We investigated the relationship between protracted wound healing (PWH) and glycemic variability (GV) and already-known risk factors (AKRFs) in non-critical surgery patients with diabetes (NCSPDs). We retrospectively analyzed 372 NCSPDs who underwent glucose monitoring >3 times per day. PWH was defined as the number of days from surgery to the day on which stitches were removed from a cutaneous operative wound. Hypoglycemia, GV (standard deviation [SD], coefficient of variation [CV] and average daily risk range [ADRR]), and the mean glucose concentrations were determined based on all of the glycemic data collected during the period before stitch removal. We analyzed the association between the period before stitch removal and AKRFs using a linear regression analysis. No AKRFs were associated with the period before stitch removal. However, significant independent associations were found between a high ADRR, CV and SD and a long period before stitch removal. GV, rather than the AKRFs, was associated with PWH in NCSPDs.
We retrospectively analyzed the CoDiC® data from 33 institutes in the Japan Diabetes Clinical Data Management Study Group in order to clarify the therapeutic efficacy of DPP-4 inhibitors (DPP-4is) and sulfonylureas (SUs) in Japanese patients with type 2 diabetes who have not previously received pharmacologic treatment. At the end of July in 2015, 498 and 349 patients were treated for more than two years with DPP-4is and SUs, respectively. In comparison to SUs, the DPP-4is group showed a more prominent HbA1c reduction (even in patients with a higher initial HbA1c [<9.0 %]), a higher proportion of patients who continued monotherapy with the initial agent, and a higher proportion of patients with an HbA1c value of <7.0 %. Additional hypoglycemic therapy was administered to 42 % of the patients treated with DPP-4is and 54 % of the patients treated with SUs; this mainly involved biguanide treatment (DPP-4i vs SU; 53 % vs 56 %). Among the DPP-4i-treated patients, weight gain was only observed in the patients with an initial HbA1c value of >10 %, whereas it was observed irrespective of the initial HbA1c value in the SU-treated patients. These results were confirmed by a propensity score matching analysis. In conclusion, these results suggest that DPP-4is show superior therapeutic efficacy to SUs as an insulin secretion promoting agent in the treatment of drug-naive type 2 diabetes patients.
Flash glucose monitoring (FGM) is useful in that patients can see fluctuations in their glucose level in real time. Due to the huge amount of information now available, we must re-consider self-management education. In the present study, individuals with type 1 (T1DM) and 2 diabetes (T2DM) who performed self-monitoring of blood glucose three times a day and twice a day, respectively, were enrolled. All participants were subjected to FGM for 14 days, and we evaluated their self-management performance, psychological well-being, diabetes treatment satisfaction, HbA1c level, fasting blood glucose level, frequency of hypoglycemia, body weight, body composition, blood pressure and serum lipid before and after FGM and after 12 weeks. Wearing the FGM device helped the improve HbA1c levels and reduced hypoglycemia in T1DM patients and improved the psychological well-being in T2DM patients. However, it tended to have a negative effect on diet therapy, as the lipid intake increased in T1DM patients, and the intake of vegetables decreased in T2DM patients. No marked changes in exercise therapy, blood pressure or serum lipid levels were noted. When performing FGM, it is important for healthcare professionals to provide patients with comprehensive care guidance and to support self-care behavior improvement.
Mitochondrial diabetes accounts for about 1 % of diabetes cases in Japan; however, the influence of mitochondrial diabetes on pregnancy is not well known. We observed two cases of mitochondrial diabetes in sisters with an A3243G gene mutation. Case 1 was a 25-year-old woman with normal glucose tolerance before pregnancy, who was diagnosed with gestational diabetes mellitus at 28 weeks of gestation. Following the administration of ritodrine hydrochloride, insulin therapy was initiated at 34 weeks of pregnancy, with a maximum amount of 36 units/day during pregnancy. Case 2 was a 27-year-old woman (the older sister of Case 1) who had received insulin (13 units/day) for diabetes before pregnancy. Because of the rapid deterioration of the patient's plasma glucose control at around 22 weeks of pregnancy, the required insulin dose was increased to 136 units/day. Neither patient was obese; thus, it was considered that mitochondrial dysfunction could have been a cause of the marked increase in the insulin requirement. The current cases suggest that mitochondrial diabetes is a risk factor for impaired glucose tolerance, especially during pregnancy.