Effects of long-term monotherapy with glimepiride vs glibenclamide on glycemic control and macrovascular events in Japanese Type 2 diabetic patients

We investigated whether long-term glimepiride (GP) monotherapy improves insulin resistance and exerts a beneficial effect on beta cell function, as compared with glibenclamide (GC). One hundred Japanese Type 2 diabetic patients were randomly assigned to the GP (n = 50) or the GC (n = 50) group. During a 5-year monitoring period, patients received the indicated SU monotherapy, while changes in SU doses were allowed as needed to maintain HbA1C below 7.0%. The GC group, in parallel with fasting insulin, showed a rapid homeostatic model assessment (HOMA)-R increase and maintained a high HOMA-R level. In contrast, HOMA-R in the GP group decreased continuously, from 2.9 at baseline to 1.8 at study completion. In the GC group, HOMA-b was markedly increased in the first 6 months, then gradually decreased through 18 months. While the HOMA-β elevation in the GP group was more moderate than that in the GC group, HOMA-β levels were maintained with a slight decrease. The cumulative macrovascular disease outcome was 1 for the GP and 7 for the GC group, showing a significant difference. These results suggest that glimepiride monotherapy markedly improved HOMA-R with moderate insulin stimulation, which may account for the difference in macrovascular disease development as compared with the group receiving glibenclamide.

Examination of Screening of the Pachinko/Pachislot Playing Disorder Based on Gambling Disorder Scales

Pachinko and pachislot are unique forms of entertainment that dominate gambling activities in Japan. In this study, a web survey and interview were conducted in order to adjust three scales (DSM-5, SOGS, and PGSI) to pachinko/pachislot and explore an appropriate cutoff point for each of them. Using the assessment result in the interview as the outcome, the ROC curve of each scale was examined. The cutoff points were 4, 7, and 8 and the area under the curves (AUC) were 0.730, 0.783, and 0.724 for the DSM-5, SOGS, and PGSI, respectively. The study found that the type and situation of gambling influenced cutoff points in different ways depending on the questions asked in the scale.

Prevalence of Pachinko-Pachislot Playing Disorder and the Characteristics of Individuals with the Disorder: Analysis of National Pachinko/Pachislot Survey Results

To understand the reality of gambling disorder caused by playing pachinko/pachislot, a national pachinko/pachislot survey was conducted. Based on the survey result, we examined the appearance ratio and the characteristics of individuals with a suspected pachinko-pachislot playing disorder. The analysis result indicated that approximately 0.4% of survey respondents were suspected to have the disorder. This appearance ratio was comparable to the prevalence of gambling disorder in the general population. Those who had a suspected disorder were likely to be divorced, and have no savings. Meanwhile, no distinctive characteristics were found in their gender, annual household income, or the highest educational attainment.

Clinical Characteristics of Japanese Type 2 Diabetic Patients Responsive to Sitagliptin

Japanese type 2 diabetic patients were treated with sitagliptin to evaluate the efficacy of this agent, and also to investigate the clinical characteristics of those who responded to sitagliptin. In total, 1001 diabetic patients, inadequately controlled (HbA1c ≥ 6.5%) with oral hypoglycemic agents (OHA) other than DPP-4 inhibitors or with diet and exercise only, were enrolled. We added 50mg of sitagliptin to the therapeutic regimens of 410 patients including 68 OHA naive patients, while the other 591 patients were switched from a single OHA to 50 mg of sitagliptin. After 6 months, glycemic control was significantly improved due to both reduced insulin resistance, as demonstrated by a significant HOMA-R reduction, and recovery of pancreatic β cell function, as assessed by HOMA-β and the proinsulin/insulin (PI/I) ratio. In the bivariable analysis, a good response, defined as an HbA1c reduction during the 6 months of at least 0.9%, was associated with high HbA1c and PI/I at baseline and combination treatments with sulfonylurea, biguanide and α-glucosidase inhibitors, but not with obesity. On the other hand, in the multivariable regression analysis, only high baseline HbA1c and combination treatment with anα-glucosidase inhibitor were significantly associated with a good response to sitagliptin. In patients with type 2 diabetes, the addition of sitagliptin or switching from another OHA to this agent achieved an HbA1c reduction without overloading β cells. In particular, we suggest that a good response to sitagliptin can be expected when this agent is combined with an α-glucosidase inhibitor (UMIN No. #000014157).