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Volume 57, Issue 6
Displaying 1-7 of 7 articles from this issue
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Review
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Tetsuro Kobayashi, Mitsuyoshi Namba, Akio Kuroda, Munehide Matsuhisa, ...2014 Volume 57 Issue 6 Pages 403-415
Published: June 30, 2014
Released on J-STAGE: July 02, 2014
JOURNAL FREE ACCESSThe use of continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) in clinical practice is increasing in Japan. Against this background, the Association for the Study of Innovative Diabetes Treatment in Japan (ASINDTJ) arranged a Consensus Statement of opinions for the optimal and safe routine use of CSII and CGM. The Consensus Statement on the routine use of CSII and CGM includes patient selection and indications for clinical outcomes as well as risk management for routine use. The development of patient educational programs conducted by diabetologists in association with certified diabetes educators (CDEs) regarding the use of pumps and/or CGM is a prerequisite for clinical use. In addition, items associated with CSII and CGM, such as insulin dose adjustment, application methods for use in daily life, diet and exercise, risk management of pump difficulties, " sick day" occasions and skin problems, are included in the Consensus Statement. Our consensus opinion and suggestions also emphasize the usefulness of CSII and CGM in adult diabetic patients as well as children with type 1 and type 2 diabetes and pregnant diabetic patients. According to the Consensus Statement, the development of detailed educational guidelines for the use of CSII and CGM is needed.View full abstractDownload PDF (489K)
Original Articles
Epidemiology
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Hiroshi Sobajima, Taiga Shibata, Atsushi Fujiya, Ikuho Wada, Gifu-Sein ...2014 Volume 57 Issue 6 Pages 416-424
Published: June 30, 2014
Released on J-STAGE: July 02, 2014
JOURNAL FREE ACCESSRegarding the specific medical examinations covered by national health insurance in the Gifu Seino area, 75gOGTT testing is recommended in patients with an HbA1c level of 5.9 %to 6.8 %. In addition, a system combining interventions from the aspects of both health guidance and medical care was established. Subsequently, data for 901 75gOGTT tests among 5,640 individuals were obtained in 2010. The rate of positive specific medical findings (an abdominal circumference or BMI greater than the cut-off criterion) was 39.3 %. The results of the 75gOGTT examinations showed 309 patients with normal values, 91 patients normal-borderline values (a 60-minute level higher than 180 mg/dl with a normal status), 343 patients with borderline values and 158 patients with diabetes. The findings of the HbA1c and positive specific medical examinations strongly contributed to detecting the type of disease. In 2011, 664 of 901 patients received specific medical examinations. Meanwhile, the rate of intervention by medical staff and/or the provision of health guidance was 52 %. The HbA1c values fell significantly from 6.11±0.22 to 6.04±0.29 %, while the BMI values decreased from 23.3±3.2 to 23.0±3.5. Treatment with nutritional guidance at the medical office and/or personal coaching at a public health center was effective in reducing the HbA1c and BMI values. 75gOGTT recommendations on specific medical examinations and the use of intervention, such as the provision of medical care and health guidance for high-risk patients, are useful for glucose intolerance management.View full abstractDownload PDF (468K)
Health Service, Medical Economics
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Mari Tanaka, Hiroyuki Ito, Mariko Abe, Shinichi Antoku, Mizuo Mifune, ...2014 Volume 57 Issue 6 Pages 425-430
Published: June 30, 2014
Released on J-STAGE: July 02, 2014
JOURNAL FREE ACCESSThe duration and medical costs of hospitalization among diabetic patients who developed cerebrovascular disease (CVD, n=56), ischemic heart disease (IHD, n=91) or peripheral arterial disease (PAD, n=28) were investigated in comparison with that observed in nondiabetic patients with these diseases (n=129, 557 and 57, respectively) between 2010 and 2011. The duration of hospitalization was significantly longer in the diabetic patients with CVD (40 days), IHD (nine days), or PAD (19 days) than in the nondiabetic patients with CVD (27 days), IHD (five days), or PAD (nine days), respectively. Medical costs were also higher in the diabetic patients with CVD (1.8 million yen), IHD (2.0 million yen), or PAD (1.7 million yen) than in the nondiabetic patients with CVD (1.4 million yen), IHD (1.6 million yen), or PAD (1.5 million yen), respectively. The early evaluation and prevention of atherosclerosis in diabetic subjects is important from the viewpoint of economics as well as the prognosis and ability to perform ADLs.View full abstractDownload PDF (373K)
Case Reports
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Wataru Fujii, Minoru Makita, Naohide Koyanagawa, Yoshinari Takano, Nao ...2014 Volume 57 Issue 6 Pages 431-437
Published: June 30, 2014
Released on J-STAGE: July 02, 2014
JOURNAL FREE ACCESSWe herein report the case of a 55-year-old woman with polysplenia and a short pancreas. She had received pacemaker therapy for sick sinus syndrome at 35 years of age and was diagnosed with type 2 diabetes at 44 years of age. Therapy with medical nutrition and the administration of oral agents allowed her to achieve adequate glycemic control initially; however, her glycemic control gradually became unsatisfactory. In February 2012, she was admitted to our hospital due to epigastric pain, nausea and vomiting. A gastrointestinal X-ray showed intestinal obstruction, while a computed tomography scan disclosed polysplenia, interruption of the vena cava with azygos continuation, a right bilobed lung, the absence of the body or tail of the pancreas and a pancreatic volume that was approximately 50 %of normal. Therefore, a deficiency in insulin secretion resulting from agenesis of the dorsal pancreas was the leading cause of the patient's diabetes. Near normal glycemic control was achieved with multiple daily insulin injections. Polysplenia syndrome is a rare congenital disorder associated with cardiac and visceral anomalies. Only 5-10 %of polysplenia patients without cardiac involvement reach adulthood. The present patient was diagnosed with polysplenia after a 10-year history of diabetes. We suggest that more studies, including imaging examinations, are needed in cases of diabetes.View full abstractDownload PDF (676K) -
Tomoaki Osugi, Kentaro Toyoda, Emi Okamura, Akihiro Hamasaki, Nobuya I ...2014 Volume 57 Issue 6 Pages 438-445
Published: June 30, 2014
Released on J-STAGE: July 02, 2014
JOURNAL FREE ACCESSAn 83-year-old man was diagnosed with type 2 diabetes and began receiving treatment with oral hypoglycemic agents in 2004. Insulin therapy with an insulin analog was initiated due to poor glycemic control in September 2010. However, the patient's glycemic control worsened, and fasting hypoglycemia and afternoon hyperglycemia were observed starting in April 2011. Simultaneously, mild erythema and subcutaneous nodules appeared at the injection site shortly after insulin treatment. The patient was found to be positive for human insulin specific IgE antibodies, while an intradermal skin test was additionally positive for both human recombinant insulin and insulin analogs. Moreover, a high titer of insulin antibodies was detected, and a Scatchard analysis demonstrated a low affinity constant and high binding capacity of high-affinity binding sites. Continuous glucose monitoring revealed daytime hyperglycemia with a drop in the glucose level from midnight to morning. Following the cessation of all insulin preparations, treatment with acarbose, sitagliptin and fexofenadine was administered. The patient's glycemic control subsequently improved, and his allergic reactions disappeared. The current patient simultaneously presented with both an allergic reaction to insulin and unstable glycemic control due to the presence of insulin antibodies.View full abstractDownload PDF (543K) -
Saeko Shibasaki, Soichi Kurioka, Seiko Hirono, Jyungo Terasaki, Hiroki ...2014 Volume 57 Issue 6 Pages 446-452
Published: June 30, 2014
Released on J-STAGE: July 02, 2014
JOURNAL FREE ACCESSA 62-year-old man was diagnosed with type 2 diabetes complicated by an intraductal papillary mucinous neoplasm (IPMN) and underwent pancreatoduodenectomy (PD). In order to assess changes in his insulin secretion, insulin resistance, and glucose control pre- and postoperatively, 75 g OGTT and glucagon loading tests were performed before PD and one, three and six months after PD (Pre, Post 1, 3, 6). The insulinogenic index (I.I.), disposition index (D.I.), ΔCPR, AUC (ins) /AUC (glu), HOMA-IR and Matsuda index were calculated based on the results of the 75 g OGTT and glucagon loading tests. In addition, the level of HbA1c was measured as a marker of glucose control. The I.I., D.I., ΔCPR, and AUC (ins) /AUC (glu) values were decreased by half at the Post 1 time point and continued to decrease until Post 6, thus indicating a decline in insulin secretion. Meanwhile, the HOMA-IR decreased from 3.5 (Pre) to 1.9 (Post 6) and the Matsuda index increased from 3.1 (Pre) to 5.2 (Post 6), indicating an improvement in insulin resistance. The HbA1c level was found to be worse at every postoperative time point. In conclusion, the possibility of a decrease in insulin secretion and defects in glucose control should be taken into account in patients with type 2 diabetes accompanied by IPMN who undergo PD.View full abstractDownload PDF (767K)
Proceeding of the Local Societies
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2014 Volume 57 Issue 6 Pages 453-489
Published: June 30, 2014
Released on J-STAGE: July 02, 2014
JOURNAL FREE ACCESSDownload PDF (1107K)
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