Initiating SGLT2 inhibitor therapy to improve renal outcomes for persons with diabetes eligible for an intensified glucose-lowering regimen: hypothetical intervention using parametric g-formula modeling

[Introduction] Sodium–glucose cotransporter 2 (SGLT2) inhibitors are now recommended in guidelines for persons with type 2 diabetes mellitus (T2DM) and at risk of advanced kidney disease as part of the glucose-lowering regimen. [Research design and methods] To explore the optimal threshold at which to initiate SGLT2 inhibitor therapy, we conducted an observational study analyzed under a counterfactual framework. This study used the electronic healthcare database in Japan, comprising data from approximately 20 million patients at approximately 160 medical institutions. Persons with T2DM with an estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m2 in April 2014 were eligible. The primary end point was the composite of renal deterioration (>40% decline in eGFR) and the development of eGFR<30 mL/min/1.73 m2. We estimated the risk of the composite end point occurring over 77 months in different scenarios, such as early or delayed intervention with SGLT2 inhibitors for uncontrolled diabetes at different hemoglobin A1c (HbA1c) thresholds. The parametric g-formula was used to estimate the risk of the composite end point, adjusting for time-fixed and time-varying confounders. [Results] We analyzed data from 36 237 persons (149 346 person-years observation), of whom 4679 started SGLT2 inhibitor therapy (9470 person-years observation). Overall, initiating SGLT2 inhibitor therapy was associated with a 77-month risk reduction in the end point by 1.3–3.7%. The largest risk reduction was observed within 3 months of initiation once the HbA1c level exceeded 6.5% (risk reduction of 3.7% (95% CI 1.6% to 6.7%)) compared with a threshold of 7.0% or higher. [Conclusions] Our analyses favored early intervention with SGLT2 inhibitors to reduce the renal end point, even for persons with moderately controlled HbA1c levels. Our findings also suggest caution against clinical inertia in the care of diabetes

Analysis of Foraging Behavior of Cattle Using a Wearable Camera under Diverse Vegetation

Although it is important to estimate the ingested plant species and the amount of forage intake by grazing animals, recording these items at the 1-bite scale has been difficult under diverse vegetation. Recent research confirmed that a small and inexpensive wearable camera is useful to determine ingested plant species and their proportion in total bites with high accuracy. In this study, we attempted to generate bite codes for cattle under diverse vegetation using wearable cameras. We used two cows which had a grazing experience in the previous year (GE) and the other two which had no grazing experience (NE). They grazed on a mountainous area (3 ha of sown pasture and 17 ha of forest) from late spring to mid-summer. A wearable camera (Panasonic HX-A500, 185 g) was fixed on the right cheek of the cows. Foraging behavior was continuously recorded for 120 min during morning foraging bouts, and direct observation was also conducted simultaneously. Bite codes were generated based on the morphological characteristics of ingested plants and the characteristics of foraging manner of the cows. Bite codes were classified into A (\u3e 100 cm), B (100–60 cm), and C (\u3c 60 cm) based on foraging height, then further classified into 5 types in A, 4 types in B, and 16 types in C (total 25 types) based on the differences in feeding manner. NE cows showed more frequent occurrence of the codes with low bite size than GE cows when foraging at a height of B in immediately after the start of grazing season. The results suggest that bite codes reflect bite size and thus can provide a precise understanding of their foraging behavior. It was also suggested that changes in bite codes due to the accumulation of grazing experience may affect foraging efficiency of grazing cattle

Monitoring Foraging Behavior in Ruminants in a Diverse Pasture

Symposium mini revie

Comparative Effectiveness of Sodium-Glucose Cotransporter-2 Inhibitors Versus Other Classes of Glucose-Lowering Medications on Renal Outcome in Type 2 Diabetes

Objective: To assess whether sodium-glucose cotransporter-2 inhibitor (SGLT2i) therapy is associated with a favorable renal prognosis for patients with type 2 diabetes melllitus (T2DM) outside the clinical trials setting. Participants and Methods: This retrospective study analyzed routinely collected health care records of ∼160 medical institutions in Japan from April 1, 2014, to December 31, 2017/2018 (varying at the institutional level). Adults with T2DM but without end-stage renal disease who initiated either SGLT2i or other classes of glucose-lowering medications (o-GLM) were matched using propensity score. The primary outcome was the time course of estimated glomerular filtration rate (eGFR) displayed in spline curve. The composite of renal worsening (>40% decline in eGFR) and the development of eGFR<30 mL/1.73 m2 per minute was evaluated as a secondary outcome. Two sensitivity analyses were conducted to determine the robustness of results. Results: We compared a matched cohort of 1433 SGLT2i users and 2739 o-GLM users (mean age: 61 years). The eGFR declined over time in both groups during the observation period (median: 17 months; maximum: 54 months), with a slower eGFR slope observed in SGLT2i users. This slower decline was consistently observed across different SGLT2i agents and different baseline eGFR groups. The cumulative incidence of composite renal endpoints was lower in the SGLT2i group with a hazard ratio of 0.70 (95% CI, 0.50-0.98; P=.039). Those findings were consistent in sensitivity analyses limited to the period adherent to the initial drug regimen and with a different approach for propensity score calculation. Conclusion: In a matched cohort of T2DM patients, SGLT2i use was associated with preserved renal function relative to o-GLM use over 2 to 4 years

Effect of Plant Diversity on Ruminal Degradability of Goats Grazing in a Semi-natural Pasture

Poster Session

A strategy for improving FDG accumulation for early detection of metastasis from primary pancreatic cancer: Stimulation of the Warburg effect in AsPC-1 cells.

13301甲第4202号博士（保健学）金沢大学博士論文本文Full 以下に掲載：Nuclear medicine and biology 42(5) pp.475-481 2015. Elsevier. 共著者：小倉 正人, 鹿野, 直人, 中島 修一, 相良 順一, 山口 直人, 草薙 健太郎, 奥井 悠也, 水谷 明日香, 小林 正和, 川井 恵

アストログリア細胞のグルタミントランスポーター機能に関する分子薬理学的研究

取得学位：博士(薬学)，学位授与番号：博甲第1114号，学位授与年月日：平成21年3月23

Hyperspectral Assessment for Legume Content and Forage Nutrient Status in Pastures

Symposium mini revie

Hyperspectral Assessment for Legume Contents and Forage Nutrient Status in Pasture

Oral Session