Aim: To determine regional risk factors associated with worsening of diabetic kidney disease (DKD). Methods: We conducted a retrospective longitudinal study using four-year records of a specific health examination among participants with National Health Insurance in Toyooka City (n=5,169 at baseline). Results: A survival analysis with a 20 % increase in the serum creatinine level set as an endpoint revealed that both diabetes mellitus and hypertension are significantly associated with a worsening renal function. Among people with diabetes, an increased HbA1c value or decreased HDL cholesterol levels were associated with worsening of DKD. For those with a high HbA1c (≥8 %), lack of medical treatment for diabetes was associated with a particularly elevated risk. For those with diabetes without macroalbuminuria, reduced HDL cholesterol levels were significantly associated with worsening of DKD. Conclusion: Data from a specific health examination revealed regional risk factors associated with worsening of DKD among participants with National Health Insurance.

We herein report the case of an obese 54-year-old woman with type 2 diabetes (T2DM) following bilateral transfemoral amputation. At 43 years of age, she underwent bilateral transfemoral limb amputation. At 50 years of age, she was diagnosed with T2DM, and therapy with sitagliptin and metformin was initiated, but her obesity and glycemic control deteriorated due to poor dietary compliance. In September X, her HbA1c became 9.6 %, and she was admitted to our hospital in October. Her height was 114.0 cm, and her body weight was 58.8 kg against an estimated standard body weight of 35.0 kg as a bilateral transfemoral amputee. We estimated her caloric intake would be 1200 kcal using the Harris-Benedict formula and measurements of her oxygen consumption. Liraglutide 0.3 mg was initiated instead of sitagliptin, which resulted in an improved glycemic control. Traumatic lower limb amputees are at a high risk of developing an increase in body fat and cardiovascular disease because of sedentary behavior, a high caloric intake and adiposopathy. In the present case, the estimated caloric intake based on her lower limb amputee status and the administration of liraglutide to reduce her appetite in order to manage her body weight and cardiovascular events seemed effective.

A 71-year-old woman had been diagnosed with type 2 diabetes and treated by diet therapy and oral diabetes medicine at 56 years of age. She developed a generalized itching rash two years prior to admission and was administered topical class II steroids by the Department of Dermatology at her local hospital. Although her HbA1c level was approximately 7 %, she was admitted to her local hospital's Department of Dermatology due to aggravation of the itching rash. While hospitalized, topical steroids were changed to class I agents, and she was discharged after approximately three weeks of treatment. The day after being discharged, she visited our department, where it was found that her casual blood glucose level was high (803 mg/dL), leading to her being admitted once again. Upon inspection at admission, the involvement of type 1 diabetes onset, malignant tumors, and infection were ruled out and the topical steroids were deemed to have deteriorated her glycemic control. The local administration of topical steroids rarely affects the internal organs due to its low absorption efficiency. However, it is necessary to be alert for deteriorating glycemic control when using high-titer topical steroids in individuals with a dysfunctional skin barrier, as shown in this study.

A 76-year-old man was diagnosed with type 2 diabetes at 41 years of age and treated with oral hypoglycemic agents. Insulin therapy was started at 63 years of age. Because his glycemic control was worsened by insulin antibodies (binding rate 53.1 %, serum level >5000 nU/mL), his insulin formulation was replaced at 70 years of age. His glycemic control improved only temporarily, so prednisolone (20 mg/day) was started, and this dramatically improved his glycemic control. The dosage of prednisolone was gradually reduced, and it was discontinued entirely at 76 years of age. However, his glycemic control worsened again after stopping steroid therapy. We admitted him to our hospital and evaluated his daily blood glucose profile via continuous glucose monitoring (CGM). CGM showed gradual reductions in both the fasting and postprandial blood glucose from the day after he began prednisolone (20 mg/day). We therefore reduced his insulin dose (total daily dose: 95 units on admission, 48 units at discharge). We also evaluated the glycemic variability using the following indicators: M value, MAGE and CONGA-1. We observed that these indicators decreased with steroid therapy.