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Volume 57, Issue 11
Displaying 1-7 of 7 articles from this issue
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Original Article
Diagnosis, Treatment
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Yukie Nakagawa, Yuichi Ishikawa, Keiko Watanabe, Hitomi Asakura, Kazuh ...2014 Volume 57 Issue 11 Pages 813-819
Published: November 30, 2014
Released on J-STAGE: December 01, 2014
JOURNAL FREE ACCESSFrequent healthcare counseling is thought to be important for the prevention and treatment of diabetes mellitus. However, the HbA1c-reducing effects decrease in association with an increasing disease duration. In this study, we examined whether the effects of the frequency of counseling involving a registered dietitianled medical nutrition therapy (MNT) program on the HbA1c levels are determined by the disease duration. Data were collected before and after MNT for six months among 725 patients with type 2 diabetes treated at 281 hospitals. Consequently, the post-MNT HbA1c levels decreased more significantly in the patients with a short disease duration (≤1 years, -2.09 %) than in those with a long disease duration (≥6 years, -0.99 %, P<0.001) as well as in the subjects who received more frequent counseling (4 times, -1.99 %) than in those who received less frequent counseling (≤2 times, -0.67 %, P<0.001). The positive effects of more frequent counseling were significant, even in the patients with a long disease duration (P<0.05). A logistic regression analysis revealed that the change in HbA1c inversely correlated with the frequency of counseling (P<0.001), independent of age, sex, changes in medications, family history of diabetes, baseline HbA1c and disease duration. These findings indicate that frequent counseling improves the effectiveness of MNT in lowering the HbA1c levels, regardless of the presence or absence of a history of type 2 diabetes.View full abstractDownload PDF (349K)
Case Reports
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Shuro Kogawa, Yuki Yagi, Atsushi Nakajima, Syuuhei Kobashi, Yasushi Oh ...2014 Volume 57 Issue 11 Pages 820-825
Published: November 30, 2014
Released on J-STAGE: December 01, 2014
JOURNAL FREE ACCESSA 58-year-old woman with a nine-year history of type 2 diabetes mellitus began vomiting after lunch one day in October 2011. She had no other symptoms and subsequently visited our hospital. The vomiting persisted even after the administration of antiemetic drugs, and she was therefore admitted under a diagnosis of acute gastroenteritis. Neither computed tomography of the abdomen or head nor upper endoscopy revealed any abnormalities, and there was no acidosis. However, brain magnetic resonance imaging (MRI) performed on Day 4 revealed vasogenic edema in the bilateral occipital lobes. We thus diagnosed the patient with posterior reversible encephalopathy syndrome (PRES). After admission, her blood pressure remained between 150/70 mmHg and 180/90 mmHg. In order to treat the PRES, we kept her blood pressure under 140/90 mmHg with intravenous nicardipine. Thereafter, her vomiting gradually diminished, ultimately disappearing by Day 7. Brain MRI performed on Day 10 showed no abnormalities, and she was discharged on Day 11. Although the number of reports of PRES associated with diabetes mellitus is increasing, no previous studies have described a case of PRES in a patient with diabetes mellitus presenting with only repetitive vomiting, no headaches, triggered by mild hypertension. This case suggests the importance of considering PRES in the differential diagnosis of repetitive vomiting in diabetic patients with mild hypertension.View full abstractDownload PDF (664K) -
Sayaka Utsumi, Takeshi Kanno, Masataka Ootomo2014 Volume 57 Issue 11 Pages 826-829
Published: November 30, 2014
Released on J-STAGE: December 01, 2014
JOURNAL FREE ACCESSDipeptidyl peptidase (DPP)-4 inhibitors are often used to treat type 2 diabetes patients due to their characteristics of safety and tolerance, with good diabetic control. Ileus has been reported to be a rare side effect of DPP-4 inhibitor therapy. However, until recently, the potential for ileus following treatment with DPP-4 inhibitors was only considered in patients with a past history of abdominal surgery and ileus. We herein present case of paralytic ileus that may have been caused by linagliptin. The patient was hospitalized for meningitis; he had a past history of cerebral hemorrhage, but no history of abdominal surgery or ileus. He subsequently developed paralytic ileus with vomiting and a stomachache. However, his condition recovered following conservative therapy with the discontinuation of linagliptin. This case may have been associated with diabetic gastroparesis, meningitis or the patient's past history of cerebral hemorrhage. The details of this case suggest that using DPP-4 inhibitors may induce ileus as a severe side effect in patients without a past history of abdominal surgery or ileus.View full abstractDownload PDF (425K) -
Noriko Kodani, Yoshifumi Saisho, Masami Tanaka, Jin Nakahara, Shu Megu ...2014 Volume 57 Issue 11 Pages 830-836
Published: November 30, 2014
Released on J-STAGE: December 01, 2014
JOURNAL FREE ACCESSThis case report involves a 69-year-old woman who was diagnosed with type 2 diabetes at 27 years of age. Her diabetes had been well controlled with an oral hypoglycemic agent, and her recent HbA1c level was 7.0-7.5 % under treatment with 80 mg of gliclazide. Seven days prior to hospitalization, she developed a fever up to 39 °C. She also presented with diarrhea and vomiting and gradually experienced difficulty in walking. Upon admission, her blood glucose level was elevated at 307 mg/dl, associated with ketosis (urinary ketone 3+) and an HbA1c level of 7.3 %. The urinary C-peptide immunoreactivity (CPR) level was below 2 μg/day, and a glucagon tolerance test showed the patient to be in an insulin-dependent state. Islet-related antibodies were negative, whereas HLA-DNA typing revealed the DRB1*04:05-DQB1*04:01 genotype. The patient was therefore diagnosed with fulminant type 1 diabetes, although her pancreatic exocrine enzyme level remained normal. She subsequently presented with cerebellar ataxia, and her clinical course, as well as the results of a cerebrospinal fluid test, suggested aseptic meningitis. We herein reported a case of type 2 diabetes in a patient who developed fulminant type 1 diabetes accompanied by aseptic meningitis. In this case, both diseases may have been caused by the same virus.View full abstractDownload PDF (464K) -
Kaku Tsuruzoe, Akira Yamamoto, Yoshiaki Hirashima, Kazuki Fukuda, Nobu ...2014 Volume 57 Issue 11 Pages 837-842
Published: November 30, 2014
Released on J-STAGE: December 01, 2014
JOURNAL FREE ACCESSA 65-year-old man with type 2 diabetes began treatment with a SGLT2 inhibitor, as his obesity and high glucose level were not improved with his current therapy comprised of insulin and oral hypoglycemic agents. The patient received 50 mg of ipragliflozin after the withdrawal of metformin and thiazide. His blood glucose level decreased following the administration of ipragliflozin, and the dose of injected insulin was reduced by approximately 10 %. On the third day of ipragliflozin treatment, he developed severe hyperkalemia (7.3 mEq/l) in addition to generalized skin eruptions, ketosis (3-OHBA: 626 μmol/l), moderate metabolic acidosis (PH: 7.348, HCO3-: 18.3 mmol/l) and renal dysfunction (Cr: 1.6 mg/dl). His previous history of hyperkalemia, habit of eating seaweed (Kombu) containing a high amount of potassium and use of ARB therapy for hypertension may have contributed to the onset of hyperkalemia. In addition, the shift of potassium from the intra- to extracellular space increased by acidosis and insufficient action of insulin during SGLT2 treatment may have been a trigger. The patient's renal dysfunction and the withdrawal of thiazide would also have contributed to the abnormalities observed in this case. It is necessary to pay attention to the potassium level during SGLT2 treatment, especially in patients with a predisposition to hyperkalemia.View full abstractDownload PDF (327K) -
Mariko Abe, Hiroyuki Ito, Takashi Omoto, Masahiro Shinozaki, Shinya Ni ...2014 Volume 57 Issue 11 Pages 843-847
Published: November 30, 2014
Released on J-STAGE: December 01, 2014
JOURNAL FREE ACCESSA 71-year-old woman was admitted to our department due to cerebellum and brainstem infarction in May 2014. She had been diagnosed with diabetes mellitus at 40 years of age. Her glycemic control had been poor despite treatment with oral antidiabetic agents, and ipragliflozin (50 mg daily) was added in April. She subsequently became thirsty and consulted our hospital with complaints of dizziness, nausea and vomiting nine days after the initiation of ipragliflozin. Her blood glucose and HbA1c levels were 219 mg/dl and 9.8 %, respectively. The hemoglobin and hematocrit levels were 13.4 g/dl (11.0 g/dl in March) and 40.6 % (35.3 % in March), respectively, indicating dehydration. An ECG showed ischemic changes, with an ankle brachial index of 0.85/0.76 as well as stenosis and occlusion of the bilateral anterior and posterior tibial arteries on ultrasonography. She was discharged after withdrawing ipragliflozin and administering insulin therapy and treatment for cerebral infarction. Her condition was considered to be associated with the onset of cerebral infarction due to her older age, lack of obesity, treatment with diuretic drugs and uncontrolled diabetes. It is desirable to perform screening tests for arteriosclerosis prior to initiating SGLT2 inhibitor therapy.View full abstractDownload PDF (386K)
Proceeding of the Local Societies
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2014 Volume 57 Issue 11 Pages 848-882
Published: November 30, 2014
Released on J-STAGE: December 01, 2014
JOURNAL FREE ACCESSDownload PDF (1043K)
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