Among 21,217 type 2 diabetic patients under 75 years old and receiving pharmacological treatment from diabetes specialists for more than 3 years, there were 3.9 % whose HbA1c value at each consulting session exceeded 8.0 %, with a mean value exceeding 8.5 % in the past year (poor glycemic group). In addition, in 14.0 % of patients, every HbA1c measurement was <7.0 %, and the mean HbA1c was <6.5 % in the same period (good glycemic group). On comparing these two groups, the poor glycemic group included higher proportions of women, a family history of diabetes, complicated drug therapy, and two times more in microangiopathy and coronary heart disease. After 1 year, 39 % of patients in the poor glycemic group had improved their glycemic control (improved group). Compared with the nonimproved group, the improved group patients were three years older on average and changed the prescription to drugs with different mechanism of action or decreased dosages of the prescribed drugs. The main reasons for this improvement according to the attending physicians were the amelioration of medical compliance and patients' willingness to achieve good diabetic control. A prospective study is needed in order to elucidate the method for escaping long-term poor glycemic control.

(Purpose) The safety and efficacy of once-weekly dulaglutide (DT), were evaluated in Japanese patients with type 2 diabetes (T2DM) controlled inadequately using oral antidiabetic drugs (OADs) or insulin.

(Study design) We investigated the effect of once-weekly DT 0.75 mg over 48 weeks on glycemic control in 95 T2DM patients with inadequate glycemic control on conventional treatment. A total of 38 patients were on insulin, and 85 % of subjects were on a DPP-4 inhibitor together with metformin treatment. Concomitant OADs and insulin were not changed or uptitrated. After 48 weeks, the mean changes in the glycated hemoglobin (HbA1c) level and body mass index (BMI) were evaluated in an analysis of BMI subgroups. The incidence of adverse events was also assessed.

(Results) After 48 weeks of DT treatment, in the 95 total patients, a significant reduction in HbA1c from baseline (-1.3 %) was observed without an accompanying reduction in the BMI. The mean change from baseline in HbA1c was -1.5 % in the non-obese subgroup (<25 kg/m²) without a reduction in BMI and -1.0 % in the obese subgroup (≥25 kg/m²) with a reduction in BMI of -0.9. Gastrointestinal adverse events were relatively rare in these 95 patients.

(Conclusions) Among Japanese T2DM patients, DT administered over 48 weeks improved glycemic control in non-obese subjects without a BMI reduction as well as in obese subjects.

A 50-year-old man diagnosed with type 2 diabetes at 46 years old had poorly controlled disease, having often discontinued treatment despite having multiple complications. The patient consulted an ophthalmology/otolaryngology clinic for pain behind his eyes and was diagnosed with sinusitis and given antibiotics. As this did not improve his symptoms, he was hospitalized for a further examination and treatment. A histopathological examination of the necrotic sinus tissue sample revealed rhinocerebral mucormycosis complicated with bone marrow infiltration. The patient was subsequently started on liposomal amphotericin B and underwent drainage/necrotic tissue debridement repeatedly using a nasopharyngolaryngoscope, thereby achieving a cure. It is assumed that, devoid of any specific signs and symptoms, mucormycosis is not only often difficult to diagnose, being characterized by vascular infiltration involving thrombosis formation, it may also have a rapid clinical course and poor prognosis. Its treatment entails surgical debridement of affected tissue and the use of appropriate antibiotics. It was considered likely in this case that, given the relatively localized tissue infiltration, the treatments implemented led to effective local control of the disease, resulting in a favorable clinical course. Appropriate control of blood glucose is important for preventing the onset and worsening or symptoms of mucomycosis.

This report of a working group established by the Japan Diabetes Society proposes a new classification and diagnostic criteria for insulin resistance syndrome. Insulin resistance syndrome is defined as a condition characterized by severe attenuation of insulin action due to functional impairment of the insulin receptor or its downstream signaling molecules. This syndrome is classified into two types: genetic insulin resistance syndrome, caused by gene abnormalities, and type B insulin resistance syndrome, caused by autoantibodies to the insulin receptor. Genetic insulin resistance syndrome includes type A insulin resistance as well as Donohue and Rabson-Mendenhall syndromes, all of which are caused by abnormalities of the insulin receptor gene; conditions such as SHORT syndrome caused by abnormalities of PIK3R1, which encodes a regulatory subunit of phosphatidylinositol 3-kinase; conditions caused by abnormalities of AKT2, TBC1D4, or PRKCE; and conditions in which a causative gene has not yet been identified. Type B insulin resistance syndrome is characterized by severe impairment of insulin action due to the presence of insulin receptor autoantibodies. Cases in which hypoglycemia alone is induced by autoantibodies that stimulate insulin receptor were not included in Type B insulin resistance syndrome.