We studied current smoking status of 8,290 diabetic subjects —5,090 men and 3,200 women— regularly going to specialized medical facilities for diabetes, and compared results to those from a survey of the general Japanese population (National Health and Nutrition survey 2008). Subjects were classified as current smokers, past smokers, and nonsmokers to compare smoking influence on metabolic diabetes-related indexes. Smoker prevalence in gender and age resembled those for diabetic subjects and the general population. The prevalence of experienced current and past smokers was significantly higher, however, in diabetic subjects than in the general population —80.1% vs. 62.0% in men, 18.4% vs. 16.1% in women; p<0.0001, chi-square test). The proportion of those starting smoking below age 20 was greater in diabetics than in the general population. Diabetic subjects who currently smokers had higher HbA1c than past and nonsmoking subjects —7.18 vs. 6.90, 6.97% in men, 7.39 vs. 7.09, 7.09% in women— p<0.05, t-test. Some 15% of current diabetic smokers showed a positive attitude toward education for immediate smoking cessation. Results of previous studies implicated smoking as a risk factor in diabetes onset. Our finding of a higher proportion of experienced smokers among diabetic subjects than in the general population supports this hypothesis. Our results also confirm previous findings that smoking correlates with poor glycemic control in diabetic subjects. From the view of primary diabetes prevention, we believe that adolescents should be better educated in not smoking, and that secondary prevention requlreas better immediate education of current smokers.

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We analyzed the effects of pioglitazone coadministered reducing stimulators of insulin secretion on glucose and lipid metabolism, hypoglycemia episode frequency, and body weight in 109 outpatients with type 2 diabetes. A decrease in HbA1c of 0.5% or more was considered an effective response and HbA1c deterioration of 0.5% or more represented an invalid response, and the remaining were an invariable response to treatment. Treatment improved HbA1c from 6.9±0.9% (mean±SD) to 6.6±0.9%, with an effective response in 38.5%, an invalid response in 13.8%, and an invariable response in 47.7% of subjects. The three-month treatment improved insulin resistance, tripled the high-molecular-weight adiponectin serum level, significantly reduced low-density lipoprotein-cholesterol, increased high-density lipoprotein-cholesterol, and tended to reduce serum triglycerid. Safety analysis showed a mild weight gain of 1.5 kg and no hypoglycemia episodes. Our results indicated that glucose control can be improved together with insulin resistance, hypoadiponectinemia, and lipid profile. Weight gain was suppressed and hypoglycemia episodes minimized using pioglitazone combined with reduced doses of insulin secretion stimulators in subjects with type 2 diabetes.

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Subjects numbering 44 11 healthy men and 33 women with a mean age of 59.2 ±7.1 years taking part in a university-designed physical exercise program were followed up for 5 years. At baseline, 27 (61%) had normal glucose tolerance (NGT), 14 (32%) either impaired glucose tolerance (IGT) or impaired fasting glucose (IFG), and 3 (7%) diabetes (DM), in a 75 g oral glucose tolerance test (OGTT). At the end of this study, 8 had improved and 3 worsened OGTT, i.e., the relative number of NGT, IGT/IFG, and DM subjects was 73%, 25%, and 2%. Fasting plasma immunoreactive insulin (F-IRI) vs homeostasis-model assessment for insulin resistance (HOMA-R) decreased significantly -7.2 ±4.1 μU/ml to 3.5 ±2.7 μU/ml: p<0.001, and 1.8 ±1.1 to 0.9 ±0.7: p<0.01). The insulinogenic index (II) did not change significantly. In 8 with improved OGTT, HOMA-R decreased by over 1.0 and II by 0.4. In conclusion, the intervention of exercise appears effective in subjects with high HOMA-R and II >0.4.

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A 75-year Japanese woman with type 2 diabetes was admitted to our hospital with diabetic ketoacidosis (DKA) accompanied by acute kidney injury and sepsis due to a urinary tract infection. On admission, her serum levels of amylase and lipase were slightly elevated (138 U/l and 113 U/l, respectively) . Abdominal physical signs, abdominal computed tomography, ultrasonography and magnetic resonance cholangiopancreatography revealed no evidence of acute pancreatitis. Both the DKA and urinary tract infection improved rapidly with administration of intravenous insulin infusion and antibiotics; however, the serum concentrations of amylase and lipase were gradually elevated to the maximum of 478 U/l and 796 U/l, respectively, about 20 days after onset of DKA. These prolonged elevations of serum pancreatic enzymes were accompanied by increased serum creatinine levels. It finally took about 3 months for the amylase and lipase levels to normalize even after improvement of the acute kidney injury. The elevations of amylase and/or lipase have reportedly been observed in 16-25% of patients with DKA; however, there have been few reports of such a case with prolonged elevations of these enzymes for more than 3 months. We report on the present case in comparison to past cases with DKA in our Diabetes Center.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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A 22-year-old man diagnosed with type 2 diabetes mellitus at age 15 had been administered 750 mg/day of metformin. He was taken to the hospital by ambulance with vomiting and diarrhea 5 hours after attempting suicide by consuming 48,000 mg of metformin. Blood tests showed mild renal dysfunction of Cre 1.4, decreased prothrombin activity of 64.4%, and progressively decreased pH from 7.36 to 7.29. We started hemodialysis 8.5 hours after the suicide attempt. Following hemodialysis, the man's consciousness improved and he survived. Few reports in Japan have described metformin overdose. Those overdosing on metformin is expected to increase because, since April 2010, doctors are permitted to prescribe up to 2250 mg/day, up from the previous dose of 750 mg/day. We review metformin overdose outcome and treatment.

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