The purpose of this retrospective observational study is to analyze the clinical course of sensor augmented pump (SAP) therapy after switching from insulin pump therapy and to evaluate the predictors of the therapeutic effects of SAP therapy. Twenty-two type 1 diabetes patients who received SAP therapy for more than one year after switching from insulin pump therapy were enrolled. HbA1c levels were unchanged at 6 months and significantly improved at 12 months. The HbA1c levels at 6 months were decreased in 14 patients and unchanged or increased in the other 8 patients. In the latter group with unchanged or increased HbA1c levels at 6 months, the mean HbA1c level at the induction of SAP therapy was significantly lower and the percentage of patients with SMBG <70mg/dL before SAP therapy was higher in comparison to the former group. A multiple regression analysis showed a significant negative correlation between the change in %TBD (6M) and the change in the HbA1c level (6M). Conclusively, in patients with frequent hypoglycemia, we should evaluate the therapeutic effects based on various parameters, such as average sensor glucose levels and AUC <70mg/dL, since it is possible that the HbA1c level may transiently increase after the induction of SAP therapy in such cases.

Recent studies have shown that sodium-glucose cotransporter-2 (SGLT2) inhibitors improve the hepatic function in patients with type 2 diabetes. However, the effects of SGLT2 inhibitors on indicators of liver fibrosis are unclear. We retrospectively investigated the effects of SGLT2 inhibitors on the hepatic function and fibrosis-4 (FIB4) index, a noninvasive indicator of liver fibrosis, in 138 patients with type 2 diabetes who started treatment with SGLT2 inhibitors and were able to be followed for 6 months. Although the hepatic function, based on levels of aspartate transaminase, alanine transaminase (ALT), and γ-glutamyltransferase, significantly improved over the study period (p<0.005), the FIB4 index had not significantly improved after 6 months of SGLT2 inhibitor treatment. In contrast, among patients with high ALT levels (≥36 U/L at baseline), the FIB4 index showed significant improvement (p=0.008). These findings suggest that SGLT2 inhibitors may be useful for improving indicators of liver fibrosis in patients with type 2 diabetes and liver dysfunction.

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome is an acute-onset rheumatic disease in the elderly characterized by pitting edema and arthralgia of the extremities. RS3PE syndrome has been reported as an adverse effect of DPP-4 inhibitors, which are used to treat type 2 diabetes; however, the details regarding this relationship are unclear. We herein report 6 cases of RS3PE syndrome associated with DPP-4 inhibitors (sitagliptin [n=3], vildagliptin [n=2], linagliptin [n=1]). Two patients were being treated for other autoimmune diseases, one experienced exacerbation of RS3PE syndrome, and the other three had family members with autoimmune diseases. Interestingly, two patients had taken other kinds of DPP-4 inhibitors before they took the agent suspected of causing RS3PE syndrome. One patient developed RS3PE syndrome after increasing sitagliptin dose. The symptoms improved rapidly after the cessation of DPP-4 inhibitors in all patients, although two showed a marked inflammatory response and required an additional dose or up-titration of prednisolone. We suspect that a history of autoimmune disease in a patient or their family is a risk factor of developing RS3PE syndrome while under DPP-4 inhibitor treatment. In addition, our findings suggest that RS3PE syndrome with DPP-4 inhibitor therapy may be induced by some immunological change in a patient and in a dose-dependent manner.

The Japan Diabetes Society's Committee to Promote Female Diabetologists conducted a questionnaire survey from May to June 2017 to investigate the work style and living situation of diabetologists. The survey targeted 5,298 diabetologists, with answers obtained from 1,566 diabetologists (male, n=1,003; female, n=563). Ninety-four percent of the males and 72 % of the females worked full-time. Twenty-one percent of the male subjects and 7 % of the female subjects served as heads of clinical departments. Twenty-three percent of the male subjects and 13 % of the female subjects were diabetes training instructors, showing that there were fewer women than men in both roles. Regarding the allocation of time per day, men spent 10.7 hours working, while women spent 8.5 hours working. Both men and women slept for 6.3 hours. Men spent 1.0 hour on housework, while women spent 3.3 hours on housework. Men spent 0.7 hours on childcare and nursing care, while women spent 2.8 hours. Among diabetologists in the childrearing generation, men spent 1.4 hours providing childcare and nursing care, while women spent 4.9 hours, showing that women spent significantly more time on these tasks than men. To encourage female diabetologists to work more actively, to reduce overworking on the part of male diabetologists, and to enhance the careers of both men and women as diabetologists, we conclude that it is necessary to improve the workplace environment and for the Japan Diabetes Society to offer support.