According to the American NCEP-ATP III (National Cholesterol Education Program-Adult Treatment Panel III) criteria, metabolic syndrome is characterized by an abnormal abdominal circumference (AO), high blood pressure (HT), high fasting glucose (HFPG), high triglyceride level (HTG) and low HDL cholesterol level (LHDL). The present study investigated the concept of metabolic syndome with regand to insulin resistance in Japanese males. The subjects consisted of 808 males (60±12years) living in two rural communities in Hokkaido, Japan, who had undergone health screening examinations and a 75g oral glucose tolerance test. The subjects were divided into a metabolic syndrome (MS) group (24.4%) and a non-MS group (75.6%) based on the NCEP-ATP III criteria (but with the criterion for AO being 85cm). The overall percentages of patients with an AO, HTG, LHDL, HT and HFPG were each 42.7%, 34.1%, 16.7%, 59.1% and 13.5%, respectively. As the number of risk factors increased from 0 to 5, the level of 120-IRI, HOMAR increased significantly. A multiple regression analysis showed that 120-IRI and HOMA-R were significantrisk factors in a model that included BMI and age. The presence of metabolic syndrome may be useful for predicting insulin resistance in Japanese males.

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A 66-year-old man being treated for type 2 diabetes mellitus with an α-glucosidase inhibitor was transferred to our hospital because of sudden onset of severe abdominal pain and vomiting. Abdominal CT showed a massive amount of gas in theintrahepatic portal vein and the mesenteric veins. The patient was treated conservatively because of the absence of any evidence of bowel necrosis or peritonitis. The symptoms subsided in response to conservative treatment, and a CT scan obtained two weeks later showed no portal venous gas (PVG).
PVG is known to be a rare condition with a poor prognosis, however, in a few cases, such as ours, it is associated with simple intestinal or gastric distention. Non-surgical management is permissible in patients with no evidence of life-threatening complications.

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A 58-year-old man who had been diagnosed with type 2 diabetes mellitus in 1999 was admitted to our hospital in 2001 complaining of dyspnea and systemic wheals with itching at the site of human insulin (Penfill N^®) injection for 1 year after starting insulin therapy. An intradermal skin test revealed a positive reactionto human insulin and protamine sulfate, the human insulin specific IgE antibody titer was also markedly increased. He was diagnosed with an immediate-type allergy against human insulin. Desensitization therapy using Penfill R^® was attempted. Following the therapy, the dyspnea, itching, andwheals did not reappear. Our results suggest that desensitization therapy may be useful for the treatmentof human insulin allergies.

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[in Japanese]

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Drug monitoring is essential to improving patients' adherence to insulin administration schedules. However, do physicians prescribe accurate doses of insulin? Actual prescribed doses (PD) of insulin were compared with calculated necessary doses (ND) in twenty seven periods of fourteen outpatients for three years. The PD/ND ratio was 1.20±0.35 (M±SD), and the correlation between PD and ND was r=0.73 (p<0.001). According to patient background factors, the PD/CD ratio was significantly higher in the patients on insulin therapy for less than ten years than in those on insulin therapy for more than ten years. It is important to estimate PD and ND, and physicians should ask patients how much insulin they have left.

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[in Japanese]

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The Japan Diabetes Society (JDS) Committee on Standardization of Laboratory Testing Related to Diabetes Mellitus has established primary standard material (deeply frozen material, 5 levels, called JDS Lot 2) for measurement of hemoglobin A₁c (HbA₁c). Lot 2 has been distributed by HECTEF since March 1, 2001. The Lot 2 numbers have been carried over from the former JDS Lot 1 numbers. The HbA₁c Standardization Working Group, on the other hand, was organized by the International Federation of Clinical Chemistry and LaboratoryMedicine (IFCC) to establish worldwide standardization of HbA₁c. The Working Group proposed a highly specific method of measurement of HbA₁c by an analytical chemistry procedure using endoproteinase Glu-C, and it was named the IFCC method. The Working Group also qualified10 laboratories throughoutthe world as reference laboratories to maintain the technical level of this method. The JDS Committee sent Lot 2 to reference laboratories to determine the IFCCnumber of HbA1c, and the results showed that the relationship between the JDS and the IFCC numbers was as follows:
IFCC number (%) =1.068×JDS number (%)-1.741%.
In conclusion, in the international standardization of HbA₁c accordingto the IFCC method, the HbA₁c numbers will significantly differ from the currentJDS numbers. Our Committee will discuss changing the JDS numbers to IFCC numberswith JDS members, and make a decision in the near future.

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