The efficacy of switching basal-bolus insulin therapy to basal insulin-supported oral therapy with a glinide and an α-glucosidase inhibitor in patients with type 2 diabetes depends on insulin secretory capacity, but not on blood glucose profiles and insulin dosages prior to the switching.

Aims: We aimed to identify patients who would benefit from basal insulin-supported oral therapy (BOT) with a glinide and an α-glucosidase inhibitor (a fixed-dose combination tablet of mitiglinide 10 mg and voglibose 0.2 mg) in Japanese type 2 diabetic patients. Methods: Patients who were hospitalized to improve hyperglycemia received basal-bolus insulin therapy. After the reduction of glucose toxicity, a 75 g oral glucose tolerance test and a glucagon test were performed. Thereafter, the basal-bolus insulin therapy was switched to BOT with mitiglinide, followed by further addition of voglibose. Interstitial glucose levels were continuously monitored throughout the study period. Diurnal glucose profile was recorded and analyzed. Patients were divided into two groups according to whether their percentage of time in range (TIR, 70-180 mg/dL) under BOT with mitiglinide/voglibose was higher than 70% or not, and the differences in clinical characteristics between the groups were analyzed. Results: Twenty patients were enrolled, and 19 of them completed the study. BOT with mitiglinide/voglibose achieved ≥ 70% of TIR in thirteen patients. The area under the curve of serum C-peptide levels during the oral glucose tolerance test was significantly higher in the patients with ≥ 70% of TIR. The daily insulin dosages and blood glucose profiles were comparable between the two groups. Conclusions: The efficacy of BOT with mitiglinide/voglibose depended on residual insulin secretory abilities. This therapy would be a useful therapeutic option for patients with type 2 diabetes.

Validity and reliability of a point-of-care nerve conduction device in diabetes patients.

AIMS/INTRODUCTION: Although nerve conduction study (NCS) using a standard electromyography system (EMGS) is considered to be the gold standard in evaluating diabetic polyneuropathy, this examination requires expensive equipment and well-trained technicians. We aimed to validate a point-of-care device, NC-stat/DPNCheck™, that has been developed for widespread use of NCS in diabetic polyneuropathy. MATERIALS AND METHODS: Diabetes patients underwent two kinds of NCS: DPNCheck™ and electromyography system. Inter-/intrarater reliability of DPNCheck™ were also determined by the intraclass correlation coefficient. RESULTS: A total of 57 patients were evaluated. The parameters of NCS between the two methods correlated well (r = 0.7734 for the sural nerve conduction velocity, r = 0.6155 for the amplitude of sural nerve action potential). The intraclass correlation coefficients were excellent (intrarater: the velocity 0.767, the amplitude 0.811; interrater: the velocity 0.974, the amplitude 0.834). CONCLUSIONS: The point-of-care device has excellent reproducibility and good agreement with standard electromyography system. The device might be useful to evaluate diabetic polyneuropathy.

Case of ketoacidosis by a sodium-glucose cotransporter 2 inhibitor in a diabetic patient with a low-carbohydrate diet.

We present a case of a 32-year-old diabetic woman with Prader-Willi syndrome who developed severe ketoacidosis caused by a sodium-glucose cotransporter 2 (SGLT2) inhibitor, a novel class of antihyperglycemic agents, during a strict low-carbohydrate diet. At admission, a serum glucose level of 191 mg/dL was relatively low, though laboratory evaluations showed severe ketoacidosis. This is the first report of ketoacidosis caused by a SGLT2 inhibitor. It is necessary to not only pay attention when using a SGLT2 inhibitor in patients following a low-carbohydrate diet, but also to start a low-carbohydrate diet in patients treated with a SGLT2 inhibitor because of a high risk for developing ketoacidosis.

Choroidal and optic disc metastases from breast cancer and their response to combination pharmacotherapy with tamoxifen, cyclophosphamide hydrate, letrozole, and bevacizumab.

PURPOSE: The purpose of this study was to report a patient with choroidal and optic disc metastases from breast cancer and the response to combination pharmacotherapy with tamoxifen, cyclophosphamide hydrate, letrozole, and bevacizumab. METHODS: We report a case of a 51-year-old woman with a medical history of breast cancer treated with mastectomy at 16 years earlier followed by 5'-deoxy-5-fluorouridine and tamoxifen for 12 years, who has been followed by annual check-up, with no additional findings. Two weeks prior to her first visit to our hospital, she noted blurred and abnormal color vision and field loss in her right eye. Her right eye showed choroidal metastasis from breast cancer, with retinal detachment involving the macula and inferior periphery. RESULTS: Multiple metastases involving bones, lymph nodes in the mediastinum, ovaries, and pelvic nodes were diagnosed after ocular metastases were established. Combination therapy with tamoxifen, cyclophosphamide hydrate, letrozole, and bevacizumab was administered to the patient. The retinal detachment and optic disc metastasis improved dramatically. CONCLUSIONS: The patient underwent combination pharmacotherapy with tamoxifen, cyclophosphamide hydrate, letrozole, and bevacizumab, which was effective in the treatment of ocular metastases from breast cancer.