To assess the clinical usefulness of insulin detemir, we observed HbA1c, BMI, insulin dose, and hypoglycemia frequency during the 6 months after subjects with type 2 diabetes switched from insulin NPH to insulin detemir with intensive insulin therapy. In 63 subjects, the daily insulin detemir dose increased significantly at 6 months compared to baseline, whereas the daily insulin aspart dose decreased. HbA1c was reduced over the 6 months, i.e., 8.01±1.36 % at baseline, 7.81±1.39 % at 3 months, p=0.02 vs baseline; 7.78±1.41 % at 6 months, p=0.08 vs baseline. BMI also decreased significantly from 24.1±3.5 to 23.6±3.3 kg/m², p=0.034, during the 6 months after switching. The frequency of hypoglycemia induced by insulin detemir was significantly lower than that induced by NPH insulin, i.e., 1.04±1.28/month and 0.61±1.03/month, p=0.031. These results strongly suggest that insulin detemir is useful as basal insulin of intensive insulin therapy in those with type 2 diabetes.

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General diet therapy restricting caloric intake as the basis for diabetes treatment forces subjects to endure subjective hardship without corresponding results while leaving dietary goals largely unachieved. To improve the meal quality of life (QOL) while minimizing the rise in blood glucose levels, we compared the influence on glucose and the lipid index in the consumption of low-carbohydrate and regular cake in healthy controls prior to use in subjects with diabetes. We found that the consumption of low-carbohydrate cake group lowered the postconsumption rise of blood glucose and weakened insulin secretion while not adversely affecting triglyceride or free fatty acid levels. Postconsumption satisfaction, moreover, was equal between low-carbohydrate and regular cake. Introducing low-carbohydrate cake in the diabetic diet thus appears potentially effective in effecting dietary goals.

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We investigated the divergence factor between HbA1c measurement using DCA2000/Vantage (DCA) and the domestic daily method used in Japan referencing the KO 500 method, i.e., JSCC/JDS standard measurement. Calibration settings of the international standardization material and of DCA internal calibration material mostly resembled DCA measurement but measured 7 % to 10 % lower in relative percentage than the KO 500 method setting. KO500 chromatography recognized the peak of foreign substances not recognized by JDS Lot 4 in calibration of the international standardization material or of the DCA internal calibration material. The DCA divergence factor was thought to be caused by a difference in standard material composition or a difference in operation method separation capability. DCA showed a valid result by adopting calibration decided by the Japan Diabetes Society (JDS) and supplied the product based on JDS Lot 4 from July 2010.

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[in Japanese]

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A 74-year-old man diagnosed with diabetes at age 51 and treated with oral hypoglycemic agents had increased HbA1c (JDS, 8.3 %) noted at age 71. Insulin therapy (Humalog Mix 50^®) was started, resulting in good control (HbA1c <7 %). Unstable blood glucose levels were observed one year later, however, with morning hypoglycemia and daytime hyperglycemia. The blood IRI concentration was 2430 μU/ml and the insulin antibody binding rate 78.4 %. Scatchard plot analysis showed this antibody to have low affinity and high binding capacity. Changing the insulin product still left blood glucose levels unstable. During follow-up, the man developed a cerebral infarction. Discontinuing insulin to prevent insulin-antibody-induced hypoglycemia and changing to a GLP-1 receptor agonist improved glycemic control. This enabled glucose to be monitored continuously to visually and quantitatively assess circadian variation.

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We report a dialysis patient with nondiabetic end-stage renal disease (ESRD) whom we subsequently diagnosed as having type 1 diabetes and chronic thyroiditis. A 62-year-old woman undergoing hemodialysis for 19 years due to nondiabetic ESRD first evidenced severe hyperglycemia (≥500 mg/dl, nonfasting plasma glucose) in December 2009. Her laboratory data showed marked hyperglycemia, i.e., nonfasting plasma glucose of 382 mg/dl, HbA1c of 14.4 %, and glycated albumin of 82.7 %. Presumably because of hemodialysis, however, she had neither acidosis nor dehydration. Anti-GAD antibody was detected at 5190 IU/ml, so we diagnosed her as having type 1 diabetes. She was also diagnosed as having autoimmune thyroid disease since several thyroid autoantibodies were positive. Intensive insulin therapy quickly restored glycemic control. This case suggests that we should consider both testing for anti-GAD antibody and excluding malignancy in dialysis patients with acute hyperglycemia.

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A 30-year-old man reporting thirst, general malaise, and body weight loss was admitted in May 2011 with ketosis and marked hyperglycemia. His excessive soft-drink intake had first been noted in glucose intolerance found elsewhere in November 2010. Because glucose intolerance was mild and he was symptoms free, however, the man was not instructed in or treated for diabetes. His glucose tolerance worsened rapidly with a positive change in serum GAD antibody. We had, however, judging from his clinical course and beta cell function preservation, diagnosed him as having latent adult autoimmune diabetes or slowly progressive insulindependent diabetes mellitus. We therefore consider it important to investigate diabetes etiology, to promote diabetes education, and to conduct regular examinations regardless of the degree of glucose intolerance. These actions could thus prevent marked hyperglycemia caused by habits such as excessive soft-drink intake.

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[in Japanese]

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