Exercise instruction can be broadly classified into "face-to-face" and "remote" types, based on the form of communication. In this study, we investigated the effects of remote exercise guidance using smartphones on the HbA1c levels, body mass index (BMI), physical function and physical activity in elderly people with type 2 diabetes in the short term (during the intervention period) and long term (12 months after the end of the intervention). Twenty elderly individuals with type 2 diabetes who attended medical institutions in the mountainous areas of Hiroshima Prefecture were included in the study. The physical function was measured, and exercise instructions were provided once a month for six months using a smartphone application and a telephone. In the short term, a significant increase in physical activity levels was observed in both men and women. In the long term, physical activity levels decreased and returned to the preintervention status in women who did not have a habit of exercising. The short-term effectiveness of the remote exercise guidance using smartphones has been confirmed, but there are long-term issues regarding exercise fixation that must be addressed in elderly women.

The present pilot study examined the acute effect of a low-carbohydrate diet (LCD) for lunch and dinner on glycemic parameters in healthy young Japanese women. Sixteen women wore a flash glucose monitoring system for seven days and consumed test meals on days four to six. Participants consumed a standard-carbohydrate diet (SCD) during the study period, except for lunch and dinner on the day of the LCD. The energy ratios of carbohydrate, fat, and protein in the SCD were 64 %, 21 %, and 15 %, respectively, whereas those in the LCD were 30 %, 49 %, and 21 %, respectively. The mean blood glucose, mean amplitude of the glycemic excursion, incremental glucose peak, and incremental area under the glucose curve (IAUC) of lunch and dinner in the LCD period were significantly lower than those in the SCD period. However, the next day, the postprandial blood glucose concentrations and IAUC of the SCD were significantly higher than before consuming the LCD, although the SCD meals were identical throughout the study period. This indicates that switching from an LCD to an SCD causes an elevation in the blood glucose parameters on subsequent consumption of an SCD in young Japanese women. This result suggests that this diet may cause hyperglycemia in people with type 2 diabetes.

Pancreatic cancer lacks specific symptoms in its early stages, but worsening diabetes or positive tumor markers can trigger suspicion of the disease. We herein report a 79-year-old man with type 2 diabetes and pancreatic cancer who had undetectable carbohydrate antigen 19-9 (CA19-9) and was Lewis blood type-negative. The patient was referred to our hospital due to deteriorating glycemic control. After various tests, the patient was diagnosed with pancreatic cancer with liver metastasis. The CA19-9 level was below the measurable range, the Lewis blood type was negative, and the Dupan-2 level was elevated. The Lewis blood type is a human blood group system, and a mutation in the Lewis antigen gene can cause a lack of Le enzyme activity, resulting in a negative result. CA19-9 is produced when the Le enzyme acts on a sialylated precursor; therefore, individuals with a negative Lewis blood type have undetectable CA19-9 levels. In contrast, Dupan-2, a precursor of CA19-9, can complement CA19-9 as a tumor marker. Further investigations should involve a combination of other tumor markers, including Dupan-2, and imaging tests to obtain more definitive results.