Clinically Both Effects of Weight and Glucose Variability by Oral Semaglutide (Rybelsus) for Younger Female Patient with Type 2 Diabetes (T2D)

Background: Obesity and Type 2 Diabetes (T2D) are crucial problems worldwide. Oral semaglutide (Rybelsus) was introduced to medical practice for Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA). Case presentation: The patient is 24-year-old female with obesity (BMI 39.3 kg/m2), T2D and fatty liver. Results: She started and increased Rybelsus from 3mg, 7mg to 14mg/day each 4 weeks. She showed significant efficacy for 4 months as HbA1c 6.3% to 5.6% and weight 107kg to 103kg, without Gastrointestinal Adverse Events (GIAEs). Discussion: Rybelsus is provided just after waking up, and kept >30 min fasting period. Longer fasting time may contribute current effect

Clearer Image of Computed Tomography by Reconstruction Analysis Method

Computed tomography (CT) has been widely used for long. In recently years, the useful application of CT would be the method of the reconstruction images. Historically speaking, reconstruction images were conducted so far by algebraic reconstruction technique (ART), filtered back projection (FBP), iterative reconstruction (IR) algorithms and so on. There are various effects of reconstruction image of CT in clinical practice. Two cases with such beneficial experiences were reported. Case 1 is 74-year-man with hypertension. He was diagnosed to have abdominal aortic aneurysm (AAA). By reconstruction images, the general shape and details were clearly observed including regulating background data. Case 2 is 48-year-female without history of low back pain. When she received abdominal CT, she was pointed out to have lumbar disc herniation between L4 and L5. The diagnosis was done from the lateral tomography of lumbar vertebrae. By reconstruction images with colored modification, the detail status of herniation was clearly observed. Consequently, reconstruction image method of CT would be useful and effective. Further evolution of CT apparatus and development of computer analysis would be expected for better clinical practice and research in the future

Familial Case of Type 1 Diabetes Mellitus (T1DM) with Similar Onset and HLA Analysis

Subjects: Cases are two patients with type 1 diabetes mellitus (T1DM), with the characteristic relationship and onset situation. Case 1 is 46-year-old daughter and case 2 is 69-year-old mother. They have been living apart and they rarely meet together. Twenty-two months after the onset of T1DM case 1, case 2 also developed T1DM. They did not notice clinical manifestation of upper respiratory infection, or they did not have any stressful matters before the onset of T1DM. Results: Their data in case 1 vs 2 were as follows: BMI 21.3 vs 19.8, HbA1c 10.3% vs 9.8%, anti-IA-2 antibody (IA-2 Ab) 2.1 vs 6.0 (<0.4), anti-GAD antibody (GAD Ab) 24 vs 10000 (<1.5), HLA-DR type DR9 / DR13 vs DR4/DR13. Discussion and conclusion: These 2 cases have characteristic mode for the onset of T1DM. In Japanese race, DR4 and DR9 have rather high sensitivity for T1DM, DR15 (DR2) has resistance for T1DM and DR13 has unremarkable influence. From these, HLA-DR type would be possible involved in the onset of T1DM, and further investigation would be expected

Daily improvement of glucose variability by Continuous Glucose Monitoring (CGM)

Continuous Glucose Monitoring (CGM) has been recently applied in the clinical diabetic practice. Authors have continued research of glucose variability. In this study, 51 year-old female patient with Type 1 diabetes mellitus (T1DM) was investigated. She has given multiple daily insulin injection (MDI) for long and her recent daily glucose profile was unstable. After applied with FreeStyle Libre, her blood variability was improved with the average glucose from 222 mg/dL to 135 mg/dL, which was partly from her motivation for better diabetic control. Thus, CGM may become a trigger to give beneficial influence for regular lifestyle of the patients

Effective Xultophy administration to stable blood glucose profile by Continuous Glucose Monitoring (CGM)

Type 2 diabetes mellitus (T2DM) need adequate diet, exercise and pharmacotherapy. Authors have continued diabetic practice and research on low carbohydrate diet (LCD), calorie restriction (CR), continuous glucose monitoring (CGM), and so on. The case is 50-year-old female patient with T2DM for 10 years. She has received insulin treatment with recent HbA1c 7.4 – 8.7%, then her glucose profile was studied on CGM by FreeStyle Libre. Treatment was changed from Glargine 15 units (until day 5) to Zultophy10-12 doses (after day 6), then her glucose variability showed remarkably improved. The average blood glucose on day 3, 5, 6, 8,10,13 was 174, 164, 125, 111, 101, 98 mg/dL, respectively. FreeStyle Libre showed estimated HbA1c as 6.2% and 44 mmol/mol

Glucose-lowering efficacy of Xultophy with low doses by FreeStyle Libre as continuous glucose monitoring (CGM)

The daily profile of blood glucose can be detected by continuous glucose monitoring (CGM) using FreeStyle Libre. The case was a 51-year-old female with type 2 diabetes mellitus (T2DM) for uncontrolled glucose variability as HbA1c 10.3%. During CGM measurement, diabetic treatment was changed from multiple daily insulin injections (MDI) to Xultophy (insulin degludec and liraglutide). Xultophy starting from 10 to 18 doses has brought the improvement of glucose variability, such as decreased pre-prandial glucose from 268 mg/dL to 101 mg/dL. Consequently, detailed data of glucose variability on Xultophy using CGM would be beneficial and become some reference for further clinical diabetic research

Carnitine for Body Composition in Hemodialysis Patients

Background: Authors and colleagues have continued clinical research for hemodialysis patients. Currently, a pilot study presents intervention of carnitine for changes of the body composition. Subjects and Methods: Subjects were six patients on hemodialysis with intervention of carnitine (group 1). Average data were 74.3 years, 65.4 kg, 22.6 in BMI. As levocarnitine, L-Cartin FF injection 1000 mg was administered three times a week for six months. Group 2 has six control patients for age-, sex-, body weight, BMI-matched (group 2). Body composition of muscle and fat tissues were measured by InBody 770 on 0 and 6 months. Results: In group 1, muscle volume and skeletal muscle showed increasing tendency without statistical significance. In contrast, there were significant decreases of body fat volume (22.3 kg vs 20.5 kg, 39.0% vs 35.8%) (p<0.05). No significant differences were found in hemoglobin, total protein, albumin and Cardio-Thoracic Ratio (CTR) of chest X-ray. Group 2 showed no significant changes. Discussion and Conclusion: Hemodialysis patients often have muscular reduction. Previous reports showed improved lean body mass by carnitine administration, which may support our result. These results from current pilot study would be expected to become useful reference data in the pathophysiological investigation in patients on hemodialysis

Variability Of Glucose And Lifestyle In Continuous Glucose Monitoring (CGM)

Background: Investigation of glucose variability is crucial for patient with Type 1 Diabetes mellitus (T1DM) on insulin treatment. For Continuous Glucose Monitoring (CGM), FreeStyle Libre (Abbott) has been introduced to clinical practice with useful and beneficial efficacy. Case and Results: The patient was 55 year-old T1DM female with body mass index (BMI) 21 kg/m2, HbA1c 8.0 %. She was on CGM for 14 days, with obtained glucose data in every 15 minutes. Treatment included multiple daily insulin injection (MDI) of Insulin Aspart 3 times and Insulin Glargin once a day. She showed unstable blood glucose variability with hyperglycemia and hypoglycemia, besides 2 hours delay shift in daily lifestyle rhythm. There was a discrepancy of HbA1c between actual value 8.0% and presumed value 6.9% by FreeStyle Libre. Discussion and Conclusion: Obtained glucose data from FreeStyle Libre have been satisfactory. One reason for lower HbA1c value would be from the characteristic tendency in lower glucose region. Larger distribution of glucose variability would be due to delayed shift of lifestyle, sleep situation and irregular meal. These results would become the basal data for CGM, the reference to better modification of MDI and clinical diabetic practice in future research

Association between Mammographic Breast Density and Lifestyle in Japanese Women

A high mammographic breast density is considered to be a risk factor for breast cancer. However, only a small number of studies on the association between breast density and lifestyle have been performed. A cross-sectional study was performed using a survey with 29 questions on life history and lifestyle. The breast density on mammography was classified into 4 categories following the BI-RADS criteria. The subjects were 522 women with no medical history of breast cancer. The mean age was 53.3 years old. On multivariate analysis, only BMI was a significant factor determining breast density in premenopausal women (parameter estimate, －0.403;p value, 0.0005), and the density decreased as BMI rose. In postmenopausal women, BMI (parameter estimate, －0.196;p value, 0.0143) and number of deliveries (parameter estimate, －0.388;p value, 0.0186) were significant factors determining breast density;breast density decreased as BMI and number of deliveries increased. Only BMI and number of deliveries were identified as factors significantly influencing breast density. BMI was inversely correlated with breast density before and after menopause, whereas the influence of number of deliveries on breast density was significant only in postmenopausal women in their 50 and 60s

Daily improvement of blood glucose profile by continuous glucose monitoring (CGM)

Background: The problem of glucose variability has been in focus for type 1 diabetes mellitus (T1DM) on insulin treatment. Daily profile of blood glucose was studied on Continuous Glucose Monitoring (CGM) using Free Style Libre. Case presentation and results: Patient is 54 year-old T1DM female, with HbA1c 7.8%. The blood glucose variability was measured by Free Style Libre. Insulin therapy included multiple daily insulin injection (MDI) of Insulin Glargin and Aspart. The result revealed unstable blood glucose profile in day 1 and 2. After that, the level and fluctuation of blood glucose gradually decreased from day 3 to 14. Average blood glucose in a day was 174mg/dL, 159mg/dL, 138mg/dL, 125mg/dL and 110mg/dL, in day 2, 4, 7, 9, 11, respectively. There was a discrepancy of HbA1c between 7.8% by laboratory measurement and 6.3% presumed value by Free Style Libre. Discussion and Conclusion: Free Style Libre showed satisfactory results as CGM. There was lower HbA1c value by presumed calculation, which would be possibly due to every 15minutes measurement and difficulty in checking abrupt glucose surges. CGM application would probably bring diabetic subjects behavioral change of life style, leading to better diabetic control. These results would become reference data in CGM study for future research