A subjective assessment of patients' treatment Quality of Life (QOL) is an important factor to consider when assessing the efficacy of diabetes treatment. We investigated whether or not switching from basal-bolus therapy to dulaglutide and basal insulin combination treatment improved the QOL in patients with type 2 diabetes mellitus. We utilized the Diabetes Therapy-Related QOL (DTR-QOL) questionnaire to define changes in the QOL. The DTR-QOL questionnaire were administered before switching therapy and one month after switching. A total of 11 patients were enrolled in the study. The analysis using the DTR-QOL showed that this switching therapy significantly improved the patients' "burden on social and daily activities", "anxiety and dissatisfaction with treatment" and "hypoglycemia". Switching therapy was also able to keep the HbA1c levels elevated for three months in this study. Switching from basal-bolus therapy to dulaglutide and basal insulin combination treatment improved the DTR-QOL in patients with type 2 diabetes mellitus without affecting their glycemic control.

[Aim] We performed a cross-sectional study to investigate the current status of unused medicines in subjects with lifestyle-related diseases and examined how to reduce the number of type 2 diabetes patients with unused medicines. [Methods] A questionnaire survey was conducted. The subjects were 530 patients with lifestyle-related diseases (type 2 diabetic patients, n=481; non-diabetic patients, n=49). [Results] Forty-one percent of the diabetic patients and 39 % of the non-diabetic patients reported having unused medicines. Among the diabetic patients, the subjects' age and satisfaction with treatment of the patients with unused medicines were significantly lower than those without unused medicines. Significantly higher percentages of patients with unused medicines were employed and had a high level of education in comparison to those without unused medicines. Among patients with unused medicines, fewer subjects received explanations from their pharmacists, and they more frequently felt that they were taking too many drugs in comparison to those without unused medicines (75 % vs. 83 % and 22 % vs. 34 %, respectively). In a multiple logistic regression analysis, eating-out, working and not receiving an explanation from the pharmacist were factors that were significantly associated with unused medicines. [Conclusion] Diabetes education, including drug education, may therefore help to resolve the problem of unused medicines among patients with type 2 diabetes.

The burden of payment of medical costs was investigated in 294 outpatients with lifestyle-related diseases (type 2 diabetes, n=272; non-diabetes, n=22). The annual medical and self-paid costs were significantly higher in the patients with type 2 diabetes (425,000 yen and 88,000 yen, respectively) than in those without diabetes (160,000 yen and 31,000 yen, respectively). A higher percentage of patients with type 2 diabetes (63 %) found self-payment to be a burden compared to patients without diabetes (45 %). The patients who considered self-payment to be a burden had a higher self-burden ratio of medical costs and a more frequently had a family who lived together than those who did not consider self-payment to be a burden. The percentage of patients who were satisfied with their diabetes treatment was significantly lower among the patients who considered self-payment to be a burden than among those who did not consider it to be a burden. The burden of self-payment was not associated with the amount that was paid. These findings suggest that the burden of self-payment might be associated with the future onset of vascular complications and an increase in medical costs among patients with type 2 diabetes. Increased satisfaction with treatment may help reduce the burden of self-payment and treatment interruption.

A 34-year-old man had developed psoriasis vulgaris at 25 years of age and received treatment from a dermatologist, but he discontinued the treatment because the symptoms did not improve. He was diagnosed with type 2 diabetes at 28 years of age and introduced to our hospital. He was administered sulfonylurea and DPP-4 inhibitor but had insufficient glycemic control. As obesity, fatty liver, and insulin resistance were recognized, the addition of a biguanide and SGLT2 inhibitor improved his HbA1c, and, interestingly, marked improvement of his psoriasis was also observed. Because the exacerbation of psoriasis and obesity, fatty liver, and insulin resistance are closely related, treatment that reduces visceral fat and improves fatty liver may also improve psoriasis. We herein report a case of type 2 diabetes in which psoriasis vulgaris was improved by the administration of biguanide and SGLT2 inhibitor.