Subjects were 402 diabetic patients hospitalized for 1 day and 139 diabetic patients switched from insulin therapy alone to combination insulin and sulfonylurea therapy during ordinary hospitalization. In the 402, we examined the correlation between the M-value, calculated from the daily profile of blood glucose, and HbA_1C shortly before hospitalization to identify the influence of different treatments. In the 139 patients, we compared the correlation between M-value and mean blood glucose (MBG: calculated from the daily profile of blood glucose) between the above two therapies. A positive correlation with the M-value was confirmed for both HbA_1C and MBG, while the slope of the regression line was significantly less steep for combined therapy than for therapy with insulin alone. The M-value was lower for combined therapy than for therapy with insulin alone, even when HbA_1C and MBG were similar, suggesting that combined therapy may achieve more stable glycemic control than the use of insulin alone.

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[in Japanese]

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[in Japanese]

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A 69-year-old man diagnosed with diabetes mellitus 30 years earlier but not treated, was admitted with a gangrenous left foot and severe hyperglycemia (plasma glucose 513 mg/dl, HbA_1C 7.9%). Having stabilized the patient's hyperglycemia with insulin, we amputated the gangrenous foot. Fourteen days postoperatively, the man suffered abdominal pain and diarrhea. We observed blood in the patient's stool and pyrexia 24 days postoperatively. Endoscopical findings from the descending sigmoid colon and rectum showed multiple punched-out ulcerations. Microscopic examination of the descending colon showed cytomegalic inclusion cells in necrotic mucosal tissue. Cytomegalovirus (CMV)-DNA was detected by polymerase chain reaction. These findings were consistent with CMV colitis. Ganciclovir therapy effectively eliminated the symptoms. Immunocompromization associated with hyperglycemia may thus reactivate CMV.

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A 31-year-old woman reporting weight gain and oligomenorrhea for 9 years who married at age 25 was diagnosed at the age of 29 with polycystic ovary syndrome (PCOS). She underwent infertility treatment for two years, but failed to conceive. At age 31, she was diagnosed with diabetes mellitus. Her laboratory data was as follows: BMI, 32.0 kg/m²; HbA_1C, 6.4%; HOMA-R, 5.15. Through continuous diet and exercise guidance over 5 months, her laboratory data improved as follows: BMI, 26.6 kg/m²; HbA_1C, 5.1%; HOMA-R, 2.15. Fourteen months later, she gave birth at BMI, 26.2 kg/m², and HbA_1C, 4.8%. This illustrates the value of improving insulin resistance through lifestyle changes.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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