We investigated the influence that hyperglycemia and elevation of blood pressure exerted on the serum concentration of Type IV collagen-7S (7S collagen) in 33 non-insulin dependent diabetic patients without clinical proteinuria and hypertension over a period of 2 years. We measured blood pressure and HbA₁c every month. The averages of mean blood pressure (MBP) and HbA1c for 6 months before study were used as the initial MBP and HbA₁c. MBP and HbA1c levels obtained by follow-up were taken as the averages of MBP and HbA1c, respectively, over the course of 2 years. Serum concentrations of 7S collagen were significantly increased in patients with elevated MBP and HbA1c (p<0.01). But there were no significant changes in patients with elevated MBP or HbA₁c. These results suggest that the elevation of both blood glucose level and blood pressure after a period of 2 years affects serum 7S collagen concentration which may reflect the impaired metabolism of type IV collagen in the basement membrance in non-insulin dependent diabetic patients without clinical proteinuria. Control of blood glucose and blood pressure may be required for the management of vascular complications in non-insulin dependent diabetic patients.

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We examined frequency, metabolic state, and complications of diabetes mellitus among day-laborers living in Sanya-District, Tokyo Metropolis. Among about 2, 000 day-laborers who visited Johoku Welfare Center Clinic between April 1987 and March 1988, 222 subjects were selected for this study, based on past history of diabetes or positive urine sugar test. Among these subjects, 166 were diagnosed as having non-insulin-dependent diabetes mellitus on the basis of elevated plasma glucose or the presence of diabetic retinopathy. The estimated over all prevalence of diabetes was 3.2%. The 166 diabetics were 51±7 yrs of age (Mean±SD). In addition, 134 (83%) were alcohol-drinkers. At the first visit, HbA₁ showed a unimod a distribution with a peak at 11-11.9%, although random plasma glucose levels produced a bimodal distribution with two peaks at 250-299 and 500-549mg/dl.Retinopathy and proteinuria were found in 26% and 34%, respectively. Achilles tendon reflex was diminished or absent in 64%. Chronic liver diseases, such as liver cirrhosis, wen found in 103 (62%). Circulatory diseases and respiratory diseases, including pulmonary tuberculosis were found in 46 (28%) and 41 (25%), respectively.
The prevalences of diabetes and diabetic complications in Sanya-District patients seem to be similar to those of previous reports in Japan. Many of the diabetics in Sanya-District had poor metabolic control. High frequencies of chronic liver disease and pulmonary tuberculosis were notable in Sanya-District diabetics.

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We measured insulin autoantibody (IAA), insulin receptor antibody (IRAb), and islet cell antibody (ICA) in NIDDM inpatients and outpatients who had no history of insulin treatment.
In IAA-positive patients, changes in antibody titers and clinical course were evaluated after 3 years.
ICA and IRAb were measured in 9 IAA-positive patients among 185 NIDDM patients without history of insulin treatment. After 3 years, changes in these antibodies and clinical course were evaluated. At the initial measurement. ICA were positive in 2 of the 9 IAA-positive patients, but IRAb was negative in all. After 3 years, both were negative in the other 7 patients. In one of the patients positive for both IAA and ICA, the 2-hour postprandial blood IRI and CPR were relatively low and the patient required treatment with 7.5 mg of glibenclamide, and glucose tolerance had deteriorated over the 3 years.
These results suggest that 1) around 5% of NIDDM patients without history of insulin treatment are positive for IAA, 2) IAA fiter fluctuates and that 3) some of the patients who are persistently positive for IAA and ICA will show progressive deterioration in insulin secretion. Therefore, IAA is a technically a convenient and relatively useful screening marker for slowly progressive IDDM.

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A clinical study was performed to clarify the nature of limited joint mobility (LJM) in 388 diabetics (mean age 54.9±10.6 y. o., mean duration of DM 10.7±7.1 yrs) whose RA test. antinuclear factor and LE test were negative. In 62 subjects, LJM, which had persisted for more than 1 year, could be detected (the mean age 54.7±8.7 y. o., the mean duration of DM 9.7±5.6 yrs), and their clinical signs were classified into painful shoulder with restricted mobility (PSRM) in 29 cases, hand syndrome (HS) in 16, PSRM with HS in 13, restricted hip joint mobility (RHJM) in 1, PSRM with RHJM in 2, and PSRM and RHJM with HS in 1. At the onset of LJM, glycemic control was poor (HbA₁≥12.0%) in approximately 50% of cases, and the prevalence of advanced retinopathy was higher in diabetics with LJM than in age matched diabetics without LJM.
Although it remains unclear whether DM itself results in LJM, we suggest that LJM, being not uncommon in Japanese adult diabetics, can be exacerbated or caused by long term diabetic effects-advanced glycation or microangiopathy-in addition to the degenerative processes which accompany aging, in the constituent tissues of not only joints but also skin and tendons.

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Recently, high levels Of plasma Lipoprotein (a)[Lp (a)] have been considered an independent risk factor for atherosclerosis, which is the most common complication of diabetes. Therefore, fasting plasma Lp (a) levels were measured by ELISA kits [TERUMO Macra Lp (a)] in 114 NIDDM patients (60 men aged 55±1.1, 54 women aged 58±1.3), 20 NIDDM patients with renal insufficiency and 56 healthy subjects. Plasma Lp (a) levels in diabetics were significantly higher than those of controls (20.2±1.7 vs 10.8±1.1mg/dl, mean±SE). There was no significant correlation between plasma Lp (a) levels in diabetics and other factors such as age, sex, body mass index, diabetic duration and plasma levels of HbA₁c, FRA and lipids except for LDL-C. But a significant positive correlation was found between the change in Lp (a) levels and HbA₁c levels [ΔLp (a) vs ΔHbA₁c, rs=0.292, P<0.01] in 75 patients, in whom plasma Lp (a), HbA1c and FRA levels were traced for 1 to 12 months. A significant correlation was found between plasma Lp (a) levels and stage of nephropathy. We therefore conclude that NIDDM patients have high levels of plasma Lp (a) and that glycemic control can effectively reduce them.

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The present study was designed to investigate the effect of insoluble dietary fiber (IDF) on plasma lipoprotein metabolism in non-insulin dependent diabetic patients. Twelve diabetic patients (6 males and 6 females) consumed wafers containing 14.4 g of dietary fiber (DF)(hemicellulose 39.6%, cellulose 35.3%, lignin 0.7%, and soluble storage polysaccharides 24.4%) per day for 4 to 8 weeks. The plasma concentration of total cholesterol (Ch) was significantly decreased from 190± 13mg/dl (mean±S. E.) to 174±12mg/dl by the DF treatment. The plasma level of low density lipoprotein-Ch was also significantly decreased from 126±10mg/dl to 111±10mg/dl. Plasma levels of triglyceride and high density lipoprotein-Ch were not changed significantly by DF treatment. The plasma apolipoprotein B concentration was significantly decreased from 99±8mg/dl to 91±8mg/dl, but the plasma apolipoprotein A-I concentration was significantly increased from 102±5mg/dl to 107±5mg/dl. These results suggest that IDF improves plasma lipoprotein metabolism and may protect against coronary heart disease.

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To evaluate the effects of acute loading of protein from different sources on GFR, six healthy volunteers and six diabetic subjects were studied before and after ingestion of (1) tuna fish containing 0.7g/kg body weight of protein, (2) boiled egg white containing the same amount of protein as tuna fish, and (3) boiled egg white containing 1.4 g/kg body weight of protein on separate days. In addition, to assess the possible role of prostaglandins and amino acids in the response of GFR to protein, urinary excretion of prostaglandins and plasma levels of amino acids were measured during these tests. In normal subjects, GFR rose significantly (p<0.01) from 98.7±8.3ml/min/1.73m² during the baseline period to 134.5±9.2ml/min/1.73m² after ingestion of tuna fish. No significant differences were defected between GFR before and after ingestion of each amount of egg white. GFRs in diabetic subjects after ingestion of each meal were similar to the responses in healthy volunteers. Plasma levels of glycine and alanine in-creased more after ingestion of tuna fish than after administration of egg white in all subjects. No differences were found in the plasma concentrations of almost any amino acids except glycine and alanine following loads of tuna fish and egg white containing 1.4g/kg of protein. Urinary 6-keto-PGF_1α excretion increased significantly (p<0.01), from 215±11pg/min during the baseline period to 484±21pg/min following tuna fish loading in healthy volunteers. This finding could be explained either by differences in renal vasodilatory prostaglandin secretion or by the increased plasma levels of glycine and alanine observed only after ingestion of tuna fish. Thus, independent of quantity of protein ingested, administration of egg white has renal effects on GFR different from those of tuna fish.

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Pyomyositis is a primary pyogenic infection of skeletal muscle which is common in tropical climates but notably rare in temperate climates. It is impossible to identify a unifying etiologic factor for pyomyositis at present and diagnosis of this disease is difficult because symptoms are limited. However, it is known that diabetic patients with poor control suffer from defects in host defence mechanisms and impaired polymorphonuclear leukocyte functions that put them at increased risk for bacterial infections.
We report on a NIDDM patient with pyomyositis in the right erector spinae muscle that was diagnosed after treatment for diabetic ketoacidosis. The patient had no history of travel or residence in tropical climates. There was only slight tenderness and swelling in the affected area, but a low grade fever and positive CRP persisted even after blood glucose levels had improved. Findings from CT scan and scintigram led to the diagnosis of pyomyositis. The infection was treated with antibiotic therapy, and the patient was eventually able to control glucose levels with diet alone. The results in this case suggest that there may be a relationship between the onset of pyomyositis and ketoacidosis.

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A 46-year-old woman who had suffered from diabetes mellitus (DM) for 10 years developed blepharoptosis at the beginning of Dec, 1989. The symptoms were worse in the evening than in the morning. She was admitted to the hospital on Feb 20, 1990. She was diagnosed as having myasthenia gravis (MG) without thymoma (ocular form). Oral administration of 360 mg of pyridostigmine bromide was affective. DM was controlled by oral administration of 3.75 mg of glibenclamide. She was discharged on Jun 29, 1990.
Five diabetic patients with associated MG have been reported over the past 10 years in Japan. These six cases, including the present patient, were reviewed. It has been repored that the frequency of females with MG is higher than that of males with MG and that patients with MG over 70 years old are very rare. In these six cases, the male to female ratio was equal. Two of six cases were patients over 70 years old. In all six cases DM preceded MG. Two cases were IDDM; two cases, NIDDM; the remainder, unknown. In the three cases in which HLA antigens were reported, HLA-DR4 was observed. Diabetic patients with associated MG are seldom reported. In some diabetic patients MG may be a chance complication. Follow-up studies may resolve an association between DM and MG.

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