We compared the effects of two kinds of commercial diets, termed MM3 for “long-term rearing”(high fiber diet) and MB3 for “special breeding”(low fiber diet), on the development of spontaneously occurring diabetes in WBN/Kob rats. Male WBN/Kob rats were fed MM3 or MB3 after weaning. Although there was no significant difference in peak body weight between the two groups, body weight in the MB3-fed group reached a peak earlier than that in the MM3-fed group. Food intake in both groups increased after the onset of diabetes. Before the onset of diabetes, although there was no significant difference in caloric intake between the two groups, a remarkable difference in dietary fiber intake was observed. At 14 weeks of age, the MB3-fed group showed glucose intolerance while the MM3-fed group did not. At 40 and 54 weeks of age, glucose tolerance in the MB3-fed group was more impaired than that in the MM3 fed group. Morever, the IRI response during OGTT in the MB3-fed group was lower than that in the MM3-fed group.
These data suggest that the difference in diabetes development between rats on the two kinds of diet might be caused by differences in dietary fiber intake.

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The prevalence of diabetes mellitus was studied in Toshima Island, Tokyo, with high response rates to screening tests and 75g0GTT. In September 1990, 311 inhabitants of Toshima Island (168males, 143 females) were surveyed for the 1988-1991 period. From among 291 subjects (94% of all inhabitants) screened by post-prandial urine glucose test, 19 subjects with positive urine glucose were selected. From among 115 adults (47% of inhabitants over 20 years of age) screened by determination of fasting plasma glucose (FPG), 18 subjects with FPG≥110 mg/dl were selected. Excluding 7 previously-known diabetics, 19 of 21 screened subjects received 75gOGTT. Five showed diabetic glucose tolerance (by the criteria of the Japan Diabetes Society, 1982). Without OGTT, 1 subject was diagnosed as diabetic because of hyperosmolar non-ketotic diabetic coma. Altogether, 13 subjects (9 males and 4 females) were diagnosed as diabetics.
These results indicate that the prevalence of diabetes in Toshima Island in 1990 was 4.5% for all ages (male, 5.7%; female, 3.0%). The prevalence increased with age; 7.6% of those older than 40 years, and 11.0% of those older than 60 years. These data demonstrate that repeated simple screening tests with follow-up OGTT in a local area are a potentially useful method of determining the prevalence of diabetes in the area.

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Annual changes in total daily insulin dosage were examined in 15 Japanese patients with a history of insulin-dependent diabetes mellitus exceeding 25 years (5 males and 10 females, mean age at onset; 4.9 years). Their heights and weights were within normal±2 SD, except for 1 male and 3 females whose heights were 2 SD under the mean. Mean total insulin dosage increased rapidly between 14 yr (1.3 U/kg/day) and 15 yr (1.7 U/kg/day), and reached a peak level at 17-18 yr (1.8 U/kg/day) in male patients. In female patients, the dosape increased gradually from 10 yr (0.9 U/kg/day) to 14 yr (1.5 U/kg/day), and reached a plateau stage at 14-20 yr (1.5 U/kg/day). Thereafter, that of patients with normal height and weight decreased until 30 yr, and was stable at 0.8-1.0 U/kg/day in males and at 0.6-0.7 U/kg/day in females. Among patients whose heights were 2 SD below the mean, insulin dosage was evidently low in one patient as compared with those showing normal growth.

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Personality traits of 51 patients, participating in our diabetes education program, were measured by Picture-Frustration Study, and patient compliance was evaluated in terms of the amount of knowledge, familiarity with the food exchange list, the skill to make reasonable meal plans and learning attitude. The following characteristics contributed positively to the attainment of good compliance. 1) Intraggression: in which one attributes the cause of frustration to oneself followed by attempts to solve the difficulty. 2) Ability for self-reflection. 3) Imaggression: in which one considers accidents which occur as luck, fate or chance. These individuals accept a situation with patience. 4) Maturity of psychological development. On the other hand, extraggression, the tendency to impute the cause of frustration to others and to depend on them for solving difficulties, showed a negative correlation with the effects of diabetes education. Gender and age had partial effects on the amount of knowledge but no effects on the attainment of diet therapy.
Our results suggest that recognition of the personality traits of each patient is necessary before enrollment in a diabetes education program so that the mode of education can be adjusted to the patient.

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Twenty-five obese NIDDM patients, 20 men and 5 women, visiting our diabetic clinics over the past 3 years, showed transient ketosis. The mean age was 31 years and ranged from 15 to 67. The body mass index was 27.6±5.4kg/m² at the onset of ketosis, and maximal weight was 32.1±5.2kg/m². Only five of them had been told they had diabetes or glucosuria. Twenty-two of the 25 patients had overconsumed soft drinks, 2.2l/day on average, before seeking medical attention. The fasting serum C-peptide value was 1.90±0.96 ng/ml. Three patients were acidotic, and 7 had disturbed consciousness. After an initial period of insulin therapy, 20 patients could be treated with diet therapy alone, and 2 required oral hypoglycemic agents. Overconsumption of glucose-containing soft drinks may result in a vicious circle of glucose toxicity and thirst, leading to ketosis.

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We report a case of a diabetic patient with hemoglobinopathy who had an abnormally high HbA1c value measured by cation-exchange high performance liquid chromatography (HPLC) but had moderate HbA1c level measured by a new immunoassay system. A 43-year-old man with non-insulin-dependent diabetes mellitus was referred to our hospital because of a disproportionately high HbA₁C value (22.4%) relative to the plasma levels of glucose and fructosamine. Since a falsely elevated value of HbA1c due to the presence of abnormal hemoglobins was suspected, further analysis was performed and the patient was shown to have Hb J Cape Town, α92 (FG4) Arg-Gln. Therefore, to measure HbA1c in this patient, we applied a newly developed immunoassay system specific for the Amadori product of the three N-terminal amino acid residues of the β-chain of the HbA1c molecule. Using this immunoassay system, the patient was found to have an HbA1c level (6.3%), comparable to that of fructosamine (238 μmol/l). These findings indicate that the new immunoassay system is applicable to the measurement of HbAI c levels in diabetic subjects with certain types of hemoglobinopathy in whom the standard HPLC method cannot be used to assess glycemic control.

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Glycemic control by continuous subcutaneous insulin infusion (CSII) therapy in patients with IDDM was worse after treatment with short-acting neutral human insulin with m-cresol and without a buffer (B) than during treatment with short-acting neutral human insulin with methyl p-hydroxybenzoate and buffer (A). We assessed 6 women and 2 men with IDDM, aged 38-61 years, 3 of whom had simple retinopathy or albuminuria. They were treated with CSII using A insulin for more than 2 years.The means (±SD) of mean blood glucose per day, mean amplitude of glycemic excursion, glycohemoglobin A1C and fructosamine were 108±43 mg/dl, 67±27 mg/dl, 6.6±1.9% and 323±58/2mol/l, respectively, indicating that good glycemic control had been achieved. There was no trouble in any of the patients. One month after treatment with CSII using B insulin, the parameters had significantly (p<0.05) increased to 183±48 mg/dl, 142±73 mg/dl, 6.9±1.1% and 348±721umol/l, respectively, and this persisted for 3 months.In all patients, insulin delivery via the catheter was frequently occluded, causing pump failure in 1 patient, bone fracture due to severe hypoglycemia in 1 patient and acute pneumonia in 1 patient. The results indicate that the type of insulin preparation used in CSII is important, since insulin may be aggregated byauxiliar substances in insulin preparation. Resolving this problem will be a major issue in the future.

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