Journal of the Japan Diabetes Society
Online ISSN : 1881-588X
Print ISSN : 0021-437X
ISSN-L : 0021-437X
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Volume 57, Issue 2
Displaying 1-12 of 12 articles from this issue
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Feature
Recent Progress in the Genetics of Diabetes
Original Article
Diagnosis, Treatment
  • Relationship between Diabetes Mellitus and Cardiovascular Events in Hypertensive Patients Receiving Olmesartan-based Treatment (OMEGA Study Subanalysis)
    Ryuzo Kawamori, Tamio Teramoto, Shigeru Miyazaki, Satoshi Teramukai, K ...
    2014 Volume 57 Issue 2 Pages 94-101
    Published: February 28, 2014
    Released on J-STAGE: March 11, 2014
    DOIhttps://doi.org/10.11213/tonyobyo.57.94
    JOURNAL FREE ACCESS
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    We studied the relationships between the occurrence of cardiovascular events (CVD) and the presence/absence of diabetes mellitus, blood pressure and the HbA1c levels in 13,052 patients with no history of cardiovascular disease among those included in the full analysis set of the OMEGA study, a large-scale prospective observational study investigating the relationships between the occurrence of CVD and blood pressure and/or other risk factors in hypertensive Japanese patients receiving antihypertensive therapy based on the angiotensin II receptor blocker (ARB) olmesartan. During the 36-month study period, the incidence of CVD (per 1,000 subject-years) was 9.83 in the diabetic group (3,155 patients) and 4.23 in the nondiabetic group (9,897 patients). For the prevention of CVD, our results suggest that it is advisable to control the blood pressure to <140/90 mmHg in hypertensive patients with no history of cardiovascular disease and further control the HbA1c level to <7.0 % with a blood pressure of <130/80 mmHg in those with diabetes mellitus.
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Case Reports
  • Efficacy of Liraglutide in Patients with Glucocorticoid-induced Glucose Intolerance: A Case Study
    Ichiro Yamauchi, Yoshihiro Matsumoto, Kanako Mitsuda, Toshiko Yasuda, ...
    2014 Volume 57 Issue 2 Pages 102-107
    Published: February 28, 2014
    Released on J-STAGE: March 11, 2014
    DOIhttps://doi.org/10.11213/tonyobyo.57.102
    JOURNAL FREE ACCESS
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    Previous reports have suggested that glucagon-like-peptide 1 receptor agonists prevent glucocorticoid-induced glucose intolerance in healthy subjects. We investigated the clinical efficacy of liraglutide in patients with glucocorticoid-induced glucose intolerance based on the treatment course in five cases. In three cases, the patients presented with normal fasting blood glucose (105 mg/dl, 104 mg/dl, and 89 mg/dl), and liraglutide monotherapy successfully improved their glucose intolerance. In the other two cases, the patients both presented with mildly elevated fasting blood glucose (137 mg/dl, and 135 mg/dl), and combination therapy with liraglutide and insulin glargine was required. The present investigation suggests that liraglutide improves glucocorticoid-induced glucose intolerance, especially in patients with normal fasting blood glucose. Currently, glucocorticoid-induced glucose intolerance is frequently treated with multiple daily injections of insulin. We believe that liraglutide therapy is superior to multiple daily insulin injections for the following reasons: (1) a reduced number of injections, (2) a lower risk of hypoglycemia, (3) the lack of need for real-time dose adjustment.
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  • Simultaneous Emergence of Multiple Islet-associated Autoantibodies in a Patient with Acute-onset Type 1 Diabetes
    Junichi Yasui, Eiji Kawasaki, Ai Haraguchi, Toshiyuki Ikeoka, Ikuko Ue ...
    2014 Volume 57 Issue 2 Pages 108-112
    Published: February 28, 2014
    Released on J-STAGE: March 11, 2014
    DOIhttps://doi.org/10.11213/tonyobyo.57.108
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    A 61-year-old woman had been diagnosed with diabetic ketosis at 54 years of age due to hyperglycemia (plasma glucose: 598 mg/dl, HbA1c: 14.2 %) and the presence of urinary ketones. She was admitted to a hospital, and insulin therapy was initiated based on her low endogenous insulin secretion (urinary CPR: 28 μg/day). She was admitted to the same hospital again at 56 years of age for glycemic control, at which time, she was diagnosed with type 1A diabetes due to positive GAD antibodies (337.4 U/ml). Her blood glucose level was uncontrollable as a result of exhausted endogenous insulin secretion, and she was referred to our hospital. We examined the emergence pattern of islet-associated autoantibodies using the patient's stored serum samples. Consequently, the simultaneous emergence of autoantibodies to GAD, IA-2, and ZnT8 was detected at the onset of type 1 diabetes. Although GAD antibodies were persistently positive, autoantibodies to IA-2 and ZnT8 became negative within three years after disease onset. The emergence of islet-associated autoantibodies generally occurs before the clinical development of type 1 diabetes. We herein demonstrated a rare case of type 1 diabetes in which islet-associated autoantibodies developed simultaneously, not sequentially.
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  • A Case of Hypertriglyceridemic Pancreatitis during Pregnancy in a Patient with Type 2 Diabetes
    Yuki Hosokawa, Mariko Fukumoto, Yoko Yoshida, Megumi Okada, Yosuke Yak ...
    2014 Volume 57 Issue 2 Pages 113-117
    Published: February 28, 2014
    Released on J-STAGE: March 11, 2014
    DOIhttps://doi.org/10.11213/tonyobyo.57.113
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    The patient was an obese 20-year-old pregnant female who developed abdominal pain at 28 weeks of gestation. She was diagnosed with acute pancreatitis based on an elevated serum amylase level, hypertriglyceridemia, hyperglycemia and pancreatic enlargement detected on abdominal ultrasound. Her condition did not improve with primary treatment, and intrauterine fetal death was confirmed. A cesarean section was performed on the third hospital day. Furthermore, plasma exchange was performed in addition to the continuous administration of heparin and insulin to treat the hypertriglyceridemia. After these treatments, both the laboratory and clinical findings showed improvements. The serum triglyceride level is usually elevated during normal pregnancies due to the low lipoprotein lipase activity. However, the elevation is more obvious during pregnancy complicated by glucose metabolism disorders. Considering the high HbA1c level (HbA1c 9.8 %) observed at the onset of pancreatitis in this patient, acute pancreatitis presumably occurred as a result of existent hypertriglyceridemia induced by an undiagnosed underlying glucose metabolism disorder. The acute pancreatitis and fetal death could have been prevented with the diagnosis and management of the glucose metabolism disorder during the early stage of pregnancy.
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  • A Patient with Variant Hemoglobin Diagnosed Based on an Abnormal Pattern between the s-A1c and A0 Peaks on Routine Laboratory HbA1c Measurements Using HPLC
    Keiko Naruse, Yasuko Kobayashi, Nobuhisa Nakamura, Tatsuaki Matsubara
    2014 Volume 57 Issue 2 Pages 118-123
    Published: February 28, 2014
    Released on J-STAGE: March 11, 2014
    DOIhttps://doi.org/10.11213/tonyobyo.57.118
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    A 29-year-old male who was found to have a high HbA1c level at a health checkup visited our hospital for a further examination. His blood glucose level was 92 mg/dl and his HbA1c level was 7.2 %. The pattern of 75 gOGTT was normal, and the levels of glycoalbumin and 1,5-AG were within the normal range. In the analysis of HbA1c using the HPLC method, HbF exhibited a mild increase (1.9 %) and HPLC displayed a high valley between the s-A1c and A0 peaks, suggesting the existence of variant hemoglobin. An analysis with high-quality HPLC revealed a peak in variant hemoglobin near the A0 peak, and the patient was diagnosed with variant hemoglobin. In conclusion, performing a careful analysis of HPLC data in HbA1c measurements helps to detect variant hemoglobin in cases involving suspicion of the HbA1c data.
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  • A Patient with Type 1 Diabetes in Whom Hypoglycemia-related Hypothermia Repeatedly Induced Marked Bradycardia
    Toshika Otani, Miki Kanoh, Asako Sato, Atsushi Aoki, Aki Ikoma, Yasuko ...
    2014 Volume 57 Issue 2 Pages 124-130
    Published: February 28, 2014
    Released on J-STAGE: March 11, 2014
    DOIhttps://doi.org/10.11213/tonyobyo.57.124
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    The patient was a 67-year-old male. At 42 years of age, diabetes was diagnosed. Insulin therapy was started; however, the hyperglycemia persisted. On February 7, 2012, hypoglycemia with cold sweating led to hypothermia, causing disorientation. On February 10, the patient was admitted. It was impossible to measure his body temperature (BT) (lower than 32.0 °C). His heart rate (HR) was 35/min and his blood glucose level (BG) was 90 mg/dl. Electrocardiography showed bradycardia and J waves (V4-6). The administration of BT recovery treatment, intravenous glucose injection and fluid replacement increased the BT and HR to 36.0 °C and 60/min or more, respectively, the following morning. Electrocardiography confirmed the disappearance of J waves. On March 5, the patient was admitted with a consciousness disorder. The BT, HR, and BG were 30.8 °C, 23/min, and 65 mg/dl, respectively. The treatment-related rise in BT was observed, consciousness was regained, and a normal sinus rhythm a returned. On April 11, a consciousness disorder appeared immediately after dinner, and the patient was therefore admitted to our hospital. The BT and HR were 32.8 °C and 26/min, respectively. The coefficient of variation R-R interval was 0.90 %. Due to severe autonomic neuropathy, hypothermia-related hypothermia may have repeatedly induced marked bradycardia.
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