We investigated the length and predictors of the therapeutic response to liraglutide in 55 patients with type 2 diabetes. The rate of reducing the HbA1c level by more than 1.0 % nearly peaked at week 12. The achievement of HbA1c<7.0 % and <8.0 % nearly peaked at weeks 28 and 20, respectively. A logistic regression analysis was used to identify the predictors of the therapeutic response to liraglutide. The predictors in patients whose HbA1c level was reduced by more than 1.0 % included a higher baseline HbA1c level (≥9.0 %), shorter duration of diabetes (<13 years) and lower triglyceride level (<219 mg/dL) (P<0.05). The use of sulfonylurea agents in a prior treatment was negatively associated with the achievement of HbA1c<7.0 % (P=0.001). Given these findings, a higher baseline HbA1c level, shorter duration of diabetes, lower triglyceride level and non-use of sulfonylurea agents appear to be useful factors for predicting the efficacy of liraglutide in patients with type 2 diabetes. Continuous therapy with liraglutide should be evaluated at weeks 12 and 28.

The findings of vascular endothelial function tests have attracted attention as surrogate markers for cardiovascular disease prevention in patients with type 2 diabetes. The flow-mediated dilation (FMD) and reactive hyperemia index (RHI) were measured at the same time in 106 patients with type 2 diabetes. In a univariate analysis, the FMD was significantly positively correlated with the estimated glomerular filtration rate (eGFR) and significantly negatively correlated with age, urinary albumin-to-creatinine ratio (ACR), systolic blood pressure, brachial-ankle pulse wave velocity (baPWV) and carotid intima-media thickness (IMT). The RHI was significantly positively correlated with ABI and significantly negatively correlated with the ABI and carotid IMT. Student's t-test showed that the FMD was significantly lower in diabetic patients who were male or suffering from nephropathy than in others and that the RHI was significantly lower in those who were smokers or being treated with statins than in others. In a multiple regression analysis, the FMD was associated with gender, eGFR and baPWV, while the RHI was associated with the ABI, carotid IMT and treatment with statins. The clinical parameters for cardiovascular disease that were associated with the FMD differed from those associated with the RHI, and the FMD was not significantly correlated with the RHI.

A 63-year-old man was admitted due to the rapid deterioration of glycemic control and ketosis over the previous few months; he was subsequently diagnosed with autoimmune polyglandular syndrome type 3 with both diabetes mellitus positive for islet-specific autoantibodies and Graves' disease. His insulin secretion capability has not decreased despite treatment with both insulin and oral hypoglycemic agents for more than five years, and he remains insulin-independent. Differentiation between acute-onset and slowly progressive type 1 diabetes mellitus may be difficult in patients complicated with Graves' disease. A genotype analysis of both class I and class II human leukocyte antigen (HLA) performed on several alleles suggests the existence of alleles characteristic of a simultaneous diagnosis of type 1 diabetes mellitus and Graves' disease.

We evaluated the clinical background of type 2 diabetes mellitus patients with favorable glycemic control (HbA1c<7 %). The patients were stratified into 3 groups based on their HbA1c concentration at the time of their first visit to participating JDDM sites: Group I (<7 %), Group II (7 to <8 %), and Group III (≥8 %). We then compared the characteristics of the groups, prevalence of concomitant diseases, and the differences in their treatment. The duration of diabetes in the three groups was approximately 11 years. Group III was younger and more obese rather than Groups I and II. We therefore hypothesized that Group I included cases of diabetes mellitus that were originally mild along with cases in which favorable glycemic control had already been obtained with previous treatments. In Groups II and III, the mean HbA1c concentration reached ≤7 % after 1 year of treatment at the participating JDDM sites. The prevalence of retinopathy and nephropathy in Group I was less than that in Group III. The proportion of cases in which favorable glycemic control was maintained with diet and exercise was high in Group I. The HbA1c concentration at the first visit influenced the clinical features in the present study. The results show the importance of achieving glycemic control at the early stage of diabetes.