Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
ISSN-L : 0918-2918
57 巻, 20 号
選択された号の論文の30件中1~30を表示しています
ORIGINAL ARTICLES
  • Takashi Otsuka, Yosuke Okada, Keiichi Torimoto, Yoshiya Tanaka
    2018 年 57 巻 20 号 p. 2923-2927
    発行日: 2018/10/15
    公開日: 2018/10/15
    [早期公開] 公開日: 2018/05/18
    ジャーナル オープンアクセス

    Objective Patients on outpatient insulin therapy are at a high risk of severe hypoglycemia and a high incidence of hypoglycemic coma. However, only a few studies have explored the risk factors for hypoglycemic coma in such patients. We retrospectively analyzed the clinical characteristics of diabetic patients who had developed hypoglycemic coma during outpatient insulin therapy.

    Methods This study included 33 diabetic patients on insulin therapy who were transported to the hospital by ambulance for severe hypoglycemia. Patients with a Japan Coma Scale score <100 were classified as the non-coma group (n=18), while those with a score ≥100 (n=15) were classified into the coma group.

    Results Patients in the coma group were significantly older, with a higher proportion of elderly patients ( ≥65 years of age), than those in the non-coma group. Although no marked difference in the basal insulin dose was observed between the two groups, the bolus insulin dose was significantly higher in the coma group. However, no marked differences in the disease type or renal function were noted between the two groups.

    Conclusion An advanced age and bolus insulin dose are risk factors for hypoglycemic coma in diabetic patients on insulin therapy. Bolus insulin dose minimization should be performed in order to prevent hypoglycemic coma, especially in elderly diabetic patients.

  • Yuya Tsurutani, Kosuke Inoue, Chiho Sugisawa, Jun Saito, Masao Omura, ...
    2018 年 57 巻 20 号 p. 2929-2935
    発行日: 2018/10/15
    公開日: 2018/10/15
    [早期公開] 公開日: 2018/06/06
    ジャーナル オープンアクセス

    Objective To clarify the associations between serum omega-6 (n-6) and omega-3 (n-3) polyunsaturated fatty acid (PUFA) levels and obesity-related metabolic abnormalities in patients with type 2 diabetes.

    Methods and Materials Data from 225 Japanese patients with type 2 diabetes were cross-sectionally analyzed. The serum levels of n-6 PUFAs [dihomo-γ-linolenic acid (DGLA) and arachidonic acid (AA)] and n-3 PUFAs (eicosapentaenoic acid and docosahexaenoic acid) were measured, and the estimated Δ-5 desaturase (D5D) activity was calculated based on the AA to DGLA ratio. The associations between the composition of PUFAs and obesity-related parameters, including the body mass index (BMI), waist circumference, alanine amino transferase (ALT) level, homeostatic model assessment of insulin resistance (HOMA-IR), and body fat percentage, as measured by a bioelectrical impedance analysis, were analyzed.

    Results Among the PUFAs, the DGLA level had the strongest correlations with BMI (p<0.001), waist circumference (p<0.001), ALT level (p<0.001), HOMA-IR (p<0.001), and body fat percentage (p<0.01). AA was positively correlated and D5D was negatively correlated with several obesity-related parameters, while n-3 PUFAs did not have a constant correlation. A multivariate regression analysis revealed that the DGLA level was an independent determinant for HOMA-IR (β=0.195, p=0.0066) after adjusting for sex, age, BMI, and the ALT, triglyceride, and HbA1c levels.

    Conclusion A high serum DGLA level was associated with obesity, body fat accumulation, a high ALT level, and insulin resistance in patients with type 2 diabetes. The measurement of the serum PUFA levels may be useful for evaluating metabolic abnormalities and estimating the dietary habits of patients.

  • Yuko Iwashita, Masaki Ohya, Satoko Kunimoto, Yu Iwashita, Toru Mima, S ...
    2018 年 57 巻 20 号 p. 2937-2944
    発行日: 2018/10/15
    公開日: 2018/10/15
    [早期公開] 公開日: 2018/05/18
    ジャーナル オープンアクセス

    Objective This report presents a part of a survey pertaining to drug burden in maintenance hemodialysis patients in Japan.

    Methods A patient-reported questionnaire-based survey was conducted from September to November 2016 in six regions in Japan.

    Patients A total of 700 patients (50-79 years old) on maintenance hemodialysis for >3 years and members of the Japan Association of Kidney Disease Patients (JAKDP) were provided with the questionnaire. They were randomly selected using stratified sampling according to patient distribution observed from the Japanese Society for Dialysis Therapy Renal Data Registry (JSDT JRDR).

    Results A total of 524 (74.9%) patient questionnaires were evaluated [mean (standard deviation; SD) age, 66.6 (7.2) years; males, 63.4%; dialysis vintage, 16.9 (9.1) years]. Patients' age, gender, and regional distribution were similar to the JSDT JRDR. They were taking an average (SD) of 16.4 (8.34) and 16.3 (8.55) oral medications/day on dialysis and nondialysis days, respectively. A majority of the patients were taking ≥10 oral medications/day on dialysis (75.1%) and nondialysis (74.4%) days, with phosphate binders being the most taken (7.0 tablets/day). A similar proportion (74.4%, 72.9%, respectively) was taking ≥6 different types of oral medications/day. Most patients were taking oral medications 3 (31%, 33%), 4 (24%, 22%), and ≥5 times (31%, 30%) a day, respectively. The drug burden was similar on dialysis and nondialysis days and did not vary with dialysis vintage.

    Conclusion The number, type, and frequency of oral medications in maintenance hemodialysis patients are high in Japan. The proportion of phosphate binders was highest among the prescription medications.

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