We examined the relationship between a multidisciplinary individual team approach (MTA) and the hemodialysis (HD) course and prognosis after HD compared to only a dietitian approach (ODA). Sixty-nine diabetic patients with diabetic nephropathy (DN) receiving HD periodically from 2010 to 2016 were examined. The duration from a creatinine value of 2.0 mg/dL to HD induction in MTA was significantly longer than in ODA. The hemoglobin and hematocrit values, cardiothoracic ratio, hospitalization and costs were significantly better for MTA than ODA. MTA patients more frequently underwent 24-h urine collection than did ODA patients. The survival rate from baseline in MTA patients was significantly longer than in ODA patients. The MTA might have beneficial effects on the HD course and prognosis in patients with DN, since various staff members provide multiple and broad information on the present and future clinical condition as well as self-management.

A nerve conduction study (NCS) is essential for the definitive diagnosis of diabetic polyneuropathy (DPN). Baba's diabetic neuropathy classification (BDC) is an NCS-based severity classification of DPN. Although the frequency of diabetic foot and macroangiopathy is reportedly increased in patients with DPN of grade ≥2 BDC (BDC-2+), NCS has low availability. We investigated the BDC-2+detection performances of the coefficient of variation of R-R intervals and the number of positive features among sensory symptoms, diminished or absent Achilles tendon reflexes, and diminished vibration sensation, with a receiver operating characteristic analysis in 139 patients with type 2 diabetes mellitus. However, we were unable to determine useful judgement criteria. Point-of-care testing NCS on sural nerves performed in 108 patients suggested that the criteria of a compound sensory nerve action potential ≤6.5 μV and a sensory conduction velocity ≤48 m/s were able to detect BDC-2+with 100 % sensitivity and 85.7 % specificity.

We retrospectively studied the factors associated with longitudinal poor glycemic control in type 2 diabetes patients. We examined outpatients who had been in our hospital for one or more years, administered a questionnaire to their attending doctors, created the items of the cause for poor glycemic control, and performed a statistical analysis to determine the factors predicting HbA1c levels at two years. Sixty-two patients with HbA1c ≥8 % were extracted, among whom 53 had visited for 2 years. Twenty-three patients (43 %) showed improvement in their HbAlc levels at 2 years. The HbA1c levels at the start, age, and duration of hospitalization were selected as explanatory variables for the improvement of HbA1c levels after 2 years in a logistic regression analysis. Most outpatients with poor glycemic control had psychological and behavioral problems, and patients with two or more problems were significantly younger and had a poorer improvement of HbA1c than those without. Healthcare professionals should discuss methods of supporting these patients with poor glycemic control.

Impaired glucose regulation is often observed in pheochromocytoma, which is associated with both insulin resistance and defective insulin secretion. However, cases that lead to diabetic ketoacidosis (DKA) are rare. We experienced two cases of paraganglioma/pheochromocytoma that required treatment of diabetes roughly 10 years prior to the treatment of hypertension: one had paraganglioma with severe impairment of insulin secretion but without a history of ketosis, and the other developed diabetic ketosis and DKA without typical pheochromocytoma crisis, showing a ketosis-prone state. Immunohistochemical findings showed a low number of somatostatin-positive cells, and there has been no evidence of exceptional pathological features in the cases of pheochromocytoma-associated DKA reported thus far. After surgical resection, both cases showed a remarkable improvement in insulin secretion but still required insulin treatment. When a patient with diabetes showing decreased insulin secretion develops DKA with no apparent triggers, pheochromocytoma may be one of the precipitating diseases.

The subject was an 81-year-old male. He visited his local general hospital upon becoming aware of dryness of the mouth, perspiration, palpitations, and anarthria literalis while driving. Although these symptoms disappeared when he visited our department, he was hypoglycemic with a blood glucose level of 53 mg/dL from time to time. Therefore, he was referred to our department for scrutiny and treatment. With no usage history of insulin, he had hyperinsulinemia (1629 μU/mL) and HLA-DR4, in addition to being positive for insulin antibodies. He was diagnosed with insulin autoimmune syndrome (IAS). Although this patient had no history of the oral administration of drugs with an SH base, such as thiamazole and alpha lipoic acid, which are thought to be associated with the onset of IAS, he had been diagnosed with pulmonary tuberculosis at 78 years old and underwent multi-drug therapy using antituberculosis agents including isoniazid. This may affect the onset of IAS.