Introduction The dose of roxadustat, a hypoxia-inducible factor prolyl hydroxylase (HIF-PH) inhibitor, required to treat anemia, the hemoglobin level and the rate of hemoglobin target achievement ...were retrospectively investigated in non-dialyzed chronic kidney disease (CKD) patients with and without type 2 diabetes. Methods As the full analysis set, 25 subjects (10 with diabetes and 15 without diabetes) were observed over six months among 44 non-dialyzed CKD patients who received roxadustat. The target hemoglobin level was set at 110-130 g/L. Results The comorbidities of diabetes and body weight at baseline were significantly associated with each dose of roxadustat at six months and the change in each dose of roxadustat from the initiation of roxadustat treatment. There was no significant difference in the amount of increase in the hemoglobin level (14±11 g/L vs. 15±8 g/L) and the rate of hemoglobin target achievement (70% vs. 67%) between patients with and without diabetes. Each dose of roxadustat gradually decreased in patients without diabetes, whereas it increased in those with diabetes. Each dose of roxadustat was significantly higher in patients with diabetes than in those without diabetes at 3 (60±21 mg vs. 42±14 mg) and 6 (61±22 mg vs. 41±14 mg) months after the initiation of roxadustat treatment. Conclusion Roxadustat is useful for the treatment of anemia in both CKD patients with and without diabetes. However, the dose required to achieve the target hemoglobin level may be higher in patients with diabetes than in those without diabetes.
A 68-year-old man was admitted to our hospital with swelling of his left leg. We administered antibiotics following a diagnosis of cellulitis, and the symptoms improved. However, the cellulitis ...recurred at the same site and became severe, and he was hospitalized for treatment and an examination. His plasma glucose was 341 mg/dL, but his hemoglobin A1c (HbA1c) was only 4.3 % on high-performance liquid chromatography (HPLC; HLC®-273G9; Tosho. We therefore suspected the presence of variant hemoglobin and performed isoelectric focusing followed by a genetic analysis. A globin gene analysis revealed a heterozygous mutation, and we identified variant hemoglobin HbE-Saskatoon β22 Glu (GAA) →Lys (AAA) . We considered the HbA1c value measured by HPLC to have been a falsely low value. We then treated him with no reference to the HbA1c, and he has since shown a good course with no recurrence of cellulitis. We encountered a case of HbA1c on HPLC showing a falsely low value due to HbE-Saskatoon. Treatment of the patient's infectious disease resulted in a good outcome following the identification of the cause of the false HbA1c value and appropriate glycemic control.
To study the relationship between the intima-media thickness (IMT) of the carotid artery and the stage of chronic kidney disease (CKD) based on the estimated glomerular filtration rate (eGFR) and ...diabetic nephropathy graded by the urinary albumin excretion (UAE) in the patients with type 2 diabetes mellitus.
A cross-sectional study was performed in 338 patients with type 2 diabetes mellitus. The carotid IMT was measured using an ultrasonographic examination.
The mean carotid IMT was 1.06 +/- 0.27 mm, and 42% of the subjects showed IMT thickening (>or= 1.1 mm). Cerebrovascular disease and coronary heart disease were frequent in the patients with IMT thickening. The carotid IMT elevated significantly with the stage progression of CKD (0.87 +/- 0.19 mm in stage 1, 1.02 +/- 0.26 mm in stage 2, 1.11 +/- 0.26 mm in stage 3, and 1.11 +/- 0.27 mm in stage 4+5). However, the IMT was not significantly different among the various stages of diabetic nephropathy. The IMT was significantly greater in the diabetic patients with hypertension compared to those without hypertension. The IMT positively correlated with the age, the duration of diabetes mellitus, and the brachial-ankle pulse wave velocities (baPWV), and negatively correlated with the eGFR. In a stepwise multivariate regression analysis, the eGFR and the baPWV were independently associated with the carotid IMT.
Our study is the first report showing a relationship between the carotid IMT and the renal parameters including eGFR and the stages of diabetic nephropathy with a confirmed association between the IMT and diabetic macroangiopathy. Our study further confirms the importance of intensive examinations for the early detection of atherosclerosis and positive treatments for hypertension, dyslipidaemia, obesity, as well as hyperglycaemia are necessary when a reduced eGFR is found in diabetic patients.
Full text
Available for:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Patients with type 2 diabetes (history of treatment discontinuation, n=78; no history of treatment discontinuation, n=516) were prospectively observed for 5 years, and the incidence of treatment ...discontinuation was investigated. Age and a history of treatment discontinuation were associated with treatment discontinuation in the overall population (hazard ratio: 2.17). HbA1c (hazard ratio: 2.12) was significantly associated with treatment discontinuation in patients with a history of discontinuation, while age and BMI were significantly associated with treatment discontinuation in patients without a history of treatment discontinuation. The treatment discontinuation rate after 5 years was 23 % in patients with a history of treatment discontinuation, which was significantly higher in comparison to that in patients without a history of treatment discontinuation (11 %). At the start of the observation period, the HbA1c value was higher in patients with a history of treatment discontinuation; however, after the first year it remained similar to that in the group without a history of treatment discontinuation. The prevalence of retinopathy and nephropathy remained higher in the group with a history of treatment discontinuation. A history of treatment discontinuation is a risk factor for re-discontinuation, and even if treatment is continued, vascular complications cannot be sufficiently reduced. Therefore, it is important to prevent discontinuation from the start of treatment.
We examined the relationship between outpatient medical costs and changes in body weight in 105 obese patients (BMI >25.0 kg/m2) with type 2 diabetes without diabetic macroangiopathies, GLP-1 ...receptor agonist use or SGLT2 inhibitor use for 5 years from 2008. The outpatient medical cost significantly increased in the weight-loss group (n=56), from an average of 323,000 yen/year to 369,000 yen/year as well as in the weight-gain group, from 356,000 yen/year to 473,000 yen/year. However, the change (46,000 yen/year vs. 117,000 yen/year) was significantly lower in the weight-loss group than in the weight-gain group. Furthermore, in the weight-loss group, the HbA1c value did not worsen, and the number of prescribed drugs for lifestyle-related diseases did not increase, in contrast to the weight-gain group. The change in outpatient medical cost was significantly correlated with the change in the number of drugs being administered for lifestyle-related diseases. These results suggest that non-pharmaceutical weight loss in obese patients with type 2 diabetes may suppress the increase in medical costs via an absence of deterioration in glycemic control and no increase in numbers of prescribed drugs.
Aims
The aim of the present study was to clarify the relationships between the duration of diabetes and the current statuses of diabetes in elderly (aged ≥65 years) patients with type 2 diabetes.
...Methods
Clinical characteristics were cross‐sectionally examined in 1436 patients (684 elderly and 752 non‐elderly) with type 2 diabetes.
Results
As the duration of diabetes increased, the patients' age, frequency of receiving insulin therapy and glycated hemoglobin value increased in both the elderly and non‐elderly groups, whereas the urinary C‐peptide immunoreactivity and glomerular filtration rate decreased. The duration of diabetes (years) was significantly associated with the prevalence of diabetic retinopathy (OR 1.05, 95% CI 1.03–1.07, P < 0.01), nephropathy (OR 1.03, 95% CI 1.01–1.05, P < 0.01) and neuropathy (OR 1.08, 95% CI 1.05–1.12, P < 0.01), but not with cerebrovascular disease (OR 1.01, 95% CI 0.99–1.03, P = 0.38), coronary heart disease (OR 1.02, 95% CI 1.00–1.04, P = 0.09) or peripheral artery disease (OR 1.02, 95%CI 0.99–1.05, P = 0.12) in the elderly patients after adjusting for the traditional risk factors of diabetic angiopathies. In contrast, the duration of diabetes showed a significant association with the prevalence of both diabetic micro‐ and macroangiopathies in the non‐elderly patients.
Conclusions
It should be noted that atherosclerotic diseases are present in the clinical setting for the management of elderly diabetic patients independent of the duration of diabetes. Geriatr Gerontol Int 2017; 17: 24–30.
Full text
Available for:
FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
We aimed to investigate the long-term effect of metformin on the blood glucose control in non-obese patients with type 2 diabetes mellitus.
A retrospective study was performed in 213 patients with ...type 2 diabetes mellitus under the administration of metformin for more than one year. The clinical parameters were investigated for 3 years. The obese and non-obese individuals were defined as a body mass index (BMI) of 25 kg/m2 or over (n = 105) and a BMI of less than 25 kg/m2 (n = 108), respectively.
HbA1c levels were significantly decreased compared with those at the baseline time. The course of HbA1c was similar between the non-obese and the obese groups, while the dose of metformin required to control blood glucose was significantly lower in the non-obese group than in the obese group. The reductions in HbA1c were 1.2% and 1.1% at 12 months, 0.9% and 0.9% at 24 months, and 0.8% and 1.0% at 36 months in the non-obese and obese groups, respectively. BMI did not change during the observation periods. Approximately half of all patients required no additional antidiabetic agents or a reduction in other treatments after the initiation of metformin in either of the two groups.
The present study demonstrated the long-term beneficial effect of metformin in non-obese (BMI < 25 kg/m2) diabetic patients. This effect appears to be maintained even after the observation period of this study, because metformin was limited to a relatively low dose in the non-obese group and the observed worsening in glycemic control over time can probably be attenuated by increasing the dose of metformin.
Full text
Available for:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Nurses assigned to a ward observe the feet of diabetic patients on admission and provide medical support for the early detection and prevention of diabetic foot in our hospital. The relationship ...between the results obtained from a DPNCheck®, a simple nerve conduction measurement device that is useful for diagnosing diabetic neuropathy, and the risk of diabetic foot assessed by the nurses was examined in the present study. One hundred and eleven patients with type 2 diabetes (mean age: 64±14 years, duration of diabetes: 10±9 years) was studied. The abnormal group was defined as the patients with ≥2 abnormalities in 16 observation items for the feet. Assignment to the abnormal group was relatively frequent (n=54, 49 %), and the sensory nerve action potential amplitude (SNAP) was significantly lower in the abnormal group (7.1±4.2 μV) than in the normal group (9.5±5.1 μV). The total number of abnormalities in observation items showed a significantly negative correlation with the SNAP. In particular, the SNAP was significantly lower in the patients found to have an abnormality in their skin or blood flow than in those without such an abnormality. The DPNCheck® is considered useful for identifying patients who should receive educational guidance and/or medical support concerning foot care.
We aimed to clarify the usefulness of measuring the flow mediated dilatation (FMD) in patients with type 2 diabetes mellitus without and with coronary heart disease (CHD). The FMD was measured in 480 ...patients with type 2 diabetes and in 240 nondiabetic subjects. The FMD was significantly lower in the subjects with CHD (n = 145, 5.4±3.2%) than in those without CHD (n = 95, 6.9±3.5%) among the nondiabetic subjects. The FMD was also lower in the subjects both with CHD (n = 161, 5.6±2.8%) and without CHD (n = 319, 6.1±3.3%) among the patients with diabetes compared to those without both diabetes and CHD. The FMD showed a significant positive correlation with the estimated glomerular filtration rate (eGFR) in the diabetic patients without CHD, while there was no significant association in those with CHD. The FMD was significantly lower with the progressive stages of the GFR or albuminuria in the patients without CHD among those with diabetes, although the FMD was not different in those with CHD. In conclusion, the FMD is considered to be useful for the detection of atherosclerosis in patients with type 2 diabetes, even if overt macroangiopathy is not diagnosed.
Full text
Available for:
FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK
PDF
