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Volume 56, Issue 4
Displaying 1-7 of 7 articles from this issue
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Original Articles
Health Service, Medical Economics
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Ikuma Fujiwara, Junko Kanno, Akiko Hakoda, Aki Nishii, Yutaka Igarashi2013 Volume 56 Issue 4 Pages 213-218
Published: 2013
Released on J-STAGE: May 11, 2013
JOURNAL FREE ACCESSThe East Japan Great Earthquake, which occurred on March 11, 2011, was an extraordinary disaster due to both the major earthquake and the subsequent tsunami. People who experienced the disaster were obliged to live under unusual conditions. We conducted a questionnaire survey of patients with type 1 diabetes mellitus (T1DM), who require insulin treatment to survive, about their actions and feeling during and following the disaster. One hundred and eleven T1DM patients or their guardians who visited three hospitals in Sendai City answered the questionnaire soon after the earthquake (ages: 2-40 years; 37 of them were residents of the coastal area). The results of the survey (percentages and numbers in parentheses are for patients who lived on the coast) showed that 48 % of the subjects were at school or work when the earthquake occurred, while 30 % were at home. Eleven (16) % of the patients faced a shortage of insulin, and less than half answered that they had enough insulin. To get insulin, 24 (11) of the patients visited the hospital before their scheduled appointment, 16 (10) visited neighboring hospitals, and four (2) picked up insulin from dispensing pharmacies without prescriptions. To control their diabetes, more than 40 % of the patients decreased the dose of insulin injected, some used the same needles for multiple injections, and some decreased the frequency of measuring their BG. Many experienced a deviation of their diet (carbohydrate) and a shortage of food. The amount of exercise decreased in half of the patients. Patients got most of the information about controlling their diabetes from the television, followed by radio and newspaper, and about 10 % got their information from the internet and e-mail. There were five patients on the coast who could not get any information at all. To prepare for a disaster, it is important to keep extra insulin and other devices on hand, to ensure that there is contact between patients and hospitals, and also to form a local network of patients who can help each other during an emergency.
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Immunogenicity of an Inactivated Vaccine against Influenza A (H1N1) pdm09 Virus in Diabetic PatientsTakashi Eto, Megumi Matsubara, Misato Nagamizu, Motoki Ishibashi, Tomo ...2013 Volume 56 Issue 4 Pages 219-226
Published: 2013
Released on J-STAGE: May 11, 2013
JOURNAL FREE ACCESSDiabetic patients are particularly susceptible to influenza, and studies show that diabetic patients have higher morbidity and mortality rates, compared with people without diabetes. It is important to analyze the immunogenicity of influenza vaccines among diabetic patients. Forty-nine patients received the (A (H1N1) pdm09) vaccine twice. We finally analyzed 48 patients after excluding one who was suspected to have been infected. We calculated the geometric mean titer (GMT), mean fold rise (MFR), seroprotection proportion (SP), seroresponse proportion (SR), seroconversion proportion (SC), and analyzed the relationship between immunity and the prevaccination titer, the HbA1c and other parameters. After vaccination, the GMT increased in all categories, and the MFR in all patients increased by 5.3 after the first dose. An analysis of all of the patients showed that the SP after the first dose (S1) was 52 %, that after the second dose (S2) was 54 %, the SR S1 was 69 %, the S2 was 77 %, the SC S1 was 46 % and the S2 was 48 %. The MFR and SC met the standards of the European Agency for the Evaluation of Medical Products for Inducing Immunity. No significant relationship was found between the diabetic factors and the antibody response to the influenza A (H1N1) vaccine. These results suggest that advanced diabetic factors do not materially influence the immunogenicity of the influenza vaccine. Thus, it is reasonable to consider that influenza vaccination should be recommended for diabetic patients.
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Case Reports
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Seiya Kondou, Shuji Hidaka, Jin Kashima, Kimihiko Mitsutomi, Yutaka Fu ...2013 Volume 56 Issue 4 Pages 227-234
Published: 2013
Released on J-STAGE: May 11, 2013
JOURNAL FREE ACCESSOn March 8th, 2007, an 89-year-old woman visited the hospital because of impaired consciousness. She was examined in the Department of Neurosurgery, and no abnormalities were found by physical examination or brain MRI. However, because she had a blood glucose level of 37 mg/dl, she was treated with an intravenous glucose infusion. Improvement of the glucose levels and symptoms were rapidly noticed after the treatment, and the patient was discharged. The next day, in the early morning, the patient presented to the ER complaining of similar neurological symptoms; an analysis of her blood glucose levels revealed hypoglycemia, and the patient was admitted for treatment and further evaluation. Hyperinsulinemia of 30151 μU/ml during hypoglycemia, anti-insulin antibodies of 62.5 %, no history of exogenous insulin use and a carrier state of DRB1*04:06, an HLA type commonly observed in patients with insulin autoimmune syndrome (IAS), confirmed the diagnosis of IAS, which made our patient the oldest ever diagnosed with IAS in Japan. In a previous report of 212 IAS cases from 1970 to 1993, there were no differences in the incidence between genders. However, this time we reported 120 IAS cases from 1994 to 2010, and the female cases of IAS have been increasing; this has been linked with the use of α lipoic acid, a known risk factor for drug-related IAS. Moreover, among the 120 cases, 17 cases were reported from elderly patients aged 75 or over, and interestingly, there were no cases of typical drug-related IAS induced by α lipoic acid or thiamazole; thereby, a lower incidence of drug-related IAS was noted in these patients compared with that in the younger patients. A corresponding bibliographic analysis accompanies this report.
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Takanori Takai, Kazuki Ikura, Takako Onai, Risa Fujimaki, Ko Hanai, Ke ...2013 Volume 56 Issue 4 Pages 235-239
Published: 2013
Released on J-STAGE: May 11, 2013
JOURNAL FREE ACCESSA 53-year-old male presented with necrotizing fasciitis that had progressed from a diabetic foot ulcer. He was treated by a wide range debridement procedure, resulting in the loss of the majority of the skin and subcutaneous tissue in the left plantar region around the heel, and necrotic tissues were still observed around the exposed parts of the bones. There was also mild osteomyelitis in the left calcaneus. Negative pressure wound therapy using a vacuum-assisted closure system (VAC therapy) was started for wound healing on the 36th day after the admission after the inflammatory response was improved by antibiotics (meropenem, vancomycin and clindamycin). VAC therapy was performed in our hospital for four weeks (the longest period approved by the Japanese medical insurance system) and in another hospital for four weeks after he was transferred there. As a result, the wounded area was reduced drastically, and skin grafting could be performed. VAC therapy may become an effective method for treating intractable diabetic foot lesions.
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Sumiko Yoshida, Akio Kuroda, Saori Nii, Yuri Matsumoto, Eri Kondo, Nan ...2013 Volume 56 Issue 4 Pages 240-245
Published: 2013
Released on J-STAGE: May 11, 2013
JOURNAL FREE ACCESSThe Medtronic Minimed Paradigm 722 device allows the determination of the active insulin duration for two to eight hour periods, and suggests the appropriate dose of bolus insulin injection after a meal. We intended to validate the dose of post-meal bolus insulin automatically calculated by the Bolus Wizard Calculator of the Paradigm 722. The subject was a female in her 50's with type 1 diabetes mellitus. She had been introduced to the Paradigm 722 insulin pump therapy during several weeks of hospitalization. The pump settings were three hours of active insulin, a specific carbohydrate-to-insulin ratio (11, 15, 13) g/U and 60 mg/dl/U of insulin sensitivity factor (ISF). We compared the bolus dose of insulin automatically suggested by the Bolus Wizard Calculator and that manually calculated using the ISF, with a targeted blood glucose level of 150 mg/dl at two hours post-meal for one week before leaving hospital. The automatically calculated bolus insulin dose was more suitable than the manually calculated dose seven out of the 14 times it was calculated. The automatic correction program for the bolus insulin for post-meal hyperglycemia included with the Paradigm 722 was equivalent to the conventional manual calculation method, and achieves good glycemic control with just carbohydrate counting.
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Hiroko Ijima, Noriko Nakamura, Ayami Matsushita, Mayumi Fukunaga, Hide ...2013 Volume 56 Issue 4 Pages 246-251
Published: 2013
Released on J-STAGE: May 11, 2013
JOURNAL FREE ACCESSA 65-year-old male visited our hospital for the first time in 2002 after complaining of polyposia and polyuria. His fasting blood glucose (FPG) was 169 mg/dl, indicating diabetes, but his HbA1c (HPLC method) was 5.4 % (NGSP level), which was at the reference interval. Thereafter, he underwent follow-up diet therapy and exercise therapy; however, in 2008, his average FPG and glycoalbumin (GA) levels were high, while his HbA1c was 6.1±0.1 %, transitioning at the reference interval. His average glucose level under continuous glucose monitoring was 186 mg/dl and while the HbA1c speculated based on this value was 8.4 %, the measured HbA1c was 5.9 %. No abnormalities were observed upon globin gene analysis, and the HIV antigen/antibody titer was negative. Although mild anemia and a slightly high level of indirect bilirubin were seen, no other findings indicating hemolytic anemia were observed. However, the red cell survival in this case was significantly lower than that of the control. It was therefore believed that the cause of the low level of HbA1c in this case was the decreased red cell survival, however, the cause of this decrease was unknown.
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Proceeding of the Local Societies
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2013 Volume 56 Issue 4 Pages 252-274
Published: 2013
Released on J-STAGE: May 11, 2013
JOURNAL FREE ACCESSDownload PDF (838K)
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