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Tsujimoto T.,National Center for Global Health and Medicine | Tsujimoto T.,Jichi Medical University | Yamamoto-Honda R.,National Center for Global Health and Medicine | Yamamoto-Honda R.,Diabetes Research Center | And 9 more authors.
Diabetes Care | Year: 2014

Objective To assess vital signs, QT intervals, and newly diagnosed cardiovascular disease during severe hypoglycemia in diabetic patients. Research Design And Methods From January 2006 to March 2012, we conducted a retrospective cohort study to assess type 1 and type 2 diabetic patients with severe hypoglycemia at a national center in Japan. Severe hypoglycemia was defined as the presence of any hypoglycemic symptoms that could not be resolved by the patients themselves in prehospital settings. Results A total of 59,602 cases that visited the emergency room by ambulance were screened, and 414 cases of severe hypoglycemia were analyzed. The median (interquartile range) blood glucose levels were not significantly different between the type 1 diabetes mellitus (T1DM) (n = 88) and type 2 diabetes mellitus (T2DM) (n = 326) groups (32 [24-42] vs. 31 [24-39] mg/dL, P = 0.59). During severe hypoglycemia, the incidences of severe hypertension (‡180/120 mmHg), hypokalemia (3.5mEq/L), and QT prolongationwere 19.8 and 38.8% (P = 0.001), 42.4 and 36.3% (P = 0.30), and 50.0 and 59.9% (P = 0.29) in the T1DM and T2DM groups, respectively. Newly diagnosed cardiovascular disease during severe hypoglycemia and death were only observed in the T2DM group (1.5 and 1.8%, respectively). Blood glucose levels between the deceased and surviving patients in the T2DM group were significantly different (18 [14-33] vs. 31 [24-39] mg/dL, P = 0.02). Conclusions T1DM and T2DM patients with severe hypoglycemia experienced many critical problems that could lead to cardiovascular disease, fatal arrhythmia, and death. © 2014 by the American Diabetes Association. Source


Kishimoto M.,Center Hospital | Kishimoto M.,National Health Research Institute | Noda M.,National Health Research Institute
Journal of Multidisciplinary Healthcare | Year: 2014

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. © 2014 Kishimoto and Noda. Source


Kishimoto M.,Center Hospital | Kishimoto M.,National Health Research Institute | Noda M.,National Health Research Institute
Diabetology International | Year: 2014

The number of diabetic patients undergoing hemodialysis in Japan is increasing. These patients are likely to have other diabetic complications and a high risk of cardiovascular disease. Therefore, accurate, yet cautious, diabetes management is required. Challenges in glycemic control exist because of the dialysis process itself in addition to altered glucose metabolism, a propensity for hypoglycemia, and the limited use of antidiabetic medication. To assess glycemic control, glycemic markers, such as a single blood glucose measurement or glycated albumin, are useful. Fluctuations in glucose levels during and after hemodialysis and between dialysis days and non-dialysis days also present challenges in maintaining appropriate glycemic control. To attenuate these fluctuations, modification in the use of antidiabetic agents is necessary. Finally, we present representative cases to indicate that continuous glucose monitoring appears to be clinically useful for assessing glycemic control in these patients. © 2014 The Japan Diabetes Society. Source


Kishimoto M.,Center Hospital | Kishimoto M.,Diabetes and Metabolism Information Center
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy | Year: 2013

Dipeptidyl peptidase-4 (DPP-4) inhibitors have recently emerged as a new class of antidiabetic that show favorable results in improving glycemic control with a minimal risk of hypoglycemia and weight gain. Teneligliptin, a novel DPP-4 inhibitor, exhibits a unique structure characterized by five consecutive rings, which produce a potent and long-lasting effect. Teneligliptin is currently used in cases showing insufficient improvement in glycemic control even after diet control and exercise or a combination of diet control, exercise, and sulfonylurea- or thiazolidine-class drugs. In adults, teneligliptin is orally administered at a dosage of 20 mg once daily, which can be increased up to 40 mg per day. Because the metabolites of this drug are eliminated via renal and hepatic excretion, no dose adjustment is necessary in patients with renal impairment. The safety profile of teneligliptin is similar to those of other available DPP-4 inhibitors. However, caution needs to be exercised when administering teneligliptin to patients who are prone to QT prolongation. One study has reported that the postprandial blood glucose-lowering effects of teneligliptin administered prior to breakfast were sustained throughout the day, and the effects observed after dinner were similar to those observed after breakfast or lunch. Thus, although clinical data for this new drug are limited, this drug shows promise in stabilizing glycemic fluctuations throughout the day and consequently suppressing the progression of diabetic complications. However, continued evaluation in long-term studies and clinical trials is required to evaluate the efficacy and safety of the drug as well as to identify additional indications for its clinical use. © 2013 Kishimoto, publisher and licensee Dove Medical Press Ltd. Source


Serdaroglu G.,Ege University | Aydinok Y.,Ege University | Yilmaz S.,Ege University | Manco L.,Center Hospital | Ozer E.,Dokuz Eylul University
Pediatric Neurology | Year: 2011

Triosephosphate isomerase deficiency constitutes a rare autosomal recessive disorder, characterized by hemolytic anemia, neurodegeneration, and recurrent bacterial infections. It is the most severe glycolytic enzyme defect associated with progressive neurologic dysfunction. Patients with various inherited triosephosphate isomerase deficiency gene mutations were identified. The most frequent is a Glu104Asp mutation, manifested in homozygous and compound heterozygous states. The mutation Val231Met is very rare. We describe a second triosephosphate isomerase-deficient patient homozygous for the Val231Met mutation, with different phenotypic characteristics from the previous case. © 2011 Elsevier Inc. All rights reserved. Source

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