Diabetes mellitus (DM) patients receiving insulin often manifest low HbAic, a marker used for glycemic control.The ratio of glycated albumin (GA) to HbAic for patients whose DM was well controlled by insulin (insulin group) was significantly higher (p<0.01) than in patients whose DM was well controlled by kinesitherapy alone (diet group) or oral hypoglycemic agents (OHA group), and HbAic was clearly low.
In examining the relationship of HbA1c to GA HbA₁c ratios, HbA₁c was below 6.5% in each therapy group.The ratio of GA HbA₁c in the insulin group was significantly higher than in the diet or OHA group. The same trend was observed with 1, 5-AG, a daily glycemic control marker.
GA is highly useful as a glycemic control marker. In this study, GA proved to be highly useful as a glycemic control marker in the insulin therapy group where HbA₁c was low.

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[in Japanese]

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A 56-year-old woman admitted to emergency for loss of consciousness had significant hyperglycemia and ketoacidosis and plasma glucose of 882mg/dl, total ketone body of 3795μmol/L, and arterial blood pH of 7.265. She had inflammation with an elevated total white blood count (WBC of 13000/mm³) and CRP of 16.4mg/dl, which was suspected to be the cause of ketoacidosis. Computed tomography (CT) of her left thigh 10 days after admission showed pyomyositis associated with abscesses. She was treated with intravenous antibiotic drugs and cured without any surgical intervention. Although pyomyositis is rare in nontropical countries, case reports of immunocompromised patients having it are increasing.Because diabetes mellitus may be a risk factor for pyomyositis, it is important to check for it when examining diabetic patients with localized muscle pain.

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[in Japanese]

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The maximal dose of metformin is limited to 750mg/day in Japan.To evaluate the efficacy of high dose metformin, we administrated 1500mg/day for 12 weeks in 12 type-2 diabetic patients whose HbA₁c exceeded 7.0% with 750mg/day. Fasting plasma glucose, HbA1c, plasma insulin, and insulin resistance index of homeostasis model assessment decreased significantly from 194±42mg/dl, 8.2±1.1%, 9.3±2.6mUml, and 4.27±1.14 to 165±28, 7.5±0.9, 7.5±3.1, and 2.95±1.36 with the increased dose. No significant change was detected in serum lactate. Although half of patients had gastrointestinal symptoms such as diarrhea, abdominal bloating, and constipation, symptoms were mild and disappeared within a week.These results indicate that high-dose metformin is effective in patients with inadequate low dose glycemic control.

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[in Japanese]

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