We developed a new diabetes stigma scale for healthcare professionals and conducted a survey of 507 healthcare professionals working at our hospital to examine the actual state of stigma that healthcare professionals have towards diabetes. The Cronbach's alpha for the entire scale was 0.832, confirming its reliability. Of the five factors of stigma, unfounded self-confidence and stereotypes were the highest, followed by prejudice and shameful disease, while social discrimination was the lowest. Stigma was significantly higher among those who did not like interacting with diabetic patients (p<0.001), and higher among those who had more interactions with them (p<0.001). There was no difference in overall stigma by occupation; however, stereotypes were significantly higher among doctors than among other occupations (p<0.001). Furthermore, nursing staff were more likely to be aware of diabetes as a shameful disease relative to doctors (p=0.02). These results revealed that medical professionals had misconceptions about diabetes. This may be due to incorrect perceptions in relation to diabetes among medical professionals and discrepancies in awareness between them and patients due to seeking the ideal image of a diabetic patient. We believe that this may be linked to stigma.

Understanding the perspectives of patients with diabetes is crucial for accurately identifying important points for improving medical care and policies. In this study, we conducted a self-reported survey on experiences related to diabetes medical care and daily life, analyzing the results from 1,099 people with type 1 diabetes (T1DM) and 1,436 people with type 2 diabetes (T2DM). Over 90 % chose "physicians" as their primary consultants for diabetes at medical institutions, with a minority choosing non-doctors. The rate of treatment discontinuation was 3.2 % for T1DM and 8.7 % for T2DM due to a lack of understanding of the importance of treatment and financial constraints. Factors prompting a return to treatment were interactions with healthcare professionals, such as being called in and worsening health conditions. The proportion of patients who felt "heavily burdened" by medical costs was 33.8 % for T1DM and 13.4 % for T2DM. There was a higher rate of perceived societal prejudice against diabetes in younger patients and patients with T1DM, with 21.9 % of T1DM and 12.0 % of T2DM patients, indicating that prejudice exists among healthcare providers. There is a need for multidisciplinary involvement of patients and discussions to address specific challenges. Addressing the prejudice felt by patients should be a priority, starting with healthcare providers.

An 82-year-old woman was treated with atezolizumab and bevacizumab for hepatocellular carcinoma recurrence after RFA. Four months later, she was brought to our hospital with a complaint of drowsiness. Other than mild hyperammonemia, there were no apparent abnormalities. Her blood glucose level was 170 mg/dL and her HbA1c value was 5.6 %. Drowsiness persisted after treatment for hepatic encephalopathy, and her serum sodium level, which was normal on admission, dropped to 121 mmol/L after 1 week of hospitalization. Her serum cortisol and ACTH levels were both low, and a loading test was performed, resulting in a diagnosis of isolated adrenocorticotropic hormone deficiency. After the administration of hydrocortisone, her fasting blood glucose level was 332 mg/dL, which was managed with multiple daily insulin injections. Although the patient tested positive for anti-GAD antibodies, insulin secretion persisted, and hyperglycemia was considered to be due to hepatic diabetes mellitus and excessive hydrocortisone administration. After discharge from the hospital, the patient's blood glucose level showed significant elevation, and insulin secretion decreased substantially within 6 weeks, leading to a diagnosis of acute-onset type 1 diabetes caused by atezolizumab. This is a rare case in which 2 endocrinologic immune-related adverse events developed successively after anti-PD-L1 antibody treatment, and the course of decline in insulin secretion could be observed.