The implementation of programs for diabetes control and complication prevention depends on reliable data. A survey of diabetes conducted at local pharmacies in the Toyono area to evaluate the severity of disease and capacity for self-management revealed that, among 1,026 participants (mean age: 66.9 years, 36.6 % women, an approximate duration of therapy of 10 years and mean HbA1c: 7.2 %) , only 31 % had the required HbA1c level (below 6.9 %) recommended by the Japan Diabetes Society. A substantial proportion (12.8 %) of the patients had an HbA1c level of more than 8.4 %. In addition, 9.8 % of the patients were unaware of their HbA1c level and 32.1 % did not undergo regular eye examinations to check for diabetic retinopathy. Multivariate analyses revealed that a higher HbA1c level was associated with a younger age, female gender and longer duration of therapy. Having regular eye examinations was found to be associated with an older age, female gender, longer duration of therapy and possession of the Diabetes "Renkei" Notebook. The Diabetes "Renkei" Notebook is a notebook with instructions and patient records that helps in sharing information among clinics, hospitals, caregivers and the patient. Although the "Renkei" Notebook is thought to make it easier to stay organized in the management of diabetes, this has yet to be proven. The present study demonstrated that the use of a "Renkei" Notebook is associated with favorable improvements in self-care, such as knowledge of one's HbA1c level and attendance at regular eye checkups. The results indicate the need for a continuous, systematic analysis of patient knowledge and education along with the widespread use of the "Renkei" Notebook for diabetes management and self-care.

View full abstract

We investigated the early effects of short-term intensive insulin therapy (STIIT) in 174 type 2 diabetic patients with HbA1c level 8.4 % and above. We also compared the long-term effects of voglibose and metformin after STIIT in 74 newly diagnosed patients and 64 previously treated patients. STIIT significantly decreased the levels of blood glucose and high-sensitivity C-reactive protein and the HOMA-IR scores and increased the HOMA-β scores. The HbA1c levels were correlated with the blood glucose levels and inversely correlated with the HOMA-β scores and duration of diabetes before STIIT; however, three months after treatment, the HbA1c levels were directly correlated with the duration of diabetes, reflecting the basic β-cell function under the subsidence of glucose toxicity. The newly diagnosed patients exhibited significantly stronger improvements than the previously treated patients (HbA1c level less than 6.9 %: 66 % vs. 30 %) . The patients with a shorter duration of diabetes demonstrated better responses to STIIT than those with a longer duration of diabetes. A multiple logistic regression analysis adjusted for age and gender showed that both factors independently contributed to the improvements. Among the previously treated patients, some patients exhibited difficulties during treatment, while others demonstrated β-cell preservation. Early relief from glucose toxicity due to STIIT offers substantial benefits to patients with poorly controlled type 2 diabetes.

View full abstract

No studies have been conducted regarding a negative cognition towards diabetes, and there are currently no psychological tests to measure it. To address this problem, we developed and tested the "Diabetes Negative Cognition Scale" (DNCS) for reliability and validity. A preliminary questionnaire of 111 items was distributed to 200 patients with type 1 diabetes and 310 patients with type 2 diabetes. Five psychological tests were also administered, and demographic and medical data were collected. A cluster procedure of variance analysis identified seven clusters: "Absence of a reason for living,""Burden of diabetes,""Distrust toward medical treatment,""Watching and meddling by surrounding people,""Sense of alienation,""Rejection of antidiabetic drugs or insulin" and "Pressure related to diabetic self-management." In total, the DNCS has 26 items. The validity of this scale was demonstrated by a good factor structure and higher DNCS scores among the patients with poor glycemic control. The reliability of the scale was demonstrated by the good internal consistency of Cronbach's α and the high consistency in the test-retest method.

View full abstract

A 67-year-old woman was diagnosed with type 2 diabetes mellitus at 40 years of age. Three years earlier, insulin therapy with biphasic insulin aspart 30 was initiated. She recently began to suffer from hypoglycemia in the early morning and was subsequently admitted to our hospital. The titer and insulin-binding capacity of insulin antibodies were high, and a scatchard analysis showed that the insulin antibodies had a larger capacity and weaker affinity in high-affinity binding sites compared with that observed in insulin antibody-positive patients under insulin treatment. Changing the insulin preparation did not ameliorate the hypoglycemia, while the withdrawal of insulin therapy resulted in more severe hyperglycemia in the daytime. Treatment with a combination of liraglutide and insulin analogue immediately attenuated the hypoglycemia in the morning and severe hyperglycemia in the daytime. A late scatchard analysis revealed changes in the characteristics of the insulin antibodies, thus suggesting one reason for the dissipation of the patient's hypoglycemia.

View full abstract

A 45-year-old man was diagnosed as having type-2 diabetes mellitus in 2005. Glimepiride and insulin therapy with premixed insulin lispro 25/75 was initiated in June 2010, and combination therapy with PEG-interferon α-2b and ribavirin for chronic hepatitis C was started in July 2010. The patient exhibited an allergic reaction at the injection site in November 2010, during the administration of interferon therapy. This symptom persisted after changing the type of insulin, and the patient's glycemic control began to worsen in association with deteriorating fasting plasma glucose and HbA1c levels (NGSP value) , which increased to 264 mg/dl and 10.0 %, respectively. The patient was admitted in March 2011. Marked elevation of specific IgE antibodies against human insulin was observed. A skin test for allergies was positive for both human insulin and human recombinant insulin. The patient was diagnosed with an immediate-type allergy to insulin. The laboratory data also showed a high titer of insulin antibodies in the serum. We changed the treatment regimen to glimepiride and liraglutide after discontinuing the insulin analogue therapy. Thereafter, the allergic reaction in the skin disappeared and the patient's glycemic control gradually improved simultaneously with a reduction in the titer of insulin antibodies in the serum. The development of autoimmune diseases, such as type 1 diabetes, has been reported to be a side effect of treatment with interferon; however, few cases of immediate-type allergies to insulin have been documented. This is a rare case of insulin antibody-positive type 2 diabetes mellitus with an insulin allergy that developed during interferon therapy.

View full abstract

Type 1 diabetes is characterized by the destruction of pancreatic beta cells, which leads to an absolute deficiency in insulin secretion. Depending on the manner of onset and progression, the disease is classified as fulminant, acute or slowly progressive. We herein propose diagnostic criteria for acute-onset type 1 diabetes mellitus. Among patients who develop ketosis or diabetic ketoacidosis within three months after the onset of hyperglycemic symptoms and require insulin treatment continuously after the diagnosis of diabetes, those with anti-islet autoantibodies are diagnosed with "acute-onset type 1 diabetes mellitus (autoimmune)." On the other hand, those whose endogenous insulin secretion is exhausted (a fasting CPR level of <0.6 ng/ml) without verifiable anti-islet autoantibodies are diagnosed simply with "acute-onset type 1 diabetes mellitus." Patients should therefore be reevaluated after certain periods in cases in which the status of anti-islet autoantibodies and/or endogenous insulin secretion is unknown.

View full abstract

Diagnostic criteria for slowly progressive insulin-dependent (type 1) diabetes mellitus (SPIDDM) have been proposed by the Committee on Slowly Progressive Insulin-dependent (Type 1) Diabetes Mellitus of the Japan Diabetes Society. The following two criteria are required for a definitive diagnosis: 1) the presence of glutamic acid decarboxylase antibodies (GADAbs) and/or islet cell antibodies (ICAs) at some time during the patient's clinical course and 2) the absence of ketosis or ketoacidosis at the onset (or diagnosis) of diabetes mellitus without the need for insulin treatment to correct hyperglycemia immediately after diagnosis. It remains unclear whether insulinoma-associated antigen-2 autoantibodies (IA-2Abs), insulin autoantibodies (IAAs) or zinc transporter 8 autoantibodies (ZnT8Abs) are essential markers for the diagnosis of SPIDDM. Hence, the presence of IA-2Abs, IAAs and ZnT8Abs was excluded from the diagnostic criteria for SPIDDM. Furthermore, ketosis and/or ketoacidosis are observed in cases of SPIDDM complicated by soft drink-induced ketosis. Supplementary information for the diagnosis includes the following: 1) most SPIDDM patients require insulin treatment for more than three months after the onset (or diagnosis) of diabetes mellitus and frequently progress to an insulin-dependent state, 2) GADAbs and ICAs become negative during the clinical course in many cases, 3) a small proportion of patients will maintain their endogenous beta cell function, irrespective of the titer of GADAbs and ICAs, over 10 years after the onset (or diagnosis) of diabetes; and 4) sometimes, early insulin treatment is initiated when GADAbs and/or ICAs are positive in both adult and pediatric cases.

View full abstract