The diagnostic criteria of the Metabolic Syndrome (MetS) was established by 8 societies including the Japanese Diabetes Society in 2005. However, there are no serum markers for MetS. To evaluate the clinical significance of serum levels of adiponectin and ApoB48, we measured their fasting serum levels in 121 outpatients in our clinic. Serum levels of adiponectin were significantly lower in males with the MetS (5.9±2.8 vs 7.6±3.8 μg/ml, p=0.036). On the other hand, serum ApoB48 levels were significantly higher in males with the MetS (6.1±7.3 vs 2.3±2.1 μg/ml, p=0.0014). Adiponectin levels negatively correlated with abdominal circumference (r=-0.31, p=0.0075) and triglyceride levels (r=-0.27, p=0.023), and positively correlated with HDL-cholesterol levels (r=0.54, p<0.0001) in males. LogApoB48 levels positively correlated with abdominal circumference (r=0.25, p=0.031) and serum triglyceride levels (r=0.67, p<0.0001), and negatively correlated with HDL-cholesterol levels (r=-0.25, p=0.035) in males. In females with the MetS, adiponectin levels positively correlated only with abdominal circumference, and ApoB48 levels correlated with triglyceride levels, possibly due to the small number of subjects. Stepwise regression analysis revealed that logApoB48 levels, but not serum triglyceride levels, were selected, in addition to gender, abdominal circumference, systolic blood pressure, HbA_1C and HDL-cholesterol as significant independent variables for the MetS. These results suggest that in addition to adiponectin, determination of serum ApoB48 levels may be useful to diagnose the MetS, especially in relation to abdominal obesity since serum levels of ApoB48 might reflect the exogenous fatty acid intake.

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In order to clarify the role of the kidney in glucose homeostasis, the frequency of severe hypoglycemia and the instability of postprandial blood glucose levels in four type 1 diabetic patients undergoing hemodialysis were compared with those in 13 type 1 diabetic patients without renal dysfunction. These determinations were conducted in a type 1 diabetic patient with end-stage renal disease during a 26-month period prior to, and a 26-month period 12 months after, initiation of hemodialysis treatment. The incidence of severe hypoglycemia was significantly higher in the patients on hemodialysis than those without hemodialysis despite lower daily insulin doses in the former group. The postprandial blood glucose levels fluctuated more markedly day after day in the dialysis group compared with those in the non-dialysis group. The impaired production and utilization of glucose by the affected kidneys are most likely to be one of the causes for these disruptions to glucose homeostasis in type 1 diabetic patients on hemodialysis.

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[in Japanese]

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In a 61-year-old woman, high blood sugar was discovered during a routine medical examination for residents around 1996, and she consulted a physician of the medical institution for the first time in June, 2002. She started diet therapy and then took appropriate medication, but her blood sugar levels were poorly controlled. She was therefore admitted to hospital in December 2002. Since her anti-GAD antibody tested positive, she was diagnosed as having slowly progressive type 1 diabetes mellitus, and was treated with the intensive conventional insulin therapy. She was diagnosed as having polyglandular autoimmune syndrome type III August 2003, because she had slowly progressive type 1 diabetes mellitus associated with chronic thyroiditis and pernicious anemia. Her anemia was improved by intramuscular injections of mecobalamin. However, the platelet count began to decrease gradually around June, 2004, and then she was diagnosed as having idiopathic thrombocytopenic purpura. She is a rare case of autoimmune polyglandular syndrome type III associated with slowly progressive type 1 diabetes mellitus, chronic thyroiditis, pernicious anemia and idiopathic thrombocytopenic purpura. Moreover, interestingly, she had DQA1 0102, 0103 and DQB1 0602, 0601 that were considered as type 1 diabetes protective HLA alleles.

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[in Japanese]

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A 35-year-old man was admitted to our hospital after going into a hyperglycemic hyperosmolar coma. He had untreated depression and was reclusive. He was found by his family, complaining of agony, abdominal pain and dysuria on the night before admission. He was admitted to the local hospital and underwent a glucose-free transfusion. Early the next morning, however, he fell into a comatose state. He exhibited marked hyperglycemia, 2,380 mg/dl and mild metabolic acidosis due to renal failure. Thereafter, he was transferred to our hospital. His HbA_1C was 11.1% and the biochemical findings showed severe dehydration and uremia. Although he was treated with massive transfusion with insulin, he soon fell into shock, and was refractory to intensive treatment, including antibiotics, ventilatory support and polymixin B immobilized fiber therapy. The patient died 27.5 hours after discovery. Clinically, we considered this case as type 2 diabetes mellitus with obesity. However, serum C-peptide level was not detectable and histologically the islets of Langerhans were markedly decreased in size and number, without the characteristic insulitis. The anti-GAD antibody was negative. As a consequence, we considered the etiology of this case to be chronic type 1B diabetes mellitus or the destruction of the B cells by oxidative stress from prominent glucose toxicity. Recently, the number of young persons, who are reclusive with mental or social maladjustments, has been increasing. Therefore, we have to pay much more attention to obese people who are reclusive.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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