Objective Small dense (sd) LDL and LDL triglycerides (TG) are potent risk markers of atherosclerotic cardiovascular disease (ASCVD). GLP-1 receptor agonists (RAs) have been reported to reduce the incidence of ASCVD; therefore, we investigated the effect of oral semaglutide on LDL subfractions. Methods In total, 107 patients treated with oral semaglutide were analyzed. Among them, 87 patients were treated with DPP-4 inhibitors prior to the administration of oral semaglutide, while 20 patients were treated with other medications without DPP-4 inhibitors. The numbers of patients taking semaglutide at doses of 3, 7, and 14 mg were 28, 71, and 8, respectively. The sdLDL-C and LDL-TG levels were measured using a direct quantification method. Results. Most patients were relatively young and obese, with an age of 50±13 years and a BMI of 29±6 kg/m². The administration of semaglutide decreased HbA1c from 7.9 to 7.5 % and body weight from 76.4 to 74.9 kg. sdLDL-C decreased from 32.4 to 28.6 mg/dL and LDL-TG from 15.6 to 14.7 mg/dL. The LDL-C, TG, and HbA1c levels also decreased. The semaglutide dosage and administration method did not affect lipid changes (Δ). ΔsdLDL-C was positively correlated with ΔLDL-C, ΔTG, and ΔHbA1c, whereas ΔLDL-TG was only correlated with ΔHbA1c. Conclusions Oral semaglutide lowered overall LDL and its subfractions, which may contribute to the suppression of ASCVD.

We conducted a questionnaire survey on the changes in anxiety/fear, sleep, exercise, and eating habits, as well as the social determinants of health (SDH) regarding economic circumstances and social isolation, in patients with diabetes being treated on an outpatient basis, which provide free/low-cost medical system, in Osaka during the COVID-19 emergency Free/Low-cost Medical Service is an enterprise that provides appropriate medical services for free or at with a low cost for those who migh not usually be afford it. The effects of the above on the HbA1c value and body weight were investigated. Analyses were conducted among 705 patients in the first survey (June-August 2020) and 632 in the second survey (September-October 2021). Over time, feelings of anxiety/fear increased (first survey 75.3 %, second survey 72.2 %), the frequency of exercise and going out decreased (first survey 76.9 %, second survey 76.2 %), and conversations with other people decreased (first survey 41.3 %, second survey 53.1 %) Compared to before the state of emergency declared. No significant differences were seen in HbA1c values, while the body weight decreased significantly over time (p<0.01). Among patients under 60 years old and those receiving free/low-cost medical service, a significantly greater percentage experienced economic hardship than others (p<0.01). During the COVID-19 pandemic, medical care should be provided with consideration of socioeconomic circumstances.

A 66-year-old man had been treated with nivolumab and ipilimumab for non-squamous cell carcinoma of the lung since May X−1. In October Y−7, X, his blood glucose level and blood C-peptide were 147 mg/dL and 1.76 ng/mL, respectively. In October Y, he visited the emergency room with complaints of dry mouth, polydipsia, nausea, and decreased appetite. His blood glucose level and blood C-peptide were 1,684 mg/dL and 0.09 ng/mL, respectively, and he had ketoacidosis, which was diagnosed as diabetic ketoacidosis due to fulminant type 1 diabetes associated with immune checkpoint inhibitors. This case is unique in that the onset of DKA occurred 17 months after administration. The insulin secretory capacity was maintained one week before the onset of the disease, and it was confirmed that this capacity decreased rapidly. Based on this experience, we held a case conference, revised the in-hospital algorithm for immune-related adverse events, prepared a manual for reverse engineering, conducted educational activities for patients, and shared the information with physicians. We report the activities of our hospital in this study.

The patient was a 49-year-old man who had weighed 85 kg at 20 years old, with his weight increasing to a maximum of 160 kg in his 40s. He was diagnosed with glucose intolerance in X-4 during a health checkup. In X-3, he was diagnosed as diabetic with an HbA1c of 8.5 % and started on intensive insulin therapy. The treatment was subsequently changed to dapagliflozin 5 mg/day, metformin 500 mg/day and dulaglutide 0.75 mg/week. The HbA1c value was stable at around 6.0 %, but the patient had hypertension and other complications and was referred to our metabolic surgery clinic in X-1. A preoperative examination revealed a high anti-GAD antibody level of 143 IU/mL (via an enzyme-linked immunosorbent assay) and a diagnosis of slowly progressive insulin-dependent diabetes mellitus (SPIDDM) based on his clinical history. After hospitalization for weight loss, he underwent laparoscopic sleeve gastrectomy (LSG). Nine months after surgery, insulin secretion was still preserved on the glucagon tolerance test, with a ΔCPR of 4.72 ng/mL (previous value: 2.06 ng/mL). This is the first report of LSG in a patient with SPIDDM with a relatively high titer of anti-GAD antibodies and disease duration of <10 years in Japan and is considered a valuable case.

In Japan, the Classification (or Staging) of Diabetic Nephropathy revised in 2014 has been widely used. Since 2022, the Joint Committee on Diabetic Nephropathy has discussed the need to revisit the staging due to the diverse kidney phenotype in individuals with diabetes against the background of aging of the population, an increase in obese individuals, and the development of new therapeutic agents for diabetes and hypertension. As of now, no new evidence has been presented that suggest the necessity of changing the basic framework of the 2014 staging, which was based on the levels of albuminuria and estimated glomerular filtration rate. Therefore, the Committee has decided not to alter the fundamental structure of the 2014 staging. However, with a focus on maintaining consistency with the CKD classification by the Japanese Society for Nephrology and international notation, the former stages have been renamed as follows: "normal albuminuria (stage 1) ", "microalbuminuria (stage 2) ", "macroalbuminuria (stage 3) ", "severely decreased GFR/end-stage kidney disease (stage 4) ", and "kidney replacement therapy (stage 5) ".