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Volume 58, Issue 6
Displaying 1-7 of 7 articles from this issue
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Original Articles
Diagnosis, Treatment
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Kazuki Kobayashi, Minoru Takemoto, Takahiro Ishikawa, Emiko Okabe, Shu ...2015 Volume 58 Issue 6 Pages 381-387
Published: June 30, 2015
Released on J-STAGE: July 08, 2015
JOURNAL FREE ACCESSPostprandial hypertriglyceridemia (PPhTG) is one of the features of dyslipidemia in type 2 diabetes mellitus. PPhTG has been reported to be an independent risk factor for cardiovascular disease that is distinct from fasting hTG. Twenty patients with type 2 diabetes mellitus who showed PPhTG as their main condition, were treated with 300 mg/day of acarbose (an alpha-glucosidase inhibitor) for three months to assess the effect of acarbose on PPhTG. Following the treatment, the patients' postprandial metabolic parameters were evaluated 2 hours after the ingestion of a test meal in the morning. After the treatment, bodyweight, HbA1c and postprandial triglyceride (PPTG) levels were significantly reduced. There was a significant negative association between the level of PPTG before the treatment and the changes to PPTG and apoprotein B48 (ApoB48) levels after the treatment. Furthermore, postprandial ApoB48 was significantly reduced by the treatment in only13 patients who showed over 150 mg/dl of PPTG, which could be defined as PPhTG. These results suggested that acarbose treatment could be useful for reducing postprandial hyperglycemia in type 2 diabetes patients through the suppressive effect seen in the extrinsic lipid metabolism, which can be evaluated by serum ApoB48.View full abstractDownload PDF (399K) -
Kazuhisa Kusuki, Tomoyuki Yoshizaki, Tomoko Takeda, Munehiro Honda2015 Volume 58 Issue 6 Pages 388-397
Published: June 30, 2015
Released on J-STAGE: July 08, 2015
JOURNAL FREE ACCESSThe present study was carried out to clarify the histology, imaging features, and insulin absorption in 10 diabetic patients who developed subcutaneous masses in the abdomen during insulin therapy. The histological findings showed mainly amyloid depositions in 4 cases and mainly fibrosis in 6 cases. Foreign body giant cells and epithelioid cell granulomas were present in or near the amyloid depositions and the fibrosis. We also found phagocytosis of insulin by histiocytes in the granulomas. Amyloid depositions appeared as low-echoic masses with deep attenuation on body surface ultrasonography and as high density masses on computed tomography. A marked reduction of insulin absorption was recognized, not only in the cases of amyloid deposition, but also in the cases of fibrosis. We speculate that the observed fibrosis represents an earlier stage that occurs before amyloid deposition. In conclusion, in addition to an ocular inspection and palpation, it is important to perform an imaging examination in some cases for early detection of subcutaneous mass at the stage of fibrosis.View full abstractDownload PDF (1338K) -
Katsuya Fuse, Hajime Ishiguro, Koji Sato, Maki Ohashi, Kumiko Takano, ...2015 Volume 58 Issue 6 Pages 398-406
Published: June 30, 2015
Released on J-STAGE: July 08, 2015
JOURNAL FREE ACCESSObjective: The purpose of this study was to provide patients with diabetes with proper guidance about snow-removal work. A survey was conducted about snow-removal work in winter, individual drug therapy, frequency of hypoglycemia during the work, and how patients had been instructed in relation to the prevention and self-treatment of hypoglycemia and real actions that were taken in response to the presentation of symptoms of hypoglycemia. Results: The survey revealed that 85.7 % (203/237) of male and 61.8 % (122/197) of female diabetic patients performed snow-removal work and that 133 patients even worked on the roof during the winter season of 2011-2012. From these patients 8.9 % (29/325) of the snow-removers and 9.0 % (12/133) of roof snow-removers responded that they experienced hypoglycemic symptoms during the work. Very few patients had received guidance on reduction policies in relation to insulin or oral diabetic drugs. Conclusion: Snow removal work is routine and necessary in heavy snow areas, even for people with diabetes. Patients should be taught the signs, symptoms, and proper treatment of hypoglycemia, as well how it may be prevented. It is important to educate not only diabetes patients, but also other members of the diabetes-management team on the need for individualized therapy.View full abstractDownload PDF (752K)
Case Reports
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Daigo Suemaru, Takahiro Ishizuka, Tetsu Hashida, Yasuko Nakamura, Yuta ...2015 Volume 58 Issue 6 Pages 407-412
Published: June 30, 2015
Released on J-STAGE: July 08, 2015
JOURNAL FREE ACCESSAn 83-year-old woman was admitted to our hospital in an emergent condition due to involuntary movement of both upper limbs, gait disturbance, and somnolence. On admission, her consciousness corresponded to the level of E 3 V 5 M 6 of the Glasgow Coma Scale. She had no paralysis in her upper or lower limbs, and there were no abnormal findings on brain computed tomography (CT) or magnetic resonance imaging (MRI). She showed marked hyperglycemia (950 mg/dl) and a hemoglobin A1c level of 15.1 %, accompanied by ketoacidosis. Physiologic saline administration and continuous venous insulin infusion were started to treat diabetic ketoacidosis. After treatment, her blood glucose level decreased to below 300 mg/dl, and her involuntary movements completely disappeared. Her neurological symptoms were diagnosed as diabetic chorea due to the lack of abnormal findings on brain CT and MRI and because of her marked hyperglycemia. On the laboratory findings, the titer of anti-GAD antibody was high, and the excretion of urinary C-peptide was decreased (12.4 μg/day). She was diagnosed with elderly-onset type 1 diabetes mellitus, and treated with intensive insulin therapy. No recurrence of involuntary movements was observed during the course of her hospitalization.View full abstractDownload PDF (484K) -
Shinya Nishio, Yoko Yamaya, Takashi Omoto, Masahiro Shinozaki, Mariko ...2015 Volume 58 Issue 6 Pages 413-418
Published: June 30, 2015
Released on J-STAGE: July 08, 2015
JOURNAL FREE ACCESSThe patient was a 68 year-old man with a 3-year history of type 2 diabetes mellitus who took an oral hypoglycemic agent. He was admitted to our hospital for the initiation of insulin injections because his laboratory data showed a plasma glucose level of 596 mg/dl and an HbA1c level of 14.4 %. The patient's plasma glucose level decreased after the initiation of premixed insulin and he was discharged. A month after the initiation of insulin injections, he developed chorea in the right extremities. A T1-weighted brain MRI detected abnormal high intensity areas in the left putamen. He was diagnosed with diabetic chorea because the MRI findings were consistent with diabetic chorea. The administration of haloperidol 2.25 mg/day was initiated and his symptoms resolved after three days. Haloperidol treatment was discontinued ten months after the improvement of symptoms. The abnormal MRI findings disappeared in a follow up examination after five months after the occurrence of chorea. There was no recurrence of chorea or abnormal MRI findings for seven years. In general, diabetic chorea develops in connection with hyperglycemia. In the present case, however, diabetic chorea was diagnosed during the rapid improvement of the patient's plasma glucose level.View full abstractDownload PDF (487K) -
Tomohiro Santo, Yu Ihara, Hideki Yano2015 Volume 58 Issue 6 Pages 419-425
Published: June 30, 2015
Released on J-STAGE: July 08, 2015
JOURNAL FREE ACCESSA 55-year-old man visited a general practitioner due to a 3 day history of rigor and elevated temperature. Oral antipyretic medicines were administered. The next day he presented to our hospital with an erythematous skin rash. The patient's blood glucose was 113 mg/dl. On the sixth day the papules and erythematous areas became larger and began to merge. His blood glucose level increased to 200 mg/dl on the seventh day. On the ninth day, no deterioration in hepatic function was found but an abdominal CT scan revealed the significant enlargement of the pancreas, liver, and spleen. The patient complained of increased thirst, polyuria and general fatigue from day 11 and he was transferred to our department on the thirteenth day after the onset of symptoms. He was diagnosed with acute diabetic ketoacidosis. His blood glucose level was 807 mg/dl, his arterial blood pH was 7.285 and he was positive for both urine and blood ketones, however, his HbA1c was 6.9 % and he was negative for autoantibodies. A glucagon loading test showed a decrease but not a complete exhaustion in his insulin secretion at onset. Here, we report a case of fulminant type 1 diabetes-like disease and the details of the patient's pancreatic size, blood glucose levels and insulin secretion in response to a glucagon stimulation test before and after the onset of symptoms.View full abstractDownload PDF (665K)
Report of the Committee
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[in Japanese], Rimei Nishimura, Kazuo Izumi, Yasuaki Hayashino, Hideki ...2015 Volume 58 Issue 6 Pages 426-436
Published: June 30, 2015
Released on J-STAGE: July 08, 2015
JOURNAL FREE ACCESSThe Japan Diabetes Complications and Prevention (JDCP) study is a prospective, large-scale observational study that was designed and conducted to investigate the current state of diabetes management among Japanese patients with type 1 and type 2 diabetes and its relationship with the occurrence of events detected during follow-up, thereby exploring the risk factors for the development and progression of diabetic complications. The study enrolled a total of 6,338 diabetes patients, who ranged from 40-75 years of age and who were treated in an outpatient setting between 2007 and 2009. The primary endpoint of the study was the occurrence of nephropathy, retinopathy, neuropathy, macroangiopathy or periodontal disease. The secondary endpoint was the occurrence of malignancy or mortality. Of the patients who were enrolled, those with type 1 diabetes (n=394) became the focus of this study. Their baseline clinical characteristics were examined. The men/women comprised 44.2 % and 55.8 % of the study population, respectively. Their baseline characteristics were as follows (men/women): mean age (55.3/56.8 years); duration of diabetes (11.9/11.1 years); percentage of patients with a family history of diabetes (22.7 %/35.6 %); BMI (22.4/21.8 kg/m2) (P=0.048); HbA1c (7.9 %/7.7 %); percentage of patients who achieved an HbA1c level of <7 % (23.1 %/26.9 %); systolic blood pressure (SBP) (126.0/124.9 mmHg); and LDL-C (106.1/107.7 mg/dL). The insulin therapy in place among the patients entailed 33.0±17.1 U of insulin as well as 0.58±0.25 U of insulin per 1 kg of body weight; 95.8 % of the patients performed self-monitoring of their blood glucose levels (SMBG).View full abstractDownload PDF (472K)
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