We herein describe a case of variant hemoglobin HbC in a non-diabetic subject treated with anti-diabetic drugs due to falsely high HbA1c levels measured by an immunoassay. A 29-year-old male was found to have a high HbA1c level (8.0 %) at his health check-up, and his doctor began administering anti-diabetic drugs. We measured his HbA1c using high-pressure liquid chromatography [HPLC; standard mode (SM) and variant mode (VM) ], an immunoassay and enzymatic assay to determine the cause behind the falsely high HbA1c levels. The HbA1c levels measured by both HPLC (VM) and an enzymatic assay were within the reference range, while those measured by HPLC (SM) were falsely low (3.8-4.2 %). The immunoassay was performed using five reagent kits, and the findings for HbA1c levels measured by two kits were falsely high while those measured by three kits were within the reference range. On investigation, we determined that the higher HbA1c levels measured by the immunoassay were due to the two kits using an antibody that recognizes the area containing a mutated sixth amino acid on the hemoglobin β chain, which led to increased antigenicity of the variant hemoglobin.

An 82-year-old man was admitted to our hospital with a consciousness disturbance. His plasma glucose level was low (22 mg/dL), but the results of other examinations were normal. We determined that the patient was in a hypoglycemic coma and administered 7.5-10 % glucose solution continuously and 50 % glucose solution every hour through a peripheral vein, but the patient's hypoglycemia did not improve. The next day, we inserted a central vein catheter in the right internal jugular vein and administered a 30 % glucose solution. The hypoglycemia and consciousness state improved after 36 hours and the patient was discharged after eight days of hospitalization. A blood analysis revealed a high concentration of glibenclamide (211.8 ng/mL) immediately after admission. During that time, he was not being treated for diabetes; however, his wife had been on antidiabetic medications, including glibenclamide. We therefore presumed that he had accidentally taken his wife's glibenclamide. Clinicians should be aware of the possible accidental ingestion of sulfonylureas, prescribed to other family members, particularly among elderly individuals.

Hypoglycemia can cause arrhythmia or cardiovascular diseases through the autonomic nervous system. We analyzed the alterations in ECG and autonomic nerve activities during nocturnal hypoglycemia in an insulin-dependent type 1 diabetic patient using Holter electrocardiography with continuous glucose monitoring (CGM). The patient was a 77-year-old man with slowly progressive type 1 diabetes for 30 years. The CGM analyses showed that nocturnal hypoglycemia continued for 4 hours without clinical symptoms. During this period, Holter electrocardiography showed a decrease in a parasympathetic nerve activity parameter (high frequency: HF), and an increase in a sympathetic nerve activity parameter (low frequency/high frequency: LF/HF) compared to the non-hypoglycemic period based on heart rate variability analyses using the Maximum Entropy Method. An increase in the number of ventricular premature beats and the prolongation of the corrected QT interval (QTc) were also detected. We successfully assessed the effect of nocturnal hypoglycemia on autonomic nerve activities using concomitant Holter electrocardiography and CGM in an insulin-treated patient.

An 89-year-old man was admitted to our hospital due to poorly controlled type 2 diabetes, a high white blood cell count, and an elevated C reactive protein level. Computed tomography (CT) with contrast agent revealed a huge prostatic abscess, which was considered refractory to conservative therapy, but the patient and his family refused invasive treatment. Methicillin-sensitive Staphylococcus aureus was isolated in both blood and urine cultures on admission, and the intravenous administration of cefazolin was started. On Day 3 of hospitalization, reddening of the skin and swelling near the left sternoclavicular joint emerged. Magnetic resonance imaging showed arthritis of the left sternoclavicular joint spreading to the superior mediastinum and multiple abscesses of the left greater pectoral muscle. Prolonged antibiotics treatment was continued under the diagnosis of septic arthritis, and his general condition and the skin inflammation findings ameliorated. Although the white blood cell count and C reactive protein levels gradually decreased, follow-up CT on Day 27 of hospitalization revealed a new massive abscess at the left erector spinae muscles. He ultimately needed antibiotics treatment for 14 weeks until all the abscesses had disappeared on imaging.

In this study, the efficacy of sitagliptin (Sita) was investigated in 627 patients with type 2 diabetes at 248 institutions in Nagoya City. The clinical laboratory findings were evaluated in patients treated with Sita at a daily dose of 50 mg, at the time of initiation and 3, 6, and 12 months after initiation. The mean HbA1c (NGSP) significantly decreased from 7.87 % to 7.13 %, and the mean fasting blood glucose significantly decreased from 157.80 mg/dL to 141.59 mg/dL at 12 months after starting the administration of Sita. The mean levels of triglycerides, LDL-C, ALT, and dBP significantly decreased, while uric acid and serum Cr significantly increased. No significant changes in the body weight or levels of insulin, AST, γ-GTP, HDL-C, or BUN were observed. The HbA1c values stratified by age, BMI, duration of diabetes, and concomitant medications indicated that the efficacy of Sita was comparable in each subgroup. Taken together, our results suggest that Sita is an oral hypoglycemic agent useful in a wide range of patients, including the elderly.