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Ōsaka, Japan

Oishi M.,Oishi Clinic | Yamazaki K.,Kawai Clinic | Okuguchi F.,Okuguchi Clinic | Sugimoto H.,Sugimoto Clinic | And 2 more authors.
Journal of Diabetes Investigation | Year: 2014

Aims/Introduction: Six kinds of oral antidiabetic drugs (OADs), including the new dipeptidyl peptidase 4 (DPP-4) inhibitors, are available. The present study aimed to define trends within the prescribing patterns of OADs, as well as changes in glycemic control in Japan over a 10-year period from 2002 to 2011. Materials and Methods: We carried out a cross-sectional study using data of type 2 diabetes mellitus patients from 24 clinics for 2002, 2005, 2008 and 2011. OAD use was analyzed combined with clinical data. Results: Sulfonylureas (SUs) were the most commonly used OAD, but their use for monotherapy markedly decreased over the study period. Biguanides (BGs) were the second most commonly used OAD, and their prescribing rate increased both for mono- and combination therapy. DPP-4 inhibitors (DPP-4I), released in 2009, were the third most commonly prescribed OAD in 2011 both for mono- and combination therapy. Among combination therapies, two OADs were mostly prescribed, but the use of three OADs and four OADs in 2011 was two- and 14.8-fold those in 2002. These trends were accompanied by an improvement in average glycated hemoglobin from 7.5 ± 1.2% in 2002 to 7.1 ± 0.9% in 2011. Conclusions: The OAD prescribing trend has moved away from monotherapy with SUs and toward combination therapies to achieve better glycemic control. Increased use of BGs and DPP-4I was predominant in 2011. These trends were accompanied by an improvement of the glycated hemoglobin level. © 2013 The Authors. Source

Yokoyama H.,Jiyugaoka Medical Clinic | Araki S.,Shiga University of Medical Science | Kawai K.,Kawai Clinic | Hirao K.,H.E.C. Science Clinic | And 16 more authors.
Diabetes Research and Clinical Practice | Year: 2015

Aims: 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. Methods: 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. Results: 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. Conclusions: 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. © 2015 Elsevier Ireland Ltd. Source

Nakatani K.,Osaka University | Sugimoto T.,Sugimoto Clinic | Masuda D.,Osaka University | Okano R.,Osaka Police Hospital Dock | And 13 more authors.
Atherosclerosis | Year: 2011

Background: Postprandial hyperlipidemia (PPHL) is an independent risk factor for coronary heart disease (CHD) which is based on the accumulation of chylomicrons (CM) and CM remnants containing apolipoprotein B-48 (apoB-48). Since atherosclerotic cardiovascular diseases are frequently observed even in subjects with normal serum triglyceride (TG) level, the correlation between fasting apoB-48 containing lipoproteins and carotid intima-media thickness (IMT) was analyzed in subjects with normal TG levels. Methods: From subjects who took their annual health check at the Osaka Police Hospital (n=245, male), one-hundred and sixty-four male subjects were selected to take part in this study; the excluding factors were: systolic blood pressure ≥140. mmHg, intake of antihypertensive or antihyperlipidemic drugs, or age >65 years. The association between biochemical markers and IMT was analyzed and independent predictors of max-IMT were determined by multiple regression analysis in all subjects and in groups N-1 (TG < 100 mg/dl, n=58), N-2 (100 ≤ TG < 150. mg/dl, n=53) and H (150 ≤ TG mg/dl, n=53), respectively. Results: Fasting total cholesterol, LDL-cholesterol, HDL-cholesterol, apoB-100 and ln. RemL-C (remnant lipoprotein-cholesterol) levels were not correlated with max-IMT, but ln. TG and ln. apoB-48 were significantly correlated with max-IMT in all subjects. Ln. apoB-48 and apoB-48/TG ratio were significantly correlated with max-IMT in group N-2. By multiple regression analysis, age and ln. apoB-48 were independent variables associated with max-IMT in group N-2. Conclusion: Serum apoB-48 level might be a good marker for the detection of early atherosclerosis in middle-aged subjects with normal-range levels of blood pressure and TG. © 2011 Elsevier Ireland Ltd. Source

Masuda D.,Osaka University | Sugimoto T.,Sugimoto Clinic | Tsujii K.-I.,Tsujii Clinic | Inagaki M.,Osaka University | And 11 more authors.
European Journal of Clinical Investigation | Year: 2012

Background Postprandial hyperlipidemia partially refers to the postprandial accumulation of chylomicrons and chylomicron remnants (CM-R). Many in vitro studies have shown that CM-R has highly atherogenic properties, but consensus is lacking on whether CM-R accumulation correlates with the development of atherosclerotic cardiovascular diseases. We investigated the correlation between CM-R accumulation and the prevalence of coronary artery disease (CAD). Design Subjects who received a coronary angiography and did not take any lipid-lowering drugs (n=189) were enrolled. Subjects with coronary artery stenosis (≥75%) were diagnosed as CAD. Biochemical markers for glucose and lipid metabolism including fasting apolipoprotein (apo) B-48 concentration were compared between CAD patients (n=96) and age-, sex-, and body mass index (BMI)-matched non-CAD subjects without overt coronary stenosis (<75%) (n=67). We tried to determine which metabolic parameters were correlated with the prevalence of CAD by multiple logistic regression analysis, and whether or not the combination of high apo B-48 and other coronary risk factors (high triglyceride, low HDL-C, high HbA1c or low adiponectin levels) increased the prevalence of CAD. Results Fasting serum apo B-48 levels were significantly higher in CAD patients than in non-CAD subjects (3·9±2·4 vs. 6·9±2·6μg/mL, P<0·0001) and had the most significant correlation with the existence of CAD. The clustering of high fasting apo B-48 levels (>4·34μg/mL, the cut-off value) and other coronary risk factors were found to be associated with a stronger risk of CAD compared with single high fasting apo B-48 levels. Conclusion Fasting serum apo B-48 levels significantly correlated with the prevalence of CAD. © 2012 The Authors. European Journal of Clinical Investigation © 2012 Stichting European Society for Clinical Investigation Journal Foundation. Source

Yokoyama H.,Jiyugaoka Medical Clinic | Matsushima M.,Jikei University School of Medicine | Kawai K.,Kawai Clinic | Hirao K.,H.E.C. Science Clinic | And 4 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. Source

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