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Volume 55, Issue 2
Displaying 1-8 of 8 articles from this issue
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Original ArticlesOriginal Articles
Epidemiology
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Yoshinao Uezu, Hideaki Tanaka, Hiroyuki Yogi, Masahiro Yamazato, Takes ...2012 Volume 55 Issue 2 Pages 91-96
Published: 2012
Released on J-STAGE: March 09, 2012
JOURNAL FREE ACCESSWe conducted a cross-sectional study of type 2 diabetic nephropathy prevalence and treatment goal achievement in Okinawa Nanbu in June 2008. Subjects numbering 1,279 had type 2 diabetes and were seen at 9 clinics or hospitals in Okinawa Nanbu. Their mean age was 61.9 (SD 11.8), systolic blood pressure 131.2 (14.7) mmHg, diastolic blood pressure 74.1 (10.0) mmHg, HbA1c 7.1 (1.5) % (JDS), total cholesterol 195.6 (33.7) mg/dl, low-density lipoprotein (LDL) cholesterol 112.4 (29.6) mg/dl, and serum creatinine 0.95 (0.68) mg/dl.
We set the treatment goal at <6.5 % for HbA1c, <130/80 mmHg for blood pressure, and <100 mg/dl for serum LDL cholesterol. The proportion of those achieving the treatment goal was 40.3 % for HbA1c, 37.9 % for blood pressure, and 32.1 % for lipids. The prevalence of diabetic nephropathy stage 1 was 55.4 %, stage 2 25.3 %, stage 3 16.6 %, and stage 4 2.7 %. Diabetic nephropathy prevalence above stage 2 was high in Okinawa, emphasizing the need it for detecting diabetic nephropathy early and treating it aggressively and multifactorially.
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Pathophysiology, Metabolic Abnormalities, Complications
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Yukako Nakashima, Kenji Takahashi, Takahiro Suzuki, Atsushi Yoshida, M ...2012 Volume 55 Issue 2 Pages 97-102
Published: 2012
Released on J-STAGE: March 09, 2012
JOURNAL FREE ACCESSAim and Method: To clarify clinical characteristics of "type 1 on type 2" diabetes mellitus, i.e., autoimmune type 1 diabetes developed during long-term type 2 diabetes, we analyzed clinical data from 5 subjects with this uncommon type of diabetes seen in the last decade at our hospital.
Results: Of the two men and three women, four were previously obese and four had a family history of diabetes. Their mean age at seroconversion of at least one islet-associated antibody was 68, when they had suffered from the disease for an average of 14 years. GADAb became positive in 4 of the 5, ICA in 2, and IA-2Ab in 1. The mean increment of serum C-peptide concentration during glucagon or meal loading decreased from 1.85 ± 0.89 ng/ml before seroconversion to 0.38 ± 0.46 ng/ml after (p<0.01). Of the 4 administered insulin before seroconversion, 1 showed skin insulin allergy at the injection site. The HLA DR/DQ DNA genotype in all had a disease-sensitive haplotype to Japanese type 1 diabetes, such as DRB1*0405-DQB1*0401 or DRB1*0901-DQB1*0303.
Conclusion: Autoimmune type 1 diabetes mellitus may develop during long-term type 2 diabetes among elderly subjects who were previously obese, had a family history of diabetes, and had a disease-sensitive haplotype to type 1 diabetes at HLA classII region.
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Masashi Shimoda, Hiroshi Yoshioka, Kazuhito Tawaramoto, Takatoshi Anno ...2012 Volume 55 Issue 2 Pages 103-109
Published: 2012
Released on J-STAGE: March 09, 2012
JOURNAL FREE ACCESSThe ankle-brachial index (ABI) estimated in diagnosing peripheral arterial disease (PAD) often does not reflect PAD severity in arterial medium calcification. To assess the toe-brachial index (TBI) on PAD diagnosis in subjects with type 2 diabetes (T2DM), the ABI and TBI were measured and the relationship assessed with clinical parameters in 74 subjects with T2DM. Of these, 40 (54.1 %) had an ABI of 0.9-1.29 and a TBI of ≥0.6 (group A), 28 (37.8 %) an ABI of 0.9-1.29 and a TBI of <0.6 (group B), 3 (4.1 %) an ABI of ≥1.3 and a TBI of ≥0.6, and 3 (4.1 %) an ABI of <0.9 and a TBI of <0.6. The ABI correlated positively with the TBI and both correlated negatively with age. The TBI, but not the ABI, correlated negatively with diabetes duration, HbA1c, systolic blood pressure, the albumin extraction index (AEI), highly-sensitive CRP (hs-CRP), baPWV, average IMT, and max IMT. The TBI reflected how microvascular complications progressed and the number of risk factors for arteriosclerosis. Group B had higher age, HbA1c, baPWV, AEI, and hs-CRP than group A and the duration of diabetes was longer. Average IMT also tended to increase in group B. In conclusion, the TBI appeared to be more useful than the ABI in assessing PAD development in subjects with T2DM.
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Case Report
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Y. Narabayashi, M. Ishikawa, K. Sakamoto, A. Morise, N. Hiroi, K. Kubo ...2012 Volume 55 Issue 2 Pages 110-115
Published: 2012
Released on J-STAGE: March 09, 2012
JOURNAL FREE ACCESS -
Ken Takeshima, Norihiko Murakami, Keita Hamamatsu, Masakazu Notsu, Hir ...2012 Volume 55 Issue 2 Pages 116-121
Published: 2012
Released on J-STAGE: March 09, 2012
JOURNAL FREE ACCESSA 64-year-old woman with a three year history of diabetes mellitus was admitted to the hospital for glycemic control in 2005. She had been treated for type 2 diabetes mellitus with an oral hypoglycemic agent. A family history of diabetes mellitus was evident in the patient's mother. The patient was obese, with a high BMI (36.9). Laboratory examinations showed a fasting plasma glucose level of 127 mg/dl and an HbA1c of 6.8 % (JDS value). Fasting serum C-peptide, postprandial serum C-peptide and HOMA-R levels were 2.43 ng/ml, 6.06 ng/ml and 4.39 respectively. Insulin secretory capacity remained and insulin resistance was observed. Testing for GADAb was positive with high titer (627.2 U/ml). In addition, ICA and IA-2Ab was also positive. The patient was placed on a diet and prescribed the oral hypoglycemic agent Acarbose.
Five years following her initial hospitalization, insulin secretory capacity was still preserved. She still remained obese and had experienced a brain infarction and angina pectoris. These clinical features strongly suggested that she was suffering from type 2 diabetes mellitus. Nevertheless, the presence of islet autoantibodies (GADAb, ICA and IA-2) and HLA genotype is a predisposition to type 1 diabetes. Although the pathophysiology of diabetes mellitus is ambiguous, the present case may imply the possibility of the coexistence of type 1 and 2 diabetes.
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Junpei Yamamoto, Keizo Kaneko, Kei Takahashi, Chihiro Satake, Uiko Tsu ...2012 Volume 55 Issue 2 Pages 122-128
Published: 2012
Released on J-STAGE: March 09, 2012
JOURNAL FREE ACCESSA 55-year-old man, recognized as having impaired glucose tolerance three years earlier, presented with an HbA1c (JDS) of 11 %. Sulfonylurea plus α-glucosidase inhibitor treatment was started, resulting in a decrease in HbA1c to 6.6 % two months later. However, since GAD (glutamic acid decarboxylase) antibodies were positive, he was diagnosed as having autoimmune type 1 diabetes and his treatment regimen was switched to intensive insulin therapy. Ten U/day of insulin effectively controlled his metabolic state for about 40 days: preprandial SMBG (self-monitoring of blood glucose) levels were approximately 100 mg/dl. However, despite the absence of known triggers including dietary conditions, he developed sudden abdominal fullness, thirst and polyuria and preprandial SMBG levels rose rapidly to more than 300 mg/dl for ten days. On admission, though he had already started insulin therapy, clinical findings met the diagnostic criteria for fulminant type 1 diabetes. At the time of discharge, 36 U/day of insulin were needed for glycemic control. In this case, SMBG enabled us to demonstrate rapid metabolic deterioration, mimicking the onset of fulminant type 1 diabetes, despite good control of autoimmune type 1 diabetes.
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Mayumi Kawaguchi, Hiromi Ogata, Keiko Iwasaki, Akemi Inoue2012 Volume 55 Issue 2 Pages 129-135
Published: 2012
Released on J-STAGE: March 09, 2012
JOURNAL FREE ACCESSA 75-year-old woman diagnosed with type 1 diabetes mellitus at age 58 and requiring insulin several times a day was admitted for disturbance of consciousness. She also had a defect of right range of vision. MRI showed a high-intensity FLAIR sequence and a little high in DWI imaging of the bilateral occipital lobe and cerebellum. Despite suspected brain infarction, symptoms and MRI imaging problems were rapidly resolved by controlling blood glucose, yielding a diagnosis of posterior reversible encephalopathy syndrome (PRES). Our recent use of MRI has involved many cases of PRES, some with diabetes mellitus and many with both hyperglycemia and hypertension or other risk factors. It is still unknown whether hyperglycemia itself induce PRES. We conducted examinations by referencing reported cases. PRES treatment and prognosis differ from those of brain infarction and epilepsy, making it important to diagnose PRES as early as possible.
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Proceeding of the Local Society
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2012 Volume 55 Issue 2 Pages 136-172
Published: 2012
Released on J-STAGE: March 09, 2012
JOURNAL FREE ACCESSDownload PDF (1066K)
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