1. Journal Club 埼玉医科大学 総合医療センター 内分泌・糖尿病内科 Department of Endocrinology and Diabetes, Saitama Medical Center, Saitama Medical University 松田 昌文 Matsuda, Masafumi 2012 年 8 月 23 日 8:30-8:55 ８階 医局 van de Ven KC, van der Graaf M, Tack CJ, Heerschap A, de Galan BE. Steady-state brain glucose concentrations during hypoglycemia in healthy humans and patients with type 1 diabetes. Diabetes. 2012 Aug;61(8):1974-7. Epub 2012 Jun 11. Cresswell JA, Campbell OM, De Silva MJ, Filippi V. Effect of maternal obesity on neonatal death in sub-Saharan Africa: multivariable analysis of 27 national datasets. Lancet. 2012 Aug 8. [Epub ahead of print]

2. the 1 Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands; the 2 Clinical Physics Laboratory, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands; and the 3 Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands. Corresponding author: Bastiaan E. de Galan, b. Diabetes 61:1974–1977, 2012

3. Background The objective of this study was to investigate the relationship between plasma and brain glucose levels during euglycemia and hypoglycemia in healthy subjects and patients with type 1 diabetes mellitus (T1DM).

4. Methods Hyperinsulinemic euglycemic (5 mmol/L) and hypoglycemic (3 mmol/L) [1- 13 C]glucose clamps were performed in eight healthy subjects and nine patients with uncomplicated T1DM (HbA1c 7.7 ± 1.4%). Brain glucose levels were measured by 13 C magnetic resonance spectroscopy. Linear regression analysis was used to fit the relationship between plasma and brain glucose levels and calculate reversible Michaelis-Menten (MM) kinetic parameters.

6. 60mU/min per m 2 : middle high 1mU/kg per min : 40mU/m 2 per min 5mmol/L = 90mg/dl 3mmol/L = 54mg/dl

8. E:enzyme S:substrate P:product Km: MM kinetic constant Lineweaver-Burk plot

9. Neurochem. 1998 Jan;70(1):397-408.

14. Results Brain glucose values during euglycemia (1.1 ± 0.4 mmol/g vs. 1.1 ± 0.3 mmol/g; P = 0.95) and hypoglycemia (0.5 ± 0.2 mmol/g vs. 0.6 ± 0.3 mmol/g; P = 0.52) were comparable between healthy subjects and T1DM patients. MM kinetic parameters of combined data were calculated to be maximum transport rate/cerebral metabolic rate of glucose (Tmax/CMRglc) = 2.25 ± 0.32 and substrate concentration at half maximal transport (Kt) = 1.53 ± 0.88 mmol/L, which is in line with previously published data obtained under hyperglycemic conditions.

15. Conclusions In conclusion, the linear MM relationship between plasma and brain glucose can be extended to low plasma glucose levels. We found no evidence that the plasma to brain glucose relationship or the kinetics describing glucose transport over the blood–brain barrier differ between healthy subjects and patients with uncomplicated, reasonably well-controlled T1DM.

16. Message 脳脊髄液のブドウ糖濃度は血中濃度より低い。 正常人でも１型糖尿病患者でもこの関係は同じよ うである。 １型糖尿病患者ということで低血糖への対応がお かしくなるということは基本的にないということ でよいのではないか。 ともかくブドウ糖が重要！

18. Population Health, London School of Hygiene and Tropical Medicine, London, UK (J A Cresswell PhD, Prof O M R Campbell PhD, M J De Silva PhD, V Filippi PhD) Published online August 9, 2012 http://dx.doi.org/10.1016/S0140-6736(12)60869-1

19. Background Rates of obesity are increasing worldwide, including in sub-Saharan Africa. Neonates born to obese mothers in low-income settings are at increased risk of complications including admission to neonatal intensive care, macrosomia, low Apgar scores, and perinatal death. We investigated whether maternal obesity is a risk factor for neonatal death in sub-Saharan Africa and the eff ect on the detailed timing of death within the neonatal period.

20. Methods Cross-sectional Demographic and Health Surveys from 27 sub-Saharan countries (2003–09) were pooled. We used multivariable logistic regression to assess the risk of neonatal death (in women’s most recent singleton livebirth in the 5 years preceding the survey) by maternal body- mass index (BMI) category (measured during the survey). Timing of death was investigated with a discrete-time survival model.

27. Findings 15 518 of 81 126 eligible women were overweight (4266 were obese), 52 006 had an optimum BMI, and 13 602 were underweight. Maternal obesity was associated with an increased odds of neonatal death after adjustment for confounding factors (adjusted odds ratio 146, 95% CI 111–191). Maternal obesity was a signifi cant risk factor for neonatal deaths occurring during the fi rst 2 days of life (162, 111–237). We noted no statistically significant relation later in the neonatal period (days 2–6 136, 084–221; days 7–27 119, 065–218), possibly because of low statistical power.

28. Interpretation Maternal obesity in sub-Saharan Africa is associated with increased risk of early neonatal death. Potential mechanisms include prematurity, intrapartum events, or infections. Strategies to prevent and reduce obesity need to be considered; obese women should be advised to deliver in a health-care facility that can provide emergency obstetric and neonatal care. Funding Economic and Social Research Council.

29. Message サブサハラアフリカ 27 カ国の縦断的人口保健調 査のデータを基に、妊婦の肥満と新生児死亡の関 連を多変量解析で検討。 8 万 1126 人の妊婦の 1 万 5518 人が過体重（うち 4266 人が肥満）だっ た。妊婦の肥満は新生児の死亡確率の増加に関連 し（調整後オッズ比 1.46 ）、生まれた日と次の 日の死亡の有意なリスク因子だった（同 1.62 ）。