1)新潟大学第1内科における糖尿病外来の現状（シンポジウム　糖尿病合併症の治療, 第535回新潟医学会）

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論文(リポジトリ)

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中川, 理 ; 大山, 泰郎 ; 鈴木, 克典 ; 羽入, 修 ; 小林, 茂 ; 金子, 晋 ; 金子, 奈々子 ; 平山, 哲 ; 上村, 宗 ; 山田, 聡子 ; 谷, 長行 ; 小田野, 行雄 ; 相澤, 義房

出版情報:

新潟医学会, 1998-10

掲載情報:

新潟医学会雑誌 — 新潟医学会雑誌

ISSN:

00290440      

著者名:

中川, 理

大山, 泰郎

鈴木, 克典

羽入, 修

小林, 茂

金子, 晋

金子, 奈々子

平山, 哲

上村, 宗

山田, 聡子

谷, 長行

小田野, 行雄

相澤, 義房

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巻:

112

通号:

10

開始ページ:

589

終了ページ:

601

概要:

At the symposium on treatment of diabetic complications 1998 we reported ; I. The present state of diabetic patients, II. Diabetic retinopathy from the physicians' viewpoint, III. Macroangiopathy and IV. Clinical experiences of the new … diabetic therapies. I. We examined approximately 435 patients in our diabetic clinic between November and the middle of December 1997. There were no significant differences in age, BMI, mean blood pressure, glycemic control, or lipids between men and women. With respect to treatment, 23.6 % of the patients were treated by dietetic therapy alone, 37.8 % were administered with SU drug and, in addition, about 50 % were treated by oral antihyperglycemic agents including a glucosidase inhibitor (αGI) and troglitazone. Insulin was administrated to 26.2 % of the patients (conventional therapy, 69.2 %, multiple injection, 20.6 %, continuous infusion, 9.9 %). II. Twenty-three patients (8 males, 15 females) with NIDDM in whom the onset of simple retinopathy could be specified, were divided into 2 groups ; Group S, with simple retinopathy without progression and Group P, with progression to preproliferative or proliferative retinopathy. The following items were retrospectively compared：1. duration of simple retinopathy (prior to study), 2. HbA1c, 3. blood pressure (systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean blood pressure (MBP)), and 4. serum total cholesterol (TC). The results showed significant differences in the period of suffering from simple retinopathy (p<0.005), HbA1c (p<0.05) and TC (p<0.005) between the two groups. The assosiation of the retinopathy with the short period would mean that HbA1c and TC were poorly controlled in these patients.<br />III. We paid attention to 1) silent myocardial ischemia in diabetic patients and 2) significance of cerebral blood flow scintigraphy in diabetic patients. Concerning the results, 1) there was no significant difference regarding the presence or absence of angina pain or incidence of abnormal findings of scintigraphy or coronary angiography. It Was difficult to predict the presence of silent myocardial ischemia from the presence or absence of diabetic neuropathy. 2) Cerebral blood flow scintigraphy was performed in 37 diabetic patients, 25 patients were allocated to a group having uneven distribution of RI which never detected normally and an ununiform drop of peripheral blood flow (Micro group) and 12 cases without these findings to another group (Non-micro group). In the Microgroup, HbA1c was significantly higher and the incidence of diabetic nephropathy was also higher. IV. 1) αGI was used to improve postprandial hyperglycemia in 33 patients with NIDDM for 16.1 months on average and HbA1c was improved from 7.96 ± 1.16 % to 7.28 ± 0.91 % after αGl. It was more effective when being used concomitantly with a SU agent although the effect tended to decrease relatively in the cases of long term use. 2) Troglitazone was used as an agent for improving insulin resistance in 29 diabetic patients with NIDDM. In 2.9 months on the average HbA1 c was improved from 8.99 ± 1.05 % to 8.34 ± 0.87 % after the drug. Improvement was observed in 90 % of the patients which showed BMI of 24.2 or above and, thus, it was demonstrated that the drug is more effective if BMI and fasting IRI are high. 続きを見る

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