Objective: Because patients with diabetes mellitus (DM) were forced to stay indoors during the state of emergency, resulting in stress and a lack of physical activity, concerns about their glycemic control were raised. Patients and Methods: The 165 patients’ glycated hemoglobin (HbA1c) levels were compared during the following periods: the 4 months that were selected as a representative condition 1 year before the COVID-19 pandemic (May 2018, March 2019, June 2019, and July 2019) and the latter 3 months as a 1-year follow-up during the COVID-19 pandemic (May 2019, March 2020, June 2020, and July 2020). Results: The patients’ HbA1c levels were 7.32 ± 1.23, 7.44 ± 1.20, 7.16 ± 1.06, 7.01 ± 1.05, 7.23 ± 1.06, 7.45 ± 1.18, 7.15 ± 10.7, and 7.11 ± 1.17 in May 2018, March 2019, June 2019, July 2019, May 2019, March 2020, June 2020, and July 2020, respectively (expressed as mean ± standard deviation). Conclusion: The analysis showed that HbA1c levels did not worsen during the self-restraint period.

In this study, we compared the efficacy of a dipeptidyl peptidase-4 inhibitor (DPP4i) to improve glucose control in patients with type 2 diabetes mellitus (T2DM) with or without Hashimoto's thyroiditis (HT). First, we compared the change in glycated hemoglobin (HbA1c) between the hypothyroid condition (before levothyroxine sodium hydrate [LT4] treatment) and euthyroid condition (after LT4 treatment when patients had achieved euthyroidism for at least six months) in patients with T2DM and HT. Next, we compared the change in HbA1c levels before and six months of DPP4i treatment in patients with T2DM with and without HT. In hypothyroid condition the change in HbA1c after six months of DPP4i treatment was 0.13% ± 0.86%. The change in HbA1c levels from when patients first achieved euthyroidism to after six months in the euthyroid condition was 0.26% ± 0.90%. DPP4i efficacy in patients with T2DM and HT was reduced compared to patients with T2DM but without HT (-0.40 ± 0.90 vs. -0.99 ± 0.5, p = 0.0032). These data suggest that hypothyroidism does not impact on DPP4i efficacy. However, the effect of DPP4i in patients with T2DM and HT was reduced compared to that in T2DM patients without HT. An estimation of thyroid function before prescribing DPP4i may be useful tool for predicting the efficacy of DPP4i, allowing the ruling out complications from HT.

Anemia due to angiotensin receptor blocker (ARB) therapy has been previously reported in patients with diabetes mellitus with glomerular filtration rates of <60 mL min -1 /1.73 m 2 . However, whether Japanese patients with type 2 diabetes mellitus (T2DM) receiving ARB therapy for chronic cardiac failure and chronic kidney disease develop reduced hemoglobin (Hb) levels has not been elucidated. Thus, this cross-sectional study was conducted, and Hb levels were compared between patients with T2DM with and without ARB administration. No significant difference in the prescribed proportion of antidiabetic medicines such as biguanide, sodium glucose co-transporter 2 inhibitors, and α-glucosidase inhibitors was found between the group treated with ARBs and the group without ARBs. Thus, we considered that the effects of antidiabetic medicines on the results were minimum. In this study, the Hb levels of patients who received ARBs (13.8 ± 1.7 g/dL) were significantly lower than those of patients without ARBs (14.9 ± 1.35 g/dL) (p = 0.034). The difference between this study and a previous study relies on eGFR levels. Thus, the eGFR levels of the patients in this study and the previous study were above 60 and below 60 mL min -1 /1.73 m 2 , respectively. Despite those differences, both studies showed that the use of ARBs was associated with a decrease in Hb levels in patients with T2DM. Thus, the evaluation of glycated Hb levels should be focused on whether ARBs are prescribed for patients with T2DM.

COVID-19 pandemic poses problems that not only concern the economy but also the health of people all over the world. In Japan, despite the declaration of a “state of emergency”, no lockdown was implemented, and a request for self-restraint and avoidance of non-essential trips was instead issued. After a month, the state of emergency was lifted. Because patients with diabetes mellitus (DM) were forced to stay during the state of emergency, resulting in a lack of physical activity, concerns about their glycemic control were raised. Therefore, glycated hemoglobin (HbA1c) levels during different time periods were compared (May 2018, March 2019, June 2019, July 2019, May 2019, March 2020, June 2020, July 2020). We analyzed 165 patients with DM. The mean age of subjects was 67.8 + 11.5 years. Male comprised 67.3% of the participants. The mean body weight was 65.6 + 14.6 kg on July 2019 and 66.1 + 15.2 kg on July 2020. The mean body mass index (BMI) was 24.4 + 3.6 kg/m2 on July 2019 and 24.4 + 3.6 on July 2020. Patients with Type 2 DM (T2DM) comprised 90% of the participants, while the rest had T1DM. Mean duration of DM was 12.0 + 7.4 years. In order to assess the effect of the self-restraint on plasma glucose control, HbA1c levels during these periods were compared: May 2018, March 2019, June 2019, July 2019 (one year before COVID-19 pandemic.), and May 2019, March 2020, June 2020, July 2020 (The last three months during COVID-19). March 2020 is corresponded to a period before the request for self-restraint, while June and July 2020 corresponded to the periods right after the end of self-restraint. We also compared HbA1c levels between May 2019 and July 2020 using the Self-Monitoring of Blood Glucose (SMBG) to assess whether SMBG affected plasma glucose control during the period of self-restraint. HbA1c levels in May 2018, March 2019, June 2019, July 2019, May 2019, March 2020, June 2020, July 2020, were 7.32 + 1.23, 7.44 + 1.20, 7.16 + 1.06, 7.01 + 1.05, 7.23 + 1.06, 7.45 + 1.18, 7.15 + 10.7, and 7.11 + 1.17, respectively. Similarly, HbA1c levels between May 2019 without SMBG and May 2019 with SMBG were not statistically different. In this clinical study, we found that the request to avoid non-essential trips as a form of self-restraint during the country’s state of emergency did not affect plasma glucose control of patients with DM. We noted that the patients did not have signs of insulin resistance as their BMI on July 2019 and July 2020 were 24.4 + 3.6 and 24.4 + 3.6, respectively. Unexpectedly, the HbA1c levels were not affected by the absence or presence of SMBG. This could explain why HbA1c levels were not elevated, despite a temporarily sedentary lifestyle and a lack of exercise for a month. In addition, due to the self-restraint, the frequency of dining outside the house decreased, which could have contributed to the non-elevation of HbA1c levels.