Increased and widespread psychological support should be given to people with diabetes in Japan. This study aims to review the case studies on psychological support for people with diabetes to understand the characteristics of support and present prospects for future research. The study targeted 84 case studies on psychological support for people with diabetes after an article search. The following categories were generated according to the contents of the articles: (1) research on the relationship between diabetes and other diseases/disorders or comorbidities and psychological support; (2) research focusing on the process of change in people with diabetes as a result of psychological support; (3) research demonstrating the effectiveness of psychological support techniques; (4) research on the relationship between people with diabetes and the people around them (i. e., medical personnel or family members); and (5) research on understanding the mind of people with diabetes. This study reports the characteristics of the research thus far, as well as the prospects for each category. This study finds that research that aims to deepen the understanding of people with diabetes is required and that research perspectives should not be limited to treatment.

We collected HbA1c values and patient clinical information in the Hamamatsu area to investigate the state of diabetic treatment in October 2012. Since that time, several new drugs have been introduced, and target HbA1c values have been proposed. For comparison with 2012 another investigation was performed in October 2019. Study 1: HbA1c in outpatients. In comparison to 2012, the average HbA1c in general clinics was 6.87 % higher, while that in specialized clinics and hospitals was 7.15 % lower. Study 2: Clinical information of type 2 diabetes patients with HbA1c ≥8 %. In comparison to 2012, the average age was 4 years older in general clinics and 2 years older in specialized clinics and hospitals. In both institutions BMI decreased with aging. Similarly to 2012, patients in the higher HbA1c group were younger and had higher BMI values. In specialized clinics and hospitals, insulin therapy decreased. In both institutions the prescription of sulfonylurea decreased. Therapy with dipeptidyl-peptidase 4 inhibitors, sodium/glucose cotransporter 2 inhibitors, and glucagon-like peptide-1 receptor agonists increased in both institutions. These drug therapy changes can be expected to prevent vascular complications without increasing hypoglycemia or weight gain. The treatment of obese diabetes in younger patients, and the prevention of frailty in elderly patients are future issues.

We investigated the association between depression and barriers to medication adherence in diabetic patients of ≥65 years of age. Depression was assessed using the Japanese version of the Patient Health Questionnaire-9, and adherence to medication was assessed using the Adherence Starts with Knowledge-20 (ASK-20). Adjusted odds ratios (ORs) of depression for barriers to medication adherence were calculated. A total of 195 cases were analyzed. Among the items of the ASK-20, the adjusted ORs of depression for medication forgetfulness, anxiety about the impact on sex life, and barriers to medication adherence were 2.90 [95 % confidence interval (95 %CI) =1.190-7.060], 23.70 (95 %CI=1.450-389.0), and 3.780 (95 %CI=1.340-10.70). In elderly diabetic patients, depression was significantly associated with barriers to medication adherence.

The patient was a 65-year-old female with a history of diabetic ketoacidosis that was diagnosed at 51 years of age. She underwent therapy with insulin that was later discontinued because of frequent episodes of hypoglycemia. She consulted the Emergency Department of our institution with a 1-week history of general malaise and dizziness with body weight loss of 12 kg during 5 years. She was diagnosed with diabetic ketosis based on the following findings: plasma glucose 577 mg/dL, urinary ketone 4+, and blood gas analysis with pH 7.377. Chest CT showed diffuse small nodular shadows and consolidation in the right lung area. Swallowing video fluorography revealed micro-aspiration in the airways. These findings suggested the diagnosis of diffuse aspiration bronchiolitis. Additional studies revealed a reduction of grip strength, walking speed, and skeletal muscle mass, indicating complication with severe sarcopenia. Our clinical interpretation was that diabetes mellitus-associated sarcopenia predisposed the patient to airway micro-aspiration, ultimately causing diffuse aspiration bronchiolitis. The diagnosis of diffuse aspiration bronchiolitis was based on chronic silent micro-aspiration and characteristic pulmonary abnormalities on chest CT. This case underscores the importance of considering pneumonia caused by silent aspiration when we examine diabetic patients with severe sarcopenia in clinical practice.