Background: Doege-Potter syndrome presents as solitary fibrous tumors and non-islet cell tumor hypoglycemia (NICTH). Here, we report a case of Doege-Potter syndrome in which retroperitoneal tumor resection was performed with continuous intraoperative blood glucose monitoring. Case Presentation: The patient was a 37-year-old healthy man with no relevant medical history. They were brought to the emergency room because of defecation difficulties and incontinence caused by hypoglycemia, and a tumor measuring 10 × 12 × 9 cm was found in the right kidney. High-molecular-weight insulin-like growth factor-II (IGF-II) was detected in the blood, indicating an IGF-II-producing tumor with NICTH. The patient underwent tumor resection, and the pathological results indicated a solitary fibrous tumor of retroperitoneal origin. Thus, retroperitoneal primary Doege-Potter syndrome was diagnosed. Continuous blood glucose monitoring was performed intraoperatively, and no hypoglycemic attacks occurred; insulin secretory abnormalities improved immediately after surgery. Previous studies suggest that IGF-II is metabolized in a few hours. Therefore, serum IGF-II levels were analyzed one week and one month postoperatively; the levels were within the normal range at both time points. Two years have passed since the surgery without recurrence. Conclusions: Doege-Potter syndrome of retroperitoneal primary origin is rare. Furthermore, continuous intraoperative blood glucose monitoring was performed during surgery; thus, we report blood glucose level trends for the first time. This case highlights that this type of surgery can be performed safely without special blood glucose adjustments and that insulin secretion resumes soon after surgery.
Effectiveness of real time continuous glucose monitoring (RT-CGM) compared with intensive self-monitoring of blood glucose (SMBG) is not clear. To analyze the effectiveness of RT-CGM, retrospective CGM and, intensive SMBG in adults with type 2 diabetes, we conducted a randomized, open-labelled clinical trial. Patients were type 2 diabetes adults admitted to our hospital from August 2016 to August 2017. Patients of age over 85 years, pregnant, admission less than 1 week were excluded. Patients were randomized to SMBG with RT-CGM using the Medtronic MiniMed 620G, SMBG with retrospective CGM using Medtronic iPro2, or SMBG alone. Both CGMs were worn for 6 days. SMBG was done 6 times a day at every pre-meal and 2 hours post-meal. Primary outcome was the change in HbA1c from baseline to 12weeks. As the secondary outcomes, change in mean glucose level from the admission day to discharge day, and frequency of in-hospital hypoglycemia were evaluated. We also evaluated patients’ satisfaction to treatment using Diabetes Treatment Satisfaction Questionnaire (DTSQ). As the result, 111 patients were enrolled and 33 patients were allocated to RT-CGM group, 26 to retrospective CGM group, and 52 to SMBG group. Among these 111 patients, 63 (56.8%) were male, mean age was 65.1 years, diabetes duration was 8.3 years, BMI was 26.3 kg/m^2, and HbA1c was 9.1%. Overall, glycemic control was improved after treatment for both HbA1c and the mean glucose level; HbA1c from 9.1±1.7% to 6.8±1.0%, mean glucose level from 189±56mg/dl to 137±19mg/dl. However, the changes were not significantly different between the groups. As the safety profile, 34 hypoglycemia was seen during hospitalization with no difference in frequency between the groups (P=0.11). There were no differences in patients’ satisfaction to treatment assessed by DTSQ, either. In conclusion, among adults with type 2 diabetes, intensive SMBG may have the equivalent effect to RT-CGM and retrospective CGM. Disclosure Y. Takano: None. Y. Namiki: None. H. Hiiragi: None. T. Yamada: None. H. Sasaki: None. Y. Murohashi: None. H. Takamine: None. K. Inazumi: None. Y. Terauchi: Research Support; Self; MSD K.K.. Speaker's Bureau; Self; MSD K.K.. Advisory Panel; Self; MSD K.K.. Research Support; Self; Ono Pharmaceutical Co., Ltd.. Speaker's Bureau; Self; Ono Pharmaceutical Co., Ltd.. Research Support; Self; Novartis Pharma K.K., Boehringer Ingelheim GmbH. Speaker's Bureau; Self; Boehringer Ingelheim GmbH. Advisory Panel; Self; Boehringer Ingelheim GmbH. Research Support; Self; Mitsubishi Tanabe Pharma Corporation. Speaker's Bureau; Self; Mitsubishi Tanabe Pharma Corporation. Advisory Panel; Self; Mitsubishi Tanabe Pharma Corporation. Research Support; Self; Daiichi Sankyo Company, Limited. Speaker's Bureau; Self; Daiichi Sankyo Company, Limited. Advisory Panel; Self; Daiichi Sankyo Company, Limited. Research Support; Self; Sanwa Kagaku Kenkyusho Co., Ltd.. Speaker's Bureau; Self; Sanwa Kagaku Kenkyusho Co., Ltd.. Research Support; Self; Novo Nordisk Inc.. Speaker's Bureau; Self; Novo Nordisk Inc.. Advisory Panel; Self; Novo Nordisk Inc.. Research Support; Self; Eli Lilly and Company. Speaker's Bureau; Self; Eli Lilly and Company. Advisory Panel; Self; Eli Lilly and Company. Research Support; Self; Sanofi. Speaker's Bureau; Self; Sanofi. Advisory Panel; Self; Sanofi. Research Support; Self; Sumitomo Dainippon Pharma Co., Ltd.. Speaker's Bureau; Self; Sumitomo Dainippon Pharma Co., Ltd.. Research Support; Self; Shionogi & Co., Ltd.. Speaker's Bureau; Self; Shionogi & Co., Ltd., Bayer Yakuhin, Ltd., Astellas Pharma US, Inc., AstraZeneca. Advisory Panel; Self; AstraZeneca, Teijin Pharma Limited. U.N. Osada: None.
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