Oral semaglutide is a GLP-1 receptor agonist that is preferred because it does not require injections. However, its efficacy and safety in the elderly remain unclear. Thirty-nine elderly Japanese patients with type 2 diabetes mellitus were retrospectively examined. After excluding 7 patients who discontinued treatment, 32 patients were analyzed. Changes in HbA1c and BMI at 12 and 24 weeks after administration were evaluated, as well as the achievement rate of individual target HbA1c. The mean age was 76.0±4.8 years, and the mean BMI was 27.7±5.1 kg/m². After 24 weeks, HbA1c and BMI showed a significant decrease in the overall population, while LDL cholesterol significantly decreased in the overall population and the 7 mg group. Twenty-two of 32 patients (68.8 %) achieved their individual target HbA1c levels. In elderly Japanese patients with type 2 diabetes, 3 or 7 mg of oral semaglutide effectively contributed to the achievement of individual target HbA1c levels.

This study conducted an internet-based survey among people with type 2 diabetes who were registered with a research firm to determine the characteristics and psychological traits associated with their actual diet and exercise. A total of 510 participants completed the survey. The average frequency of diet therapy was 3.4 days per week, and the average frequency of exercise therapy was 2.2 days per week. The most frequent response for both diet and exercise frequency was 0 days. A binomial logistic regression analysis showed that the implementation of a healthy diet was associated with the absence of an alcohol drinking habit, younger age, higher self-efficacy, and higher autonomous motivation. Exercise practice was associated with lower BMI, having had an educational hospitalization, having complications, no self-injection, and high autonomous motivation. Autonomous motivation was the only factor associated with both diet and exercise therapy. This study clarifies the characteristics that should be taken into account when providing medical care support for exercise and diet therapy and highlights the importance of medical care support that enhances autonomous motivation.

A 16-year-old Japanese girl had suffered from acute-onset type 1 diabetes mellitus. Her HbA1c values were maintained at 5 %-6 % with human regular and NPH insulins for the next 17 years. She suffered hypoglycemic coma at 33 years old. Her height at the time was 158 cm, and her weight was 41.6 kg (body mass index 16.7 kg/m²). There were no signs of retinopathy or nephropathy, although mild neuropathy was present. Laboratory data were as follows: FPG 94 mg/dL, HbA1c 5.5 %, serum CPR 0.33 ng/mL, urinary CPR 12.8 μg/day. Anti-GAD antibody and anti-IA-2 antibody were positive. The insulin regimen was switched to insulin lispro and insulin degludec. Insulin degludec was reduced from 1 unit every other day to 1 unit every 3 days at 35 years old based on intermittently scanned continuous glucose monitoring (isCGM). Insulin lispro was then switched to insulin aspart at 36 years old, and insulin degludec was withdrawn at 37 years old, as frequent hypoglycemic episodes were detected. She retained excellent glycemic control with a time-in-range of 94 % on isCGM and HbA1c value of 6.1 %. Exceptionally high insulin sensitivity secondary to her leanness and dietary and exercise habits were thought to be the factors underlying her good glycemic control without basal insulin.

The patient was a 47-year-old man with massive obesity, who weighed 115 kg 6 months prior to admission but had never been diagnosed with glucose intolerance. He presented with a 6-month history of weight loss (20 kg) and had presented polydipsia and polyuria for 2 months. Three days prior to admission, involuntary movements of the left face and left upper limb appeared, and when he visited another hospital. His blood glucose and HbA1c levels were 595 mg/dL and 15.0 %, respectively. He was referred to our hospital on the day of admission. Brain CT on the day of admission showed a high-density area in the right lenticular nucleus, and magnetic resonance imaging of the brain on day 14 showed T1-weighted hyperintensity in the same area, leading to the diagnosis of diabetic chorea (DC). The symptoms improved with glycemic control and the administration of haloperidol, and hyperintensity on T1-weighted imaging disappeared on day 419. Although DC is considered to be associated with vascular disease and is more common in elderly individuals, the probability of DC should be considered in obese patients presenting with chorea, even at younger ages.

A 56-year-old man was transported to our hospital by ambulance due to headache, vomiting, and impaired consciousness. He had right homonymous inferior quadrantanopsia and his blood pressure was 192/100 mmHg. A laboratory analysis revealed the following: serum glucose, 233 mg/dL; HbA1c, 10.8 %; urinary protein excretion, 12.0 g/gCr; serum albumin, 2.1 g/dL; and eGFR, 41 mL/min/1.73 m². Fluid attenuated inversion recovery and T2-weighted head MRI showed chronic ischemic lesions in the white matter. Arterial spin labeling (ASL) demonstrated hyperperfusion in the left parietal and occipital lobes. The patient was diagnosed with posterior reversible encephalopathy syndrome (PRES). The patient's hyperperfusion and visual field loss almost normalized, along with his blood pressure and glycemic control. The current case report suggests the usefulness of ASL in the diagnosis of PRES in the clinical setting.

The Japan Diabetes Society (JDS) and the Japan Cancer Association (JCA) launched a joint committee and published their "First Joint Committee Report on Diabetes and Cancer" in 2013, compiling recommendations for physicians and healthcare providers as well as for the general population. In 2016, the "Second Joint Committee Report on Diabetes and Cancer" summarized the current evidence on glycemic control and cancer risk in patients with diabetes. The current "Third Joint Committee Report on Diabetes and Cancer", for which the joint committee also enlisted the assistance of the Japanese Society of Clinical Oncology (JSCO) and the Japanese Society of Medical Oncology (JSMO), reports on the results from the questionnaire survey, "Diabetes Management in Patients Receiving Cancer Therapy, " which targeted oncologists responsible for cancer management and diabetologists in charge of glycemic control in cancer patients. The results of the current survey demonstrated that there is a general consensus among oncologists and diabetologists with regard to the need for guidelines on glycemic control goals, the relevance of glycemic control, and glycemic control during cancer therapy in cancer patients.