It is important to monitor diabetes-related distress in daily practice in association with poor self-care and consequent worsening of glycemic control. The presence of subjective symptoms in a patient is expected to be positively associated with diabetes-related distress, but few studies have examined this relationship. This cross-sectional study was conducted on 228 patients at their first visit to an endocrine out-patient clinic. Diabetes-related distress was evaluated by the Problem Areas in Diabetes Survey (PAID), and the effect of specific subjective symptoms on the PAID score was evaluated by a logistic regression analysis. A multivariate analysis incorporating gender, age, and HbA1c revealed that having two or more of the symptoms of thirst, polyuria, malaise, and weight loss was associated with an increased PAID score (odds ratio: 3.2; 95 % confidence interval: 1.5-6.4; p = 0.002). Patients with more symptoms of hyperglycemia may benefit from psychological intervention to relieve their feelings of diabetes-associated burden in addition to the usual glycemic control.

A 72-year-old man was hospitalized because of diarrhea, anorexia, and motion difficulty that occurred 76 weeks after starting pembrolizumab therapy as third-line treatment for lung cancer (left pulmonary large cell neuroendocrine carcinoma), which had been diagnosed at 70 years old. A rapid increase in the blood glucose level from 88 mg/dL (HbA1c, 6.4 %) at admission to 468 mg/dL (C-peptide, 0.07 ng/mL) on day 4 of hospitalization, together with deficiency in insulin secretion, led to a diagnosis of type 1 diabetes mellitus. Adrenal insufficiency due to isolated adrenocorticotropic hormone (ACTH) deficiency was also diagnosed based on his eosinophilia, decreased ACTH (<1.5 pg/mL) and cortisol (1.65 μg/dL) levels, and loading test results. While the diagnostic criteria for fulminant type 1 diabetes mellitus were not met (no evidence of ketosis at the time of the diagnosis), his adrenal insufficiency may have contributed to the suppression of ketone production. This is the first report of the occurrence and diagnosis of type 1 diabetes mellitus and adrenal insufficiency around the same time, which are individually known to be adverse reactions to pembrolizumab. Since adrenal insufficiency may have delayed the manifestation of hyperglycemia, close attention should be paid during diagnostic testing to detect symptoms.

Adolescents tend to suffer from psychological problems, and patients with type 1 diabetes mellitus (T1DM) it can find it difficult to accept their disease. We herein report a patient with T1DM who resolved her psychosocial problems through the introduction of an insulin pump. The patient developed T1DM at 13 years old. She suffered from psychosocial problems, such as absence from elementary school due to bullying and a lack of sufficient care from her parents. She had many younger brothers and sisters and worried about causing accidental needle injuries. Consequently, she voluntarily started insulin pump therapy. We enacted psychosocial and behavioral medicine interventions, such as an empowerment-based approach and cognitive behavioral therapy, at the introduction of the insulin pump. As a result, she was able to develop self-efficacy through overcoming the various difficulties she encountered when using the insulin pump and gained a positive outlook and confidence through her treatment. In addition, her trust in others enabled her to work on her psychosocial problems, and she was able to return to school.

A 66-year-old woman was admitted to our hospital with diabetic ketoacidosis of remarkably acute onset. Her plasma glucose concentration was 719 mg/dL, her HbA1c level was 5.9 %, and her urine C-peptide level was undetectable. Based on the diagnostic criteria for fulminant type 1 diabetes (FT1D), the patient was diagnosed with FT1D. The patient was positive for anti-GAD antibody. She possesses an HLA DR-DQ haplotype, which is very rare for Japanese.

Case 1: A 46-year-old man with a medical history of type 2 diabetes mellitus (T2DM) presented to our hospital with chief complaints of thirst and malaise. On admission, he had a fever, increased inflammatory response, and high HbA1c (14.2 %). Blood cultures on admission were positive for Staphylococcus aureus, and abscesses were detected by contrast-enhanced computed tomography (CT) in the prostate, lung, and thigh muscles. The prostate abscess was treated by surgical drainage, and the infections resolved in response to cefazolin treatment. Case 2: A 64-year-old man with a 25-year history of DM and elevated HbA1c levels (13.4 %) was admitted to a hospital due to pyuria. Blood cultures indicated the growth of Staphylococcus aureus; cefazolin was initiated, and the patient was transferred to our hospital for further treatment. Contrast-enhanced CT revealed abscesses in the prostate and hip joint; both resolved with antibiotic administration. Prostate abscess is a rare disease in patients with DM. The infection has no specific symptoms, but it may result in bacteremia if left untreated.