All issues
Volume 55, Issue 3
Displaying 1-8 of 8 articles from this issue
- |<
- <
- 1
- >
- >|
Original Articles
Pathophysiology, Metabolic Abnormalities, Complications
-
Nobuhisa Mizuno, Eiiti Ogawa2012 Volume 55 Issue 3 Pages 175-184
Published: 2012
Released on J-STAGE: April 24, 2012
JOURNAL FREE ACCESSBiguanides have not been prescribed generally in Japan because of the lactic acidosis risk. We reevaluated the guanide metformin for efficacy and safety. Our subjects were 535 diabetic outpatients treated for 10 years with metformin. Of these, 43 had no liver injury, renal failure, or alcoholic intake but had lactate elevated at least once. Lactate and pyruvate levels in these 43 were higher than in 40 diabetic outpatients not taking metformin. The regression line ratio and slope between lactate and pyruvate in the 43 did not differ significantly from those in the 40 diabetic outpatients without metformin or from those in 58 diabetic outpatients on metformin having normal lactate concentration. The elevated lactate concentration experienced in our 43 subjects was due to elevated pyruvate, not excess acid. Our DM outpatients, to whom metformin was prescribed and who had elevated lactate concentration at least once, did not have lactic acidosis. When elevated lactate in DM outpatients taking oral metformin is evaluated, both the pyruvate level and the ratio of lactate to pyruvate must therefore be considered.
View full abstractDownload PDF (856K)
Psychology, Behaviour Science
-
Mieko Habuka, Akihiro Sakurai, Masanori Yamazaki, Mitsuhisa Komatsu, H ...2012 Volume 55 Issue 3 Pages 185-192
Published: 2012
Released on J-STAGE: April 24, 2012
JOURNAL FREE ACCESSBoth the lifestyle factor and genetic susceptibility influence the development of diabetes, but information on the genetic diabetes factor appears insufficient compared to that on the lifestyle factor. We surveyed the perception of subjects with type 2 diabetes about the contribution of environmental and genetic factors to the development of diabetes. Subjects with a familial diabetes history tended to overestimate the influence of the genetic factor on diabetes while those with no familial diabetes history underestimated it. No such trend was seen in nondiabetic control subjects. A correct knowledge of the influence of lifestyle and genetic susceptibility should thus improve self-management by subjects. Appropriate, efficient strategies providing information on the etiology of diabetes should thus be established and the ensuing medical intervention should be based on such knowledge.
View full abstractDownload PDF (533K)
Health Service, Medical Economics
-
Mari Tanaka, Hiroyuki Ito, Koshiro Oshikiri, Shinichi Antoku, Mariko A ...2012 Volume 55 Issue 3 Pages 193-198
Published: 2012
Released on J-STAGE: April 24, 2012
JOURNAL FREE ACCESSDirect medical costs determined for 708 outpatients with type 2 diabetes mellitus averaged an annual ¥388,029 and increased with subject age and diabetes mellitus duration. Expenses were ¥187,321 for those treated with nonpharmacological modalities' ¥308,521 for those given oral antidiabetic agents, and ¥574,667 for those undergoing insulin therapy. Medical costs were higher for those with diabetic micro- or macrovascular complications than in those without. They also increased with the number of atherosclerosis risk factors, such as hypertension, hyperlipidemia, obesity, and reduced eGFR (<60 ml/min/1.73 m2). In multiple regression analysis, hypertension and reduced eGFR were associated significantly with health care costs. Medical costs for those with type 2 diabetes mellitus were related to age, disease duration, treatment type, vascular complications, and atherosclerosis risk factors. If eGFR is reduced or surrogate atherosclerosis markers indicate an abnormality, intensive examination for diabetic vascular complications is important in suppressing future medical costs.
View full abstractDownload PDF (492K)
Case Reports
-
Takako Ohyama, Takateru Akiyama, Ken-ichiro Nishikawa, Tatsuo Yanagawa2012 Volume 55 Issue 3 Pages 199-203
Published: 2012
Released on J-STAGE: April 24, 2012
JOURNAL FREE ACCESSMitiglinide is a rapid- and short-acting insulinotropic SU receptor ligand whose blood concentration rises rapidly after oral administration, falling quickly thereafter. Mitiglinide thus rarely causes prolonged hypoglycemia. We report a subject with diabetes having prolonged hypoglycemia induced by mitiglinide.
An 80-year-old woman admitted in a hypoglycemic coma had been diagnosed with diabetes at age 50 and had undergone treatment with mitiglinide at 30 mg/day for 5 years. Her right kidney was removed at age 73 due to a tumor. She ate breakfast and took medication, including mitiglinide, as usual, but these were discontinued after admission. Some 30 hours after the last mitiglinide intake, she went into a hypoglycemic coma again with high IRI, C-peptide, and mitiglinide blood concentrations suggestive of prolonged hypoglycemia induced by mitiglinide. Mitiglinide is predominantly metabolized in the liver, but renal impairment did not explain the prolonged high concentration. We analyzed the genes involved in drug metabolism, transport, and excretion using the Affymetrix Targeted Genotyping System, but results were not contributory. This case thus shows that mitiglinide may induce prolonged hypoglycemia. Careful attention must therefore be paid when mitiglinide is prescribed to elderly subjects with renal impairment.
View full abstractDownload PDF (416K) -
Masuomi Tomita, Tadashi Matsuoka, Yusuke Kabeya, Maki Kawasaki, Takesh ...2012 Volume 55 Issue 3 Pages 204-208
Published: 2012
Released on J-STAGE: April 24, 2012
JOURNAL FREE ACCESSA 36-year-old man seen for hyperglycemia and ketosis was started on multiple insulin injections. Two weeks later, he was hospitalized for swelling, redness, and pain in the left thigh. Magnetic resonance imaging (MRI) of the thighs indicated diabetic muscle infarction. Symptoms resolved spontaneously within three weeks. Diabetic muscle infarction, a rare diabetes complication, is usually seen in subjects with long-term poorly controlled type 1 diabetes associated with advanced diabetic complications. Our subject, in contrast, had short-term type 2 diabetes free of complications such as nephropathy, retinopathy, or neuropathy. Even so, alternating glycemic states after insulin injections are started may be responsible for muscle infarction.
View full abstractDownload PDF (389K) -
Ikki Sakuma, Yoko Matsuzawa, Jun Saito, Hiroko Ito, Masao Omura, Tetsu ...2012 Volume 55 Issue 3 Pages 209-214
Published: 2012
Released on J-STAGE: April 24, 2012
JOURNAL FREE ACCESSCongenital adrenal hyperplasia due to 21-hydroxylase deficiency (21-OHD) was well maintained after diagnosis is a 1-year-old girl in administering hydrocortisone (HC), with clitoral plasty done while maintaining hydrocortisone at age 3. She was treated with 0.75 mg/day of dexamethasone (Dex) after HC was discontinued when the woman reached adulthood with no signs or symptoms of iatrogenic Cushing syndrome (CS). The Dex dose was increased to 2.5 mg when the woman was 27, when glucocorticoid activity was potentially equivalent to 60 mg of HC because the urology physician in charge misunderstood the Dex dose used due to undetectable serum cortisol. The woman gradually gained weight, reaching over 100 kg by age 30 due to the inappropriately high Dex dose. This continued with inappropriately high predonisolone or Dex dosage until she was finally diagnosed with diabetes and increased HbA1c at age 34. Glimepiride had already been started elsewhere in outpatient diabetes treatment and she was admitted to our hospital due to insufficient hyperglycemic control. Family history showed that her father and brother had already been diagnosed with type 2 diabetes. A physical examination when she weighed 98 kg but was 158 cm tall showed Cushingoid signs such as moon face, buffalo hump, and central obesity. No diabetic complications such as microangiopathy or arteriosclerosis were seen. We diagnosed her as suffering from iatrogenic CS and steroid-induced diabetes with hyperinsulinemia. Glimepiride was discontinued and combination therapy with metformin and voglibose started. We changed from Dex to HC, gradually reducing glucocorticoid replacement. Her weight decreased as the HC dose was lowered and blood glucose levels improved. An appropriate amount of glucocorticoid is generally acceptable for suppressing adrenal androgen secretion sufficiently without adversely affecting hypothalamic-pituitary-adrenal axis function during 21-OHD treatment. It is difficult to reduce excess androgen without administering a high glucocorticoid dose that could induce iatrogenic CS, as in our present case. Glucocorticoid use should be considered carefully in replacement therapy, especially in elderly subjects with 21-OHD at risk for diabetes mellitus.
View full abstractDownload PDF (574K) -
Michino Mugishima, Junko Oya, Miho Takizawa, Maya Harada, Akiko Ishii, ...2012 Volume 55 Issue 3 Pages 215-219
Published: 2012
Released on J-STAGE: April 24, 2012
JOURNAL FREE ACCESSWe report lifesaving treatment in a case of poorly controlled diabetes mellitus associated with severe infection and suspected septic thrombosis. A 55-year-old man diagnosed with type 2 diabetes 18 years ago and treated with insulin but having poor glycemic control was admitted in January 2010 for high fever, wet cough, and consciousness loss. Laboratory findings on admission showed plasma glucose of 857 mg/dl, metabolic acidosis, and high urine ketone body levels. He developed severe inflammatory reactions resulting in sepsis and disseminated intravascular coagulation, and was put on an artificial respirator due to progressive respiratory failure. Computed tomography showed a cavity-forming nodular shadow in the apical right lung, peripheral round densities, and inferior vena cava thrombosis. Sputum and bronchi wash cultures were negative for tuberculosis. Lung biopsy findings did not indicate cancer or collagen disease. The final pathological diagnosis was lung abscess. An inferior vena cava thrombus was suspected of being infectious and had developed a septic pulmonary embolism. The man's general condition improved following intensive treatment.
View full abstractDownload PDF (529K)
Proceeding of the Local Societies
-
2012 Volume 55 Issue 3 Pages 220-232
Published: 2012
Released on J-STAGE: April 24, 2012
JOURNAL FREE ACCESSDownload PDF (704K)
- |<
- <
- 1
- >
- >|