[Objective] A questionnaire survey was conducted to clarify the thoughts of facility staff regarding their interactions with elderly people with diabetes and to obtain information to improve support. [Methods] An anonymous self-administered questionnaire or web survey was administered to 1,497 elderly care facility staff members in Prefecture A [please check this carefully]. This study was conducted in November 2020. Free-form responses were analyzed using text mining. [Results] A total of 331 participants were initially surveyed (response rate, 22.1 %), of whom 89 (26.9 %) were surveyed after excluding missing data. The occupations included nurses (36.0 %) and care workers (34.8 %). The most frequently occurring words were "food," "think," "difficult," "cognition," and "eat," and the co-occurrence network showed connections with "think," "eat," "blood sugar," and "lifestyle." The correspondence analysis showed characteristics according to facility nurse staffing criteria. [Discussion] Many of the staff members had conflicts about "food" and "eating" and found it difficult to manage their diet. The results also suggest that they had a desire to acquire knowledge about diabetes care.

Obesity and complicated diabetic pregnancies increase the risk of perinatal maternal and fetal complications. In this case, we encountered a patient with severe obesity and type 2 diabetes mellitus who experienced pregnancy and delivery before and after metabolic and bariatric surgery. At the time of pregnancy before bariatric surgery, the patient weighed 114.6 kg, had a BMI of 47.5 kg/m², and an HbA1c level of 6.5 %. During this pregnancy, she gained 16.5 kg and had difficulty controlling her blood glucose, even with a maximum of 46 units of insulin per day. Postpartum, her weight and HbA1c levels worsened for several months. In contrast, at the time of pregnancy after bariatric surgery, the patient weighed 91.9 kg, had a BMI of 38.1 kg/m², and an HbA1c level of 5.7 %. She gained 6.9 kg, achieved glycemic control through diet alone, did not require insulin, and no postpartum weight gain or worsening of HbA1c levels was observed. Metabolic and bariatric surgery may be an effective option for the preconception management of patients with severe obesity and type 2 diabetes who are difficult to treat.