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Subcutaneous insulin resistance syndrome is a rare condition that causes difficulty in glycemic control due to severe resistance to subcutaneous insulin injections. We herein present a case of a 40-year-old woman with type 2 diabetes mellitus who had been diagnosed with subcutaneous insulin resistance syndrome since the age of 29 years, and had been persistently treated with continuous subcutaneous insulin infusion using a mixture of insulin lispro and heparin. The patient was switched from insulin lispro plus heparin to ultra-rapid insulin lispro; given that it contains treprostinil and citrate, it is expected to have similar effects as heparin, and shows similar glucose-lowering effects and insulin absorption. Our results suggest that treatment with ultra-rapid insulin lispro is effective for subcutaneous insulin resistance syndrome.

Background Severe hypoglycemia (SH) remains a central problem in the management of type 1 diabetes (T1D); however, little is known about the protective and risk factors associated with recurrent SH (RSH). This study aimed to identify the protective and risk factors for RSH in adults with T1D. Methods This cross-sectional study enrolled 287 adults with T1D (mean age: 50.3 ± 14.5 years, male: 36.2%, diabetes duration: 17.6 ± 11.2 years, mean HbA1c: 7.7 ± 0.9%) and divided them into non-SH (n = 262), solitary SH (n = 17), and RSH (n = 8) groups. Impaired awareness of hypoglycemia (IAH) assessed using the Gold’s method, diabetic complications, fear of hypoglycemia, diabetes distress, hypoglycemia problem solving abilities, and treatment data were collected. Results The overall SH rate was 16.7/100 person-years. The odds ratios of diabetic peripheral neuropathy and IAH were associated with an increased risk of RSH (odds ratio [OR]: 5.53 ,95% confidence interval [CI]: 1.18–25.98 and OR: 4.82 [95% CI:1.09–21.23], respectively); hypoglycemia problem-solving perception score was associated with a decreased risk of RSH (OR: 0.35 [95% CI: 0.18–0.69]). The rate of rtCGM use decreased as the SH category increased, but no difference was found in the rate of isCGM use. Conclusion We identified the protective factors, such as hypoglycemia problem-solving perception, in addition to the risk factors for RSH in adults with T1D. Trial registration: University hospital Medical Information Network (UMIN) Center: UMIN000039475)、Approval date 13 February 2020

This paper presents a case with type 2 diabetes mellitus on a very low-carbohydrate diet who developed euglycemic diabetic ketoacidosis (EDKA) 3 days after starting sodium-glucose cotransporter 2 inhibitors (SGLT2i). When initiating SGLT2i, healthcare providers should confirm the implementation of a low-carbohydrate diet and provide intensive guidance to prevent EDKA.

Background Hypoglycemia in type 1 diabetes (T1D) is associated with mortality and morbidity, especially when awareness of hypoglycemia is impaired. This study aimed to investigate the protective and risk factors for impaired awareness of hypoglycemia (IAH) in adults with T1D. Methods This cross-sectional study enrolled 288 adults with T1D (mean age, 50.4 ± 14.6 years; male, 36.5%; diabetes duration, 17.6 ± 11.2 years; mean HbA1c level, 7.7 ± 0.9%), who were divided into IAH and non-IAH (control) groups. A survey was conducted to assess hypoglycemia awareness using the Clarke questionnaire. Diabetes histories, complications, fear of hypoglycemia, diabetes distress, hypoglycemia problem-solving abilities, and treatment data were collected. Results The prevalence of IAH was 19.1%. Diabetic peripheral neuropathy was associated with an increased risk of IAH (odds ratio [OR] 2.63; 95% confidence interval [CI] 1.13–5.91; P = 0.014), while treatment with continuous subcutaneous insulin infusion and hypoglycemia problem-solving perception scores were associated with a decreased risk of IAH (OR, 0.48; 95% CI, 0.22–0.96; P = 0.030; and OR, 0.54; 95% CI, 0.37–0.78; P = 0.001, respectively). There was no difference in continuous glucose monitoring use between the groups. Conclusions We identified protective factors in addition to risk factors for IAH in adults with T1D. This information may help manage problematic hypoglycemia. Trial registration: University hospital Medical Information Network (UMIN) Center: UMIN000039475)、Approval date 13 February 2020

We conducted a randomized, crossover trial to compare intermittent-scanning continuous glucose monitoring (isCGM) device with structured education (Intervention) to self-monitoring of blood glucose (SMBG) (Control) in the reduction of time below range.This crossover trial involved 104 adults with type 1 diabetes mellitus (T1DM) using multiple daily injections. Participants were randomly allocated to either sequence Intervention/Control or sequence Control/Intervention. During the Intervention period which lasted 84 days, participants used the first-generation FreeStyle Libre (Abbott Diabetes Care, Alameda, CA, USA) and received structured education on how to prevent hypoglycemia based on the trend arrow and by frequent sensor scanning (≥10 times a day). Confirmatory SMBG was conducted before dosing insulin. The Control period lasted 84 days. The primary endpoint was the decrease in the time below range (TBR;70 mg/dL).The time below range was significantly reduced in the Intervention arm compared to the Control arm (2.42 ± 1.68 h/day [10.1 %±7.0 %] vs 3.10 ± 2.28 h/day [12.9 %±9.5 %], P = 0.012). The ratio of high-risk participants with low blood glucose index 5 was significantly reduced (8.6 % vs 23.7 %, P 0.001).The use of isCGM combined with structured education significantly reduced the time below range in patients with T1DM.

This university has published the "MMDAgent" voice interaction system toolkit as opensource software. MMDAgent enables users to develop voice interaction system easily by editing the voice interaction scenario based on Finite State Transducer (FST) format. For increase agent's vocabulary, it is important to describe a lot of voice interaction scenario. Until now, voice interaction scenario has been described by a small organization. So, it takes a high cost to describe a lot of voice interaction scenario. For solve this problem, we construct crowdsourcing model for creation voice interaction scenario. In this study, the works of creation of voice interaction scenario is devided and distributed to a large number of people via the internet.

This university has published the "MMDAgent" voice interaction system toolkit as open source software. Voice Interaction Agent, produced using MMDAgent, is active in various scenarios and provides voice interaction capability. Voice interaction agents produced using MMDAgent talk to people by loading a script file that describes a voice interaction scenario. To increase the agent's vocabulary, it is important to describe many voice interaction scenarios. To date, voice interaction scenarios have been described by a small organization. Therefore, they require high costs to describe many voice interaction scenarios. To resolve this problem, we construct a crowdsourcing[1] model for the creation of a voice interaction scenario. In this study, the works of creation of voice interaction scenario are divided and distributed to numerous people via the internet. Furthermore, we provide in this study a tool for creation voice interaction scenario and test operation of voice interaction agent as a web application service. We hereby reduce the cost of installation MMDAgent and provide a comfortable environment for the creation voice interaction scenario.

This university has published the “MMDAgent” voice interaction system toolkit as opensource software. MMDAgent enables users to develop voice interaction system easily by editing the voice interaction scenario based on Finite State Transducer (FST) format. However, having numerous people edit it simultaneously is difficult. For that reason, tremendous labor costs are necessary to describe an abundant voice interaction scenario in an FST script. Therefore, in this study, we propose construction of a crowdsourcing environment for the creation of a voice interaction scenario for systems, facilitating the editing of a FST script by numerous people.