Association Between Nerve Conduction Velocity and Clinical Parameters Related to Diabetic Complications inPatients with Type 2 Diabetes

The main purpose of the study was to investigate the association of median motor nerve conduction velocity(MCV) and sural sensory nerve conduction velocity( SCV) with parameters related to diabetic complicationsin patients with type 2 diabetes. A total of 263 patients hospitalized for glycemic control from 1999to 2006 who underwent single or multiple nerve conduction velocity tests (at least a right median MCVtest) were enrolled in the study retrospectively. Right median MCV showed a significant negative correlationwith age and diabetic duration, and was also significantly negatively correlated with systolic blood pressure(SBP) and log urinary albumin excretion (UAE). Right median MCV showed strong positive correlationswith left median MCV and right median SCV, and significant but relatively mild positive correlationswith right peroneal MCV and right sural SCV. In multiple regression analysis, only SBP and diabetic durationshowed a significant association with right median MCV. Although right sural SCV showed significantnegative correlations with SBP and log UAE, the correlations were relatively weak compared with those forright median MCV. Of 215 patients who underwent complete sural SCV measurements, right and left suralSCV were detected in 159( 74%) and 163 patients( 76%), respectively. In conclusion, these results suggestthat median MCV is more closely associated with markers related to diabetic complications such as SBP orUAE, compared with sural SCV, but that sural SCV is more sensitive than median MCV for detection of diabeticneuropathy

SIADH induced by pneumonia in a patient with Shy-Drager syndrome

Patients with Shy-Drager syndrome have impaired baroreceptor-mediated vasopressin release when inan upright position. We report a case of Shy-Drager syndrome in which the syndrome of inappropriate secretionof antidiuretic hormone (SIADH) developed with pneumonia. It has been speculated that pneumonia-induced SIADH is caused by baroreceptor-mediated vasopressin release. Our case presents the possibilitythat pneumonia-induced SIADH is caused by non-baroreceptor-mediated ADH release

Long Term Evaluation of Glycemic Control in Patients with Type 2 Diabetes Receiving Either Alogliptin and Lansoprazole or Alogliptin Mono-therapy for 3 Months Followed by Alogliptin Mono-therapy:A Retrospective Analysis

Aims:This study was the retrospective analysis of the previous study named as APPLE study( study of combination effect of AlogliPtin and lansoPrazoLE on glycemic control in patients with type 2 diabetes), in which the effect of the combination therapy of alogliptin (a dipeptidyl peptidase-4 inhibitor, DPP4-I) and lansoprazole (a proton pump inhibitor, PPI) was compared with alogliptin mono-therapy without PPI on glycemic control in a randomized open-label study design. The aim of this study was to investigate whether so called legacy effect of proton pump inhibitor on glycemic control is observed. Patients and Methods:In the patients that participated in the APPLE study( 3 months observation;total: 100 patients), the patients who continued the intake of alogliptin at least more than 1 year after the registration(enrollment)in APPLE study was evaluated on glycemic control retrospectively. As a rule, the administration of lansoprazole in combination group was discontinued after the finish of 3 months- of the APPLE study. Twenty-six patients in the alogliptin mono-therapy group and 26 patients in combination group met the requirement in this analysis. Mean observation periods were respectively 16 months. In these patients, the number of patients in whom all diabetic drugs were not changed in observation-period was respectively 18 in alogliptin mono-therapy group and 17 in combination group.Results:The decrease of HbA1c was maintained also after long term observation (16 months) in both alogliptin mono-therapy and combination groups (the decrease was respectively -1.054±0.548 and - 1.123±0.723%), which was similar compared with that observed in 3 months-APPLE study. There were no significant differences in change of HbA1c and fasting plasma glucose (FPG) at the time in enrollment of APPLE study and at final visit( approximately 16 weeks) between these groups. The significant difference in change of HbA1c and FPG was not found also between alogliptin mono-therapy and combination group in the subgroup of patients where all diabetic drugs were unchanged during observation period.Conclusion:This study found that the legacy effect of PPI on glycemic control was not apparent more than 9 months after the APPLE study. Based on the results in the previous APPLE study and in this current retrospective study, we concluded that the add-on effect of PPI for DPP4-I on glycemic control in patients with type 2 diabetes is not clinically apparent

The Effect of Switching from Either Mitiglinide or Glimepiride to Repaglinide on Both Glycemic Control and Oxidative Stress in Patients with Type 2 Diabetes

Aims:The goal of this study was to investigate the effect of switching from either the low dose sulfonylurea glimepiride(1?mg once daily)or the glinide mitiglinide(10?mg three times daily)to repaglinide(0.5?mg three times daily)on both glycemic control and oxidative stress in patients with type 2 diabetes.Patients and Methods:Finally 17 patients(patients treated with either glimepiride:n=11 or mitiglinide:n=6)completed the study. The type and dose of all drugs, including the anti-diabetic treatments, were not changed for at least 1?month prior to the study.Results:Both groups showed a significant decrease in HbA1c levels. FPG showed a tendency(not significant)toward a decrease in the mitiglinide-treated group, while no change was found in the glimepiride-treated group. A significant decrease in 8-iso-PGF2α levels was found only in the glimepiride-treated group. There was a significant correlation between the difference in 8-iso-PGF2α levels and that in either FPG or HbA1c before and after the switch only in the mitiglinide-treated group.Conclusions:Repaglinide may have an anti-oxidative effect probably due to the strong postprandial glucose lowering observed in patients with type 2 diabetes

A case in which water intoxication due to excessive water ingestion did not inhibit the secretion of arginine vasopressin

We experienced a case of water intoxication due to excessive water ingestion that was complicated by the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). A 60-year-old Japanese woman with nervous depression drank too much lemon tea within several hours, vomited ten times, and developed disturbed consciousness and dysarthria. Her plasma arginine vasopressin (AVP) concentration was not inhibited,although her plasma osmolality was low. Nausea and/or stress may stimulate AVP secretion regardless of the hypo-osmolality. We believe that dilatation of her stomach due to excessive liquid ingestion and cerebral edema due to hypo-osmolality brought on her nausea. Stress induced by a psychiatric problem and/or admission to a hospital may also stimulate AVP secretion by the central nervous system. Treatingnausea and stress may help reduce AVP secretion and resolve hyponatremia

テイNa ケッショウ ノ ビョウタイ セイリ

日常診療において低Na 血症は最も頻回に遭遇する電解質異常である.その治療には,ヒトの体液恒常性維持のメカニズムと,低Na 血症となる病態の正確な理解が必要不可欠である.本稿では低Na 血症の概説と,その代表的疾患であるSIADH について詳しく述べる.最新の知見を紹介しながらSIADH の鑑別診断にも触れる.Hyponatremia is a most common electrolyte abnormalityin routine practice. It is extremely necessary to understandboth the mechanism of maintaining fluid homeostasis of humanbody and the true pathophysiology of hyponatremia. Ifyou meet a male patient who needs fluid management, youmust choose appropriate fuild content or he might causeiatrogenic hyponatremia, even though he is not a patientwith hyponatremia. We tried to summarize hyponatremiaand SIADH as a review in this manuscript

キュウセイ ジンフゼン, コウCPKケッショウ オ トモナイ, キュウゲキ ニ ケトアシドーシス オ テイシタ ヒ ジコ メンエキセイ ゲキショウガタ 1ガタ トウニョウビョウ ノ 1レイ

We present a 40 year male patient who developed diabetic ketoacidosis with acute renal failure and high serum values of CPK and uric acid. Because of acute onset of ketoacidosis during several days with an elevation of serum amylase, negative findings of antibodies associated with autoimmune type 1 diabetes mellitus, he was diagnosed of a non-autoimmune, fuluminant, type 1 diabetes mellitus, which is a newly established subtype of type 1 diabetes mellitus. Since the patient\u27s post-prandial plasma glucose was extremely high (1123 mg/dl) when he developed ketoacidosis, the severe dehydration due to extreme hyperglycemia might have caused acute renal failtire and rhabdomyolysis

Role of bile acid sequestrants in the treatment of type 2 diabetes

Cholestyramine is a first-generation bile acid sequestrant (BAS) and antihyperlipidemic agent that currently has limited use because of its relatively weak effect on lowering low density-lipoprotein (LDL)-cholesterol (C) and poor tolerability. The current first choice drugs for hyper-LDL-cholesterolemia are 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) because of their strong LDL-C lowering effects and efficacy in prevention of cardiovascular disease. However, after lowering the target levels of LDL-C in very high risk patients, combination therapy with statins and other antihyperlipidemic drugs may become more important for treatment of hyper-LDL-cholesterolemia. Second-generation BASs such as colesevelam and colestimide have a glucose-lowering effect and improved tolerance, which has led to re-evaluation of their utility in combination with statins or antidiabetic agents