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Background: Authors and collaborators have continued clinical research for Low Carbohydrate Diet (LCD) and Calorie Restriction Diet (CRD), glucose variability and M value. We investigated patients with Type 2 Diabetes Mellitus (T2DM) with positive Glutamic Acid Decarboxylase Antibody (GADA). Subjects and methods: Subjects were 12 patients with T2DM showing positive GADA (group 1). They were given CRD on day 1,2, and LCD on day 3-14. Daily profile of blood glucose was measured each day, and data were calculated to M value expressing average glucose and Mean Amplitude of Glycemic Excursions (MAGE). Further, 12 T2DM cases with negative GADA were recruited, who were age-, sex-glucose-related data-matched (group 2). Results: Data of group 1 were as follows: age 54.9 ± 14.3 yo, HbA1c 7.1 ± 0.9%, average blood glucose and M value on day 2 vs 4 were 187 (157-255) vs 145 (114-172), 76.9 (45.9-278) vs 27.2 (19.3-83.5), respectively. In group 2, M value on day 2 vs 4 were 69.9 (37.8-149) vs 5.8 (3.5-13.3), respectively. Group 1 showed insufficient decreased glucose in M value. Discussion and conclusion: These results suggested that cases with positive GADA would have insufficient insulin secretion in response to LCD, and may lead to Slowly Progressive Insulin-Dependent Diabetes Mellitus (SPIDDM) status in the future.

Background: Diabetes has been great problem worldwide. Continuous Glucose Monitoring (CGM) has been in focus, and useful CGM, FreeStyle Libre (Abbott) has been introduced to clinical ordinary practice of medicine. Case and results: The patient was 57 year-old female with type 1 diabetes mellitus (T1DM), who showed BMI 20.6 kg/m2, HbA1c 8.6%. She was on CGM measured glucose every 15 minutes in 24 hours for 14 days. Treatment included 3 times of Insulin Aspart and once of Insulin Glargin. She showed characteristic pattern of blood glucose profile according to the working schedule of the day. Discussion and conclusion: The beneficial points of FreeStyle Libre have been convenient and accurate for clinical use for reducing hypoglycemia episodes. Treatment using CGM associated with multiple daily insulin injection (MDI) confers similar or greater benefits for glycemic profile. When evening insulin was not injected one day, blood glucose increased 320 mg/dL, suggesting 64 g of carbohydrate ingested for supposed calculation. These results suggest that CGM could recommend the timing and doses of insulin injection according to the lifestyle of the patients with clinical merit.

Background: Discussion concerning Carbohydrate Restriction (CR) and Low Carbohydrate Diet (LCD) has been continued. Authors formerly proposed insulinogenic index-carbohydrate 70 g (IGI-carbo70). Along this, C-peptide index for Carbohydrate-70 g (CPI-Carbo70) is studied. Subjects and Methods: Subjects were 46 patients (62.5 yo. in average) with Type 2 diabetes mellitus (T2DM) and admitted for evaluation. CR diet was given on day 1-2 with 60% carbohydrates, 25% lipids and 15% protein with 1400 kcal/day. On day 2, breakfast with Carbo70 was given, and glucose and C-peptide (CP) were measured at 0 and 30 minutes and analyzed. Results: As basal data, average HbA1c was 8.1%, median HbA1c, average daily glucose, median M value was 7.7%, 187 mg/dL, 71, respectively. In response to Carbo70, median values of glucose-0, glucose-30, delta-glucose, CP-0, CP-30, delta-CP was 142, 186, 22 mg/dL, 0.9, 1.4, 0.4 ng/mL, respectively. CPI-Carbo70 was 1.54 in median. There were significant correlation between glucose and CP on 0, 30min, delta-0-30min (p<0.01). Significant correlation was observed between CPI and HbA1c, CPI and M value (p<0.01). Discussion and Conclusion: CPI-Carbo70 might be useful for evaluating pancreas function and glucose variability in clinical research. Current data would become the fundamental data for the future diabetic practice and research development.

Carbohydrate and lipid metabolism were studied. Subjects were 121 patients with type 2 diabetes mellitus (T2DM), and provided Calorie restriction (CR) on day 1,2 and Low Carbohydrate Diet (LCD) from 3 to 14 days. Basal biomarkers, daily glucose profile on day 2, 4, and lipids including remnant-like particle cholesterol (RLP-C) were measured, subjects were classified into 4 groups due to average glucose with mean HbA1c 6.3%, 6.9%, 7.9%, 9.2%, respectively. Average glucose from day 2 to 4 in each group was significantly decreased. M value considerably decreased in group 2, 3, 4, indicating useful M value. Correlations were investigated among glucose, HbA1c, urinary C-Peptide and M value. As for lipids, Triglyceride from day 2 to 14 decreased considerably. RLP-C levels showed significant correlation with Triglyceride, LDL-C, atherogenic index (T-C - HDL / HDL) and TG/HDL value. These results would suggest that RLP-C may be involved in the development of arteriosclerosis of T2DM, and may have the role of further research direction in the future. In current study, our results would become the fundamental data for the further development of LCD therapy in various counties and districts, and suggest the research direction for patients with T2DM from the combined point of glucose and lipid metabolism in the future.

Background: Arguments have continued for long concerning low carbohydrate diet and calorie restriction (calorie-restricted diet). Authors have reported clinical studies of low carbohydrate diet on ketone bodies, glucose variability and Morbus value so far. Subjects and methods: Subjects are 28 patients with Type 2 diabetes mellitus, which were 20/8 (M/F) with 48.3 ± 13.9 years old with serum triglyceride more than 250 mg/dL on blood sampling with overnight fasting. They were admitted for 14 days and the protocol was as follows: 1) calorie-restricted diet on day 1 and 2, which had 60% carbohydrates, 2) low carbohydrate diet on day 3-14 days which is so-called super-low carbohydrate diet formula with 12% carbohydrates. Results: Mean HbA1c was 8.0 ± 1.7% and mean fasting glucose was 177 ± 52 mg/dL. Median data days 2 to 4 were 208 to 147 mg/dL in average glucose, 146 to 21 in Morbus (M) value and 123 to 94.5 mg/day in urinary C-peptide. Median data days 2 to 14 were 366 to 159 mg/dL in Triglyceride, 46 to 42 mg/dL in HDL-C and 111 to 120 mg/dL in LDL-C. Remnant-like particle cholesterol on day 2 was 15.9 mg/dL in median. Significant correlations on day 2 were shown between Triglyceride and HDL-C (p<0.05), Triglyceride and LDL-C (p<0.05). Remnant-like particle cholesterol-C showed significant positive correlation with Atherogenic Index (AI) and triglyceride (p<0.01), significant negative correlation with HDL (p<0.05). Significant correlations were shown on day 2 and 14 in Triglyceride and LDL-C/HDL-C Ratio (p<0.01). Discussion and conclusion: Decrease of blood glucose indicated short effect of low carbohydrate diet only for 2 days from calorie restriction to low carbohydrate diet. Apparent large decrease of M value would be useful for clinical management and research. Analyses of correlations among RLP-C, triglyceride, HDL-C, LDL-C, AI and LDL-C/HDL-C Ratio would become the fundamental data for clinical research and give the hint for research direction in the future.