The influence of health checkup and previous intermittent treatment for diabetes was investigated in 133 type 2 diabetic patients who visited and were registered in the Diabetes Center of Tokyo Women's Medical University School of Medicine between November 1998 and January 1999. Seventy-six cases were diagnosed as diabetes mellitus during the health checkup, while 57 cases were diagnosed by other means. No difference in the frequency of previous intermittent treatments and the severity of the diabetic complications at the time of their first visit was seen between the two groups.However, when patients who had previous intermittent treatments (48 cases) were compared with those who had received continuous treatment (85 cases), the intermittent treatment group exhibited a significant deterioration in complications at the time of their first visit.The longer the duration of the previous intermitted treatment, the larger the deterioration in the complications (p<0.0001). When the health checkup group was divided into intermittent treatmentand non-intermittent treatment subgroups, a significant deterioration in complications was seen in the intermittent treatment group.These findings show that previous intermittent treatments, but not health checkups, were associated with the development of severe diabetic complications.

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We report a case of insulin autoimmune syndrome (IAS) with rheumatoid arthritis (RA) and chronic thyroiditis. A 60-year-old woman was referred to our clinic because of goiter and RA. She had not received any medication.She had been experiencing hypoglycemic symptoms after fasting for 6 months. Her fasting plasma glucose level was 73mg/dl, but her fasting IRI determined using a double antibody method was 155μU/ml.Her fasting free insulin level was 2.7μU/ml, and the percentage of ¹²⁵I-insulin bound to her serum was 79.2%. A Scartchard analysis for ¹²⁵I-insulin binding showed two binding sites in her serum. The Kd value of the high-affinity site, which is clinically important, was 0.332±0.078 (10⁸l/mol), and the Bmax value was 10.6±1.44 (10^-8mol/l). In an HLA analysis, she was found to be DRB 10403 for DR 4 and DRB 10901 for DR 9, which are essential conditions for the development of IAS. An autoimmune mechanism may be associated with the development of IAS, since this case exhibited signs of autoimmune disease.

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