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Comparison of Weight Reduction, Change in Parameters and Safety of a Very Low Carbohydrate Diet in Comparison to a Low Carbohydrate Diet in Obese Japanese Subjects with Metabolic Disorders. Nutrients 2023; 15:nu15061342. [PMID: 36986072 PMCID: PMC10052897 DOI: 10.3390/nu15061342] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/04/2023] [Accepted: 03/08/2023] [Indexed: 03/12/2023] Open
Abstract
Recently, low-carbohydrate diets (LCDs) have gained worldwide attention. LCDs are potentially effective for Japanese overweight and obese individuals with metabolic disorders. However, few randomized trials of LCDs have focused on the difference between LCDs and VLCDs. We conducted a randomized, prospective study of 42 Japanese, obese adults aged 28–65 years to evaluate the efficacy and safety of LCD and VLCD. To ensure the accuracy of the study, all test meals were provided, and compliance was checked using a smartphone app. Body composition measurements and blood tests were performed before and after the 2-month dietary intervention. The results showed that both methods significantly reduced body weight and fat, and also improved lipid abnormalities and liver function. In the current study, the reductions in weight and fat were comparable. The results of a questionnaire at the end of the study indicated that the LCD was easier to carry out than the VLCD, suggesting that the LCD was sustainable. The present study was unique in that it was a randomized, prospective study of Japanese subjects and that accurate data were obtained by providing meals.
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Blocking Periostin Prevented Development of Inflammation in Rhabdomyolysis-Induced Acute Kidney Injury Mice Model. Cells 2022; 11:cells11213388. [DOI: 10.3390/cells11213388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/13/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Rhabdomyolysis is the collapse of damaged skeletal muscle and the leakage of muscle-cell contents, such as electrolytes, myoglobin, and other sarcoplasmic proteins, into the circulation. The glomeruli filtered these products, leading to acute kidney injury (AKI) through several mechanisms, such as intratubular obstruction secondary to protein precipitation. The prognosis is highly mutable and depends on the underlying complications and etiologies. New therapeutic plans to reduce AKI are now needed. Up to now, several cellular pathways, with the nuclear factor kappa beta (NF-kB), as well as the proinflammatory effects on epithelial and tubular epithelial cells, have been recognized as the major pathway for the initiation of the matrix-producing cells in AKI. Recently, it has been mentioned that periostin (POSTN), an extracellular matrix protein, is involved in the development of inflammation through the modulation of the NF-kB pathway. However, how POSTN develops the inflammation protection in AKI by rhabdomyolysis is uncertain. This study aimed to investigate the role of POSTN in a rhabdomyolysis mice model of AKI induced by an intramuscular injection of 50% glycerol. Methods: In vivo, we performed an intramuscular injection of 50% glycerol (5 mg/kg body weight) to make rhabdomyolysis-induced AKI. We examined the expression level of POSTN through the progression of AKI after glycerol intramuscular injection for C57BL/6J wildtype (WT) mice. We sacrificed mice at 72 h after glycerol injection. We made periostin-null mice to examine the role of POSTN in acute renal failure. The role of periostin was further examined through in vitro methods. The development of renal inflammation is linked with the NF-kB pathway. To examine the POSTN function, we administrated hemin (100 μM) on NIH-3T3 fibroblast cells, and the following signaling pathways were examined. Results: The expression of periostin was highly increased, peaking at about 72 h after glycerol injection. The expression of inflammation-associated mRNAs such as monocyte chemotactic protein-1 (MCP-1), tumor necrosis factor-alpha (TNF-a) and IL-6, and tubular injury score in H-E staining were more reduced in POSTN-null mice than WT mice at 72 h after glycerol injection. Conclusion: POSTN was highly expressed in the kidney through rhabdomyolysis and was a positive regulator of AKI. Targeting POSTN might propose a new therapeutic strategy against the development of acute renal failure.
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Kushiyama A, Takahashi M, Kushiyama S, Kikuchi T, Asano T. Metabolism-dependent Vascular Pathophysiology in Adult Diseases. YAKUGAKU ZASSHI 2022; 142:465-471. [DOI: 10.1248/yakushi.21-00176-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | | | - Sakura Kushiyama
- National College of Nursing, National Center for Global Health and Medicine
| | - Takako Kikuchi
- Division of Diabetes and Metabolism, The Institute of Medical Science, Asahi Life Foundation
| | - Tomoichiro Asano
- Department of Medical Chemistry, Division of Molecular Medical Science, Graduate School of Biomedical Sciences, Hiroshima University
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Kasahara T, Tsujiguchi H, Takeshita Y, Hara A, Suzuki K, Narukawa N, Hayashi K, Miyagi M, Asai A, Yamada Y, Nakamura H, Suzuki F, Pham KO, Hamagishi T, Nakamura M, Shibata A, Shimizu Y, Nguyen TTT, Miyagi S, Kambayashi Y, Kannon T, Tajima A, Tsuboi H, Konoshita T, Takamura T, Nakamura H. A retrospective cohort study on the association between poor sleep quality in junior high school students and high hemoglobin A1c level in early adults with higher body mass index values. BMC Endocr Disord 2022; 22:40. [PMID: 35164727 PMCID: PMC8845399 DOI: 10.1186/s12902-022-00951-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/31/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Few epidemiological studies have been performed to clarify the association between glucose metabolism disorders in early adults (20 years old) and physiological and environmental factors, including body mass index (BMI) in junior high school days. Therefore, we examined the association between hemoglobin A1c (HbA1c) level and body size (BMI) in early adulthood and lifestyles, including sleep habits and BMI in junior high school days in Shika town, a small town in Japan, by conducting a retrospective cohort study. METHODS We examined the HbA1c levels and body size (BMI) of 99 early adults who turned 20 years old between 2016 and 2020 and were residing in Shika town, Ishikawa Prefecture. We obtained the information on lifestyles and living environment factors, including BMI, from a questionnaire survey conducted among the subjects during their junior high school days (13-15 years old) from 2009 to 2013. RESULTS No correlations were observed between the HbA1c levels and the BMI values of the early adults. A two-way analysis of covariance (with the HbA1c levels and BMI values of the early adults as main factors) of the body size and lifestyle habits of the junior high school students revealed that "sleep quality in junior high school" was significantly poorer in the high HbA1c group than in the low HbA1c group in the early adults with high BMI values only. This result was also supported by the logistic regression analysis result. CONCLUSIONS The present results indicate that poor sleep quality in junior high school was associated with the high HbA1c levels of the early adults with higher BMI values, which suggests that good sleep quality in junior high school prevents the development of hyperglycemia. However, the present study did not find any relationship between early-adult BMI and HbA1c level.
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Affiliation(s)
- Tomoko Kasahara
- Department of Hygiene and Public Health, Graduate School of Advanced Preventive, Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan.
| | - Hiromasa Tsujiguchi
- Department of Hygiene and Public Health, Graduate School of Advanced Preventive, Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
- Department of Hygiene and Public Health, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
- Kanazawa University Advanced Preventive Medical Sciences Research Center, Takara-Machi 13-1, Kanazawa, Ishikawa, 920-8640, Japan
| | - Yumie Takeshita
- Department of Endocrinology and Metabolism, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Akinori Hara
- Department of Hygiene and Public Health, Graduate School of Advanced Preventive, Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
- Department of Hygiene and Public Health, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
- Kanazawa University Advanced Preventive Medical Sciences Research Center, Takara-Machi 13-1, Kanazawa, Ishikawa, 920-8640, Japan
| | - Keita Suzuki
- Department of Hygiene and Public Health, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Nobuhiko Narukawa
- Department of Hygiene and Public Health, Graduate School of Advanced Preventive, Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Koichiro Hayashi
- Department of Hygiene and Public Health, Graduate School of Advanced Preventive, Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Masateru Miyagi
- Department of Hygiene and Public Health, Graduate School of Advanced Preventive, Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Atsushi Asai
- Department of Hygiene and Public Health, Graduate School of Advanced Preventive, Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Yohei Yamada
- Department of Hygiene and Public Health, Graduate School of Advanced Preventive, Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Haruki Nakamura
- Department of Hygiene and Public Health, Graduate School of Advanced Preventive, Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Fumihiko Suzuki
- Department of Hygiene and Public Health, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
- Community Medicine Support Dentistry, Ohu University Hospital, Koriyama, Fukushima, 963-8611, Japan
| | - Kim-Oanh Pham
- Department of Hygiene and Public Health, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Toshio Hamagishi
- Department of Hygiene and Public Health, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Masaharu Nakamura
- Department of Hygiene and Public Health, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Aki Shibata
- Department of Hygiene and Public Health, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Yukari Shimizu
- Department of Hygiene and Public Health, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
- Faculty of Health Sciences, Department of Nursing, Komatsu University, 14-1 Mukaimotoori-Machi, Komatsu, Ishikawa, 923-0961, Japan
| | - Thao Thi Thu Nguyen
- Department of Hygiene and Public Health, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
- Faculty of Public Health, Haiphong University of Medicine and Pharmacy, 180000, Ngo Quyen, Hai Phong, Vietnam
| | - Sakae Miyagi
- Innovative Clinical Research Center, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Yasuhiro Kambayashi
- Department of Public Health, Faculty of Veterinary Medicine, Okayama University of Science, 1-3 Ikoinooka, Imabari, Ehime, 794-8555, Japan
| | - Takayuki Kannon
- Kanazawa University Advanced Preventive Medical Sciences Research Center, Takara-Machi 13-1, Kanazawa, Ishikawa, 920-8640, Japan
- Department of Bioinformatics and Genomics, Graduate School of Advanced Preventive, Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Atsushi Tajima
- Kanazawa University Advanced Preventive Medical Sciences Research Center, Takara-Machi 13-1, Kanazawa, Ishikawa, 920-8640, Japan
- Department of Bioinformatics and Genomics, Graduate School of Advanced Preventive, Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Hirohito Tsuboi
- Institute of Medical, Pharmaceutical & Health Sciences, Kanazawa University, Kanazawa, 920-1192, Japan
| | - Tadashi Konoshita
- Department of Endocrinology and Metabolism, University of Fukui Hospital, 23-3, Matsuokashimoaizuki, Eiheiji, Fukui, 910-1193, Japan
- Third Department of Internal Medicine, University of Fukui Faculty of Medical Sciences, 23-3, Matsuokashimoaizuki, Eiheiji, Fukui, 910-1193, Japan
| | - Toshinari Takamura
- Department of Endocrinology and Metabolism, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Hiroyuki Nakamura
- Department of Hygiene and Public Health, Graduate School of Advanced Preventive, Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
- Department of Hygiene and Public Health, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
- Kanazawa University Advanced Preventive Medical Sciences Research Center, Takara-Machi 13-1, Kanazawa, Ishikawa, 920-8640, Japan
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Sugawa SW, Yoshida Y, Hikima Y, Sato H, Shimada A, Noda M, Kushiyama A. Characteristics Associated with Early Worsening of Retinopathy in Patients with Type 2 Diabetes Diagnosed with Retinopathy at Their First Visit: A Retrospective Observational Study. J Diabetes Res 2021; 2021:7572326. [PMID: 34337073 PMCID: PMC8313317 DOI: 10.1155/2021/7572326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/06/2021] [Indexed: 11/17/2022] Open
Abstract
MATERIALS AND METHODS Our study design was a retrospective observational study. Subjects with type 2 diabetes diagnosed with either simple or preproliferative diabetic retinopathy by ophthalmologists at their first visit and followed up for 6-18 months thereafter were included and divided into worsening and nonworsening groups. Thereafter, baseline characteristics and changes in HbA1c and therapy over a year were investigated. RESULTS Among the 88 subjects with simple diabetic retinopathy, 16% improved to no retinopathy, 65% retained their simple diabetic retinopathy, 18% worsened to preproliferative diabetic retinopathy, and 1% worsened to proliferative diabetic retinopathy. Among the 47 subjects with preproliferative diabetic retinopathy, 9% improved to simple diabetic retinopathy, 72% retained their preproliferative diabetic retinopathy, and 19% worsened to proliferative diabetic retinopathy. Patients with simple diabetic retinopathy had an odds ratio of 1.44 for worsening retinopathy with a 1% increase in baseline HbA1c. Meanwhile, the odds ratios for worsening retinopathy with a 1% decrease in HbA1c from baseline at 3, 6, and 12 months were 1.34, 1.31, and 1.38, respectively. Among patients with simple diabetic retinopathy, significantly more new interventions were introduced in the worsening group than in the nonworsening group. CONCLUSIONS Increased baseline HbA1c, a substantial decrease in HbA1c, and intensified therapy were identified as risk factors for early worsening of diabetic retinopathy in patients with simple diabetic retinopathy at the first visit. Patients should therefore be intimately followed for retinopathy after their first visit.
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Affiliation(s)
- Sayaka Wakabayashi Sugawa
- Division of Diabetes and Metabolism, The Institute of Medical Science, Asahi Life Foundation, 2-2-6, Nihonbashi Bakurocho, Chuo-ku, Tokyo 103-0002, Japan
- Department of Endocrinology and Diabetes, Saitama Medical University, 38 Morohongo Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan
| | - Yoko Yoshida
- Division of Diabetes and Metabolism, The Institute of Medical Science, Asahi Life Foundation, 2-2-6, Nihonbashi Bakurocho, Chuo-ku, Tokyo 103-0002, Japan
| | - Yusuke Hikima
- Department of Endocrinology and Diabetes, Saitama Medical University, 38 Morohongo Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan
| | - Haruhiko Sato
- Department of Endocrinology and Diabetes, Saitama Medical University, 38 Morohongo Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan
| | - Akira Shimada
- Department of Endocrinology and Diabetes, Saitama Medical University, 38 Morohongo Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan
| | - Mitsuhiko Noda
- Department of Endocrinology and Diabetes, Saitama Medical University, 38 Morohongo Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan
- Department of Diabetes, Metabolism and Endocrinology, Ichikawa Hospital, International University of Health and Welfare, 6-1-14 Kounodai, Ichikawa City, Chiba 272-0827, Japan
| | - Akifumi Kushiyama
- Division of Diabetes and Metabolism, The Institute of Medical Science, Asahi Life Foundation, 2-2-6, Nihonbashi Bakurocho, Chuo-ku, Tokyo 103-0002, Japan
- Department of Pharmacotherapy, Meiji Pharmaceutical University, 2-522-1, Noshio, Kiyose City, Tokyo 204-8588, Japan
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Biradar RA, Singh DP, Thakur H, Halli SS. Gender differences in the risk factors for high and very high blood glucose levels: A study of Kerala. Diabetes Metab Syndr 2020; 14:627-636. [PMID: 32422447 DOI: 10.1016/j.dsx.2020.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIMS Worldwide, lifestyle is a significant risk factor for diabetes. Lifestyle changes can lead to differences in the extent of risk of diabetes among women and men. Kerala, a state with one of the best health indicators in India, has a high prevalence of diabetes. This study aimed at comparing the variations in the risk factors for HBG and VHBG among adult women and men in Kerala. METHODS Data from the fourth round of the National Family Health Survey (2015-16) used to examine the differences in the risk factors for HBG and VHBG in men and women aged 15-49 years. We used bivariate, multivariate and Population Attributable Risk (PAR) techniques for analysing the data. RESULTS Bivariate results have shown the pattern of HBG and VHBG prevalence in women and men was same among all the age groups; however, men show a higher HBG and VHBG than women in all the age groups. Prevalence of HBG and VHBG was higher in women with a primary education, who were poor and not working as compared to their male counterparts. PARs results show that the prevalence of VHBG was higher among obese men and women as compared to normal men and underweight women. Prevalence of HBG was higher among men as compared to women due to alcohol use and weekly consumption of non-vegetarian food. CONCLUSIONS The study suggests that there is an urgent need for targeted intervention programs to address the problem of HBG and VHBG in both men and women in Kerala to control blood glucose levels.
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Affiliation(s)
- Rajeshwari A Biradar
- School of Development Studies, Tata Institute of Social Sciences, Mumbai, India.
| | - Dharmendra P Singh
- School of Research Methodology, Tata Institute of Social Sciences, Mumbai, India.
| | - Harshad Thakur
- National Institute of Health and Family Welfare, New Delhi, India; School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India.
| | - Shiva S Halli
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
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Pamungkas RA, Chamroonsawasdi K. Self-management based coaching program to improve diabetes mellitus self-management practice and metabolic markers among uncontrolled type 2 diabetes mellitus in Indonesia: A quasi-experimental study. Diabetes Metab Syndr 2020; 14:53-61. [PMID: 31887715 DOI: 10.1016/j.dsx.2019.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/07/2019] [Accepted: 12/07/2019] [Indexed: 12/11/2022]
Abstract
Diabetes mellitus self-management practice is an essential part of diabetes management among uncontrolled type 2 diabetes mellitus (T2DM). This study aimed to examine the effectiveness of the diabetes mellitus self-management (DMSM) based coaching program on improvement of the DMSM practice and metabolic markers. A quasi-experimental study, pre-test, and post-test design with the non-equivalent control group were applied in this study. Sixty samples were selected and were randomly assigned to both the experimental group and the control group. The Diabetes Self-Management Questionnaire (DSMQ) was used to measure the DMSM practice, while metabolic biomarkers were assessed by using the laboratory test. We conducted and compared the DMSM practice and clinical value at baseline and 12 weeks after completing the program. The DMSM based coaching program was a 12-week program with several strategies based on a self-management model. The findings showed that patients who received the DMSM based coaching program have a positive effect on DMSM practice and metabolic marker except for body mass index (BMI). This study revealed that the DMSM based coaching program was practical and feasible for implementation in a broad population with uncontrolled T2DM in Indonesia.
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Affiliation(s)
- Rian Adi Pamungkas
- Department of Nursing, Faculty of Health Sciences, Esa Unggul University, Jakarta, 11530, Indonesia.
| | - Kanittha Chamroonsawasdi
- Department of Family Health, Faculty of Public Health, Mahidol University, Bangkok, 10400, Thailand.
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8
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Kanai N, Shono A, Kushiyama A, Akazawa M. Characteristics and Early Hypoglycemic Medications of Patients at Risk of Progression to Type 2 Diabetes in Japan: A Retrospective Cohort Study of Health Checkup and Claims Data. Biol Pharm Bull 2019; 42:2016-2023. [PMID: 31787718 DOI: 10.1248/bpb.b19-00505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Medication therapy management by tracking patients with risk of progression to type 2 diabetes has not been investigated in Japan. We aimed to assess the characteristics of these patients and their early medications. Claims (n = 190507) and health checkup data (n = 106984) between April 2005 and March 2015 in Japan were selected. We selected patients aged ≥40 years with fasting plasma glucose levels of 100-125 mg/dL or glycated hemoglobin A1c values of 5.7-6.4%. The early-medication group comprised patients who received hypoglycemic medications within 6 months after their first clinic visit, while the no-medication group comprised patients who did not receive any hypoglycemic medications. Main outcome measures were characteristics and early hypoglycemic medications of patients at risk of progression to type 2 diabetes. Of 5676 individuals, hypoglycemic medications were initiated in 276 (5%). The early-medication group had a higher proportion of individuals with a body mass index ≥25 kg/m2 and current smokers and drinkers than the no-medication group. Approximately 83% of patients in the early-medication group were prescribed a single hypoglycemic medication, and since 2010, dipeptidyl peptidase-4 inhibitors were prescribed to one-third of these patients. In our population, early hypoglycemic medication was initiated within 6 months of the first clinic visit, indicating that initiation took place earlier than recommended by current guidelines. Early hypoglycemic medications, especially dipeptidyl peptidase-4 inhibitors with low risks of hypoglycemia, might be prescribed based on patient characteristics. Further epidemiological studies are needed to confirm the suitability of early hypoglycemic medication.
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Affiliation(s)
- Norihito Kanai
- Department of Public Health and Epidemiology, Meiji Pharmaceutical University.,Department of Pharmacy, Niiza Hospital
| | - Aiko Shono
- Department of Public Health and Epidemiology, Meiji Pharmaceutical University
| | | | - Manabu Akazawa
- Department of Public Health and Epidemiology, Meiji Pharmaceutical University
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Harashima S, Inagaki N, Kondo K, Maruyama N, Otsuka M, Kawaguchi Y, Watanabe Y. Efficacy and safety of canagliflozin as add-on therapy to a glucagon-like peptide-1 receptor agonist in Japanese patients with type 2 diabetes mellitus: A 52-week, open-label, phase IV study. Diabetes Obes Metab 2018; 20:1770-1775. [PMID: 29473709 PMCID: PMC6033027 DOI: 10.1111/dom.13267] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/16/2018] [Accepted: 02/19/2018] [Indexed: 12/13/2022]
Abstract
Sodium-glucose co-transporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1RAs) are antihyperglycaemic agents with weight-lowering effects. The efficacy and safety of the SGLT2 inhibitor canagliflozin as add-on therapy in Japanese patients with type 2 diabetes mellitus (T2DM) and inadequate glycaemic control with a GLP-1RA (≥12 weeks) were evaluated in this phase IV study. Patients received canagliflozin 100 mg once daily for 52 weeks. Efficacy endpoints included change in glycated haemoglobin (HbA1c), fasting plasma glucose (FPG), body weight, systolic blood pressure (SBP) and HDL cholesterol from baseline to week 52. Safety endpoints included adverse events (AEs), hypoglycaemia and laboratory tests. Of the 71 patients treated with canagliflozin, 63 completed the study. At 52 weeks, HbA1c was significantly reduced from baseline (-0.70%; paired t test, P < .001). Significant changes were also observed in FPG (-34.7 mg/dL), body weight (-4.46%), SBP (-7.90 mm Hg), and HDL cholesterol (7.60%; all P < .001). The incidence of AEs, adverse drug reactions and hypoglycaemia was 71.8%, 32.4% and 9.9%, respectively. All hypoglycaemic events were mild. These findings suggest that the long-term combination of canagliflozin with a GLP-1RA is effective and well tolerated in Japanese patients with T2DM.
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Affiliation(s)
- Shin‐ichi Harashima
- Department of Diabetes, Endocrinology and NutritionKyoto University Graduate School of MedicineKyotoJapan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and NutritionKyoto University Graduate School of MedicineKyotoJapan
| | - Kazuoki Kondo
- Ikuyaku Integrated Value Development DivisionMitsubishi Tanabe Pharma CorporationTokyoJapan
| | - Nobuko Maruyama
- Ikuyaku Integrated Value Development DivisionMitsubishi Tanabe Pharma CorporationTokyoJapan
| | - Makiko Otsuka
- Ikuyaku Integrated Value Development DivisionMitsubishi Tanabe Pharma CorporationTokyoJapan
| | - Yutaka Kawaguchi
- Ikuyaku Integrated Value Development DivisionMitsubishi Tanabe Pharma CorporationTokyoJapan
| | - Yumi Watanabe
- Ikuyaku Integrated Value Development DivisionMitsubishi Tanabe Pharma CorporationTokyoJapan
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Miyazawa I, Kadota A, Miura K, Okamoto M, Nakamura T, Ikai T, Maegawa H, Ohnishi A. Twelve-year trends of increasing overweight and obesity in patients with diabetes: the Shiga Diabetes Clinical Survey. Endocr J 2018. [PMID: 29526989 DOI: 10.1507/endocrj.ej17-0415] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The prevalence of obesity is increasing globally in patients with diabetes. This study aimed to examine 12-year trends of increasing obesity in Japanese patients with diabetes, and their clinical features. The study used results of the Shiga Diabetes Clinical Survey, which recorded medical performance in diabetic patients in 2000, 2006 and 2012. Data were analyzed from 14,205, 14,407 and 21,449 adult patients in these three years, respectively. Overweight and obesity prevalence and the clinical features of diabetes patients were examined, stratified by body mass index (BMI) and age. The prevalence of overweight (BMI 25-30 kg/m2) and obesity (BMI ≥30 kg/m2) were 27.0% and 5.1% in 2000, 28.9% and 7.3% in 2006 and 30.9% and 10.0% in 2012. Glycemic control, blood pressure and serum lipid profile improved over 12 years in all BMI categories. However, glycemic and triglyceride control were insufficient in obese patients aged <65 years (hemoglobin A1c 7.5 ± 1.4%, triglyceride 197.7 ± 178.4 mg/dL in 2012). The percentage of patients who used antihypertensive and lipid-lowering drugs increased and patients with higher BMI had increased frequency of using these drugs, both in young and old age groups. Higher BMI was significantly and positively associated with albuminuria. In summary, overweight and obesity have increased in Japanese diabetic patients, particularly for younger generations. Findings suggest that obesity may lead to poorer glycemic control, blood pressure and lipid profiles. Overweight and obesity are important modifiable risk factors for diabetes, suggesting that more active weight-control interventions are warranted.
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Affiliation(s)
- Itsuko Miyazawa
- Department of Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Aya Kadota
- Department of Public Health, Shiga University of Medical Science, Otsu 520-2192, Japan
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Otsu 520-2192, Japan
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu 520-2192, Japan
| | | | - Takashi Nakamura
- Department of Cardiology, Saiseikai Shiga Hospital, Ritto 520-3046, Japan
- Shiga Medical Association, Ritto 520-3031, Japan
| | - Tsuyoshi Ikai
- Wakakusa Clinic, Kusatsu 525-0045, Japan
- Shiga Medical Association, Ritto 520-3031, Japan
| | - Hiroshi Maegawa
- Department of Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Atsushi Ohnishi
- Ohnishi Clinic, Kusatsu 525-0054, Japan
- Shiga Medical Association, Ritto 520-3031, Japan
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11
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Kawazu S, Kanazawa Y, Iwamoto Y, Katayama S, Origasa H, Kuzuya T. Effect of antihyperglycemic drug monotherapy to prevent the progression of mild hyperglycemia in early type 2 diabetic patients: the Japan Early Diabetes Intervention Study (JEDIS). Diabetol Int 2017; 8:350-365. [PMID: 30603341 PMCID: PMC6224919 DOI: 10.1007/s13340-017-0319-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 03/27/2017] [Indexed: 11/25/2022]
Abstract
To effectively prevent the worsening of hyperglycemia in type 2 diabetes mellitus, it is of interest to see the clinical efficacy of early introduction of pharmacotherapy in addition to lifestyle intervention which is not always easy to continue throughout life. This is a randomized unblinded comparative clinical study on suppressive effects of lifestyle intervention alone and additional monotherapies for mild hyperglycemia at an early stage of treatment-naïve type 2 diabetic patients, whose fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c) are less than 140 mg/dl and 7.4%, respectively. The control group (group N = arm N) received conventional lifestyle intervention assisted by routine facilities, while the pharmacological intervention group (group D composed of 4 arms) was additionally treated by monotherapy with one of four kinds of oral antihyperglycemic agents i.e., sulfonylurea (SU), α-glucosidase inhibitor, biguanide and dipeptidyl peptidase-4 inhibitor. The participants were scheduled to follow up for 3 years to maintain glycemic control below primary endpoint which was defined as the first occurrence of FPG ≥140 mg/dl and HbA1c ≥7.4% simultaneously even by increasing doses of oral drug in group D, if necessary. The outcomes of occurrences of primary endpoint were not different between group N and group D composed of 4 arms during 3 years by Kaplan-Meyer plots (p = 0.405). On the other hand, ΔFPG (Δ: incremental change from baseline) and ΔHbA1c in group D significantly decreased when compared to those of group N during 3 years (p < 0.05 and p < 0.01 respectively). Significant reductions of ΔBMI were seen similarly in both groups throughout the study (p < 0.05), but did not differ between two groups. Among these 5 arms, significant decreases of ΔHbA1c were observed in three monotherapy arms of group D compared to arm N for 3 years (p < 0.05 or p < 0.01), except for arm SU in which ΔBMI and ΔHbA1c tended to increase at the latter half of the study. The final achievement rates of target HbA1c less than 7.4, 7.0 and 6.5% in all the participants tended to be higher in group D than in group N (p < 0.047 for 7.4%, but not significant for others). In conclusion, the early introduction of pharmacological monotherapy in addition to lifestyle intervention seem to suppress mild hyperglycemia with small doses of antihyperglycemic agents for 3 years, except for the use of SU drug. Although a larger scale of trial will be necessary to conclude, the early treatment with suitable monotherapy could be effective to bring and keep "safe level of glycemia".
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Affiliation(s)
- Shoji Kawazu
- The Institute for Adult Diseases, Asahi Life Foundation, 2-2-6 Nihonbashi, Bakuro-cho, Chuo-ku, Tokyo, 103-0002 Japan
| | | | - Yasuhiko Iwamoto
- The Institute for Adult Diseases, Asahi Life Foundation, 2-2-6 Nihonbashi, Bakuro-cho, Chuo-ku, Tokyo, 103-0002 Japan
| | | | - Hideki Origasa
- Department of Biostatistics and Clinical Epidemiology, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | | | - The JEDIS (Japan Early Diabetes Intervention Study) Research Group
- The Institute for Adult Diseases, Asahi Life Foundation, 2-2-6 Nihonbashi, Bakuro-cho, Chuo-ku, Tokyo, 103-0002 Japan
- Jichi Medical University, Tochigi, Japan
- Saitama Medical University, Saitama, Japan
- Department of Biostatistics and Clinical Epidemiology, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
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12
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Fujishiro M, Kushiyama A, Yamazaki H, Kaneko S, Koketsu Y, Yamamotoya T, Kikuchi T, Sakoda H, Suzuki R, Kadowaki T. Gastrointestinal symptom prevalence depends on disease duration and gastrointestinal region in type 2 diabetes mellitus. World J Gastroenterol 2017; 23:6694-6704. [PMID: 29085214 PMCID: PMC5643290 DOI: 10.3748/wjg.v23.i36.6694] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/12/2017] [Accepted: 06/01/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To unravel relationships between gastrointestinal (GI) symptoms impairing quality of life (QOL) and clinical profiles of diabetes mellitus (DM) patients.
METHODS We enrolled 134 outpatients with type 2 DM. Mean age was 64.7 years, mean body mass index was 24.7 kg/m2, mean glycated hemoglobin was 7.1%, and mean DM duration was 13.7 years. GI symptom-related QOL was determined using the Izumo scale, based on five factors, i.e., heartburn, gastralgia, postprandial fullness, constipation and diarrhea. The sum of scores obtained for the three questions in each domain was calculated, and subjects with a score of 5 or higher were considered to be symptomatic with impaired QOL. JMP Clinical version 5.0 was used for all statistical analyses.
RESULTS Lower abdominal symptoms were found to be more frequent than those affecting the upper abdomen. Diabetic duration and medications showed associations with GI symptoms. We identified differences in peak prevalences of the five symptoms. Gastralgia (P = 0.02 vs 10-14 years) and total GI symptoms (P = 0.01 and P = 0.02 vs 5-9 years and 10-14 years, respectively) peaked at a diabetes duration of 15-19 years. Heartburn (P = 0.004) and postprandial fullness (P = 0.03) tended to increase with disease duration. Constipation and diarrhea showed bimodal peaks, with the first early and the second late (e.g., P = 0.03 at 15-19 years vs 10-14 years for diarrhea) in the disease course. Finally, GI symptoms showed clustering that reflected the region of the GI tract affected, i.e., constipation and diarrhea had similar frequencies (P < 0.0001).
CONCLUSION Our study highlights the importance of questioning patients about QOL impairment due to abdominal symptoms, especially in the early and the late periods of diabetes.
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Affiliation(s)
- Midori Fujishiro
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, the University of Tokyo, Tokyo 113-8655, Japan
| | - Akifumi Kushiyama
- Division of Diabetes and Metabolism, Institute for Adult Diseases, Asahi Life Foundation, Tokyo 103-0002, Japan
| | - Hiroki Yamazaki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, the University of Tokyo, Tokyo 113-8655, Japan
| | - Sunao Kaneko
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, the University of Tokyo, Tokyo 113-8655, Japan
| | - Yuko Koketsu
- Department of Diabetes and Metabolic Diseases, Shinko Hospital, Kobe 651-0072, Japan
| | - Takeshi Yamamotoya
- Department of Medical Science, Graduate School of Medicine, University of Hiroshima, Hiroshima 734-8553, Japan
| | - Takako Kikuchi
- Division of Diabetes and Metabolism, Institute for Adult Diseases, Asahi Life Foundation, Tokyo 103-0002, Japan
| | - Hideyuki Sakoda
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kiyotakecho Kihara, Miyazaki 889-1692, Japan
| | - Ryo Suzuki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, the University of Tokyo, Tokyo 113-8655, Japan
| | - Takashi Kadowaki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, the University of Tokyo, Tokyo 113-8655, Japan
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Asada F, Nomura T, Tagami M, Kubota M, Ohashi M, Nomura M. Lower-limb muscle strength according to bodyweight and muscle mass among middle age patients with type 2 diabetes without diabetic neuropathy. J Phys Ther Sci 2017; 29:1181-1185. [PMID: 28744042 PMCID: PMC5509586 DOI: 10.1589/jpts.29.1181] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 04/17/2017] [Indexed: 12/12/2022] Open
Abstract
[Purpose] This study assessed the effects of type 2 diabetes without diabetic
polyneuropathy on muscle strength according to body composition in middle age patients.
[Subjects and Methods] This study included 45 non-diabetic individuals (control group) and
50 patients with type 2 diabetes (DM group), 40 to 64 years of age. The body composition
was examined, including the leg muscle volume (LMV), which was the sum of the lower-limb
muscle mass. The muscle strength was also examined, and the knee extension force (KEF),
ankle dorsiflexion force (ADF). The KEF and ADF were normalized to the bodyweight, and the
total leg muscle force (TLMF) were calculated by combining the KEF and ADF. The leg muscle
quality (LMQ) was calculated as the TLMF normalized with the LMV. [Results] While no
significant differences were found in the LMV between groups, the body mass index were
higher in the DM group than in the control group. Significant differences were observed in
%KEF, %ADF, and the LMQ in the DM group, with 15.8%, 18.7%, and 11.5% lower values than
those in the control group, respectively. [Conclusion] The results of this study may
demonstrate that muscle weakness occurs before diabetes progresses to a severe
condition.
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Affiliation(s)
- Fuminari Asada
- Research Center for the Health Promotion and Employment Support, Osaka Rosai Hospital, Japan
| | - Takuo Nomura
- Department of Rehabilitation Sciences, Faculty of Allied Health Sciences, Kansai University of Welfare Sciences, Japan
| | - Mitsuo Tagami
- Central Department of Rehabilitation, Osaka Rosai Hospital, Japan.,Present address: Central Department of Rehabilitation, Chugoku Rosai Hospital, Japan
| | - Masashi Kubota
- Research Center for the Health Promotion and Employment Support, Osaka Rosai Hospital, Japan
| | - Makoto Ohashi
- Research Center for the Health Promotion and Employment Support, Osaka Rosai Hospital, Japan
| | - Makoto Nomura
- Center for Diabetes Mellitus, Osaka Rosai Hospital, Japan
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14
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Nishimura T, Itoh Y, Yamashita S, Koide K, Harada N, Yano Y, Ikeda N, Azuma K, Atsumi Y. Clinical significance of serum complement factor 3 in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract 2017; 127:132-139. [PMID: 28365560 DOI: 10.1016/j.diabres.2017.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 03/16/2017] [Indexed: 02/07/2023]
Abstract
AIMS Although serum complement factor 3 (C3) is an acute phase reactant mainly synthesized in the liver, several recent studies have shown high C3 gene expression in adipose tissue (AT). However, the relationship between C3 and AT levels has not been fully clarified in type 2 diabetes mellitus (T2DM) patients. METHODS A total of 164 T2DM patients (109men and 55 women) participated in this cross-sectional study. A computed tomography scan was performed to measure visceral, subcutaneous, and total AT. The correlation between these factors and C3 levels was examined using Pearson's correlation analysis. A multivariate regression model was used to assess an independent determinant associated with C3 levels after adjusting the explanatory variables (i.e., all ATs [visceral, subcutaneous, and total], and clinical features [sex, age, body mass index, waist circumference, glycated hemoglobin, duration of diabetes, systolic blood pressure, diastolic blood pressure, aspartate aminotransferase levels, alanine aminotransferase levels, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, log(triglyceride levels), estimated glomerular filtration rate, and log(high-sensitivity C-reactive protein levels)]). RESULTS Serum C3 levels were correlated with visceral, subcutaneous, and total AT among both men (r=0.505, p<0.001; r=0.545, p<0.001; r=0.617, p<0.001, respectively) and women (r=0.396, p=0.003; r=0.517, p<0.001; r=0.548, p<0.001, respectively). In the multivariate regression model, the association between total AT and C3 levels remained significantly positive (β=0.490, p<0.001). CONCLUSIONS Serum C3 levels are associated with visceral, subcutaneous, and total AT in T2DM patients. Furthermore, C3 levels seem to be a marker for overall adiposity rather than regional adiposity.
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Affiliation(s)
- Takeshi Nishimura
- Department of Diabetes and Endocrinology, Eiju General Hospital, Life Extension Research Institute, Japan.
| | - Yoshihisa Itoh
- Medical Laboratory, Eiju General Hospital, Life Extension Research Institute, Japan
| | - Shigeo Yamashita
- Department of Diabetes and Endocrinology, Eiju General Hospital, Life Extension Research Institute, Japan
| | - Keiko Koide
- Diabetes Research Center, Eiju General Hospital, Life Extension Research Institute, Japan
| | - Noriaki Harada
- Medical Laboratory, Eiju General Hospital, Life Extension Research Institute, Japan
| | - Yasuo Yano
- Medical Laboratory, Eiju General Hospital, Life Extension Research Institute, Japan
| | - Nobuko Ikeda
- Medical Laboratory, Eiju General Hospital, Life Extension Research Institute, Japan
| | - Koichiro Azuma
- Institute for Integrated Sports Medicine, Keio University School of Medicine, Japan
| | - Yoshihito Atsumi
- Diabetes Research Center, Eiju General Hospital, Life Extension Research Institute, Japan
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15
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Transient remission of nonalcoholic fatty liver disease decreases the risk of incident type 2 diabetes mellitus in Japanese men. Eur J Gastroenterol Hepatol 2016; 28:1443-1449. [PMID: 27603300 DOI: 10.1097/meg.0000000000000736] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION It is unclear how the transient remission of nonalcoholic fatty liver disease (NAFLD) affects incident type 2 diabetes mellitus (T2DM). Here, we sought to determine the effect of the transient remission of NAFLD on incident T2DM in Japanese men. MATERIALS AND METHODS We used a population-based health check-up program. The primary outcome was set as incident T2DM. We divided the participants who showed NAFLD at the time of enrollment into three groups according to their clinical course of NAFLD: the Regression group, in which the participants showed a regression of NAFLD and no relapse during the follow-up period; the Transient Remission group, in which participants achieved a transient remission of NAFLD, but had a relapse of NAFLD; and the Persistent group, in which participants showed NAFLD throughout the follow-up. The Never group of participants who did not show NAFLD throughout the follow-up served as a reference. RESULTS The incidence rates of T2DM in the Never group, the Regression group, the Transient Remission group, and the Persistent group were 4.7% (62/1306), 9.2% (14/153), 18.0% (25/139), and 35.1% (120/342), respectively. In a multivariate Cox regression analysis with covariates, the adjusted hazard ratios for incident T2DM compared with the Never group were as follows: Regression group: 1.08 [95% confidence interval (CI) 0.53-2.04, P=0.81], Transient Remission group: 2.12 (95% CI 1.22-3.57, P<0.01), and Persistent group: 3.44 (95% CI 2.29-5.21, P<0.001). The adjusted hazard ratio of the Transient Remission group was significantly lower than that of the Persistent group (P<0.05). CONCLUSION Transient remission of NAFLD significantly decreased the risk of developing T2DM.
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16
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Kushiyama A, Kikuchi T, Tanaka K, Tahara T, Takao T, Onishi Y, Yoshida Y, Kawazu S, Iwamoto Y. Prediction of the effect on antihyperglycaemic action of sitagliptin by plasma active form glucagon-like peptide-1. World J Diabetes 2016; 7:230-238. [PMID: 27326345 PMCID: PMC4909424 DOI: 10.4239/wjd.v7.i11.230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 03/12/2016] [Accepted: 04/22/2016] [Indexed: 02/05/2023] Open
Abstract
AIM: To investigate whether active glucagon-like peptide-1 (GLP-1) is a prediction Factor of Effect of sitagliptin on patients with type 2 diabetes mellitus (GLP-1 FEST:UMIN000010645).
METHODS: Seventy-six patients with type 2 diabetes, who had insufficient glycemic control [Hemoglobin A1c (HbA1c) ≥ 7%] in spite of treatment with metformin and/or sulfonylurea, were included in the investigation. Patients were divided into three groups by tertiles of fasting plasma active GLP-1 level, before the administration of 50 mg sitagliptin.
RESULTS: At baseline, body mass index, serum UA, insulin and HOMA-IR were higher in the high active GLP-1 group than in the other two groups. The high active GLP-1 group did not show any decline of HbA1c (7.6% ± 1.4% to 7.5% ± 1.5%), whereas the middle and low groups indicated significant decline of HbA1c (7.4 ± 0.7 to 6.8 ± 0.6 and 7.4 ± 1.2 to 6.9 ± 1.3, respectively) during six months. Only the low and middle groups showed a significant increment of active GLP-1, C-peptide level, a decreased log and proinsulin/insulin ratio after administration. In logistic analysis, the low or middle group is a significant explanatory variable for an HbA1c decrease of ≥ 0.5%, and its odds ratio is 4.5 (1.40-17.6) (P = 0.01) against the high active GLP-1 group. This remains independent when adjusted for HbA1c level before administration, patients’ medical history, medications, insulin secretion and insulin resistance.
CONCLUSION: Plasma fasting active GLP-1 is an independent predictive marker for the efficacy of dipeptidyl peptidase 4 inhibitor sitagliptin.
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Fukuda T, Hamaguchi M, Kojima T, Hashimoto Y, Ohbora A, Kato T, Nakamura N, Fukui M. The impact of non-alcoholic fatty liver disease on incident type 2 diabetes mellitus in non-overweight individuals. Liver Int 2016; 36:275-83. [PMID: 26176710 DOI: 10.1111/liv.12912] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 07/06/2015] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS The aim of this study was to evaluate the impact of non-alcoholic fatty liver disease (NAFLD) on incident type 2 diabetes mellitus (T2DM) in non-overweight individuals with NAFLD. METHODS A population-based retrospective cohort study of 4629 participants who were enrolled in a health check-up programme for more than 10 years. A standardized questionnaire and abdominal ultrasonography were used to diagnose NAFLD. A cut-off point of BMI 23 kg/m(2) was used to define overweight (≥23.0 kg/m(2)) or non-overweight (<23.0 kg/m(2)). The primary outcome was incident T2DM. RESULTS Over a mean follow-up of 12.8 years, 351 participants (7.6%) developed T2DM. The incidence rate of T2DM was 3.2% in the non-overweight without NAFLD group, 14.4% in the non-overweight with NAFLD group, 8.0% in the overweight without NAFLD group and 26.4% in the overweight with NAFLD group. The adjusted hazard ratios for incident T2DM compared with the non-overweight without NAFLD group were as follows: 3.59 (95% CI: 2.14-5.76) in the non-overweight with NAFLD group, 1.99 (95% CI: 1.47-2.69) in the overweight without NAFLD group and 6.77 (95% CI: 5.17-8.91) in the overweight with NAFLD group. The adjusted hazard ratio in the non-overweight with NAFLD group was significantly higher than that in the overweight without NAFLD group or that in the non-overweight without NAFLD group. CONCLUSIONS Non-overweight individuals with NAFLD had a high risk of incident T2DM. Diagnosis of NAFLD is important in non-overweight individuals, and therefore it might be necessary to follow their health conditions on a long-term basis after detection of NAFLD.
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Affiliation(s)
- Takuya Fukuda
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Masahide Hamaguchi
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Takao Kojima
- Department of Gastroenterology, Murakami Memorial Hospital, Asahi University, Gifu, Japan
| | - Yoshitaka Hashimoto
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Akihiro Ohbora
- Department of Gastroenterology, Murakami Memorial Hospital, Asahi University, Gifu, Japan
| | - Takahiro Kato
- Department of Internal Medicine, Aiseikai Yamashina Hospital, Kyoto, Japan
| | - Naoto Nakamura
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
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Inagaki N, Goda M, Yokota S, Maruyama N, Iijima H. Safety and efficacy of canagliflozin in Japanese patients with type 2 diabetes mellitus: post hoc subgroup analyses according to body mass index in a 52-week open-label study. Expert Opin Pharmacother 2015; 16:1577-91. [PMID: 26104600 DOI: 10.1517/14656566.2015.1055250] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The safety and efficacy of sodium glucose co-transporter 2 inhibitors in non-obese compared with obese patients with type 2 diabetes mellitus is unknown. METHODS We conducted post hoc analyses of the results of a 52-week open-label study of Japanese type 2 diabetes mellitus patients treated with 100 or 200 mg canagliflozin. Patients were divided into four subgroups according to their baseline body mass index (BMI): group I, BMI < 22 kg/m(2); group II, BMI ≥ 22 to < 25 kg/m(2); group III, BMI ≥ 25 to < 30 kg/m(2) and group IV, BMI ≥ 30 kg/m(2). RESULTS The overall safety was similar among the four BMI subgroups, although there were slight differences in terms of the incidences of hypoglycemia, asymptomatic hypoglycemia, female genital infections and proportions of patients with total ketone body levels exceeding 1000 μmol/l at any time for both canagliflozin doses. Hemoglobin A1c, fasting plasma glucose and body weight decreased significantly from baseline to week 52 at both canagliflozin doses. The changes in hemoglobin A1c, and fasting plasma glucose were not significantly different among the four BMI subgroups for either dose. CONCLUSION Canagliflozin was tolerated in patients irrespective of their BMI at the start of treatment, although some caution may be needed.
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Affiliation(s)
- Nobuya Inagaki
- Kyoto University Graduate School of Medicine, Department of Diabetes, Endocrinology and Nutrition , Kyoto , Japan
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Kushiyama A, Tanaka K, Hara S, Kawazu S. Linking uric acid metabolism to diabetic complications. World J Diabetes 2014; 5:787-795. [PMID: 25512781 PMCID: PMC4265865 DOI: 10.4239/wjd.v5.i6.787] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 10/22/2014] [Accepted: 11/10/2014] [Indexed: 02/05/2023] Open
Abstract
Hyperuricemia have been thought to be caused by the ingestion of large amounts of purines, and prevention or treatment of hyperuricemia has intended to prevent gout. Xanthine dehydrogenase/xanthine oxidase (XDH/XO) is rate-limiting enzyme of uric acid generation, and allopurinol was developed as a uric acid (UA) generation inhibitor in the 1950s and has been routinely used for gout prevention since then. Serum UA levels are an important risk factor of disease progression for various diseases, including those related to lifestyle. Recently, other UA generation inhibitors such as febuxostat and topiroxostat were launched. The emergence of these novel medications has promoted new research in the field. Lifestyle-related diseases, such as metabolic syndrome or type 2 diabetes mellitus, often have a common pathological foundation. As such, hyperuricemia is often present among these patients. Many in vitro and animal studies have implicated inflammation and oxidative stress in UA metabolism and vascular injury because XDH/XO act as one of the major source of reactive oxygen species Many studies on UA levels and associated diseases implicate involvement of UA generation in disease onset and/or progression. Interventional studies for UA generation, not UA excretion revealed XDH/XO can be the therapeutic target for vascular injury and renal dysfunction. In this review, the relationship between UA metabolism and diabetic complications is highlighted.
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20
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Tanaka K, Hara S, Hattori M, Sakai K, Onishi Y, Yoshida Y, Kawazu S, Kushiyama A. Role of elevated serum uric acid levels at the onset of overt nephropathy in the risk for renal function decline in patients with type 2 diabetes. J Diabetes Investig 2014; 6:98-104. [PMID: 25621139 PMCID: PMC4296709 DOI: 10.1111/jdi.12243] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 03/11/2014] [Accepted: 04/07/2014] [Indexed: 02/06/2023] Open
Abstract
AIMS/INTRODUCTION Despite the use of intensive therapies, declining renal function is often observed during the overt nephropathy stage of type 2 diabetes. We aimed at investigating the role of serum uric acid (SUA) levels at the onset of overt nephropathy in the risk of renal function decline in type 2 diabetes patients. MATERIALS AND METHODS The present cohort study included 290 type 2 diabetes patients who were followed from the onset of overt nephropathy. The relationship between SUA and declining renal function was assessed using Cox regression models after adjusting for known risk factors. RESULTS Over a median 4.8-year follow-up period, 85 patients (4.9/100 person-years) showed serum creatinine (Cr) doubling with a total cumulative incidence of 71.9% at 20 years of follow up. The highest SUA tertile resulted in significantly a higher incidence (7.7/100 person-years) and cumulative incidence at 20 years (85.7%) than the middle (3.9/100 person-years, 54.2%) and lowest (3.0/100 person-years, 55.5%) tertiles. The univariate Cox hazard model resulted in significant risks for Cr doubling related to female sex, short diabetes duration, smoking and elevated levels of low-density lipoprotein cholesterol (LDL-c), glycated hemoglobin and SUA tertiles. SUA tertiles remained statistically significant in the multivariate model (highest vs lowest hazard ratio 2.68, 95% confidence interval 1.48-5.00, P = 0.0009). CONCLUSIONS Elevated SUA levels within the normal range (men >6.3 mg/dL, women >5.1) at the onset of overt nephropathy resulted in an increased risk for declining renal function in type 2 diabetes patients.
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Affiliation(s)
- Kentaro Tanaka
- Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation Tokyo, Japan
| | - Shigeko Hara
- Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation Tokyo, Japan
| | - Masakazu Hattori
- Division of Diabetes, Clinical Research Center for Endocrinology and Metabolic Diseases, National Hospital Organization, Kyoto Medical Center Kyoto, Japan
| | - Ken Sakai
- Department of Nephrology, School of Medicine, Faculty of Medicine, Toho University Tokyo, Japan
| | - Yukiko Onishi
- Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation Tokyo, Japan
| | - Yoko Yoshida
- Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation Tokyo, Japan
| | - Shoji Kawazu
- Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation Tokyo, Japan
| | - Akifumi Kushiyama
- Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation Tokyo, Japan
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