In a retrospective study, we followed up 292 nondiabetic subjects monitored by fasting plasma glucose (FPG) over 3 years and analyzed their incidence of diabetes. On their first examination at Toma Hospital in 1985-1990, HbA1c was measured and oral glucose tolerance test (OGIT) undertaken. Of the 292, 102 had normal glucose tolerance (NGT) and 190 impaired glucose tolerance (IGT).
The ROC plot for HbAic revealed that 5.6% the most appropriate cutoff for predicting progression to diabetes. Accordingly, subjects were classified into 3 groups based on baseline FPG≥110 mg/dl, 100-109 mg/dl, ≤99 mg/dl) and into 2 groups based on baseline HbA1c (≥5.6%, ≤5.5%). Diabetes was defined as FPG≥126 mg/dl.
Cumulative incidence of diabetes from each FPG group was higher in the group with FPG (≥110 mg/dl) than in that with FPG 100-109 mg/dl or ≤99 mg/dl.Cumulative incidence of diabetes in combined FPG and HbA1c groups was higher in the group with HbA1c≥5.6% than in that with HbA1c≥5.5%, regardless of FPG.
The incidence of diabetes in subjects whose insulinogenic index (I.I.) was ΔIRI/ΔPG (30-0 min) was<0.4 were higher in the group with HbA1c≥5.6 % than in that in that with HbA1c≤5.5 %, regardless of FPG.
In conclusion, for screened nondiabetic subjects, the use of paired FPG and HbA1c helps to identify potential diabetic subjects.

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[in Japanese]

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[in Japanese]

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A 20-year-old man was first admitted to our hospital due to diabetic ketoacidosis. Metabolic control improved with insulin injection, then insulin therapy was stopped. Diabetic ketosis recurred after 5 years and the man was hospitalized 4 times due to diabetic ketosis in the next 5 years. Antibodies against glutamic acid decarboxylase (GAD) and islet cells were negative in several examinations. Daily urinary C-peptide (CPR) was very low during admission but recovered to normal after insulin therapy. Body mass index (BMI) was almost normal and insulin resistance was not detected in the euglycemic insulin clamp test. Anamnesis before each admission revealed no excessive intake of sugar-containing soft drinks or diet failure. Oral glucose tolerance tests after improvement in diabetes control demonstrated decreased insulin secretion at an early phase. These findings suggest that transient but intense suppression of pancreatic insulin secretion probably caused the frequently recurrence of diabetic ketosis observed in this patient.

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Lithium intoxication is an important complication due to its frequent use and narrow therapeutic index. Concurrent illness such as diabetes mellitus, anorexia, or a cold increases serum lithium concentrations. We report 2 Japanese patients with type 2 diabetes mellitus who took lithium for manic-depressive psychosis and developed neurological disorders.Case 1, a 57-year-old woman, developed coma and acute renal failure. Her renal function recovered and neurological signs of intoxication, except for ataxia, disappeared after 3 sessions of hemodialysis. Case 2, a 72-year-old woman whose condition was complicated by an old myocardial infarction, became drowsy but responded well to intravenous normal saline infusion.In both cases, lithium serum was found to be elevated to toxicity (>1.5 mEq/l). Many factors such as other medications or illness increase serum lithium concentrations, so diabetologists must have a through understanding of lithium since diabetes mellitus and diabetes medication increase the risk of lithium toxicity.

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[in Japanese]

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AAtherosclerotic diseases are reported to very frequently occur and decrease the quality of life in diabetic patients. Joint committee meetings of the Japan Diabetes Society and Japan Atherosclerosis Society have been held since 1998. We investigated and discussed the goal of treatment for atherosclerotic diseases in diabetes mellitus. We studied clinical reports on the relationship between diabetes mellitus and atherosclerosis. For the prevention and treatment of atherosclerotic diseases, blood glucose control and other risk factors, including hypertension, dyslipidemia, and body mass index (BMI), should be ameliorated the adequately and cigarette smoking should be stopped. We propose a guideline for treatment of atherosclerotic diseases in diabetes mellitus to prevent diabetic patients from suffering macroangiopathy.

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