We studied associations and onset patterns of type 1 diabetes mellitus (T1DM) and autoimmune thyroid disease (AITD), also known as Graves' disease or Hashimoto's disease which requires hormone replacement. Of the 3,540 DM subjects with diabetes mellitus seen, 159 had T1DM, including 54 with slowly progressive insulin-dependent DM (SPIDDM) and 105 with acute onset T1DM. AITD was prevalent in 8.8% with T1DM, 0.8% with T2DM, 18.6% with SPIDDM, 3.9% with acute on set T1DM, 14.2% with anti-GAD antibody (GADA) positive T1DM, and 1.5% with GADA negative T1DM. AITD in T1DM was significantly higher than T2DM, and its prevalence in women was higher than in men. The prevalence of AITD in GADA of ≥50 U/ml was higher than <50 U/ml. In 14 T1DM with AITD, AITD preceded in all but 1 patient. These results show that the AITD prevalence in DM is higher in T1DM, women, positive GADA, high GADA, SPIDDM and AITD mostly precedes T1DM.

View full abstract

We compared performances of a new point-of-care testing (POCT) StatStrip^TM connectivity meter, a conventional POCT device, and three self-monitoring-of-blood-glucose (SMBG) devices using a laboratory routine as a reference.
StatStrip^TM was acceptable within-run precision whose coefficients of variation were less than 2.5% and differences from the reference 4-9%. Correlation statistics to the reference of r=0.994, slope=0.966 and intercept=1.66 mg/dl satisfied accuracy criteria (ISO 15197). StatStrip^TM was not affected by the 5 interfering substances used in this study or hematocrit, although another POCT device was adversely affected by hematocrit.
SMBG devices study showed significant device-to-device variation, with 1) 1 SMBG device showing very low values compared to the reference, 2) 2 SMBG devices not satisfying accuracy criteria, 3) SMBG devices adversely affected by interfering substances, such as ascorbic acid, maltose, and acetaminophen, and 4) low and high hematocrit interfering with glucose measurement by SMBG devices.
Hospital-use POCT devices must measure glucose to the accuracy level of the reference without interference from substances or hematocrit against SMBG devices.
Our findings suggest that StatStrip^TM is sufficiently reliable as a POCT device for glucose measurement in hospitals.

View full abstract

We report a case of ANCA-associated vasculitis associated with hearing loss in a person with type 1 diabetes.
An 81-year-old Japanese woman diagnosed two years earlier with type 1 diabetes with high titer IA-2 antibodies was hospitalized for tinnitus and severe bilateral hearing loss. Despite being treated for acute otitis media and mastoiditis, her symptoms worsened and she developed fever, general fatigue, and appetite loss. Autoimmune screening tests raised the possible involvement of vasculitis associated with antineutrophil cytoplasmic antibody (ANCA) because (1) plasma antimyeloperoxydase (MPO)-ANCA was significantly elevated, and (2) treatment with glucocorticoid markedly relieved symptoms and significantly reduced MPO-ANCA. Her human leukocyte antigen (HLA) genotypes were DRB1*0901, susceptible to type 1 diabetes and frequent for MPO-ANCA-associated vasculitis in Japan. Our case may indicate that ANCA-associated vasculitis should be considered a possible cause of hearing disorder when developing in those with type 1 diabetes.

View full abstract

[in Japanese]

View full abstract

We report dramatic improvement in diabetic control using continuous glucose monitoring (CGM) in a patient with type 1 diabetes. An 18-year-old woman with diabetes onset at 11 years of age had been started on continuous subcutaneous insulin infusion (CSII) since a year earlier, but her diabetic control remained poor, so she was admitted for CSII adjustment. On admission, basal insulin settings were as follows: from 0:00 to 21:00; 1.0 U/h, from 21:00 to 0:00; 0.9 U/h. The injected bolus insulin was calculated based on carbohydrate counting. After admission, she wore the CGM monitor. Results showed shortage of midnight basal insulin dose and dawn and daytime basal overdose. Adjusting the basal insulin dose accordingly markedly elevated postprandial blood glucose likely due to postprandial bolus insulin infusion. She was instructed to inject meal bolus insulin before meals. These adjustments markedly improved blood glucose 3 days after admission. We thus found CGM to be effective in intensively managing diabetes, providing continuous blood glucose monitoring between each blood glucose value of SMBG.

View full abstract

A 49-year-old woman was admitted after kidney transplantation to treat severe pneumonia. She had undergone hemodialysis due to IgA nephropathy for 4 years. At the age of 42, she underwent renal transplantation with a kidney from her brother. Her transplanted kidney was rejected in Jan. 2008 despite steroid pulse therapy and additional immunosuppression. In mid-March she suffered respiratory failure. During pneumonia treatment, she suffered diabetic ketoacidosis (DKA) on hospital day 33. Plasma glucose was 840 mg/dl, HbA₁c 6.4%, pH 7.384, and serum amylase and lipase concentration elevated. Glucagon stimulation test showed no response of serum C-Peptide. Neither ICA nor anti-GAD antibody was detected. Based on these findings, she was diagnosed with fulminant type 1 diabetes mellitus. Cytomegalovirus antigenemia was detected by direct immunoperoxidase using a peroxidase-labeled monoclonal antibody in the serum at DKA onset. Cytomegalovirus IgG titer elevation was confirmed with pair serums before and after DKA. Cytomegalovirus reactivation during immunosuppression therapy may thus participate in destroying pancreatic β-cells.

View full abstract

The ankle-brachial blood pressure index (ABI) is an established marker for evaluating peripheral leg circulation, especially in those with diabetic foot. The importance of the tibial-brachial blood pressure index (TBI), however, has yet to be clarified. We simultaneously determined the ABI and TBI in 156 subjects with type 2 diabetes (median age: 67±10 years, HbA₁c: 7.0±1.1%). The TBI correlated significantly with the ABI (R=0.462, P<0.001). The TBI (TBI<0.6) decreased concomitantly with the ABI (ABI<0.9). Subjects with a lower ABI and lower TBI (group III, 17 subjects) and with a normal ABI and lower TBI (group II, 22 subjects) had a longer duration of diabetes than those with a normal ABI and TBI (group I, 117 subjects). Subjects in groups II and III were also older than those in group I. The body mass index (BMI) in group II was lower than that in groups I and III. Group II subjects showed normal ABI, but also frequently had peripheral arterial disease and limb ulcers. In conclusion, the TBI is useful in detecting arterial sclerosis lesions in the lower limb early and may serve as a useful index of higher risk for limb ulcers.

View full abstract