Journal of the Japan Diabetes Society
Online ISSN : 1881-588X
Print ISSN : 0021-437X
ISSN-L : 0021-437X
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Volume 56, Issue 10
Displaying 1-16 of 16 articles from this issue
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Lecture by the Prize Winner of 2013
Feature
Perspective on DPP-4 Inhibitors
Original Articles
Diagnosis, Treatment
  • A Multiclinical Study on the Cessation of Treatment for Type 2 Diabetic Patients
    Hidekatsu Sugimoto, Yoshio Nakaishi, Haruhiko Isotani, Mariko Oishi, H ...
    2013 Volume 56 Issue 10 Pages 744-752
    Published: October 30, 2013
    Released on J-STAGE: November 07, 2013
    DOIhttps://doi.org/10.11213/tonyobyo.56.744
    JOURNAL FREE ACCESS
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    As diabetes is often asymptomatic, diabetic patients tend to discontinue treatment. Type 2 diabetic patients, who were recently treated as outpatients at the 42 clinics belonging to the Japan Clinicians Diabetes Association, answered questionnaires concerning the six-month interval between the first diagnosis of diabetes and initial treatment (whether they were " left untreated" ) and also concerning their cessation of treatment. Among 1753 subjects, 18.7 %of cases were left untreated, and 21.7 %had received intermittent treatment. In both groups, males were significantly more common than females (p<0.001). Additionally, the ages at the first diagnosis of diabetes was younger in both of these groups than that in the group that received early treatment (p<0.005) and continuous treatment (p<0.0001). In comparison to the continuous treatment group, the recent HbA1c level (p=0.057) and rate of severe low vision (p=0.055) tended to be higher, and the phase of nephropathy was significantly more advanced (p=0.03) in the intermittent treatment group. The continuous treatment group exhibited a higher rate of receiving treatment for hypertension or dyslipidemia (p<0.02). Patients who were left untreated had a significantly higher probability of discontinuing diabetic treatment in the future (Odds ratio 1.5, p<0.01) than those who had received early treatment.
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Pathophysiology, Metabolic Abnormalities, Complications
  • Effect of Rosuvastatin on Glucose Metabolism: A Comparative Study with Atorvastatin
    Haruyuki Takama, Akio Ota, Junro Fuse, Akira Kubota, Mitsuo Obana, Shi ...
    2013 Volume 56 Issue 10 Pages 753-758
    Published: October 30, 2013
    Released on J-STAGE: November 07, 2013
    DOIhttps://doi.org/10.11213/tonyobyo.56.753
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    The influence of HMG-CoA reductase inhibitors (statins) on glucose metabolism is controversial. Additionally, the effects of statins on the glycemic control in Japanese type 2 diabetic patients have not been fully evaluated. Thus, we evaluated the effect of 2.5 mg daily rosuvastatin (Rs) and 10 mg daily atorvastatin (At) treatment on the glucose metabolism by examining the HbA1c, glycated albumin (GA), and several parameters obtained from the 75 g OGTT. A cross-over trial (each treatment lasted three months) was performed in non-obese Japanese type 2 diabetic patients. While the fasting plasma glucose (FPG), HbA1c and GA levels after the three-month treatment with Rs were not significantly different from baseline, the GA, but not the FPG and HbA1c, was significantly increased by At treatment. However, there were no significant differences in the FPG, HbA1c or GA between the Rs and At treatments. The areas under the curve for glucose and insulin, HOMA-R and the whole body insulin sensitivity index, the insulinogenic index, and disposition index as a marker of β-cell function after three months of Rs or At treatment did not differ from those at baseline, and there were no significant differences between the two treatments. Therefore, 2.5 mg daily Rs treatment may not affect the glucose metabolism in Japanese non-obese type 2 diabetic patients.
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Psychology, Behaviour Science
  • Effects of Exenatide on the Glycemic Control and Eating Behavior in Obese Japanese Patients with Type 2 Diabetes Mellitus
    Masaru Tokuda, Humihiro Ochi, Kana Miyakoshi, Yuko Kubooka, Yoshiki Ku ...
    2013 Volume 56 Issue 10 Pages 759-768
    Published: October 30, 2013
    Released on J-STAGE: November 07, 2013
    DOIhttps://doi.org/10.11213/tonyobyo.56.759
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    We examined the effects of exenatide on the glycemic control and eating behavior in obese Japanese type 2 diabetic patients. During the 12-week study, we administered exenatide (5 μg, twice/day) to 22 outpatients and increased the dose up to 10 μg twice/day in cases where a sufficient effect for weight reduction or improvement of the glycemic control could not be achieved. Before and after the follow-up period, we measured the HbA1c (NGSP), fasting plasma glucose and serum CPR levels, and evaluated the patients' eating behavior based on a questionnaire with seven separate domains. After the exenatide administration, the HbA1c improved and the plasma CPR level was significantly increased, and the body weight (BW) was significantly decreased. The eating behavior of the patients was significantly improved in all of the domains. When we compared the effects of the HbA1c improvement and BW reduction after exenatide administration in the subanalyses in accordance with the improvement or non-improvement of the HbA1c, the reduction or non-reduction of the BW, and male or female gender, we could not find any correlations between the effects on the improvement of the HbA1c and BW reduction. In obese female patients, the effects of exenatide on the eating behavior, HbA1c improvement and, BW reduction were the most advantageous.
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Case Reports
  • A Case of Slowly Progressive Type 1 Diabetes Mellitus with Autoimmune Pancreatitis
    Wataru Sano, Yasushi Sano, Kaoru Sano
    2013 Volume 56 Issue 10 Pages 769-774
    Published: October 30, 2013
    Released on J-STAGE: November 07, 2013
    DOIhttps://doi.org/10.11213/tonyobyo.56.769
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    A 48-year-old male presented with a rapid exacerbation of diabetes mellitus and elevated serum levels of hepatobiliary enzymes. Although he had a history of mild diabetes mellitus, he had not ever been pointed out to have liver dysfunction. He had elevated serum levels of IgG4, and autoimmune pancreatitis with sclerosing cholangitis was diagnosed by ultrasonography, computed tomography and endoscopic retrograde cholangiopancreatography. In addition, he had elevated serum titers of anti-GAD antibody and his diabetes mellitus was diagnosed to be slowly progressive type 1 diabetes mellitus. Steroid therapy and insulin therapy were administered for the autoimmune pancreatitis and type 1 diabetes mellitus, respectively. After steroid therapy, the patient's serum levels of hepatobiliary enzymes and IgG4 were normalized, and the swelling of the pancreas disappeared. Although type 1 diabetes mellitus and autoimmune pancreatitis are both autoimmune diseases whose target organ is the pancreas, there have been few case reports in which both diseases developed in the same patient. Further case reports are required.
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  • A Large Insulinoma in a Patient with Postoperative Hyperglycemia Due to Decreased Insulin: A Case Report
    Tohru Eguchi, Shozo Miyauchi, Yoshitomo Ueno, Hidenori Kiyochi, Shoich ...
    2013 Volume 56 Issue 10 Pages 775-780
    Published: October 30, 2013
    Released on J-STAGE: November 07, 2013
    DOIhttps://doi.org/10.11213/tonyobyo.56.775
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    A 73-year-old female was admitted to our hospital in a coma in December 2011. The laboratory analyses upon admission revealed hypoglycemia, with a serum glucose level of 29 mg/dl and a serum immunoreactive insulin level of 23.3 μIU/ml, which rapidly improved after glucose injections. Abdominal computed tomography (CT) demonstrated a large tumor (6×10×12 cm) in the body and tail region of the pancreas. Distal pancreatectomy was performed in February 2012. The histological diagnosis was a low grade (G1) neuroendocrine tumor (NET), made on the basis of the current WHO classification. Immunohistochemically, the tumor cells were positive for insulin and chromogranin A. After the operation, the serum C-peptide and urinary C-peptide levels decreased from 7.3 to 1.6 ng/ml and from 51.8 to 10.1 μg/day, respectively. The HOMA-β was 27.3 %and the CPR index was 0.8. Hyperglycemia persisted after surgery because of the decreased endogenous insulin. Therefore, insulin therapy was initiated. The present case suggests that a large insulinoma in the body and tail region of the pancreas can cause a significant decrease in endogenous insulin and a postoperative requirement for insulin therapy.
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Letters to the Editor
Proceeding of the Local Societies
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