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

Correlation between HIV disease and lipid metabolism in antiretroviral-naïve HIV-infected patients in Japan

Antiretroviral therapy alters lipid metabolism in HIV-infected patients. However, interpreting the impact of HIV infection on lipid metabolism is difficult because of various associated factors, including antiretroviral drugs and demographic characteristics. A few studies have associated HIV infection with lipid metabolism in antiretroviral-naïve HIV-infected patients. Because there were no data in this regard from Japan, the present study examined the impact of HIV infection, as well as demographic and clinical features, on lipid metabolism in antiretroviral-naïve HIV-infected patients in Japan. We performed a cross-sectional study to examine the impact of HIV disease, demographic and clinical characteristics on lipid metabolism among 168 HIV-infected Japanese men who were antiretroviral naïve and who did not have hemophilia, including patients who took medication for dyslipidemia. The mean age of the patients was 45.7 years; 0.6% of the patients took medication to dyslipidemia. The mean CD4 lymphocyte count was 289/μL, the mean baseline log10 HIV viral load was 4.2 HIV-1 RNA copies/mL, and 22% of the patients had a history of AIDS-defining events. A higher HDL-C concentration was associated with a higher CD4 lymphocyte count (p = 0.043). Also, a higher LDL-C concentration was associated with a higher CD4 lymphocyte count (p = 0.003). Infection with HIV was associated with dyslipidemia in antiretroviral-naïve patients. More advanced HIV disease was associated with less favorable lipid homeostatic profiles. These results are similar to findings from other countries

Infective endocarditis with Lactococcus garvieae in Japan: a case report

<p>Abstract</p> <p>Introduction</p> <p><it>Lactococcus garvieae </it>is a well-recognized fish pathogen, and it is considered a rare pathogen with low virulence in human infection. We describe the 11th case of <it>L. garvieae </it>infective endocarditis reported in the literature, and the first reported case in Japan.</p> <p>Case presentation</p> <p>We report a case of a 55-year-old Japanese woman who had native valve endocarditis with <it>L. garvieae</it>. The case was complicated by renal infarction, cerebral infarction, and mycotic aneurysms. After anti-microbial treatment, she was discharged from the hospital and is now well while being monitored in the out-patient clinic.</p> <p>Conclusion</p> <p>We encountered a case of <it>L. garvieae </it>endocarditis that occurred in a native valve of a healthy woman. The 16S ribosomal RNA gene sequencing was useful for the identification of this pathogen. Although infective endocarditis with <it>L. garvieae </it>is uncommon, it is possible to treat high virulence clinically.</p

Achievement of Target Blood Pressure Levels among Japanese Workers with Hypertension and Healthy Lifestyle Characteristics Associated with Therapeutic Failure

<div><p>Background</p><p>Few studies have examined Japanese with regard to the achievement rates for target blood pressure levels, or the relationship between these rates and healthy lifestyle characteristics in patients with hypertension as defined by the newly established hypertension management guidelines (JSH2014). The aim of this study was to elucidate achievement rates and examine healthy lifestyle characteristics associated with achievement status among Japanese.</p><p>Methods</p><p>This cross-sectional study, conducted in January-December 2012, examined blood pressure control and healthy lifestyle characteristics in 8,001 Japanese workers with hypertension (mean age, 57.0 years; 78.8% were men) who participated in a workplace health checkup. Data were collected from workplace medical checkup records and participants’ self-administered questionnaires. We divided into 5 groups [G1; young, middle-aged, and early-phase elderly patients (65–74 years old) without diabetes mellitus or chronic kidney disease (CKD) (<140/90 mmHg), G2; late-phase elderly patients (≥75 years old) without diabetes mellitus or CKD (<150/90 mmHg), G3; diabetic patients (<130/80 mmHg), G4; patients with CKD (<130/80 mmHg), and G5; patients with cerebrovascular and/or coronary artery diseases (<140/90 mmHg)] according to JSH2014. And then, achievement rates were calculated in each group. Multivariate analysis identified healthy lifestyle characteristics associated with “therapeutic failure” of target blood pressure.</p><p>Results</p><p>Target blood pressures were achieved by 60.2% of young, middle-aged, and early-phase elderly patients (G1), 71.4% of late-phase elderly patients (G2), 30.5% of diabetic patients (G3), 33.4% of those with chronic kidney disease (G4), and 66.0% of those with cerebrovascular and/or coronary artery diseases (G5). A body mass index of 18.5–24.9 and non-daily alcohol consumption were protective factors, and adequate sleep was found to contribute to therapeutic success.</p><p>Discussion</p><p>We found low achievement rates for treatment goals among patients with chronic kidney disease and diabetes mellitus. Maintaining an ideal body weight and adequate alcohol consumption may help with blood pressure control. Lifestyle modification may be necessary for better management of hypertension.</p></div

Factors associated with therapeutic failure in chronic kidney disease (n = 961) (logistic regression analysis).

<p>a) Odds ratio</p><p>b) 95% confidence interval</p><p>*<i>P</i><0.05</p><p>**<i>P</i><0.01.</p><p>Factors associated with therapeutic failure in chronic kidney disease (n = 961) (logistic regression analysis).</p

Factors associated with therapeutic failure in patients with cerebrovascular and/or coronary artery disease (n = 409) (logistic regression analysis).

<p>a) Odds ratio</p><p>b) 95% confidence interval</p><p>*<i>P</i><0.05</p><p>**<i>P</i><0.01.</p><p>Factors associated with therapeutic failure in patients with cerebrovascular and/or coronary artery disease (n = 409) (logistic regression analysis).</p

Factors associated with therapeutic failure in failure in diabetes mellitus (n = 1,074) (logistic regression analysis).

<p>a) Odds ratio</p><p>b) 95% confidence interval</p><p>*<i>P</i><0.05</p><p>**<i>P</i><0.01.</p><p>Factors associated with therapeutic failure in failure in diabetes mellitus (n = 1,074) (logistic regression analysis).</p

Mean blood pressures and achievement rates for target blood pressure levels.

<p>a) Standard deviation.</p><p>Mean blood pressures and achievement rates for target blood pressure levels.</p

Factors associated with therapeutic failure in young, middle-aged, and early-phase elderly patients without diabetes mellitus or chronic kidney disease (n = 5397) (logistic regression analysis).

<p>a) Odds ratio</p><p>b) 95% confidence interval</p><p>*<i>P</i><0.05</p><p>**<i>P</i><0.01.</p><p>Factors associated with therapeutic failure in young, middle-aged, and early-phase elderly patients without diabetes mellitus or chronic kidney disease (n = 5397) (logistic regression analysis).</p