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Volume 56, Issue 1
Displaying 1-7 of 7 articles from this issue
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Original Articles
Psychology, Behaviour Science
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Tetsuji Niiya, Daisuke Miyazaki, Sonei Shoujima, Akiko Ogawa, Eriko Ka ...2013 Volume 56 Issue 1 Pages 1-7
Published: 2013
Released on J-STAGE: February 07, 2013
JOURNAL FREE ACCESSThe aim of this study was to investigate the frequency of depressive symptoms and the effectiveness of a diabetic educational program in type 2 diabetic patients. We enrolled 101 type 2 diabetic patients admitted to our hospital for diabetic education. We evaluated depressive symptoms before and after the diabetic educational program using the Zung Self-rating Depression Scale (SDS). Before the diabetic education, the numbers of patients in a non, mild or moderate/severe depressive state were 32 (31.7 %), 35 (34.7 %) or 34 (33.7 %), respectively. The SDS score did not change significantly in any patient (p=0.224). The SDS scores of the patients in a nondepressive state increased significantly (p=0.007). On the other hand, the SDS scores of the patients in a mild (p=0.019) or moderate/severe depressive state (p=0.010) decreased significantly. These results suggest that diabetic hospitalization may affect the depression scores of type 2 diabetic patients.
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Katsunori Suzuki2013 Volume 56 Issue 1 Pages 8-14
Published: 2013
Released on J-STAGE: February 07, 2013
JOURNAL FREE ACCESSWe assessed the effectiveness of a simple self-monitored blood glucose device with a function that displays whether the blood glucose level is high or low in different colors (C device). In the first intervention phase, we switched patients from a conventional monochrome-display device to the C device and evaluated the consequences of the switch in diabetics. Two months after switching, we noted an improvement in the patients' awareness of their blood glucose levels. In the second intervention phase, patients were randomly assigned to either an intervention group (56 patients; 60.7±14.8 years of age) in which they entered their blood glucose level according to color using color educational tools, or a non-intervention group (56 patients: 61.0±14.6 years of age) in which patients only measured their blood glucose levels, then the patients' behavioral changes and HbA1c levels were evaluated. As a result, the proportion of patients with behavioral changes in the intervention group was 14 % higher compared to the non-intervention group, while their HbA1c levels were also 0.25 % lower (P<0.01). This suggests that the introduction of the C device and educational intervention with colors using the C device were effective for achieving an improvement in the treatment of diabetes.
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Case Reports
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Shuji Hidaka, Yumiko Kawabata, Toshiyuki Nakayama, Jin Kashima, Kimihi ...2013 Volume 56 Issue 1 Pages 15-23
Published: 2013
Released on J-STAGE: February 07, 2013
JOURNAL FREE ACCESSAn 81-year-old female was diagnosed with Hashimoto's thyroiditis in 1998. In 2002, she developed diabetes mellitus with blood glucose and HbA1c levels of 508 mg/dl and 12.1 % (JDS), respectively. Initially, she was treated with insulin and subsequently with oral hypoglycemic agents, achieving improved blood glucose control. In 2005, pancytopenia was noticed, and a diagnosis of myelodysplastic syndrome was made. In 2008, due to poor glycemic control, the treatment was switched to insulin therapy. In 2009, she was admitted to our hospital because of progressive anemia and poor glycemic control, and the further analyses confirmed a diagnosis of type 1 diabetes mellitus with low endogenous insulin and a positive anti-GAD antibody titer. After being discharged, the patient showed macrocytic anemia with low serum VitB12 and autoantibodies against intrinsic factor and gastric parietal cells, resulting in a diagnosis of pernicious anemia. The co-existence of type 1 diabetes, Hashimoto's thyroiditis and pernicious anemia indicates the presence of polyglandular autoimmune syndrome type III-A. We herein report a rare case of polyglandular autoimmune syndrome type III-A associated with a strong family history of autoimmune thyroid diseases complicated with myelodysplastic syndrome, which has accumulating evidence of an association with autoimmunity. The analyses of HLA and CTLA4 genotypes, as well as a literature review, are described.
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Akiko Tsuchiya, Tatsumi Moriya, Sonomi Yoshino, Junro Ogawa, Akinori H ...2013 Volume 56 Issue 1 Pages 24-30
Published: 2013
Released on J-STAGE: February 07, 2013
JOURNAL FREE ACCESSA 48-year-old woman was admitted in order to undergo hemodialysis (HD) . Her entire clinical course of diabetes was followed at our hospital. The duration from her first visit to the beginning of hemodialysis (HD) was almost 20 years. She was admitted three times for glycemic control, diabetic ketosis and HD induction, respectively. A renal biopsy performed during the first admission revealed typical diabetic glomerulosclerosis. The level of urinary albumin increased from normoalbuminuria to overt proteinuria followed by GFR decline and serum creatinine elevation. Proliferative retinopathy proceeded to overt proteinuria.
Glycemic control was achieved with dietary management and insulin therapy, with the exception of self-discontinuance of therapy for six months before the second admission. Microalbuminuria occurred at 33 of years of age followed by overt proteinuria at 36 years of age. Diabetic retinopathy was first diagnosed at 35 years of age and progressed to a proliferative stage within one year.
Dietary management and insulin therapy for glycemic control were going well, and the patient's dietary energy was increased during this period. The proteinuria gradually increased and the GFR decreased; however, a preserved stage of chronic renal failure continued for almost 10 years under multifactorial therapy for diabetic nephropathy.
This patient followed a typical clinical course of longstanding diabetic nephropathy. Further examinations should be conducted to clarify typical DN cases following a staged classification of DN for type 2 diabetes.
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Chisato Maki, Mizuho Sawada, Arisa Niwa, Kenji Ikeda, Mitsunobu Kawamu ...2013 Volume 56 Issue 1 Pages 31-36
Published: 2013
Released on J-STAGE: February 07, 2013
JOURNAL FREE ACCESSA 56-year-old female was diagnosed with type 2 diabetes mellitus 15 years ago and had been treated with several oral hypoglycemic agents, but her glycemic control was poor. She was admitted to our hospital yearly and always showed negative results for anti-GAD antibodies (GADAb). At her last admission, she had a low titer of GADAb (4.6 U/ml), and insulin therapy was started. At that point, her urinary C-peptide level was 77 μg/day. Ten months later, she was admitted to our hospital again, and her laboratory data showed the following: HbA1c level, 9.7 %; serum C-peptide levels after fasting and 2 h after breakfast, 0.7 ng/ml and 2.1 ng/ml, respectively; mean urinary C-peptide level, 18.5 (22.1/14.8) μg/day; increase in the serum C-peptide level six minutes after the intravenous loading of glucagon (1 mg), 1 ng/ml; and the titer of GADAb, 1.2 U/ml. In the current case, the titer of GADAb was initially low, and its positive period was short, last only 10 months. During this period, the endogenous insulin secretion decreased remarkably. Based on these findings, it was thought that the decrease of insulin secretion in this case was associated with an autoimmune mechanism.
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Letters to the Editor
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K. Tanigawa2013 Volume 56 Issue 1 Pages 37
Published: 2013
Released on J-STAGE: February 07, 2013
JOURNAL FREE ACCESSDownload PDF (119K)
Proceeding of the Local Societies
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2013 Volume 56 Issue 1 Pages 38-55
Published: 2013
Released on J-STAGE: February 07, 2013
JOURNAL FREE ACCESSDownload PDF (727K)
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