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Multicenter Study
. 2025 Apr;16(4):680-688.
doi: 10.1111/jdi.14392. Epub 2024 Dec 23.

Elucidation of the clinical traits of diabetic chorea through a questionnaire survey of people with diabetic chorea from 59 Japanese hospitals

Naoko Arakawa  1   2 , Tomohisa Aoyama  1 , Hirotsugu Suwanai  1   3 , Gotaro Toda  1 , Iseki Takamoto  4 , Yukiko Okazaki  1   5 , Takashi Kadowaki  1   6 , Toshimasa Yamauchi  1
Affiliations
Multicenter Study

Elucidation of the clinical traits of diabetic chorea through a questionnaire survey of people with diabetic chorea from 59 Japanese hospitals

Naoko Arakawa et al. J Diabetes Investig. 2025 Apr.

Abstract

Aims: Diabetic chorea refers to sudden involuntary movements developing in people with diabetes mellitus and is known to occur mainly in those with severe hyperglycemia. We conducted a questionnaire survey of case-reporting facilities in Japan to elucidate their clinical characteristics.

Methods: We searched the PubMed and Ichushi databases for case reports published from January 1, 2012, to December 31, 2017, using "diabetes" and "chorea" as keywords, and sent a questionnaire to the reporting institutions.

Results: Data from a total of 64 cases were included in this study. While most cases had severe hyperglycemia at the onset of diabetic chorea, hypoglycemia/improvement of the plasma glucose served as the trigger for the symptom in 14 cases (21.9%). The Early Remission Group (≤6 months) consisted of 39 cases (60.9%), while the Prolonged Partial Remission Group (>6 months) included 25 cases (39.1%). In the Prolonged Partial Remission Group (>6 months), there were more cases with widespread involuntary movement symptoms, a higher number of cases exhibiting typical imaging findings, and a greater incidence of chorea onset after the initiation of antidiabetic treatment, including hypoglycemia.

Conclusions: Most reported cases of diabetic chorea in Japan were elderly persons with type 2 diabetes mellitus and severe hyperglycemia, although there were also some cases in which the symptom developed in the setting of hypoglycemia. It has been suggested that rapid plasma glucose correction and hypoglycemia might be associated with the risk of development and prognosis of diabetic chorea.

Keywords: Clinical features; Diabetic chorea; Questionnaire survey.

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Conflict of interest statement

The authors have no conflicts of interests to declare. Takashi Kadowaki and Toshimasa Yamauchi are an Editorial Board member of Journal of Diabetes Investigation and a co‐author of this article. To minimize bias, they were excluded from all editorial decision‐making related to the acceptance of this article for publication.

Approval of the research protocol: This study was approved by the Ethics Review Committee of the University of Tokyo Graduate School of Medicine, and was conducted in conformity with the principles of the Declaration of Helsinki (Ethics review number: 11866‐(4)).

Informed consent: This study was a retrospective analysis, and obtaining consent from the people with diabetic chorea at each institution was difficult, and consent was obtained from those attending or fellow physicians. To protect personal information, we asked that no personally identifiable information be included in the questionnaire responses. An option for opt‐out was posted on the website of the Department of Diabetes and Metabolic Diseases at the Graduate School of Medicine, University of Tokyo, Japan.

Approval date of registry and the registration no. of the study/trial: N/A.

Animal studies: N/A.

Figures

Figure 1
Figure 1
A flowchart of selection of study cases.
See this image and copyright information in PMC

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