The clinical usefulness of maximal nerve conduction velocity (NCV) and amplitude (Amp) in microneurography were investigated and compared with motor nerve conduction velocity (MCV). Intraobserver variability of NCV or Amp on repeated measurements was very low, and variability of MCV after weekly intervals was higher than that of NCV, but lower than that of Amp. Correlation between NCV and Amp was lower than between NCV and MCV, which suggested that NCV and Amp methods of evaluating the diabetic polyneuropathy were different. The average values of NCV, Amp, and MCV were significantly different between patients with and without numbness, retinopathy, or nephropathy except for NCV in cases with nephropathy. Amp was less sensitive than NCV and Amp for evaluating the duration of diabetes or blood glucose control. For the evaluation of subjects with or. without numbness, NCV was more sensitive than MCV, and the combined use with NCV and Amp showed a higher abnormal rate than separate use. These results suggest that microneurography may be more useful than MCV for evaluating diabetic polyneuropathy especially in patients with numbness but normal MCV.

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Toassess the subjective value for the quality of life in individuals with diabetes mellitus, we measured utilities (preference for health states) of 12 diabetic patients and 11 non-diabetic persons by using the rating scale method (rating of value for health states) and the time trade-off technique (preference for a short but healthy life). Four diabetic health states were evaluated: 1) noninsulin-dependent diabetes mellitus without anti-diabetic agents; 2) diabetes treated with oral hypoglycemic agents; 3) next stage of diabetes requiring daily insulin injections; and 4) advanced stage complicated with diabetic retinopathy indicating photocoagulation surgery. Non-diabetic persons showed utilities which decreased gradually with the deterioration of diabetes in both the rating scale and trade-off techniques. Diabetic patients exhibited different patterns of utility change from those of non-diabetic persons in both methods, and all of diabetic patients had time trade-off utilities of 1.0 for advanced diabetic health state. Diabetic patients' utilities by the time trade-off technique were also higher than those of non-diabetic persons. These results suggest that different subjective values may exist for the same diabetic health states between diabetic and non-diabetic individuals.

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We describe our experience with a case of insulin-dependent diabetes mellitus (IDDM) with sudden onset in a 78-year-old woman.
The diagnosis of IDDM was made because she abruptly developed severe hyperglycemia with ketosis due to exhausted endogenous insulin release.
The patient showed antibodies to glutamic acid decarboxylase (GAD) detected by radioimmunoassay and Western blotting. However, this finding was contrary to previous reports in the literature, which assert that the antibodies to GAD in IDDM patients are generally recognized conformational epitopes of GAD. In addition, this patient showed no characteristic IDDM human leukocyte antigen (HLA) such as DR 4 and DR 9. These immunological and genetical differences may be key factors in the aged in developing IDDM.

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[in Japanese]

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[in Japanese]

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We investigated the effects of combination therapy with voglibose, a carbohydrase inhibitor, and a sulfonylurea (SU) drug in an open prospective study in 27 NIDDM patients. Fifteen patients were treated with voglibose combined with SU (combination group), while 12 patients were treated with SU alone (SU group). Insulin secretion and insulin sensitivity were measured before treatment and at week 4 of treatment. At the end of the study, plasma glucose concentrations had significantly decreased in both groups. Postprandial 2-hr glucose levels tended to be lower in the combination group than in the SU group. Insulin secretion measured by postprandial 2-hr C-peptide increased significantly from 3.7 ± 0.5 to 6.1 ±0.6 ng/ml in the SU group. In contrast, no change in postprandial C-peptide was observed (from 5.0±0.6 to 5.3±0.6 ng/ml) in the combination group. Insulin sensitivity (K index of the insulin tolerance test) significantly improved after combination therapy as well as in the SU group. Insulin sensitivity after combination therapy was comparable to that DI the SU group and lipid profiles after treatment improved only in the combination group. These results suggest that combination therapy using voglibose and a SU drug may reduce the risk of hyperinsulinism usually noted in patients treated only with a SU drug.

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[in Japanese]

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In 1995, the Japan Diabetes Society (JDS) appointed the Committee for the Classification and Diagnosis of Diabetes Mellitus. The following report of the Committee was prepared, taking account of the previous reports from JDS (1970 and 1982), opinions of the council members of the JDS, recent reports of the Expert Committee of American Diabetes Association (ADA) and the WHO Consultation, and new data presented at the JDS Symposium on the Classmcation and Diagnosis Of Diabetes Mellitus held in June, 1998.
Concept of diabetes mellitus: Diabetes mellitus is a group of diseases characterized by chronic hyperglycemia and other speciflc metabolic abnormalities, with heterogenous etiologies in which both genetic and environmental factors are involved. After a long duration of metabolic derangement, specific complications of diabetes (retinopathy, nephropathy and neuropathy) may occur. Arteriosclerosis is also accelerated in the presence of diabetes. Depending on the severity of metabolic abnormality, diabetes may be asymptomatic, may present with characteristic symptoms such as thirst, polyuria, polydipsia, weight loss, or it may progress to ketoacidosis and coma.

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