A Case of Obese Non-insulin-dependent Diabetes Mellitus with Macroangiopathy Associated with Positive Islet Autoantibodies for 5 years

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  • Takeshima Ken
    Department of Endocrinology and Rheumatology, Kurashiki Central Hospital
  • Murakami Norihiko
    Department of Endocrinology and Rheumatology, Kurashiki Central Hospital
  • Hamamatsu Keita
    Department of Endocrinology and Rheumatology, Kurashiki Central Hospital
  • Notsu Masakazu
    Department of Endocrinology and Rheumatology, Kurashiki Central Hospital
  • Murabe Hiroyuki
    Department of Endocrinology and Rheumatology, Kurashiki Central Hospital
  • Yokota Toshihiko
    Department of Endocrinology and Rheumatology, Kurashiki Central Hospital
  • Takahashi Kenji
    Diabetes Division, Depertment of Internal Medicine, Kurashiki Central Hospital

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Other Title
  • インスリン非依存状態が持続し，肥満および大血管障害を伴った膵島関連抗体陽性糖尿病の1例
  • 症例報告 インスリン非依存状態が持続し,肥満および大血管障害を伴った膵島関連抗体陽性糖尿病の1例
  • ショウレイ ホウコク インスリン ヒイソン ジョウタイ ガ ジゾク シ,ヒマン オヨビ ダイ ケッカン ショウガイ オ トモナッタ スイトウ カンレン コウタイ ヨウセイ トウニョウビョウ ノ 1レイ

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Abstract

A 64-year-old woman with a three year history of diabetes mellitus was admitted to the hospital for glycemic control in 2005. She had been treated for type 2 diabetes mellitus with an oral hypoglycemic agent. A family history of diabetes mellitus was evident in the patient's mother. The patient was obese, with a high BMI (36.9). Laboratory examinations showed a fasting plasma glucose level of 127 mg/dl and an HbA1c of 6.8 % (JDS value). Fasting serum C-peptide, postprandial serum C-peptide and HOMA-R levels were 2.43 ng/ml, 6.06 ng/ml and 4.39 respectively. Insulin secretory capacity remained and insulin resistance was observed. Testing for GADAb was positive with high titer (627.2 U/ml). In addition, ICA and IA-2Ab was also positive. The patient was placed on a diet and prescribed the oral hypoglycemic agent Acarbose.<br> Five years following her initial hospitalization, insulin secretory capacity was still preserved. She still remained obese and had experienced a brain infarction and angina pectoris. These clinical features strongly suggested that she was suffering from type 2 diabetes mellitus. Nevertheless, the presence of islet autoantibodies (GADAb, ICA and IA-2) and HLA genotype is a predisposition to type 1 diabetes. Although the pathophysiology of diabetes mellitus is ambiguous, the present case may imply the possibility of the coexistence of type 1 and 2 diabetes.<br>

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