Age-Specific Effectiveness and Safety of Newly Initiated Insulin Therapy in Japanese Patients with Uncontrolled Diabetes

INTRODUCTION: One consequence of population aging is an increase in the number of elderly patients with diabetes mellitus. These elderly patients often experience atherosclerotic complications, and diabetes prevention and management are strongly desired to promote health and reduce the financial burden on the healthcare system. In this study, we conducted an age-specific evaluation of the effectiveness and safety of comprehensive management with newly initiated insulin therapy over a 1-year period in elderly (≥65 years) compared with non-elderly (≤64 years) Japanese patients with uncontrolled diabetes [glycated hemoglobin (HbA1c) ≥ 8% for ≥ 3 months]. METHODS: This retrospective single-center cohort study was conducted in Japan. We screened all outpatients with diabetes mellitus who visited the clinic for diabetes treatment between December 2006 and March 2011. Of these patients, 132 with type 2 diabetes who were newly initiated on insulin therapy for continued poor glycemic control and undergoing comprehensive management through self-monitoring of blood glucose (SMBG) were registered to the study. RESULTS: Thirty-two of 132 registered patients were excluded from the analysis. Among the 100 patients (67 non-elderly, 33 elderly) included in the analysis, median age and proportion of male patients was 69 years and 66.7%, respectively, among the elderly, and 52 years and 68.7%, respectively, among the non-elderly patients. After initiation of insulin therapy, median HbA1c levels improved from 9.6% to 7.2% in elderly patients, and from 10.8% to 7.3% in non-elderly patients at baseline and 12 months. Severe hypoglycemic events were not observed in either patient group; however, uncontrolled diabetes was ongoing in 31.8% of non-elderly and 15.4% of elderly patients, and obesity was associated with poor glycemic control. CONCLUSION: Our results indicate that the effectiveness and safety of newly initiated insulin therapy are similar between elderly and non-elderly Japanese patients with uncontrolled diabetes, and highlight the importance of comprehensive management using SMBG to avoid hypoglycemia. Better glycemic control supported by adequate intensive management is required to improve mortality and morbidity. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s13300-013-0049-4) contains supplementary material, which is available to authorized users

Epidemiology, education, and care for patients with diabetes in Belarus

More than 64 million people in the World Health Organization European Region are living with diabetes, and Belarus is no exception to the diabetes epidemic. This study was conducted as a part of the Joint Usage/Research Projects program for promoting collaborative research in regions affected by environmental radiation exposure. We reviewed locally available documents on the epidemiology and management of diabetes in Belarus. Over the past 20 years, there has been a 2.8-fold increase in the number of patients with diabetes mellitus in Belarus, and in response, an integrated approach for prevention and treatment has been implemented. Strategies unique to Belarus include the establishment of a diabetes registry, the monitoring of patients at local outpatient units called dispensaries, and the upgrading of diabetes education provided at Diabetes Schools. Despite the strategic developments made to diabetes services, further improvements are warranted, including better quality assurance of services at dispensaries, revision of patient education to take into consideration new treatments and technologies, and more epidemiological research

Changes in antidiabetic prescription patterns and indicators of diabetic control among 200,000 patients over 13 years at a single institution in Japan

Abstract Background We examined the long-term changes in the management of diabetes at a single institution in Japan. Methods Two repeated cross-sectional studies and a retrospective cohort study were conducted among patients who visited our institution between 2001 and 2013. We examined the changes in glycated hemoglobin (HbA1c) and glycated albumin levels, the prescription frequencies, and the daily doses of each antidiabetic agent among patients treated regularly for diabetes during the 13-year study period. The trends in control and treatment parameters were analyzed using Spearman’s rank correlation coefficient. Results In the first repeated cross-sectional studies, 200,298 patients had their glucose metabolism indicators measured, and diabetologists prescribed medications to 193, 445 patients. Of these, 170 patients were included in the retrospective cohort study. The patients’ diabetic control tended to improve over the study period. The mean HbA1c level improved from 7.9 to 7.6% (from 63 to 60 mmol/mol) (rs = −0.11, p < 0.01) in the cross-sectional study, corresponding to a change from 8.2 to 7.7% (from 66 to 61 mmol/mol) (rs = −0.22, p < 0.01) in the retrospective study. The mean GA level improved from 22.7 to 20.7% (rs = −0.13, p < 0.01) in the cross-sectional study and from 23.5 to 21.5% (rs = −0.14, p < 0.01) in the retrospective study. Over the study period, prescription frequencies and daily doses of antidiabetic agents changed as treatment guidelines were altered. Conclusions The present study revealed a tendency toward long-term improvements in diabetic control, with changes in the prescription patterns consistent with research and guideline evidence

Age- and Sex-Specific Impact of Health Literacy on Healthy Lifestyle Characteristics among Japanese Residents in a Rural Community

The study aimed to examine age- and sex-specific associations between health literacy (HL) and healthy lifestyle characteristics. The cross-sectional study was conducted to examine a total 1348 Japanese participants (613 male and 735 female) who took the health check-up program in April 2013, at Tsumagoi Village, Japan. Information was collected by self-administered questionnaire on three communicative and two critical HL items, and healthy lifestyle characteristics listed in Breslow’s seven health practices. In multivariate logistic analysis, high HL (≥18) was significantly associated with healthy lifestyle characteristics in both non-elderly (&lt;65 years old) and elderl

Association between serum uric acid levels and achievement of target blood pressure among Japanese community residents with hypertension

Abstract The authors examined the sex‐specific association between serum uric acid (SUA) levels and achievement of target blood pressure among Japanese patients with hypertension. This cross‐sectional study was conducted between January 2012 and December 2015 and examined 17 113 eligible participants (6499 men; 10 614 women) with hypertension among 66 874 Japanese community residents who underwent voluntary health checkups. Multivariate analysis was used to estimate the association between high SUA level (≥7.0 mg/dL for men and ≥6.0 mg/dL for women) and “therapeutic failure” in achieving target blood pressure (BP) of 140/90 and 130/80 mmHg in both sexes. Multivariate analysis revealed that high SUA level was significantly associated with failure to achieve the 130/80 mmHg treatment goal among men (AOR = 1.24, 95% CI = 1.03–1.50, p = .03). Among women, high SUA level was significantly associated with failure to achieve both the 130/80 and 140/90 mmHg treatment goals (AOR = 1.33, 95% CI = 1.20–1.47, p < .01 and AOR = 1.17, 95% CI = 1.04–1.32, p < .01, respectively). Each increase in SUA quartile was positively associated with increases in systolic BP (SBP) and diastolic BP (DBP) (p < .01 for trend) in both sexes. SBP and DBP in each quartile (Q2–Q4) were also significantly higher compared with those of Q1 in both sexes (p < .01). Our data confirms the difficulties in maintain goal BP control in those with elevated SUA

Demographic and clinical characteristics of patients with zinc deficiency: analysis of a nationwide Japanese medical claims database

Abstract Zinc deficiency, affecting more than 2 billion people globally, poses a significant public health burden due to its numerous unfavorable effects, such as impaired immune function, taste and smell disorders, pneumonia, growth retardation, visual impairment, and skin disorders. Despite its critical role, extensive large-scale studies investigating the correlation between patient characteristics and zinc deficiency still need to be completed. We conducted a retrospective, cross-sectional observational study using a nationwide Japanese claims database from January 2019 to December 2021. The study population included 13,100 patients with available serum zinc concentration data, excluding individuals under 20 and those assessed for zinc concentrations after being prescribed zinc-containing medication. Significant associations with zinc deficiency were noted among older adults, males, and inpatients. Multivariate analysis, adjusting for age and sex, indicated significant associations with comorbidities, including pneumonitis due to solids and liquids with an adjusted Odds Ratio (aOR) of 2.959; decubitus ulcer and pressure area (aOR 2.403), sarcopenia (aOR 2.217), COVID-19 (aOR 1.889), and chronic kidney disease (aOR 1.835). Significant association with medications, including spironolactone (aOR 2.523), systemic antibacterials (aOR 2.419), furosemide (aOR 2.138), antianemic preparations (aOR 2.027), and thyroid hormones (aOR 1.864) were also found. These results may aid clinicians in identifying patients at risk of zinc deficiency, potentially improving care outcomes

Barriers to Prevention and Treatment of Type 2 Diabetes Mellitus Among Outpatients in Belarus

Objectives: This study aimed to determine the main barriers and reasons for non-adherence to preventive measures and treatment for type 2 diabetes mellitus among outpatients in Belarus.Methods: An anonymous questionnaire survey was conducted with 814 adults aged 18 years and over who visited outpatient health care units and hospitals in Belarus. The questionnaire was developed to analyze the perceived barriers that limit adherence to preventive measures and treatment for type 2 diabetes.Results: The proportion of respondents who reported doing daily physical activity was 53.2%, and 46.6% consumed at least 400 grams of fruit and vegetables per day. Among the 42.8% of respondents with a prescribed treatment for type 2 diabetes mellitus, 50.1% sometimes forgot to take their medicine. The specific barriers to treatment most frequently identified by survey respondents were “Financial situation” (23.5% of respondents), and “Fear of side effects” (25.2%). Those for lifestyle instructions were “Insufficient knowledge” (29.3%), “Financial situation” (27.9%), and “Lack of motivation” (21.7%).Conclusions: The study revealed that the main barriers to adherence were insufficient knowledge of diabetes and its treatment and an underestimation of the role of behavioral risk factors in health, combined with financial difficulties. We recommend that physicians should take a patient-centered approach to raising awareness of behavioral risk factors for type 2 diabetes mellitus, and suggest that the importance of adhering to preventative measures and treatment should be promoted in consultations in Belarus