Objective: The aim of this study was to clarify the impact of individualized HbA1c targets on the rate of HbA1c goal achievement. Methods: Individualized HbA1c target values were set for 389 randomly selected outpatients with type 2 diabetes and the relationship to the clinical parameters was examined. Results: Individualized HbA1c target values of <7 % and <8 % were set in 227 (58 %) and 162 (42 %) patients, respectively. While 55 % of the patients achieved an HbA1c level of <7 %, 69 % of the patients achieved the individualized HbA1c goal. The patients who failed to achieve the individualized HbA1c goal showed higher BMI values and lower C-peptide to glucose ratios in comparison to those who achieved the goal. Conclusion: The application of individualized HbA1c targets to clinical practice resulted in an achievement rate that was ~15 % higher in comparison to a target HbA1c level of <7 %. Obesity and a lower beta cell function were associated with failure to achieve the individualized HbA1c goal.

Few studies have so far examined the factors associated with the use of Food for Specified Health Uses (FOSHU) in diabetic patients in Japan. Therefore, we conducted a cross-sectional study based on a questionnaire survey to identify the characteristics of diabetic patients associated with the use of FOSHU. We received responses from 1500 diabetic patients at the Kanamori Diabetes Clinic over 2 months, starting in December 2014. A total of 614 diabetic patients had previously used complementary and alternative medicine (CAM). The most common CAM category was FOSHU (n=248). Patients were divided into type 1 diabetes (n=12) and type 2 diabetes (n=236). Multivariate logistic analyses showed that female gender and aging were correlated with a lower prevalence of FOSHU in type 2 diabetes patients. In contrast, no relationship was observed between clinical variables and the use of FOSHU in type 1 diabetes patients. CAM use is common among diabetic patients. Our results suggest that multiple factors are associated with the use of FOSHU in type 2 diabetes patients. Therefore, health care personnel need to be aware that patients with these factors may use FOSHU in clinical practice.

A 65-year-old male patient who had been diagnosed with diabetes mellitus in 2007 was admitted to Shin-Koga hospital in 2014 due to HbA1c elevation (11.6 %). Since 2011, the patient had complained of general fatigue, dizziness and weight loss and in February 2012 he noticed a mass in his submandibular region. Upon admission, he was found to have proliferative diabetic retinopathy, nephropathy (Stage III) and both peripheral and autonomic neuropathy. An ultrasonographic examination of the patient's submandibular region revealed the enlargement of his submandibular and sublingual glands. In addition, a CT examination revealed diffuse swelling of the pancreas along with the narrowing of the pancreatic duct(s), mediastinal and hilar lymph node swelling, and a retroperitoneal tumor. The patient's serum IgG4 level was as high as 999 mg/dL. A histological examination of a biopsy specimen from his submandibular glands showed dense fibrosis, the loss of acinar cells and plasma cell infiltration. An immunohistochemical examination revealed that the infiltrating cells were predominantly IgG4-positive plasma cells (the IgG4-positive cells accounted for 79.8 % of the IgG-positive cells). Treatment with prednisolone resulted in the significant shrinkage of the tumors, especially those in the submandibular gland. This was accompanied by a significant reduction in the serum IgG4 level. The patient's fasting and postprandial C-peptide levels in meal tests were observed to increase after treatment with insulin and prednisolone.

We herein report two cases of clinically diagnosed X-linked sideroblastic anemia with subsequent diabetes mellitus. Cases 1 and 2 are brothers, 69 and 61 years old, who both developed anemia and secondary hemochromatosis. Case 1 was first diagnosed with diabetes mellitus at the age of 63, and insulin therapy was initiated 5 years later. At this point, his urinary C-peptide levels were 257 μg/day. Approximately one year later, he was admitted to the hospital to have his diabetes management regimen adjusted. The urinary C-peptide levels were found to have fallen to 15.2 μg/day, and abdominal CT showed atrophy of the pancreas. Case 2, the younger brother, had more severe anemia and had also required frequent transfusions since adolescence. He developed liver cirrhosis, hepatocellular carcinoma and left ventricular diastolic dysfunction. His diabetes was first diagnosed at the age of 54, and insulin therapy was initiated. At the age of 61, his insulin deficiency had progressed. X-linked sideroblastic anemia is a rare hereditary form of anemia, and diabetes mellitus as its complication is not well-documented. In our two cases, both developed insulin deficiency, but Case 1 showed pronounced insulin resistance initially before he developed pancreatic β-cell dysfunction.

A 28-year-old woman first experienced muscle cramps in both lower legs from April 2006 and developed diabetic ketosis 1 month later, with a low insulin secretory level and positive anti-GAD antibody test results. She was diagnosed with type 1 diabetes mellitus and treated with multiple daily insulin injections. Her muscle cramps did not resolve thereafter, and because she frequently experienced painful episodes complicated with muscle destruction, she was hospitalized in 2012 for further scrutiny. She had a short stature, emaciation, a maternal family history of diabetes mellitus, sensorineural hearing loss, high lactate levels in both blood and cerebrospinal fluid, calcification of the basal ganglia of brain and an A3243G mutation in the mitochondrial DNA-encoded tRNA (Leu,UUR) gene. Her major neurological and muscular symptoms were restricted to muscle cramps and mild sensory disturbance, and the duration from the onset of diabetes mellitus was very short; her symptoms were therefore considered to be associated with mitochondrial gene abnormalities rather than diabetic polyneuropathy. Mitochondrial diabetes may be associated with a decreased insulin secretory capacity and therefore treated as type 1 diabetes mellitus, but there is less involvement of autoimmune mechanisms and positive anti-GAD antibody test results are rare.

A 78-year-old man developed megaloblastic anemia (hemoglobin 11.5 g/dL, mean corpuscular volume [MCV] 109 fL) 3.8 years after metformin was first administered. Because we suspected that metformin had induced megaloblastic anemia, metformin administration was immediately discontinued. Thereafter, the hemoglobin and MCV levels improved (13.6 g/dL and 104 fL, respectively) immediately after administration of oral and intramuscular cobalamin for approximately 1 month. Biguanide has recently been used to treat type 2 diabetes. Therefore, we must be careful when administering particularly high doses of metformin because of the gradual and delayed progression of megaloblastic anemia after metformin administration.