We surveyed the interests in diabetes nursing and medical expenses as well as the degree of recognition of medical treatment fees for diabetes nursing (home care guidance, diabetic complications management, and diabetic dialysis prevention guidance management) in 224 outpatient nurses. We found that the awareness of medical expenses was higher among nurses working in hospitals with more than 200 beds with diabetes outpatient clinics or diabetologists than among others. Furthermore, the degree of recognition of diabetic dialysis prevention guidance management was lower among locum nurses of the internal medicine and those working at hospitals which claim diabetic complications management and diabetic dialysis prevention guidance management fees than among others.

Acute-onset type 1 diabetes is a subtype of type 1 diabetes in which the process of beta cell destruction and subsequent hyperglycemia and ketoacidosis develop within approximately 3 months. Acute-onset type 1 diabetes patients are positive for at least one of islet cell autoantibodies. A 67-year-old Japanese man who had shown an HbA1c value of 5.7 % two months previously developed polyuria, polydipsia, and appetite loss two days after a seasonal influenza vaccination and lost 6 kg body weight during the initial week after the vaccination. His serum levels of pancreatic exocrine enzymes were elevated. The patient was negative for serum glutamic acid decarboxylase (GAD) antibody, insulinoma-associated antigen-2 (IA-2) antibody and insulin antibody, but positive for zinc transporter 8 (ZnT8) antibody (22.8 U/mL). HLA phenotyping revealed the specific HLA haplotype (DQB1*06:01:01- DQB1*06:02:01), which was previously found to be negatively associated with acute-onset type 1 diabetes. Despite the abrupt onset of hyperglycemia mimicking fulminant type 1 diabetes, he did not ultimately progress into complete impairment of insulin secretion and it was also atypical as acute-onset type 1 diabetes. A seasonal influenza vaccination may have triggered the development of autoimmune type 1 diabetes.

A 65-year-old man with slowly progressive type 1 diabetes mellitus (DM) was hospitalized with diabetic ketoacidosis (DKA). He underwent 19 hours of insulin therapy and hydration, and had no chest pain. However, electrocardiography (ECG) revealed ST elevation in leads I-III, aV_F, V₅ and V₆. His serum creatine phosphokinase rapidly increased to 1,983 U/L and he was positive for troponin T. Coronary angiography (CAG) revealed diffuse hypokinesis of the left ventricle without coronary artery stenosis. The patient was finally diagnosed with asymptomatic myocardial damage due to viral infection and his serum phosphorus level rapidly fluctuated during treatment for DKA. We should pay attention to myocardial damage in patients without symptoms at the beginning of DKA treatment.

An 81-year-old woman was treated for ulcerative colitis at the Department of Gastroenterology of Kawanishi City Hospital. Because her HbA1c measured by standard-mode (SM)-high-performance liquid chromatography (HPLC) method (G8) showed a maximum value of 11.4 %, she was referred to our department for detailed examinations of high HbA1c levels. Since her randomly measured plasma glucose was 143 mg/dL and glycated albumin was 16.7 %, there was a discrepancy between these results and the HbA1c level. Based on the results of a 75-g oral glucose tolerance test, she was diagnosed with mild diabetes mellitus. All HbA1c levels measured with the SM-HPLC method (HA-8180), immunoassay, enzymatic assay and affinity assay were between 6.3 % and 6.5 %. The fraction of labile HbA1c (LA1c+) in HPLC (G8) was also quite high, at 4.2 % (reference range 1.7 %-2.7 %). Therefore, we suspected her of having variant hemoglobin and analyzed the globin gene. Consequently, we found a heterozygous mutation of the α₂-globin chain and diagnosed her with Hb Prato (α₂ 31Arg→Ser). There are three case reports of Hb Prato, and this is the first case with HbA1c measurement. Hb Prato is a rare variant hemoglobin characterized by the HbA1c levels measured on HPLC differing depending on the model used, showing falsely high or true values.