HEC Science Clinic

Yokohama-shi, Japan

HEC Science Clinic

Yokohama-shi, Japan

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Kanatsuka A.,Diabetes Center | Kawai K.,Kawai Clinic | Hirao K.,H.E.C. Science Clinic | Yokoyama H.,Jiugaoka Medical Clinic | Kobayashi M.,Takaoka Social Insurance Hospital
Diabetology International | Year: 2012

Introduction: We examined the clinical characteristics of type 2 diabetes mellitus (T2D) patients requiring insulin therapy and evaluated the efficacy of adding insulin therapy regimens to oral anti-diabetic drugs. Materials and methods: Members of the Japan Diabetes Data Management Study Group across 55 institutes specializing in diabetes entered their clinical data into the CoDiC ® database. Of 19,800 patients treated with oral drugs from 1 May to 31 July 2006, we analyzed the data from 15,589 patients whose data input was continued until 31 July 2009. Results: A total of 1,014 patients out of those studied were started on insulin therapy during 2006-2009. Age and age-of-onset were lower in the insulin-initiated patients compared with patients who continued on oral drugs (P < 0.001). Insulin therapy was initiated at a mean HbA1c level of 9. 18 %. The HbA1c levels at 6 months after initiation of insulin treatment and at the end of the study were lowest in patients treated with a prandial rapid-acting insulin analog (RA) (P < 0.001). Only 7 patients were started on the basal-bolus therapy, while 95 patients were transferred to this therapy from their original insulin regimen. These patients had the lowest age and age-of-onset, and the highest body mass index (P < 0.001, P = 0.003 and P = 0.013, respectively). Conclusion: The initiation rate of insulin therapy in patients treated with oral drugs is estimated to be 2. 2/100 per year in Japan, and the therapy is initiated at an HbA1c level far from the target level. The significant characteristics of patients who started on insulin therapy were a relatively low age and age-of-onset, and long diabetes duration. Prandial RA insulin treatment is superior for glycemic control, and this therapy can be transferred to basal-bolus therapy based on the severity of T2D. © 2012 The Japan Diabetes Society.


Arai K.,Arai Clinic | Hirao K.,H.E.C. Science Clinic | Yamauchi M.,H.E.C. Science Clinic | Kobayashi M.,Takaoka Social Insurance Hospital | Kashiwagi A.,Shiga University of Medical Science
Endocrine Journal | Year: 2013

Insulin therapy is often required to achieve good glycemic control for the patients with type 2 diabetes mellitus (T2DM), while protraction of glycemic control without insulin therapy may be preferable for patients. To determine the characteristics of and therapeutic regimen in outpatients with T2DM who were able to stop insulin therapy with satisfactory glycemic control in a real clinical practice setting in Japan by a case-control study. The present study was performed on 928 patients with T2DM who started insulin therapy in 2007. Data regarding age, sex, body mass index, duration of diabetes, HbA1c, postprandial plasma glucose, plasma fasting C-peptide immunoreactivity and treatment modality were compared between patients who were able to stop insulin therapy and those who continued with insulin. Of the 928 patients, 37 had stopped insulin therapy within 1 year. In the patients who stopped insulin therapy, the duration of diabetes was significantly shorter and the daily insulin dosage at initiation and the prevalence of sulfonylurea pretreatment significantly lower compared with patients who continued on insulin. In conclusion, almost 4% of T2DM patients were able to stop insulin therapy with satisfactory glycemic control in a real clinical practice setting in Japan. Shorter duration of diabetes and disuse of sulfonylureas prior to insulin may associate with stopping insulin therapy as a near-normoglycemic remission in outpatients with T2DM in Japan. © The Japan Endocrine Society.


Matsuba I.,Matsuba Medical Clinic | Sone H.,University of Tsukuba | Saito K.,University of Tsukuba | Takai M.,Takai Internal Medicine Clinic | Hirao K.,H.E.C. Science Clinic
Diabetes Care | Year: 2012

OBJECTIVE - To investigate the relationship between fasting insulin levels andmetabolic risk factors (MRFs) in type 2 diabetic patients at the first clinic/hospital visit in Japan over the years 2000 to 2009. RESEARCH DESIGN AND METHODS - In total, 4,798 drug-naive Japanese patients with type 2 diabetes were registered on their first clinic/hospital visits. Conventional clinical factors and fasting insulin levels were observed at baseline within the Japan Diabetes Clinical Data Management ( JDDM) study between consecutive 2-year groups. Multiple linear regression analysis was performed using a model in which the dependent variable was fasting insulin values using various clinical explanatory variables. RESULTS - Fasting insulin levels were found to be decreasing from 2000 to 2009. Multiple linear regression analysis with the fasting insulin levels as the dependent variable showed that waist circumference (WC), BMI, mean blood pressure, triglycerides, and HDL cholesterol were significant, with WC and BMI as the main factors. ANCOVA after adjustment for age and fasting plasma glucose clearly shows the decreasing trend in fasting insulin levels and the increasing trend in BMI. CONCLUSIONS - During the 10-year observation period, the decreasing trend in fasting insulin was related to the slight increase in WC/BMI in type 2 diabetes. Low pancreatic β-cell reserve on top of a lifestyle background might be dependent on an increase in MRFs. © 2012 by the American Diabetes Association.


Arai K.,Arai Clinic | Hirao K.,H.E.C. Science Clinic | Yamauchi M.,H.E.C. Science Clinic | Takagi H.,Toho University | Kobayashi M.,University of Toyama
Clinical Drug Investigation | Year: 2010

Background and Objective: Good glycaemic control in patients with diabetes mellitus often requires insulin supplementation therapy. Recent developments of analogue insulin and premixed formulations have increased the therapeutic options for patients who need such therapy. This study aimed to retrospectively clarify appropriate treatment regimens according to age, body mass index (BMI) and duration of diabetes in Japanese patients with type 2 diabetes previously entered in an open-label, randomized trial that compared convenience-oriented biphasic insulin aspart 30 versus multiple injections of insulin aspart with or without NPH insulin. Methods: Japanese insulin-nai ve patients were randomized to receive either biphasic insulin aspart 30 twice daily or insulin aspart three times daily with or without multiple injections of NPH insulin for a treatment period lasting 6 months. Results: Reduction of glycosylated haemoglobin (HbA1c) at the end of 6 months was not different in the two treatment groups irrespective of BMI, age and duration of diabetes. However, the achievement rate of HbA1c <7.0% was significantly higher in patients with a BMI <25 kg/m2 in the multipleinjection group and tended to be higher in patients with a diabetes duration <10 years in the twice-daily injection group. Conclusion: Twice-daily injections of biphasic insulin aspart 30 may be more suitable for obese patients whereas multiple injections of insulin aspart with or without NPH insulin may be preferable for those with a longer duration of diabetes. © 2010 Adis Data Information BV. All rights reserved.


Kaneko S.,Red Cross | Chow F.,Chinese University of Hong Kong | Choi D.S.,Korea University | Taneda S.,Manda Memorial Hospital | And 5 more authors.
Diabetes Research and Clinical Practice | Year: 2015

AimsInsulin degludec/insulin aspart (IDegAsp) is a soluble co-formulation of IDeg and IAsp. This pan-Asian, 26-week trial investigated efficacy and safety of IDegAsp vs biphasic insulin aspart 30 (BIAsp 30) in Asian adults with type 2 diabetes (T2DM), inadequately controlled on once- or twice-daily (BID) basal, premixed or self-mixed insulin. MethodsParticipants (mean age 59.8 years, HbA1c 8.4%, FPG 7.9mmol/L, BMI 25.4kg/m2) were randomised 2:1 to BID IDegAsp (n=282) or BIAsp 30 (n=142) and continued existing metformin treatment. Insulins were administered with breakfast and main evening meal, titrated to a pre-breakfast and pre-main evening meal self-measured plasma glucose target of 4-5mmol/L. ResultsIDegAsp achieved the primary endpoint of non-inferiority to BIAsp 30 for mean change in HbA1c (estimated treatment difference [ETD] IDegAsp-BIAsp 30: 0.05% points [95% CI -0.10; 0.20]). IDegAsp was superior in lowering fasting plasma glucose (FPG) (ETD -1.06mmol/L, 95% CI -1.43; -0.70, p<0.001), and resulted in a lower final mean daily insulin dose (0.79U/kg vs 0.99U/kg, estimated rate ratio [RR] 0.79, 95% CI 0.73; 0.85, p<0.0001).Rates of overall confirmed and severe hypoglycaemia were similar between treatments, while rate of nocturnal confirmed hypoglycaemia was numerically (. p=. ns) lower with IDegAsp. During the maintenance period there was a trend (. p=. ns) towards lower hypoglycaemia rates for IDegAsp. ConclusionIn Asian adults with T2DM, IDegAsp BID effectively improves long-term glycaemic control, and compared to BIAsp 30, provides superior reductions in FPG with a lower dose, and numerically less nocturnal hypoglycaemia. © 2014 The Authors.


PubMed | Red Cross, Aarhus University Hospital, Korea University, Chinese University of Hong Kong and 4 more.
Type: Journal Article | Journal: Diabetes research and clinical practice | Year: 2015

Insulin degludec/insulin aspart (IDegAsp) is a soluble co-formulation of IDeg and IAsp. This pan-Asian, 26-week trial investigated efficacy and safety of IDegAsp vs biphasic insulin aspart 30 (BIAsp 30) in Asian adults with type 2 diabetes (T2DM), inadequately controlled on once- or twice-daily (BID) basal, premixed or self-mixed insulin.Participants (mean age 59.8 years, HbA1c 8.4%, FPG 7.9 mmol/L, BMI 25.4 kg/m(2)) were randomised 2:1 to BID IDegAsp (n=282) or BIAsp 30 (n=142) and continued existing metformin treatment. Insulins were administered with breakfast and main evening meal, titrated to a pre-breakfast and pre-main evening meal self-measured plasma glucose target of 4-5 mmol/L.IDegAsp achieved the primary endpoint of non-inferiority to BIAsp 30 for mean change in HbAc (estimated treatment difference [ETD] IDegAsp-BIAsp 30: 0.05% points [95% CI -0.10; 0.20]). IDegAsp was superior in lowering fasting plasma glucose (FPG) (ETD -1.06 mmol/L, 95% CI -1.43; -0.70, p<0.001), and resulted in a lower final mean daily insulin dose (0.79 U/kg vs 0.99 U/kg, estimated rate ratio [RR] 0.79, 95% CI 0.73; 0.85, p<0.0001). Rates of overall confirmed and severe hypoglycaemia were similar between treatments, while rate of nocturnal confirmed hypoglycaemia was numerically (p=ns) lower with IDegAsp. During the maintenance period there was a trend (p=ns) towards lower hypoglycaemia rates for IDegAsp.In Asian adults with T2DM, IDegAsp BID effectively improves long-term glycaemic control, and compared to BIAsp 30, provides superior reductions in FPG with a lower dose, and numerically less nocturnal hypoglycaemia.


Yokoyama H.,Jiyugaoka Medical Clinic | Araki S.,Shiga University of Medical Science | Haneda M.,Asahikawa University | Matsushima M.,Jikei University School of Medicine | And 7 more authors.
Diabetologia | Year: 2012

Aims/hypothesis: In type 2 diabetic patients at low risk for cardiovascular disease (CVD), the relationship between the clinical course of nephropathy by stage of chronic kidney disease (CKD) and onset of CVD remains unclear. Clarification of this relationship is important for clinical decision-making for both low-and high-risk diabetic patients. Methods: This 4 year prospective study enrolled 2,954 type 2 diabetic patients with no prevalent CVD, and serum creatinine <176.8 μmol/l. The risk for CVD onset (non-fatal and fatal CVD and stroke, and peripheral arterial disease) was assessed according to CKD stage categorised by urinary albumin-to-creatinine ratio (ACR; mg/mmol) and estimated GFR (eGFR; ml min-1 1.73 m-2). Association of progression from žno CKD' stage (ACR <3.5 mg/mmol and eGFR ≥90 ml min 1.73 m-2) with risk for CVD onset was also evaluated. Results: During follow-up (median 3.8 years), 89 CVD events occurred. Compared with patients with žno CKD' as reference, those with ACR≥35.0 mg/mmol with coexisting eGFR 60-89 ml min-1 1.73 m-2 or <60 ml min-1 1.73 m-2 showed increased risk for CVD onset, whereas those with eGFR ≥90 ml min1- 1.73 m-2 did not. Those with ACR ≤3.5 mg/mmol and eGFR ≤60 ml min-1 1.73 m -2 did not show any increased risk. Among patients with žno CKD' stage at baseline, those who progressed to ACR ≥3.5 mg/mmol during follow-up showed an increased risk compared with those who did not, whereas those who progressed to eGFR ≥90 ml min-1 1.73 m-2 did not have increased risk. Conclusions/interpretation: The risk for CVD was associated with progression of albuminuria stage rather than eGFR stage in type 2 diabetic patients at relatively low risk for CVD. © Springer-Verlag 2012.


Yokoyama H.,Jiyugaoka Medical Clinic | Matsushima M.,Jikei University School of Medicine | Kawai K.,Kawai Clinic | Hirao K.,HEC Science Clinic | And 6 more authors.
Diabetic Medicine | Year: 2011

Aims To investigate whether a reduced incidence of cardiovascular disease in Type2 diabetes can be achieved in a newly recruited cohort following the recently advanced concept of multifactorial treatment and followed in primary care settings as compared with earlier cohorts. Methods A prospective study was performed in primary care settings at multiple clinics nationwide in the Japan Diabetes Clinical Data Management (JDDM) study group. Subjects were 2984 patients with Type2 diabetes without prevalent cardiovascular disease. The main outcome measure was the first event of non-fatal or fatal coronary heart disease, ischaemic stroke or peripheral artery disease, and the incidence was compared with other representative cohorts. Results There were 90 cardiovascular events over 10827 person-years of follow-up with a dropout rate of 6%. The incidences (per 1000 person-years, 95% confidence interval) of composite, coronary heart disease, ischaemic stroke and peripheral artery disease in the JDDM study were 8.3 (6.6-10.0), 4.4 (3.2-5.6), 3.1 (2.1-4.2), and 0.7 (0.2-1.2), respectively. Each incidence was lowest in the JDDM study compared with other cohorts (P<0.01 vs. each cohort). In the JDDM study, significant variables predictive of the occurrence of a cardiovascular event were age, duration of diabetes, HbA 1c, HDL cholesterol and urinary albumin. Conclusion The novel finding of low cardiovascular disease occurrence in this study may be conferred by the feasibility at primary care settings for providing patients with Type2 diabetes with favourable control of blood glucose, blood pressure and lipids, coupled with unique ethnicity/country factors. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.


PubMed | HEC Science Clinic, Oishi Clinic, Kurihara Clinic, Shiga University of Medical Science and 5 more.
Type: Journal Article | Journal: BMJ open diabetes research & care | Year: 2016

The fact that population with type 2 diabetes mellitus and bodyweight of patients are increasing but diabetes care is improving makes it important to explore the up-to-date rates of achieving treatment targets and prevalence of complications. We investigated the prevalence of microvascular/macrovascular complications and rates of achieving treatment targets through a large-scale multicenter-based cohort.A cross-sectional nationwide survey was performed on 9956 subjects with type 2 diabetes mellitus who consecutively attended primary care clinics. The prevalence of nephropathy, retinopathy, neuropathy, and macrovascular complications and rates of achieving targets of glycated hemoglobin (HbA1c) <7.0%, blood pressure <130/80mmHg, and lipids of low-density/high-density lipoprotein cholesterol <3.1/1.0mmol/L and non-high-density lipoprotein cholesterol <3.8mmol/L were investigated.The rates of achieving targets for HbA1c, blood pressure, and lipids were 52.9%, 46.8% and 65.5%, respectively. The prevalence of microvascular complications was 28% each, 6.4% of which had all microvascular complications, while that of macrovascular complications was 12.6%. With an increasing duration of diabetes, the rate of achieving target HbA1c decreased and the prevalence of each complication increased despite increased use of diabetes medication. The prevalence of each complication decreased according to the number achieving the 3 treatment targets and was lower in subjects without macrovascular complications than those with. Adjustments for considerable covariates exhibited that each complication was closely inter-related, and the achievement of each target was significantly associated with being free of each complication.Almost half of the subjects examined did not meet the recommended targets. The risk of each complication was significantly affected by 1 on-target treatment (inversely) and the concomitance of another complication (directly). Total diabetes care including one-by-one management of modifiable risk factors and complications may be important for high-quality care. The future studies including more subjects and clinics with precise complication status are needed.


PubMed | HEC Science Clinic, Oishi Clinic, Shiga University of Medical Science, Niigata University and 3 more.
Type: Journal Article | Journal: Diabetes research and clinical practice | Year: 2015

The protective association of pioglitazone with cardiovascular events and death was investigated over 6-years in large-scale type 2 diabetic subjects without established cardiovascular disease in a primary care setting.A six-year observational cohort study including 2864 subjects with type 2 diabetes without established cardiovascular disease was performed. The primary endpoint was a composite of first occurrence of cardiovascular disease or death. The effect of pioglitazone use at a baseline year with a Cox proportional hazard model and the time-dependent use in each one-year examination interval with a pooled logistic regression model were analyzed.Baseline use of pioglitazone (n=493) did not show a statistically protective effect on the primary endpoint (n=175), although it tended to reduce the risk (adjusted hazard ratio 0.67 [95% CI: 0.43-1.05]). However, pooled logistic regression analysis indicated a significant protective association of pioglitazone with the primary endpoint (0.58 [0.38 to 0.87] and cardiovascular disease (0.54 [0.33-0.88]), independent of concurrent levels of blood glucose, blood pressure, lipids, albuminuria, and renal function. In particular, this protective association was observed in those with diabetic nephropathy regardless of the daily dose of pioglitazone. Among a total of 898 subjects who took pioglitazone during the period, 43% experienced a discontinuation at least once; however, serious adverse effects were rare.This observational study indicated a protective association of pioglitazone with cardiovascular disease and death in type 2 diabetic subjects without established vascular disease, particularly those with nephropathy.

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