To determine the efficacy of fidarestat, subjective nerve symptoms and peripheral nerve function in patients with diabetic neuropathy were studied by administering a novel aldose reductase inhibitor, fidarestat, 1 mg once daily for 28 weeks.
Peripheral and autonomic nerve functions were examined with vibration perception threshold and R-R interval variations on electrocardiogram. The improvement of overall nerve function was assessed based on the combined improvement of each nerve function. Subjects were 27 patients with diabetic neuropathy. Of these, 25 completed the study. HbA_1c was 7.6% at baseline and 7.7% atposttreatment, indicating no changes during treatment. Improvement equal or better than moderatein overall nerve function and subjective symptoms were 45.8% and 48.0%.Vibration perception thresholds of upper and lower extremities improved significantly (upper: p=0.0198, lower: p=0.0093), but no significant changes were observed in any parameters of autonomic nerve function tests.A statistically significant correlation was seen between improvement in the vibration perception threshold and that of autonomic nerve function (r=0.5530).
In safety profile, 1 case each of abnormal GPT, γ-GTP, and ALP returned to normal at the end of this trial. No other side effects were observed.
These results suggest that fidarestat may be a useful therapeutic drug for patients with diabetic neuropathy.

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We studied the relationship between total antioxidant capacity (TAOC) and hydroperoxide (HPO) in plasma from 165 patients with type 2 diabetes mellitus, and the influence on TAOC by plasma glucose. Control subjects were 78 age-gender ratio-matched individuals.In the diabetes group, TAOC correlated negatively with HPO (r=-0.414, p<0.0001). TAOC was significantly lower in the diabetes group than in the control group (p=0.0130), and HPO was significantly higher in the diabetes group than in the control group (p<0.0001). Multiple regression analysis using TAOC as the object variable and various factors as explanatory showed that serum uric acid was strongly positively significant (β=0.665, p<0.0001), and that fasting plasma glucose was a negatively significant (p=-0.118, p=0.0403) independent contributing factor. These results show that consumption of antioxidant molecules in plasma by hyperglycemia causes higher HPO and may constitute a risk factor for atherosclerosis.

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Advanced retinopathy is one of the most crucial determinants of quality of life in diabetic patients undergoing dialysis.
To determine whether recent advances in ophthalmological treatment improve retinopathy before and after dialysis commencement, we examined 1, 304 eyes of 652 diabetic patients who started hemodialysis during 23 years.Eyes were classified into the following three groups according to the year dialysis was started in each patient: group 1: 104 eyes in 1978-1985;group 2: 456 eyes in 1986-1993;and group 3: 744 eyes in 1994-2000.Ophthalmological information obtained included history of laser photocoagulation and vitrectomy, stage of retinopathy, and visual acuity.Progression of retinopathy after dialysis commencement was also determined.
Prevalence of eyes with previous photocoagulation or vitrectomy increased gradually over time with statistical significance among the three groups.Eyes with proliferative retinopathy and those with blindness both decreased in recent years.Outcome of retinopathy after dialysis also improved significantly with three-year cumulative progression rates of 43% in group 1, 25% in group2, and 22% in group 3 (p<0.05). In conclusion, ophthalmological intervention for diabetic retinopathy has yielded less frequent advanced retinopathy and severe visual disturbance, with improved retinopathy outcome in diabetic patients undergoing dialysis in recent years.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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An 18-year-old woman was initially diagnosed with acute pancreatitis because of upper abdominal pain, elevated serum pancreatic amylase level and the feature of swollen pancreas on computed tomography. Symptoms of pancreatitis improved rapidly with conservative treatment.However, on the 14th day after admission, she suffered from hyperglycemia and diabetic ketoacidosis.Insulin therapy was started immediately and hyperglycemia was improved, but insulin secretion of this patient was severely reduced.Pancreatic biopsy was performed on the 52nd day after the onset of acute pancreatitis.Pancreas biopsy specimens revealed marked reduction of islets in both size and number and lymphocytic infiltration in exocrine pancreas, but neither insulitis nor edema, necrosis, hemorrhage or fatty degeneration in exocrine pancreas. She suffered from diabetes following acute pancreatitis, but clinical and pathological findings suggest that the diagnosis belongs to the entity of non-autoimmune fulminant type 1 diabetes

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[in Japanese]

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[in Japanese]

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