We analyzed the costs of artificial dialysis, the quality of life (QOL) in patients on dialysis and with type 2 diabetes, and factors affecting them. The direct cost per month in medical care of outpatients with dialysis (n=106) were ¥428,788±44,249 (Mean±SD) in the Matsushima clinic (2004). The sample of patients in the Matsushima clinic (n=70) were given questionnaires to assess QOL, and the score of KDQOL-SF in patients with dialysis were the following: without diabetes, 63.94±15.96 (mean±SD), and with diabetes, 47.32±17.39 (p=0.00001). The QOL scores of SF-36 in patients with diabetes in the Matsushima clinic (n=24) and the diabetes clinic of Kyoto University hospital (n=87) became lower as the number of complications increased (p<0.0256) as follows: without complications, 73.09±9.57 (mean±SD); with one complication, 67.71±8.33; with two complications, 60.17±8.61; with three complications, 37.94±9.24; with four complications, 36.42±14.52. We further gave questionnaires of KDQOL-SF to ascertain the impression of potential kidney disease in subjects without kidney disease. The scores in non-kidney patients were lower than patients with kidney disease. Multiple regression analysis expressed the factors that affect QOL. The negative factors of QOL for patients with dialysis were aging, living alone, morning dialysis, questionnaire at home, cardiovascular, cerebrovascular disease, and neuropathy. In contrast, the negative factors of QOL for patients without dialysis but with diabetes were gender and living alone. Because all QOL scores by KDQOL-SF were lower and medical cost per month is much more expensive in patients with dialysis and diabetes than patients with dialysis without diabetes (non-dialysis but with diabetes vs. dialysis with/without diabetes, ¥428,788 vs. ¥5,140,000/year), reducing medical cost is important and hence there should be provisions for secondary prevention of complications along with the primary prevention of disease.

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We studied the probability of fatty liver (FL) onset by subjecting FL risk factors to logistic regression analysis and clarifying the probability of FL disappearance due to weight loss. Subjects were 611 people with an average age of 50.6±9 years who underwent thorough medical checkups. Of risk factors for FL, we analyzed BMI, HDL cholesterol (HDL), triglyceride (TG), HbA₁c (A₁c), and uric acid (UA) to investigate FL onset probability. Results indicated that probability in terms of the average risk factor score for people without FL was estimated at 15% for men and 1% for women. At a A₁c of 6.5%, probability was 75.5% for men and 22% for women. At a TG of 200 mg/dl, probability was almost 100% for men and 85% for women. Regarding the effects of weight loss from a multiple risk syndrome state, the probability of FL onset at a BMI of 26 kg/m², A₁c of 5.8%, UA of 7.0 mg/dl, TG of 150 mg/dl, and HDL of 39 mg/dl was 88% for men and 46% for women. With weight loss of 1 kg/m² of BMI, the probability decreased to 59% for men and 9.3% for women, and with weight loss of 2 kg/m² of BMI, it decreased to 20% for men and 7.6% for women. These findings suggest that weight loss of approximately 10% for men and 5% for women is sufficient for reducing the FL risk.

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We examined the efficacy of conversion from NPH insulin to glargine in Japanese type 1 diabetic adults using basal/bolus therapy. Retrospective chart analysis was done for 41 patients 12 months after switching to insulin glargine therapy. Insulin glargine was well tolerated with less frequent unrecognized hypoglycemia. After 6 months, the average HbA₁c in the entire cohort dropped from 7.87±1.20% to 7.29±1.09% (p<0.01) but returned to initial levels after 12 months (7.87±1.03%, p>0.05). After the 12 months, the average insulin requirement per day of the cohort decreased from 37.4±13.9 units to 35.7±12.9 units (p<0.01). Of 25 patients injecting NPH insulin two or three times a day, 18 patients switched to single daily injections of insulin glargine. The average ratio of daily insulin glargine use to that of total insulin after 12 months was 0.35±0.09, similar to other reports from Japan, but smaller than that reported from other countries. Small body mass index (mean±S.D. 21.9±2.20 kg/m²) and a diet rich in carbohydrates among Japanese may require less basal insulin and more bolus insulin to control glycemia in Japanese patients with type 1 diabetes in adults.

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[in Japanese]

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A 26-year-old primipara with a positive family history of type 2 diabetes mellitus presented with abrupt onset of thirst, generalized malaise and slight disturbance of consciousness at 11 weeks of gestation. Her BMI was 15.7 kg/m². Blood chemistry tests revealed a plasma glucose level 1,049 mg/dl, HbA₁c of 5.5%, serum total ketone body level of 13,260 μmol/l; arterial blood gas analysis revealed a pH of 7.282 and BE of -17.9 mmol/l. The patient was diagnosed as having diabetic ketoacidosis and started on an intravenous infusion of insulin and saline. The patient tested negative for both anti-GAD antibody and the HLA haplotype associated with type 1 diabetes mellitus. However, the serum levels of exocrine pancreatic enzymes were elevated despite the absense of clinical findings of pancreatitis. After insulin therapy for 3 weeks, the blood glucose levels decreased, and the insulin therapy was discontinued. A 75-g OGTT revealed normal glucose tolerance. Glycemic control was well maintained by diet therapy alone until 39 weeks of gestation, when she delivered a healthy girl vaginally. While the clinical features in our patient resembled those of fulminant type 1 diabetes mellitus at the onset. Endogenous insulin secretion was preserved, and the glucose tolerance became entirely normal following short-term insulin therapy. Recovery from diabetic ketoacidosis during pregnancy is extremely rare.

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[in Japanese]

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[in Japanese]

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The principal causes of death among 18,385 diabetics (11,632 men and 6,753 women) who died in 282 hospitals throughout Japan during 1991-2000 were determined based on a survey of the hospital records. Autopsy had been conducted in 1,750 of the 18,385 diabetics.
1. The most frequent cause of death was malignancy (34.1%), followed, in order of descending frequency, by vascular diseases (26.8%), including renal failure (6.8%), ischemic heart disease (10.2%) and cerebrovascular disease (9.8%), and then infections (14.3%). Diabetic coma associated with hyperglycemia with or without ketoacidosis? accounted for only 1.2% of the deaths.
2. In regard to the relationship between the age and cause of death in diabetics, the incidence of death due to vascular diseases increased in an age-dependent fashion, and the incidence of death due to ischemic heart disease was significantly higher in patients over the age of 50 years. Malignancy was still? the most frequent cause of death over the age of 40 years, and a remarkably high incidence of malignancy as a cause of death (43.6%) was observed in patients over the age of 60 years.
3. “Poor” glycemic control reduced the lifespan of diabetics, especially those with diabetic nephropathy and infections. The average age at death in the survey population was 69.3 years. The lifespan was 2.5 and 1.6 years shorter in male and female patients, respectively, with “poor” glycemic control than in those with “good” or “fair” glycemic control.
4. As risk factors, the degree of glycemic control was not related to either microangiopathy or macroangiopathy as the causes of death. In patients with diabetes of less than 10 years' duration, however, the incidence of death due to macroangiopathy was higher than that due to nephropathy.
5. Of the 18,385 diabetics, 29.5% were on oral medication only, 44.2% received insulin therapy (including cases treated with a combination of oral medication and insulin), and 21.5% were treated by diet control alone. Among the patients in whom the cause of death was diabetic nephropathy, a high percentage, 58.4%, was on insulin therapy.
6. The average age at death of the 18,385 diabetics was 68.0 years in men and 71.6 years in women. However, the report of the Ministry of Health and Welfare of Japan in 2000 set the average lifespan of the Japanese at 77.6% years for men and 84.6 years for women. Thus, the average lifespan of diabetics still appears to be shorter than that of the general population in Japan, despite the recent remarkable advances in the therapeutic strategies for diabetes mellitus.

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