We assessed the prevalence and role of abnormal glucose tolerance in subacute stroke patients with undiagnosed diabetes mellitus (DM). An oral glucose tolerance test was performed for 132 post-stroke patients in a rehabilitation ward, and 19.7 % of them were newly diagnosed with DM, while 44.7 % had impaired glucose tolerance (IGT), and 35.6 % had normal glucose tolerance (NGT). The clinical features were compared between the non-diabetic group, consisting of patients with NGT or IGT, and the diabetic group. The age, body mass index, renal function, and intima-media thickness of the carotid artery did not substantially differ between the two groups. Greater proportions of the diabetic group had hypertension and dyslipidemia than the non-diabetic group. The fasting blood glucose (FBG), 2-hour post-meal blood glucose (2hBG), C-peptide immunoreactivity, HbA1c and carotid artery plaque area were all significantly higher in the diabetic group. In cases presenting with FBG, 2hBG or HbA1c levels that are more than 101 mg/dL, 124 mg/dL, 6.1 %, respectively, a 75gOGTT would therefore be useful to detect DM cased that have previously remained undiagnosed.

The Aozora Pharmacy conducted a study on the relationship between the rate of self-coverage of medical costs and the treatment outcomes in type-2 diabetes patients. A group of patients who received discounted or free-of-charge services from a hospital, which excluded members of the government's social security program (Mutei group; n=60) was compared to a group of patients who did not receive discounted or free-of-charge services (Non-mutei group n=931). Significant differences were observed in the HbA1c (%) (Mutei group: 7.5±1.5, Non-mutei group: 7.0±1.0, p<0.05) and BMI (kg/m²) values (Mutei group: 26.8±4.8, Non-mutei group: 25.0±4.7, p<0.05). The results also showed that the use of insulin or GLP-1 receptor agonists (Odds ratio: 4.3, p<0.001) was significantly higher in the Mutei Group. It was suggested that the patients in the Mutei Group were likely to be in a situation in which they required sophisticated treatment due to high blood sugar levels, but were unable to afford to make lifestyle improvements due to financial difficulties.

It is necessary for pharmacists to be fully aware of the social environment of patients when providing assistance in relation to medication or pharmaceutical control for diabetes.

Invasive fungal rhinosinusitis often influences the symptoms of orbital apex syndrome (OAS) and induces the development of severe infections in patients with a decreased immune function. An 84-year-old man with diabetes mellitus was being treated with oral hypoglycemic agents, and his HbA1c was 8.4 %. His initial presenting symptoms were right-side headache and visual impairment in the right eye. He was diagnosed with invasive sphenoid fungal sinusitis with OAS and treated with endoscopic sinus surgery. Cultures revealed an infection of Aspergillus fumigatus. Despite treatment with oral voriconazole and insulin injection therapy, he developed cardiac failure and died. An autopsy found normal tissue around the orbital portion of the bilateral optic nerve, and Aspergillus was detected around the bone of the basal skull and the optic chiasm, frontal lobe of the brain, and the wall of the anterior communicating arterial aneurysm. When diabetic patients complain of visual loss or headache, physicians should remember to start empiric therapy and clearly distinguish invasive fungal rhinosinusitis from OAS, which has a very poor prognosis.