Journal of the Japan Diabetes Society
Online ISSN : 1881-588X
Print ISSN : 0021-437X
ISSN-L : 0021-437X
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Volume 53, Issue 8
Displaying 1-8 of 8 articles from this issue
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Original Articles
  • Apolipoprotein B48 Increment After Test Meal A Increases Small Dense Low-Density Lipoprotein Cholesterol Independently of Triglyceride
    Yusaku Mori, Takeshi Yamamoto, Anna Tokuno, Tsutomu Hirano
    2010 Volume 53 Issue 8 Pages 593-600
    Published: 2010
    Released on J-STAGE: September 08, 2010
    DOIhttps://doi.org/10.11213/tonyobyo.53.593
    JOURNAL FREE ACCESS
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    Small dense low-density lipoprotein (sd-LDL) and postprandial lipemia have been highlighted as risk factors for cardiovascular disease. Such dyslipidemia is widely found in those with type 2 diabetics, but the interaction is poorly understood. We studied the effect of postprandial changes in apolipoprotein (apo) B48, a sensitive postprandial lipemia marker, on sd-LDL increase in 17 healthy controls and 27 subjects with type 2 diabetes. Blood samples were taken at 0, 1, 2, 4, and 6 h after Test meal A ingestion (460 Kcal, 18 g fat) . ApoB48 and triglyceride (TG) were measured and postprandial response calculated as the incremental area under the curve (iAUC) . ApoB48, ApoB48 iAUC, TG, and sd-LDL cholesterol (sd-LDL-C) were higher and lipoproteinlipase lower in those with diabetes than in controls. ApoB48 iAUC, TG, and TG iAUC correlated positively with sd-LDL-C in the overall study population. Multiple regression analysis identified apoB48 iAUC and TG as independent variables of sd-LDL-C, suggesting that postprandial lipemia increases sd-LDL independent of hypertriglycemia.
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  • Diagnostic Sensitivity and Specificity of HbA1c assay in Screening of Diabetes Mellitus
    Masao Yano, Minoru Yamakado, Akihiro Isogawa, Teruo Shiba
    2010 Volume 53 Issue 8 Pages 601-606
    Published: 2010
    Released on J-STAGE: September 08, 2010
    DOIhttps://doi.org/10.11213/tonyobyo.53.601
    JOURNAL FREE ACCESS
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    We assessed HbA1c sensitivity and specificity in detecting diabetes using the 75 g oral glucose tolerance test (OGTT) as the gold standard in 1485 subjects aged 22-89 years.
    For HbA1c at the recommended ≥6.1% (JDS) cutoff, sensitivity was 56.6% and specificity 98.5%.
    Based on receiver operating characteristic (ROC) analysis, the optimal HbA1c cutoff was 6.0% and FPG 106 mg/dl. Combining ≥6.0% HbA1c and ≥106 mg/dl FPG to detect diabetes, sensitivity increased markedly to 94% but specificity dropped to 92%.
    Both HbA1c and FPG have low sensitivity of <40% for detecting poor (borderline) glucose tolerance.
    The limited sensitivity of HbA1c alone may fail to identify a high proportion ->40%- of those with diabetes, so diabetes screening strategy should combine at least HbA1c and FPG.
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Case Reports
  • A Case of Pulmonary Cryptococcosis After Kidney-Pancreas Transplantation in Type 1 Diabetes
    Akira Nakamura, Hisafumi Yasuda, Taichi Akisaki, Kenta Hara, Masao Nag ...
    2010 Volume 53 Issue 8 Pages 607-612
    Published: 2010
    Released on J-STAGE: September 08, 2010
    DOIhttps://doi.org/10.11213/tonyobyo.53.607
    JOURNAL FREE ACCESS
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    A 41-year-old man diagnosed with type 1 diabetes at age 9 and undergoing kidney-pancreas transplantation at age 39, suffered fever and a chest pain in January 2008. Chest X-ray and Computed Tomography (CT) showed multiple nodules with cavities in the lung. Since he had been taking Mycophenolate Mofetil (MMF) , Tacrolimus (FK506) , and Methyl prednisolone (mPSL) , he was suspected of opportunistic infection and admitted in January 15. No microorganella were detected. Blood tests showed WBC 10400/μl, CRP 1.14 mg/dl, ESR26 mm/h, β-glucan <4 pg/ml, serum aspergillus antigen negative, serum candida antigen×2, and serum cryptococcal antigen ×256. These results and high serum cryptococcal antigen titer suggested pulmonary cryptococcosis. MMF was stopped and antifungal drug administration was started immediately. After over one year of antifungal drug, chest X-ray and CT showed reduced lesion of infiltration and gradually decreased serum cryptococcal antigen titer. In conclusion, pancreatic transplantation is useful in type 1 diabetes, but increases the possibility of opportunistic infection, requiring careful follow-up.
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  • A Case of Diabetic Ketoacidosis with Severe Pancreatitis and Marked Hypertriglyceridemia Successfully Treated with Plasma Exchange
    K. Yamamoto, S. Yanagimoto, A. Kubota, T. Terano, N. Hattori, Y. Morit ...
    2010 Volume 53 Issue 8 Pages 613-618
    Published: 2010
    Released on J-STAGE: September 08, 2010
    DOIhttps://doi.org/10.11213/tonyobyo.53.613
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    [in Japanese]
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  • A Case Report of Successful Secession from Continuous Subcutaneous Insulin Infusion Utilizing Continuous Glucose Monitoring in a Patient with Diabetes Complicated by Insulin Antibody Production and an Allergic Reaction to Insulin
    Jun Kinoshita, Aya Morimoto, Daiji Kawanami, Tsuyoshi Isaka, Masako Ta ...
    2010 Volume 53 Issue 8 Pages 619-625
    Published: 2010
    Released on J-STAGE: September 08, 2010
    DOIhttps://doi.org/10.11213/tonyobyo.53.619
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    A 72-year-old man was diagnosed as having diabetes mellitus at the age of 60 years. At the age of 64 years, he started talking gliclazide. At the age of 69 years, insulin therapy with the insulin analog aspart and isophane insulin was started because of poor glycemic control. At that time, his glycosylated hemoglobin (HbA1c) level was 9.7%. Following insulin therapy, his glycemic control improved. At the age of 71 years, his glycemic control began to worsen again, with his HbA1c level increasing to 8.6%. An examination at an other hospital revealed insulin antibodies and an allergic reaction to insulin. Although the insulin therapy was changed from lispro (which produced a slight allergic reaction to insulin on a skin test) to miglitol, the poor glycemic control persisted and continuous subcutaneous insulin infusion (CSII) was started. Fasting hypoglycemia and daytime hyperglycemia persisted, and he was admitted to our hospital for 24-hour glucose monitoring using continuous glucose monitoring (CGM) . As detailed glucose variations were confirmed, we changed the patient's treatment to lispro taken three times a day after stopping CSII. This change in the patient's therapy enabled the insulin dose to be lowered from 67.3 to 40 units. We concluded that CGM is beneficial for the treatment of brittle diabetes in patients with insulin antibodies and who are unaware of their hypoglycemia, as in the present case.
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  • A Case of Diabetes Mellitus Caused by a Type A Insulin Receptor Abnormality Who has been Treated with Insulin-like Growth Factor 1 and Oral Glycemic Agents for 19 Years
    Maya Harada, Yasuko Uchigata, Nanako Kataoka, Junnosuke Miura, Hiroshi ...
    2010 Volume 53 Issue 8 Pages 626-630
    Published: 2010
    Released on J-STAGE: September 08, 2010
    DOIhttps://doi.org/10.11213/tonyobyo.53.626
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    A 30-year-old woman with diabetes mellitus caused by an insulin receptor abnormality was admitted for glycemic control. She had been diagnosed as having glycosuria at the age of 10 years and was admitted to a hospital. Careful examinations showed that she had insulin resistance, acanthosis nigricans, and decreased insulin receptor binding on red blood cells, suggesting that the disorder was due to a type A insulin receptor abnormality. Treatment was started with insulin-like growth factor 1 (IGF-1) (0.07 mg/kg/day) . However, glycemic control remained poor (glycosylated hemoglobin [HbA1c], 8～10%) . She was admitted to our hospital to receive appropriate therapy for her insulin receptor abnormality. Meal tolerance tests under some established therapies for insulin receptor abnormality, such as IGF-1, insulin, metformin and pioglitazone, indicated that a combined treatment with IGF-1 (0.14 mg/kg/day) and metformin (1000 mg/day) was feasible. Her HbA1c level improved from 9.0% to 6.8% at 8 months after discharge, and good control (HbA1c < 6.5%) has been continued for 22 months. We report here the case of a woman treated with IGF-1 for 19 years who has not developed retinopathy or nephropathy.
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Co-medicals; Original Article
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