Aims/Introduction:  The effectiveness of incretin‐based therapies in Asian type 2 diabetes requires investigation of the secretion and metabolism of glucose‐dependent insulinotropic polypepide (GIP) and glucagon‐like peptide 1 (GLP‐1). Plasma extractions have been suggested to reduce variability in intact GLP‐1 levels among individuals by removing interference that affects immunoassays, although no direct demonstration of this method has been reported. We have evaluated the effects of ethanol and solid‐phase extractions on incretin immunoassays. We determined incretin levels during meal tolerance tests in Japanese patients with type 2 diabetes and characterized predictors for incretin secretion.Materials and Methods:  Japanese patients with type 2 diabetes (23 anti‐diabetic drug‐naïve and 18 treated with sulfonylurea [SU] alone) were subjected to meal tolerance tests, and incretin levels were determined by immunoassays with or without extraction.Results:  Intact GLP‐1 levels determined by an intact GLP‐1 immunoassay with ethanol and solid‐phase extractions were lower than those determined without extraction. Intact GLP‐1 levels determined by the extractions were highly correlated with each other, much more so than the levels with and without extraction. Total GLP‐1 was unaffected by extractions, showing that extractions remove interference only in the case of intact GLP‐1. Incretin secretion after meal ingestion was similar between drug‐naïve and SU‐treated patients. Fasting and postprandial GLP‐1 levels were correlated positively with fasting free fatty acids and negatively with dipeptidyl peptidase‐4 activity.Conclusions:  Ethanol and solid‐phase extractions remove interference for intact GLP‐1 immunoassay. SU showed little effect on incretin secretion. GLP‐1 and GIP secretion were predicted by different factors. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2011.00141.x, 2012)

Aims/IntroductionThe safety and efficacy of insulin‐to‐liraglutide switch in type 2 diabetes has not been studied adequately. Here, we retrospectively characterize clinical parameters that might predict insulin‐to‐liraglutide treatment switch without termination due to hyperglycemia, and examine the effects of switching the therapies on glycated hemoglobin (HbA1c) and bodyweight in Japanese type 2 diabetes.Materials and MethodsJapanese type 2 diabetes patients who underwent the switch of therapy were evaluated for their clinical data including β‐cell function‐related indices, such as increment of serum C‐peptide during glucagon stimulation test (GST‐ΔCPR). HbA1c and bodyweight were analyzed in patients continuing with liraglutide after switching from insulin for 12 weeks.ResultsOf 147 patients, 28 failed in the switch due to hyperglycemia, nine failed because of other reasons and 110 continued with liraglutide for the 12‐week period. Patients failing in the switch due to hyperglycemia showed longer duration and higher daily insulin dose, as well as lower GST‐ΔCPR. Receiver–operating characteristic analysis showed that GST‐ΔCPR of 1.34 ng/mL is a cut‐off point for insulin‐to‐liraglutide switch without termination due to hyperglycemia. In patients continuing liraglutide for 12 weeks, the switch significantly reduced HbA1c and bodyweight with no severe hypoglycemia, irrespective of sulfonylurea co‐administration, body mass index, duration and total daily insulin dose. The switch also significantly reduced the percentage of body fat and visceral fat areas.ConclusionsInsulin‐to‐liraglutide switch can improve glycemic control and reduce bodyweight in Japanese type 2 diabetes patients. However, caution must be taken with the switch in patients with reduced insulin secretory capacity as predicted by GST‐ΔCPR.

There are significant differences in the diameters of the aortic root, which represent the echocardiographic annulus, when measured using bisecting as opposed to off-center cuts. Account should be taken of these differences when using cross-sectional echocardiographic measurements to assess the dimensions of the aortic root.

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This study was initiated to identify clinical and dietary parameters that predict efficacy of dipeptidyl peptidase‐4 inhibitors. A total of 72 untreated Japanese patients with type 2 diabetes who received DPP‐4 inhibitors (sitagliptin, alogliptin or vildagliptin) for 4 months were examined for changes of glycated hemoglobin (HbA1c) and body mass index (BMI), and self‐administered 3‐day food records, as well as serum levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). DPP‐4 inhibitors significantly reduced HbA1c (before initiation of DPP‐4 inhibitors 7.2 ± 0.7%, 4 months after initiation of DPP‐4 inhibitors 6.7 ± 0.6% [paired t‐test, P < 0.01 vs before]). Multiple regression analysis showed that changes of HbA1c were significantly correlated with baseline HbA1c, as well as estimated intake of fish. Furthermore, changes of HbA1c were significantly correlated with serum levels of EPA (r = −0.624, P < 0.01) and DHA (r = −0.577, P < 0.01). HbA1c reduction by DPP‐4 inhibitors is significantly correlated with estimated intake of fish and serum levels of EPA and DHA. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2012.00214.x, 2012)

Myocardial edema and inflammation play an important role in dilated cardiomyopathy (DCM). This pathologic condition can be identified noninvasively using cardiovascular magnetic resonance imaging (CMR). The purpose of this study was to determine the effectiveness of T2 values obtained with T2 mapping in the detection of edema in DCM patients, compared with that of conventional T2-weighted imaging (T2WI). CMR was used for 15 normal controls (NML) and 26 DCM patients. The DCM patients were classified as having either mild dysfunction with a left ventricular ejection fraction (EF) >35% or severe dysfunction with an EF ≤35%. Myocardial edema was assessed by both T2 mapping and T2WI. The differences between the T2 values determined from T2 mapping and the T2 ratios that were calculated from the T2WI were compared among the NML, mild DCM, and severe DCM patients. The T2 values for the NML, mild DCM, and severe DCM patients were 51.2 ± 1.6, 61.2 ± 0.37, and 67.4 ± 6.8, respectively (P < 0.05 for each pair), and the corresponding T2 ratios were 1.88 ± 0.09, 2.12 ± 0.37, and 2.04 ± 0.34, respectively (P > 0.05). T2 mapping clearly showed that the myocardial water content was larger in DCM patients than in NML controls and that the myocardial water content increased as the disease progressed. Thus, T2 mapping is a useful technique for the diagnosis and quantitation of diffuse myocardial edema.

The inferior pyramidal space (IPS) comprises the epicardial visceral adipose tissue wedged between the bottoms of the four cardiac chambers from the postero-inferior epicardial surface of the heart. Understanding the complex anatomy around the IPS is important for clinical cardiologists. Although leading anatomists and radiologists have clarified the anatomy of the IPS in detail, few studies have demonstrated this anatomy in three dimensions. The aim of this study was to visualize the three-dimensional anatomy of the IPS reconstructed from the living heart using multidetector-row computed tomography. We also developed an original paper model of the IPS to enhance understanding of its intricate structure.

An optimal image intensifier angulation used for obtaining an en face view of a target structure is important in electrophysiologic procedures performed around each coronary aortic sinus (CAS). However, few studies have revealed the fluoroscopic anatomy of the target area. This study investigated the optimal angulation for each CAS and the interventricular septum (IVS). The study included 102 consecutive patients who underwent computed tomography coronary angiography. The optimal angle for each CAS was determined by rotating the volume-rendered image around the vertical axis. The angle formed between the anteroposterior axis and IVS was measured using the horizontal section. The frontal direction was defined as zero, positive, or negative if the en face view of the target CAS was obtained in the frontal view, left anterior oblique (LAO) direction, or right anterior oblique (RAO) direction, respectively. The optimal angles for the left, right, and non-CASs were 120.3 ± 10.5°, 4.8 ± 16.3°, and -110.0 ± 13.8°, respectively. The IVS angle was 42.6 ± 8.5°. Accordingly, the optimal image intensifier angulations for the left, right, and non-CASs and the IVS were estimated to be RAO 60°, LAO 5°, LAO 70°, and RAO 50°, respectively. The IVS angle was the most common independent predictor of the optimal angle for each CAS. Differences in the optimal angulations for each CAS and the IVS are demonstrated. The biplane angulation needs to be tailored according to the individual patients and target structures for electrophysiologic procedures.