We retrospectively examined the changes in HbA1c and body weight and analyzed background factors related to changes in HbA1c in patients with type 2 diabetes mellitus who were treated with sacubitril/valsartan, an angiotensin receptor neprilysin inhibitor (ARNI). The angiotensin II receptor blocker (ARB) group was matched to the control group using the propensity score-matching method. After matching, 45 patients in each group were included in the analysis (mean body mass index, 27.6±5.4 kg/m²; systolic blood pressure, 149.1±17.9 mmHg; and HbA1c, 6.9 %±0.7 %). The systolic blood pressure, HbA1c, and body weight were significantly lower in the ARNI group than in the ARB group, and the HbA1c reduction was significantly larger in dipeptidyl peptidase 4 inhibitor (DPP-4i) users than in DPP-4i non-users. A multiple regression analysis showed that the HbA1c change correlated with the pretreatment HbA1c level and weight change (p < 0.01). The increase in the glucagon-like peptide 1 activity and natriuretic peptide by neprilysin inhibition was suggested to be the mechanism underlying the improvement in blood glucose and weight loss. In conclusion, HbA1c reduction due to ARNI treatment was significant in patients with a high pretreatment HbA1c level, weight loss during treatment, and DPP-4i use.

The "Client-Nurse Relationship Scale (CNRS) " and the "Problem Area in Diabetes Survey (PAID) " as well as patient characteristics were assessed by a web survey in 400 diabetic patients. The median PAID score of 42.5 in 67 female patients was significantly higher than that of 30.0 in 333 male patients. The median CNRS scores were 2.9 for the humanistic subscale, 3.5 for the overbearing subscale, and 2.7 for the specialty subscale. The PAID scores were inversely correlated with the CNRS scores. These findings suggested that when the nurse-patient relationship improved, then the emotional distress related to diabetes was better relieved.

The present study assessed the factors related to readiness for transition to adult healthcare services among patients with childhood-onset type 1 diabetes after studying the characteristics of patients who had already been transferred to the Department of Internal Medicine. Sixty-nine patients (12-24 years old) were surveyed for their readiness for transition to adult healthcare services, diabetes self-management status, acceptance of disease, and self-efficacy for diabetes. As a result, only 4 (36.4 %) of the 11 patients were ready for transition, even if they had already transferred to the Department of Internal Medicine. Furthermore, only 14 (24.1 %) of the 58 patients being followed up in the Department of Pediatrics were ready for transition. The median total score for "knowledge" and "behaviors" related to readiness were both higher in patients who had already been transferred to the Department of Internal Medicine than in those who had yet to transfer, but the difference between the two groups was not significant. In addition, the number who had participated in diabetes camp, their age, and their disease duration were newly identified as factors related to readiness. Patients should be made ready for transition before transferring to the Department of Internal Medicine, but they are not at present. Thus, more support for pediatric patients to prepare them for transition to adult healthcare services is urgently needed.

Aims/Introduction: We investigated the prevalence and characteristics of diabetic symmetric sensorimotor polyneuropathy (DSPN) in patients with type 2 diabetes registered in the JDCP (Japan Diabetes Complication and its Prevention Prospective) study.

Materials and Methods: A total of 6,338 patients with diabetes were registered in 2007-2009. Of these, patients with type 2 diabetes who were able to be evaluated for DSPN were analyzed. DSPN was diagnosed using the Simple Diagnostic Criteria for Diabetic Polyneuropathy proposed by the Diabetic Neuropathy Study Group in Japan.

Results: Of the total participants, 5,451 patients (mean age: 61.4 years old; mean duration of diabetes: 10.8 years) were analyzed. The prevalence of DSPN and sensory symptoms was 35.8 % and 25.8 %, respectively. The following factors increased the risk for DSPN: age (odds ratio 1.57; 95 % confidence interval 1.42-1.73), duration of diabetes (1.32; 1.21-1.43), body mass index (1.19; 1.09-1.30), systolic blood pressure (1.06; 1.01-1.10), hemoglobin A1c (1.15; 1.09-1.22), biguanides (1.22; 1.06-1.39), and insulin therapy (1.59; 1.36-1.84). The following factors decreased the risk for DSPN: total cholesterol (0.98; 0.96-1.00) and exercise therapy (0.85; 0.73-0.98).

Conclusions: This survey clarified the prevalence, characteristics, and risk factors for DSPN in Japanese patients with type 2 diabetes.

In the large-scale, prospective, observational JDCP study, a total of 5,944 type 2 diabetic patients (mean age at baseline, 61.4 years old; women, 39.9 %; and duration of diabetes, 10.8 years) were followed up for incidence of malignancy. During a mean 5.38±2.92 years of follow-up, malignancies occurred in 322 patients, accounting for a crude incidence of 10.35/1000 person-years. The 3 most frequently reported malignancies included colorectal cancers (20.4 %), breast cancer (16.5 %) and lung cancers (13.6 %) in women, and gastric cancers (18.3 %), colorectal cancers (15.7 %) and lung/prostate cancers (12.7 %) in men. During follow-up, men had a significantly higher relative risk for malignancy than women. In contrast, women had a significantly shorter time to the first diagnosis of malignancy following a diagnosis of diabetes than men (13.79±7.90 and 17.11±8.50 years, respectively), although there was no marked difference in the age at the diagnosis of malignancy (67.39±7.27 and 68.44±6.62 years, respectively). Cox proportional hazard models revealed that increasing age, a history of drinking and a history of acute myocardial infarction were significantly associated with an increased risk of malignancy. This report may be of interest in that it provides valuable insight into which malignancies Japanese type 2 diabetic patients are likely to be at risk of developing over time.