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Volume 55, Issue 7
Displaying 1-9 of 9 articles from this issue
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Original Articles
Pathophysiology, Metabolic Abnormalities, Complications
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Machi Furuta, Yoshinori Shimajiri, Minoru Ueyama, Shuhei Morita, Akiko ...2012 Volume 55 Issue 7 Pages 445-449
Published: 2012
Released on J-STAGE: August 22, 2012
JOURNAL FREE ACCESSVascular conduction velocity in type 2 diabetic patients (n=313) was examined using the cardio-ankle vascular index (CAVI) and the relationship between the CAVI and clinical parameters was evaluated. A significant correlation was seen between the CAVI and the brachial ankle pulse wave velocity (baPWV). Multiple regression analysis indicated that age, body mass index (BMI), and diastolic blood pressure correlated independently with the CAVI. To evaluate the relationship between the CAVI and BMI, patients were divided into four groups based on BMI and the CAVI of each group was evaluated. The CAVI in the high BMI group was found to be significantly lower than in other groups. Although the CAVI is a parameter affected by blood pressure less often than the baPWV, our data suggests that the CAVI is affected by BMI and diastolic blood pressure.
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Keiichiro Fujishima, Ai Haraguchi, Kazunari Matsumoto2012 Volume 55 Issue 7 Pages 450-455
Published: 2012
Released on J-STAGE: August 22, 2012
JOURNAL FREE ACCESSTo investigate the impact of carotid atherosclerosis on the incidence of cardiovascular events, we evaluated carotid intima media thickness (IMT) and plaque presence in 368 patients with type 2 diabetes mellitus but no history of cardiovascular disease. Follow-up was a mean 6 years. The endpoint was defined as acute myocardial infarction, angina pectoris, stroke, or sudden death. The 51 patients reaching the endpoint showed significantly increased IMT of 1.10±0.17 vs 0.93±0.20 mm (p<0.05) and increased plaque incidence of 45.1 vs 28.4 % (p<0.05) . Patients were divided into IMT-based tertiles. Kaplan-Meier survival analysis showed that cardiovascular events occurred earlier in the increased IMT group (log-rank test p<0.05). The same results were obtained for plaque incidence. Univariate analysis showed that the hazard ratio for achieving the endpoint with increased IMT and plaque incidence was significant as in Cox's proportional hazard model. In multivariate analysis, however, the significance of IMT and plaque for the endpoint decreased. Factors independently related to the endpoint were age, systolic blood pressure, and HDL cholesterol level. These results suggest that carotid atherosclerosis is useful for predicting cardiovascular events. Poor blood pressure and abnormal lipid profiles, however, showed a higher risk of cardiovascular event occurrence compared to that with the presence of carotid atherosclerosis.
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Case Reports
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Hiroshi Kamiyama, Erina Shigematsu, Yukina Inoue, Uru Nezu, Tadashi Ya ...2012 Volume 55 Issue 7 Pages 456-462
Published: 2012
Released on J-STAGE: August 22, 2012
JOURNAL FREE ACCESSAn unconscious 23-year-old man with plasma glucose of 2149 mg/dl was admitted to the ICU in an emergency. He was diagnosed as having diabetic ketoacidosis (DKA) due to fulminant type 1 diabetes mellitus (FT1DM) , together with severe acute pancreatitis, rhabdomyolysis, and acute renal failure. After multidisciplinary treatment by ER and gastroenterology physicians, he was discharged without complications on hospital day 27. Case reports of FT1DM with severe acute pancreatitis are limited, and this case may contribute to future FT1DM therapy.
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Junko Kawahara, Hiroyuki Takata, Yoshio Hiraiwa2012 Volume 55 Issue 7 Pages 463-469
Published: 2012
Released on J-STAGE: August 22, 2012
JOURNAL FREE ACCESSA 48-year-old woman admitted for generalized edema and untreated hypertension and diabetes mellitus had a blood pressure of 210/138 mmHg. Laboratory data showed blood glucose of 503 mg/dl, HbA1c of 12.8 %, serum albumin of 2.7 g/dl, LDL-C of 197 mg/dl, and Cr of 0.9 mg/dl. Daily urinary protein excretion was 1.24 g. Fundic examination showed proliferative diabetic retinopathy. Carotid artery ultrasonography showed stenosis of the left internal carotid artery. Carotid intima-media thickness (CIMT) was 2.5 mm at the left common carotid artery. She was treated with acarbose, pioglitazone, cilnidipine, telmisartan, atorvastatin, cilostazol, and eicosapentaenoic acid. After 5 years, urinary protein excretion decreased to the level of normoalbuminuria. Carotid artery plaque regressed becoming hyperechoic and 1.5 mm thick. These results suggest that physicians should pursue diabetic nephropathy remission and early atherosclerosis regression by using intensive lipid-lowering therapy.
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Sari Hoshina, Tomoko Kondo, Misuzu Fujioka, Naoki Gocho, Akihiro Tagaw ...2012 Volume 55 Issue 7 Pages 470-476
Published: 2012
Released on J-STAGE: August 22, 2012
JOURNAL FREE ACCESSA-76-year man diagnosed with type 2 diabetes mellitus in 1993 was initially treated through diet and exercise, then with an oral hypoglycemic agent (OHA) in October 2005 due to poor blood glucose control. Polymyalgia rheumatica developing in November 2005 led to corticosteroid therapy, with the OHA changed simultaneously to insulin. Nocturnal hypoglycemia occurred three months later and a subcutaneous mass appeared at the insulin injectionsite. Insulin antibody was detected and the binding rate was 92.7 % in November 2007. Glycemic control remained poor despite insulin dose adjustment and change in the insulin type. The man was admitted in October 2009 and high-dose mPSL of 250 mg/day for three days started. This was followed with PSL of 30 mg/day for two weeks. Two years ofter corticosteroid therapy was started, PSL administration of 5 mg/day was continued and nocturnal hypoglycemia disappeared. The insulin antibody binding rate decreased and antibody affinity improved, as was confirmed in Scatchard analysis. In this case, corticosteroid therapy successfully improved a long-term glycemic daily profile caused by insulin antibody, as reported together with a comparison of cases.
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Mariyo Rokutan, Daisuke Yabe, Ryota Usui, Kenji Sugawara, Yuka Kitamot ...2012 Volume 55 Issue 7 Pages 477-482
Published: 2012
Released on J-STAGE: August 22, 2012
JOURNAL FREE ACCESSWe report a case of triple cancer of the pancreas, colon, and peripheral nerve sheath. A 68-year-old woman diagnosed with type 2 diabetes at age 63 had been administered antidiabetic oral medications since then. Her HbA1c had been 6.0-7.0 % in NGSP. We found that, in the last 5 months, her HbA1c had increased by 3.5 % and she had lost 9 kg, suggesting the need to check for possibly malignant disease. Contrast-enhanced computed tomography showed 1 tumor each of the pancreas, chest wall. Preoperative colonoscopy showed a tumor of the colon. The first two tumors, diagnosed pathologically as cancer of the pancreas and of the peripheral nerve sheath, were completely resected with no significant metastasis. The third tumor, diagnosed as cancer of the colon, was removed by endoscopic mucosal resection. Symptoms in those with diabetes that include progressive weight loss and deteriorating glycemic control should thus suggest the need to check for possibly malignant disease.
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Letters to the Editor
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N. Sado, K. Yoshimi, Y. Tahara, Y. Sato, S. Kaneko2012 Volume 55 Issue 7 Pages 483-484
Published: 2012
Released on J-STAGE: August 22, 2012
JOURNAL FREE ACCESSDownload PDF (168K)
Reports of the Committee
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Y. Seino, K. Nanjo, N. Tajima, T. Kadowaki, A. Kashiwagi, E. Araki, C. ...2012 Volume 55 Issue 7 Pages 485-504
Published: 2012
Released on J-STAGE: August 22, 2012
JOURNAL FREE ACCESS -
Takumi Hirata, Akira Shimada, Akihisa Imagawa, Takuya Awata, Hiroshi I ...2012 Volume 55 Issue 7 Pages 505-511
Published: 2012
Released on J-STAGE: August 22, 2012
JOURNAL FREE ACCESSWe performed a national survey of cases that had progressed rapidly from type 2 diabetes to insulin deficiency such as fulminant type 1 diabetes, and analyzed clinical case characteristics. We found that, compared to classical fulminant type 1 diabetes, subjects in these cases were relatively older at disease onset and had a higher body mass index (BMI), a higher rate of consciousness disturbance, a higher level of HbA1c, a lower level of arterial blood pH, and a lower level of urine C-peptide (CPR). We also found that BMI was significantly higher in cases with consciousness disturbance than in cases without. Due to their severe clinical course, it is very important that these cases be diagnosed, although 27.8 % of the cases surveyed did not comply with current diagnostic criteria for fulminant type 1 diabetes. We suggest that a combination of changes in markers such as low serum and urine CPR levels, short-term HbA1c elevation, and increases in serum pancreas exocrine enzymes, such as elastase-1 and lipase, may be useful for diagnosing these cases.
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