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Volume 58, Issue 11
Displaying 1-7 of 7 articles from this issue
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Original Articles
Diagnosis, Treatment
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Kaori Ikeda, Akihiro Hamasaki, Kenichiro Shide, Nobuya Inagaki2015 Volume 58 Issue 11 Pages 805-811
Published: November 30, 2015
Released on J-STAGE: November 30, 2015
JOURNAL FREE ACCESSWe evaluated the correlation of the methods for estimating energy requirements using standard body weight (SBW) and basal energy expenditure (BEE) with body weight change in patients with diabetes. One hundred sixty-four patients were included in the analyses. The remainder, after energy intake was subtracted from the energy requirement (as estimated by SBW), was correlated with body weight change from day 2 (r=-0.26). The remainder, after energy intake was subtracted from the energy requirement (as estimated by the BEE prediction equations), was correlated with body weight change from day 2. The correlation coefficients of the prediction equations were -0.48 (Harris-Benedict), -0.42 (Oxford), -0.44 (National Institute of Health and Nutrition), and -0.40 (Kyoto University). The correlation coefficients with body weight change from day 4 were -0.34 (SBW), -0.51 (Harris-Benedict), -0.48 (Oxford), -0.50 (National Institute of Health and Nutrition), and -0.48 (Kyoto University). All P values were <0.001. The BEE prediction equations, including the Kyoto University equation (BEE=10×weight-3×age+750+125 [if male]) were more strongly correlated with body weight change than the equation using standard body weight.View full abstractDownload PDF (479K) -
Koji Nagayama, Misaki Okada, Ayana Iguchi, Kosuke Yogo, Hiroshi Morita ...2015 Volume 58 Issue 11 Pages 812-817
Published: November 30, 2015
Released on J-STAGE: November 30, 2015
JOURNAL FREE ACCESSIn Hamamatsu Medical Center, we introduced a data management software (DMS) system that allows all diabetic outpatients to access a computer-readable self-monitoring blood glucose (SMBG) meter using non-contact integrated circuit cards. We herein examine the reliability of the patients' SMBG logbooks and how educating the patients who use the DMS system can play a role in their treatment. Methods and Results. Accurate SMBG values in the patients' logbooks were defined as those that differed less than 10 % from the values in the DMS system's memory. The percentage accuracy was represented by the number of accurate SMBG values divided by the sum of the numbers of patient-recorded and non-recorded values. The median accuracy was 95.1 % and the average was 86.4 %. Sixty out of 104 patients (57.7 %) had problems with reliability. Among 63 patients, the hemoglobin A1c (HbA1c) value one year after the introduction of the DMS system improved significantly in the non-accuracy group (accuracy group: 7.34±0.88 % before and 7.33±0.91 % after, p=NS; non-accuracy group: 7.62±1.20 % before and 7.27±1.06 % after; p<0.05). Conclusion. The blood glucose data should therefore be used with caution due to reliability problems.View full abstractDownload PDF (391K)
Case Reports
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Rie Nakae, Yoshiki Kusunoki, Tomoyuki Katsuno, Kahori Watanabe, Masata ...2015 Volume 58 Issue 11 Pages 818-826
Published: November 30, 2015
Released on J-STAGE: November 30, 2015
JOURNAL FREE ACCESSA 23-year-old woman with a history of type 1 diabetes mellitus since 4 years of age achieved poor blood glucose control with continuous subcutaneous insulin infusion (CSII). In 2014, she elected to receive care in our department. She was subsequently found to be 7 weeks pregnant, and she was admitted to our hospital with a glycated hemoglobin (HbA1c) value of 10.0 %, indicating poor blood glucose control. We provided education to the patient and began treatment with a sensor augmented pump (SAP) for blood glucose control. When the patient was discharged, she was capable of self-management and had achieved improved blood glucose control, and we continued to follow up with outpatient visits. However, she was unable to comply with her diet therapy regimen, gaining substantial weight, and was readmitted for obstetric care at 34 weeks of gestation with a suspected large for gestational age fetus. The patient was again managed with diet therapy and SAP. She underwent a caesarean section at 38 weeks of gestational, delivering a girl weighing 3,850 g. The neonate was hypoglycemic but free of deformation. Switching to SAP in early pregnancy allowed satisfactory blood glucose control through delivery. This case is particularly informative due to the paucity of reports regarding the use of SAP to manage diabetes in pregnancy in Japan.View full abstractDownload PDF (477K) -
Tomoki Nagare, Naoko Hasegawa, Kurando Kanaya, Yasuo Okamoto, Ikuzo Fu ...2015 Volume 58 Issue 11 Pages 827-834
Published: November 30, 2015
Released on J-STAGE: November 30, 2015
JOURNAL FREE ACCESSGastric volvulus is a rare disease in adults. Few cases of gastric volvulus are encountered in the care of ordinary patients. We herein report two cases of gastric volvulus which we experienced in our facility. Both cases involved patients with a long-term clinical history of type 2 diabetes. Case 1 was a 93-year-old male with a more than three-decade history of type 2 diabetes who was brought to the emergency room (ER) of our hospital with sudden-onset severe epigastric pain and fullness. Case 2 was an 84-year-old female with type 2 diabetes who was brought to the ER with symptoms of acute postprandial emesis and epigastric pain. Both patients had a history of recurrent visits to the ER with similar symptoms since their 80s. After a careful review of their CT scan images, the patients were eventually diagnosed with gastric volvulus. Although laparotomic or laparoscopic gastric fixation is generally used to cure gastric volvulus, percutaneous endoscopic gastrostomy was successfully applied in both of our cases. Based on our experience with these patients, the diagnosis of gastric volvulus should be considered in patients with type 2 diabetes who present with acute-onset stomach symptoms.View full abstractDownload PDF (906K) -
Mariko Sugiyama, Syuko Yoshioka, Akira Mizoguchi, Yuri Shinohara, Kimi ...2015 Volume 58 Issue 11 Pages 835-841
Published: November 30, 2015
Released on J-STAGE: November 30, 2015
JOURNAL FREE ACCESSOur patient was a 44-year-old man who drank 4 l of soft-drinks per day. He developed consciousness disturbance after experiencing general malaise for a period of 2 weeks and was transported to our hospital. The laboratory tests on admission revealed the following: blood glucose, 1500 mg/dl; HbA1c, 12.3 %; pH, 7.143; PCO2, 27.5 mmHg; HCO3-, 9.1 mmol/l; Na, 144 mEq/l; K, 4.4 mEq/l; serum osmolality, 408 mOsm/kg H2O, metabolic acidosis and a high ketone level. He was diagnosed with diabetic ketoacidosis and was treated with a transfusion and insulin. The patient's blood glucose levels returned to normal and his acidosis improved, but the dehydration and hypernatremia persisted. A brain MRI and hypertonic saline test showed that the patient was suffering from partial central diabetes insipidus. This finding suggested that the patient's dehydration, hyperglycemia, and the increase in his plasma osmotic pressure had been caused by the excessive intake of glucose-containing drinks. Further dehydration, hyperglycemia, and serious hyperosmolality developed due to coexisting diabetes insipidus, which impaired the additional secretion of anti-diuretic hormone, leading to diabetic ketoacidosis.View full abstractDownload PDF (589K) -
Yu Hirata, Yushi Hirota, Yukiko Odake, Yuki Nishimoto, Tomoko Nishiumi ...2015 Volume 58 Issue 11 Pages 842-849
Published: November 30, 2015
Released on J-STAGE: November 30, 2015
JOURNAL FREE ACCESSA 72-year-old man was diagnosed with diabetes mellitus and had been treated with oral hypoglycemic agents since he was 45 years of age, and pre-mixed insulin since he was 69 years of age. Although his HbA1c levels were from 8.8-9.8 %, he began to suffer from hypoglycemia in the early morning. It was revealed that his plasma insulin levels and insulin antibody titer were markedly elevated, and that the insulin-binding rate of his insulin antibodies was 95.5 %. A Scatchard analysis of the patient's insulin antibodies showed a high binding capacity and low affinity in high-affinity binding sites. These data suggested that the insulin antibodies observed during insulin therapy induced unstable glycemic control, including hypoglycemia in the early morning. Insulin therapy could not be withdrawn because due to the marked decrease in the patient's endogenous insulin secretion. However, changing the insulin preparations and reducing the frequency of insulin injections improved the glycemic variability and characteristics of the insulin antibodies. We assessed the efficacy of adding liraglutide to the insulin analogue by continuous glucose monitoring (CGM), which was useful for evaluating the patient's daily glucose profiles. In addition, the assessment of the characteristics of the patient's insulin antibodies over a four-year period by the Scatchard analysis was beneficial for maintaining reduced glycemic variability.View full abstractDownload PDF (792K)
Report of the Committee
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Yuzo Sato, Hirohito Sone, Masashi Kobayashi, Ryuzo Kawamori, Yoshihito ...2015 Volume 58 Issue 11 Pages 850-859
Published: November 30, 2015
Released on J-STAGE: November 30, 2015
JOURNAL FREE ACCESSTo investigate the actual situation and problems of exercise therapy for patients with diabetes mellitus in Japan, we conducted nationwide surveys for diabetic patients. The subjects were 5,100 patients with diabetes mellitus. Data from 4,176 patients (81.9 %) who responded to the questionnaire were analyzed. The HbA1c level of the exercise therapy group was significantly lower than that in the non-exercise therapy group. Approximately 30 % of diabetic patients did not receive exercise guidance, while 10 % of the patients did not receive dietary guidance; 52 % of the diabetic patients received exercise guidance by physicians, while 64 % of the patients received dietary guidance by registered dieticians. Only half of the diabetic patients performed regular physical exercise. The results of the current surveys showed that there were significant differences between exercise guidance and dietary guidance, such as the frequency and education systems. To solve the lack of exercise guidebook for physicians, the members of this committee published "A Teaching Manual for Therapeutic Exercise in Diabetes Mellitus" (Nankodo). We recommend the establishment of an exercise therapy guideline for patients with diabetes mellitus conducted by the Japan Diabetes Society in the near future.View full abstractDownload PDF (485K)
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