The present study evaluated the changes in cost for diabetes care by the initiation of treatment with the once-weekly GLP-1 receptor agonist dulaglutide. Seventy-four patients with type 2 diabetes who started dulaglutide (0.75 mg/week) were retrospectively analyzed. In patients treated with injectable drugs at the initiation of dulaglutide, the median increase in self-paid cost was 1,704, 564, and 688 JPY in patients with 30 %, 20 %, and 10 % copayments, respectively. In patients treated without injectable drugs at the initiation of dulaglutide, the median increase in self-paid cost was 7,282, 4,626, and 2,057 JPY for those with 30 %, 20 %, and 10 % copayments, respectively. In eight patients, the self-paid costs decreased significantly after the initiation of dulaglutide, and the proportion of GLP-1RA usage at the initiation of dulaglutide in these patients was significantly higher than that in other patients. A multivariate analysis revealed that the usage of other GLP-1 receptor agonists or insulin at the initiation of dulaglutide and the HbA1c value were negatively correlated with the change in self-paid cost, while the duration of diabetes was positively correlated.

A self-administered survey of patients with type 2 diabetes, who were at least 40 years of age and who were on medication was conducted via the internet. The questionnaire investigated the respondents' knowledge levels regarding diet therapy, experience of nutritional counseling, and educational hospitalization, and included select clinical or sociodemographic items. In total, 553 responses were collected. The level of knowledge on diet therapy - which was assessed via 20 items - was generally high; however, responses indicated a lack of knowledge regarding the required quantity of vegetables, and a misunderstanding of carbohydrate restriction. Approximately 40 % of respondents had experienced nutritional counseling. Almost half of the respondents visited hospitals or specialist clinics, with the remaining half having visited general practitioners. A lower percentage of nutritional counseling experience was observed among patients who received treatment from general practitioners in comparison to those who received treatment at a hospital or specialist clinic. In the logistic regression analysis, with control status - which consists of body weight and blood glucose - as a dependent variable, nutritional counseling experience was not a significant independent variable. Conversely, age, educational hospitalization, night work, and understanding of the differences between calories and carbohydrates were found to be associated with the risk of poor control of body weight and blood glucose.

We performed a randomized crossover trial to investigate the effects of ingesting vegetables before or after a mixed meal and a mixed meal alone on postprandial interstitial fluid glucose levels in patients with type 2 diabetes mellitus, using flash glucose monitoring (FGM). When vegetables were ingested before a mixed meal, interstitial fluid glucose levels were significantly lower at 40-90 minutes after the start of ingestion, and the glucose incremental area under the curve (IAUC) values from 0 to 60, 90, and 120 minutes were significantly lower in comparison to when vegetables were consumed after a mixed meal (p< 0.05). In addition, glucose levels were also significantly lower at 40 and 55-70 minutes after the start of ingestion, and the IAUC from 0-90 minutes was significantly lower, in comparison to when a mixed meal was ingested alone (p< 0.05). However, there was no difference in the postprandial interstitial fluid glucose levels when vegetables were consumed after a mixed meal in comparison to when a mixed meal was consumed alone. In conclusion, our results suggest that when patients with type 2 diabetes mellitus eat a mixed meal, ingesting vegetables before the mixed meal may suppress the elevation of postprandial blood glucose levels.

We recently introduced a fundus examination system in which photos and optical coherence tomographs without pupil dilatation are taken at an internal medicine clinic and then assessed by an ophthalmologist on a cloud computing service. The system has been used for diabetic patients presenting for initial consultations and for returning patients who are reluctant to visit an ophthalmologist. A total of 277 patients were included in the system evaluation, including 122 initial patients and 155 returning patients. The mean disease duration was 7.5±8.2 years. The mean HbA1c level was 8.0 %±2.1 %. Ocular findings were present in 35.7 % of all patients, 29.0 % of initial patients, and 45.1 % of returning patients. The conditions observed in these patients included retinopathy (9.0 %), macular edema (3.6 %), glaucoma (20.2 %), and cataracts (3.2 %). More than 90 % of the returning patients with ocular findings subsequently consulted with the ophthalmologist. This system has several advantages. For example, internists can quickly identify urgent ophthalmic diseases and make referrals to ophthalmologists. Furthermore, this approach enables a fundus examination to be performed in patients who are reluctant to visit an ophthalmologist. The evaluation results may encourage patients to visit an ophthalmologist. Future collaboration between internists and ophthalmologists may facilitate the early detection of diabetes-related ocular diseases.

The diabetes educational card system (CS) is a tool that aims to homogenize and improve the quality of treatment guidance. The introduction of the CS into a diabetes educational hospitalization program in the mixed ward of an acute care hospital significantly increased both the ward nurses' awareness of diabetes education and the number of nursing records (p=0.005). After the introduction of the CS, a comparison of problem areas in diabetes (PAID), the self-efficacy scale for diabetes self-care (SESD), and the exercise self-efficacy scale for diabetes self-care (ESESD) at hospital admission and discharge revealed a significant decrease in PAID scores (p<0.001) and significant increases in SESD and ESESD scores (both p<0.001), as well as before the introduction of CS. However, no significant differences were seen in the degree of change (total score at discharge - total score at admission) in the PAID, SESD, and ESESD scores during hospitalization before and after the introduction of CS. These findings suggest that the introduction of the CS could help to improve diabetes education and maintain both the quality of nursing education and the psychological aspects of hospitalization, even in environments with limited specialized staff, such as mixed wards in acute care hospitals.

We examined the relationship between outpatient medical costs and changes in body weight in 105 obese patients (BMI >25.0 kg/m²) with type 2 diabetes without diabetic macroangiopathies, GLP-1 receptor agonist use or SGLT2 inhibitor use for 5 years from 2008. The outpatient medical cost significantly increased in the weight-loss group (n=56), from an average of 323,000 yen/year to 369,000 yen/year as well as in the weight-gain group, from 356,000 yen/year to 473,000 yen/year. However, the change (46,000 yen/year vs. 117,000 yen/year) was significantly lower in the weight-loss group than in the weight-gain group. Furthermore, in the weight-loss group, the HbA1c value did not worsen, and the number of prescribed drugs for lifestyle-related diseases did not increase, in contrast to the weight-gain group. The change in outpatient medical cost was significantly correlated with the change in the number of drugs being administered for lifestyle-related diseases. These results suggest that non-pharmaceutical weight loss in obese patients with type 2 diabetes may suppress the increase in medical costs via an absence of deterioration in glycemic control and no increase in numbers of prescribed drugs.