Japanese Clinical Practice Guideline for Diabetes 2019

Journal of Diabetes Investigation, Год журнала: 2020, Номер 11(4), С. 1020 - 1076

Опубликована: Июль 1, 2020

The current guideline represents the 6th edition of 'Japanese Clinical Practice Guideline for Diabetes' which has been revised every three years since its first appearance in 2004 to promote evidence-based, rational, efficient and consistent clinical practice diabetes. Of note, dramatic progress made recent diabetes research practice, includes approval antidiabetic agents with novel mechanisms action along publication trial results these drugs, diagnostic therapeutic devices, such as continuous glucose monitoring (CGM) sensor augmented pumps (SAP). Again, from large-scale trials Japan, J-DOIT 1 3 JDCP studies, have recently reported. Further, last years, new guidelines lipid blood pressure control released a timely fashion Japan Atherosclerosis Society Japanese Hypertension. Therefore, compiled include not only relevant advances but findings lines evidence that available date. While organized similar those preceding 2016 using same questions (CQs) (Qs) format, each CQ or Q closely reviewed revision further CQs Qs added appropriate use practice. Readers are therefore referred 'Methods developing "Japanese Diabetes 2019"' detailed account development processes involved make effective guideline. It is hoped will prove helpful guide evidence-based medicine (EBM) settings thereby contributing prolongation healthy lifespan improved quality life patients consists general (cited Qs) CQs) followed by explanations. Statements recommendation were developed solely CQs. committee (CGC) members conducted systematic review (SR) several resources develop statement presented strength rated grade. SR support team helped CGC literature retrieval confirm an level articles they obtained. A brief criterion process was shown this We all important necessary judgement Abstract tables constructed recommend They contained PICO (Populations, Interventions, Comparators, Outcomes interest), study design, defined Table 1. also summarized based on 5 items meta-analysis review, randomized controlled grade determined member consideration given certainty overall evidence, balance benefits harms, patient preferences/values, costs (Table 2). Grades B stand strong weak recommendations, respectively. discussed guidelines. Votes taken statement. 75% agreement among eligible required approve strength. Satisfies following items: I. Type (Characterized pancreatic β-cell destruction usually leading absolute insulin deficiency) III. due some other specific mechanism disease Individuals who met above criteria 1–3 be diagnosed acute-onset (autoimmune) type Those 1, 2, 4 2 re-evaluated after interval diagnosis put hold. fulminant such. Some may lead onset ketosis ketoacidosis within about 1–2 weeks. associated pregnancy. Exocrine enzymes, e.g., amylase, lipase, esterase elevated 98% affected individuals. Upper airway gastrointestinal symptoms noted 70% Fulminant linked HLA DRB1*04:05–DQB1*04:01. [Q2-3] How glycemic goal set individual patient? (Figure 5) Glucose levels individuals close normal possible. Achieving maintaining favorable early initiation treatment likely long-term outcomes individuals1. [Q2-4] chronic diabetic complications prevented their progression delayed? management aimed merely at control1 ensuring continued smoking cessation levels, preventing delaying progression2-5. [CQ3-2] Is MNT education registered dieticians effective? effective10, 11 (grade A: 95% agreement). As per target body weight vs total energy intake, patient, his/her intake individually determined. values below primarily intended suggested targets need modified, required, during consultation, patient's weight, parameters. There accumulating determination. For elderly patients, coefficient could larger than actual physical activity prevent them frailty. Conversely, obese loss program, lower activity. In either case, whose widely differs flexibly corresponding coefficients above. Given wide-ranging affecting metabolism protein metabolism, linked, energy-producing nutrients components must assessed validity against condition, well risks including hyperglycemia. Furthermore, safety dietary cuisine culture preferences, ensure implementation MNT. However, there no effectiveness any particular nutrient ratios contribute To diabetes, priority honoring eating habits preferences thus allowing enjoy meals far do defeat purpose medically, while time giving potential diet regimens. Advantage: This Scr-based formula offers convenience renal function estimated test alone. With formula, eGFR fall ± 30% measured GFR (mGFR) patients. Disadvantage: Adjusted average surface area (BSA) (1.73 m2), greater estimation error large small build. overestimated low muscle mass. Secreted nucleated cells, cysteine C thought less influenced mass content. BSA Subjective polyneuropathy characterized as: Findings interest (diabetic neuropathy confirmed if one two met, despite failure meet described above) [Q15-3] What office threshold initiating antihypertensive therapy diabetes? 7, Figure 6) [CQ15-4] controlling <130/80 mmHg hypertension? 7) GDM more 75 g OGTT: ① Fasting value ≥92 mg/dL ② 1-h post-OGTT ≥180 ③ 2-h ≥153 Overt pregnancy met: ≥126 HbA1c ≥6.5% mellitus before Pregnancy unequivocal retinopathy <5.3 mmol/L*4 (<95 mg/dL) PPG <140 Or <120 <7.8 mmol/L (<140 <6.4 (115 [I-CQ-1] relationship between aging impaired tolerance? [I-CQ-2] characteristics elderly? [I-CQ-3] [II-CQ-1] Are employed used adults? [II-CQ-2] susceptible postprandial hyperglycemia? [II-CQ-3] hyperosmolar hyperglycemic state (HHS)? [II-CQ-4] hypoglycemia [II-CQ-5] drug-related adverse events? [II-CQ-6] increased incidence atherosclerotic disease? [II-CQ-7] risk mortality compared without? [II-CQ-8] cognitive impairment dementia? [II-CQ-9] psychological states watched [II-CQ-10] function? [III-CQ-1] for? [III-CQ-2] Why [III-CQ-3] screened impairment? [III-CQ-4] [IV-CQ-1] should [IV-CQ-2] Should ophthalmologist assessment retinopathy? [IV-CQ-3] regularly urinary albumin/protein glomerular filtration rates (eGFR)? [IV-CQ-4] cared [IV-CQ-5] infections to? Summary [IV-CQ-6] amenable prevention pneumococcal influenza vaccines? [V-CQ-1] hyperglycemia factor dementia [V-CQ-2] severe [V-CQ-3] tight reducing [VI-CQ-1] decreased ADL, sarcopenia, falls/fractures [VI-CQ-2] frailty [VI-CQ-3] ADL [VI-CQ-4] depression (depression depressive tendency) [VII-CQ-1] inhibiting [VII-CQ-2] [VII-CQ-3] macroangiopathy mortality? [VII-CQ-4] implemented [VII-CQ-5] considerations kept mind determining [VIII-CQ-1] non-elderly patients? [VIII-CQ-2] adequate * term 'ideal weight' section version Guidelines reference Management Elderly 2017, 'target used, instead weight', consistency Chapter Medical nutrition (MNT) English-language version. [VIII-CQ-3] carbohydrate, intakes [VIII-CQ-4] sodium (salt) restriction [VIII-CQ-5] vitamin/fatty acid [VIII-CQ-6] pattern recommended [VIII-CQ-7] inadequate vitamin D/calcium bone mineral density (BMD)? [VIII-CQ-8] undernutrition? [IX-CQ-1] activity/exercise improving control, function, QOL [X-CQ-1] precautions when implementing glucose-lowering [X-CQ-2] sulfonylureas (SUs) cause [X-CQ-3] Does metformin reduce cardiovascular death [X-CQ-4] lactic acidosis [X-CQ-5] oral hypoglycemic SUs metformin, GLP-1 receptor agonists, [X-CQ-6] multi-drug combination falls [XI-CQ-1] [XII-CQ-1] younger [XII-CQ-2] factors [XII-CQ-3] sick days fever, diarrhea, vomiting appetite? [XIII-CQ-1] microangiopathy [XIII-CQ-2] antidyslipidemic [XIV-CQ-1] nursing home institutionalization? [XIV-CQ-2] institutionalized [XV-CQ-1] providing terminal care [Q21-1] determine Various identified model (risk scores) currently being Japanese1-3. Eiichi Araki received honoraria AstraZeneca, Daiichi Sankyo, Kowa, Mitsubishi Tanabe Pharma, MSD, Novo Nordisk, Ono Pharmaceutical Sanofi, subsidies donations Astellas Bayer Yakuhin, Eli Lilly Nippon Boehringer Ingelheim, Novartis Pfizer Sumitomo Dainippon Taisho Takeda Pharmaceutical, belongs endowed departments Terumo. Mitsuhiko Noda Nordisk Teijin Pharma. Hiroshi Noto MSD. Haruhiko Osawa funding Sysmex, Toyama Pharmaceutical. Yukio Tanizawa Seastar, Kyowa Kirin, Pharma Kazuyuki Tobe Kowa Uehara Memorial Foundation Naito Foundation, Asahi Kasei Fuji Chemical Industries Arkray. Narihito Yoshioka Atsushi Goto, Tatsuya Kondo, Hideki Origasa, Akihiko Taguchi nothing declare. Society: Organizational Conflict Interest Co-sponsored seminar: Abbott Diagnostics Medical, Vascular Aegerion Pharmaceuticals, Ajinomoto, AR Brown, Arkray, Arkray Global Business, ASKA Cosmic Corporation, Covidien Eiken Chemical, Eizai, Fujifilm Fukuda Colin, Denshi, Gilead Sciences, Hakubaku, Healthy Network, Hitachi Systems, Horiba, InBody Johnson & Johnson, Kaken Kissei Kotobuki Kracie LifeScan LSI Medience, Medtronic Mochida Mylan EPD, Nikkiso, Becton Dickinson, Nipro, Otsuka Rizap Group, Roche DC Santen Sanwa Kagaku Kenkyusho, SRL, Terumo, Unex, Welby. Supporting member: Bunkodo, Chugai EA H + Life Science, Tobacco, PHC, Sekisui Shionogi, Tosoh. Research grant: Award system: Sanofi. Funding statement: society work. article does contain studies human animal subjects performed authors. clear emerged multiple meta-analyses data population demonstrate association cancer risk1, 2. 2010, American Association Cancer jointly consensus report cancer3. Experts launched Joint Committee, published 2013, provided recommendations physicians healthcare providers public (including patients)4. Committee second report, Report II 20165. date, number reported risk6, 7. Generally, (mainly variety) colonic, hepatic, pancreatic, breast, endometrial, bladder cancers, reduced prostate cancer. Assumed oncogenesis resistance hyperinsulinemia, inflammation. whether causal remains elucidated. At present, fully clarified. Thus, it preferable maximizing agents, attention warnings package inserts. 'Report II' addressed issue examined impact subsequent diabetes5, demonstrating high-quality available, clarify poorer short-term prognosis without diabetes8, 9. receive aggressive diabetes10 thatpatients 9.0% higher survival rate 9.0%11. Bone quality. former amount tissue, latter various composition structure. Any decrease fracture1. relative proximal femoral fractures 3- 7-fold diabetes2-5. These generally density, fracture disproportionately high. assumed deteriorated accounts apparent 1.3- 2.8-fold diabetes2, 3, 6, although significantly diabetes7. 10 (RCTs) comparing receiving thiazolidinediones (TZDs; rosiglitazone, pioglitazone) demonstrated 1.45-fold TZDs8. 2.23-fold women men reached insulin, DPP-4 inhibitors, SGLT2 inhibitors. post hoc analysis RCTs different increase lumbar vertebra neck alendronate controls9. Pancreas transplantation broadly divided into simultaneous pancreas kidney (SPK), pancreas-after-kidney (PAK), alone (PTA). SPK >80% transplants rest world. Data 361 brain-dead non-heart beating donor transplants, end 2014, 5-year graft 94.9%, 76.0% 91.4%, Islet form tissue involves transplanting islets isolated portal vein recipient. insulin-depleted repeatedly specialist care. While, unlike transplantation, islet allow recipients remain off prolonged periods time, expected frequency mean stabilizing variations. Islets non-heart-beating donors 34 times 18 (male/female, 5/13) modified Edmonton protocol 2007 Japan1. Western improved, resolved, successful engraftment1. improvement challenges University Minnesota protocol, induction immunotherapy antithymocyte globulin (thymoglobulin) anti-TNF-α antibody maintenance low-dose calcineurin inhibitor (tacrolimus) mTOR (sirolimus) anti-metabolic agent (mycofenolate mofetil), secession 8 single donor2. 2012 onwards, resumed part advanced medical program presenting episodes, employing First-class Regenerative Medicine according 'Act Securing Safety Medicine'. Between March 2012, Outcome Intervention Trial (J-DOIT1) investigate non-face-to-face, telephone-based intervention high incident people undergoing health check-ups fiscal year 2006, high-risk (i.e., fasting [IFG]) aged 20–65 allocated group (n = 1,367) self-management 1,240). After completion one-year intervention, up 5.5 way annual questionnaires found significant difference cumulative groups did find (−41%) telephone counselling 6 analyzed site. 'Japan (J-DOIT 2)' interventional address how consultation interruptions measures included encouraging treated family continue treatment/consultation, instructions, assisting treatment/consultations. treatment/consultation 63%, suggesting effective. J-DOIT3, 2,542 hypertension/dyslipidemia 45 69 randomly assigned guideline-consistent (conventional group; targets, <6.9%, 130/80 mmHg, LDL-cholesterol [or <100 history disease]) stringent (intensive <6.2%, 120/75 <80 <70 disease]). median follow-up 8.5 primary endpoints all-cause mortality, myocardial infarction, stroke, coronary/cerebral artery revascularization) 19% intensive group, reduction conventional (P 0.094) 24% adjustment pre-specified factors, 0.042), group1. prospective observational identify diabetes-related comorbidities follow-up. enrolled 6,338 40–74 age participating sites nationwide June November 2009. onset/progression nephropathy, retinopathy, neuropathy, macroangiopathy, periodontal disease. All events observed course subspecialty working study. registry needs built attempt occur result, provide toward policy. objectives mind, 2015 joint project (JDS) National Center Health Medicine, solicitating participation JDS-accredited facilities. 2018, 51 university facilities participated project, totaling 54,000, whom 1,900 GUIDELINE FOR THE DIAGNOSIS OF DIABETES MELLITUS

Язык: Английский

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Nutrition Management in Older Adults with Diabetes: A Review on the Importance of Shifting Prevention Strategies from Metabolic Syndrome to Frailty

Nutrients, Год журнала: 2020, Номер 12(11), С. 3367 - 3367

Опубликована: Ноя. 1, 2020

The increasing prevalence of older adults with diabetes has become a major social burden. Diabetes, frailty, and cognitive dysfunction are closely related to the mechanisms aging. Insulin resistance, arteriosclerosis, chronic inflammation, oxidative stress, mitochondrial may be common shared by frailty impairment. Hyperglycemia, hypoglycemia, obesity, vascular factors, physical inactivity, malnutrition important risk factors for impairment in diabetes. impact nutrients on health outcomes varies age; thus, shifting diet therapy strategies from treatment obesity/metabolic syndrome prevention necessary patients who over 75 years age, have or sarcopenia, experience malnutrition. For optimal energy intake, sufficient protein vitamin healthy dietary patterns should recommended. after middle age include awareness proper glycemic control aimed at extending life expectancy nutrition, exercise, connectivity. Nutritional combination metabolic control, participation/support can extend maintain quality mellitus.

Язык: Английский

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JCS/JACR 2021 Guideline on Rehabilitation in Patients With Cardiovascular Disease

Circulation Journal, Год журнала: 2022, Номер 87(1), С. 155 - 235

Опубликована: Дек. 8, 2022

PAD peripheral arterial disease PCI percutaneous coronary intervention peak V ˙O2 oxygen uptake PH pulmonary hypertension PVCs premature ventricular contraction QOL quality of life RCT randomized controlled trial RPE rating perceived exertion SGA Subjective Global Assessment STEMI ST elevation myocardial infarction TG triglyceride TAVI transcatheter aortic valve implantation VAD assist device ˙CO2 carbon dioxide output ˙E minute ventilation ˙E/V ventilatory equivalent for vs. slope ˙O2/HR pulse capacity is assessed by cardiopulmonary exercise testing (CPX), an prescription prepared based on the risk in terms severity illness, and then a treatment CR plan established.If CPX cannot be performed due to complications, low physical fitness, or left function, should confirmed 6-minute walk test.For frail patients, after hospital discharge, their living environment, nursing care certification, use services confirmed.In addition, counseling program lifestyle modification adherence medication, assessment management comorbidity, psychological provided.It not rare patients with cardiac depressed discharge anxiety about health, financial problems, concerns returning work sexual potency. 11Regarding recovery phase CR, comprehensive that includes training, smoking cessation, diet therapy, appropriate factors, as well evaluations, return-to-work counseling, support, are important.In importance self-management prevent recurrence explained families, information goals content shared within multidisciplinary team discussed at regular conferences.Counseling will given activity capacity, excessive adjusted level.If there signs findings suggest exacerbation medical condition/heart failure load, must reviewed consideration intensify treatment.Admission Acute (Phase I) Return daily Early mobilization Comprehensive (disease program) Discharge from hospital, home Maintain comfortable life, Prevention Returning society-workforce, Establish new healthy Inpatient rehabilitation (CCU/ICU/ward) Exercise stress tests (other than CPX) may considered IIb B C1 III balance function In suspected frailty falling, "Single leg standing time", "Functional reach test", "Timed up go test" COR, class recommendation; CPX, testing; rehabilitation; GOR, grade LOE, level evidence.* If ≥3 items apply, patient frail.If only 1 2 diagnosed pre-frailty

Язык: Английский

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Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2022

Journal of Atherosclerosis and Thrombosis, Год журнала: 2023, Номер 31(6), С. 641 - 853

Опубликована: Дек. 18, 2023

Язык: Английский

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Gradient boosting decision tree becomes more reliable than logistic regression in predicting probability for diabetes with big data

Scientific Reports, Год журнала: 2022, Номер 12(1)

Опубликована: Окт. 11, 2022

Abstract We sought to verify the reliability of machine learning (ML) in developing diabetes prediction models by utilizing big data. To this end, we compared gradient boosting decision tree (GBDT) and logistic regression (LR) using data obtained from Kokuho-database Osaka prefecture, Japan. develop models, focused on 16 predictors health checkup April 2013 December 2014. A total 277,651 eligible participants were studied. The developed a light (LightGBM), which is an effective GBDT implementation algorithm, LR. Their reliabilities measured based expected calibration error (ECE), negative log-likelihood (Logloss), diagrams. Similarly, their classification accuracies area under curve (AUC). further analyzed while changing sample size for training. Among participants, 15,900 (7978 males 7922 females) newly diagnosed with within 3 years. LightGBM achieved ECE 0.0018 ± 0.00033 (0.0048 0.00058), Logloss 0.167 0.00062 (0.172 0.00090), AUC 0.844 0.0025 (0.826 0.0035). From analysis, became higher than LR when increased more $$10^4$$ 10 4 . Thus, confirmed that provides reliable model development ML could potentially produce highly model, helpful tool improving lifestyle preventing diabetes.

Язык: Английский

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Risk prediction score and equation for progression of arterial stiffness using Japanese longitudinal health examination data

Hypertension Research, Год журнала: 2025, Номер unknown

Опубликована: Фев. 20, 2025

Abstract The brachial-ankle pulse wave velocity (baPWV) is useful for evaluating arterial stiffness. No longitudinal studies have examined the association between multiple stiffness risk factors and increased baPWV. We sought to identify associated with baPWV ≥1400 cm/s within 5 years create an equation simple score predict its occurrence, using data from a large-scale Japanese health examination database. Of 10,284 participants aged 30–69 whom follow-up were available over 5-year period, 3394 men 2710 women baseline baPWV<1400 analyzed. used age, body mass index (BMI), systolic blood pressure (SBP), diastolic (DBP), heart rate (HR), fasting sugar (FBS), low-density lipoprotein cholesterol (LDL-C), high-density (HDL-C), triglyceride (TG), estimated glomerular filtration (eGFR), habitual exercise, drinking, smoking history as variables. In multivariate logistic regression analysis, baPWV≥1400 was significantly BMI, SBP, DBP, HR, FBS, TG in women. A prediction based on these yielded area under curve (AUC) incidence of 0.68 0.71 Furthermore, showed AUC = 0.77 are easy implement clinically. predictive ability scores equations should be validated prospective studies.

Язык: Английский

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Evidence-based clinical practice guidelines for chronic pancreatitis 2021

Journal of Gastroenterology, Год журнала: 2022, Номер 57(10), С. 709 - 724

Опубликована: Авг. 22, 2022

Chronic pancreatitis (CP) is defined according to the recently proposed mechanistic definition as a pathological fibro-inflammatory syndrome of pancreas in individuals with genetic, environmental, and/or other risk factors who develop persistent responses parenchymal injury or stress.The clinical practice guidelines for CP Japan were revised 2021 based on 2019 Japanese diagnostic criteria CP, which incorporate concept pathogenic pancreas. In this third edition, questions are reclassified into questions, background and future research questions.Based analysis newly accumulated evidence, strength evidence recommendations each question described terms treatment selection, lifestyle guidance, pain control, exocrine endocrine insufficiency, complications. A flowchart outlining indications, policies cases ineffective provided. For pharmacological indications timing endoscopic surgical have been updated edition.These provide clinicians useful information assist diagnosis CP.

Язык: Английский

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Deletion of skeletal muscle Akt1/2 causes osteosarcopenia and reduces lifespan in mice

Nature Communications, Год журнала: 2022, Номер 13(1)

Опубликована: Окт. 5, 2022

Abstract Aging is considered to be accelerated by insulin signaling in lower organisms, but it remained unclear whether this could hold true for mammals. Here we show that mice with skeletal muscle-specific double knockout of Akt1 / 2 , key downstream molecules signaling, serve as a model premature sarcopenia resistance. The exhibit progressive reduction muscle mass, impairment motor function and systemic sensitivity. They also osteopenia, reduced lifespan largely due death from debilitation on normal chow tumor high-fat diet. These phenotypes are almost reversed additional knocking out Foxo1 4 only partially Tsc2 activate the mTOR pathway. Overall, our data suggest that, unlike suppression Akt activity mammals associated resistance aging accelerate osteosarcopenia consequently reduce lifespan.

Язык: Английский

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Efficacy and safety of imeglimin add‐on to insulin monotherapy in Japanese patients with type 2 diabetes (TIMES 3): A randomized, double‐blind, placebo‐controlled phase 3 trial with a 36‐week open‐label extension period

Diabetes Obesity and Metabolism, Год журнала: 2022, Номер 24(5), С. 838 - 848

Опубликована: Янв. 5, 2022

Abstract Aims To evaluate the efficacy and safety of imeglimin for up to 52 weeks as combination therapy with insulin in Japanese patients type 2 diabetes. Materials Methods This double‐blind, randomized, parallel‐group phase 3 trial was performed at 35 sites Japan. Eligible were individuals aged ≥20 years diabetes inadequate glycaemic control insulin. Patients randomly assigned (1:1) either (1000 mg twice daily) or matched placebo, insulin, 16 weeks. In a subsequent 36‐week, open‐label extension period, all received 1000 daily. The primary endpoint change mean glycated haemoglobin (HbA1c) from baseline week 16. Results all, 108 107 treatment daily respectively. Compared adjusted difference HbA1c Week −0.60% (95% confidence interval [CI] −0.80 −0.40; P < 0.0001). decrease sustained −0.64% CI −0.82 −0.46) versus baseline. incidence experiencing adverse events serious similar two groups. number hypoglycaemia receiving imeglimin, hypoglycaemic mild severity; no episodes required assistance. Conclusions Imeglimin significantly improved insufficiently controlled by had profile placebo. on top represents potential new option this population add‐on therapy.

Язык: Английский

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Laughter yoga as an enjoyable therapeutic approach for glycemic control in individuals with type 2 diabetes: A randomized controlled trial

Frontiers in Endocrinology, Год журнала: 2023, Номер 14

Опубликована: Март 31, 2023

Laughter has been reported to have various health benefits. However, data on the long-term effects of laughter interventions diabetes are limited. This study aimed investigate whether yoga can improve glycemic control among individuals with type 2 diabetes.In a single-center, randomized controlled trial, 42 participants were randomly assigned either intervention or group. The consisted 12-week program. Hemoglobin A1c (HbA1c), body weight, waist circumference, psychological factors, and sleep duration evaluated at baseline week 12.Intention-to-treat analysis showed that in group experienced significant improvements HbA1c levels (between-group difference: -0.31%; 95% CI -0.54, -0.09) positive affect scores 0.62 points; 0.003, 1.23). Sleep tended increase between-group difference 0.4 hours (95% -0.05, 0.86; P = 0.080). mean attendance rate for program was high (92.9%).A is feasible improves control. These findings suggest having fun could be self-care intervention. Further studies larger numbers warranted better evaluate yoga.http://www.chinadrugtrials.org.cn, identifier UMIN000047164.

Язык: Английский

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