OBJECTIVE—Recently, repeated home blood pressure (HBP) measurements in the morning for a long period have been shown to have a stronger predictive power for mortality in patients with hypertension than occasional casual/clinic blood pressure (CBP) measurements. We studied whether HBP in the morning in type 2 diabetic patients is useful for prediction of diabetic complications. RESEARCH DESIGN AND METHODS—The occurrence of diabetic complications (nephropathy, retinopathy, coronary heart disease [CHD], and cerebrovascular disease [CVD]) were examined in relation to morning HBP as well as to CBP in 170 type 2 diabetic patients treated with antidiabetic and antihypertensive drugs. Blood pressure was measured at the clinic during the day and at home after awakening in the morning. Clinic hypertension (CH) and morning hypertension (MH) were defined as systolic blood pressure (SBP) ≥130 mmHg and/or diastolic blood pressure (DBP) ≥85 mmHg. The relation of CH and MH to the prevalence of these events was examined. RESULTS—There were no significant differences in the prevalence of nephropathy, retinopathy, CHD, and CVD between the two groups with (n = 131) and without CH (n = 39), whereas the prevalences of these events in the patients with MH (n = 97) were significantly higher (P < 0.05) than in those without MH (n = 73). The prevalence of nephropathy was highly associated with systolic MH. CONCLUSIONS—Elevations of HBP in the morning in diabetic patients are strongly related to microvascular and macrovascular complications, especially nephropathy. It is concluded that the control of MH may prevent vascular complications in type 2 diabetic patients.

A major earthquake struck the Niigata Prefecture, Japan, on October 23, 2004. This study investigated the effect of the earthquake on morning home blood pressure (MHBP) measurements, as well as clinic blood pressure (CBP) and associated complications, in 222 type 2 diabetic patients who measured MHBP and CBP before the earthquake. Physical and laboratory examinations were assessed at every three months. Each patient completed a questionnaire on MHBP measurement, Japanese intensity grade (JIS), patient's lifestyle and psychological impact using posttraumatic stress disorder (PTSD) symptom score. Median JIS showed all patients lived in areas affected by strong aftershocks. Most patients stayed in their own houses, while one-third of patients sought refuge in other houses. No new clinical manifestations of disease were noted. Median PTSD score was low. Patients in public refuge houses had daytime blood pressure, but MHBP was not measured. In the first month, the number of patients who continued MHBP measurements decreased to 27% of pre-shock level. Many patients were unable to measure MHBP for several reasons, including losing MHBP equipment, having equipment destroyed, or suffering from anxiety due to the extensive devastation. Mean systolic MHBP and median urinary albumin excretion rate (UAER) increased significantly within three months and returned to pre-earthquake level at six months. On multiple regression analysis, increased systolic and diastolic MHBPs were significantly associated with UAER elevation. In type 2 diabetic patients following an earthquake, it is important to develop a device of MHBP measurement for maintaining control of MHBP to prevent vascular complications.

How smoothly insulin is injected is one of the major concerns when patients commence insulin injection therapy. Improving its usability may be important in initiation therapy and adherence, resulting in clinical In a single-center, open-label and randomized two-period crossover trial, the effect of the tapered needle of NanoPass® (33 gauge, 5 mm) on usability in comparison with the standard needle of Micro Fine Plus® (31 gauge, 5 mm) was examined using a questionnaire. Patients with insulin-dependent diabetes (n = 40, self-injecting insulin four times daily for more than 3 months) were randomized to use NanoPass or Micro Fine Plus needles for 1 week and then use the alternative for 1 week. Patients completed the questionnaire before and after each test week. Each evaluation was scored from −100 (worst) to +100 (best) by a visual analogue scale. A higher score indicated a more favorable outcome compared with the other needle. The NanoPass needles. Meanwhile, the NanoPass needle, which had less resistance in insertion with a new lubricant coating P < 0.001) overall patient's satisfaction score, including less frightening use, less bleeding, and less dribbling of injected insulin in comparison with the former evaluation. For overall patient satisfaction in using an insulin needle, developing a thinner needle and improving other factors, such as lubricity coating the needle, are important.

High clinic blood pressure (BP), male sex, cigarette smoking, dyslipidemia, renal function, anemia and thiazolidenediones (TZD) treatment are known predictors for clinically significant diabetic macula edema (CSDME). This study was performed to identify the most significant risk factors for CSDME in Japanese patients with type 2 diabetes mellitus (T2DM) and retinopathy (DR), using optical coherence tomography (OCT) if necessary, by multiple regression analysis. One of the risk factors was BP in awakening. Seven diabetic Japanese patients with CSDME (group 1) and 124 subjects without CSDME (group 2) with DR on OCT were studied. The durations of T2DM in groups 1 and 2 were 15 ± 10 years and 20 ± 15 years, respectively. There was no significant difference in sex distribution, duration, age, body mass index (BMI), and HbA1c, lipids (TC, LDL, TC/HDL), creatinine and Hb levels, urinary albumin excretion rate, cigarette smoking, and clinic BP between two groups. Morning systolic home BP (MSHBP) and foveal thickness were significantly (p<0.001) greater in group 1 than in group 2, and visual acuity was significantly (p<0.001) lower in group 1 than group 2. The patients in both groups had received various kinds of drugs for hyperglycemia, hypertension and others. There were no significant differences in the prevalence of other variables between two groups. On multiple regression analysis, MSHBP and nephropathy were significantly (p <0.03) positive predictors for CSDME, while BMI had a significantly (p <0.001) negative predictor. Other variables were not significantly correlated to CSDME. Thus, MSHBP is a predictive factor for CSDME that can be added to the previously reported risk factors in patient with T2DM.