(Objectives) We investigated whether the use of a smartphone personal health record (PHR) application would result in the improvement of HbA1c and body weight in patients with type 2 diabetes. (Methods) We analyzed 74 patients (65 men, 9 women) with type 2 diabetes who were treated at our clinic and who were able to use the Welby Mykarte PHR application. We measured HbA1c, body weight, and blood pressure when the patients started using the PHR application, and then monthly for 6 months. Patients were stratified according to the frequency of use of the application (<15 or ≥15 times per month). (Results) HbA1c values improved significantly, from 7.1 % at baseline to 6.9 % at 6 months in all patients. The frequent user group demonstrated a greater improvement (from 7.1 % to 6.7 %) in comparison to the less frequent user group. Both body weight and blood pressure decreased. It should be noted that of the 74 patients, 20 patients changed treatment during the observation period. (Conclusion) These data suggest that better compliance to lifestyle modifications through the use of a PHR application may bring about therapeutic effects, including improved HbA1c.

Diabetes treatment is part of primary medical care, and standardized treatment is not only useful for general practitioners (GPs) but also important for cooperative patient care with diabetologist (DTs). The Diabetes Measures Promotion Council in Kagoshima performed five consecutive seminars for GPs and their staff concerning standardized diabetes treatment in four different secondary medical areas of Kagoshima Prefecture, Japan. We assessed the outcome of the seminars based on the change in average HbA1c levels in two areas and a questionnaire administered to the participants. The effectiveness of the seminars was not proven based on the changes in HbA1c values due to methodological limitations. However, many participants stated that a flowchart concerning the standardized use of oral hypoglycemics, namely the "SDM customized Kagoshima" presented in the seminars, played a major role in the improvement of. This flowchart has been revised several times to address problems in diabetes care in Kagoshima Prefecture and is now used to facilitate cooperative patient care between GPs and diabetologist in Kagoshima City.

A 48-year-old man was admitted with dyspnea. He had been diagnosed with type 2 diabetes at 40 years of age and insulin treatment had been introduced 4 years previously. He was diagnosed with diabetes ketoacidosis (DKA) and acute interstitial pneumonia (AIP) with bilateral pulmonary shadows. Steroid pulse therapy was performed immediately from the second day of hospitalization. It was effective and the bilateral ground-glass opacities disappeared. The patient's laboratory data on admission revealed a high serum level of CEA (60.2 ng/mL); however, there was no malignancy. The patient's serum CEA level decreased to 19.6 ng/mL after steroid pulse therapy. In this case, serum CEA might have been associated with disease progression and the activity of DKA and AIP.

A 28-year-old woman (weight 134.8 kg, body mass index 46.7 kg/m²) who had been undergoing infertility treatment at another hospital for 2 years presented with type 2 diabetes (HbA1c 7.6 %) and amenorrhea due to polycystic ovary syndrome. She was referred to our hospital for weight loss to improve her fertility. Initially, she was unable to maintain her weight through diet and exercise, so her amenorrhea persisted. The next line of treatment was metabolic surgery, the efficacy and risks of which were explained to her. She opted for laparoscopic sleeve gastrectomy. In preparation for surgery, she was given comprehensive nutrition education. Over approximately 5 months, she lost 10 kg, reaching a weight of 119 kg, which allowed her to undergo surgery. Six months postoperatively, her weight had decreased to 90.1 kg, and her HbA1c was 5.0 %-5.3 %. The postoperative course was good, allowing her to resume amenorrhea treatment, which led to pregnancy and childbirth. Her glucose metabolism by 75 g OGTT was borderline before surgery but normal at 28 months postoperatively. She achieved childbirth as a result of compliance with the dietary regimen through a comprehensive understanding of the preoperative nutrition education.