Journal of the Japan Diabetes Society
Online ISSN : 1881-588X
Print ISSN : 0021-437X
ISSN-L : 0021-437X
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Volume 58, Issue 4
Displaying 1-13 of 13 articles from this issue
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Feature
Early Diagnosis of Diabetic Complications and Prevention of Their Progression
Original Articles
Diagnosis, Treatment
  • Evaluation of the Effect and Influencing Factors of Educational Hospitalization for Diabetes
    Masaaki Miyauchi, Masao Toyoda, Han Miyatake, Eitaro Tanaka, Naoyuki Y ...
    2015 Volume 58 Issue 4 Pages 257-264
    Published: April 30, 2015
    Released on J-STAGE: May 20, 2015
    DOIhttps://doi.org/10.11213/tonyobyo.58.257
    JOURNAL FREE ACCESS
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    We investigated the effect of an in-hospital diabetes education program on glycemic control at five years after hospitalization and identified factors influencing the outcomes. We examined changes in glycemic control, body weight and other metabolic factors in 180 patients with type 2 diabetes mellitus who visited the clinic ≥5 years after hospital admission for diabetes education. Subjects with a mean HbA1c value below 6.9 % during the 5-year post-discharge period were classified into the "satisfactory" group, while the remaining patients were assigned to the "unsatisfactory" group. We compared various clinical laboratory parameters as well as the presence or absence of complications and investigated the effects of these variables on the HbA1c values using a logistic analysis. Finally, we investigated 17 patients who discontinued their visits to the outpatient clinic. The satisfactory group comprised approximately 44 % of the total patients. The logistic analysis using the satisfactory group as the dependent variable showed a treatment-naïve status to be an independent and significant contributing factor, although there were also numerous treatment-naïve patients among those who discontinued their outpatient visits. While the long-term effects of a treatment-naïve status are numerous, continuous monitoring of this population is necessary based on the high number of patients who discontinue outpatient visits.
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  • Current Situation of Diet and Exercise Therapy in Terms of Medical Consultations in Patients with Diabetes Mellitus in Japan: A Nationwide Survey
    Satomi Arakawa, Tomoyuki Watanabe, Hirohito Sone, Masashi Kobayashi, R ...
    2015 Volume 58 Issue 4 Pages 265-278
    Published: April 30, 2015
    Released on J-STAGE: May 20, 2015
    DOIhttps://doi.org/10.11213/tonyobyo.58.265
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    This study was performed to investigate the present situation of diet and exercise therapy associated with medical consultations in diabetes patients in Japan. The subjects included 5,100 patients with diabetes mellitus. A self-recorded questionnaire was distributed and collected at out-patient clinics and medical institutions specialized in diabetes. Responses were obtained from a total of 4,176 of the 5,100 patients with diabetes mellitus. The rate of exercise guidance was significantly lower than that of dietary guidance. Dietary guidance was given mostly by dietitians, while exercise guidance was conducted chiefly by physicians. The rate of implementation of exercise therapy was almost 50 %. As to the responses to the questions, "why did you not perform the exercise therapy" and "what factors are necessary to continue the exercise therapy," most participants answered a "lack of time to engage in physical exercise." The physically active patients showed lower HbA1c levels. In conclusion, the frequency of exercise guidance was significantly low in this study, and there were large differences in the rates of dietary versus exercise guidance. These results suggest that personalized exercise programs should be provided to patients considering the daily background factors of each individual, and the importance of a physically active daily lifestyle should be emphasized.
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  • Efficacy of Switching to Basal-bolus Insulin from Three Times Injection of Premixed Insulin in Patients with Type 2 Diabetes
    Tatsuo Mizuno, Kento Ogawa, Rei Hattori, Takashi Yagi, Sachiyo Ookawau ...
    2015 Volume 58 Issue 4 Pages 279-285
    Published: April 30, 2015
    Released on J-STAGE: May 20, 2015
    DOIhttps://doi.org/10.11213/tonyobyo.58.279
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    We examined the efficacy and safety of switching to basal-bolus insulin therapy in patients with type 2 diabetes treated with the three-injection method using premixed insulin. The patients were assigned to receive either titration by a physician (PT) or self-titration (ST) and subsequently classified into the insulin glargine (Gla) +insulin glulisine (Glu) group or insulin detemir (Det) +insulin aspart (Asp) group. At 24 weeks after switching, the HbA1c levels decreased from 8.46 % to 7.81 % (P<0.001). Regarding the titration method, there was a tendency to obtain better control with the ST method. In terms of the formulations, a greater improvement in the HbA1c values was seen in the Gla+Glu group. We then conducted a survey on treatment satisfaction before and after switching the therapies; however, no deterioration in the scores was noted. Switching to basal-bolus therapy from the three-injection method is useful.
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Case Reports
  • A Case of Type 2 Diabetes Mellitus with NASH Successfully Treated Using Integrated Therapy Including Ipragliflozin
    Hiroko Mori, Yosuke Okada, Mayuko Kawaguchi, Masaaki Hiura, Shintaro A ...
    2015 Volume 58 Issue 4 Pages 286-292
    Published: April 30, 2015
    Released on J-STAGE: May 20, 2015
    DOIhttps://doi.org/10.11213/tonyobyo.58.286
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    Ipragliflozin is a novel selective inhibitor of sodium glucose co-transporter 2 (SGLT2 inhibitor) in clinical development for the treatment of type 2 diabetes mellitus. SGLT2 inhibitors improve glycemic control by not enhancing insulin secretion, with the additional benefits of reductions in body weight, blood pressure and visceral fat as well as improvements in lipid metabolism. Therefore, effects in improving fat storage pathologies, such as fatty liver, are expected. We herein report the case of a patient who demonstrated improvements in glycemic control in addition to abnormalities in liver aminotransferases caused by non-alcoholic steatohepatitis (NASH) following reductions in body weight achieved under treatment with ipragliflozin and integrated therapy consisting of diet and exercise.
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  • A Case of Diabetic Hemichorea with Pathological Changes on Cranial MRI and MR Spectroscopy (MRS)
    Yuri Tsugawa, Ryutaro Komuro, Shigeki Nishitani, Miwa Takamure, Kazuhi ...
    2015 Volume 58 Issue 4 Pages 293-299
    Published: April 30, 2015
    Released on J-STAGE: May 20, 2015
    DOIhttps://doi.org/10.11213/tonyobyo.58.293
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    An 81-year-old woman was diagnosed with type 2 diabetes mellitus at 65 years of age. Over the six-month period before being introduced to our hospital, the patient's treatment was interrupted. One week before admission, remarkable involuntary movements in the right arm were noted, and hyperglycemia, with a plasma glucose level of 498 mg/dl and HbA1c level of 14.1 %, was detected. On the day of admission, the patient developed chorea in the right arm in addition to nonketotic hyperglycemia and slight hyperosmolarity. Cranial MRI demonstrated high intensity in the left putamen on T1-weighted imaging (WI), with normal intensity on T2WI, T2*WI and diffusion WI. Diabetic hemichorea was diagnosed, excluding the possibility of cerebral hemorrhage and/or infarction. MRS revealed a low N-acetylaspartate/creatine ratio in the left putamen, suggesting neural damage. The chorea subsequently disappeared under conditions of glycemic control achieved with insulin therapy. In addition, the high-intensity area on MRI T1 was attenuated 111 days later. In this case, the onset of diabetic hemichorea due to neural damage in the left putamen was speculated to be caused by the patient's hyperosmolar hyperglycemic state.
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  • A Case of GAD Antibody-positive, Adult-onset Diabetes Mellitus with Familial Clustering of Diabetes and Protective HLA DR-DQ Haplotypes for Type 1 Diabetes
    Yuka Kimura, Takahiro Suzuki, Kenji Takahashi, Satoru Goda, Miki Wada, ...
    2015 Volume 58 Issue 4 Pages 300-306
    Published: April 30, 2015
    Released on J-STAGE: May 20, 2015
    DOIhttps://doi.org/10.11213/tonyobyo.58.300
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    A 46-year-old woman was admitted to the hospital due to poor glycemic control. At 36 years of age, the detection of hyperglycemia and a positive anti-GAD antibody test led to a diagnosis of type 1 diabetes, and the administration of intensive insulin therapy was initiated three months later. The patient demonstrated a familial clustering of type 2 diabetes and had previously been obese. Examinations showed decreased, but not deteriorated, insulin secretion and with the sustained secretion of insulin on a glucagon loading test despite a 10-year disease duration. A serological examination revealed the HLA-DR15 haplotype, and the HLA DR-DQ genotype was confirmed to be protective for Japanese autoimmune type 1 diabetes. We herein present this case of type 1 diabetes characterized by a peculiar gene status and describe the clinical features, including the phenotypic expression of type 2 diabetes. Cases of diabetes mellitus similar to the current case have only rarely been reported, and the pathophysiology and genetic background of this condition are of interest.
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