[Causes of emergency hospitalization of elderly diabetic patients].

In recent years there has been a rise in the number of diabetic patients in Japan, with the increase in elderly diabetic patients becoming a serious problem. This study looked at 488 elderly type 2 diabetes patients who were admitted as emergency cases to the Department of Internal Medicine, JA Yoshida General Hospital, Akitakada City, Japan. All patients were classified by age into three groups: <70, 70-80 and >80. The most common cause of emergency hospitalization in each of the three age groups was infection. This was significantly higher in the >80 group in comparison with<70 (p<0.05). The most common infection among the three groups was respiratory infection, followed by urinary tract infection. The number of emergency hospitalization cases due to hypoglycemia was much higher in the over 80 group, particularly in comparison with<70-80 (p<0.05). The incidence of hypoglycemia in our patients could be explained mainly by reduced energy intake. Most cases were treated with oral administration of hypoglycemic drugs. As elderly diabetic patients have a number of underlying illnesses that are prone to aggravation and may lead to unfavorable prognosis, early medical examination and disease detection are considered to be important. Pharmacists are required to educate patients, home-visit nursing care personnel on sick-day rule, and provide diabetes care.

Development and validation of a GC-EI-MS method with reduced adsorption loss for the quantification of olanzapine in human plasma.

A simple and sensitive GC-EI-MS method using solvent extraction and evaporation was developed for the determination of olanzapine concentrations in plasma samples. Because olanzapine and promazine, which was used as the internal standard (IS), are nitrogenous bases, they can adsorb to the weakly acidic silanol groups on the surfaces of glass centrifuge tubes during solvent extraction and evaporation. Silylation of the glass tubes, addition of triethylamine (TEA), and use of a sample solution with a basic pH could prevent adsorption loss. The extraction method involved mixing plasma (500 µL) in a silylated glass tube with a promazine solution (2 µg/mL, 25 µL) in methanol containing 1% TEA. After addition of aqueous sodium carbonate (0.5 mol/L, pH 11.1, 1 mL) and extraction into 3 mL of dichloromethane/n-hexane (1:1, v/v) containing 1% TEA, the organic phase was evaporated to dryness in a silylated glass tube. The residue was dissolved in ethyl acetate containing 1% TEA (50 µL). For GC-EI-MS analysis, the calibration curves of olanzapine in human plasma were linear from 0.5 to 100 ng/mL. Intra- and interday precisions in plasma were both less than 7.36% (coefficient of variation), and the accuracy was between 94.6 and 110% for solutions with concentrations greater than 0.5 ng/mL. The limit of quantification was 0.5 ng/mL in plasma. The assay was applied to therapeutic drug monitoring in samples from three schizophrenic patients.

[Relation between comprehensive-geriatric assessment and the ability of self-administration in elderly diabetic patients].

Intellectual ability of self-administration plays a crucial role in a diabetes regimen. However, in many cases, self-administration is considered difficult, because of the impairment of activities of the individual's daily living (ADL), instrumental ADL and cognitive function. To assess comprehensive-geriatric-assessment (CGA) in elderly diabetic sufferers, 62 elderly inpatients and outpatients aged over 70 years were investigated. CGA includes Barthel index (BI), Mini-mental-state-examination (MMSE) and the Tokyo Metropolitan Institute of Gerontology index of competence (TMIGIC). The relation of ability to self-administer and CGA was examined. In oral therapy, there was significant difference between self-administration and non-self-administration in MMSE (p=0.0065), BI (p=0.0219) and TMIGIC (p=0.0053). Among these indexes, TMIGIC was the most sensitive index in oral therapy. In insulin therapy, there was also significant difference between self-administration and non-self-administration: MMSE (p=0.00042), BI (p=0.000019) and TMIGIC (p=0.0019). Among these indexes, BI was the most sensitive index in insulin therapy. It was suggested that CGA was useful to assess the ability of self-administration in elderly diabetic patients.