Background/Objective: Nutrition therapy is essential for continuing effective weight loss in obese patients who have undergone laparoscopic sleeve gastrectomy (LSG); however, in a clinical setting, quite a few patients have been unable to adequately execute diet therapy. To understand the barriers to accomplishing nutrition therapy after LSG in obese patients, we evaluated the caloric intake, nutritional value, and changes in the amounts and preferences of various foods. Method: The Brief-type Self-administered Diet History Questionnaire (BDHQ) was performed before LSG and 6, 12 and 18 months after in 6 obese patients with type 2 diabetes. Results: The percentage of the caloric intake loss calculated from the BDHQ at 18 months after LSG was 28.1±22.6 %. The ratios of protein and fat calories to the total caloric intake were significantly increased, whereas that of carbohydrates was significantly decreased. Of note, although the analysis of food preference shows that the intakes of rice/bread/noodles, high-fat foods and vegetables were significantly decreased, the snack intake, including both sweet and salty foods, versus the total caloric intake was not significantly changed. Conclusion: These results suggest that obese patients seem to retain skewed food preferences after undergoing LSG.

We herein report the case of a 33-year-old pregnant woman who developed fulminant type 1 diabetes mellitus. The results of a routine urine sugar test during gestation had been negative. She visited our hospital with complaints of abdominal pain and decreased fetal movement at 30 weeks and 4 days of gestation. She was admitted immediately because fetal heart rate monitoring showed severe late deceleration. On admission, her blood glucose level was 601 mg/dL, HbA1c level 5.5 %, urinary ketone bodies 4+, 24-h urine CPR (C-peptide immunoreactivity) concentration <1.1 μg/day, blood gas analysis pH 7.238, and BE−16.7 mmol/L. Flulike symptom occurred 5 days before visiting our hospital, and thirst, polydipsia, and polyuria occurred 2 days before visiting. She was diagnosed with fulminant type 1 diabetes and treated with continuous subcutaneous insulin infusion and a large amount of fluid replacement with normal saline. The treatment improved her diabetic ketoacidosis, and the fetal movements recovered. She delivered her infant naturally at 38 weeks and 2 days of gestation. Fulminant type 1 diabetes in pregnant women usually leads to a poor outcome. This case is noteworthy as a report of the successful treatment with insulin and natural delivery in a pregnant patient with fulminant type 1 diabetes.

A 43-year-old deaf woman who presented with headache and nausea was referred to our department to undergo treatment for diabetic ketoacidosis. She needed basal-bolus insulin treatment because her insulin secretory reserve was severely reduced. Mitochondrial diabetes mellitus (MDM) was suspect based on her sensorineural deafness and a maternal family history of diabetes. Because a mitochondrial DNA 3243 A>G mutation was detected in her blood leukocytes, she was diagnosed with MDM. Although there was no evidence of diabetic microangiopathy, she exhibited atrophy of both the occipital lobe of the cerebrum and cerebellum associated with an m.3243A>G mutation. Her 41-year-old younger sister was also deaf and was previously diagnosed with diabetes. The younger sister's treatment course differed in that she was treated with oral glucose-lowering agents. She also had an m.3243A>G mutation and was diagnosed with MDM. Her manifestations were differed from her sister's in that she had renal dysfunction and cardiomyopathy. The clinical manifestations in patients with mitochondrial disease vary because heteroplasmy levels of m.3243A>G mutation are divergent in organs and tissues. We report sibling cases of MDM that presented with distinct clinical manifestations.

We herein report a 77-year-old female diabetes mellitus patient with insulin antibodies. The patient was diagnosed with diabetes mellitus at 62 years of age and had been receiving oral glucose-lowering drugs following short-term insulin therapy. At 74 years of age, her HbA1c level was 9.1 %, and insulin therapy with insulin glargine was introduced, although she had high titers of insulin antibody (binding rate: over 90 %). At 75 years of age, due to fasting hypoglycemia, her insulin began to be reduced, and insulin therapy was stopped completely 2 years later. Three months after the cessation of this therapy, she continued to show fasting hypoglycemia, possibly due to her insulin antibodies (binding rate at this point: 84 %). We administered steroid therapy along with double-filtration plasmapheresis, and her fasting hypoglycemia episodes disappeared. A series of Scatchard analyses showed a decrease in the antibody affinity and an increase in the insulin binding capacity, indicating that an insulin analogue may change the characteristics of insulin antibodies.

Members of the Japanese Society of Physical Therapy for Diabetes Mellitus (n=4680) were surveyed to investigate the actual involvement of physical therapists in the treatment of patients with diabetic nephropathy (hereinafter, nephropathy) (recovery rate: 30.3 %). The proportion of physical therapists who indicated that they provided physical therapy for patients with nephropathy was as low as 39.4 %. The main reasons as to why they were not involved in the treatment of patients with nephropathy were that physical therapy was not prescribed by a physician, or that they had no patients with nephropathy. Considering that exercise is rarely recommended for patients with nephropathy, it was suggested that physicians would prescribe exercise therapy in very few cases. Twenty-four physical therapists involved in the treatment of nephropathy answered that they participated in a treatment team where the medical fee for the instruction to prevent dialysis in patients with diabetes was calculated. Among them, 7 answered that physical therapy was included in the additional medical charges for exercise instructions in patients with renal failure, a new medical fee category established in FY2016. Based on the survey results, evidence on the utility of physical therapy was be accumulated in order to increase physical therapists' opportunities to participate in team-based medical care to prevent dialysis.