The efficacy of incretin therapy in patients with type 2 diabetes undergoing hemodialysis

BACKGROUND: Although incretin therapy is clinically available in patients with type 2 diabetes undergoing hemodialysis, no study has yet examined whether incretin therapy is capable of maintaining glycemic control in this group of patients when switched from insulin therapy. In this study, we examined the efficacy of incretin therapy in patients with insulin-treated type 2 diabetes undergoing hemodialysis. METHODS: Ten type 2 diabetic patients undergoing hemodialysis received daily 0.3 mg liraglutide, 50 mg vildagliptin, and 6.25 mg alogliptin switched from insulin therapy on both the day of hemodialysis and the non-hemodialysis day. Blood glucose level was monitored by continuous glucose monitoring. After blood glucose control by insulin, patients were treated with three types of incretin therapy in a randomized crossover manner, with continuous glucose monitoring performed for each treatment. RESULTS: During treatment with incretin therapies, severe hyperglycemia and ketosis were not observed in any patients. Maximum blood glucose and mean blood glucose on the day of hemodialysis were significantly lower after treatment with liraglutide compared with treatment with alogliptin (p < 0.05), but not with vildagliptin. The standard deviation value, a marker of glucose fluctuation, on the non-hemodialysis day was significantly lower after treatment with liraglutide compared with treatment with insulin and alogliptin (p < 0.05), but not with vildagliptin. Furthermore, the duration of hyperglycemia was significantly shorter after treatment with liraglutide on both the hemodialysis and non-hemodialysis days compared with treatment with alogliptin (p < 0.05), but not with vildagliptin. CONCLUSIONS: The data presented here suggest that patients with type 2 diabetes undergoing hemodialysis and insulin therapy could be treated with incretin therapy in some cases

Acute Inflammatory Syndrome and Intrahepatic Cholestasis Caused by an Interleukin-6-Producing Pheochromocytoma with Pregnancy

We herein describe the case of a 30-year-old woman who experienced high fever during the puerperal period and was diagnosed with pheochromocytoma. Acute inflammatory syndrome, as indicated by the elevated serum levels of interleukin-6 (IL-6), and cholestatic liver dysfunction were observed. Since this condition resolved before the operation, it was probably caused by massive central necrosis within the tumor. The IL-6 production from the tumor cells was confirmed by immunohistochemistry. When a case of pheochromocytoma accompanied with acute inflammatory syndrome is encountered, the possibility that the tumor itself might produce some cytokines should be considered, even in the presence of massive necrosis within the tumor.私たちは分娩後，発熱を契機に診断されたIL-6 産生褐色細胞腫の一例を経験したので報告する．症例は30歳，女性．妊娠24 週目に高血圧を指摘されたが，その後は血圧安定しており，加療なし．37週目，血圧200/146 mmHg と急激に上昇し，妊娠高血圧症候群の診断の下，当院救急搬送後，即日帝王切開となった．無事第一子を出産したが，その後も高血圧は改善せず，産褥期３週目頃より38℃台の発熱が出現し，原因精査の結果，左副腎に壊死を伴う径10cm 大の褐色細胞腫の存在が明らかになった．また同時期に血中胆道系酵素，CRP およびIL-6 の増加を認めた．その後，解熱とともにこれらの値も徐々に低下し，産褥18週目までにはいずれも正常化した．産褥21 週目，左副腎摘出術を施行．摘出した腫瘍の免疫組織化学的検査の果，腫瘍からのIL-6 の産生が確認された． 私たちが調べ得た限り，IL-6 を産生する褐色細胞腫の報告は本例を含め８例であった．いずれも血中IL-6 の増加の他，急性炎症反応あるいは肝胆道系酵素の上昇を認めたが，８例中３例（本例含）は，腫瘍摘出前に血中濃度はすべて正常化していた．特に本例のように腫瘍内部に壊死を伴う場合は，腫瘍細胞からのIL-6 産生を見逃されてきた可能性があり，今後acute inflammatory syndrome を伴う褐色細胞腫の診断の際には，IL-6の産生を疑う必要があると考えられた