Insulin treatment should be introduced for patients with slowly progressive insulin-dependent diabetes mellitus (SPIDDM) according to the revised diagnostic criteria of SPIDDM (2023). However, SPIDDM (probable) cases are in a non-insulin-dependent state, so more flexible treatment can be considered, although sulphonylurea agents should be avoided. Insulin treatment helps maintain the intrinsic insulin secretion capacity, but this does not mean that all SPIDDM (probable) cases should use insulin from the early phase. However, while DPP4 inhibitors and biguanides can be selected for treating SPIDDM (probable), no evidence yet exists concerning the efficacy of other hypoglycemic agents. Careful monitoring of the intrinsic insulin secretion capacity should therefore be performed, and if a reduction in the intrinsic insulin secretion capacity is suspected, changing the treatment should be considered in order to prevent progression to an insulin-dependent state.

We reported multiple cases of Hb A2-Niigata with δ-chain variant hemoglobin triggered by falsely high HbA1c levels measured using high-performance liquid chromatography (HPLC). We compared the HbA1c and LA1c+levels measured by HPLC (HLC-723 G9) in 5 subjects with Hb A2-Niigata with those of 50 non-diabetic and 50 diabetic controls. The HbA1c levels in subjects with Hb A2-Niigata were significantly higher than those in non-diabetic subjects, but there was no significant difference from diabetic subjects. In contrast, their LA1c+levels showed no significant difference from the non-diabetic subjects but were significantly lower than the values in diabetic subjects. The HbA1c/LA1c+ratio in subjects with Hb A2-Niigata was significantly higher than that of non-diabetic or diabetic controls. When the cutoff value of the HbA1c/LA1c+ratio was set to 3, it was possible to diagnose Hb A2-Niigata with high sensitivity and specificity. For cases where falsely high HbA1c levels are suspected, the HbA1c/LA1c+ratio is useful for first-line screening of δ-chain variant hemoglobin, Hb A2-Niigata.

A randomized crossover comparative study of tofogliflozin and empagliflozin in patients with type 2 diabetes was conducted. The primary endpoint was inter-drug differences in NT-proBNP levels, while the secondary endpoints were the inter-drug differences in laboratory test values, which are considered cardiovascular risk factors. Patients were randomly allocated to one of two groups. The tofogliflozin/empagliflozin group (n=28) initially received tofogliflozin once daily for 12 weeks, which was switched to empagliflozin once daily for 12 weeks. For the empagliflozin/tofogliflozin group (n=28), empagliflozin was administered prior to tofogliflozin, and the same regimen was maintained. No significant difference was noted between the two groups in the NT-proBNP levels or most laboratory test values. No serious side effects were noted in either group. This study suggests that the effects and safety of tofogliflozin and empagliflozin may be comparable.

Hyperuricemia involves not only overproduction of uric acid but also its decreased excretion. The urinary uric acid-to-creatinine ratio (UUA/UCr) was measured in 470 Japanese patients with type 2 diabetes as a method of evaluating urinary uric acid excretion, and the factors associated with urinary uric acid excretion were investigated. The UUA/UCr was 0.46±0.18, and the patient background characteristics associated with a decreased UUA/UCr were male sex, a reduced estimated glomerular filtration rate, and the use of urate synthesis inhibitors. The UUA/UCr was significantly lower in the group with hyperuricemia and no use of urate synthesis inhibitors (0.44±0.16) and the group with hyperuricemia and use of urate synthesis inhibitors (0.28±0.13) than in the group with normouricemia (0.51±0.17). Patients with a UUA/UCr of <0.5 were significantly more frequent in the group with hyperuricemia and no use of urate synthesis inhibitors (69 %) and the group with hyperuricemia and use of urate synthesis inhibitors (94 %) than in the group with normouricemia (51 %). It is therefore necessary to consider the new prescription of urate-lowering drugs in male subjects or patients under the use of urate synthesis inhibitors with type 2 diabetes.

We conducted a cross-sectional observational study using an anonymous self-administered questionnaire to identify factors related to health literacy in adult inpatients with diabetes at a university hospital. We used the Health Literacy Scale, ENDCOREs Scale, and Social Support Scale (Japanese ver. ). We analyzed 54 patients, and a multiple regression analysis was performed for each of the 3 health literacy subscales. The only factor exhibiting a significant correlation with functional health literacy was "support from family and significant others". Those exhibiting a significant correlation with communicative health literacy were Usefulness of information from the Internet, communication skills, and support from significant others. Those exhibiting a significant correlation with critical health literacy were diabetes seminar attendance, Usefulness of information from the Internet, and communication skills. Thus, addressing the factors for which intervention is possible may improve health literacy.

We herein report a 67-year-old man with type 1 diabetes mellitus receiving combination immune checkpoint inhibitor (ICI) therapy. He was being treated with nivolumab and ipilimumab for lung metastasis from renal cancer. After one cycle, hyperthyroidism was detected, which evolved into manifest hypothyroidism over the next few weeks, requiring levothyroxine substitution therapy. Eight weeks after initiating ICI therapy, he presented at the emergency department with thirst, weight loss, and generalized weakness. Hyperglycemia (1,234 mg/dL), anion gap metabolic acidosis (pH 7.112), and ketonemia (β-hydroxybutyrate 1,590 μmol/L) were observed. The glycated hemoglobin level was 9.1 %. Islet-related autoantibodies were all negative. The glucagon tolerance test revealed attenuated secretion of insulin. Human leukocyte antigen was heterozygous for the DRB1*0405-DQB1*0401 haplotype. We compared these findings with those of four cases of type 1 diabetes related to blockade of the cytotoxic T-lymphocyte antigen 4 (CTLA-4) or programmed cell death 1 (PD-1) receptor or its ligand (PD-L1) or combination (ICI) therapy at our institution. All patients showed the DRB1*0405 or DRB1*0901 HLA haplotype, which has been shown to be associated with type 1 diabetes in Japan.