We evaluated 21 patients with type 2 diabetes with poor glycemic control (glycated hemoglobin [HbA1c]: 11.0 %±1.8 %). After improving their glucose control with a basal-bolus therapy (BBT) during hospitalization, treatment was switched to a combination of insulin degludec/insulin aspart (IDegAsp) and dulaglutide (Dula). After switching, the insulin requirement decreased to 51.2 % (p <0.01), the mean blood glucose level decreased from 150±18 to 140±14 mg/dL (p <0.05), and the M values decreased from 11.5±5.5 to 8.0±5.0 (p <0.05). A meal tolerance test was performed. The CPR increased from 2.4±1.2 to 3.3±2.0 ng/mL (p <0.05) after 2 h. The HbA1c significantly decreased from 11.0 %±1.8 % to 7.0 %±1.5 % (p <0.01) 12 months after switching to combination therapy. Thirteen patients who received BBT as outpatient treatment were switched to combination therapy, and its effect was evaluated after one year. The HbA1c level showed a decreasing trend, from 7.3 %±0.7 % to 6.9 %±1.0 % (ns), and body weight decreased from 69.2±15.0 to 67.3±13.0 kg (p<0.01). Using a combination of IDegAsp and Dula, it was possible to switch from BBT to once-daily injection.
This study examined the relationship between the avoidance of disease and self-care behavior in patients with type 2 diabetes mellitus (T2DM) and any differences in their self-care behavior based on the pattern of psychological flexibility. A hierarchical cluster analysis was performed for 124 patients with T2DM. In addition, an analysis of variance was performed to assess the presence of a significant difference in self-care variables based on the degree of avoidance or clusters. Patients with a high avoidance of diabetes had more DM distress, external eating behavior, and emotional eating behavior than did those with a low avoidance of diabetes. The 124 total patients with T2DM were classified into 3 clusters (C1-C3). C1 consisted of high cognitive fusion (CF), low mindfulness, and high continuing behavior (CB). C2 consisted of standard CF and mindfulness and low CB. C3 consisted of low CF, high mindfulness, and slightly high CB. Patients in C1 exercised more frequently than did those in C2 but had more DM distress and emotional eating behavior than did those in C3. The characteristics of self-care behavior were in accordance with the balance of psychological flexibility. Accordingly, appropriate interventions should also be developed.
A female infant with unrelated healthy parents was delivered at 1,511 g in weight at 37 weeks of gestation with intrauterine growth retardation. At 10 years of age, glycosuria was detected in an in-school routine medical examination; she was then referred to our hospital. Her height at that time was −1.76 standard deviations (SD), and her obesity degree was −24 %. Because she had hirsutism, acanthosis nigricans, teeth malalignment, hyperglycemia, high glycated hemoglobin, hyperinsulinemia, and negative anti-glutamic acid decarboxylase antibody/anti-insulin antibody, she was suspected of having an insulin receptor abnormality. Using the Sanger sequencing method, her insulin receptor gene showed two compound heterozygote mutations in exon 12, and we diagnosed her with Rabson-Mendenhall syndrome. We administered insulin-like growth factor-I (IGF-I) therapy because her condition did not improve with diet, exercise therapy, biguanide drug, or α-glucosidase inhibitor. Her compound hetero mutations in exon 12 were both at the FnIII-2 region, far from the folded nucleus1). We experienced a case of slowly progressive Rabson-Mendenhall syndrome in which the mutations were analyzed.
We herein report a 46-year-old man with type 2 diabetes who developed a fixed-drug eruption due to the inactive ingredients of metformin. He was admitted to our hospital due to asthma attack. At that time, he was treated with insulin and vildagliptin/metformin combination tablets. He said that previously, he had developed skin rashes on his lower left thigh and the back of his body after taking metformin. However, eczema did not appear with vildagliptin/metformin combination tablets. Therefore, we switched the vildagliptin/metformin combination tablets to liraglutide and generic metformin tablet (metformin hydrochloride TE®). Ten days after metformin hydrochloride TE® prescription, he developed a rash in the same area where the drug eruption caused by metformin had previously appeared. The rash was diagnosed as a fixed-drug eruption. Considering the difference between the metformin combination tablets and metformin hydrochloride TE®, the allergy was suspected to be induced not by the active ingredients of metformin but by the inactive ingredients of the drug. Subsequently, he tried another generic metformin tablet that did not contain the suspected inactive ingredient (crospovidone). The generic metformin tablet did not induce a fixed-drug eruption. It is important to consider the possibility of drug allergies caused by inactive ingredients.
A 52-year-old man was treated with steroids for Kimura's disease and chemotherapy for relapsed lung cancer. In November X, he was admitted with a fever and dyspnea and diagnosed with pneumocystis pneumonia. He was initially given steroids and sulfamethoxazole-trimethoprim, but the treatment was changed to pentamidine due to side effects of sulfamethoxazole-trimethoprim on day 10. Seven days after starting pentamidine, he experienced fasting hypoglycemia and was given dextrose (10 g). We suspected pentamidine-induced hypoglycemia, and he had recurrent nocturnal hypoglycemia for 10 days after the cessation of pentamidine. The use of a continuous glucose monitoring system helped avoid nocturnal hypoglycemia in this patient. Pentamidine has rarely been reported to induce hypoglycemia. Drug-induced hypoglycemia is a significant adverse effect and may be an important cause of morbidity. This case is the first to demonstrate the value of continuous glucose monitoring for the detection of pentamidine-induced nocturnal hypoglycemia.