The effectiveness and durability of oral semaglutide (S) for treating 103 outpatients with type 2 diabetes mellitus were retrospectively investigated in clinical practice. After the administration of oral S, the body weight and BMI were significantly lower after 1 and 3 months, and HbA1c was significantly lower after 3 months than before administration. In 69 patients in whom oral S had been initiated instead of DPP-4 inhibitors, HbA1c declined significantly after 3 months with no significant change after 1 month. In 32 of 69 patients, the dosage of oral S increased after 1 month, and HbA1c declined significantly from 1 month to 3 months. Although 14 patients complained of nausea, 6 patients had vomiting, and 5 patients had diarrhea, none except for one patient was obliged to discontinue the medication for 3 months. In real-world clinical practice, the effectiveness of oral S on body weight, BMI, and HbA1c has been demonstrated even in patients who switched from DPP-4 inhibitors. Oral S is therefore expected to be a novel therapeutic strategy for patients with type 2 diabetes.

The DPN check^® is a device that can easily perform nerve conduction studies (NCS) of the sural nerve. We assessed the validity of the DPN check^® in comparison to conventional NCS for evaluating diabetic neuropathy. We compared the measured values and determination of the presence or absence of neuropathy in 136 patients with diabetes mellitus who were evaluated by both the DPN check^® and an NCS. The correlation coefficients between the results of the DPN check^® and NCS for SNAP Amp and SCV were 0.71 and 0.60, respectively. The concordance rate for judging whether or not the severity of neuropathy is more than moderate was 82.4 % (vs. Baba's DN Classification, κ value 0.61). The DPN check^® normal group tended to have a prolonged distal latency of the median nerve (4.17 ms). It is difficult to assess the full range of neurological disorders using the DPN check^®. However, we consider it to have sufficient ability for application in screening for diabetic neuropathy.

A 44-year-old man with no history of diabetes visited our emergency room in December X because of symptoms of fatigue and vomiting. On arrival, his blood glucose level was extremely high (2163 mg/dL), and his HbA1c was 6.3 %. A blood gas analysis showed metabolic acidosis (pH 6.866, HCO₃^- 4.6 mEq/L, BE -28.9 mEq/L) and high 3-hydroxybutyrate levels. Additionally, the patient's rectal temperature was 27 °C. The initial diagnosis was diabetic ketoacidosis (DKA) complicated by accidental hypothermia. Immediate treatment included massive fluid replacement, continuous intravenous insulin infusion, and extracorporeal rewarming therapy. One day after admission, the patient developed takotsubo cardiomyopathy (TTS) with ventricular tachycardia, prompting the introduction of percutaneous cardiopulmonary support. On the 4^th hospital day, his condition improved, and he was diagnosed with fulminant type 1 diabetes mellitus. After intensive insulin therapy, he was discharged on the 33^rd hospital day. We report the successful management of a case of DKA secondary to fulminant type 1 diabetes mellitus complicated by accidental hypothermia and TTS.