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Volume 58, Issue 1
Displaying 1-8 of 8 articles from this issue
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Original Articles
Diagnosis, Treatment
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Takahiro Sakuma, Wataru Yumita, Sanshiro Uchida, Keishi Yamauchi2015 Volume 58 Issue 1 Pages 1-8
Published: January 30, 2015
Released on J-STAGE: February 04, 2015
JOURNAL FREE ACCESSUnlike a phase III trial evaluating the efficacy of combination treatment with sitagliptin and insulin in Japan, which was designed to assess only the combination of insulin and sitagliptin, actual treatments for type 2 diabetic patients with insulin and sitagliptin often include combination therapy with both of these drugs and/or other oral hypoglycemic agents (OHAs). For this reason, we administered sitagliptin to insulin-treated type 2 diabetic patients treated with or without other OHAs and followed the subjects for one year. We evaluated the body mass index (BMI), HbA1c level and daily dose of insulin at three, six, nine and 12 months. These assessments revealed no significant changes in the BMI values, HbA1c levels or daily doses of insulin (the median values decreased during the reported period, at 7.7, 7.3, 7.2, 7.2 and 7.0 (%) and 22, 16, 14, 13 and 13 (units/day), respectively). These findings indicate that combination therapy with insulin and sitagliptin is clinically useful in type 2 diabetic patients.View full abstractDownload PDF (398K)
Health Service, Medical Economics
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Haruka Yamane, Chiemi Oka, Yukari Takeda, Toyoko Nakatani, Toshitsugu ...2015 Volume 58 Issue 1 Pages 9-19
Published: January 30, 2015
Released on J-STAGE: February 04, 2015
JOURNAL FREE ACCESSWe herein clarified issues with respect to the use of the long-term care insurance system in accordance with the increase in the number of elderly patients with diabetes mellitus (DM). We investigated the lifestyle status, certification level for care and the service use status in a total of 459 patients≥65 years of age who visited our hospital on an outpatient basis. We then compared these variables between patients with diabetes mellitus (DM group) and those without diabetes mellitus (non-DM group). Regarding the certification level, the DM group tended to include a greater proportion of patients certified as not requiring care than the non-DM group (P=0.064), and facility admission was significantly more common in the DM group (P=0.023) in terms of the use of long-term care insurance services. The level of independence in activities of daily living among elderly individuals with dementia was significantly lower in the DM compared to the non-DM group (P=0.039). In elderly DM patients, it is important to detect cognitive declines at an early stage and provide support to enable the appropriate use of the long-term care insurance system.View full abstractDownload PDF (372K)
Case Reports
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Kazuhiro Tanabe, Shiro Fukuda, Masaharu Matsuda, Sanai Noguchi, Kunihi ...2015 Volume 58 Issue 1 Pages 20-26
Published: January 30, 2015
Released on J-STAGE: February 04, 2015
JOURNAL FREE ACCESSA 57-year-old man had been admitted to our hospital at 55 years of age complaining of thirst, excessive drinking, polyuria and weight loss. He had been previously diagnosed with impaired glucose tolerance in his late 30's and psoriasis at 47 years of age. The plasma glucose level was found to have exceeded 600 mg/dl at approximately 48 years of age; however, he did not receive a thorough examination at that time. The laboratory data obtained on admission showed a plasma glucose level of 623 mg/dl, HbA1c level of 16.6 % and relatively high serum ketone body levels, resulting in a diagnosis of diabetic ketosis. After conducting a thorough examination, he was diagnosed with type 2 diabetes mellitus. Autoimmune pancreatitis was detected during the course of treatment for type 2 diabetes mellitus. One and a half years later, the patient also developed hydronephrosis due to retroperitoneal fibrosis, and steroid therapy was initiated. While the treatment improved the retroperitoneal fibrosis, hydronephrosis and autoimmune pancreatitis, the diabetes mellitus remained unchanged. Therefore, steroid therapy for autoimmune pancreatitis was apparently ineffective in treating diabetes mellitus in this patient, although the effect could not be estimated due to the patient's disordered lifestyle.View full abstractDownload PDF (756K) -
Takuo Nambu, Tomoko Kato, Koji Matsuo, Takaaki Murakami, Yuki Matsuda, ...2015 Volume 58 Issue 1 Pages 27-33
Published: January 30, 2015
Released on J-STAGE: February 04, 2015
JOURNAL FREE ACCESSCase 1 involved a 72-year-old man with a 20-year history of diabetes with poor glycemic control who complained of pain in the left sternoclavicular (SC) joint and fever lasting for one week. On admission, he presented with severe pain in the left SC joint, and cervical-CT revealed left SC arthritis with a periarticular abscess. His symptoms improved following the administration of an antimicrobial agent and drainage of the abscess. Case 2 involved a 55-year-old man with a 15-year history of diabetes whose left fifth toe had been amputated due to diabetic gangrene two years earlier. On the present admission, he complained of pain in the right SC joint and fever lasting for one day. The pain in the right SC joint was found to be severe, and cervical-MRI revealed right SC arthritis. His symptoms initially worsened with conservative therapy, although they subsequently improved following drainage of an abscess newly recognized on repeated MRI. Septic SC arthritis is occasionally observed in patients with diabetes; however, the symptoms are often nonspecific, which may result in a delay in the diagnosis potentially leading to serious complications, such as osteomyelitis and mediastinitis. Physicians should thus be aware of the possibility of septic SC arthritis in patients with diabetes who complain of uncertain pain around the SC joint.View full abstractDownload PDF (563K) -
Saori Yabe, Hiroyuki Takahashi, Hiroko Gotoda, Takayuki Mori, Hiroyuki ...2015 Volume 58 Issue 1 Pages 34-40
Published: January 30, 2015
Released on J-STAGE: February 04, 2015
JOURNAL FREE ACCESSA 62-year-old man with a 32-year history of type 1 diabetes mellitus was admitted to our hospital for surgery to treat a diabetic foot ulcer. Although he demonstrated good wound healing, his glycemic control deteriorated. Despite increasing the dose of insulin, the patient's blood glucose concentration remained high. On a physical examination, we found subcutaneous nodules on both sides of his lower abdomen at sites of repeated insulin injections. The nodules were examined histologically and immunohistochemically and considered to be due to localized insulin-derived amyloidosis. After changing the injection sites, his glycemic control significantly improved. The present case emphasizes the need for patient education regarding insulin self-injection. In addition, physicians should consider the possibility of local amyloidosis in patients with poor glycemic control.View full abstractDownload PDF (1139K)
Brief Clinical Note
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Shinichi Itoh, Akio Ueki2015 Volume 58 Issue 1 Pages 41-44
Published: January 30, 2015
Released on J-STAGE: February 04, 2015
JOURNAL FREE ACCESSFollowing the revision of medical treatment fees in 2014, the goal of treatment has been to promote proactive participation in providing medical care for dementia among primary care physicians treating diabetics. In 2012, our clinic, which specializes in diabetes, implemented a medical cooperation system specializing in dementia care. Of 963 diabetic patients, the cognitive functions of 273 individuals 70 years of age or older who consented to complete the MMSE (Mini-Mental State Examination) were studied. There were 92 patients with suspected dementia (MMSE score 23 or below), among whom 76 subjects were willing to consult with a dementia specialist. Under medical care provided by the dementia specialist, follow-up was carried out in 28 patients and drugs for dementia were administered in 40 patients. Meanwhile, six patients were found to have vascular dementia and three patients were referred to a cerebral surgery specialist. When providing medical care for dementia, it is important for diabetes and dementia specialists to work together.View full abstractDownload PDF (415K)
Report of the Committee
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[in Japanese], Masami Murakami, Atsunori Kashiwagi, Izumi Takei, Shin ...2015 Volume 58 Issue 1 Pages 45-50
Published: January 30, 2015
Released on J-STAGE: February 04, 2015
JOURNAL FREE ACCESSFollowing the international standardization of the HbA1c levels, the Japan Diabetes Society (JDS) adopted a transition from the JDS values to the National Glycohemoglobin Standardization Program (NGSP) values in April 1, 2012. A survey of the current situation and operating conditions of the HbA1c levels as the NGSP values was conducted in June 2013 for the purpose of considering whether the transition to the NGSP values had been carried out smoothly before introducing the new system into practice. A total of 233 medical facilities with diabetes-related specialists and three major private laboratory facilities participated in this survey. The assay methods employed in this analysis included the HPLC method (88.1 %), immunological methods (9.3 %) and enzymatic method (2.5 %). The samples were adjusted using hemolysis liquids at three levels, for a coefficient of variation (CV) of the HbA1c level as the NGSP value of 2.3~3.0 %, 4.0~5.1 % and 3.7~4.9 %. Overall, the CV was 2.4~3.3 %, which was considered to be clinically acceptable. Furthermore, the NGSP value was used at 99.7 % of the participating medical facilities, and the patients were informed of the HbA1c testing results based on solely the NGSP values at more than half of the medical facilities. Therefore, the transition from the HbA1c JDS value to the NGSP value was considered to have been achieved smoothly.View full abstractDownload PDF (570K)
Proceeding of the Local Societies
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2015 Volume 58 Issue 1 Pages 51-71
Published: January 30, 2015
Released on J-STAGE: February 04, 2015
JOURNAL FREE ACCESSDownload PDF (840K)
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