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Diabetes includes various heterogeneous factors. Similar to subtypes of type 1 diabetes, type 2 diabetes may show four subtype clusters. They are cluster A: severe insulin-deficient diabetes, B: severe insulin-resistant diabetes, C: mild obesity-related diabetes, and D: mild age-related diabetes. Comparing them, the prevalence of nephropathy and cardiovascular events was highest in the cluster A. Reference data are i) the ratio of cluster A-D is 18.7%, 23.7%, 21.1%, 36.4%, ii) HbA1c for A-D is 11.05%, 8.17%, 8.49%, 7.95%, iii) event ratio of MACE is 14.4%, 10.6%, 11.4%, 9.1%. Future diabetic treatment is hopefully provided suitable for each subtype.

Background: Oral semaglutide (imeglimin) has been prescribed for patients with type 2 diabetes (T2D) as Twymeeg. Case presentation: The patient is 77-year-old male with hypertension, previous cerebral vascular accident (CVA). He continued unbalanced meal with preference of much carbohydrate. In Sept 2021, he became diabetic with HbA1c 8.8%. Results: Imeglimin 2000mg/day was started improving to 6.7% for 2 months. Discussion: Complete blood count (CBC) showed decreased Hb and increased MCV, suggesting macrocytic anemia for lack of vegetables. Much carbohydrate intake may bring T2D. Remarkable diabetic improvement may be from dual mechanisms for increasing insulin secretion and decreasing insulin resistance.

Art therapy has attracted attention in the medical field. Among them, authors have been engaged in various activities including art in hospitals. We have started the artworks using masking tape, which has various colors and the pattern. It can be also used for craft making, wrapping, decoration, and original goods such as art exhibitions. Our current work was performed on the corridor and staircase walls of Tokushima University hospital. It has psychologically three important perspectives, which are i) healing: relieving anxiety, healing the mind, ii) comfort: creating a pleasant and comfortable image, iii) wayfinding system: the wall sign can give a walk direction guide without confusion such as pilgrim walking. We plan to develop the performance in various opportunities.

Sodium-glucose Cotransporter-2 Inhibitors (SGLT2i) has been in focus for the pharmacotherapy of diabetes. SGLT2i contributes to decreasing blood pressure (BP) to some degree. BP changes were analyzed in 4 well-known mega-studies. They are Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients-Removing Excess Glucose (EMPA-REG OUTCOME) study, Canagliflozin cardioVascular Assessment Study (CANVAS), Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) and Dapagliflozin Effect on CardiovascuLAR Events (DECLARE)-TIMI 58. The ultimate goal of antihypertensive and hypoglycemic agents is not the achievement of target values, but the suppression of cardiovascular events. SGLT-2i show excellent strategy for event suppression and adjunct method for hypertension.

In the field of Complementary and Alternative Medicine (CAM), music therapy (MT) has been known and widely accepted. Authors are registered music therapists (rMTs), and continued research for MT and piano-playing. Human has five senses including hearing, sight, smell, taste and touch. Stimuli of auditory, visual and somatosensory data assemble into post parietal region, which are transmitted to prefrontal cortex. This is called as sensory-motor transformations (SMT). Consequently, neuroimaging can demonstrate several factors for activation of various brain areas, which generate the perception of musical and emotional feeling. Further research development is expected for brain function, SMT and piano-playing.

Latest Standards of Medical Care in Diabetes was presented in January 2022. Among oral hypoglycemic agents (OHAs), imeglimin has been topic for a novel agent for type 2 diabetes mellitus (T2DM). Pharmacologically, imeglimin is a cyclic molecule including triazine ring. It has both pharmacological mechanism of increased insulin action and elevation of glucose-stimulated insulin secretion (GSIS). Clinically, it showed HbA1c reduction for 0.46% by monotherapy and 0.56-0.92% by combined therapy with other OHAs. From compared administration of 500mg, 1000mg and 1500mg, 1000mg twice doses would be adequate. No remarkable treatment-emergent adverse events (TEAEs) were found for treatment of imeglimin.

Regarding COVID-19 pandemic, large waves have been found in several months. Statistic data are presented from John Hopkins University (JHU) every day. Japan has minus excess mortality until now and sharply decreased new cases in September-November, 2021. In November, new cases per day show 19 in Tokyo and 209 in Japan. Related characteristic factors include mild lockdown, basic infection control, public perspective thinking and high vaccination rate in Japan. Elderly (> 65 years) already had twice vaccination in 90.8% at present. Some COVID-19 factors include seasonal effects, 2-month cycle, changed pathogenicity and the ethnic difference of ACE1 insertion/deletion polymorphism.