OBJECTIVE -To investigate the association between carotid atherosclerosis, measured as intima-media thickness (IMT), and cardiovascular morbidity in type 2 diabetic patients. RESEARCH DESIGN AND METHODS -We investigated the relationship betweenIMT and coronary artery disease (CAD) in 40 type 2 diabetic patients and 40 control subjects. Diabetic patients with CAD determined by coronary angiography were consecutively recruited, whereas the control subjects were recruited from among diabetic outpatients without CAD at the same institution. IMT was measured in both carotid arteries using B-mode ultrasonography.RESULTS -Carotid IMT was significantly greater in the diabetic patients than in the control subjects (1.27 Ϯ 0.07 vs. 1.03 Ϯ 0.04 mm, P Ͻ 0.05). IMT was associated with CAD by logistic regression analysis using all independent variables (P ϭ 0.062). When the 40 patients with CAD were divided into a group of 20 patients with coronary artery bypass grafting (CABG) and another 20 patients without CABG, the IMT was significantly greater in the CABG group than in the non-CABG group (1.47 Ϯ 0.11 vs. 1.07 Ϯ 0.07 mm, P Ͻ 0.05).CONCLUSIONS -These results indicate that the presence of carotid atherosclerosis implies a high probability of coronary involvement in Japanese nonobese subjects with type 2 diabetes.

The occurrence of cavernous hemangiomas in the vagina is very rare. A 34-year-old woman at 33 weeks' gestation was admitted with a large reddish mass of approximately 5 cm in diameter in the vagina, with bleeding and a sensation of discomfort with walking. The vaginal mass was excised to confirm the pathological diagnosis. Histopathological analysis showed various dilated vessels lined by increased endothelial cells, and the final diagnosis was vaginal cavernous hemangioma. The immunohistochemical analysis showed positive expressions of vascular endothelial growth factor (VEGF), estrogen receptor (ER), and progesterone receptor (PgR) in perivascular stromal cells around the hemangioma. Additionally, the authors reviewed the relationship between genital hemangiomas and pregnancy from the literature. In the female genital tract, six (75%) of eight vaginal hemangiomas were associated with pregnancy, in particular, late pregnancy, in addition to the present case, and eight (32%) of 25 cervical hemangiomas were seen in late pregnancy. Taken together, the hormonal status in late pregnancy may affect the formation of vaginal hemangiomas.

ContextAccurate glucagon level measurements are necessary for investigation of mechanisms for postprandial hyperglycemia in type 2 diabetes.ObjectiveTo evaluate the accuracy of postprandial glucagon level measurements using a sandwich ELISA vs a recently established liquid chromatography-high resolution mass spectrometry (LC-HRMS) method in type 2 diabetes mellitus.Design and ParticipantsTwenty patients with type 2 diabetes treated with insulin underwent a meal test before and after administration of the dipeptidyl peptidase-4 inhibitor anagliptin for 4 weeks. Blood samples were taken serially after the meal, and glucagon levels were measured using both ELISA and LC-HRMS. We compared the change from baseline to 4 weeks (Δ0–4W) using the area under the curve for plasma glucagon during the meal test [area under the curve (AUC)0–3h] measured using ELISA and LC-HRMS.ResultsELISA-based glucagon AUC0–3h was higher than LC-HRMS–based AUC0–3h at baseline and 4 weeks. However, differences in Δ0–4W-AUC0–3h measured using ELISA and LC-HRMS were not statistically significant. Additionally, Δ0–4W-AUC0–3h measured using ELISA and LC-HRMS were strongly correlated (r = 0.87, P < 0.001).ConclusionsPlasma glucagon levels during a meal test in patients with type 2 diabetes measured using ELISA were consistently higher than those measured using LC-HRMS. However, given that the changes in glucagon levels measured using ELISA before and after dipeptidyl peptidase-4 inhibitor therapy were similar to those based on LC-HRMS, this ELISA seems to be useful for evaluating the effect of the drug interventions on postprandial glucagon levels.

Abstract. An open-label prospective cross-over trial was performed to evaluate the antioxidative effect of fluvastatin in Japanese type 2 diabetics with hyperlipidemia. The study subjects were 10 patients who were on pravastatin (10 mg/day) or simvastatin (5 mg/day). After at least 12 weeks of continuous pravastatin or simvastatin therapy, the drugs were washed out for 12 weeks and replaced with fluvastatin (30 mg/day), then the treatment was continued for another 12 weeks. Total cholesterol and LDL cholesterol were efficiently and comparably reduced by all three statin agents. There were no differences in serum parameters of oxidative stress such as malondialdehyde-modified low-density lipoprotein, thiobarbituric acid-reactive substances, and 8-iso-prostaglandin F2a between pravastatin/simvastatin and fluvastatin. However, fluvastatin, but not pravastatin/simvastatin, significantly reduced 3,5,7-cholestatriene in erythrocyte membrane, representing the extent of membrane cholesterol peroxidation. Our data demonstrated that fluvastatin has a unique anti-oxidative effect in patients with type 2 diabetes and hyperlipidemia, compared with other statins.

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