We surveyed consecutively 622 (male: 524, female: 98) Japanese subjects who visited a private primary health clinic (Group 1) and 379 (male: 166, female: 213) patients who visited our hospital (Group 2). Plasma glucose (PG) levels were determined at fasting, and 2h after a 75g oral glucose tolerance test (OGTT) and the number of diabetes cases was calculated according to Japanese Diabetes Society (JDS) criteria or the new American Diabetes Association (ADA) criteria. Seven out of 622 (1.1%) in Group 1 had fasting PG levels of 126 to 140mg/dl and 2h OGTT PG levels of more than 200mg/dl; these resuls showed no change in the number of diabetes mellitus cases (28, 4.5%) based on either criteria. In Group 2, the number of the patients with fasting PG levels from 126 to 140mg/dl was 25/379 (6.6%), of which 8 patients did not have 2h OGTT PG levels of more than 200mg/dl. Lowering fasting PG cut off points for diagnosis did not dramatically increase the number of diabetic patients, however, the sensitivity of diagnosis according to fasting PG did decrease in these subjects.
These results suggest that not only fasting PG but also 2h OGTT PG levels should be strongly recommended for diagnosis of diabetes mellitus.

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The Great Hanshin Earthquake seriously influenced glycemic control in patients with diabetes mellitus. We studied the effect of the earthquake on HbA₁c levels in outpatients with diabetes mellitus and the factors which influenced elevation of HbA₁c levels. One hundred and ninety three diabetic patients were studied who were outpatients from our hospital, lived in the affected earthquake area, and had maintained stable glycemic control before the earthquake. HbA₁c levels of all patients significantly increased after 2 months. We defined a deteriorated case as a patient whose HbA₁c after the earthquake rose to more than the mean +2 SD of HbA₁c levels for 6 months prior to the earthquake. Thirty two percent of the patients were classified as deteriorated cases. Logistic regression analysis revealed that deterioration of glycemic control after the earthquake was independent of HbA₁c levels before the earthquake, degree of house damage, exercise therapy, regularity of taking medicine and presence of insomnia after the earthquake. However, deterioration was dependent of administration of drug therapy and diet therapy after the earthquake. Namely, patients who had been using drug therapy or who did not perform diet therapy after the earthquake had poorer glycemic control after the earthquake. Furthermore, HbA₁c levels before the earthquake of patients who did not practice diet therapy were significantly higher than the levels of the patients who had practiced good control with diet therapy.

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We have been carrying out an epidemiological survey of circulatory diseases in two rural communities in Hokkaido, Japan, since 1977. Glucose tolerance tests were performed on 1, 996 inhabitants who were selected randomly in 1977 and 1978. From these results, these subjects were classified into diabetes mellitus (DM), BDM, and NGT, according to the JDS criteria (1982). Cases of diabetes that occurred during the eight-year period were classified as progressive (NGT to DM, BDM to DM) and others were classified as non-progressive.
Over the eight-year period 107 cases were classified as progressive and 1, 781 as non-progressive. The incidence of diabetes was 7.48/1, 000 persons/year. Age, obesity, blood pressure, pre-, 60-min and 120-min plasma glucose and serum triglyceride levels were all higher in the progressive group than in the non-progressive group. Even after adjustments for age, obesity, plasma glucose value, and sex, were calculated, triglyceride and blood pressure levels remained higher in the progressive group. Also, significant predictors of diabetes progression were age, blood pressure, and obesity by multiple logistic regression analysis and discriminant analysis. Factors associated with the occurrence of diabetes were aging, obesity and hypertension, and these factors should be considered of primary concern in the prevention of diabetes.

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We report a case of diabetes mellitus associated with hypoplasia of the dorsal pancreas. The patient was a 73-year-old woman. She was admitted to our hospital for the purpose of controllin diabetes mellitus on July 10, 1997. Fasting blood glucose level was 145mg/dl and HbA1c was 7.3% on admission. Her pancreatic body and tail could not be demonstrated on an abdominal ultrasonogram or CT scan. Endoscopic retrogradecholangiopancreatogram showed that the main pancreatic duct was extremely shortened and tapered. From these results, she was diagnosed as having aplasia of the dorsal pancreas. On further examination by calculating from the rate of urinary C-peptide excretion, her insulin secretion was found to be severely decreased. However, the peak concentration of plasma C-peptide following a glucagon loading test was higher than those of insulindependent diabetic patients with the same level of basal concentration of plasma C-peptide. In addition, her insulin sensitivity (85mg/dl) was normal, as measured by the steady-state of plasma glucose method. These results suggest that diabetes mellitus in this patient is caused by islet hypoplasia of the pancreas, a condition which does not necessarily predispose to diabetes.

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A 43-year-old woman was referred to our hospital because of weight loss, palpitations, thirst and polyuria. A subtotal thyroidectomy had been performed because of Graves' disease when she was 18-years-old. She had complained of hypopigmented cutaneous changes in her hands lasting for about one year, which revealed vitiligo vulgaris later. She also had a diffuse goiter and mild bilateral exophthalmos. On admission, her plasma glucose was 371 mg/dl, hemoglobin Alc was 13.0%, and arterial gas analysis and urinalysis revealed ketoacidosis. In addition serum levels of FT₃, FT₄ and TSH were 12.2 pg/ml, 3.7 ng/dl and 0.01μU/ml, respectively, and urinary excretion of Cpeptide was low (28μg/day). Autoantibodies to glutamic acid decarboxylase (GAD) and TSHbinding inhibitor immunoglobulins were positive. The 30-min thyroidal uptake of ^99mTcO₄^- was 15.8%. On the basis of these results, we diagnosed this case as diabetic ketoacidosis with autoantibodies to GAD complicated with vitiligo vulgaris and a recurrence of Graves' disease. After admission, she was initially treated with propylthiouracil, a beta-blocking agent, fluid supplementation and continuous lowdose intravenous insulin. The hyperglycemia and ketoacidosis gradually disappeared over several days. It is suggested that autoimmune mechanisms played an important role in the development of diabetes, vitiligo vulgaris and recurrence of Graves' disease in this case.

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[in Japanese]

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[in Japanese]

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