We investigated the current dementia status using the MMSE in 343 patients with type 2 diabetes mellitus who were ≥65 years of age and being treated on an outpatient basis. We compared the characteristics between patients with a score of ≥28 points (suggesting no cognitive impairment) (Group A, n=126), those with a score of > 23 to < 28 points (suggesting mild cognitive impairment) (Group B, n=175), and those with a score of ≤23 points (suggesting cognitive impairment) (Group C, n=42). The comparison of groups A, B, and C, revealed significant differences in age, BMI, diastolic blood pressure, cerebrovascular disease, sarcopenia, diabetic neuropathy, PDR, HDS-R, clock drawing, latest news, Hb, TP, Alb, and HbA1c. A multiple regression analysis with the MMSE score as the objective variable revealed significant differences in age, diastolic blood pressure, PDR, clock drawing, and latest news. Cognitive function tests, as well as early detection and early treatment intervention were thought to have a preventive effect against the development of severe diabetes and cognitive dysfunction.

We investigated discontinued cases in the community network path for diabetes care, which included 348 patients with type 2 diabetes, in Tonami General Hospital for 3.7 ± 0.4 years. The continuation rates were 70.7 %, 54.3 %, 44.8 %, and 36.7 % after 1, 2, 3, and 4 years, respectively, and did not differ markedly across age groups. The reasons for discontinuation were blood glucose deterioration and interruption of visits to our hospital for patients below 65 years of age, blood glucose deterioration and cancer for those between 65 and 74 years of age, and no hope of the path, cancer, and fractures for those 75 years of age and older. Cases with blood glucose deterioration, no hope of the path, and cancer had higher HbA1c levels, more frequently had the concomitant use of sulfonyl urea drug, and had a longer disease duration (except for cases of cancer) than continued cases did. Cases with interruption of visits to our hospital had a shorter disease duration than continued cases. Thus, it is necessary to consider the continuation and termination of the path in changes of age or various conditions in the community network path.

A 54-year-old woman with rheumatoid arthritis and Hashimoto thyroiditis presented with type 1 diabetes in 2015 due to low serum C-peptide level; therefore, she was diagnosed with autoimmune polyglandular syndrome type 3 (APS3). After a seizure in 2017, she had difficulty walking and decreased memory capacity. A cerebrospinal fluid test revealed an increased number of cells. Brain magnetic resonance imaging also indicated a high fluid-attenuated inversion recovery signal in the left valve lid. She was diagnosed with autoimmune encephalitis. Steroid pulse therapy improved the symptoms of the autoimmune encephalitis. Interestingly, HLA Class II genotyping revealed a common protective HLA allele for Japanese type 1 diabetes. Furthermore, she had a specific antibody for autoimmune encephalitis. By referencing previous reports about clinical characteristics of APS in Japan, we discuss the mechanism of APS3. The combination of APS3 and autoimmune encephalitis is extremely rare, and to our knowledge, this is the first known case among Japanese patients.

Two patients with acute-onset type 1 diabetes mellitus complicated with diabetic ketoacidosis were admitted to our hospital. Their pancreatic amylase levels were elevated, so abdominal magnetic resonance imaging (MRI) was performed. Diffusion-weighted imaging showed pancreatic high signal intensity and low values for the apparent diffusion coefficient of the pancreases. These MRI findings have been reported to be characteristic of fulminant type 1 diabetes mellitus, but as our cases indicate, they may also be seen in cases of acute-onset type 1 diabetes mellitus with elevated serum pancreatic enzyme levels.