We examined the relationship between a multidisciplinary individual team approach (MTA) and the hemodialysis (HD) course in 53 diabetic nephropathy (DN) patients who received HD periodically from 2010 to 2014. The duration from the time the patient showed a creatinine (CR) value of 2.0 mg/dL to the initiation of HD was correlated with the number of annual interventions. We also compared the HD course of patients managed using an MTA with that of patients managed with an only-dietitian approach (ODA). The hemoglobin (Hb) values, hematocrit (Ht) values, cardiothoracic ratio (CTR), days of hospitalization, cost per admission and rate of emergency hospital admission in patients who were managed with an MTA were significantly better than those in patients who were managed with an ODA. In conclusion, an MTA might have some positive effects on the HD course in patients with DN, as various staff members provide information on the present and future clinical condition and self-management practices.
Mature-onset diabetes of the young (MODY) is characterized by a young onset, impaired insulin secretion, and autosomal-dominant inheritance. In this study, we report two cases of MODY3 involving a mother and her daughter. The mother was 54 years of age and had a normal body mass index (BMI). She was diagnosed with diabetes at 17 years of age, and was negative for islet-associated antibodies. She had been receiving insulin therapy. Her daughter was 15 years of age and also had a normal BMI. The daughter's diabetes was diagnosed at 7 years of age, and she was also negative for islet-associated antibodies. In both the mother and daughter, the type of diabetes was unclear; thus, a genetic analysis was performed at the onset of diabetes in the daughter, leading to a diagnosis of MODY3. The insulin secretory abilities of the mother and daughter were evaluated at 51 and 13 years of age, respectively. Both the mother and daughter showed slightly reduced serum C-peptide levels at 6 minutes after glucagon tests. Despite the mother having a long (34 years) history of diabetes, her insulin secretory ability had not deteriorated, and the insulin secretion of her daughter-who showed improved glycemic control under sulphonylurea treatment-was also well preserved.