The adherence and barriers to dietary regimens for patients with diabetes mellitus were studied in 128 patients who had participated in a 2-week diabetes education program. They were interviewed every month after discharge from hospital. The high risk situations (HRS) preventing them from maintaning dietary regimens were estimated by modified Marlatt's model of relapse. About 38% of lapses that occurred in all encounters involving giving in to temptation were associated with environmental determinants in the presence of substance cues, which is the highest risk situation. The lapse rate of patients who had come across the HRS was 29.3% at their first visit one month after the discharge. But at their second visit in month 2 the lapse rate was 54.9%, which was significantly higher than that at their first visit. The relapse rate was significantly increased from 11.8% at the second visit to 27.6% at the third visit. The mean HbA₁c value was 9.0% before education. The lowest value was 6.4% 3 months after education. The HbA1c value gradually increased during the following 3 months. These results suggest that the HRS coping strategy should be designed around the discharge to maintain adherence to the regimen and good metabolic control.

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The purpose of this study was to investigate whether nitric oxide (NO) replacement or nitric oxide synthase (NOS) inhibition influences in vivo insulin action. The NO donor sodium nitroprusside (SNP, 3ng/kg/min), the NOS inhibitor N^G-monomethyl-L-arginine (LNMMA, 1mg/kg/min), or saline was infused constantly during the euglycemic clamp procedure in healthy and STZ-induced diabetic rats. Insulin was infused at a rate of 3.0mU/kg/min in the awake condition. Plasma insulin levels during the insulin infusion were 30μU/ml, and the blood glucose level of the diabetic and healthy rats was clamped at 140mg/dl and fasting levels, respectively, by periodic adjustment of the i. v. glucose infusion rate. LNMMA administration significantly decreased the insulin-mediated glucose disposal rate (GDR) in diabetic rats (11.2±0.8 vs.7.0±0.7mg/kg/min, p<0.05). SNP administration, however, resulted in a significant increase in GDR (21.6±2.0mg/kg/min, p<0.01) in diabetic rats, and the metabolic clearance rate for glucose (MCR) in diabetic rats infused with SNP reached 87% of the level in the healthy rats. Neither SNP nor LNMMA administration affected GDR or MCR in healthy rats. It can be concluded that NO replacement improves in vivo insulin action in diabetic rats.

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A 60-year-old man was referred to S-hospital because of body weight loss in March, 1998. On admission HbA1c level was 11.5%, leading to the diagnosis of diabetes mellitus, thus insulin therapy was started. Hisglycemic control improved rapidly, e. i. HbA1c level decreased to 6.6% in June, however bilateral numbness of hands and feet, and right hypochondriac pain occurred. He was admitted to our hospital for closer examination on Aug. 18. Based on symptoms and results of examinations, the right hypochondriac pain was considered to be due to diabetic thoracic radiculopathy. Lipo-prostaglandin E₁ (Lipo-PGE₁) was administered for treatment, and symptoms improved remarkably 14 days after the Lipo-PGE administration commenced. But 14 days after discontinuing the drug, the right hypochondriac pain recurred. When Lipo-PGE1 was readministered, the symptoms again improved. In this case the onset of the bilateral numbness of hands and feet seemed to be caused by post-treatment neuropathy. On the other hand, the effect of the Lipo-PGE₁ sug gested that radicular ischemia may play an important role in the development of diabetic thoracic radiculo pathy.

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A 56-year-old man with Type 2 diabetes mellitus, in whom diabetes mellitus was detected at the age of 46-years, was admitted on August 5, 1997 because of high fever and left lower abdominal pain. His glycemic control had been poor because he rejected insulin therapy. Abdominal enhanced CT scan and arteriography disclosed an aneurysm of the left common iliac artery. Cultures of blood and stool yielded Salmonella. Therefore, a diagnosis of aneurysm infected by Salmonella was determined. Inflammatory destruction of the entire arterial wall by abscess formation was observed and totally excised, and femorofemoral bypass graft construcion was carried out. Histological examination of the excised aneurysm showed severe atherosclero sis. Infected aneurysm is a comparatively rare disease. In Japan, only 5 cases have been reported in the last 5 years. All cases had arteriosclerotic degeneration and 3 cases had diabetes mellitus. The severe athero sclerotic change in the left common iliac artery and the poorly controlled diabetes may have been related to the Salmonella infection in this case.

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The case is a 55-year-old woman diagnosed with chronic active type C hepatitis since March, 1992 who underwent interferon (IFN) therapy at another hospital. Moreover, IFN α-2a therapy was started at the department of gastroenterology of our hospital in December 1994, and was scheduled to last for 60 weeks, however, just before its completion in December 1995, she began to complain of thirst and paresthesia of her limbs. In January 1996, her FPG level was elevated to 507mg/dl and she was admitted for insulin therapy. However, control of FPG only slightly improved, and she consulted the department of internal medicine in April 1997. At that time, urinary CPR was 8.4μg/day, anti-GAD antibody was positive-1821U/ml and because of those findings, the diagnosis of IDDM was made. We measured the change in her serum anti-GAD antibody level from before and during IFN therapy, and found it had increased at an exponential rate 8 months after the start of IFN therapy. The onset of diabetes probably occured 2 months after the elevation of the anti-GAD antibody, based on the data of 1, 5-anhydroglucitol and glycoalbumin.

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[in Japanese]

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