Publications by authors named "Miyako Kishimoto"

53 Publications

Impact of dietary counseling on the perception of diet in patients with gestational diabetes mellitus.

Diabetol Int 2021 Apr 9;12(2):151-160. Epub 2020 Jul 9.

Department of Medicine, Clinical Research Center, International University of Health and Welfare, 8-10-16 Akasaka Minato, 107-0052 Tokyo, Japan.

Aims/introduction: Medical nutrition therapy is the cornerstone of gestational diabetes mellitus (GDM) treatment. Patients with GDM should receive dietary counseling regarding diet and exercise.

Materials And Methods: To study patients' perception level of diet and their level of understanding after dietary counseling, we analyzed 225 reports of dietary counseling of patients with GDM prepared by dieticians. We also assessed the patients' level of understanding after dietary counseling by asking questions regarding the counseling content. The answers to the questions were aggregated, and substantially similar answers were grouped and categorized.

Results: The dieticians' suggestions were well understood by the patients. Moreover, the patients also identified their previous incorrect eating habits, such as excessive carbohydrate restriction or inappropriate fruit intake. Although distributed frequent meals were recommended by the dieticians, few patients actually practiced this for various reasons. Some patients were apparently influenced by dietary information from the mass media.

Conclusion: Dietary counseling was regarded as helpful and acceptable to most patients with GDM in our hospital, and many suggestions were recognized as informative for modification of previous dietary habits. By providing the results of the questionnaire survey to the dieticians, they can improve the quality of their counseling, which is expected to result in better individual care of the patients.
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http://dx.doi.org/10.1007/s13340-020-00454-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7943672PMC
April 2021

Behavioral changes in patients with diabetes during the COVID-19 pandemic.

Diabetol Int 2020 Sep 30:1-5. Epub 2020 Sep 30.

Clinical Research Center, Department of Medicine, International University of Health and Welfare, 8-10-16 Akasaka Minato, Tokyo, 107-0052 Japan.

Aims/introduction: Amid the coronavirus disease (COVID-19) pandemic, the Japanese government declared a state of emergency and urged people to stay at home to prevent disease transmission. Herein, we investigated this emergency situation's effect on diabetes patients' lifestyle and glycemic control.

Materials And Methods: Diabetes patients who visited our hospital between April 1 and June 13, 2020, for a regular consultation were asked about changes in their physical activities and dietary habits during the state of emergency period.

Results: Among 168 patients, 26 (15.5%) gained > 2 kg; HbA1c levels were elevated or decreased by > 0.2% compared to that at the last visit in 57 and 51 patients (Groups D and I), respectively. Group D patients were affected to a larger extent by changes in commuting (transition to teleworking) and closures of sport gyms than Group I patients. Increased snacks, sweets, total diet, and alcohol intake could have contributed to worsening of glucose control in Group D, whereas a healthy diet and less alcohol intake could have led to better glucose control in Group I.

Conclusion: During the state of emergency period, decreased physical activity levels negatively affected glycemic control. However, despite changes in physical activity level, maintaining or improving dietary habits could lead to better glycemic control in diabetes patients. During this COVID-19 pandemic, more diabetes patients are likely to shift to teleworking and stay home for longer periods. Therefore, we should develop effective and feasible measures to promote exercise and dietary therapy, especially for those who engage in teleworking.
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http://dx.doi.org/10.1007/s13340-020-00467-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7526069PMC
September 2020

Survey evaluation of in-hospital diabetes seminars provided by medical professionals, for medical professionals.

Authors:
Miyako Kishimoto

J Multidiscip Healthc 2019 7;12:445-452. Epub 2019 Jun 7.

Clinical Research Center, Department of Medicine, International University of Health and Welfare, Tokyo, Japan.

Diabetes is a multifactorial disease, and interprofessional teamwork is essential for its treatment. For successful interprofessional teamwork, individual medical professionals need to have certain skills, experience, and mutual understanding of the role of different professions. However, there are few opportunities to educate medical professionals to meet these demands. To resolve this problem, educational seminars about diabetes were conducted by and for medical professionals, and their effects were assessed using a questionnaire survey. Medical professionals, including a dietician, a physiotherapist, a pharmacist, a clinical laboratory technician, and a doctor, provided 10 lectures, approximately 50 mins each, for medical professionals about their specialized skills in diabetes care. Nurses who were certified diabetes educators in Japan planned and organized the seminars. In every seminar, participants were asked to complete a questionnaire regarding their profession, motivation to attend the seminar, general comments about the seminar, expectations regarding future seminars, and effects of the seminar on their daily work or attitude toward patients. Among the 367 participants, 332 completed the questionnaire (respondents). The results revealed that by attending the seminars, some respondents strongly realized their lack of knowledge, some were inspired and encouraged to study more about diabetes, and some could understand other professions' work in diabetes care better than before. Over 70% of respondents reported that attending the seminar had changed their daily work or attitude toward patients; the remainder, however, felt unchanged for reasons such as their own lack of experience and ability, and the few chances to aid patients with diabetes. Educational diabetes seminars by and for medical professionals were implemented. The survey of the effects of the seminar has provided further insights into the needs and current situation of education for medical professionals.
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http://dx.doi.org/10.2147/JMDH.S209576DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6559776PMC
June 2019

Clonazepam-induced liver dysfunction, severe hyperlipidaemia, and hyperglycaemic crisis: A case report.

SAGE Open Med Case Rep 2019 8;7:2050313X19842976. Epub 2019 Apr 8.

Clinical Research Center, Department of Medicine, International University of Health and Welfare, Tokyo, Japan.

In this study, we report a case of a 50-year-old Japanese man who had chronic whiplash-associated disorder, hyperlipidaemia, hyperuricacidaemia, and mild liver dysfunction due to excessive alcohol intake. Recently, he developed mild tremor in his left hand. Initiation of clonazepam (0.5 mg once daily before bedtime) helped to gradually ameliorate the tremor. However, 13 days after clonazepam initiation, his liver function and lipid profiles aggravated, and his postprandial glucose level increased to 400 mg/dL. Clonazepam was stopped promptly, and at 7 days after discontinuation, the abnormal triglyceride levels, liver dysfunction, and glycometabolism improved without any other medical intervention. This case may provide information on cautious use of clonazepam. When clonazepam is used for patients with existing hyperlipidaemia and liver dysfunction, it may cause abnormal lipid profile, aggravate liver dysfunction, and lead to remarkable glucose elevation.
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http://dx.doi.org/10.1177/2050313X19842976DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6454642PMC
April 2019

Combination Therapy with Empagliflozin and Insulin Results in Successful Glycemic Control: A Case Report of Uncontrolled Diabetes Caused by Autoimmune Pancreatitis and Subsequent Steroid Treatment.

Case Rep Endocrinol 2019 14;2019:9415347. Epub 2019 Feb 14.

Clinical Research Center, Department of Medicine, International University of Health and Welfare, Tochigi, Japan.

A 66-year-old Japanese male presented with thirst, polyuria, and hemoglobin A1c and postprandial glucose levels (13.1% and 529 mg/dL, respectively) that indicated severe hyperglycemia. Based on his high immunoglobulin G4 level and the results of magnetic resonance imaging and magnetic resonance cholangiopancreatography, we diagnosed him with autoimmune pancreatitis. Insulin was initiated to control his diabetes. One month later, the patient commenced on prednisolone therapy for the treatment of autoimmune pancreatitis, after which his total insulin dosage increased to a maximum of 52 units/day. When the prednisolone dosage was later tapered, the patient's total dosage of insulin was reduced to 42 units/day. However, he had gained 3.6 kg from the start of prednisolone therapy, and 42 units/day was insufficient for maintaining glycemic control. Thus, empagliflozin, a sodium-dependent glucose transporter 2 (SGLT2) inhibitor, was added. Thereafter, we were able to reduce the patient's total dosage of insulin; it was eventually discontinued with good glycemic control and weight loss. Such results suggest that the combination of insulin with an SGLT2 inhibitor may be a viable option for the treatment of diabetic patients on prednisolone therapy.
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http://dx.doi.org/10.1155/2019/9415347DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6393920PMC
February 2019

Successful glycemic control using a flash glucose monitoring system for a pregnant woman with diabetes: a case report.

J Diabetes Metab Disord 2017 6;16:44. Epub 2017 Nov 6.

Clinical Research Center, Department of Medicine, International University of Health and Welfare, Tokyo, Japan.

Background: Glucose control for pregnant women with glucose intolerance is important, as hyperglycemia may adversely affect the mother and the fetus.

Case Presentation: We report the case of a pregnant Japanese woman who experienced gestational diabetes mellitus during her first pregnancy and developed impaired glucose tolerance after the delivery. During her second pregnancy with twins, she required up to 75 units of injected insulin to control her postprandial hyperglycemia and occasionally experienced hypoglycemia. We used a newly developed flash glucose monitoring system, which allowed her to successfully achieve ideal glycemic control and experience an uncomplicated delivery.

Conclusion: We suggest that this flash glucose monitoring system may be clinically effective for similar cases that involve pregnant women with abnormal glucose tolerance.
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http://dx.doi.org/10.1186/s40200-017-0327-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5674842PMC
November 2017

Postprandial Glucose Surges after Extremely Low Carbohydrate Diet in Healthy Adults.

Tohoku J Exp Med 2017 09;243(1):35-39

Department of Endocrinology and Diabetes, Saitama Medical University.

Carbohydrate-restricted diets are prevalent not only in obese people but also in the general population to maintain appropriate body weight. Here, we report that extreme carbohydrate restriction for one day affects the subsequent blood glucose levels in healthy adults. Ten subjects (median age 30.5 years, BMI 21.1 kg/m, and HbA1c 5.5%), wearing with a continuous glucose monitoring device, were given isoenergetic test meals for 4 consecutive days. On day 1, day 2 (D2), and day 4 (D4), they consumed normal-carbohydrate (63-66% carbohydrate) diet, while on day 3, they took low-carbohydrate/high-fat (5% carbohydrate) diet. The daily energy intake was 2,200 kcal for males and 1,700 kcal for females. On D2 and D4, we calculated the mean 24-hr blood glucose level (MEAN/24h) and its standard deviation (SD/24h), the area under the curve (AUC) for glucose over 140 mg/dL within 4 hours after each meal (AUC/4h/140), the mean amplitude of the glycemic excursions (MAGE), the incremental AUC of 24-hr blood glucose level above the mean plus one standard deviation (iAUC/MEAN+SD). Indexes for glucose fluctuation on D4 were significantly greater than those on D2 (SD/24h; p = 0.009, MAGE; p = 0.013, AUC/4h/140 after breakfast and dinner; p = 0.006 and 0.005, and iAUC/MEAN+SD; p = 0.007). The value of MEAN/24h and AUC/4h/140 after lunch on D4 were greater than those on D2, but those differences were not statistically significant. In conclusion, consumption of low-carbohydrate/high-fat diet appears to cause higher postprandial blood glucose on subsequent normal-carbohydrate diet particularly after breakfast and dinner in healthy adults.
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http://dx.doi.org/10.1620/tjem.243.35DOI Listing
September 2017

Sodium-glucose co-transporter type 2 inhibitors reduce evening home blood pressure in type 2 diabetes with nephropathy.

Diab Vasc Dis Res 2017 05 1;14(3):258-261. Epub 2017 Feb 1.

3 Department of Medicine, Musashino Tokushukai Hospital, Tokyo, Japan.

Background: The effects of sodium-glucose co-transporter type 2 inhibitors on home blood pressure were examined in type 2 diabetes with nephropathy.

Methods: The patients with diabetic nephropathy were screened from medical records in our hospitals. Among them, 52 patients who measured home blood pressure and started to take sodium-glucose co-transporter type 2 inhibitors were selected. Clinical parameters including estimated glomerular filtration rate, albuminuria and home blood pressure for 6 months were analysed.

Results: Sodium-glucose co-transporter type 2 inhibitors (luseogliflozin 5 mg/day or canagliflozin 100 mg/day) reduced body weight, HbA1c, albuminuria, estimated glomerular filtration rate and office blood pressure. Although sodium-glucose co-transporter type 2 inhibitors did not alter morning blood pressure, it reduced evening systolic blood pressure. Regression analyses revealed that decreases in evening blood pressure predicted decrements in albuminuria.

Conclusion: The present data suggest that sodium-glucose co-transporter type 2 inhibitors suppress sodium overload during daytime to reduce evening blood pressure and albuminuria.
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http://dx.doi.org/10.1177/1479164117690299DOI Listing
May 2017

Improvement of glycemic control without severe hypoglycemia in a type 1 diabetes patient undergoing hemodialysis after a change from insulin glargine to insulin degludec.

J Diabetes Investig 2016 Sep;7(5):805-6

Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan.

Insulin degludec improved glycemic control in a type 1 diabetes patient undergoing hemodialysis.
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http://dx.doi.org/10.1111/jdi.12500DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5009146PMC
September 2016

Beneficial effects through aggressive coronary screening for type 2 diabetes patients with advanced vascular complications.

Medicine (Baltimore) 2016 Aug;95(33):e4307

Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo Division of General Medicine, Jichi Medical University Graduate School of Medicine, Shimotsuke Department of Clinical Study and Informatics, Center for Clinical Sciences, National Center for Global Health and Medicine Department of Public Health/Health Policy, the University of Tokyo Department of Diabetes Research, Diabetes Research Center Department of Nuclear Medicine Department of Cardiovascular Medicine, Center Hospital, National Center for Global Health and Medicine, Tokyo First Department of Comprehensive Medicine, Saitama Medical Center, Jichi Medical University School of Medicine Department of Endocrinology and Diabetes, Saitama Medical University, Saitama, Japan.

Glycemic control alone does not reduce cardiovascular events in patients with type 2 diabetes (T2D), and routine screening of all T2D patients for asymptomatic coronary artery disease (CAD) is not effective for preventing acute cardiac events. We examined the effectiveness of an aggressive screening protocol for asymptomatic CAD in T2D patients with advanced vascular complications.We designed a 3-year cohort study investigating the effectiveness of the aggressive coronary screening for T2D patients with advanced vascular complications and no known coronary events using propensity score adjusted analysis at a national center in Japan. Eligibility criteria included T2D without known coronary events and with any 1 of the following 4 complications: advanced diabetic retinopathy, advanced chronic kidney disease, peripheral artery disease, or cerebrovascular disease. In the aggressive screening group (n = 122), all patients received stress single photon emission computed tomography and those exhibiting myocardial perfusion abnormalities underwent coronary angiography. In the conventional screening group (n = 108), patients were examined for CAD at the discretion of their medical providers. Primary endpoint was composite outcome of cardiovascular death and nonfatal cardiovascular events.Asymptomatic CAD with ≥70% stenosis was detected in 39.3% of patients completing aggressive screening. The proportions achieving revascularization and receiving intensive medical therapy within 90 days after the screening were significantly higher in the aggressive screening group than in the conventional screening group [19.7% vs 0% (P < 0.001) and 48.4% vs 9.3% (P < 0.001), respectively]. The cumulative rate of primary composite outcome was significantly lower in the aggressive screening group according to a propensity score adjusted Cox proportional hazards model (hazard ratio, 0.35; 95% confidence interval, 0.12-0.96; P = 0.04).Aggressive coronary screening for T2D patients with advanced vascular complications reduced cardiovascular death and nonfatal cardiovascular events.
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http://dx.doi.org/10.1097/MD.0000000000004307DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5370783PMC
August 2016

Factors complicating the diabetes management of visitors to Japan: advices from a Japanese National Center for overseas medical staff.

J Med Invest 2016 ;63(1-2):15-8

Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine.

Linguistic, cultural, and geographical differences might challenge the management of diabetes patients travelling in a culturally and linguistically homogeneous country. This article presents an instructive case and identifies various factors that can help in effective diabetes management of such cases. A Russian female patient aged 23 came to Japan and visited our hospital for a second opinion regarding glycemic control. She was diagnosed with type 1 diabetes at age three and started insulin injections and diet therapy with carbohydrate counting methods. Her HbA1c level was 11.0% with multiple daily insulin injections. She showed neuropathy, nephropathy, and blindness due to her progressed retinopathy. Because of the language barrier, suggestions for lifestyle modification were not effectively conveyed to the patient. We analyzed possible barriers to effective diabetes management in such foreign patients. In addition to language barriers and difficulties in diet therapy, dissimilar diabetes treatment guidelines, inadequate healthcare insurance, and stress-inducing conditions can be barriers to effective diabetes management. Foreign diabetes patients might face several barriers in effective management while travelling in Japan. Use of medical interpreters, adequate medical insurance, and trained medical staff will help in overcoming these barriers.
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http://dx.doi.org/10.2152/jmi.63.15DOI Listing
January 2017

Continuous Glucose Monitoring in Patients with Abnormal Glucose Tolerance during Pregnancy: A Case Series.

Jpn Clin Med 2016 24;7:1-8. Epub 2016 Feb 24.

Diabetes and Metabolism Information Center, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan.; Department of Diabetes Research, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan.; Department of Endocrinology and Diabetes, Saitama Medical University, Iruma-gun, Saitama, Japan.

Abnormal glucose tolerance during pregnancy is associated with perinatal complications. We used continuous glucose monitoring (CGM) in pregnant women with glucose intolerance to achieve better glycemic control and to evaluate the maternal glucose fluctuations. We also used CGM in women without glucose intolerance (the control cases). Furthermore, the standard deviation (SD) and mean amplitude of glycemic excursions (MAGE) were calculated for each case. For the control cases, the glucose levels were tightly controlled within a very narrow range; however, the SD and MAGE values in pregnant women with glucose intolerance were relativity high, suggesting postprandial hyperglycemia. Our results demonstrate that pregnant women with glucose intolerance exhibited greater glucose fluctuations compared with the control cases. The use of CGM may help to improve our understanding of glycemic patterns and may have beneficial effects on perinatal glycemic control, such as the detection of postprandial hyperglycemia in pregnant women.
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http://dx.doi.org/10.4137/JCM.S34825DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4767119PMC
March 2016

Accelerated decline of renal function in type 2 diabetes following severe hypoglycemia.

J Diabetes Complications 2016 May-Jun;30(4):681-5. Epub 2016 Jan 22.

Department of Diabetes Research, Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan; Department of Endocrinology and Diabetes, Saitama Medical University, Saitama, Japan.

Aims: This study aimed to evaluate whether the pronounced elevation in blood pressure during severe hypoglycemia is associated with subsequent renal insufficiency.

Methods: We conducted a 3-year cohort study to assess the clinical course of renal function in type 2 diabetes patients with or without blood pressure surge during severe hypoglycemia.

Results: Of 111 type 2 diabetes patients with severe hypoglycemia, 76 exhibited an extremely high systolic blood pressure before treatment, whereas 35 demonstrated no such increase (179.1 ± 27.7 mmHg vs. 131.1 ± 20.2 mmHg, P<0.001). At 12h after treatment, systolic blood pressure did not differ significantly (131.5 ± 30.7 mmHg vs. 123.5 ± 20.7 mmHg; P=0.39). The estimated glomerular filtration rate (GFR) before and at the time of severe hypoglycemia did not significantly differ between both groups. A multivariate Cox proportional hazards regression analysis revealed that blood pressure surge during severe hypoglycemia was independently associated with a composite outcome of a more than 15 mL/min/1.73 m(2) decrease in the estimated GFR and initiation of chronic dialysis (hazard ratio, 2.68; 95% confidence interval, 1.12-6.38; P=0.02).

Conclusions: Renal function after severe hypoglycemia was significantly worse in type 2 diabetes patients with blood pressure surge during severe hypoglycemia than those without blood pressure surge.
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http://dx.doi.org/10.1016/j.jdiacomp.2016.01.015DOI Listing
January 2017

Effectiveness of Prior Use of Beta-Blockers for Preventing Adverse Influences of Severe Hypoglycemia in Patients With Diabetes: An Observational Study.

Medicine (Baltimore) 2015 Sep;94(39):e1629

From the Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo (TT, RYH, HK, MK, HN, RH); Division of General Medicine, Jichi Medical University Graduate School of Medicine, Shimotsuke (TT, MK); Department of Diabetes Research, Diabetes Research Center (RYH, MK, HN, MN); Department of Emergency Medicine and Critical Care, Center Hospital, National Center for Global Health and Medicine (AK); and First Department of Comprehensive Medicine, Saitama Medical Center, Jichi Medical University School of Medicine, Saitama, Japan (MK).

The study aimed to identify predictors of severe acute hypertension (≥ 180/110 mmHg) during severe hypoglycemia and to assess the efficacy of prior use of catecholamine-blocking agents for preventing adverse influences in diabetic patients with severe hypoglycemia. We performed a retrospective study between January 2006 and March 2012 to assess diabetic patients with severe hypoglycemia at a single center in Japan. Severe hypoglycemia was defined as the presence of any hypoglycemic symptoms that required the medical assistance of another person after visiting the emergency room by ambulance. Multivariate logistic regression analysis was performed to identify possible predictors of severe hypertension due to severe hypoglycemia and to assess whether prior use of alpha- or beta-blockers is beneficial for the prevention of severe hypertension in diabetic patients with severe hypoglycemia. Multivariate adjustments were made for age, sex, preexisting hypertension, history of ischemic heart disease, blood glucose level upon arrival, estimated GFR, and prior use of alpha- or beta-blockers. A total of 59,602 patients who visited the emergency room were screened and 352 diabetic patients with severe hypoglycemia were enrolled. Incidences of severe hypertension before and at 3 and 6 hours after the initiation of antihypoglycemic treatment were 21.3%, 6.7%, and 0% in patients with type 1 diabetes (n = 61) and 38.8%, 18.2%, and 8.2% in patients with type 2 diabetes (n = 291), respectively. Aging was positively (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.00-1.03; P = 0.02) and female sex was negatively (OR, 0.50; 95% CI, 0.29-0.86; P = 0.01) associated with occurrence of severe hypertension during severe hypoglycemia. In addition, prior use of beta-blockers was negatively associated with occurrence of severe hypertension during severe hypoglycemia using multivariate logistic regression analysis (OR, 0.31; 95% CI, 0.11-0.83; P = 0.02). None of the patients with prior use of beta-blockers had hypokalemia (<3.0 mEq/L). Prior use of beta-blockers may prevent adverse influences such as severe hypertension and hypokalemia during severe hypoglycemia in diabetic patients.
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http://dx.doi.org/10.1097/MD.0000000000001629DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4616818PMC
September 2015

Trans-ancestry genome-wide association study identifies 12 genetic loci influencing blood pressure and implicates a role for DNA methylation.

Nat Genet 2015 11 21;47(11):1282-1293. Epub 2015 Sep 21.

Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.

We carried out a trans-ancestry genome-wide association and replication study of blood pressure phenotypes among up to 320,251 individuals of East Asian, European and South Asian ancestry. We find genetic variants at 12 new loci to be associated with blood pressure (P = 3.9 × 10(-11) to 5.0 × 10(-21)). The sentinel blood pressure SNPs are enriched for association with DNA methylation at multiple nearby CpG sites, suggesting that, at some of the loci identified, DNA methylation may lie on the regulatory pathway linking sequence variation to blood pressure. The sentinel SNPs at the 12 new loci point to genes involved in vascular smooth muscle (IGFBP3, KCNK3, PDE3A and PRDM6) and renal (ARHGAP24, OSR1, SLC22A7 and TBX2) function. The new and known genetic variants predict increased left ventricular mass, circulating levels of NT-proBNP, and cardiovascular and all-cause mortality (P = 0.04 to 8.6 × 10(-6)). Our results provide new evidence for the role of DNA methylation in blood pressure regulation.
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http://dx.doi.org/10.1038/ng.3405DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4719169PMC
November 2015

Acute Multiple Arteriovenous Thromboses in a Patient with Diabetic Ketoacidosis.

Intern Med 2015 15;54(16):2025-8. Epub 2015 Aug 15.

Department of Diabetes, Endocrinology, and Metabolism, National Center for Global Health and Medicine, Japan.

Diabetic ketoacidosis (DKA) is one of the most serious acute complications of diabetes mellitus. An arterial thrombotic tendency from DKA is relatively common; however, the occurrence of acute multiple arteriovenous thromboses is rare. We herein report the case of a 49-year-old man with DKA complicated by multiple thromboses. After transfer to our emergency room with DKA, the patient developed sudden abdominal pain. Contrast-enhanced computed tomography revealed near-complete occlusion of the superior mesenteric artery, superior mesenteric vein, splenic artery, and right femoral artery. This occurrence highlights the need for considering the risk of thrombosis during the initial treatment for DKA.
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http://dx.doi.org/10.2169/internalmedicine.54.4087DOI Listing
April 2016

High risk of abnormal QT prolongation in the early morning in diabetic and non-diabetic patients with severe hypoglycemia.

Ann Med 2015 May 10;47(3):238-44. Epub 2015 Apr 10.

Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine , Tokyo , Japan.

Background: Several studies have suggested that the occurrence of severe hypoglycemia during sleep may be more dangerous for cardiac arrhythmia than that in the day-time.

Methods: We performed a retrospective study between January 2006 and March 2012 to assess electrocardiograms during severe hypoglycemia in patients with or without diabetes.

Results: A total of 59,602 patients who visited the emergency room by ambulance were screened, and 287 patients with severe hypoglycemia were enrolled. The median blood glucose levels in patients with (DM, n = 192) and without diabetes (non-DM, n = 95) were 30 and 45 mg/dL, respectively. During severe hypoglycemia, the incidence of abnormal QT prolongation was significantly higher in the early morning (4-10 a.m.) than at other times (DM group, 74.3% versus 54.1%, P = 0.02; non-DM group, 78.3% versus 50.0%, P = 0.01). Multivariate logistic regression analysis identified the occurrence of severe hypoglycemia in the early morning as a strong factor for abnormal QT prolongation (DM group, odds ratio [OR] 2.80, 95% confidence interval [CI] 1.15-6.80, P = 0.02; non-DM group, OR 4.53, 95% CI 1.30-15.74, P = 0.01).

Conclusions: The incidence of abnormal QT prolongation during severe hypoglycemia was significantly higher in the early morning than at all other times, independent of the cause of severe hypoglycemia.
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http://dx.doi.org/10.3109/07853890.2015.1017528DOI Listing
May 2015

Possible discrepancy of HbA1c values and its assessment among patients with chronic renal failure, hemodialysis and other diseases.

Clin Exp Nephrol 2015 Dec 1;19(6):1179-83. Epub 2015 Apr 1.

Department of Diabetes Research, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.

Background: Glycated hemoglobin (HbA1c) and glycated albumin (GA) are frequently used as glycemic control markers. However, these markers are influenced by alterations in hemoglobin and albumin metabolism. Thus, conditions such as anemia, chronic renal failure, hypersplenism, chronic liver diseases, hyperthyroidism, hypoalbuminemia, and pregnancy need to be considered when interpreting HbA1c or GA values. Using data from patients with normal albumin and hemoglobin metabolism, we previously established a linear regression equation describing the GA value versus the HbA1c value to calculate an extrapolated HbA1c (eHbA1c) value for the accurate evaluation of glycemic control. In this study, we investigated the difference between the measured HbA1c and the eHbA1c values for patients with various conditions.

Methods: Data sets for a total of 2461 occasions were obtained from 731 patients whose HbA1c and GA values were simultaneously measured. We excluded patients with missing data or changeable HbA1c levels, and patients who had received transfusions or steroids within the previous 3 months. Finally, we included 44 patients with chronic renal failure (CRF), 10 patients who were undergoing hemodialysis (HD), 7 patients with hematological malignancies and a hemoglobin level of less than 10 g/dL (HM), and 12 patients with chronic liver diseases (CLD).

Results: In all the groups, the eHbA1c values were significantly higher than the measured HbA1c values. The median difference was 0.75 % (95 % CI 0.40-1.10 %, P for the difference is <0.001) in the CRF group, 0.80 % (95 % CI 0.30-1.65 %, P for the difference is 0.041) in the HD group, 0.90 % (95 % CI 0.90-1.30 %, P for the difference is 0.028) in the HM group, and 0.85 % (95 % CI 0.40-1.50 %, P for the difference is 0.009) in the CLD group.

Conclusions: We found that the measured HbA1c values were lower than the eHbA1c values in each of the groups.
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http://dx.doi.org/10.1007/s10157-015-1110-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4679780PMC
December 2015

Verification of glycemic profiles using continuous glucose monitoring: cases with steroid use, liver cirrhosis, enteral nutrition, or late dumping syndrome.

J Med Invest 2015 ;62(1-2):1-10

Department of Diabetes, Endocrinology, and Metabolism Center Hospital; 2.Diabetes and Metabolism Information Center, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine.

Glycemic control is often difficult to achieve in patients with diabetes, especially in the presence of comorbid diseases or conditions such as steroid-use or liver cirrhosis, or in patients receiving enteral nutrition. Moreover, reactive hypoglycemia due to late dumping syndrome in people having undergone gastrectomy is also a matter of concern. Empirically and theoretically, the typical glycemic profiles associated with these conditions have been determined; however, what actually happens during a 24-h span is still somewhat obscure. In order to verify and provide information about the 24-h glycemic profiles associated with these conditions, 8 patients with the 4 above-mentioned conditions were monitored using a continuous glucose monitoring system (CGMS). For all 8 patients, CGMS provided detailed information regarding the 24-h glycemic profiles. The CGM results showed typical glycemic patterns for each condition, and we were moreover able to observe the effects of various practical treatments. Based on these cases, we conclude that the CGMS is highly useful for determining the glycemic patterns of patients with the aforementioned conditions in a practical setting; and this system may be used to monitor the treatment success of such cases.
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http://dx.doi.org/10.2152/jmi.62.1DOI Listing
December 2016

Additive effects of miglitol and anagliptin on insulin-treated type 2 diabetes mellitus: a case study.

Clin Drug Investig 2015 Feb;35(2):141-7

Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan,

The aim of this case study was to examine the efficacy of a dipeptidyl peptidase-4 inhibitor (anagliptin) and an α-glucosidase inhibitor (miglitol) when added to ongoing insulin treatment in patients with type 2 diabetes mellitus. Continuous glucose monitoring was performed in four Japanese insulin-treated inpatients with type 2 diabetes. Baseline data were collected on day 1. Miglitol was administered on days 2 and 3. On day 4, miglitol and anagliptin were coadministered before breakfast. On days 1, 3, and 5, blood was drawn for plasma glucose, serum C-peptide, plasma glucagon, total and active glucagon-like peptide-1 (GLP-1), and total and active glucose-dependent insulinotropic peptide (GIP) measurements. Coadministration of anagliptin with miglitol resulted in additional improvements in glycemic control over the entire day in three of the four patients. The C-peptide, glucagon, and total and active GLP-1 and GIP responded differently to the medications for each patient, suggesting interindividual differences in hormonal responses, which may be complicated by multifactorial effects.
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http://dx.doi.org/10.1007/s40261-014-0260-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4300407PMC
February 2015

Seasonal variations of severe hypoglycemia in patients with type 1 diabetes mellitus, type 2 diabetes mellitus, and non-diabetes mellitus: clinical analysis of 578 hypoglycemia cases.

Medicine (Baltimore) 2014 Nov;93(23):e148

From the Department of Diabetes, Endocrinology, and Metabolism, National Center for Global Health and Medicine, Tokyo (TT, RY-H, HK, M Kishimoto, HN, RH); Division of General Medicine, Jichi Medical University Graduate School of Medicine, Tochigi (TT, M Kakei); Department of Diabetes Research, Diabetes Research Center (RY-H, M Kishimoto, HN, MN); Department of Emergency Medicine and Critical Care, Center Hospital, National Center for Global Health and Medicine, Tokyo (AK); and First Department of Comprehensive Medicine, Saitama Medical Center, Jichi Medical University School of Medicine, Saitama, Japan (M Kakei).

Blood glucose control in patients with diabetes mellitus (DM) is reportedly influenced by the seasons, with hemoglobin A1c (HbA1c) levels decreasing in the summer or warm season and increasing in the winter or cold season. In addition, several studies have shown that sepsis is also associated with the seasons. Although both blood glucose control and sepsis can strongly affect the occurrence of severe hypoglycemia, few studies have examined the seasonal variation of severe hypoglycemia. The aim of the present study is to examine the association between severe hypoglycemia and the seasons in patients with type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and non-diabetes mellitus (non-DM). We retrospectively reviewed all the patients with severe hypoglycemia at a national center in Japan between April 1, 2006 and March 31, 2012. A total of 57,132 consecutive cases that had visited the emergency room by ambulance were screened, and 578 eligible cases of severe hypoglycemia were enrolled in this study. The primary outcome was to assess the seasonality of severe hypoglycemia. In the T1DM group (n  =  88), severe hypoglycemia occurred significantly more often in the summer than in the winter (35.2% in summer vs 18.2% in winter, P  =  0.01), and the HbA1c levels were highest in the winter and lowest in the summer (9.1% [7.6%-10.1%] in winter vs 7.7% [7.1%-8.3%] in summer, P  =  0.13). In the non-DM group (n  =  173), severe hypoglycemia occurred significantly more often in the winter than in the summer (30.6% in winter vs 19.6% in summer, P  =  0.01), and sepsis as a complication occurred significantly more often in winter than in summer (24.5% in winter vs 5.9% in summer, P  =  0.02). In the T2DM group (n  =  317), the occurrence of severe hypoglycemia and the HbA1c levels did not differ significantly among the seasons. The occurrence of severe hypoglycemia might be seasonal and might fluctuate with temperature changes. Patients should be treated more carefully during the season in which severe hypoglycemia is more common.
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http://dx.doi.org/10.1097/MD.0000000000000148DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4616344PMC
November 2014

The factors that limit activities of certified diabetes educators in Japan: a questionnaire survey.

Springerplus 2014 17;3:611. Epub 2014 Oct 17.

Diabetes and Metabolism Information Center, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655 Japan ; Department of Diabetes Research, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655 Japan.

Background: The certified diabetes educator (CDE) is a qualification awarded to health professionals with specialized knowledge, skills, and experiences in diabetes management and education. To clarify whether CDEs consider themselves to be working sufficiently, in other words, making sufficient use of their specialized skills or not, a questionnaire survey was conducted. The participants were persons involved in diabetes-related educational seminars and medical personnel engaged in diabetes care at the National Center for Global Health and Medicine. They were asked to complete a questionnaire regarding self -perception of CDE's activities and to describe the reasons for their answers.

Findings: Fewer than 40% of the responding CDEs in each of the professions surveyed were satisfied with the current state of their activities and contributions as a CDE. For CDEs, "lack of labor" is the most concerning issue that limits their satisfactory activities as CDEs, followed by "condition of facilities". Other factors such as insufficient "interprofessional teamwork", "limited personal ability", "mismatched allocation", and "low recognition for CDEs" also limited their activities.

Conclusion: Many CDEs perceived they are not working sufficiently. Further efforts should be made to support CDEs to improve their working conditions.
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http://dx.doi.org/10.1186/2193-1801-3-611DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4203788PMC
November 2014

Prediction of response to GLP-1 receptor agonist therapy in Japanese patients with type 2 diabetes.

Diabetol Metab Syndr 2014 15;6(1):110. Epub 2014 Oct 15.

Department of Diabetes Research, Diabetes Research Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655 Japan.

Background: Glucagon-like peptide-1 (GLP-1) receptor agonists can maintain good glycemic control in some diabetic. Here we compared the clinical characteristics and parameters reflecting glucose metabolism at the time of the initiation of GLP-1 receptor agonist therapy between patients who responded well to therapy and those who did not.

Methods: The records of 43 patients with type 2 diabetes who started receiving GLP-1 receptor agonist therapy during hospitalization were retrospectively reviewed. Glucagon stimulation tests were performed, and patients were started on liraglutide or exenatide therapy. Preprandial blood glucose levels were measured on days 2 and 3 of GLP-1 receptor agonist therapy. We used the Cox proportional hazard model to compare clinical parameters between responders (HbA1c level <8% at more than 3 months after the initiation of treatment) and non-responders (HbA1c level ≥8% at more than 3 months after the initiation of treatment or a switch to insulin therapy at any time).

Results: Twenty-six of the 43 patients were classified as non-responders. At baseline, mean HbA1c levels were 9.9% among responders and 9.7% among non-responders. Compared with treatment with only diet or metformin, the hazard ratio [HR] for non-response was 5.3 (95% confidence interval [CI]: 1.16-24.6, P = 0.03) for insulin therapy and 5.0 (95% CI: 1.13-22.16, P = 0.03) for sulfonylurea therapy. Compared with the lowest tertile, the HRs for non-response in the highest tertile were 3.1 (95% CI: 1.04-8.97, P = 0.04) for the mean preprandial blood glucose level on days 2 and 3 and 3.4 (95% CI: 1.05-11.01, P = 0.04) for the body mass index. The response was not significantly associated with the duration of diabetes or the glucagon stimulation test results. A receiver operating curve analysis showed that the mean preprandial blood glucose level had the highest area under the curve value (=0.72) for the prediction of non-responders.

Conclusions: In patients with poorly controlled diabetes, the response to GLP-1 receptor agonist therapy was significantly associated with the treatment used before the initiation of therapy, the body mass index, and the mean preprandial blood glucose level during the 2 days after the initiation of therapy.
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http://dx.doi.org/10.1186/1758-5996-6-110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4209043PMC
October 2014

Prediction of 90-day mortality in patients without diabetes by severe hypoglycemia: blood glucose level as a novel marker of severity of underlying disease.

Acta Diabetol 2015 Apr 7;52(2):307-14. Epub 2014 Sep 7.

Department of Diabetes, Endocrinology, and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan.

Aim: The present study examined the clinical conditions and predictors of death in non-diabetic patients with pre-hospital severe hypoglycemia.

Materials And Methods: From January 2006 to March 2012, we retrospectively reviewed the medical records to assess the patients with pre-hospital severe hypoglycemia at a national center in Japan. Severe hypoglycemia was defined as the presence of any hypoglycemic symptoms requiring the medical assistance of another person. The patients were followed up for 90 days after the severe hypoglycemia episode.

Results: A total of 59,602 consecutive cases that visited the emergency room were screened, and 530 patients with severe hypoglycemia were included in the subsequent analysis. The mean blood glucose levels in the non-diabetes (non-DM, n = 163) and diabetes (DM, n = 367) groups were 42.9 and 33.7 mg/dL, respectively. The incidence of extremely abnormal QT prolongation (corrected QT interval ≥0.50 s) was high in both groups [22.1 vs. 14.7 % (P = 0.11)]. Mortalities within 90 days after severe hypoglycemia were significantly higher in the non-DM group than in the DM group [20.3 vs. 1.6 % (P < 0.001)]. In addition to patient age, preexisting advanced liver disease and cancer, and the coexistence of sepsis, a blood glucose level of <40 mg/dL was identified as a strong predictor of death in the non-DM group using multivariate Cox proportional hazards models (hazard ratio 3.75; 95 % confidence interval 1.52-9.27; P = 0.004).

Conclusions: Death in non-diabetic patients with severe hypoglycemia was independently associated not only with age, advanced liver disease, cancer, and sepsis, but also with the blood glucose level upon arrival.
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http://dx.doi.org/10.1007/s00592-014-0640-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4374114PMC
April 2015

The difficulties of interprofessional teamwork in diabetes care: a questionnaire survey.

J Multidiscip Healthc 2014 5;7:333-9. Epub 2014 Aug 5.

Diabetes and Metabolism Information Center, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan ; Department of Diabetes Research, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.

Background: Diabetes is a multifactorial disease and its nature means that interprofessional teamwork is essential for its treatment. However, in general, interprofessional teamwork has certain problems that impede its function. To clarify these problems in relation to diabetes care, a questionnaire survey was conducted.

Methods: The participants who were involved in diabetes-related educational seminars, and medical personnel who were engaged in diabetes care from the National Center for Global Health and Medicine, were asked to complete the questionnaire about perceptions of, and satisfaction with, interprofessional teamwork across multiple health care providers, who were actually involved in diabetes care.

Results: From 456 people who were asked to take the questionnaire, 275 people answered. The percentages of the respondents according to profession who considered multidisciplinary teamwork sufficient were as follows: physicians, 20.5%; nurses, 12.7%; registered dietitians, 29.6%; pharmacists, 21.9%; physiotherapists, 18.2%; and clinical laboratory technicians 15.4%. Insufficient interprofessional communication and inconsistency in motivation levels among staff were frequently cited as causes of insufficient teamwork. All professions considered interprofessional meetings or conferences necessary and essential for teamwork.

Conclusion: The survey revealed that interprofessional teamwork in diabetes care is currently insufficient. Continuous efforts to change each profession's perceptions about interprofessional teamwork and efforts to improve the quality of interprofessional meetings are necessary.
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http://dx.doi.org/10.2147/JMDH.S66712DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4128836PMC
August 2014

Systematic fine-mapping of association with BMI and type 2 diabetes at the FTO locus by integrating results from multiple ethnic groups.

PLoS One 2014 30;9(6):e101329. Epub 2014 Jun 30.

Department of Gene Diagnostics and Therapeutics, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.

Background/objective: The 16q12.2 locus in the first intron of FTO has been robustly associated with body mass index (BMI) and type 2 diabetes in genome-wide association studies (GWAS). To improve the resolution of fine-scale mapping at FTO, we performed a systematic approach consisting of two parts.

Methods: The first part is to partition the associated variants into linkage disequilibrium (LD) clusters, followed by conditional and haplotype analyses. The second part is to filter the list of potential causal variants through trans-ethnic comparison.

Results: We first examined the LD relationship between FTO SNPs showing significant association with type 2 diabetes in Japanese GWAS and between those previously reported in European GWAS. We could partition all the assayed or imputed SNPs showing significant association in the target FTO region into 7 LD clusters. Assaying 9 selected SNPs in 4 Asian-descent populations--Japanese, Vietnamese, Sri Lankan and Chinese (n≤26,109 for BMI association and n≤24,079 for type 2 diabetes association), we identified a responsible haplotype tagged by a cluster of SNPs and successfully narrowed the list of potential causal variants to 25 SNPs, which are the smallest in number among the studies conducted to date for FTO.

Conclusions: Our data support that the power to resolve the causal variants from those in strong LD increases consistently when three distant populations--Europeans, Asians and Africans--are included in the follow-up study. It has to be noted that this fine-mapping approach has the advantage of applicability to the existing GWAS data set in combination with direct genotyping of selected variants.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0101329PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4076329PMC
October 2015

Improvement of both fasting and postprandial glycemic control by the two-step addition of miglitol and mitiglinide to basal insulin therapy: a pilot study.

Diabetol Metab Syndr 2014 31;6:48. Epub 2014 Mar 31.

Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine Center Hospital, Tokyo, Japan ; Department of Diabetes Research, Diabetes Research Center, National, Center for Global Health and Medicine, Tokyo, Japan.

Background: Combination therapy consisting of basal insulin and oral hypoglycemic agents (OHAs) is effective for the treatment of type 2 diabetes (T2DM) that cannot be adequately controlled using OHAs alone. Though basal insulin with metformin or sulfonylurea is an effective therapy, it cannot reduce postprandial glycemia without the risk of hypoglycemia. We examined a two-step regimen consisting of the addition of postprandial hypoglycemic agents (an alpha-glucosidase inhibitor and a glinide) in patients whose T2DM was poorly controlled using basal insulin therapy.

Methods: Inpatients between the ages of 30-79 years who had T2DM and an HbA1c level of more than 7.0% were recruited. The patients were treated with once-daily insulin glargine with or without metformin, depending on the patient's age and renal function. Insulin glargine was titrated to achieve a target fasting glucose level of 70-130 mg/dL as a first step (STEP0). If the 2-hour postprandial glucose (PBG) level was higher than the target of 180 mg/dL, miglitol treatment (150 mg/day) was initiated, with dose adjustments (75-225 mg) allowed depending on abdominal symptoms and the PBG (STEP1). If the PBG of the patients remained higher than the target after 3 days of treatment, mitiglinide (30 mg/day, titrated up to 60 mg) was added (STEP2). We then evaluated the proportion of patients who achieved the target PBG before and after the two-step regimen. Continuous Glucose Monitoring (CGM) was performed throughout the two-step protocol in most of the patients.

Results: Of the 16 patients who were recruited (median age, 67.0 [58.0-71.0] years; body mass index, 25.0 [22.0-27.9] kg/m(2); HbA1c level at admission, 9.1% [8.35-10.4%]), 1 patient (6.25%) achieved the target PBG at STEP 0 and 14 patients (87.5%) had achieved the target PBG at the end of the treatment protocol (P = 0.002). CGM showed a significant decrease in the glucose level at each step of the protocol. The standard deviations in the CGM glucose levels for 24 hours, MAGE, and M-value also improved.

Conclusions: The two-step addition of postprandial hypoglycemic agents to basal insulin therapy is potentially effective and safe for decreasing both the fasting and postprandial glucose levels.
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http://dx.doi.org/10.1186/1758-5996-6-48DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4025538PMC
August 2014

A newer conversion equation for the correlation between HbA1c and glycated albumin.

Endocr J 2014 28;61(6):553-60. Epub 2014 Mar 28.

Department of Endocrinology, Diabetes, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.

Glycated hemoglobin (HbA1c) and glycated albumin (GA) are frequently used as glycemic control markers. These markers are influenced by either altered hemoglobin metabolism or albumin metabolism. We investigated the correlation between HbA1c and GA by collecting only data that had not been affected by the turnover of either HbA1c or GA and proposed a novel equation for accurately estimating the extrapolated HbA1c (eHbA1c) value based on the GA value. Data sets for a total of 2461 occasions were obtained from 731 patients (including non-diabetes patients) whose HbA1c and GA values were simultaneously measured. Data sets obtained from patients undergoing hemodialysis, patients with hematological malignancies, pregnancy, chronic liver diseases, hyperthyroidism, steroid treatment or a blood transfusion during the past 3 months, or patients without albumin, hemoglobin, eGFR, or urinary protein measurements and data sets with an eGFR of less than 30 mL/min/1.73 m(2), a hemoglobin level of less than 10 mg/dL, an albumin level of below 3.0 g/mL, or a urinary protein level of 3+ were excluded. Finally, we selected 284 data sets. We then analyzed these data sets, performed a scatter plot to examine the correlation between HbA1c and GA, and established an equation describing the resulting correlation. Based on all the data points, the resulting equation was HbA1c = 0.216 × GA + 2.978 [R(2) = 0.5882, P < 0.001].
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http://dx.doi.org/10.1507/endocrj.ej13-0450DOI Listing
April 2015

Effects of exenatide in a morbidly obese patient with type 2 diabetes.

Diabetes Ther 2014 Jun 18;5(1):323-32. Epub 2014 Jan 18.

Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan,

Introduction: The effect of exenatide in weight loss has been reported. Presented here is a case of a morbidly obese patient with type 2 diabetes using exenatide who dramatically lost her body weight in a year and experienced improved glycemic control.

Case Report: Exenatide therapy was initiated for a 59-year-old morbidly obese Japanese woman with type 2 diabetes. To examine the effects of the exenatide treatment, continuous glucose monitoring was performed, and blood was drawn at 0, 30, 60, 120, and 180 min after breakfast to measure insulin, glucagon, glucagon-like peptide-1 (GLP-1), and glucose-dependent insulinotropic peptide (GIP) levels. After 1 year of exenatide therapy, the patient lost 37.5 kg, her glycemic control improved, and her insulin sensitivity recovered. The patient's levels of insulin, glucagon, active GLP-1, and total GIP also decreased after 1 year of exenatide treatment.

Conclusion: The exenatide treatment was effective for reducing body weight and improving glycemic control. After 1 year of exenatide treatment, decreased glucagon, active GLP-1, and total GIP levels were observed following a meal, suggesting that exenatide might affect these hormonal reactions.
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http://dx.doi.org/10.1007/s13300-014-0050-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4065292PMC
June 2014

Successful treatment of chronic intractable itching using oral pregabalin in a patient with diabetes and systemic prurigo nodularis: a case report of an iliopsoas muscle abscess.

Intern Med 2013 ;52(23):2629-33

Department of Diabetes and Metabolic Medicine, Center Hospital, National Center for Global Health and Medicine, Japan.

A 73-year-old Japanese man developed chronic intractable itching due to prurigo nodularis. High-dose glucocorticoid ointment failed, and the treatment resulted in poor glycemic control. Repeated scratching caused hematogenous bacterial dissemination via cutaneous injuries, resulting in the formation of iliopsoas and spinal epidural abscesses that required long-term antibiotic treatment. Pregabalin was administered to treat the pruritus, and a considerable improvement was observed. A reduction in the dose and intensity of the topical corticosteroids improved the patient's glycemic control, resulting in the complete resolution of the abscesses. Pregabalin significantly improved the patient's pruritus and decreased the risk of infection.
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http://dx.doi.org/10.2169/internalmedicine.52.0060DOI Listing
August 2014