Journal of the Japan Diabetes Society
Online ISSN : 1881-588X
Print ISSN : 0021-437X
ISSN-L : 0021-437X
Volume 58, Issue 2
Displaying 1-8 of 8 articles from this issue
Original Articles
Pathophysiology, Metabolic Abnormalities, Complications
  • Koichi Kawai, Hiroki Yokoyama, Koichi Hirao, Masae Minami, Akira Okada ...
    2015 Volume 58 Issue 2 Pages 87-93
    Published: February 28, 2015
    Released on J-STAGE: March 05, 2015
    JOURNAL FREE ACCESS
    We compared the clinical outcomes of Japanese diabetic patients above 20 years of age with type 1 (T1DM) or type 2 (T2DM) disease (age of onset under 20 years) using data obtained from 36 institutes participating in the Japan Diabetes Clinical Data Management Study Group. Compared to the patients with T1DM (586 patients, age: 30.8±0.4 years at the final visit), the patients with T2DM (385 patients, age: 34.8±0.8 years at the final visit) had higher BMI, systolic blood pressure and non-HDL-cholesterol values and a greater frequency of treatment discontinuation. The two groups showed the same HbA1c levels at the final visit (T1DM: 8.2±0.1 %, T2DM: 8.1±0.1 %) and a similar prevalence of microangiopathy. In the cross-sectional analysis, the HbA1c levels in the T1DM patients gradually decreased in association with the duration of diabetes (9.0±0.2 % at 5 years, 8.2±0.1 % at 20 years), whereas the HbA1c levels in the T2DM patients increased (8.4±0.2 % at 5 years, 8.9±0.4 % at 20 years). Although the prevalence of retinopathy increased similarly in association with the diabetes duration in the patients with T1DM and T2DM, that of nephropathy increased more in the patients with T2DM than in those with T1DM.
    Download PDF (417K)
Psychology, Behaviour Science
  • Aya Ishii, Makiko Takemoto, Saori Iida, Azuma Kanatsuka
    2015 Volume 58 Issue 2 Pages 94-99
    Published: February 28, 2015
    Released on J-STAGE: March 05, 2015
    JOURNAL FREE ACCESS
    We investigated the relationships between the presence of abdominal induration caused by repeated same site insulin injections and the HbA1c and daily fasting blood glucose (FBG) levels, as well as improvements in these values following injection site education in type 2 diabetes patients. Data regarding the presence/absence of abdominal induration, diurnal FBG variation and the HbA1c levels over the past three months were surveyed in 67 type 2 diabetics. Injection site education was then provided to the patients exhibiting induration, and the diurnal FBG fluctuations were compared over three months after the education. The changes in the HbA1c levels before and after the intervention were also compared. In the comparison of the groups with (n=20) and without (n=47) induration, the daily FBG variations were significantly greater in the group with induration (p<0.01). Both the degree of FBG variation and HbA1c levels significantly improved among the patients with induration who received injection site education (p<0.01, p<0.05 respectively). In addition, the post-education HbA1c improvement in the induration group was also significant compared to the HbA1c changes observed in the group without induration (p<0.05).
    Download PDF (307K)
Health Service, Medical Economics
  • Mari Tanaka, Hiroyuki Ito, Akiko Nemoto, Nozomi Ikeda, Takashi Omoto, ...
    2015 Volume 58 Issue 2 Pages 100-108
    Published: February 28, 2015
    Released on J-STAGE: March 05, 2015
    JOURNAL FREE ACCESS
    In this study, the relationship between previous intermittent treatment and diabetic vascular complications was investigated based on a questionnaire survey of 594 patients with type 2 diabetes mellitus. A history of treatment interruption was found in 78 patients (13 %), and the proportions of men and patients living alone (79 % and 30 %, respectively) were significantly higher among the subjects with a history of treatment interruption than those without (59 % and 18 %, respectively). Furthermore, the age at diagnosis of diabetes and the start of treatment was significantly younger, whereas the period prior to the start of treatment for diabetes mellitus and the duration of diabetes were significantly longer, in the subjects with a history of treatment interruption than in those without, and a history of treatment interruption was identified to be a significant independent variable for diabetic nephropathy in a multivariate logistic regression analysis (odds ratio=1.97, 95 % confidence interval=1.14-3.36, P=0.02). Therefore, it is important to emphasize education regarding severe diabetic complications, such as retinopathy and nephropathy, and/or treatment support provided by third parties, such as the government or medical institutions, in order to prevent treatment interruption for type 2 diabetes mellitus.
    Download PDF (498K)
Case Reports
  • Miyuki Shibata, Shouko Nakajima, Mariko Itoh, Seiko Takefuji, Masaaki ...
    2015 Volume 58 Issue 2 Pages 109-114
    Published: February 28, 2015
    Released on J-STAGE: March 05, 2015
    JOURNAL FREE ACCESS
    A 66-year-old type 2 diabetic man had been treated with oral hypoglycemic agents since 1991. In 2003, he was introduced to our hospital, and insulin therapy with sulfonylurea was started. The recent HbA1c levels ranged between 6 % and 7 %. In January 2011, he complained of diplopia, left ocular pain, ptosis and a disturbance of eye movement. Following examinations by an ophthalmologist and neurosurgeon using MRI, he was diagnosed with diabetic mononeuropathy (left oculomotor palsy) and prescribed beraprost. Three months later, the diplopia, left ocular ptosis and disturbance of eye movement induced by the oculomotor palsy improved. However, the left ocular pain persisted, and treatment with pregabalin and carbamazepine was prescribed. Despite receiving this therapy, the patient's pain worsened, and repeat MRI was performed. The cavernous sinus was visualized and found to have a carotid-cavernous sinus fistula on MRA, and his symptoms improved after performing endovascular treatment. This is a rare case of type 2 diabetes complicated by a carotid-cavernous sinus fistula that required differentiation from diabetic mononeuropathy (oculomotor palsy).
    Download PDF (507K)
  • Koji Matsushita, Yosuke Okada, Tadashi Arao, Hideomi Kondo, Yoshiya Ta ...
    2015 Volume 58 Issue 2 Pages 115-120
    Published: February 28, 2015
    Released on J-STAGE: March 05, 2015
    JOURNAL FREE ACCESS
    The present case involved a 62-year-old woman diagnosed with type 2 diabetes in 2001 who exhibited poor glycemic control due to self-discontinuation of treatment. After sustaining a bruise on the left buttock in December 2010, she suffered low back pain, which worsened over time. In April 2011, she was admitted to our hospital in poor general condition with deficient glycemic control (blood glucose, 426 mg/dl; HbA1c, 11.9 %). Computed tomography showed a large gas-forming abscess extending from the left paravertebral muscle at the L1 level to the internal and external muscles of the pelvis, accompanied by bone destruction in the left sacroiliac joint and right pubis. Insulin was used to reduce the marked hyperglycemia, and the deep abscess was drained by incising the skin immediately above the left sacroiliac joint. Continuous closed irrigation was performed for two weeks under aggressive intravenous antimicrobial therapy; this combination therapy resulted in an improvement in the patient's general condition. This case illustrates the possibility of diabetic neuropathy presenting as hypoalgesia of trunk deep tissues and stresses the need for a thorough examination in diabetic patients with poor glycemic control who report low back pain, irrespective of the severity of the pain.
    Download PDF (675K)
  • Sayoko Shimizu, Akiko Taira, Masahiro Hatazaki, Yutaka Umayahara, Masa ...
    2015 Volume 58 Issue 2 Pages 121-127
    Published: February 28, 2015
    Released on J-STAGE: March 05, 2015
    JOURNAL FREE ACCESS
    The HbA1c level is widely used as an indicator of glycemic control. However, this parameter does not accurately reflect the degree of glycemic control in patients with variant hemoglobin or various types of anemia. We experienced two cases of variant hemoglobin in which the patients received the administration of oral hypoglycemic agent (s) due to spuriously high levels of HbA1c. The HbA1c levels measured using immunoassays were high in both cases, although the patients did not exhibit hyperglycemia. The administration of a sulfonylurea induced hypoglycemia in one case but not the other case, in which the patient received treatment with a DPP-4 inhibitor and biguanides. After stopping the doses of the oral hypoglycemic agent (s), one patient showed borderline glucose tolerance, while the other demonstrated normal glucose tolerance, as evaluated according to oral glucose tolerance tests. We found the same heterozygous mutation on an analysis of the globin gene in each case and diagnosed the patients with hemoglobin Himeji [β140Ala→Asp]. From these experiences, the diagnosis of diabetes mellitus should not be made based only on the HbA1c level.
    Download PDF (381K)
  • Yuko Nakamura, Rieko Okano, Shinya Inada, Shin-ichiro Ueda, Tomoko Kam ...
    2015 Volume 58 Issue 2 Pages 128-135
    Published: February 28, 2015
    Released on J-STAGE: March 05, 2015
    JOURNAL FREE ACCESS
    We experienced two patients with low HbA1c levels due to subclinical hemolysis. One patient did not present with diabetes mellitus, whereas the other patient exhibited diabetes mellitus; in both cases, the glycated albumin to HbA1c ratio was extremely high. Since the HbA1c levels measured using the HPLC method and an immunoassay were identical in both patients, the possibility of variant hemoglobin was excluded. Although neither subject was anemic, the levels of haptoglobin and reticulocytes were low and high, respectively. A morphological examination of the erythrocytes revealed elliptocytes in one patient and spherocytes in the other patient according to smears of the peripheral blood and scanning electron microscopy. These findings indicated that the cause of the low HbA1c levels was subclinical hemolysis resulting from elliptocytosis and spherocytosis, respectively. Subclinical hemolysis should thus be considered in patients with apparently low HbA1c levels.
    Download PDF (571K)
Proceeding of the Local Societies
feedback
Top