To evaluate the progression of diabetic polyneuropathy (DPN), a clinical stage classification introduced by "the working group on diabetic neuropathy" has been utilized. In order to assess the sensory dysfunction in this clinical stage classification, the current perception threshold (CPT) was measured in type 2 diabetic patients using the Pain Vision^®PS-2100 (PV), a device that can be used for the quantitative analysis of perception and pain. We found the CPT of the lower extremities to significantly increase in association with the progression of DPN from stage I to III according to this classification. In addition, the CPT correlated with the results of a monofilament examination for sensory testing. These results suggest that the PV is useful for the quantitative assessment of sensory nerve dysfunction and for evaluating early stage diabetic polyneuropathy.

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The purpose of this study was to elucidate the factors that contribute to the decrease in muscle mass in patients with type 2 diabetes. We studied 111 type 2 diabetic patients who were divided into two groups based on their gender (58 males and 53 females). We measured the muscle masses of the upper and lower extremities, using a bioelectric method that measures the body composition, in order to examine the relationship between the gender-related factors and diabetes. A multiple regression analysis was performed using the upper and lower extremity muscle masses as the dependent variables. In male patients, the HbA1c (β=-0.386, p=0.003) was a significant independent variable associated with the upper extremity muscle mass. Diabetic neuropathy (β=-0.403, p=0.001) and the HbA1c (β=-0.356, p=0.002) were found to be significant independent variables associated with the lower extremity muscle mass. In female patients, diabetic neuropathy (β=-0.295, p=0.018) and the ratio of LDL-cholesterol to HDL-cholesterol (the L/H ratio; β=-0.409, p=0.001) were significant independent variables associated with the lower extremity muscle mass. Therefore, multiple factors are considered to be associated with the decreased muscle mass in type 2 diabetic patients, and these factors differ greatly depending on gender.

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The plasma homocysteine (Hcy) levels are reportedly higher in subjects with type 2 diabetes mellitus (DM) than in non-DM subjects. We investigated the associations among the plasma Hcy and serum vitamin levels, and the habitual food intakes of 149 40- to 70-year-old type 2 DM patients. The Hcy level was normal, at 7.6±3.6 (Mean±SD) nmol/ml, while the folate and vitamin B₁₂ levels were relatively high. These trends differed between males and females. Low associations of 5,10-methylenetetrahydrofolate reductase polymorphisms on the Hcy and B vitamin levels were observed. Females had higher food intake frequencies for seaweed and mushrooms (p<0.001), vegetables, fruits (all p<0.01), soy and soy-products and fish (all p<0.05), and the "Japan diet pattern" score (p<0.001), which reflects a combination of the consumption frequencies of these foods, was higher than in males. In all subjects, the "Japan diet pattern" score correlated negatively with the log Hcy level, and correlated positively with the log folate and vitamin B₁₂ levels (all p<0.01). Therefore, increasing the frequencies in the consumption of these foods may be effective for preventing hyperhomocysteinemia in type 2 DM patients.

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A 78-year-old male patient was admitted with acute abdominal pain. He had developed type 2 diabetes mellitus in 1992 and was being treated with metformin. Since his HbA1c level had increased in October 2009, an α-GI, voglibose, was prescribed. One year later, he complained of abdominal symptoms, including abdominal distension, flatus, loose stools and constipation. These symptoms worsened in January 2011. He was thereafter admitted to the emergency department due to severe abdominal pain in March 2011. Plain abdominal radiography performed four hours after the onset of the abdominal pain showed dilation of the colon with gas retention. Plain abdominal computed tomography revealed a massive amount of hepatic portal gas, an enlarged colon with gas retention and regional thickening of the small intestine. The patient was treated conservatively with starvation. Enhanced abdominal CT performed seven hours after the onset of abdominal pain showed a rapid decrease in HPVG achieved by discontinuing the α-GI. The complete disappearance of the HPVG was observed after 48 hours. HPVG should therefore be taken into consideration in the differential diagnosis of gastrointestinal disorders when symptoms similar to the side effects of α-GIs reappear during treatment with an α-GI and become dominant.

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[in Japanese]

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