Serum cystatin-C (SCys-C) levels have recently been reported to reflect renal function better than serum creatinine (SCre) levels, and urinary Cys-C (UCys-C) levels have been reported to indicate tubular impairment. We measured the SCys-C and SCre levels of 640 type 2 diabetes patients and found that the SCre levels were elevated in patients with proteinuria who had a decreased glomerular filtration rate (GFR), and the SCys-C levels were significantly elevated in patients with microalbuminuria. Although the UCys-C levels were not correlated with the urinary creatinine (UCre) levels, the UCys-C/UCre ratio (UCCR) tended to be increased in the patients with microalbuminuria, and it was significantly increased in patients with proteinuria and in patients with end-stage renal disease/hemodialysis.
These findings suggest that SCys-C and UCys-C determinations are helpful in diagnosing the early stage of diabetic nephropathy and identifying tubular impairment.

View full abstract

653 diabetic patients that visited 3 specialized diabetes clinics in Tokyo were administered the “Problem Areas In Diabetes Survey (PAID)” scale, a scale of emotional distress related to diabetes. The relation ships between the PAID score and 1) the clinical characteristics, 2) job-related stress as evaluated by JCQ (Job Content Questionnaire), 3) accuracy of prediction of the PAID score by health providers, and 4) presence of minor depression as measured by SRQ-D (Self-Rating Questionnaire for depression) were investigated.
Higher PAID scores were related to a younger age, female sex, higher HbA₁c, history of drug therapy (insulin>sulfonylurea), presence of complications, history of hospitalization and hypoglycemia. ‘Demands’ of the job as calculated by JCQ was weakly related to the PAID score.
The PAID score was underestimated by health providers in 15% of the patients. 13% of the patients with a PAID scores of over 50 were detected to have minor depression by SRQ-D.
PAID is considered to be useful to screen diabetic patients for emotional distress.

View full abstract

A 38-year-old man with a past history of obesity was admitted for glycemic control. He had been treated for type 2 diabetes with an oral hypoglycemic agent (OHA) until the start of insulin therapy. The serum C-peptide level before and 6 minutes after glucagon administration was 0.8 and 1.1 ng/ml, respectively, and impaired. Testing for GAD antibodies and ICA was negative, but testing for IA-2 antibodies was positive, 3.6 U/ml. Slowly progressive type 1 diabetes mellitus (SPT1DM) was diagnosed, and glycemic control improved on insulin therapy. The HLA type was DR4 and DR13. Impaired insulin sensitivity (GIR 4.67 mg/kg/min) by was demonstrated the euglycemic glucose clamp method. After discharge, his glycemic control improved to an HbA₁c level of 6% on 0.3 U/kg/day insulin therapy. One year later, his serum postprandial C-peptide level had decreased 0.2 ng/ml.
Recently type 1 diabetes patients have been classified in subgroups, SPT1DM, based on the presence of autoantibodies and slowly decreasing endogenous insulin secretion. Our patient had a typical history of obesity and had been treated with an OHA for type 2 diabetes before insulin therapy. We considered this case difficult to diagnose by routine serological examinations and therefore have reported it.

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

Hypothesis/aim: The pathogenesis of fulminant type 1 diabetes remains unknown, but abrupt onset and frequent flu-like symptoms at onset suggest the involvement of viral infection. We determined the titer of antiviral antibodies at fulminant type 1 diabetes onset.
Subjects and methods: Subjects were 55 patients with fulminant type 1 diabetes registered with the committee of the Japan Diabetes Society and whose sera at onset were available. The antibodies measured were: parainfluenza virus type 1-3, rotavirus, coxsackie virus type A2-A7, A9-10, A16, B1-B6, cytomegalovirus, EB virus, and human herpes virus (HHV) 6 and 7.
Results: Viral antibody elevation was observed in 11 antibodies in 7 of 38 patients in whom paired sera were available, i.e. coxsackie virus type A4, A5, A6 and B1 in one patient, and rotavirus in 2 patients. Ig-M of cytomegalovirus was positive in 1 patient and EB virus and HHV6 in one patient. Ig-G of HHV6 and HHV7 increased in one patient. Cytomegalovirus Ig-M elevation was observed in 2 of 17 patients in whom paired sera were not available.
Conclusion: Antibody titers to viruses were elevated at disease onset in some fulminant type 1 diabetes patients.

View full abstract