started. During the course of diabetes mellitus, his glycemic control markedly worsened without any trigger, and the changes on imaging findings were so slight that it wasn't recognized as an abnormal finding, regardless of the findings on CT scans in 2011 and 2012. This case was rare and instructive in terms of taking a long time (about 22 months) to diagnose AIP after a deterioration of glycemic control, thus prompting us to write this case report.

A 26-year-old woman underwent total gastrectomy for stomach cancer at 24 years of age. She subsequently presented with dumping syndrome, but the symptoms disappeared after dividing her meals into smaller portions. During pregnancy, the symptoms of dumping syndrome persisted despite dividing the meals. Therefore, the patient visited our outpatient department. Continuous glucose monitoring (CGM) was performed on an outpatient basis. High post-meal and subsequent low blood glucose levels were confirmed. During hospital admission, measures were implemented to control her high blood glucose level. Despite a six-meal-per-day regimen and insulin therapy, the increased blood glucose level could not be controlled. However, CGM of fluctuations in her blood glucose levels, adjusting the timing of insulin injections, and extending her meal times lowered her blood glucose level to within the target range. Her blood glucose level remained satisfactorily controlled even after hospital discharge, and she gave birth to a healthy child at 39 weeks' gestation. CGM was thus found to be effective for controlling the blood glucose level during pregnancy in this patient with dumping syndrome.

We encountered a 42-year-old woman with a 3-year history of breast cancer. She underwent total mastectomy of her right breast and axillary lymph node dissection when she was 39 years old. A subtyping analysis demonstrated that the tumor was triple negative. Adjuvant chemotherapy combined with radiotherapy was administered. Even after the standard therapy finished, she hoped to continue the treatment, and therefore chemotherapy was continued. Anti-programmed cell death protein-1 antibody (anti-PD-1 antibody) administration was therefore started. Four weeks after the final administration, she experienced abrupt onset of hyperglycemia and ketoacidosis and was diagnosed with type 1 diabetes mellitus. Her plasma glucose level was 366 mg/dL, HbA1c was 9.5 %, and β-hydroxybutyrate was 7581 μmol/L. Her serum C-peptide level was undetectable, and anti-GAD and anti-IA-2 antibodies were negative. Although anti-PD-1 antibody is highly effective against some cancers that are refractory to standard chemotherapies, there is concern about the development of autoimmune diseases, including type 1 diabetes. Most patients that developed type 1 diabetes after anti-PD-1 therapy exhibited a low or undetectable C-peptide level. Our patient's clinical history and these previous findings suggest that anti-PD-1 antibody may have triggered type 1 diabetes in our patient.