Journal of the Japan Diabetes Society
Online ISSN : 1881-588X
Print ISSN : 0021-437X
ISSN-L : 0021-437X
Volume 63, Issue 4
Displaying 1-6 of 6 articles from this issue
Original Articles
Epidemiology
  • Kenichi Sakurai, Masahiro Mimura, Yoko Takatsuna, Nobuichi Kuribayashi ...
    2020 Volume 63 Issue 4 Pages 163-171
    Published: April 30, 2020
    Released on J-STAGE: April 30, 2020
    JOURNAL FREE ACCESS

    We examined the clinical practice of diabetic retinopathy in Chiba Prefecture. Sixty-five medical and 16 ophthalmologic institutions participated in this survey. Of those, 37 medical institutions had board-certified diabetologists (BCDs), and 10 ophthalmologic institutions had certified ophthalmologists. The data of 3619 and 367 patients were collected from medical and ophthalmologic institutions, respectively. In the medical departments, 66.6 % of all patients were visiting ophthalmologists, including 70.9 % of patients treated by BCDs and 56.5 % of those treated by non-BCDs. Patients who had never visited or stopped visiting ophthalmologists were younger and had a shorter disease duration than those who continued to visit ophthalmologists. The age, disease duration, and type 1 diabetes mellitus were positively associated with visiting the ophthalmologist according to a multiple logistic regression analysis. In the survey for ophthalmologists, 94.8 % of the patients undergoing eye visits continued visiting medical institutions. Of the ophthalmologic patients, 77.4 % had diabetic retinopathy. Pan-retinal photocoagulation therapy had been performed in 40.9 % of the patients, and 5.7 % had a history of vitreous surgery. This survey revealed the current situation concerning diabetes care units for diabetic retinopathy in Chiba Prefecture. X does not seem sufficient at present [please define X], and patients should be encouraged to visit ophthalmologists.

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Diagnosis, Treatment
  • Yukiko Kaihoko, Maiko Yagi, Daisuke Ishiyama, Sato Watanabe, Keigo Aka ...
    2020 Volume 63 Issue 4 Pages 172-178
    Published: April 30, 2020
    Released on J-STAGE: April 30, 2020
    JOURNAL FREE ACCESS

    A decline in the muscle strength (MS) and muscle quality (MQ) has been noted in patients with type 2 diabetes. The aim of this study was to investigate the association between patient characteristics and the maintenance of or reduction in the MS and MQ in patients with type 2 diabetes. A total of 95 type 2 diabetes patients were eligible for this analysis from April 1, 2015, to December 31, 2017 (67 males, 28 females, age: 59.0±14.4 years, duration of diabetes: 6.9±8.6 years, HbA1c: 8.8 %±2.8 %). We compared the patient characteristic, body composition, and physical function between the groups with maintained and decreased MS and MQ values. A logistic regression analysis was used to examine the association between the patient characteristics and a maintained or decreased MS and MQ. Regarding the MS, the body fat percentage was independently related to a decreased MS (odds ratio [OR] 0.93, 95 % confidence interval [CI] 0.88-0.98, p=0.004). Regarding the MQ, the walking speed was independently associated with a maintained MQ (OR 5.86, 95 % CI 1.16-29.64, p=0.033). Our results suggested that the MQ reflects the walking ability more sensitively than the MS in patients with type 2 diabetics.

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Pathophysiology, Metabolic Abnormalities, Complications
  • Yoshihide Fukumoto, Mariko Oishi, Keiko Arai, Noriharu Yagi, Sinichiro ...
    2020 Volume 63 Issue 4 Pages 179-187
    Published: April 30, 2020
    Released on J-STAGE: April 30, 2020
    JOURNAL FREE ACCESS

    The clinical characteristics and treatment of patients with type 2 diabetes mellitus over 60 years old receiving treatment at facilities participating in the Japan Diabetes Clinical Study Group (JDDM) were classified into four groups and compared (Group I, patients in their 60s; Group II, patients in their 70s; Group III, patients in their 80s; and Group IV, patients in their 90s). The body mass index decreased with age, while in 90', it lies in the normal weight range. The average HbA1c level was 7.0 %±0.9 % in Group I, 6.9 %±0.8 % in Group II, and 6.9 %±0.9 % for both Groups III and IV. The low- and high-density lipoprotein cholesterol and triglycerides levels decreased with age. The serum creatinine and urinary albumin excretion increased while the serum albumin and glomerular filtration rate decreased with age. The prevalence of diabetic complications, such as nephropathy and neuropathy, increased with age, while retinopathy did not show this tendency. The prevalence of therapy without any drug increased with age, while the rate of oral medication decreased. Regarding therapy with oral anti-diabetic drugs, the rate of administering combination therapy decreased with age, while the rate of DPP-4 inhibitor monotherapy increased.

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Case Report
  • Katsuhiro Higashiura, Kenta Honma, Kiminari Itoh, Naoki Miyoshi, Rinji ...
    2020 Volume 63 Issue 4 Pages 188-194
    Published: April 30, 2020
    Released on J-STAGE: April 30, 2020
    JOURNAL FREE ACCESS

    An 83-year-old man developed high fever and systemic edematous erythema after taking mexiletine for 6 weeks. Although the patient then stopped the medicine as directed by a physician, he was hospitalized one week later due to the worsening of his symptoms. On the second day of hospitalization, the patient further developed thirst, polyuria and polyposia, and a blood analysis revealed the following biochemical abnormalities: blood sugar, 1069, mg/dL; HbA1c, 6.1 %, remarkably high blood ketone bodies, and depletion of insulin secretion capacity. Based on these findings, the patient was diagnosed with fulminant type 1 diabetes (FT1D) associated with drug-induced hypersensitivity syndrome (DIHS). Throughout the treatment course, the patient was found to be positive for serum cytomegalovirus (CMV)-DNA from the early stages, and additionally showed a high CMV IgG antibody titer. The patient was also positive for plural pancreatic islet-related autoantibodies, but negative for human herpes virus-6 antibodies. The HLA class II haplotype was DRB1*09: 01-DQB1*03:03. Since CMV may have been related to the pathophysiology of this patient, we believe that reactivation of CMV should be considered when a patient presents with DIHS complicated by FT1D.

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Report of the Committee
  • [in Japanese], Koji Inagaki, Takeshi Kikuchi, Toshihide Noguchi, Akio ...
    2020 Volume 63 Issue 4 Pages 195-205
    Published: April 30, 2020
    Released on J-STAGE: April 30, 2020
    JOURNAL FREE ACCESS

    The Japan Diabetes Complications and its Prevention (JDCP) prospective study was conducted to analyze the association between glycemic control and oral conditions in a large database of Japanese patients with diabetes. It included a total of 6,099 patients with diabetes (range, 40-75 years) who were treated as outpatients between 2007 and 2009. The mean number of teeth at baseline was 19.8 and women had fewer teeth than men in type 2 diabetes. Within the previous year, 17 % had lost teeth. At baseline, 32 % had experienced gingival swelling, 69 % brushed more than twice a day, 37 % used interdental devices, and 43 % received dental regular checkups. A multiple logistic regression analysis indicated that type 1 diabetic patients with HbA1c ≥7.0 % had a higher risk having fewer than 20 teeth (odds ratio [OR]: 2.38; 95 % confidence interval [CI]: 1.25-4.78), and type 2 diabetic patients with HbA1c ≥8.0 % also had a high risk having fewer than 20 teeth (OR: 1.16; 95 % CI: 1.00-1.34), after adjusting for 9 possible confounders. In conclusion, diabetic patients had a high risk of tooth loss and the poorer the glycemic control, the higher the risk of tooth loss.

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