Aims/IntroductionTo our knowledge, no studies have reported that cognitive tests can be used to evaluate whether or not patients can acquire the insulin self‐injection technique. We investigated whether or not the number of animal names recalled in 1 min by elderly diabetes patients could be used as a predictor of the patients’ ability to acquire the insulin self‐injection technique within 1 week.Materials and MethodsWe enrolled 57 inpatients with type 2 diabetes aged >60 years who were starting insulin therapy. We carried out the Mini‐Mental State Examination and verbal fluency tests, which included recalling animal names and common nouns starting with the letters ‘a,’ ‘ka’ and ‘shi’ (Japanese letters). We used 12 checkpoints for insulin self‐injection to judge the patients’ levels of acquisition of the technique. The most predictive cognitive test was determined by multivariate logistic regression analysis.ResultsIn the present study, multivariate logistic analysis showed that the number of animal names recalled was the most reliable predictor of the ability to acquire the insulin self‐injection technique within 1 week. A figure of 11 animal names predicted a successful acquisition, with a sensitivity of 73% and a specificity of 91% being observed (area under the curve 0.87, 95% confidence interval 0.76–0.97, P < 0.01).ConclusionsThe number of animal names recalled in 1 min was the most useful indicator of the ability of elderly diabetes patients to learn to manage insulin self‐injection therapy within 1 week. The cut‐off value was 11 animal names.

Aims/Introduction Renal dysfunction might quickly progress in patients with type 2 diabetes mellitus, when accompanied by hypertension. However, whether primary aldosteronism (PA), which autonomously over‐secretes aldosterone, causes additional renal damage in patients with type 2 diabetes mellitus is unclear. We evaluated the impact of PA on renal function in patients with type 2 diabetes mellitus. Materials and Methods A retrospective review of all patients with type 2 diabetes mellitus who visited Yokohama Rosai Hospital’s (Yokohama Japan) outpatient department between April 2017 and March 2018 was carried out. Records of patients with PA who underwent PA treatment by adrenalectomy or mineralocorticoid receptor antagonists (PA group) and those without PA (non‐PA group) were extracted, and renal function was compared between the two groups. Untreated PA patients were excluded, as their renal function might be overestimated as a result of glomerular hyperfiltration. Results There were 83 patients in the PA group and 1,580 patients in the non‐PA group. The PA group had significantly lower estimated glomerular filtration rates than the non‐PA group (66.3 [52.4–78.2] vs 70.5 [56.0–85.6] mL/min/1.73 m2, P = 0.047). Multiple regression analysis showed that PA was a factor for decreased estimated glomerular filtration rate, independent of age, sex, glycated hemoglobin, diuretic use and hypertension (P = 0.025). PA induced a 3.7‐mL/min/1.73 m2 (95% confidence interval 0.47–6.9) decrease in estimated glomerular filtration rate, equivalent to that induced by 4.4 years of aging. Conclusions Our results show that in patients with type 2 diabetes mellitus, PA is an independent risk factor for renal dysfunction. To prevent the progression of renal failure, PA should not be overlooked.

A 77-year-old-man with renal cell carcinoma who was undergoing nivolumab treatment visited our department due to hyperglycemia; his plasma glucose level was 379 mg/dL. Although his serum C-peptide immunoreactivity (CPR) level was preserved (5.92 ng/mL), we suspected an onset of fulminant type 1 diabetes mellitus (FT1DM) and immediately started insulin therapy. His CPR levels gradually decreased and were depleted within 1 week. We later discovered that the patient's casual CPR level had been abnormally high (11.78 ng/mL) 2 weeks before his admission. Hence, the possibility of FT1DM in hyperglycemic patients undergoing nivolumab treatment should not be excluded, even with a preserved CPR level.

Background: Renin suppression in primary aldosteronism indicates mineralocorticoid receptor activation via excessive aldosterone secretion, inducing renal damage. We investigated whether the reversal of renin suppression after the initiation of mineralocorticoid receptor antagonist therapy was associated with long-term renal outcomes in medically treated patients with primary aldosteronism. Methods: This retrospective cohort study included 318 patients with primary aldosteronism treated with mineralocorticoid receptor antagonist between 2008 and 2020 at the Yokohama Rosai Hospital in Japan. The posttreatment renin status was defined as unsuppressed (ie, reversal of renin suppression) when individual plasma renin activity after the initiation of mineralocorticoid receptor antagonist (post-plasma renin activity) was ≥1.0 ng/(mL h); otherwise, it was defined as suppressed. We analyzed the association of posttreatment renin status with subsequent longitudinal estimated glomerular filtration rate changes using linear mixed-effects models for repeated measurements, adjusting for potential confounders. Results: The posttreatment renin status of 119 patients was unsuppressed (median post-plasma renin activity, 1.7 ng/[mL h]) and that of 199 patients was suppressed (median post-PRA, 0.5 ng/[mL h]). Through the median follow-up period of 3.1 years, the decline in estimated glomerular filtration rate was milder among patients with the unsuppressed posttreatment renin (−0.46 [95% CI, −0.63 to −0.28] mL/min per 1.73 m 2 per year) than those with suppressed posttreatment renin (−1.41 [95% CI, −1.56 to −1.27] mL/min per 1.73 m 2 per year; difference, 0.96 [95% CI, 0.72–1.20] mL/min per 1.73 m 2 per year). Conclusions: Our findings may highlight the importance of reversing renin suppression with optimal mineralocorticoid receptor antagonist titration in medically treated primary aldosteronism, which could mitigate adverse renal outcomes.