To determine risk factors for progression of diabetic retinopathy, a study was conducted in 92 patients with diabetes whose HbA1c levels were more than 9.5% when they were admitted to our hospital.
The progression of retinopathy was observed in 50% of the patients during 12 months after admission. Their cases were diagnosed as preproliferative retinopathy. The duration of no-treatment, serum cholesterol level, blood pressure and proteinuria were significantly greater in the deterioration group of retinopathy than in the no-deterioration group. Nerve conduction velocity was significantly lower in the deterioration group of retinopathy than in the no-deterioration group. The reduction of HbA1c level during the period of 3 months after admission was significantly higher in the deterioration group than in the improved group. In the patients whose initial levels of HbA1c were less than 10%, the deterioration of retinopathy was not observed. In conclusion, these findings suggest that the duration of no-treatment, serum cholesterol level, blood pressure, proteinuria, nerve conduction velocity, retinopathy severity, the HbA1c level at admission and the reduction of HbA1c level during the 3-month period are risk factors for the progression of retinopathy.

A 62-year-old woman was adimitted to our hospital because of thirst and a body weight loss of 9kg. She had a history of vasospastic breast pang 5months before. The level of fasting plasma glucose was 320 mg/dl and the level of HbA_1c was 13.0%. The autoantibody to glutamic acid decarboxylase was positive. The level of urine C-peptide was 28.6μg/day. She rejected insulin injections and was treated with glibenclamide. The level of urine C-peptide increased to 70.0μg/day. The disease was controlled with the levels of 6.0% of HbA_1c. But her condition became uncontrollable gradually after 6 months and she was treated by insulin therapy.
Insulin secretion in type 1 diabetes mellitus was transiently improved by sulfony 1 urea. This suggests that not only the insulin secretion but also glucotoxicity plays an important role in early stage of type 1 diabetes mellitus.

The self-monitoring of blood glucose is a recommendable method for control of diabetes mellitus. But few reports of the prospective insulin sliding scale for outpatients were available in Japan. To elucidate the efficacy of the prospective insulin sliding scale for outpatients with diabetes mellitus, 14 insulin-treated patients who usedwith the prospective insulin sliding scale (scale group) and 14 insulin-treated patients who did not use with the prospective insulin sliding scale (control group) were studied over a period of 6 months.
The control group showed no significant change of Hb Aic level. But the scale group showed a significant reduction in Hb Aic level at 5 months (8.37 ± 1.14% to 7.50 ±1.42%, p<0.008). The scale group had an almost two fold increase in the frequency in hypoglycemia. However, there was no severe hypoglycamia. There were weight gains in the control group and scale group, but there was no difference between control group and scale group.
These data suggest that the prospective insulin sliding scale is useful for the better control of diabetes mellitus.

Recent technical approaches to investigating drug hypersensitivity have provided a great deal of information to solve the mechanisms that remain poorly understood. First, immunological investigations and in silico analysis have revealed that a novel interaction between T cells and antigen-presenting cells, namely the pharmacological interaction concept, is involved in drug recognition and the hapten theory. Second, progress in immunology has provided a new concept of CD4+ T cell subsets. Th17 cells have proven to be a critical player in acute generalized exanthematous pustulosis. Our recent findings suggest that this subset might contribute to the pathogenesis of Stevens-Johnson syndrome/toxic epidermal necrolysis. Third, alarmins, molecules associated with innate immunity, are also associated with exaggeration and the persistence of severe drug hypersensitivity. The latest innovative techniques are providing a new landscape to examine drug hypersensitivity.
Acute Generalized Exanthematous Pustulosis ; Alarmins ; Allergy and Immunology ; Antigen-Presenting Cells ; Computer Simulation ; Drug Hypersensitivity ; Hypersensitivity ; Immunity, Innate ; Receptors, Antigen, T-Cell ; T-Lymphocyte Subsets ; T-Lymphocytes ; Th17 Cells