We conducted a longitudinal study from 2007-2015 to identify trends in cases of severe hypoglycemia at a Japanese diabetes outpatient clinic using the Computerized Diabetes Care-Metabolic Syndrome (CoDiC-MS^®) database. There were 178 severe hypoglycemic events in 70 patients during the 9-year study period (0.8 events per 100 person-year). Thirty-seven patients (52.8 %) experienced more than 2 events. Among the 37 patients with type 1 diabetes, 13 (35.1 %) had hypoglycemia unawareness. In the 33 who had type 2 diabetes, an older age, treatment with insulin or sulfonylureas, macrovascular complications and dementia were identified as potential predictors of severe hypoglycemia. Seventy-three events (41.0 %) were caused by daily living changes in the diet or activity habits, and 41 events (23.0 %) were of unknown cause. Our results suggest that preventive behavioral approaches are necessary for high-risk patients, especially for patients with hypoglycemia unawareness.

We herein describe the case of an 83-year-old man with type 2 diabetes treated with the sodium glucose transporter-2 (SGLT2) inhibitor Ipragliflozin who developed bullous pemphigoid (BP). Five months after the administration of Ipragliflozin, he began to show pruritus multiforme, and blisters spread over the trunk of the body to the forearm. Based on the findings of a clinical examination and the presence of autoantibodies to BP antigen, BP 180, and consequently positive interferon gamma production to lymphocyte stimulation by Ipragliflozin, we confirmed the diagnosis as BP. Systemic glucocorticoid administration improved the symptoms and all skin lesions. The development of BP has not been reported in a patient receiving SGLT2 inhibitors. We herein report the first case of BP that developed following the administration of an SGLT2 inhibitor and discuss the association of BP with the administration of drugs for diabetes.

A woman was diagnosed with diabetic ketosis at 23 years of age. Her serum glutamic acid decarboxylase (GAD) antibody, insulinoma-associated antigen-2 (IA-2) antibody and insulin antibody were all negative. At 27 years of age, she was admitted for glycemic control in our hospital. Both her serum GAD antibody and IA-2 antibody were negative, but a zinc transporter 8 (ZnT8) antibody was positive (153.0 U/mL). Almost all type 1 diabetic patients are positive for GAD antibody, IA-2 antibody or insulin antibody; however, there are a few reports of type 1 diabetic patients with a single positive ZnT8 antibody. Therefore, the measurement of ZnT8 antibody should be considered when a patient has characteristics of type 1 diabetes despite GAD antibody, IA-2 antibody and insulin antibody all being negative.