This study aimed to determine the clinical characteristics and the lifestyle and socioeconomic status of young adult Japanese patients with type 2 diabetes. In total, 525 male and 257 female patients of 20-40 years of age were enrolled at 96 medical facilities of the Japan Federation of Democratic Medical Institutions. The mean ages of the male and female patients were 34.9 years and 34.6 years, respectively. The rate of diabetes among the first- and second-degree relatives of the male and female patients was 61.3 % and 70.8 %, respectively. Approximately three quarters of these patients were formerly obese (BMI: ≥30 kg/m²). Patients with a BMI value of ≥25 kg/m² at 20 years of age had more severe retinopathy and more overt proteinuria or renal insufficiency (serum creatinine: ≥2.0 mg/dl) than those with a BMI value of <25 kg/m² at 20 years of age. The household income and level of education of the study patients, as well as the percentage of those with regular employment, were lower than the corresponding values in a national survey of age-matched healthy individuals. We conclude that in recent years, the onset of type 2 diabetes in young Japanese adults has resulted from the progression of obesity and strong genetic factors.

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Patients with diabetes mellitus have a higher prevalence of coronary artery disease (CAD), which is more often accompanied by asymptomatic myocardial ischemia with severe coronary artery stenosis in comparison to non-diabetic individuals. Morbidity and mortality are high in these patients, thus it is important to seek a sensitive and effective diagnostic screening strategy for CAD. We examined the usefulness of routine CCTA screening. A total of 159 patients who had not previously been diagnosed with CAD underwent routine 320-row CCTA. Coronary artery stenosis was observed in 67 diabetic patients (42 %), 20 (30 %) of whom were diagnosed with significant myocardial ischemia after additional testing which included scintigraphy and/or exercise electrocardiography and/or coronary angiography by cardiologists. From the clinical point of view, we found that the presence of nephropathy, an increased rate of antihypertensive and antiplatelet or anticoagulant medications, a history of brain attack, a lower eGFR, a lower ankle brachial index, increased thickening of carotid intima-media layers and higher calcification scores of the coronary artery (CAC) were significant risk factors for CAD in diabetic patients.

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We used a questionnaire survey to investigate how personal characteristics and eating behavior contribute to the self-management of diabetes mellitus. The questionnaires, which were designed based on the behavioral economics model, investigated the eating behavior of 147 ambulatory type 2 diabetes patients. We then analyzed the relationship between these characteristics and the patients' clinical data. The scores in all categories that indicated a deflection in eating behavior were significantly higher in subjects with higher-BMI values than in subjects with lower-BMI values. As for the psychological characteristics, the scores that indicated a recovery of payment (highly judgment for fee) and preference-reversal (unstable preference) were significantly higher in the subjects with higher-BMI values. These results showed the importance of encouraging self-management with regard to reducing the purchase of food and/or cooking volume and narrowing the variability of the methods and targets of self-management, including nutrition and exercise therapy. Moreover the total score of eating behavioral deflection was positively correlated with various psychological characteristics. These results suggest that psychological characteristics, as determined by the behavioral economics model may impact eating behavior. Thus, a patient's psychological characteristics should be considered in addition to their eating behavior when attempting to achieve the effective self-management of diabetes mellitus.

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A 90-year-old woman developed thirst, polydipsia, polyuria and weight loss in October 2014. She visited a clinic and was diagnosed with diabetes mellitus (plasma glucose 693 mg/dl, HbA1c 14.4 %). She then presented at our hospital in November due to the development of dizziness. She became ketotic and was treated with insulin. The patient was diagnosed with acute-onset type 1 diabetes because her anti-GAD antibody titer was 46,000 U/ml and endogenous insulin production was severely impaired. We herein report a rare case of extremely elderly-onset type 1 diabetes accompanied by chronic thyroiditis, with a HLA haplotype protective against type 1 diabetes.

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