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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. Source

Katakami N.,Osaka University | Matsuhisa M.,Osaka University | Kaneto H.,Osaka University | Matsuoka T.-A.,Osaka University | And 8 more authors.
Diabetes Research and Clinical Practice | Year: 2010

We examined the association between diabetic retinopathy and monocyte chemoattractant protein (MCP)-1 A-2518G polymorphism in 3802 Japanese type 2 diabetic subjects. The prevalence of diabetic retinopathy was higher as the number of G alleles increased, suggesting that the G allele of this polymorphism is a susceptibility allele for diabetic retinopathy. © 2010 Elsevier Ireland Ltd. Source

Kanatsuka A.,Chiba University | Sato Y.,Chiba University | Kawai K.,Kawai Clinic | Hirao K.,H.E.C. Science Clinic | And 2 more authors.
Journal of Diabetes Investigation | Year: 2014

Aims/Introduction: We evaluated the long-term efficacy of insulin regimens in patients with type 2 diabetes mellitus and poor glycemic control despite oral antidiabetic drugs (OAD). Materials and Methods: We carried out a propensity score-matched cohort study using the CoDiC® database of the Japan Diabetes Data Management Study Group across 54 institutions in Japan from 2005 to 2010. A total of 10,854 patients on OAD in 2005 were studied, and 1,253 patients (11.5%) were treated with insulin until 2010. The changes in insulin regimens and glycated hemoglobin (HbA1c) levels were analyzed over this study period. Results: Propensity score matching showed no differences in the baseline patient characteristics. A total of 96 patients transferred to insulin, and HbA1c gradually and significantly decreased in the patients on a twice-daily premixed preparation of rapid-acting human-insulin analogs (twice-daily MIX) and basal-bolus therapy with rapid-acting human-insulin analogs (RA) plus long-acting insulin analog (LA; P < 0.001). A total of 418 patients had insulin added to OAD treatment, and HbA1c decreased in the patients with a twice-daily MIX (P < 0.001), but HbA1c did not differ from the baseline values in the patients on basal LA (P = 0.497). The mean decline in HbA1c at the end of the study was therefore larger in the patients receiving twice-daily MIX than in the patients receiving basal LA (P < 0.05). Conclusion: The present study could suggest the potential loss of opportunity for many patients treated using basal LA to have received alternative insulin regimens and to achieve better glycemic control. © 2014 The Authors. Source

Kanatsuka A.,Diabetes Center | Kawai K.,Kawai Clinic | Hirao K.,H.E.C. Science Clinic | Yokoyama H.,Jiugaoka Medical Clinic | Kobayashi M.,Diabetes Center
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. Source

Katakami N.,Osaka University | Kaneto H.,Osaka University | Matsuoka T.-A.,Osaka University | Takahara M.,Osaka University | And 13 more authors.
Atherosclerosis | Year: 2012

Objective: Adiponectin has anti-atherogenic properties and reduced serum adiponectin levels are associated with cardiovascular disease (CVD). In this study, we examined the relationship between CVD and adiponectin (ADIPOQ) gene G276T polymorphism that is associated with serum adiponectin level in a large cohort of type 2 diabetic patients. Research design and methods: We enrolled 2637 Japanese type 2 diabetic subjects (males, 61.1%; age, 54.9 ± 7.9 years old), determined their genotypes regarding ADIPOQ G276T polymorphisms, and evaluated the association between this polymorphism and the prevalence of CVD (myocardial infarction and/or cerebral infarction). Results: The prevalence of CVD tended to be higher as the number of G alleles increased [GG (9.5%), GT (6.8%), TT (5.6%), p value for trend = 0.0059] and was significantly higher in the subjects with GG genotype compared to those with GT or TT genotype (9.5% vs. 6.6%, p=0.0060). Multiple logistic regression analyses revealed that the number of G alleles (Odds ratio (OR) = 1.49 with 95%CI 1.09-2.05, p=0.0125) and GG genotype (OR = 1.66 with 95%CI 1.13-2.43, p=0.0098) were significantly associated with CVD even after adjustment for conventional risk factors. Interestingly, the presence of obesity further and significantly increased the risk of CVD in the subjects with GG genotype (OR = 1.67 with 95%CI 1.14-2.44, p=0.0090) but not in the subjects with TT or GT genotype (OR = 1.17 with 95%CI 0.73-1.89, NS). Conclusions: It is likely that the G allele of the ADIPOQ G276T polymorphism is a susceptibility allele for CVD in Japanese type 2 diabetic patients, especially when they accompany obesity. © 2011 Elsevier Ireland Ltd. Source

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