Journal of the Japan Diabetes Society
Online ISSN : 1881-588X
Print ISSN : 0021-437X
ISSN-L : 0021-437X
Volume 56, Issue 12
Displaying 1-12 of 12 articles from this issue
Feature
Dietary Therapy for the Management of Diabetes Revisited
Original Articles
Pathophysiology, Metabolic Abnormalities, Complications
  • Kazunari Matsumoto, Keiichiro Fujishima, Masako Ozaki
    2013 Volume 56 Issue 12 Pages 926-931
    Published: December 30, 2013
    Released on J-STAGE: January 15, 2014
    JOURNAL FREE ACCESS
    We studied the relationship between cardiovascular events and the non HDL cholesterol (non HDL-C) levels in patients with type 2 diabetes. A total of 368 patients with no history of cardiovascular disease were followed for a mean of six years. The end points were stroke and cardiac events (acute myocardial infarction, angina pectoris and sudden death). During the follow-up, stroke and cardiac events occurred in 26 and 25 patients, respectively. The non HDL-C levels did not differ significantly between the patients with and without stroke (133.1±40.0 vs. 134.1±37.4 mg/dl, NS); however, they were significantly higher in the patients with cardiac events than in those without (167.2±52.1 mg/dl, p<0.01). The non HDL-C levels were independently related to cardiac events (hazard ratio: 2.02; 95 % CI: 1.42-2.86; every 1-SD). The cutoff level for non HDL-C in relation to cardiac events was≥190 mg/dl according to a receiver operating characteristics (ROC) analysis. The area under the ROC curve for non HDL-C was greater than that for LDL-C; however, the difference was not statistically significant (0.708 vs. 0.623, p=0.31). A Kaplan-Meier survival analysis showed that cardiac events occurred significantly earlier in the patients with a non HDL-C level of≥190 mg/dl (p<0.01, log-rank test). Therefore, the non HDL-C level is closely related to the incidence of cardiac events, but not stroke, in patients with type 2 diabetes.
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  • Jo Satoh, Nobuo Kohara, Chikuma Hamada
    2013 Volume 56 Issue 12 Pages 932-937
    Published: December 30, 2013
    Released on J-STAGE: January 15, 2014
    JOURNAL FREE ACCESS
    The modified Toronto Clinical Neuropathy Score (mTCNS) is a reliable and valid clinical tool used to capture the early signs and symptoms of diabetic sensorimotor polyneuropathy in clinical research. The mTCNS was originally developed by Bril et al. in 2009. In this study, a Japanese version of the mTCNS was created with the permission of Bril to assess the reliability of the Japanese mTCNS in patients with diabetic sensorimotor polyneuropathy. All study centers were located in Japan and only Japanese patients were included. The inter-rater reliability was assessed according to the intra-class correlation coefficient (ICC) and Kraemer's kappa coefficient. The intra-rater reliability was assessed according to Cohen's kappa coefficient. The ICC for the total mTCNS score was 0.81, and, with the exception of the position sense item, the Kraemer's kappa coefficients for the mTCNS items ranged from 0.26 to 0.50. The Cohen's kappa coefficients for the mTCNS items ranged from 0.44 to 0.71. These results are similar in magnitude to those of the original mTCNS, which indicates that the Japanese translation of the mTCNS has sufficient reliability for use in clinical research in Japan.
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Case Reports
  • Yoshikuni Sawai, Taiya Kato, Naoto Kamatani, Naoyuki Katada, Mitsuyasu ...
    2013 Volume 56 Issue 12 Pages 938-942
    Published: December 30, 2013
    Released on J-STAGE: January 15, 2014
    JOURNAL FREE ACCESS
    A 73-year-old female was admitted to our hospital for the treatment of repetitive hypoglycemic episodes. Three years before admission, she was diagnosed with advanced rectal cancer with retroperitoneal and peritoneal invasion. She received two partial courses of chemotherapy following resection of the rectal cancer and subsequent alleviation of ileus. The regimen included fluorouracil, its prodrug and calcium folinate. Two weeks before the current admission, the patient underwent resection of the retroperitoneal mass and a portion of the ileum. Seven days after the surgery, she lapsed into a hypoglycemic coma (blood glucose level: 22 mg/dl). Hypoglycemic episodes recurred thereafter, even after meals. No drugs containing a sulfhydryl group were administered. The plasma glucose and insulin levels were 45 mg/dl and 305 μIU/ml, respectively, during one hypoglycemic episode. Insulin autoantibodies were positive for both IgG and IgE. Therefore, the recurrent hypoglycemic episodes were diagnosed as insulin autoimmune syndrome (IAS). The patient carried both susceptible (DRB1*0406) and resistant (DRB1*04051) HLA class II genotypes to IAS. The hypoglycemic attacks subsided spontaneously within six months. We speculate that the ileal surgery triggered the development of IAS by disrupting the patient's normal intestinal immunity.
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  • Masuomi Tomita, Yosuke Seki, Yusuke Kabeya, Maki Kawasaki, Takeshi Kat ...
    2013 Volume 56 Issue 12 Pages 943-948
    Published: December 30, 2013
    Released on J-STAGE: January 15, 2014
    JOURNAL FREE ACCESS
    We herein report the case of a 37-year-old female with a history of type 2 diabetes, dyslipidemia and hypertension who experienced repeated vomiting after undergoing laparoscopic sleeve gastrectomy with duodenal-jejunal bypass for morbid obesity (body weight: 165 kg, body mass index: 62.1 kg/m2). One year later, she developed hypoglycemic symptoms after meals. We performed an oral glucose tolerance test to determine the cause of the hypoglycemic symptoms and found that the IRI was 61.9 μU/ml and the active GLP-1 level was prominently elevated to 72.9 pmol/l at 30 minutes. We speculated that relative hyperinsulinemia and the suppression of glucagon secretion induced by the elevated GLP-1 level may have been linked to the vomiting and hypoglycemia. The present case has important implications for the surgical management of obesity in diabetic patients. With an increasing number of bariatric surgeries being performed each year, surgeons, as well as physicians, should thus be aware of the metabolic consequences that can result from these procedures.
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