We studied the correlation between reduced glomerular filtration rate (GFR) and the increased risk of arteriosclerosis by diabetic nephropathy stage. Subjects were 576 diabetic outpatients (male 53%, mean age 65 years). The prevalence of reduced estimated GFR (eGFR<60 ml/min/1.73 m²) was 29% in those without nephropathy, 40% in those with incipient nephropathy, and 67% in those with overt nephropathy. In a comparison of cardiovascular risk factors between the patients with and without reduced eGFR, those with reduced eGFR were significantly older and had significantly higher uric acid than those without in every stage of nephropathy. In cases of no and incipient nephropathy, reduced eGFR correlated with increased pulse wave velocity and decreased serum HDL cholesterol. In cases of no nephropathy, moreover, those with reduced eGFR had a longer diabetes duration, higher pulse pressure, and higher hypertension and dyslipidemia prevalence than those without. Our study indicates that diabetic patients with reduced GFR have an increased risk of developing arteriosclerosis from the stage of no nephropathy.

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In a randomized multicenter open-label parallel group trial, we compared insulin detemir (detemir) treatment efficacy and safety to NPH insulin (NPH) in subjects with diabetes mellitus requiring insulin in a basal-bolus regimen. We evaluated night-time QOL and treatment satisfaction using Insulin Therapy Related Quality-of-Life at Night (ITR-QOLN) and the Insulin Treatment Satisfaction Questionnaire Japan (ITSQ-J). For ITR-QOLN analysis, the total score in the detemir group with any type of diabetes was higher than the baseline throughout the assessment period. In type 1 diabetes, the total score at 48 weeks in the detemir group was significantly higher than that in the NPH group(p=0.03). For ITSQ-J analysis, the total score in the detemir group was maintained throughout the assessment period compared to the baseline in those with type 1 diabetes, and a higher score was seen in patients with type 2 diabetes. In type 1 diabetes, the total score at 48 weeks in the detemir group was significantly higher than that in the NPH group (p=0.04). Our results suggest that detemir may improve night-time QOL and increase treatment satisfaction due to detemir's decreased hypoglycemia risk.

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[in Japanese]

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We report two cases of severe hypoglycemia and weight gain from the age of 50, each of whom had developed type 1 diabetes mellitus during childhood.
Case 1: A 54-year-old woman developed diabetes mellitus in 1959 at the age of 6 years. Since March 2002, at age 48, she had frequent bouts of hypoglycemia with loss of consciousness (body weight 66 kg, BMI 26.1 kg/m²). In November 2007, at the age of 54 years, she often drank three liters of fruit juice a day due to hypoglycemia. She suddenly developed dyspnea and she was hospitalized with congestive heart failure (body weight 80 kg, BMI 31.6 kg/m²).
Case 2: A 55-year-old woman developed diabetes mellitus in 1961 at the age of 10 years. She weighed 54.5 kg and had a BMI of 22.0 kg/m² in March 2004 when she was 52 years old, but gained weight from May 2004. Since March 2005, she had frequent bouts of hypoglycemia with loss of consciousness (body weight 56 kg, BMI 22.4 kg/m²). She weighed 60 kg and had a BMI of 24.0 kg/m² in January 2006. On the morning of May 2007 at the age of 55 years, she had the “dead in bed” syndrome.
In these cases, severe hypoglycemia and weight gain developed during the climacteric, and proved lethal, indicating the need for close by managed treatment.

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[in Japanese]

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[in Japanese]

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We evaluated health-related quality of life (QOL) and psychological status such as depression and anxiety in those with type 1 diabetes including simultaneous pancreas-kidney transplantation (SPK) (n=5), kidney transplantation alone (KTA) (n=5), and on a waiting list (WL) for pancreas/kidney transplantation (n=20). We administered a questionnaire using Short Form-36 (SF-36 v2) and the Hospital Anxiety, and Depression Scale (HADS). Compared to those with KTA and WL patients, physical functioning in SF-36, general health perception, vitality, and emotional and physical role components scores of those with SPK were significantly higher. SPK scores ranged from 46 to 55 points, similar to the Japanese national standard range. Most with SPK had good psychological status indicated by negative cutoff points for depression and anxiety.
These results confirm the good quality of health-related QOL in those with SPK and suggest the need for routine QOL assessment and mental care for those with KTA and WL to improve health-related QOL.

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