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Volume 44, Issue 1
Displaying 1-10 of 10 articles from this issue
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Analysis of annual health checkupsHideki Hidaka, Shun-ichi Furusawa, Katsumasa Tsujinaka, Yoshimitsu Yam ...2001 Volume 44 Issue 1 Pages 1-7
Published: January 30, 2001
Released on J-STAGE: March 02, 2011
JOURNAL FREE ACCESSGlycemic control in diabetic patients was evaluated by HbA1c determined in annual health checkups in employees of an electrical component manufacturer of 14, 073 empoloyees, aged over 40 years, 498 were judged of “need treatment for diabetes medically” in 1997.A questionnaire was given to the subjects in 1999 to evaluate medical care in 1998 (response rate 88%).Some 81% answered that they were under going regular medical care.Those without medical care and diabetic subjects who did not respond to the questionnaire showed higher HbA1c (7.6±1.5% and 8.1±2.1) than those with medical care (7.5±1.5).The reasons for discontinuation of regular medical care were mostly “personal.” HbAic was similar in different types of medical facilities (i.e.outpatient clinics of general hospitals and other types of hospital, clinics of practitioners, and clinics at the place of work).Glycemic control did not significantly differ in relation to the presence of diabetes specialists registered by the Japan Diabetes Society.Patients under medical care in outpatient clinics of general hospitals and clinics with diabetologists were more frequently treated with insulin.Foot examination was poorly done, but relatively well done in the clinics with the specialists, suggesting that glycemic control of diabetic subjects is insufficient at in most medical facilities for the prevention of diabetic complications. Guidelines for diabetes treatments should therefore be used by the general practitioner to ensure better clinical care for diabetic patients.View full abstractDownload PDF (1484K) -
Hitoshi Ishii, Toshikazu Yamamoto, Yasuo Ohashi2001 Volume 44 Issue 1 Pages 9-15
Published: January 30, 2001
Released on J-STAGE: March 02, 2011
JOURNAL FREE ACCESSThe aim of this study was to develop a questionnaire that measures the impact of insulin therapy on patients' health-related quality of life QOL.The insulin therapy-related QOL measure (ITR-QOL) questionnaire includes 23 items.Factor analysis showed 4 subscales: social activities, daily activities, physical function, and therepy associated feelings with insulin therapy.Both test-retest reliability and internal consistency of the ITR-QOL questionnare were high.Content validity was confirmed by several diabetologists.In concurrent validity, ITRQOL scores were related significantly to DTSQ and W-BQ 12 scores, representative questionnaires on diabetes.Taking the above factors into consideration, we concluded that the ITR-QOL questionire is valid as the measurement of QOL in insulin-treated patients.View full abstractDownload PDF (1140K) -
Hitoshi Ishii, Toshikazu Yamamoto, Yasuo Ohashi2001 Volume 44 Issue 1 Pages 17-22
Published: January 30, 2001
Released on J-STAGE: March 02, 2011
JOURNAL FREE ACCESSWe investigated the relationship among factors, relevant to the quality of life (QOL) in patients treated by insulin, and the insulin-therapy-related QOL measure questionnaire (ITR-QOL).Type 1 patients showed significantly lower QOL than type 2 patients.Subjective estimates of better glycemic control were associated with higher QOL.The experience of severe hypoglycemia lowered the QOL score.Multiple injections decreased the QOL score in type 2 patients but not in type 1.The time between injections and meals also influenced QOL.A shorter interval between instructed and desired injection time was associated with a higher QOL score.The degree of adherence to timing and frequency of insulin injection was promoted with increasing QOL score.Several factors thus have an important influence of insulin user QOL.The ITR-QOL questionaire is useful for measuring of QOL in insulin-treated patients.View full abstractDownload PDF (1055K) -
Influence of macrovascular complications in heart, brain and lower extremitiesYasuo Kida, Atsunori Kashiwagi, Ryuichi Kikkawa2001 Volume 44 Issue 1 Pages 23-29
Published: January 30, 2001
Released on J-STAGE: March 02, 2011
JOURNAL FREE ACCESSTo investigate the influence of macroangiopathy (MA) on the prognosis of diabetic subjects with retinopathy, we studied the prevalence of ischemic heart disease (IHD), cerebral infarction (CI), and arteriosclerosis obliterans (ASO) in 827 type 2 diabetic patients. Stages of retinopathy were defined as none (group N, n=495), simple (group S, n=216), and proliferative (group P, n=116). Complicated MA (MA score) was used as a marker of systemic atherosclerosis. Prevalence of IHD, CI, and ASO increased significantly with progressive retinopathy and the MA score was the highest in group P. Mortality rate (/1000 person·year) of subjects in groups N, S, and P during the 4-year observation period was 5.6, 24.3, and 66.8. Cardiovascular and/or sudden death tended to be associated with proliferative retinopathy. Multivariate analysis suggests life prognois was influenced independently by nephropathy, autonomic neuropathy, and MA score (especially ASO and IHD). Glycemic control, other atherogenic risk factor management, and noninvasive evaluation systemic MA are thus important in improving the prognosis in diabetic with proliferative retinopathy.View full abstractDownload PDF (1145K) -
Hidenori Katsuta, Teruaki Tashiro, Toshiaki Tanaka, Shinya Yamaguchi, ...2001 Volume 44 Issue 1 Pages 31-37
Published: January 30, 2001
Released on J-STAGE: March 02, 2011
JOURNAL FREE ACCESSA 24-year-old man diagnosed with diabetes mellitus 4 years ago had occasional proteinuria accompanying body weight loss. Fasting blood glucose gradually elevated;high glibenclamide dosage was used for glycemic control.At 22 years old, he was admitted to our hospital for the induction of insulin treatment and detailed examinations to diagnose diabetic complications. He did not yet suffer from diabetic retinopathy or neuropathy, but serum creatinine was high (1.7 mg/dl) and proteinuria persistent (about 2.0g daily). Because of his short stature and hearing disturbance, the existence of mitochondrial gene mutation was suspected. Mutation of his mitochondrial gene at 3243 positions was 15% in circulating white blood cells. The same mutation was detected in his mother and sister, with mutation 1% in the mother and 18% in the sister.
Histological examination of his kidneys demonstrated typical focal glomerular sclerosis (FGS) but no diabetic nephropathy in remaining renal tissue. The point mutation of the renal mitochondrial gene was 43%, almost 3 times higher than that of peripheral leukocytes, suggesting that renal histological manifestations of FGS are derived from mitochondrial gene mutation. Although he has no symptoms of mitochondrial encephalopathy or myopathy at present, atrophic changes have been already recognized in his brain stem and cerebellum via magnetic resonance imaging.He must be followed up carefully because clinical mitochondrial encephalopathy will probably become apparent.View full abstractDownload PDF (2719K) -
Takeshi Yoshizaki, Kazuhiro Ichida, Makoto Ohashi, Makoto Nomura, Take ...2001 Volume 44 Issue 1 Pages 39-44
Published: January 30, 2001
Released on J-STAGE: March 02, 2011
JOURNAL FREE ACCESSWe treated a type 1 diabetic suffering from subacute hepatic dysfunction.After recovery, laparoscopic liver biopsy was conducted for histological evaluation. The patient was 27 years old woman and worked in an office. She suffered diabetic ketoacidosis at the age of 24, and since then she was treated with multiple insulin injection therapy. On April 20, 1998, about 11 months after administration of voglibose (0.6 mg/day) and 3 months of epalrestat (150 mg/day), her GPT and GOT markedly increased (GPT: 880IU/l, GOT: 484IU/l).To evaluate hepatic injury, she was hospitalized on April 27. Viral, autoimmune and alcoholic hepatic injury were excluded by clinical data.
After 5 weeks of hospitalization, her coagulation tests worsened: PT: 40.1%, HPT: 31.9%, and serum bilirubin concentration became 3.1 mg/dl. To treat hepatic dysfunction, high-dose continuous PGE 1 infusion therapy (PGE 1 therapy) was started in addition to glucagon-insulin (GI) therapy. After 4 weeks of treatment, her liver function and coagulation tests gradually improved and normalized 4 months later.
After recovery in coagulation tests, laparoscopic liver biopsy was conducted, showing profound hepatocellular necrosis, with slight hepatic fibrosis and focal inflammatory changes found by histological examination. Due to negative DLST for both drugs, the clinical cause her liver dysfunction remained unclear.View full abstractDownload PDF (2410K) -
[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...2001 Volume 44 Issue 1 Pages 45-49
Published: January 30, 2001
Released on J-STAGE: March 02, 2011
JOURNAL FREE ACCESS -
Taro Maruyama, Akira Kasuga, Yukako Ozawa, Tomochika Nakazato, Ryoji I ...2001 Volume 44 Issue 1 Pages 51-55
Published: January 30, 2001
Released on J-STAGE: March 02, 2011
JOURNAL FREE ACCESSGlutamic acid decarboxylase 65 antibody (GADA)-positive patients initially diagnosed with non-insulindependent diabetes very often progress to insulin-dependent diabetes, suggesting patients have type 1 noninsulin-requiring diabetes according to the new classification of diabetes.Those with low GADA titer maintain good control without insulin for long years and seldom became insulin-requiring.It is thus very important to clarify whether such patients should be classified as type 1.We examined pancreatic islet pathology histologically in tissue from a diabetic patient with low GADA titer and pancreatic cancer who was not treated with insulin.Distinct insulitis was not found in any islet, and the size and number of insulin-stainin cells did not decrease.Further study is required to clarify whether diabetic patients with low GADA titer have a cellular autoimmunity to islet cells.View full abstractDownload PDF (1713K) -
The Influence of Patients' Profiles and Diabetic Complications on Quality of LifeH. Sano, K. Asao, M. Matsushima, T. Agata, M. Kusaka, T. Sasaki, Y. Ta ...2001 Volume 44 Issue 1 Pages 57-62
Published: January 30, 2001
Released on J-STAGE: March 02, 2011
JOURNAL FREE ACCESSA self-administered questionnaire was conducted on 239 men 40 years and over with type 2 diabetes mellitus who visited the Jikei University Hospital outpatient diabetic clinic. To evaluate the effect of diabetic complications on quality of life (QOL), we used the Diabetes Quality of Life Scale for the Diabetes Control and Complications Trial, translated into Japanese. Multiple linear regression analysis showed that younger age, lower educational status, longer duration of diabetes, and insulin therapysignificantly decreased total QOL score. Multiple linear regression analysis of diabetic complications confirmed that total QOL scores of patients with proteinuria, diabetic neuropathy, and cerebral infarction were significantly lower than those of patients without these complications. The analysis by domains revealed that the score of “limitation on daily life, ” “overall satisfaction, ” “psychological burden, ” and “satisfaction with treatment” decreased in patients with diabetic neuropathy and cerebral infarction, cerebral infarction, diabeticneuropathy, and proteinurea, and protenurea. These results suggest that physical symptoms, psychological burden, and social factors of diabetic complications affect QOL of patients with type 2 diabetes mellitus.View full abstractDownload PDF (1169K) -
[in Japanese], [in Japanese], [in Japanese], [in Japanese]2001 Volume 44 Issue 1 Pages 63-67
Published: January 30, 2001
Released on J-STAGE: March 02, 2011
JOURNAL FREE ACCESS
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