The current study analyzed data collected from 198 patients with type 2 diabetes and a normal cardiovascular response to exercise as determined by the double Master two-step test. We examined body composition, muscle strength (knee extension), functional balance (one-leg standing time with eyes open), agility performance (whole-body reaction time) and cardiopulmonary fitness (maximal oxygen uptake) in these patients. In order to identify the independent correlates of reduced nerve conduction and heart rate variation, a stepwise multiple regression analysis was performed with physical fitness parameters and potential risk factors for diabetic neuropathy. The one-leg standing time was independently related to the sural sensory nerve conduction velocity, sural sensory nerve action potential, tibial motor nerve conduction velocity, minimal F-wave latency and compound muscle action potential. The whole-body reaction time was also related to the sural sensory nerve action potential, while the knee extension strength and whole-body reaction time were related to the coefficient of variation of RR interval at rest and during deep breathing, respectively. Based on these results, poor physical fitness, as indicated by a decreased one-leg standing time, increased whole-body reaction time and decreased knee extension strength, is considered to be a risk factor for peripheral nerve dysfunction in patients with type 2 diabetes.

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The Color IMPACT study demonstrated that the color display (CD) method for self-monitoring of blood glucose (SMBG) motivates insulin-treated type 2 diabetes patients to increase their level of physical exercise, although this had no impact on glycemic control. Nevertheless, the HbA1c levels improved in half of the subjects using CD. This analysis evaluated factors affecting improvements in glycemic control according to the CD method. The subjects were divided into two groups: responders and non-responders. The HbA1c levels in the responders were reduced by -0.69±0.09 %, while the HbA1c levels in the non-responders increased by+0.42±0.10 %. This difference in the change of HbA1c was 1.11±0.14 % (95 % CI 0.83 to 1.40 %) (p<0.001). There were no significant differences in the demographic data of the subjects at baseline. The scores on the exercise and support subscale of the questionnaire administered at 24 weeks were significantly increased in the responders compared with those of the non-responders. According to a logistic regression analysis, the changes in the exercise and support scores were identified to be variables for improvement in the HbA1c levels. Our results indicate that the CD method encourages patients to exercise and that glycemic control may be improved when patients access available support. These favorable circumstances of diabetes self-management highlight the benefits of the CD method in SMBG.

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Subcutaneous insulin injection is problematic for diabetes mellitus patients complicated with chronic skin graft-versus-host disease (GVHD) because of their fragile skin. We herein report a therapy regimen including subcutaneous insulin injection in a 24-year-old woman with glucocorticoid-induced diabetic and chronic skin GVHD. The patient had undergone an unrelated bone marrow transplant for acute myeloid leukemia at age 17 and developed chronic GVHD-associated scleroderma and bronchiolitis obliterans at age 21. At age 24, she received a bilateral lung transplant from a living donor and pulse steroid therapy to control rejection. Her blood glucose level rose to over 200 mg/dl, and insulin treatment was required. However, providing multiple insulin injections was difficult due to the patient's anxiety as well as subcutaneous bleeding and skin scarring. The number of injections was reduced to twice daily, with pre-mixed insulin 50:50 at breakfast and a rapid-acting insulin at dinner, in combination with 90 mg of nateglinide at lunch. The skin was protected by minimizing the sterilized area. This regimen encouraged the patient and permitted the continuation of insulin therapy. This case suggests that adjusting the insulin formulation and number of injections in combination with oral anti-diabetic therapy and specific skin care can permit successful insulin treatment in cases of diabetes complicated with skin GVHD.

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Diabetic gastropathy is a diabetic autonomic nervous system disorder characterized by the delay of food transport from the stomach to duodenum. However, the pathophysiology of this condition has not been clarified and no therapeutic approach has been established. Acotiamide hydrochloride hydrate (acotiamide), an oral acetylcholine esterase inhibitor, was recently developed and is now available for use in clinical practice. In the present study, we prescribed this agent to three diabetic patients with diabetes neuropathy and assessed the effects on the gastric emptying rate and subjective symptoms. In all three cases, the gastric emptying rate was accelerated by the administration of acotiamide accompanied by the amelioration of gastric symptoms. Our findings suggest that acotiamide efficaciously improves delayed gastric emptying and helps to ameliorate the quality of life in patients with diabetic neuropathy.

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To investigate the actual situation and problems associated with exercise therapy for patients with diabetes mellitus in Japan, we conducted a nationwide survey to physicians. A self-recorded questionnaire was prepared and sent to 1,200 randomly selected diabetologists and non-specialist physicians of the Japan Medical Association. Responses were obtained from 403 physicians. Diabetologists (78 %) and non-specialist physicians (67 %) were found to provide dietary guidance to almost all patients at their initial visit to the clinic; however, exercise guidance was given to the patients on their initial visit by only 40 % of both categories of doctors. In addition, 9 % of the diabetologists and 17 % of the non-specialist physicians did not provide exercise guidance to the patients. The main problems related to the implementation of exercise therapy by the doctors were "no additional consultation fee for providing exercise guidance," a "lack of time to provide guidance" and the "absence of specialized physical educators and specific exercise guidelines for type 2 diabetes." The results of the current surveys showed large differences between exercise and dietary guidance, such as frequency, education systems, etc. "A Teaching Manual for Therapeutic Exercise in Diabetes Mellitus" was published to address the lack of an exercise guidebook for physicians.

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[in Japanese]

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