In response to the Great East Japan Earthquake, the Japan Diabetes Society initiated an academic research program on diabetes care during disasters, leading to the publication of the first edition of the Diabetes Care Providers' Manual for Disaster Diabetes Care in 2014. During the 2016 Kumamoto Earthquake, disaster response activities based on the concept of a Diabetes Medical Assistance Team (DiaMAT), as proposed in the manual, were implemented and demonstrated their practical value in the field. Building on these experiences, a revision committee composed mainly of members with firsthand disaster experience published the updated Diabetes Care Providers' Manual for Disaster Diabetes Care in 2024.

This article provides a concise summary of the essential elements of the 2024 manual to support disaster preparedness education in routine settings and facilitate appropriate diabetes care during disasters. The key principles are distilled and organized into four sections: I. Preparedness for Disasters; II. Roles of Diabetes Healthcare Professionals During Disasters: III. Management of Individual Diabetes Conditions; and IV. Patient Preparedness. Readers seeking comprehensive guidance are encouraged to consult the full Diabetes Care Providers' Manual for Disaster Diabetes Care 2024.

This study investigated the association between the Weight-adjusted Waist Index (WWI) and exercise capacity in older males with type 2 diabetes mellitus. A total of 174 patients with a normal body mass index (BMI; 18.5–24.9 kg/m²) were included, and the WWI, BMI, and peak oxygen uptake (peak VO₂) were all assessed. The WWI showed a significant negative correlation with peak VO₂ (r = −0.35, p < 0.001). In a hierarchical multiple regression analysis adjusted for age, BMI, HbA1c, hemoglobin level, and estimated glomerular filtration rate, the WWI remained independently associated with peak VO₂ (β = −0.269, p < 0.001). Similar findings were observed in sensitivity analyses using absolute peak VO₂ and additional analyses including participants regardless of the BMI category. These findings suggest that even among older male patients with type 2 diabetes and a normal BMI, a higher WWI may be associated with a lower exercise capacity. TheWWI may therefore provide additional information on exercise capacity beyond the BMI in this population.

Objective: To investigate the implementation status of dosing conditions for oral semaglutide and explore the patient characteristics associated with medication nonadherence. Methods: A questionnaire survey was conducted on 61 outpatients with type 2 diabetes. Medication adherence was defined as fulfilling all of the following conditions: dosing frequency (no missed doses), intake on an empty stomach, appropriate water volume, and post-dose fasting time. Results: Although the proportion of patients with a good dosing frequency (≤1 missed dose/week) was high (95 %), the adherence rate for all conditions was 66 %. Specifically, adherence to water volume restriction was low at 79 %. In a multivariate analysis, high Fibrosis-4 (FIB-4) and AST to platelet ratio index (APRI) scores were independently associated with non-adherence. A restricted cubic spline (RCS) analysis demonstrated an association in which higher values of both indices were related to an increased probability of non-adherence. Conclusion: Even among patients with a good dosing frequency, "hidden" non-adherence, such as inappropriate water volume, existed. High FIB-4 and APRI scores may reflect the underlying characteristics of patient populations associated with non-adherence. It is therefore important to pay attention to such indicators and carefully assess and support patients' medication behaviors.

The patient was a 71-year-old woman who was diagnosed with left breast cancer at another hospital in year X-8 and she therefore had undergone palliative drug therapy and surgery for local disease control. She was transferred to our hospital in year X, and oral Capivasertib, an AKT inhibitor, was administered due to disease progression. Laboratory tests revealed no evidence of diabetes mellitus (HbA1c 5.5 %, random plasma glucose 103 mg/dL, and negative urine glucose) before treatment initiation. Therefore, the patient self-monitored her early morning urine glucose concentrations once daily at home during the treatment. On day 4 of the first treatment cycle, the urine test was positive for glucose. Capivasertib was discontinued because it had induced grade 3 hyperglycemia, and the patient was hospitalized. The hyperglycemia resolved promptly. On the third day of hospitalization, continuous glucose monitoring (CGM) was initiated, and the patient was discharged. Capivasertib, an AKT inhibitor approved in 2024, is known to induce insulin resistance. In this case, hyperglycemia was detected through urine glucose screening, thus enabling timely intervention before the progression to severe hyperglycemia. CGM confirmed postprandial hyperglycemia during treatment and rapid normalization during drug-free periods, thereby facilitating reintroduction and outpatient management. The treatment was continued for 18 cycles, with dose adjustments made as needed.

An 85−year-old woman without a history of diabetes developed profound hypoglycemia (17.3 mg/dL) and hyperinsulinemia (45.2 μU/mL) after being administered sulfamethoxazole-trimethoprim (SMX-TMP) for a urinary tract infection. Although renal impairment (serum creatinine: 1.39 mg/dL) limited the detailed evaluation of neoplastic lesions, other causes that could induce hypoglycemia, such as adrenal insufficiency, were excluded. SMX-TMP was therefore discontinued under the diagnosis of suspected drug-induced hypoglycemia. Along with continuous intravenous glucose infusion, diazoxide was administered, thus leading to the rapid stabilization of her blood glucose levels. In this case, advanced age and the delayed excretion of SMX-TMP due to renal dysfunction had most likely excessively enhanced its insulinotropic effects, thus resulting in severe hypoglycemia and hyperinsulinemia. Reports of managing SMX-TMP-induced hypoglycemia with diazoxide are extremely rare in Japan. This case suggests that diazoxide can be a valuable therapeutic option for the acute-phase management of such cases.

A 64-year-old man presented on August Y, 20XX after developing confusion while driving, having continued his diabetes medication despite no nutritional intake. Upon arrival by ambulance, laboratory tests revealed marked hypoglycemia (blood glucose 35 mg/dL), hypercalcemia (serum calcium 13.8 mg/dL), and elevated creatinine (4.61 mg/dL), indicating acute renal impairment. He was urgently admitted for further evaluation and management, and intravenous fluid therapy was initiated. He was diagnosed with acute renal failure due to dehydration secondary to hypercalcemia, which was secondary to sarcoidosis. Steroid therapy rapidly corrected his hypercalcemia. However, although his renal function had been normal three months earlier, the correction of dehydration alone did not sufficiently improve his condition, and recovery required time after the normalization of his serum calcium level. In patients with hypercalcemia, a rapid increase in serum calcium may reduce their food intake and trigger sudden renal deterioration. In diabetic patients on medication, a reduced food intake can cause abrupt glucose changes, including hypoglycemic comas. This case highlights the importance of close monitoring of diabetic patients with hypercalcemia, as both acute renal failure and severe hypoglycemia may occur if fluid balance and metabolic status are not properly managed.