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Background: Continuous Glucose Monitoring (CGM) has been in focus for treatment of diabetes. Recently, a sensor-based flash glucose monitoring system, FreeStyle Libre (Abbott), has been introduced to clinical practice. Case and results: The patient was 53 year-old female with type 1 diabetes mellitus (T1DM), who showed BMI 25.1 kg/m2, HbA1c 9.5% in January, 6.0% in June and 7.7% in November, 2017 as data on outclinic. CGM measured glucose every 15 minutes in 24 hours for 14 days on June and November, and estimated HbA1c was 5.4% and 6.1%, respectively with discrepancy. Discussion and conclusion: The beneficial points of FreeStyle Libre have been accurate, convenient and small size for clinical use for lessen hypoglycemia episodes. Key benefits of CGM monitoring are frequency of testing, trends, alarms, therapy optimization. Former studies for FreeStyle Libre tended to show lower values and larger mean absolute relative difference (MARD) in lower range of glucose levels, suggesting possible cause of the discrepancy for HbA1c levels. FreeStyle Libre for CGM would lead to better balance optimization of glucose control and current results would become basal data for future investigation of CGM.

Background: Authors and colleagues have reported nutritional research so far concerning Low Carbohydrate Diet (LCD). Formerly, we proposed useful method for insulin response to 70 g of carbohydrate. Similarly, C-peptide index for Carbohydrate-70 (CPI-Carbo70) is studied and proposed in this report. Subjects and Methods: Subjects enrolled were diabetic patients that were divided into three groups due to diabetic severity. Among them, average HbA1c was 6.6%, 7.8%, 10.0% in low, middle, high group, n=15, 15, 16 respectively. As in-patients, they were on Calorie Restriction meal on day 1 and 2, which has 1400kcal/day with carbohydrates 60%, lipids 25%, protein 15%. On day 2, breakfast with carbohydrate 70 g was provided, and glucose and C-peptide levels were measured at 0, 30 minutes. Results: Biomarkers were analyzed in 3 groups. Increment C-peptide (CP) and CPI-Carbo70 in 3 groups were 0.58, 0.57, 0.27 and 2.1, 3.2, 1.2, respectively. As for M value, CP increment, CP on 30 min, CPI-Carbo70 was investigated, which were lower in high group. There is significant correlation between HbA1c and CPI-Carbo70 (p<0.05). Discussion and Conclusion: CPI-Carbo70 may be useful for evaluating pancreas function and glucose variability. These data could be basal and useful in the light of clinical evaluation and further research development.

Background: The discussion concerning calorie restriction (CR) and low carbohydrate diet (LCD) has been continued for long yeas. As to LCD, we have reported lots of experience and research for glucose variability and ketone bodies. Subjects and methods: Three cases with type 2 diabetes mellitus (T2DM) were on LCD and studied. Methods included 3 patterns of LCD meal which are super, standard and petit LCD, with including carbohydrate ratio 12%, 26% and 40%, respectively. Case 1 (61, M) showed hyperglycemia about 150 mg/dL to 300 mg/dL in daily profile with 12.5% in HbA1c. Starting super LCD therapy, the glucose profile decreased to less than 150 mg/dL and HbA1c decreased to 6.7% in 3 months. Case 2 (53, M) revealed HbA1c 8.3%, weight 110 kg and body mass index 34.5. By super LCD, his weight was decreased 17 kg in 5 months, with normalized HbA1c and elevated serum 3-hydroxybutyric acid (3-OHBA). Case 3 (72, M) had always extremely elevated fasting triglyceride for 5 years. Starting petit LCD for 2 years, triglyceride and weight were decreased moderately. Successively, changing to standard LCD for 1 year, weight was decreased 6 kg, and triglyceride was normalized. Discussion and conclusion: Each case suggests the characteristic beneficial effect of LCD. From our clinical experience and research, super LCD method, which is one of the very low-carbohydrate ketogenic diet (VLCKD), has evident efficacy of weight reduction. Super-LCD is characterized by strictly limitation for carbohydrate. Standard-LCD and petit-LCD method can be useful and applicable in response to the status of the patients. Thus, LCD treatment have beneficial effects for patients with various status.