For the treatment of diabetes mellitus, two combinations of long-acting insulin and GLP-1 receptor agonist with a fixed ratio combination (FRC) are available in Japan: insulin degludec and liraglutide (IDegLira), and insulin glargine and lixisenatide (IGlaLixi). We compared the differences in daily glucose levels to evaluate the characteristics of the glucose-lowering effect in Japanese patients with type two diabetes mellitus. The glucose-lowering effects of both types of FRC (IDegLira, and IGlaLixi), which were administered at the same dose, were evaluated in 24 patients with type 2 diabetes (female, n=16; male, n=8; age, 65.5±15.1 years; duration of diabetes, 16.3±10.6 years; HbA1c, 8.6±1.3 %; C-peptide index [CPI], 1.3±1.0). IGlaLixi showed a superior effect on TIR and TAR, as well as TBR. Thus, IGlaLixi was associated with greater safety. These results might be derived from differences in pharmacological characteristics between liraglutide and lixisenatide, insulin degludeg, and glargine, and the ratios of the combination of GLP-1 receptor agonists and insulin.

The patient was an 81-year-old woman diagnosed with thymoma at 66 years old. The thymoma was surgically removed but recurred repeatedly during follow-up, and surgery was performed at 71 and 79 years old. She had no history of glucose intolerance, but thirst and weight loss appeared at the end of January X-1. In April of the same year, she was started on intensive insulin therapy after showing blood glucose 320 mg/dL, HbA1c 12.2 %, and urinary ketone body 3+. She was diagnosed with acute-onset type 1 diabetes mellitus because of deficient insulin secretion. Although islet-associated autoantibodies were negative, the diagnosis of chronic thyroiditis and presence of disease-sensitive HLA led us to suspect that this patient had autoimmune type 1 diabetes caused by thymoma-induced autoreactive T cell production and an impaired regulatory T cell maturation and function. To our knowledge, there are only four antibody-negative cases of thymoma-associated type 1 diabetes mellitus, and we report this case because it is considered an interesting and rare case in considering the pathogenesis of type 1 diabetes mellitus.

A 69-year-old man with impaired consciousness was brought to the emergency room and admitted to the hospital with a diagnosis of hypoglycemic coma. Initially, insulinoma was suspected but could not be found. Subsequently, the patient showed consistent hyperglycemia and was found to be positive for insulin receptor antibodies, resulting in a diagnosis of insulin receptor dysregulation type B. Steroid therapy was effective; continuous 24-h blood glucose monitoring before and throughout the treatment showed improvement in both hypoglycemia and hyperglycemia, and insulin receptor antibodies were negative. The patient died shortly thereafter, and an autopsy revealed islet hyperplasia. We herein report a case of type B insulin receptor dysregulation with islet hyperplasia. Repeated hypoglycemic attacks in the early mornings initially brought the patient to our hospital, and subsequent hyperglycemia and high insulin levels led to a confirmed diagnosis. Notably, insulin receptor antibodies were found to be negative after steroid therapy.