IntroductionEmerging evidence suggests that diabetes stigma and negative emotions associated with it may impair the quality of life of people with diabetes. Among these psychological distresses, shame is considered the most distressing of all human emotional experiences and may be a condition to which diabetes clinicians should pay attention. This epidemiological study focused on diabetes-related shame and aimed to determine the prevalence of diabetes-related shame, its factors, and its association with psychological indicators.Research design and methodsA cross-sectional online survey was conducted among people with type 2 diabetes preregistered with a research firm. The questionnaire included experience of diabetes-related shame and demographic data such as age, clinical characteristic measures such as hemoglobin A1c (HbA1c), and psychological indicators, including the WHO Five Well-Being Index (WHO-5) and Problem Areas In Diabetes-5 (PAID-5). Differences in each indicator between people with diabetes who experienced shame and those who did not were analyzed with the unpaired t-test. As supplemental analysis, binomial logistic regression analysis was used to identify factors associated with the prevalence of diabetes-related shame.ResultsOf the 510 participants, 32.9% experienced diabetes-related shame and 17.5% concealed their disease from colleagues or friends. Those who had experienced diabetes-related shame showed significantly lower WHO-5 and higher PAID-5 scores (p<0.001). However, no significant difference was found in HbA1c (p=0.36). Binomial logistic regression revealed that women, young adults, those without a college degree, those with low self-efficacy, and those with a strong sense of financial burden or external pressure were at higher risk of experiencing diabetes-related shame.ConclusionsAmong people with type 2 diabetes mellitus, diabetes-related shame was associated with diabetes-specific emotional distress and low psychological well-being. Further research and care development are needed to address diabetes-related shame and improve the quality of life of people with diabetes.

Hiccups (singultus) are one of the most challenging symptoms to diagnose a cause. Causes range from the gastrointestinal and cardiovascular systems to the neurological system. 1 It is essential to remember that area postrema syndrome (APS), particularly in cases caused by neuromyelitis optica spectrum disorders (NMOSD), is an important differential diagnosis. 2 Persistent and intractable hiccups are a representative symptom in patients with NMOSD and associated with damage to areas abundant with the aquaporin protein. [3][4][5] However, intractable hiccups caused by APS with NMOSD rarely are associated with sick sinus syndrome (SSS). 6,7 | C A S EA 77-year-old man presented with an acute onset of hiccups and reported vomiting 8 days prior to admission. Hiccups occurred about 10 times per minute and persisted over 48 hours. An electrocardiogram (ECG) did not show any abnormal findings. A gastrointestinal endoscope revealed an esophageal hiatal hernia and atrophic gastritis, but there was no clear cause of the hiccups. Intravenous administration of metoclopramide, haloperidol, diazepam, and chlorpromazine did not relieve the hiccups. At this point, he was transferred to our hospital, where he lost consciousness because of sinus arrests lasting 13 seconds. He was diagnosed with SSS (Figure 1A

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A 25-year-old Nepalese woman was referred to our hospital because of fever and intermittent abdominal pain with inguinal lymphadenopathy, which had lasted for several months. A liver biopsy of the positron emission tomography-positive lesion led to a diagnosis of hepatic tuberculosis. After the initiation of antituberculosis treatment, her symptoms resolved. However, 11 days after treatment initiation, chest and back pain, high-grade fever, and vomiting appeared and gradually worsened. She developed anemia and her serum ferritin level was elevated. Hemophagocytic syndrome due to the initial deterioration of tuberculosis was suspected and steroid therapy was initiated with the continuation of the antituberculosis drugs. Thereafter, the patient’s condition improved remarkably.

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