Notes

Improvement and also approval of a wallet manual to prevent suffering from diabetes base sores.
The control of postprandial plasma glucose (PPG) excursions is critical in the prevention of diabetic complications. Controversy remains on the differences in postprandial actions of insulin glulisine and lispro. The aim of this study was to define the differences in the efficacy of these two insulin analogues on PPG.

The study subjects were 20 in-hospital patients with type 2 diabetes mellitus (T2DM). Plasma glucose (PG) was tightly controlled with basal insulin and insulin glulisine or lispro, and then glulisine or lispro were switched to the other insulin analog every other day for 6 study days. PG was measured before breakfast and 0.5-, 1-, and 2h-postprandial during the study. Postprandial plasma C-peptide and lipids were analyzed in the first 2days of the study. Postprandial increments in each parameter were compared between glulisine and lispro.

Whereas the median value of 0.5h-Δ-PPG was comparable in glulisine and lispro, the 1h-Δ-PPG was significantly lower with lispro than with glulisine (41 vs 53mg/dl, respectively,
 = 0.03). Similarly, the 2h-Δ-PPG with lispro was 10mg/dl lower than that with glulisine (35 vs 45mg/dl, respectively,
 = 0.05). In parallel with PPG, Δ-C-peptide at 1- and 2h-postprandial were significantly lower with lispro than glulisine (0.50 vs 0.75ng/ml, respectively, and 0.55 vs 0.75ng/ml, respectively). The increment in LDL-C and HDL-C was significantly lower with lispro than with glulisine at 0.5h-postprandial.

Insulin lispro seems superior to glulisine in the control of PPG in Japanese patients with T2DM.
Insulin lispro seems superior to glulisine in the control of PPG in Japanese patients with T2DM.Sensor-augmented insulin pump therapy with a predictive low glucose suspend (SAP-PLGS) feature is a remarkably progressed modality for the glycemic management of patients with type 1 diabetes. This technology avoids nocturnal hypoglycemia and severe hypoglycemia. A Brazilian woman developed type 1 diabetes at age 11 and was treated with multiple daily insulin injections. At age 20, she was admitted to our internal medicine department for her first pregnancy. Her HbA1c was 7.9% in the 6 weeks of gestation. Although the combination of continuous subcutaneous insulin infusion and a sensor-augmented pump was introduced, she had a miscarriage in the next week. After 6 months, she became pregnant again. Despite an HbA1c of 7.2%, she had another miscarriage. Thereafter, she returned to multiple daily insulin injections and began using intermittently scanned continuous glycemic monitoring. At age 22, she had her third pregnancy. Her HbA1c was 7.3%. SAP-PLGS was then introduced, which reduced her frequent hypoglycemic events and blood glucose fluctuations. She gave birth to a 4137 g boy at 39 weeks without significant complications. Successful delivery can be obtained in women with type 1 diabetes following repeated miscarriages after introducing SAP-PLGS. We hypothesize that the modality might contributed to our patient's miscarriage avoidance by reducing her glycemic fluctuations.
The J-SMART study was the first national survey of Japanese patients undergoing laparoscopic sleeve gastrectomy (LSG). We performed a subgroup analysis of J-SMART focusing on the differences in patient background and diabetes remission between patients with BMI 32-34.9kg/m
and those with higher BMI.

In this multi-institutional retrospective study at 10 certified bariatric institutions, 203 Japanese with type 2 diabetes (T2D) and BMI of 32kg/m
or higher were analyzed (mean age 49.2years, BMI 43.8kg/m
, HbA1c 7.6%). Patients were stratified into five groups according to preoperative BMI.

Background characteristics in BMI 32.0-34.9 group were higher adjusted HbA1c, higher visceral/subcutaneous fat area ratio, higher prevalence of diabetic retinopathy, higher frequency of insulin use and lower serum C-peptide. Although 2-year percent total weight loss (21.7%) and diabetes complete remission (CR) rate (52.4%) were lower in BMI 32.0-34.9 group, diabetes improvement rate was 81.0%, and the decrease in HbA1c and number of antidiabetic drugs were comparable or greater than those with higher BMI. Higher BMI and no insulin use were significant independent predictors of diabetes CR. No significant independent predictor was identified for diabetes improvement.

The patients with 32-34.9kg/m
were characterized by more severe visceral obesity, T2D and the complications, and lower intrinsic insulin secretion capacity. LSG should be considered as a treatment option for patients with BMI 32-34.9kg/m
, to improve diabetes control.
The patients with 32-34.9 kg/m2 were characterized by more severe visceral obesity, T2D and the complications, and lower intrinsic insulin secretion capacity. LSG should be considered as a treatment option for patients with BMI 32-34.9 kg/m2, to improve diabetes control.
We investigated the impact of actual waiting time and perceived waiting time on treatment satisfaction in patients with diabetes receiving outpatient care.

Three hundred and thirty-six outpatients diagnosed with diabetes mellitus or impaired glucose tolerance were selected and the time they spent in reception, blood collection, consultation, and accounting were recorded to measure the time they spent waiting in the hospital (actual waiting time). Simultaneously, we conducted a questionnaire survey that included questions on their perceptions of the waiting time (perceived waiting time) and satisfaction with treatment (DTSQ).

No significant relationship was found between actual waiting time and DTSQ score, although associations were observed with perceived waiting time. The patients who felt the overall waiting time was long scored 23.0, those who felt it was short scored 26.0, and those who felt it was very short scored 34.0, with those who felt the waiting time was long having a significantly lower score (
 = 0.004,
 < 0.001, respectively) and those who felt it was short having a significantly lower score than those who felt it was very short (
 = 0.008). In addition, more patients who felt the waiting time was long expressed dissatisfaction with the responses of doctors and staff than those who felt the waiting time was short.

These results suggest that in addition to reducing actual waiting times, shortening perceived waiting times by improving the responses of medical staff could help to increase patient satisfaction.
These results suggest that in addition to reducing actual waiting times, shortening perceived waiting times by improving the responses of medical staff could help to increase patient satisfaction.Previous studies have shown that dipeptidyl peptidase (DPP)-4, is released from adipocytes in a differentiation-dependent manner and a marker for insulin resistance in obese individuals who have particularly high circulating DPP-4/soluble CD26 (sCD26) concentrations. In this study, we have evaluated the effects of short-term hospitalization with calorie restriction on body composition and circulating DPP-4/sCD26 concentrations in patients with type 2 diabetes. A total of 47 Japanese adults with type 2 diabetes were recruited to the study (age; 56.6 ± 13.0 years, body mass index (BMI); 27.3 ± 5.6 kg/m2). Body composition, circulating DPP-4/sCD26 concentrations and metabolic parameters were assessed upon admission and at discharge from hospital (average of the period 13.0 ± 2.5 days). Visceral fat area (VFA) was also assessed by dual impedance method. During hospitalization, there was a significant reduction in body weight, BMI, lean body mass, VFA and circulating DPP-4/sCD26 concentrations, but not in body fat mass. Fasting circulating DPP-4/sCD26 concentrations were significantly correlated with fasting insulin, aspartate aminotransferase, γ-glutamyltransferase (γ-GTP) levels, and HOMA-IR (r = 0.477, 0.423, 0.415, 0.548, respectively), but not with VFA (r = - 0.056) by liner regression analyses at base line. It was also observed a positive correlation between changes in circulating DPP-4/sCD26 concentrations and γ-GTP level, HOMA-IR, and a negative correlation between the changes in circulating DPP-4/sCD26 concentrations and VFA significantly (r = 0.300, 0.633, - 0.343, respectively). In conclusion, our observations suggest that liver enzymes as well as VFA might be associated with the response of DPP-4/sCD26 concentrations.
Gestational diabetes mellitus (GDM) has high prevalence worldwide. This study aimed to evaluate the fasting plasma glucose (FPG) cutoffs at first prenatal visit and at 24-28th of gestational weeks to avoid obtaining full oral glucose-tolerance test (OGTT) in the diagnosis of GDM.

This study was a cross-sectional study conducted in Tehran, Iran during October 2016 and November 2017. All pregnant women reporting for the first routine prenatal visit before 20th week of gestational age were included in this study. Participants without overt diabetes mellitus at first prenatal visit, underwent OGTT at 24-28th of gestational weeks.

Totally 952 pregnant women with mean age of 26.4 ± 14.1years took part in this study. The prevalence of GDM was 12.7% (mostly diagnosed based on the FPG alone). FPG cutoffs 75 and 80mg/dL at first prenatal visit and at 24-28th of gestational weeks can rule out the GDM with high sensitivity and negative predictive value, respectively. Lusutrombopag FPG cutoffs 85 and 90mg/dL at first prenatal visit and at 24-28th of gestational weeks had high capacity, excellent specificity and positive predictive value in diagnosing GDM, respectively.

Performing only the FPG and considering FPG cutoffs 75 and 80mg/dL at first prenatal visit and at 24-28th of gestational weeks can be a useful tool predicting the incidence of GDM, respectively, and had similar diagnostic power.
Performing only the FPG and considering FPG cutoffs 75 and 80 mg/dL at first prenatal visit and at 24-28th of gestational weeks can be a useful tool predicting the incidence of GDM, respectively, and had similar diagnostic power.
This study was aimed at retrospectively investigating some common clinical factors, including the serum level of magnesium (Mg), associated with progression and remission/regression of diabetic kidney disease (DKD).

The subjects were 690 Japanese patients with type 2 diabetes mellitus who were receiving treatment with oral antidiabetic drugs other than SGLT2 inhibitors. Routine clinical data were collected on the first and last day of the observation period. The prognosis of DKD is categorized into four stages according to the Kidney Disease Improving Global Outcomes classification. Progression was defined as transition from any of the lower three risk categories (LR, MIR, HR) at the start of the observation period, to the VHR stage/category at the end of the observation period. Remission/regression was defined as improvement of the risk category by at least one stage from the start to the end of the observation period. Factors associated with progression and regression/remission were investigated using Cia and hypertriglycemia.

Our findings confirmed previous reports that advancing age and serum HbA1c levels were associated with an increased risk of progression of DKD. Lower serum Mg concentrations were also found to be associated with a high risk of progression of DKD, and interventional studies are needed to confirm a causal relationship. Elevated HbA1c levels and hypomagnesemia were common factors in the decline in eGFR and the appearance of trace or overt proteinuria. Lower serum ALT levels were associated with the decline in eGFR. Since serum ALT is known to decrease as the renal function deteriorates, serum ALT is considered to be a marker of renal function.

The online version contains supplementary material available at 10.1007/s13340-020-00483-1.
The online version contains supplementary material available at 10.1007/s13340-020-00483-1.
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