To determine the association of educational hospitalization (EH) for gestational diabetes mellitus (GDM) with a reduction in the incidence of heavy-for-date (HFD) infants, we retrospectively examined the clinical data of 165 GDM women with a singleton pregnancy referred to us by Week 30 of gestation who consented to EH (EH Group, n=118) or received outpatient management (OM Group, n=47). EH was usually performed for three days and included education on self-monitoring of blood glucose (SMBG), daily profiling of plasma glucose, nutritional guidance and medical consultation. SMBG and nutritional guidance were also provided to the OM Group. The incidence of HFD infants (6.8 %) and gestational weight gain (6.05 kg) tended to be lower in the EH group in the present study than in previous reports. A multiple logistic regression analysis suggested that gestational weight gain and EH were independently associated with HFD birth. Although the EH Group may have simply been more health-conscious at baseline, EH may indeed influence the pregnancy outcome.

Background: Trelagliptin (TrG) is a novel, long-acting dipeptidyl peptidase-4 inhibitor (DPP-4i) developed for once-weekly administration to treat type 2 diabetes mellitus (T2DM). To assess its efficacy and safety, a study of switching from a daily DPP-4i to weekly TrG was conducted in Japanese patients with T2DM. Study Design and Method: We switched 97 patients who had been receiving daily DPP-4i at least for 3 months with other oral antidiabetic agents (OADs) or insulin to TrG 50 mg once a week. The patients were a mean 65.4 years of age and had an average of 12.7 years of T2DM. The daily doses of insulin and other OADs were not titrated up during the study. Before the study and every 8 weeks after starting over 40 weeks, the HbA1c, 1,5-anhydroglucitol levels, body mass index (BMI) and the incidence of symptomatic hypoglycemia were assessed. Results: The mean HbA1c at baseline was 7.4 % and stayed roughly 7.3 % after 8, 16 and 40 weeks of TrG administration. The mean BMI was 23.0 at baseline and stayed roughly 23.0 throughout the 40 weeks. Hypoglycemic events were uncommon. Conclusions: Switching from daily DPP-4i to weekly TrG administration was safe, effective and non-inferior for maintaining the glycemic control and BMI over 40 weeks.

To assess the clinical activity of the nurses engaged in diabetic foot care, we surveyed the situation of foot care clinics, and the nurses who worked in them. We sent a questionnaire to educational facilities certified by the JDS and diabetes clinics in which board certified diabetologists performed examinations. Answers were obtained from 414 facilities (37 %); 84 % of the facilities had foot care clinics. In addition, 78 % of the facilities provided medical services to manage diabetes-related complications, and 76 % of those had performed specialized diabetes examinations. In more than 60 % of the facilities, the nurses completed a program for the prevention of critical diabetic complications, and more than 60 % was a qualified Certified Diabetes Educator. However, only 43 % of the facilities had a foot care manual, and most of the facilities did not evaluate the clinical ability of nurses after foot care education. We found that there was a room for improvement in relation to the acquisition of manuals and educational programs in relation to foot care. Furthermore, the results suggest the need to develop a method of evaluating clinical ability in relation to preventive foot care.

Nivolumab, an anti-programmed cell death-1 (PD-1) antibody, has recently received attention as cancer immunotherapy. However, it can cause various autoimmune diseases. We herein report a case of new-onset fulminant type 1 diabetes (FD) in a patient following the administration of nivolumab. A 50-year-old man received nivolumab for lung adenocarcinoma from February 2016. After five doses, he developed symptoms of hyperglycemia and visited a nearby hospital. He exhibited an abrupt onset of ketonuria and elevated levels of plasma glucose (516 mg/dL) and hemoglobin A1c (6.3 %). His serum C-peptide levels fell below the detection limit. He was negative for islet autoantibodies. These results are in accordance with the criteria for FD; however, in this case, he had no preceding viral infection or elevated serum pancreatic enzymes at onset, which differed from the findings in typical cases of FD. The findings in this case indicated that nivolumab can cause FD. Therefore, the onset of FD after the administration of nivolumab may differ from the typical onset in terms of the immune response and histopathological changes in the exocrine pancreas. In such cases, we should be aware of this serious side effect because of the additional risks associated with nivolumab.

We herein report a patient with type B insulin resistance in whom liraglutide significantly improved postprandial hyperglycemia that had been highly resistant to other treatments, including insulin therapy. The patient was a 73-year-old Japanese male whose hyperglycemia had worsened rapidly after being diagnosed as diabetes. His fasting plasma glucose was 77 mg/dL, HbA1c was 8.6 %, and serum insulin level was 366 μU/mL. As anti-insulin receptor antibody was detected, we diagnosed the patient with type B insulin resistance. CGM (Continuous Glucose Monitoring) showed that liraglutide reduced the average blood glucose level from 124 mg/dL (standard deviation [SD] 59 mg/dL) to 80 mg/dL (SD 16 mg/dL) by improving the postprandial hyperglycemia and did not increase the time in a hypoglycemic state (27 % to 23 %). The meal tolerance test showed that liraglutide significantly enhanced the reactivity of the plasma insulin responses after food intake. Liraglutide was also effective as a treatment when the patient's postprandial hyperglycemia worsened again, in parallel with increasing inhibited insulin receptor rates. Our findings in this case imply the specific effect of liraglutide in improving type B insulin resistance complicated with postprandial hyperglycemia.

An 80-year-old man with type 2 diabetes was hospitalized because of a fever. A considerable number of white blood cells were found in the urinary sediment. He had a white blood cell count in the peripheral blood of 22,300/μL and serum C-reactive protein of 27.6 mg/dL. Abdominal computed tomography and magnetic resonance imaging (MRI) revealed bilateral hydronephrosis and irregular tumors in the corpus cavernosum of the penis, leading to a diagnosis of pyelonephritis and abscess of the corpus cavernosum. The administration of antibiotics was subsequently initiated. On the seventh hospital day, a sensation of heat and swelling developed in his left knee. Pus was found in his left knee by centesis. Because pyogenic arthritis of the left knee and osteomyelitis of the left distal femur were diagnosed on MRI, continuous closed irrigation was initiated. An incision was performed in the corpus cavernosum. Staphylococcus aureus was detected in the urine, blood and pus cultures from the corpus cavernosum and knee joint. He was discharged on the 45th hospital day after making satisfactory recovery. An abscess in the corpus cavernosum is a rare condition that is difficult to cure, but proper drainage can lead to a good prognosis.