In this study, the Japanese version of the Treatment Self-Adjustment Questionnaire for Diabetics (TSRQ-DJ), an instrument that asks people with type 2 diabetes their reasons for engaging in diabetic self-management behaviors, was developed and validated. A questionnaire survey was administered to a panel of patients with diabetes who registered with an online survey company, and 510 valid responses were obtained. A confirmatory factor analysis revealed that the model fit of the two-factor, 19-item structure, which was the same as the original version, was low; thus, the questionnaire was refined to a two-factor, 14-item structure. The goodness of fit of the improved model (GFI, 0.91; CFI, 0.6; and RMSEA, 0.08) indicated that the model fit was generally good. Cronbach's alpha was 0.91, indicating high reliability. The "autonomous motivation" and "controlled motivation" subscales showed a positive correlation (r_s = 0.49). J-SDSCA-r, PCDS, and each subscale showed a positive correlation, similarly to the characteristics of the original version of the TSRQ. In conclusion, the TSRQ-DJ is a reliable and valid scale, and its potential for use as a Japanese version of the TSRQ has been demonstrated.

We report a case involving an obese patient with type 2 diabetes and dilated cardiomyopathy, in which the long-term improvement of left ventricular contractility was observed after the administration of empagliflozin. The patient was a 45-year-old man. He developed heart failure at 30 years of age and was diagnosed with dilated cardiomyopathy. He developed type 2 diabetes at 33 years of age and was treated with an oral hypoglycemic drug; however, empagliflozin (10 mg) was started due to poor glycemic control. The patient's glycemic control improved and weight loss was noted. Before the start of empagliflozin, the left ventricular diastolic dimension (LVDd) was 55.5 mm, the left ventricular systolic dimension (LVDs) was 41.0 mm, and the left ventricular ejection fraction (LVEF) was 48.1 %, as measured by echocardiography. After 4 years and 7 months, the LVDd was 46.5 mm, the LVDs was 29.8 mm, and the LVEF was 65.6 %. This was an extremely rare case in which long-term improvement in left ventricular contractility was obtained after the administration of empagliflozin. It is a very suggestive and valuable case for observing the effect of SGLT2 inhibitors on left ventricular contractility.