There are few intervention studies focusing on the intake of a specific food rather than appropriate energy and nutrients as diet therapy for improving lifestyle-related diseases. The aim of this study was to examine the effects of dietary changes on risk factors for lifestyle-related diseases during a diet and exercise intervention program. This study was conducted for 5 months in 127 middle-aged women. We conducted a multiple regression analysis using risk factors for lifestyle-related diseases as the target variables and the dietary changes as the explanatory variables. As a result, the percent body fat was significantly associated with the intake of mushrooms and seaweed as well as green/yellow vegetables, and the arteriosclerotic index was significantly associated with the intake of plain-colored vegetables. The intake of mushrooms and seaweed, green/yellow vegetables, and plain-colored vegetables was significantly associated with the intake of fiber. These results show increasing the intake of mushrooms and seaweed, green/yellow vegetables, and plain-colored vegetables may improve the risk of lifestyle-related diseases.

A 38-year-old man was admitted to our hospital to undergo treatment for diabetes, nephrotic syndrome, hypokalemia and hypertension. He had been diagnosed with type 2 diabetes 11 years previously, and his glucose control had been poor. Four years previously, he was normotensive and showed trace levels of urinary albumin excretion and a normal serum potassium concentration. On admission, he showed metabolic alkalosis, low plasma renin activity, and low a plasma aldosterone concentration with hypertension. Because we suspected Liddle syndrome, triamterene was administered, and his hypertension and hypokalemia both improved. Our patient had no family history of hypertension, and no mutation of ENaC (amyloid-sensitive epithelial sodium channel) gene exon 13, but showed increased urinary excretion of serine protease. These findings suggested that the increased serine protease level had a similar effect to the high activation of ENaC. This case showed a similar presentation to Liddle syndrome due to nephrotic syndrome caused by diabetic nephropathy.

The patient was a 74-year-old woman with type 2 diabetes that had been diagnosed when she was 56 years of age. In early May, she visited a dermatologist due to pain in the left gluteal region, but the antibiotics that she was prescribed did not alleviate this symptom. She had been taking dapagliflozin since mid-October of the previous year. In mid-May, she was discovered after a fall and was transferred to our hospital. Her body temperature was 38.6 °C. Severe inflammation was evident from redness in the region of the left side of the anus and perineum, a white blood cell count of 17200 /μL, and a C-reactive protein level of 29.7 mg/mL. A finding of gas within the subcutaneous fat on the left perineum on computed tomography led to a diagnosis of Fournier's gangrene (FG), and the patient was subsequently transferred to the Department of Dermatology at Oita University. Emergency incision and debridement with multidisciplinary therapy saved her life. In August 2018, the US Food and Drug Administration issued safety information about an increased risk of FG in patients on SGLT2 inhibitors (SGLT2i). We encountered a patient who developed FG while on an SGLT2i and report this case as a warning about the use of SGLT2i.

Case 1 involved a 69-year-old man with prostate cancer with bone metastasis. Abiraterone acetate/steroid combination therapy was started, after which the patient noticed symptoms of hyperglycosemia. Within 1 month, he was hospitalized due to a glycated hemoglobin (HbA1c) level of 8.5 % and a random blood glucose level that had worsened to 400 mg/dL. Case 2 involved an 82-year-old man in whom abiraterone acetate/steroid combination therapy had been started after anti-androgen therapy proved ineffective for prostate cancer. During treatment, his glucose tolerance was not evaluated; he therefore had no subjective symptoms. He was hospitalized for ketosis and an HbA1c level of 9.5 % identified during a checkup performed 9 months after starting the medication. Although no significant decrease in the endogenous insulin level was observed in either case, insulin treatment and glucagon-like peptide 1 (GLP-1) receptor agonist combination were used to correct the hyperglycemia. Abiraterone acetate became available for the treatment of prostate cancer in Japan in 2014. Its use in combination with steroids requires caution due to the risk of exacerbation. We experienced two cases with impaired glucose tolerance after the initiation of treatment and report the situation of their use in our hospital with a review of the literature.

A 96-year old woman receiving linagliptin and insulin glargine for type 2 diabetes mellitus at a nearby hospital developed bullous pemphigoid and visited our hospital. She exhibited plasma glucose elevation, but her HbA1c level was only 3.7 %. Based on the detection of macrocytic normochromic anemia, indirect bilirubin-dominant hyperbilirubinemia, reticulocytosis, hypohaptoglobinemia, and false-positive occult blood in urine, hemolytic anemia was suspected to have caused the low HbA1c level. Suspecting the involvement of diaphenylsulfone (DDS), a treatment for bullous pemphigoid, we discontinued this drug. This resulted in the rapid improvement of hemolysis and HbA1c elevation, strongly suggesting that the clinical findings were due to DDS administration. Reports on DDS-induced hemolytic anemia and false low HbA1c levels are rare. However, DDS may be used as a treatment for pemphigoid, with an increased risk of development with the use of dipeptidyl peptidase-4 inhibitors and sodium glucose cotransporter 2 inhibitors, which are widely used in Japan. In addition, hemolytic anemia develops at a lower dose of DDS in Japanese patients than in patients of other nationalities. Therefore, DDS use requires further caution.