A Diabetic Male Elderly with Stable Arteriosclerosis for Years by Regular Lifestyle and Low Carbohydrate Diet (LCD)

Bando H, Iwatsuki N, Ogawa T, Okada M and Sakamoto K

Published on: 2026-01-20

Abstract

The case is a 83-year-old male with type 2 diabetes (T2D), obesity, dyslipidemia, hyperuricemia, and Gastroesophageal Reflux Disease (GERD) for years. Concerning treatment, he has kept on low carbohydrate diet (LCD), and several medication of sitagliptin, rosuvastatin, febuxostat, aspirin, rebamipide and lansoprazole. Pulse wave velocity (PWV) showed stable values of Cardio-Ankle Vascular Index (CAVI) 10.6/10.8, and ABI 1.11/1.09 (right/left) for 10 years. From physiological and psychological aspects, possible contributing factors may include stable basic lifestyle habits of meal, exercise, sleep, adequate proper diabetes control, regular intake of required medicine and his excellent interpersonal communication skill (IPCS) for other people.

Keywords

Type 2 diabetes (T2D); Petite-low carbohydrate diet (LCD); Gastroesophageal Reflux Disease (GERD); Pulse wave velocity (PWV); Arteriosclerosis

Introduction

Type 2 diabetes (T2D) associated with arteriosclerosis has been in discussion for years [1]. It brings crucial problem for usual management for T2D. For recommended guideline, American Diabetes Association (ADA) has presented the standards of care annually [2]. Diabetic complications include metabolic syndrome (Met-S) or lifestyle-related disease, such as hypertension, hyperuricemia, and dyslipidemia [3]. Diabetes will develop microangiopathy and macroangiopathy, in which the latter is deeply related with atherosclerotic cardiovascular disease (ASCVD). ASCVD would develop cerebral vascular accident (CVA) and ischemic heart disease (IHD), as well as peripheral artery disease (PAD) [4].

The authors and colleagues have presented medical reports with diabetes and ASCVD so far [5,6]. They included meaningful cases with various arteriosclerosis and low carbohydrate diet (LCD) as effective nutritional treatment [7,8]. We have always treat patients for long period associated with adequate advice and education concerning LCD and exercise therapy [9,10]. During our clinical practice, we have encountered an impressive male elderly who has type 2 diabetes (T2D) and other comorbidities and complications. In this article, his general clinical course with related discussion will be presented.

Case Presentation

History and Physicals

Current case is a 83-year-old male with some medical problems. He was diagnosed as T2D, obesity, dyslipidemia, and hyperuricemia for years. His situation has been stable for 10 years. Physical examination revealed unremarkable for vital signs, consciousness, speech, head, lung, heart, abdomen and extremities of neurological findings. His physique has been about 145cm in height, 55.2 kg in weight and 26.3kg/m² in BMI.

Formerly, he was educated to initiate petite-low carbohydrate diet (LCD), and he could continue LCD for long. He has continued LCD satisfactory, and then his weight and HbA1c have been stable for years. His medication has included sitagliptin phosphate hydrate (Januvia) 50mg, Rosuvastatin 2.5mg, Febuxostat (Feburic) 20mg, rebamipide (Mucosta) 100mg and acetylsalicylic acid (aspirin, Bayaspirin).

Several Examinations

Several basic tests were performed. Chest X-ray showed negative result, and Electrocardiogram (ECG) showed within normal limits as ordinary sinus rhythm (OSR), pulse 74/min and no remarkable ST-T changes. Urinalysis revealed that protein (-), glucose (-), urobilinogen (+/-), occult blood (-) and ketone bodies (-). Clinical progress of the blood chemistry has been summarized in Figure 1. It shows persisting normal values of liver, renal, lipids and complete blood count (CBC).

Figure 1: Progress of biochemistry.

He received the test of pulse wave velocity (PWV) (Figure 2). It revealed the normal ranges of data for ECG, PCG in the bilateral arms and feet. The value of Cardio-Ankle Vascular Index (CAVI) has gradually increased for 10 years. CAVI in 2025 showed 10.6/10.8 for right/left, which is higher values compared with the standard values of 8.6+/-0.8 for all ages (Figure 3). The obtained CAVI values ??on both sides have corresponded to the levels of 80s. The ankle-brachial index (ABI) showed gradual decrease for 10 years, where ABI revealed 1.11/1.09 (right/left) in 2025 as normal value (Figure 4) [11]. The detailed results of PWV showed that L (111) = L1(57) + L2(30) + L3(24), PEP 86, ET 265, R-AI 0.79 and PEP/ET 0.32. These data were found as within normal limit.

Abdominal CT scan revealed fatty liver, increased visceral fat, increased subcutaneous fat deposits and renal cyst without remarkable findings for gall bladder, common bile duct, pancreas and other organs (Figure 5). Unremarkable findings were found in gall bladder and common bile duct.

Figure 2: Results of Pulse Wave Velocity (PWV).

The related function showed unremarkable.

Figure 3: Clinical progress of CAVI.

Gradual increase of CAVI are found.

Figure 4: Clinical progress of ABI for years.

The related function showed unremarkable.

Figure 5: Abdominal CT scan.

fatty liver/ renal cyst

increased visceral fat

Ethical Standards

Current article complied with the Helsinki Declaration [12]. Certain comment revealed the personal light protection. The principle includes ethic rule for clinical research in human subjects. Adequate guideline is from Ministry of Education, Culture, Sports, Science Technology and Ministry of Health, Labour and Welfare. The authors and colleagues established ethical committee in Sakamoto Hospital, which included the director, physicians, registered nurse, pharmacist, nutritionist and legal professional. We discussed enough concerning the case, agreed the protocol and obtained informed consent from the case.

Discussion

This elderly case revealed some specific aspects of clinical problems. For obtained history, treatments and situations, his clinical problems can be summarized as follows.

#1 T2D: He has the history of T2D more than 10 years, and takes sitagliptin phosphate hydrate (Januvia) 50mg as DPP4-i. For nutritional therapy, basicalLCD has been continuing [13].

#2 Dyslipidemia: He has kept taking rosuvastatin 2.5 mg for years. The lipid profile including HDL, LDL and TG has been stable almost within normal range.

#3 Hyperuricemia: He has provided Febuxostat (Feburic) 20mg for long. It is common that Febuxostat would be prescribed 20 or 40 mg/day during maintenance period. In this case, 20mg would be enough for control.

#4 CVA: Since previous findings of brain CT and MRI, the case probably seems to have probable cerebral vascular accident (CVA) to some degree without apparent neurological symptoms or signs. Then, acetylsalicylic acid (aspirin, Bayaspirin) has been given for years.

#5 GERD: This case has suffered from Gastroesophageal Reflux Disease (GERD) from young period. Consequently, we prescribe him lansoprazole (Prevacid, Takepron) 15mg, where he has not felt any symptoms or signs of GERD until now.

Current case showed ideal course of HbA1c and almost stable CAVI and ABI for PWV for 10 years. PWV can suggest the degree of exacerbation of arteriosclerotic changes [14,15]. CAVI and ABI are influenced by HbA1c, glucose, mean amplitude of glucose excursions (MAGE), lipids profiles and weight [16]. One of the reason for stable HbA1c value for long in this case would be the continuation of LCD with his strong will. For practical method of LCD, authors have presented useful LCD tips in various opportunities [17]. They are petit-LCD, standard-LCD and super-LCD, that includes carbohydrate ratio as 40%, 26% and 12%, respectively [18]. Since he has Met-S as T2D, obesity, dyslipidemia, hyperuricemia and CVD, indispensable basic treatment would be continuation of LCD for long.

Regarding clinical arterial stiffness (AS), brachial-ankle pulse wave velocity (baPWV) can become the useful value for the evaluation of general arteriosclerosis [19]. For characteristic clinical issues, he had diabetes but no hypertension, and arteriosclerosis had persisted with a slight level. Concerning the measurements of arteriosclerosis, PWV, CAVI and ABI had been stable for years [20]. Possible contributing factors may include stable basic lifestyle habits, adequate proper diabetes control, and certain genetic factors. From lifestyle and psychological points of view, this case showed some characteristic aspects. They included that i) he has usually regular life for years, including exercise, meal, and sleep; ii) he grows flowers and vegetables in his house and then he can always move around training his legs, iii) his QOL and ADL has been maintained for satisfactory degree for long, iv) his interpersonal communication skill (IPCS) for other people seems to be excellent as psychological perspectives.

Uric acid is a product of purine metabolism and influences the vascular system, which affects arterial vascular stiffness, leading to vascular-mediated end-organ damage. The PWV research was from the population-based German National Cohort (NAKO) (n=70,649), and urate values from physiological range were also added (n=64,095) [21]. As a result, positive association was found between serum uric and PWV. By this research, uric acid increase by 1mg/dL corresponds to the increase of about 7 year (female) and 4 year (male).

Some limitation may exist for this report. This case has several specific problems with characteristic aspects. He showed stable clinical progress and kept less arteriosclerosis for years [22]. It may be from continuation of LCD, unchanged lifestyle, adequate medications, and others [23]. Possible related factors would be followed up with careful attention.

In summary, current 83-year-old male was described for characteristic general progress with related considerations. He has shown stable degree of HbA1c, arteriosclerosis and his regular lifestyle. Probably plural complex background factors have contributed much for the ideal clinical course. It is expected that current perspectives will become useful references for future practice and research.

Conflict of Interest: The authors declare no conflict of interest.

Funding: There was no funding received for this paper.

International Journal of Case Reports and Clinical Images