The Japan Society of Hepatology issued the "Nara Declaration 2023," which establishes an alanine aminotransferase (ALT) threshold of > 30 U/L for the early detection and management of liver diseases. Given the high prevalence of fatty liver disease among diabetic patients, this study aimed to assess the proportion of individuals with type 2 diabetes who met the criteria outlined in the "Nara Declaration 2023." A total of 4,021 patients with type 2 diabetes whose ALT levels were measured at our clinic throughout 2023 were included in the analysis. Of these, 965 (24.0 %) had ALT levels > 30 U/L. In this group, 614 patients (15.3 %) met the criteria for referral to a gastroenterologist, which was defined as platelet count < 200,000/μL or FIB-4 index ≥ 1.3. The demographic characteristics of the patients recommended for referral indicated a higher prevalence of males and older individuals.
We have been providing group (diabetic nephropathy class; DN class) and individual education at outpatient clinics to inhibit renal functional decline and delay the introduction of hemodialysis in patients with DN. Unfortunately, some patients who attended the class developed HD. Therefore, we aimed to clarify the characteristics of these patients in this study. We included 96 patients who attended the DN class held at our hospital from 2002 to 2010 and classified them into four groups using cutoff values obtained from ROC curves (urinary protein excretion [UP] 1.3 g/day, eGFR change from 6 months before the class to the time of the class [ΔeGFR] −0.3 mL/min/1.73 m2/month). The clinical characteristics of HD and non-HD patients were compared in each group. Patients who had UP ≥1.3 g/day at the time of participation in the class were at higher risk for the induction of HD and had a shorter time to induction. On the other hand, some patients with UP < 1.3 g/day had HD induction when UP at 1 year tended to be high regardless of the ΔeGFR value. Even in participants with group education, it was suggested that the amount of UP change influences the pathophysiological changes that lead to HD.
HNF1B-MODY is sometimes associated with agenesis of the dorsal pancreas, and the phenotypes reported in adults range from cases in which endogenous insulin was depleted to cases treated as type 2 diabetes (T2D). In children, many cases are diagnosed with type 1 diabetes, and there are few reports of cases treated for T2D. The patient was a 10-year-old boy with mild obesity who was being treated for T2D. He was referred to our hospital because his HbA1c level worsened even after treatment with oral hypoglycemic agents. Pancreatic islet-related autoantibodies were negative, ketosis was not observed, and the ΔCPR value determined by glucagon loading did not suggest an obvious decrease in insulin secretion. However, he had lost weight in the past month and insulin was indispensable for blood sugar control. Imaging tests revealed a defect in the pancreatic body and tail, and a cyst in the right kidney, and genetic testing confirmed the diagnosis of HNF1B-MODY. In HNF1B-MODY, decreased insulin secretion may not be obvious; therefore, even in pediatric patients with T2D, the diagnosis must be reconsidered if the clinical course is atypical.