Estimation of Diabetes Prevalence, and Evaluation of Factors Affecting Blood Glucose Levels and Use of Medications in Japan

Background: Diabetes is a noncommunicable disease caused by high levels of blood glucose, and it is currently one of the most important public health problems in the world. It is important to know the prevalence of diabetes, the factors affecting blood glucose levels, and the percentage of people with diabetes taking medications. Data and Methods Data and Methods: We analyzed the distribution of blood glucose levels and prevalence of diabetes using 10,917,173 observations obtained from the JMDC Claims Database in Japan. The factors that may affect blood glucose levels were analyzed by a regression model using 5,472,205 observations. Treatment with diabetes medications was analyzed with 9,932,854 and 5,466,361 observations using a method to approximate the inverse of probability by a continuous piecewise linear function. Results: The prevalence of diabetes in 2019 was estimated to be 9.63% in males and 5.33% in females ages 20 - 79;10.78% and 7.04% for ages 20 - 89;and 10.93% and 7.65% for ages 20 - 99, respectively. In addition to age and gender, the important variables affecting blood glucose levels were BMI, SBP, Triglyceride, ALT, AST and GGP. The percentage taking medications increased up to a blood glucose level of around 175 mg/dL, but declined over that. Conclusion: The prevalence of diabetes in Japan was estimated using a very large dataset, and considering age, gender, and time trends. Some variables may be effective for controlling blood glucose levels. Nearly half of those at a serious stage of diabetes took no medications. Proper medical care for these individuals is necessary to prevent worsening diabetes and serious complications. Limitations: The dataset was observatory, and did not include those age 80 or over. Revising medical care systems to include those outside of hospitals is necessary;however, practical approaches have not yet been developed.

Medications in type-2 diabetics and their association with liver fibrosis

BACKGROUND The prevalence of nonalcoholic fatty liver disease(NAFLD) is significantly rising worldwide. Type-2 diabetes(T2D) is a major risk factor for NAFLD progression.AIM To assess the association of commonly used medications to advanced fibrosis(AF) in patients with biopsy-proven NAFLD and T2D.METHODS We used the International Classification of Disease 9 th Revision Clinical Modification coding system to identify patients with T2D and included patients who underwent liver biopsy for suspected NAFLD between January 1, 2000 to December 31, 2015. We compared demographics, clinical characteristics, and differences in pattern of medication use in patients who had biopsy-proven AF to those without it. A univariate and multivariate analysis was performed to assess the association of different classes of medication with the presence of AF.RESULTS A total of 1183 patients were included in the final analysis, out of which 32%(n =381) had AF on liver biopsy. Mean age of entire cohort was 52 years and majority were females(65%) and Caucasians(85%). Among patients with AF, 51% were on oral hypoglycemics, 30% were on insulin, 66% were on antihypertensives and 27% were on lipid lowering agents for the median duration of 19 mo, 10 mo, 26 mo, and 24 mo respectively. Medications associated with decreased risk of AF included metformin, liraglutide, lisinopril, hydrochlorothiazide, atorvastatin and simvastatin while the use of furosemide and spironolactone were associated with higher prevalence of AF.CONCLUSION In our cohort of T2D with biopsy proven NAFLD, the patients who were receiving metformin, liraglutide, lisinopril, hydrochlorothiazide, atorvastatin and simvastatin were less likely to have AF on biopsy, while patients who were receiving furosemide and spironolactone had a higher likelihood of having AF when they underwent liver biopsy. Future studies are needed to confirm these findings and to establish measures for prevention of NAFLD progression in patients with T2D.

Issues and challenges in diabetic neuropathy management:A narrative review

Diabetic neuropathy(DN)is a devastating disorder with an increasing prevalence globally.This epidemic can pose a critical burden on individuals and communities,subsequently affecting the productivity and economic output of a country.With more people living a sedentary lifestyle,the incidence of DN is escalating worldwide.Many researchers have relentlessly worked on ways to combat this devastating disease.Their efforts have given rise to a number of commercially available therapies that can alleviate the symptoms of DN.Unfortunately,most of these therapies are only partially effective.Worse still,some are associated with unfavorable side effects.This narrative review aims to highlight current issues and challenges in the management of DN,especially from the perspective of molecular mechanisms that lead to its progression,with the hope of providing future direction in the management of DN.To improve the approaches to diabetic management,the suggested resolutions in the literature are also discussed in this review.This review will provide an in-depth understanding of the causative mechanisms of DN,apart from the insights to improve the quality and strategic approaches to DN management.

U.S.Medical Advice for Diabetics:Take a Walk

提示:请问,对老人来说,怎样的运动是最理想的运动。科学实验证明:步行。本文的调查又证明了这一点。糖尿病患者只消每周步行两小时,就会大大减少其早死率。本文最有文采的一句:Walking Was associated with lowel mortalityacross a diverse spectrum of adults with diabetes.(步行和形形色色的患糖尿病的成年人的低死亡率有关。)