The present study was conducted to examine the effect of troglitazone, a new hypoglycemic agent, on low density lipoprotein (LDL) size in non-insulin-dependent diabetes mellitus (NIDDM) patients. Thirty-two patients, 8 on diet, 16 on sulfonylureas and 10 on α-glucosidase inhibitors, were enrolled in this study.
Patients who were obese, who had thyroid, renal or hepatic diseases, or those taking steroids, diuretics or β-blockers were excluded from the study. After more than one month of stabilized blood glucose control, troglitazone (200 or 400mg/day) was administered. The dose was increased up to 400mg/day by the 2nd month. Fasting blood glucose and Hb Alc decreased significantly by the 3rd month. There were no significant changes in either plasma total-cholesterol, HDL-cholesterol, apolipoproteins (apo) Al or apo B after treatment, while plasma triglyceride decreased from the 1st month. LDL size increased significantly from the 1st month.Since changes in plasma triglyceride and LDL size preceded those of Hb A1c and fasting plasma glucose, it is speculated from the present data that LDL size was influenced by the changes in triglyceride metabolism brought about by the troglitazone treatment.

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In order to elucidate the independent risk effect of Abnormal Glucose Tolerance (AGT) other than insulin-dependent diabetes mellitus (IDDM) itself and also to investigate characteristic evolutional effect of AGT on coronary arteriosclerotic disease (CAD), we examined the results from 765 inpatients who were admitted to our department of cardiovascular medicine from January to December 1996, and also the results from 72 non-diabetic (Non-DM) CAD patients among whom there wove 64 CAD patients with AGT (IGT23, NIDDM41). The severity of CAD was determined by the coronary angiography findings and was expressed by the Gensini-score.The results were as follows:(1) The incidence of AGT in 765 inpatients with various cardiovascular diseases was high (48%).(2) After adjusting for other risk factors, CAD patients with AGT showed an even more significant and independent risk effect on CAD.(3) Because there was a significant (r=0.589p<0.05) correlation between Hb Alc and the Gensini-score in CAD patients with AGT, it was suggested that abnormal glucose metabolism itself has direct evolutional effect on CAD.
In conclusion, we wish to enforce that the control of blood glucose as well as other risk factors is becoming an even more important problem for us in the pirmany privention of CAD-related death in patients with AGT (estimated at 1, 370, 000 in Japan in 1997).

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In order to examine the relationship between diabetic complications and medical expenditure, the average medical expenditure per visit for 81 patients (8% of total visited patients) with diabetes mellitus who have regularly visited the, Diabetes Center Tokyo Women's Medical University School of Medicine, were calculated and analyzed for a period of 11 months.
The average medial expenditure of total patients per visit was 4, 526±5, 669 points. The average medical expenditure for the patients with diabetic complications, such as neuropathy, retinopathy, nephropathy, and foot diseases was significantly higher than for patients without complications. A group excluding patients with a history of hospitalization in the past year was analyzed in order to examine the relationship between medical expenditure and intermittent treatment.For the group of patients submitted to intermittent treatment, the incidence of complications was higher as well as the average medical expenditure, however the relationship between intermittent treatment and medical expenditure was not statistically significant.
Since this study was conducted at a fixed time point with a fixed time span, an extensive prospective cohort study may be necessary to demonstrate the causes which affect the medical expenditure on diabetes.

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We report two diabetic patients with hemichorea. In case 1, a 58-year-old-man with a 7-year history of diabetes admitted to our hospital because of hyperglycemia. On admission, his plasma glucose and Hb A1c level were 705mg/dl and 14.8%, respectively, and he had diabetic triopathies. After admission, his diabetes was well controlled but left-sided hemichorea appeared suddenly. CT examination revealed a high density area in the right putamen, and T 1-weighted MR images showed a high intensity in the right putamen and caudate nucleus, which diminished 3 months after the onset of hemichorea in association with the improvement of choreiform movements. In case 2, a 46-year-man with hyperglycemia and hypertension was admitted to a hospital because of abrupt onset of right-sided hemichorea. Three weeks later, he visited our hospital because his choreiform movements remained unchanged. His diabetes and hypertension were well controlled, but he had proteinuria, fundus hupertonicus and neuropathy. After administration of haloperidol, his choreiform movements disappered. Early CT examination showed a high density in the left putamen, and T1-weighted MR images also revealed a high intensity in this area, which disappeared 5 months after the onset of choreiform movements. We consider these findings suggestive of pathomechanisms of hemichorea including ischemia and imbalance of neurotransmitters in the putamen and caudate nucleus.

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A 69-year-old woman was first diagnosed to be diabetic in June 1997, and prescribed Gliclazide 40mg/day. Since her Hb A1c level did not improve sufficientlx (10.4% to 8.0%), the drug was changed to Daonil^® (Glibenclamide, Hoechst Marion Roussel Co. Ltd.) 2.5mg tablet on October 31 st. She noticed general malaise, anorexia on November 2nd, and fever of> 38°, and skin rash over her whole body on November 4th. She consulted Dermatology on November 11th, and was diagnosed with erythema multiforme. Daonil^®was the only drug she took during this period. The findings on admission were as follows: body temperature of 38.2°, Gowers sign (+), urinary protein 30mg/dl, urinary occult blood (3+), white blood cell count 18, 540/μl, C-reactive protein 23.06mg/dl, GOT 76IU/l, GPT 73IU/l, LDH 1, 108IU/l, BUN 62.1mg/dl, Cre 2.0mg/dl, s-alb 2.7g/dl, CPK 6, 030IU/l, (MM type 5, 908IU/l), myoglobin 704.0ng/ml. According to these findings, she was diagnosed with liver dysfunction, renal impairment and rhabdomyolysis. The lymphocyte stimulating test (LST) for Daonil (R) was positive. CPK levels returned to normal (178IU/l) on day 4 after admission by the cessation of Daonil^®, and the use of methylpredonisolone 500mg infusion for 3 days. Other laboratory tests and skin rash improved by day 11. Because of the history of drug intoxication of her sisters and herself, and the LST result, the mechanism of this case was considered to be allergic. This is the first case of sulfonylurea induced rhabdomyolysis reported in the literal.

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We investigated the metabolic effects of switching from sulfonylurea (SU) to troglitazone (TR) in 14 patients with mild (Hb A1c<7%) non-insulin-dependent diabetes mellitus (NIDDM). BMI, FPG, fasting IRI and C-peptide, Hb A1c, lipid profile, and homeostasis model insulin resistance index (HOMA-R) were evaluated immediately before, 12 and 24 weeks after switching from low dose SU to TR (400mg/day). BMI, FPG, Hb A1c and lipid profile did not change significantly. However, IRI, C-peptide, and HOMA-R significantly decreased after switching to TR (IRI, 10.0±5.4 to 6.7±2.8μU/ml; C-peptide, 2.4±1.0 to 1.9±0.7ng/ml; HOMA-R, 3.2±2.0 to 2.1±1.0). These results indicate that swithcing to TR monotherapy ameliorates insulin resistance in mild NIDDM patients on low dose SU.

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To clarify the influential factor on the QTc interval in impaired glucose tolerance (IGT), we investigated the correlation coefficient between the QTc interval and clinical parmeters such as age, body mass index (BMI), blood pressure (SBP, DBP), lipid (TC, HDL-C, TG), Hb A1c, plasma glucose (FPG, ΣPG), plasma immunoreactive insulin (FIRI, ΣIRI) and insulin resistance index (R) in 65 male patients with IGT.Consequently, a positive correlation was found between the QTc interval and BMI (r=0.308), SBP (r=0.434), DBP (r=0.425) and ΣIRI (r=0.282).
It is suggested that obesity, hypertension and hyperinsulinemia relative to insulin resistance may have influence on the QTc interval in IGT patients.

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