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Higashiyama A, Kohsaka S, Fujiyoshi A. Primary Prevention of Coronary and Other Cardiovascular Diseases: A Focused Review. J Atheroscler Thromb 2024:RV22019. [PMID: 38825504 DOI: 10.5551/jat.rv22019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024] Open
Abstract
In 2022, the Japan Atherosclerosis Society (JAS) updated its prevention guidelines, the "Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2022" (JAS2022GL), expanding its scope from coronary artery disease (CAD) to atherosclerotic cardiovascular diseases (ASCVDs), including atherothrombotic stroke. The following year, the Japanese Circulation Society (JCS) updated its guidelines for primary prevention entitled "JCS 2023 Guideline on the Primary Prevention of Coronary Artery Disease" (JCS2023GL). Since those publications, scientific advancements in relevant fields have continued. This review article outlines the current recommendations provided by the guidelines, provides background information supporting these recommendations, introduces scientific findings subsequent to prior publications, and discusses future directions on select topics for the primary prevention of CVD. The topics covered in this review are traditional risk factors, including dyslipidemia and hypertension, the application of comprehensive risk stratification or risk scoring systems, patient-specific topics, salt and alcohol, and environmental factors. These topics were deliberate and selected by the authors, who were involved in the compilation of either or both JAS2022GL and JCS2023GL. This review not only emphasizes the pivotal role of continuously updated guidelines in shaping clinical practice but also stresses the urgent need for ongoing research to bridge existing knowledge and practice gaps.
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Affiliation(s)
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
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Miyasaka K, Takada R, Wu J, Takeda S, Manse Y, Morikawa T, Shimoda H. Hypoglycemic effects of mountain caviar extract and inhibitory mechanism of saponins, including momordin Ic, on glucose absorption. J Nat Med 2024; 78:693-701. [PMID: 38587581 DOI: 10.1007/s11418-024-01791-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/14/2024] [Indexed: 04/09/2024]
Abstract
Mountain caviar is a fruit of Kochia scoparia that contains momordin Ic as a major saponin constituent. Its extract (MCE) has been shown to suppress blood glucose elevations in the human oral glucose tolerance test (OGTT) as well as increases in blood glucose in OGTT, gastric emptying (GE), and glucose incorporation in the small intestine in rats. However, the effects of MCE and momordin Ic on glucose absorption in mice and these action mechanisms have not been examined for more than 2 decades. Therefore, we herein investigated the effects of MCE, its saponin fraction, and momordin Ic on blood glucose elevations in mice. Mouse blood glucose elevation tests were performed on carbohydrate-loaded mice. The mountain caviar saponin fraction significantly delayed blood glucose elevations in glucose-, sucrose-, and soluble starch-loaded mice. In glucose-loaded mice, the saponin fraction, MCE, and momordin Ic significantly suppressed rapid glucose elevations after glucose loading, but not sucrose loading. A mouse GE study was performed by loading with glucose and phenolphthalein solution. Momordin Ic and MCE strongly suppressed mouse GE. Intestinal glucose absorption was evaluated by the incorporation of 2-deoxyglucose (2-DG) into Caco-2 cell layers and mouse duodenum wall vesicles. The results obtained showed that momordin Ic inhibited the incorporation of 2-DG into Caco-2 cells and mouse duodenum vesicles. Collectively, these results suggest that MCE, particularly the principal saponin, momordin Ic, preferably suppressed glucose-induced blood glucose elevations and delayed carbohydrate-induced glucose elevations in mice. The underlying mechanism was found to involve the suppression of GE and intestinal glucose absorption.
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Affiliation(s)
- Kenchi Miyasaka
- Oryza Oil & Fat Chemical Co., Ltd. 1 Numata, Kitagata-cho, Ichinomiya, Aichi, 493-8001, Japan
| | - Ryuya Takada
- Pharmaceutical Research and Technology Institute, Kindai University, 3-4-1, Kowakae, Higashi-Osaka, 577-8501, Japan
| | - Jianbo Wu
- Oryza Oil & Fat Chemical Co., Ltd. 1 Numata, Kitagata-cho, Ichinomiya, Aichi, 493-8001, Japan
| | - Shogo Takeda
- Oryza Oil & Fat Chemical Co., Ltd. 1 Numata, Kitagata-cho, Ichinomiya, Aichi, 493-8001, Japan
| | - Yoshiaki Manse
- Pharmaceutical Research and Technology Institute, Kindai University, 3-4-1, Kowakae, Higashi-Osaka, 577-8501, Japan
| | - Toshio Morikawa
- Pharmaceutical Research and Technology Institute, Kindai University, 3-4-1, Kowakae, Higashi-Osaka, 577-8501, Japan
- Antiaging Center, Kindai University, 3-4-1, Kowakae, Higashi-Osaka, 577-8501, Japan
| | - Hiroshi Shimoda
- Oryza Oil & Fat Chemical Co., Ltd. 1 Numata, Kitagata-cho, Ichinomiya, Aichi, 493-8001, Japan.
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Dal Moro R, Helal L, Almeida L, Osório J, Schmidt MI, Mengue S, Duncan BB. The Development of the Municipal Registry of People with Diabetes in Porto Alegre, Brazil. J Clin Med 2024; 13:2783. [PMID: 38792326 PMCID: PMC11121854 DOI: 10.3390/jcm13102783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/19/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objective: Diabetes registries that enhance surveillance and improve medical care are uncommon in low- and middle-income countries, where most of the diabetes burden lies. We aimed to describe the methodological and technical aspects adopted in the development of a municipal registry of people with diabetes using local and national Brazilian National Health System databases. Methods: We obtained data between July 2018 and June 2021 based on eight databases covering primary care, specialty and emergency consultations, medication dispensing, outpatient exam management, hospitalizations, and deaths. We identified diabetes using the International Classification of Disease (ICD), International Classification of Primary Care (ICPC), medications for diabetes, hospital codes for the treatment of diabetes complications, and exams for diabetes management. Results: After data processing and database merging using deterministic and probabilistic linkage, we identified 73,185 people with diabetes. Considering that 1.33 million people live in Porto Alegre, the registry captured 5.5% of the population. Conclusions: With additional data processing, the registry can reveal information on the treatment and outcomes of people with diabetes who are receiving publicly financed care in Porto Alegre. It will provide metrics for epidemiologic surveillance, such as the incidence, prevalence, rates, and trends of complications and causes of mortality; identify inadequacies; and provide information. It will enable healthcare providers to monitor the quality of care, identify inadequacies, and provide feedback as needed.
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Affiliation(s)
- Rafael Dal Moro
- Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, Brazil
- Secretaria Municipal de Saúde de Porto Alegre, Porto Alegre 90010-150, Brazil
| | - Lucas Helal
- Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, Brazil
| | - Leonel Almeida
- Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, Brazil
- Secretaria Municipal de Saúde de Porto Alegre, Porto Alegre 90010-150, Brazil
| | - Jorge Osório
- Secretaria Municipal de Saúde de Porto Alegre, Porto Alegre 90010-150, Brazil
| | - Maria Ines Schmidt
- Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, Brazil
| | - Sotero Mengue
- Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, Brazil
| | - Bruce B. Duncan
- Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, Brazil
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Onishi Y, Oura T, Takeuchi M. Metabolic Abnormalities Following Tirzepatide Monotherapy in Japanese Patients with Type 2 Diabetes: A Phase 3 SURPASS J-mono Post Hoc Analysis. Diabetes Ther 2024; 15:649-661. [PMID: 38310163 PMCID: PMC10942919 DOI: 10.1007/s13300-024-01534-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/15/2024] [Indexed: 02/05/2024] Open
Abstract
INTRODUCTION The presence of metabolic abnormalities in patients with type 2 diabetes (T2D) increases the risk of cardiovascular disease and other comorbidities. This analysis compared the effects of tirzepatide (5, 10, and 15 mg) and dulaglutide 0.75 mg on the prevalence of metabolic abnormalities in Japanese patients with T2D. METHODS This was a post hoc analysis of SURPASS J-mono, a multicenter, randomized, double-blind, active-controlled, parallel-group, phase 3 trial that compared the efficacy and safety of tirzepatide monotherapy (5, 10, and 15 mg) to dulaglutide 0.75 mg in Japanese patients with T2D. Thresholds for abnormalities were based on the Japanese criteria for metabolic syndrome. Proportions of participants meeting a composite endpoint (visceral fat accumulation measured by waist circumference plus two or more of dyslipidemia, hypertension, or hyperglycemia) or individual component thresholds were calculated at baseline and week 52 for the overall population and for baseline body mass index (BMI) subgroups (< 25, 25 to < 30, and ≥ 30 kg/m2). RESULTS Of 636 randomized participants, 431 (67.8%) met the composite endpoint at baseline, with similar findings observed across treatment arms. At week 52, the proportion of participants on treatment that met the composite endpoint was 31.7%, 23.0%, and 14.2% in the tirzepatide 5-, 10-, and 15-mg arms, respectively, and 56.5% in the dulaglutide arm (p < 0.001). A higher proportion met the composite endpoint at baseline in the BMI 25 to < 30 and ≥ 30 kg/m2 subgroups (73.2-79.3%) compared with the < 25 kg/m2 subgroup (45.3%), with reductions observed across all BMI subgroups treated with tirzepatide. The proportion of participants with individual metabolic abnormalities showed similar trends to those observed for the composite endpoint. Tirzepatide was consistently superior to dulaglutide across all assessments. CONCLUSIONS Tirzepatide reduced the prevalence of multiple metabolic abnormalities, indicating tirzepatide may have metabolic benefit in Japanese patients with T2D. TRIAL REGISTRATION ClinicalTrials.gov, NCT03861052.
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Affiliation(s)
- Yukiko Onishi
- Division of Diabetes and Metabolism, The Institute of Medical Science, Asahi Life Foundation, Tokyo, Japan
| | - Tomonori Oura
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K, Kobe, 651-0086, Japan
| | - Masakazu Takeuchi
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K, Kobe, 651-0086, Japan.
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Oshima Y, Doi T, Ohtomo N, Ito Y, Nakajima K, Nagata K, Kato S, Taniguchi Y, Matsubayashi Y, Tanaka S. Patients with a large ossification of the posterior longitudinal ligament have a higher incidence of arteriosclerosis in the carotid artery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:379-385. [PMID: 38227214 DOI: 10.1007/s00586-023-08107-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/15/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE This study aimed to investigate the impact of the severity of cervical ossification of the posterior longitudinal ligament (OPLL) on the incidence of arteriosclerosis in the carotid artery. METHODS Patients with OPLL-induced cervical myelopathy were prospectively enrolled. The study involved analyzing patient characteristics, blood samples, computed tomography scans of the spine, and intima-media thickness (IMT) measurements of the common carotid artery. Patients were divided into two groups based on the size of the cervical OPLL to compare demographic data, comorbidities, and the presence of thickening of the carotid intima-media (max IMT ≥ 1.1 mm). RESULTS The study included 96 patients (mean age: 63.5 years; mean body mass index: 26.9 kg/m2; 71.8% male; 35.4% with diabetes mellitus). The mean maximum anteroposterior (AP) diameter of the OPLL was 4.9 mm, with a mean occupancy ratio of 43%. The mean maximum IMT was 1.23 mm. Arteriosclerosis of the carotid artery was diagnosed in 62.5% of the patients. On comparing the two groups based on OPLL size, the group with larger OPLL (≥ 5 mm) had a higher BMI and a greater prevalence of carotid intima-media thickening. This significant difference in the prevalence of carotid intima-media thickening persisted even after adjusting for patient backgrounds using propensity score matching. CONCLUSIONS Patients with a larger cervical OPLL showed a higher frequency of intima-media thickening in the carotid artery.
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Affiliation(s)
- Yasushi Oshima
- Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Toru Doi
- Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Nozomu Ohtomo
- Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yusuke Ito
- Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Koji Nakajima
- Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kosei Nagata
- Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - So Kato
- Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yuki Taniguchi
- Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yoshitaka Matsubayashi
- Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Ishigaki Y, Hirase T, Pathadka S, Cai Z, Sato M, Takemura R, Ishida N. Prevalence of Metabolic Syndrome in Patients with Type 2 Diabetes in Japan: A Retrospective Cross-Sectional Study. Diabetes Ther 2024; 15:245-256. [PMID: 37856046 PMCID: PMC10786760 DOI: 10.1007/s13300-023-01484-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/28/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION Recent data on the prevalence of metabolic syndrome in Japanese patients with type 2 diabetes (T2D) are limited. METHODS This retrospective, cross-sectional, observational study investigated the prevalence of metabolic syndrome in patients with T2D using a Japanese administrative claims database. Patients with a T2D diagnosis, prescription of a hypoglycemic agent, and one or more annual health checkups in 2020 were included. Trends in the prevalence of metabolic syndrome by sex and body mass index (BMI) subgroup were assessed. RESULTS The study cohort consisted of 155,653 patients (men, 81.6%; mean age 54.6 ± 8.5 years). Patients with metabolic syndrome had a higher mean BMI (29.1 ± 4.5 kg/m2 versus 25.2 ± 4.5 kg/m2) and mean waist circumference (98.3 ± 10.0 cm versus 87.9 ± 11.2 cm) compared to those without metabolic syndrome. Overall, the prevalence of metabolic syndrome was 43.0% in patients with T2D, with prevalence higher in men (46.6%) than women (27.0%). The prevalence increased across BMI subgroups from 17.3% in the < 25 kg/m2 subgroup, to 54.6% and 66.1% in the 25 to < 30 and ≥ 30 kg/m2 subgroups, respectively. A greater proportion of patients with metabolic syndrome had cardiovascular or renal comorbidities (BMI < 25, 0.3-2.0%; BMI 25 to < 30, 0.7-6.2%; BMI ≥ 30 kg/m2, 0.7-6.8%) and cardiovascular drug usage (BMI < 25, 1.3-9.0%; BMI 25 to < 30, 3.8-31.1%; BMI ≥ 30 kg/m2, 3.5-37.0%) in the higher BMI subgroups compared to the BMI < 25 kg/m2 subgroup. CONCLUSION The prevalence of metabolic syndrome in Japanese patients with T2D was 43.0% and increased with higher BMI. In patients with T2D and metabolic syndrome, cardiovascular drug usage and comorbidities increased in patients with a higher BMI. These data highlight the importance of managing metabolic parameters in addition to glycemic control in Japanese patients with T2D, particularly in patients with metabolic syndrome and BMI ≥ 25 kg/m2.
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Affiliation(s)
- Yasushi Ishigaki
- Division of Diabetes, Metabolism, and Endocrinology, Department of Internal Medicine, Iwate Medical University, Yahaba, Japan
| | - Tetsuaki Hirase
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K., Hyogo, Japan
| | - Swathi Pathadka
- Lilly Capability Center India, Eli Lilly Services Private Ltd, 1st Floor, Building Primrose 7B, Wing B, Embassy Tech Village, Devarabisanahalli, Bengaluru, Karnataka, 560103, India.
| | - Zhihong Cai
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K., Hyogo, Japan
| | - Manaka Sato
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K., Hyogo, Japan
| | - Ryo Takemura
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Noriyuki Ishida
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
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Sharma K, Puranik N, Yadav D. Neural Stem Cell-based Regenerative Therapy: A New Approach to Diabetes Treatment. Endocr Metab Immune Disord Drug Targets 2024; 24:531-540. [PMID: 37183465 DOI: 10.2174/1871530323666230512121416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 05/16/2023]
Abstract
Diabetes mellitus (DM) is the most common metabolic disorder that occurs due to the loss, or impaired function of insulin-secreting pancreatic beta cells, which are of two types - type 1 (T1D) and type 2 (T2D). To cure DM, the replacement of the destroyed pancreatic beta cells of islet of Langerhans is the most widely practiced treatment. For this, isolating neuronal stem cells and cultivating them as a source of renewable beta cells is a significant breakthrough in medicine. The functions, growth, and gene expression of insulin-producing pancreatic beta cells and neurons are very similar in many ways. A diabetic patient's neural stem cells (obtained from the hippocampus and olfactory bulb) can be used as a replacement source of beta cells for regenerative therapy to treat diabetes. The same protocol used to create functional neurons from progenitor cells can be used to create beta cells. Recent research suggests that replacing lost pancreatic beta cells with autologous transplantation of insulin-producing neural progenitor cells may be a perfect therapeutic strategy for diabetes, allowing for a safe and normal restoration of function and a reduction in potential risks and a long-term cure.
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Affiliation(s)
- Kajal Sharma
- School of Sciences in Biotechnology, Jiwaji University, Gwalior, 474011, Madhya Pradesh, India
| | - Nidhi Puranik
- Department of Bio-logical Sciences, Bharathiar University, Tamil Nadu, India
| | - Dhananjay Yadav
- Department of Life Science, Yeungnam University, Gyeongsan, 38541, Korea
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Ono R, Ogami C, Hasegawa C, To H, Matsumoto Y, Tsuji Y. Comparison of the efficacy of anti-diabetic medications as add-on to metformin in type 2 diabetes mellitus from a real-world database. BMC Pharmacol Toxicol 2023; 24:75. [PMID: 38066653 PMCID: PMC10709883 DOI: 10.1186/s40360-023-00716-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Metformin is recommended as a first-line drug in the guidelines of the treatment for type 2 diabetes mellitus. However, high-quality evidence from clinical trials directly comparing the degree of hypoglycemic effect of combination therapy of metformin and a hypoglycemic agent with a different mechanism of action with that of monotherapy of a hypoglycemic drug is lacking. We aimed to examine whether combination therapy of hypoglycemic agents with metformin showed antagonism, addition, or synergism compared to monotherapy with hypoglycemic agents other than metformin regarding hemoglobin A1c levels. METHODS This retrospective cohort study used a medical information database in Japan. Non-insulin anti-hyperglycemic agents with different mechanisms of action were classified into eight drug classes. A monotherapy cohort and a combination therapy added to the metformin cohort were defined. The change in hemoglobin A1c levels was evaluated to compare the treatment effect between the cohorts. RESULTS A total of 13,359 patients with type 2 diabetes mellitus in the monotherapy cohort and 1,064 in the metformin combination therapy cohort were identified. A comparison of the change from baseline HbA1c level by drug class between the two cohorts showed a similar trend. Among those treated with dipeptidyl peptidase-4 inhibitor and sodium-glucose co-transporter-2 inhibitor, no clinically significant difference was observed between the two cohorts (0.00% and -0.07% for unadjusted, 0.15% and -0.03% for propensity score matching-adjusted, and 0.09% and -0.01% for inverse probability treatment weighting-adjusted analysis). CONCLUSIONS According to the results of this study, the effect of dipeptidyl peptidase-4 inhibitor or sodium-glucose co-transporter-2 inhibitor added to metformin seems to be additive with respect to the reduction in hemoglobin A1c.
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Affiliation(s)
- Ryosuke Ono
- Laboratory of Clinical Pharmacometrics, School of Pharmacy, Nihon University, 7-7-1 Narashinodai, Funabashi, Chiba, 274-8555, Japan
- Clinical Pharmacology and Bioanalytics, Pfizer R&D Japan, 3-22-7 Yoyogi, Shibuya-Ku, Tokyo, 151-8589, Japan
| | - Chika Ogami
- Department of Medical Pharmaceutics, Graduate School of Medical and Pharmaceutical Sciences for Research, University of Toyama, 2630 Sugitani, Toyama City, 930-0194, Japan
| | - Chihiro Hasegawa
- Laboratory of Clinical Pharmacometrics, School of Pharmacy, Nihon University, 7-7-1 Narashinodai, Funabashi, Chiba, 274-8555, Japan
| | - Hideto To
- Department of Medical Pharmaceutics, Graduate School of Medical and Pharmaceutical Sciences for Research, University of Toyama, 2630 Sugitani, Toyama City, 930-0194, Japan
| | - Yoshiaki Matsumoto
- Laboratory of Clinical Pharmacometrics, School of Pharmacy, Nihon University, 7-7-1 Narashinodai, Funabashi, Chiba, 274-8555, Japan
| | - Yasuhiro Tsuji
- Laboratory of Clinical Pharmacometrics, School of Pharmacy, Nihon University, 7-7-1 Narashinodai, Funabashi, Chiba, 274-8555, Japan.
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Uematsu T, Masuki H, Nakamura M, Kawabata H, Kitamura Y, Watanabe T, Watanabe T, Mochizuki T, Ushiki T, Kawase T. Metformin-suppressed platelet's function in vitro: Possible relation to delayed or failure of platelet-rich fibrin preparation. Toxicol In Vitro 2023; 93:105692. [PMID: 37673314 DOI: 10.1016/j.tiv.2023.105692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/08/2023]
Abstract
Platelet-rich fibrin (PRF) is a popular autologous blood-derived biomaterial that is used in regenerative therapy. Owing to its simple preparation without additional factors, the PRF quality directly reflects the characteristics of individual blood samples. Antiplatelet or anticoagulant drugs can hamper the successful preparation of PRF. We recently observed similar phenomena in metformin-taking type-2 diabetics (T2DM). Thus, we hypothesized that metformin interferes with platelet function, thereby suppressing coagulation. For practical reasons, leukocyte- and platelet-rich plasma was prepared from healthy male donors (n = 9-15, age: 26-80 years) and treated with metformin (1-10 mM) for 24-72 h. Intrinsic and extrinsic coagulation activities were evaluated using prothrombin time (PT) and activated partial thromboplastin time (ATPP). Platelet adhesion and aggregation assays were performed using ADP stimulation. Among the parameters tested, APTT was the most sensitive and was significantly prolonged in the concentration range of 1-10 mM in a time- and concentration-dependent manner. Although obtained from healthy platelets and relatively higher concentrations of metformin, these findings suggest that metformin may induce further dysfunction of platelets to suppress intrinsic coagulation activity in T2DM patients, leading to failure of PRF preparation. This phenomenon may not have a severe impact on clinical diabetology or hematology. However, clinicians using PRF are recommended to be more sensitive to such information to avoid unexpected events in clinical settings.
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Affiliation(s)
| | - Hideo Masuki
- Tokyo Plastic Dental Society, Kita-Ku, Tokyo, Japan
| | | | | | | | | | | | - Tomoharu Mochizuki
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Takashi Ushiki
- Division of Hematology and Oncology, Graduate School of Health Sciences, Niigata University, Niigata, Japan; Department of Transfusion Medicine, Cell Therapy and Regenerative Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan; Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Tomoyuki Kawase
- Division of Oral Bioengineering, Institute of Medicine and Dentistry, Niigata University, Niigata, Japan.
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Kato ET, Sato J. Addressing health and demographic challenges in Japan's ageing society. Lancet Diabetes Endocrinol 2023; 11:543-544. [PMID: 37500192 DOI: 10.1016/s2213-8587(23)00197-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Affiliation(s)
- Eri Toda Kato
- Department of Cardiovascular Medicine and Clinical Laboratory, Kyoto University Hospital, Kyoto 606-8507, Japan.
| | - Junko Sato
- Department of Diabetes, Endocrinology and Metabolism, Graduate School of Medicine, Juntendo University, Tokyo, Japan
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Takenoshita S, Terada S, Inoue T, Kurozumi T, Yamada N, Kuwano R, Suemitsu S. Prevalence and modifiable risk factors for dementia in persons with intellectual disabilities. Alzheimers Res Ther 2023; 15:125. [PMID: 37464412 PMCID: PMC10354971 DOI: 10.1186/s13195-023-01270-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 07/06/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND People with intellectual disability (ID) without Down syndrome (DS) are presumed to be at higher risk of developing dementia due to their lower baseline cognitive reserve. We aimed to determine the prevalence of dementia in people with ID without DS and to identify risk factors of dementia. METHODS This was a cross-sectional survey and multicenter study in Japan. Adults with ID without DS residing in the facilities were included. Caregivers of all participants were interviewed by medical specialists, and participants suspected of having cognitive decline were examined directly. ICD-10 criteria for dementia, DC-LD criteria for dementia, and DSM-5 criteria for neurocognitive disorders were used to diagnose dementia. The severity of ID, educational history, and comorbidities were compared by dividing the groups into those with and without dementia. RESULTS A total of 1831 participants were included; 118/1831 (6.44%) were diagnosed with dementia. The prevalence of dementia for each age group was 8.8%, 60-64 years; 9.0%, 65-69 years; 19.6%, 70-74 years; and 19.4%, 75-79 years. Age, severity of ID, duration of education, hypertension, depression, stroke, and traumatic brain injury were significantly associated with the presence of dementia. CONCLUSIONS Although the prevalence of dementia in people with ID without DS was found to be higher at a younger age than in the general population, the results of this study suggested that adequate education, prevention of head trauma and stroke, and treatments of hypertension and depression may reduce the risk of dementia. These may be potentially important modifiable risk factors for the prevention of dementia in these people.
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Affiliation(s)
| | - Seishi Terada
- Department of Neuropsychiatry, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Tomokazu Inoue
- Asahigawaso Research Institute, Social Welfare Corporation Asahigawaso, 866 Gion, Kita-Ku, Okayama, 703-8555, Japan
| | - Taku Kurozumi
- Asahigawaso Research Institute, Social Welfare Corporation Asahigawaso, 866 Gion, Kita-Ku, Okayama, 703-8555, Japan
| | - Norihito Yamada
- Department of Neuropsychiatry, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Ryozo Kuwano
- Asahigawaso Research Institute, Social Welfare Corporation Asahigawaso, 866 Gion, Kita-Ku, Okayama, 703-8555, Japan.
| | - Shigeru Suemitsu
- Asahigawaso Research Institute, Social Welfare Corporation Asahigawaso, 866 Gion, Kita-Ku, Okayama, 703-8555, Japan
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12
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Kiyosue A, Dunn JP, Cui X, Hickey A, Hirase T, Imaoka T, Heine RJ. Safety and efficacy analyses across age and body mass index subgroups in East Asian participants with type 2 diabetes in the phase 3 tirzepatide studies (SURPASS programme). Diabetes Obes Metab 2023; 25:1056-1067. [PMID: 36545807 DOI: 10.1111/dom.14952] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/08/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
AIM To assess the safety and efficacy of tirzepatide in people of East Asian descent based on age and body mass index (BMI). MATERIALS AND METHODS Data of participants enrolled in East Asian countries in the SURPASS-1, -3, -4, -5, J-mono and J-combo phase 3 clinical trials were included. Participants with type 2 diabetes with a baseline HbA1c of 7.0% up to 11.0% and a BMI of 23 kg/m2 or greater or 25 kg/m2 or greater were included. Participants treated with tirzepatide 5, 10 or 15 mg were evaluated to assess the safety and efficacy of tirzepatide in people of East Asian descent (94% from Japan) based on age (< 65 and ≥ 65 years) and BMI (< 25 and ≥ 25 kg/m2 ). Key safety and efficacy outcomes were assessed. RESULTS At baseline, 73% of East Asian participants had a BMI of 25 kg/m2 or greater and 74% were younger than 65 years. At week 52, tirzepatide induced a similar dose-dependent reduction in HbA1c, waist circumference and BMI across subgroups. Across all BMI and age subgroups, mean absolute HbA1c reductions across the three doses ranged from 2.3% to 3.0%, and mean waist circumference reductions ranged from 4.3 to 9.8 cm. Improvements in absolute insulin sensitivity, assessed by homeostatic model assessment for insulin resistance, were greater in those with a baseline BMI of ≥ 25 kg/m2 . Improvements in lipid profiles were similar across subgroups. While the safety profile of tirzepatide was broadly similar across BMI and age subgroups, drug discontinuation because of adverse events was higher in participants with a baseline age of ≥ 65 years. CONCLUSIONS This post hoc analysis showed that once-weekly tirzepatide had a similar safety and efficacy profile across BMI and age subgroups in East Asian participants.
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Affiliation(s)
| | - Julia P Dunn
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Xuewei Cui
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Ana Hickey
- Eli Lilly and Company, Indianapolis, Indiana, USA
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Miyoshi H, Matsuhisa M, Yabe D, Takahashi Y, Morimoto Y, Terauchi Y. Use of iGlarLixi for the Management of Type 2 Diabetes in Japanese Clinical Practice: Prior Treatment Subgroup Analysis of the SPARTA Japan Study. Diabetes Ther 2023; 14:671-689. [PMID: 36809494 PMCID: PMC10064399 DOI: 10.1007/s13300-023-01373-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/23/2023] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION iGlarLixi, a fixed-ratio combination of insulin glargine 100 U/mL and the glucagon-like peptide 1 receptor agonist (GLP-1 RA) lixisenatide, is one option for treatment intensification in individuals with type 2 diabetes (T2D) who are unable to achieve targeted glycaemic control with their current glucose-lowering agent. Real-world data on the impact of prior treatment on the effectiveness and safety of iGlarLixi may be useful to guide individualised treatment decisions. METHODS This analysis of the 6-month, retrospective, observational SPARTA Japan study compared glycated haemoglobin (HbA1c), body weight and safety for pre-specified subgroups defined by prior treatment: post oral antidiabetic agent (OAD), GLP-1 RA, basal insulin (BI) + OADs (BOT), GLP-1 RA + BI or multiple daily injections (MDI). The post BOT and MDI subgroups were further divided on the basis of prior dipeptidyl peptidase 4 inhibitor (DPP-4i) use, and the post MDI group was divided on the basis of whether participants continued bolus insulin. RESULTS Of the 432 participants in the full analysis set (FAS), 337 were included in this subgroup analysis. Across subgroups, mean baseline HbA1c ranged from 8.49% to 9.18%. iGlarLixi significantly (p < 0.05) reduced mean HbA1c from baseline in all but the post GLP-1 RA + BI group. At 6 months, these significant reductions ranged from 0.47% to 1.27%. Prior DPP-4i exposure had no impact on the HbA1c-lowering effect of iGlarLixi. Mean body weight decreased significantly in the FAS (0.5 kg) and the post BOT (1.2 kg) and MDI (1.5 and 1.9 kg) subgroups but increased in the post GLP-1 RA subgroup (1.3 kg). iGlarLixi treatment was generally well tolerated, with very few participants discontinuing because of hypoglycaemia or gastrointestinal events. CONCLUSION In participants with suboptimal glycaemic control on various regimens, 6 months of iGlarLixi treatment improved HbA1c in all but one prior treatment subgroup (GLP-1 RA + BI), and was generally well tolerated. TRIAL REGISTRATION UMIN-CTR Trials Registry, UMIN000044126; registered 10 May 2021.
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Affiliation(s)
- Hideaki Miyoshi
- Department of Immunology and Metabolism, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Munehide Matsuhisa
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, Tokushima, Japan
| | - Daisuke Yabe
- Department of Diabetes, Endocrinology and Metabolism, and Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yoko Takahashi
- General Medicine Medical, Sanofi K.K., Opera City Tower 3-20-2, Nishi-Shinjuku, Shinjuku-ku, Tokyo, 163-1488 Japan
| | - Yukiko Morimoto
- Real World Evidence Generation Partnering, Sanofi K.K., Tokyo, Japan
| | - Yasuo Terauchi
- Department of Endocrinology and Metabolism, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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14
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Matsuhisa M, Miyoshi H, Yabe D, Takahashi Y, Morimoto Y, Terauchi Y. Use of iGlarLixi for Management of Type 2 Diabetes in Japanese Clinical Practice: SPARTA Japan, a Retrospective Observational Study. Diabetes Ther 2023; 14:219-236. [PMID: 36422802 PMCID: PMC9880089 DOI: 10.1007/s13300-022-01333-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/26/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Many individuals with type 2 diabetes (T2D) experience suboptimal glycemic control. Treatment intensification options include fixed-ratio combination products containing a basal insulin and a glucagon-like peptide-1 receptor agonist, such as iGlarLixi (insulin glargine 100 U/mL and lixisenatide). This study aimed to provide real-world evidence of the effect of iGlarLixi in Japanese clinical practice. METHODS SPARTA Japan was a non-comparative, observational study conducted at 27 institutions in Japan. Anonymized individual-level data from adults with T2D receiving iGlarLixi in routine clinical practice were retrospectively collected. The primary study objective was to assess the impact of iGlarLixi on the change in glycated hemoglobin (HbA1c) at 6 months' post-treatment initiation, with preplanned subanalyses to determine the influence of baseline characteristics. Secondary and exploratory endpoints included assessment of the proportion of individuals achieving HbA1c targets, change in body weight, and incidence and severity of hypoglycemia and gastrointestinal events. RESULTS The full analysis set included 432 individuals, with data available at 6 months for 426. Of the 432 individuals, the mean (SD) age at baseline was 61.6 (12.8) years and the majority had a T2D duration of ≥ 10 years [mean (SD) 13.3 (10.4) years]. At 6 months, HbA1c had significantly decreased versus baseline ( -0.85%; P < 0.0001), with a greater decrease in those aged < 65 years, with a shorter duration of T2D and higher baseline HbA1c. A significant increase in the proportion of participants achieving age-specific HbA1c versus baseline was observed. Mean body weight decreased by 0.5 kg (P = 0.0034 versus baseline). There were few hypoglycemia and gastrointestinal events (in individuals with HbA1c data); no severe hypoglycemic events were reported. CONCLUSIONS The results of this real-world study indicate that iGlarLixi may improve glycemic control without serious adverse events in Japanese individuals with T2D who have suboptimal glycemic control on current treatment regimens and switch to iGlarLixi. TRIAL REGISTRATION UMIN-CTR Trials Registry, UMIN000044126; registered 10 May 2021.
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Affiliation(s)
- Munehide Matsuhisa
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, Tokushima, Japan
| | - Hideaki Miyoshi
- Department of Immunology and Metabolism, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Daisuke Yabe
- Department of Diabetes, Endocrinology and Metabolism, and Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yoko Takahashi
- General Medicine Medical, Sanofi K.K, Opera City Tower 3-20-2, Nishi-Shinjuku, Shinjuku-Ku, Tokyo, 163-1488 Japan
| | - Yukiko Morimoto
- Real World Evidence Generation Partnering, Sanofi K.K, Tokyo, Japan
| | - Yasuo Terauchi
- Department of Endocrinology and Metabolism, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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15
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Cao J, Kurata K, Lim Y, Sengoku S, Kodama K. Social Acceptance of Mobile Health among Young Adults in Japan: An Extension of the UTAUT Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15156. [PMID: 36429875 PMCID: PMC9690921 DOI: 10.3390/ijerph192215156] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/09/2022] [Accepted: 11/12/2022] [Indexed: 06/16/2023]
Abstract
The unprecedented development of information and communication technologies has opened up immense possibilities in the field of health care. Mobile health (mHealth) is gaining increasing attention as an important technology for solving health-related problems. Although a high rate of smartphone usage among young people in Japan has been identified, smartphone usage for health management is not high. As Japanese youth are important potential users of mHealth, it is necessary to explore theories that influence the behavioral intention of Japanese youth to adopt mHealth. This study conducted a questionnaire survey in a Japanese university and collected 233 valuable responses. This study was adapted and extended from the unified theory of acceptance and use of technology (UTAUT) model to measure eight constructs: health consciousness, social influence, facilitation conditions, perceived risk, trust, performance expectancy, effort expectancy, and behavioral intention. Structural equation modeling was used for hypothesis testing. We found that trust, performance expectancy, and effort expectancy directly influenced the behavioral intention to use mHealth. Health consciousness and social influence indirectly influence behavioral intention through trust and performance expectancy. Facilitation conditions indirectly influenced behavioral intention through effort expectancy. This study makes a vital theoretical contribution to policymakers and product developers for the further diffusion of mHealth among young people in Japan.
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Affiliation(s)
- Jianfei Cao
- Graduate School of Technology Management, Ritsumeikan University, Ibaraki 567-8570, Japan
| | - Karin Kurata
- Graduate School of Corporate Business, Ritsumeikan University, Ibaraki 567-8570, Japan
| | - Yeongjoo Lim
- Graduate School of Corporate Business, Ritsumeikan University, Ibaraki 567-8570, Japan
| | - Shintaro Sengoku
- School of Environment and Society, Tokyo Institute of Technology, Tokyo 152-8550, Japan
| | - Kota Kodama
- Graduate School of Technology Management, Ritsumeikan University, Ibaraki 567-8570, Japan
- Center for Research and Education on Drug Discovery, The Graduate School of Pharmaceutical Sciences, Hokkaido University, Sapporo 060-0812, Japan
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16
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Chin R, Nagaoka S, Nakasawa H, Tanaka Y, Inagaki N. Safety and effectiveness of dulaglutide 0.75 mg in Japanese patients with type 2 diabetes in real-world clinical practice: 36 month post-marketing observational study. J Diabetes Investig 2022; 14:247-258. [PMID: 36367417 PMCID: PMC9889676 DOI: 10.1111/jdi.13932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 09/26/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS/INTRODUCTION This study evaluated the safety and effectiveness of dulaglutide in patients with type 2 diabetes in the real-world setting in Japan. MATERIALS AND METHODS This prospective, observational post-marketing surveillance study was conducted for 36 months (July 2016 to July 2021) in Japan. Investigators reported data via an electronic data capture system. Data were analyzed by overall population and age group (<65, ≥65 to <75, and ≥75 years). RESULTS The analysis population (N = 3,136) included 1,538 (49.04%), 869 (27.71%), and 729 (23.25%) patients aged <65 years, ≥65 to <75 years, and ≥75 years, respectively. Overall, 231 patients (7.37%) experienced ≥1 adverse drug reactions, with the highest frequency in the ≥75 years group. The most common adverse drug reactions were gastrointestinal disorders (n = 106; 3.38%). Severe hypoglycemia (n = 4; 0.13%), major adverse cardiovascular events (n = 4; 0.13%), and acute pancreatitis (n = 1; 0.03%) were uncommon. The mean glycated hemoglobin and bodyweight were reduced from baseline by -0.76% and -1.6 kg, respectively (last observation carried forward). The rate of dulaglutide continuation at 36 months was 58.03% overall and 59.43%, 63.13%, and 48.88% in the <65, ≥65 to <75, and ≥75 years groups, respectively. A factor analysis showed age ≥65 years was associated with a greater incidence of gastrointestinal adverse drug reactions as well as larger reductions in glycated hemoglobin and bodyweight. CONCLUSIONS The current real-world data are in accordance with clinical trial findings and further confirm the safety and effectiveness of dulaglutide for elderly patients, whose numbers were limited in the clinical trials.
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Affiliation(s)
- Rina Chin
- Japan Drug Development and Medical Affairs, Eli Lilly JapanKobeJapan
| | - Soshi Nagaoka
- Japan Drug Development and Medical Affairs, Eli Lilly JapanKobeJapan
| | - Haru Nakasawa
- Japan Drug Development and Medical Affairs, Eli Lilly JapanKobeJapan
| | - Yoko Tanaka
- Japan Drug Development and Medical Affairs, Eli Lilly JapanKobeJapan
| | - Nobuya Inagaki
- Division of Diabetes, Metabolism and EndocrinologyKyoto UniversityKyotoJapan
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17
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Kadowaki T, Chin R, Ozeki A, Imaoka T, Ogawa Y. Safety and efficacy of tirzepatide as an add-on to single oral antihyperglycaemic medication in patients with type 2 diabetes in Japan (SURPASS J-combo): a multicentre, randomised, open-label, parallel-group, phase 3 trial. Lancet Diabetes Endocrinol 2022; 10:634-644. [PMID: 35914542 DOI: 10.1016/s2213-8587(22)00187-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/29/2022] [Accepted: 05/30/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Due to potential ethnic differences in the pathophysiology of type 2 diabetes, new therapeutics need to be evaluated in Japanese patients. We aimed to assess the safety and glycaemic efficacy of tirzepatide as an add-on treatment in Japanese patients with type 2 diabetes who had inadequate glycaemic control with stable doses of various oral antihyperglycaemic monotherapies. METHODS This multicentre, open-label, parallel-group, randomised, phase 3 trial was conducted at 34 medical research centres and hospitals in Japan. Eligible participants were aged 20 years or older with inadequately controlled (HbA1c ≥7·0% to <11·0%) type 2 diabetes and were receiving oral antihyperglycaemic monotherapy (sulfonylureas, biguanides, α-glucosidase inhibitors, thiazolidinedione, glinides, or SGLT2 inhibitors) for at least 3 months (stable dose for ≥8 weeks before screening), had a BMI of 23 kg/m2 or higher, and stable bodyweight (±5%) for at least 3 months before screening. After a 2-week screening and 2-week lead-in period, all participants were randomly assigned (1:1:1) to receive 5, 10, or 15 mg of tirzepatide, administered once per week subcutaneously for 52 weeks followed by a 4 week safety follow-up period, using a computer-generated random sequence and interactive web response system, stratified by oral antihyperglycaemic medication group. All participants started receiving 2·5 mg tirzepatide and doses were escalated by 2·5 mg every 4 weeks until the assigned dose was reached. The primary endpoint was safety and tolerability during 52 weeks of treatment, assessed as incidence of treatment-emergent adverse events in the modified intention-to-treat (mITT) population. This trial is registered with ClinicalTrials.gov, NCT03861039. FINDINGS Between March 30, 2019, and Feb 16, 2021, with recruitment and enrolment continuing until Feb 4, 2020, 484 participants were assessed for eligibility and 443 were randomly assigned to receive at least one dose of tirzepatide (148 [33%] in the 5 mg group, 147 [33%] in the 10 mg group, and 148 [33%] in the 15 mg group). 398 (90%) participants completed the study and treatment. Most participants (343 [77%] of 443) had at least one treatment-emergent adverse event. Treatment-emergent adverse events were more frequent in the tirzepatide 15 mg group (125 [84%] of 148) than the 5 mg (109 [74%] of 148) and 10 mg groups (109 [74%] of 147). The most frequent treatment-emergent adverse events with tirzepatide were mild or moderate nasopharyngitis (75 [17%]), nausea (74 [17%]), constipation (54 [12%]), diarrhoea (51 [12%]), and decreased appetite (44 [10%]). At week 52, mean changes from baseline in bodyweight were -3·8 kg (SE 0·5; -5·1% reduction) in the 5 mg group, -7·5 kg (0·5; -10·1% reduction) in the 10 mg group, and -10·2 kg (0·5; -13·2% reduction) in the 15 mg group. Least squares mean HbA1c at baseline reduced from 8·5% (SE 0·1) to 6·0% (0·1) in the 5 mg tirzepatide group, from 8·6% (0·1) to 5·6% (0·1) in the 10 mg group, and from 8·6% (0·1) to 5·6% (0·1) in the 15 mg group at week 52. No adjudication-confirmed deaths were reported. INTERPRETATION Tirzepatide was well tolerated as an add-on to oral antihyperglycaemic monotherapy in Japanese participants with type 2 diabetes and showed improvement in glycaemic control and bodyweight, irrespective of background oral antihyperglycaemic medication. Tirzepatide is a potential new treatment option for Japanese patients with type 2 diabetes that is inadequately controlled with single oral antihyperglycaemic medication. FUNDING Eli Lilly and Company. TRANSLATION For the Japanese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
| | | | | | | | - Yoshihiro Ogawa
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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18
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Liu N, Yang DW, Wu YX, Xue WQ, Li DH, Zhang JB, He YQ, Jia WH. Burden, trends, and risk factors for breast cancer in China from 1990 to 2019 and its predictions until 2034: an up-to-date overview and comparison with those in Japan and South Korea. BMC Cancer 2022; 22:826. [PMID: 35906569 PMCID: PMC9334732 DOI: 10.1186/s12885-022-09923-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 07/21/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The difference in epidemiological characteristics of breast cancer (BC) across countries is valuable for BC management and prevention. The study evaluated the up-to-date burden, trends, and risk factors of BC in China, Japan and South Korea during 1990-2019 and predicted the BC burden until 2034. METHODS Data on incident cases, deaths, disability-adjusted life-years (DALYs) and age-standardized rate (ASR) of BC were extracted from the Global Burden of Disease Study 2019. Trend analysis and prediction until 2034 were conducted by estimated annual percentage change and a Bayesian age-period-cohort model, respectively. Besides, the attributable burden to BC risk factors was also estimated. RESULTS In 2019, the number of BC incident cases, deaths and DALYs in China were 375,484, 96,306 and 2,957,453, respectively. The ASR of incidence increased, while that of death and DALYs decreased for Chinese females and Japanese and South Korean males during 1990-2019. High body-mass-index (BMI) was the largest contributor to Chinese female BC deaths and DALYs, while alcohol use was the greatest risk factor for Japanese and South Korean as well as Chinese males. The incident cases and deaths were expected to continue increase during 2020-2034 (except for Japanese female incident cases). CONCLUSIONS China had the greatest burden of BC among the three countries. Incident cases and deaths of BC were projected to increase over the next 15 years in China, particularly among Chinese males. Effective prevention and management strategies are urgently necessary for BC control in China.
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Affiliation(s)
- Na Liu
- Department of Oncology, Luohe Central Hospital, Luohe, 462000, China.
| | - Da-Wei Yang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Yan-Xia Wu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Wen-Qiong Xue
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Dan-Hua Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Jiang-Bo Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Yong-Qiao He
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Wei-Hua Jia
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.
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High-frequency HbA1c testing among older patients with diabetes in Japan: a longitudinal analysis using medical claims data. Diabetol Int 2022; 13:644-656. [PMID: 36117931 PMCID: PMC9478002 DOI: 10.1007/s13340-022-00584-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/15/2022] [Indexed: 10/18/2022]
Abstract
Aims We aimed to determine the rate of high-frequency HbA1c testing among older Japanese patients (≥ 75 years) with type 2 diabetes who did not have diabetic complications and were not using insulin, and to explore its influencing factors and association with the number of hospital admissions. Methods A retrospective, longitudinal observation study design based on medical claims data between 2015 and 2020 was adopted. We tracked patients for 3 years to describe the annual rate and determine factors associated with high-frequency HbA1c testing using a hierarchical logistical model. We employed a zero-inflated Poisson model to examine the association between frequency of HbA1c testing and the number of hospitalizations. Results Among 6594 patients included (mean age 80.4 years), the rates of high-frequency HbA1c testing in the first, second, and third year were 10.2%, 4.8%, and 4.7%, respectively. Follow-up year [odds ratio (OR) = 0.54, 95% confidence interval (CI) = 0.49-0.59];insulin use (OR = 1.63, 95% CI = 1.26-2.11); multi facility for HbA1c testing (OR = 5.51, 95% CI = 4.66-6.51); more than 48 outpatient days per year (OR = 2.13, 95% CI = 1.81-2.51); hospitalizations (OR = 0.66, 95% CI = 0.55-0.79); two or more classes of antidiabetic agents at baseline (OR = 1.32, 95% CI = 1.11-1.56); and dementia at baseline (OR = 0.70, 95% CI = 0.51-0.97) were significantly associated with high-frequency HbA1c testing. No significant association between frequent HbA1c testing and the number of all-cause hospitalizations was found. Conclusions We revealed a high rate of HbA1c testing among older Japanese patients with type 2 diabetes in ambulatory care and indicated that high-frequency HbA1c testing was more likely to result from the decentralized healthcare system and its structure.
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Jiang X, Yang Z, Wang S, Deng S. “Big Data” Approaches for Prevention of the Metabolic Syndrome. Front Genet 2022; 13:810152. [PMID: 35571045 PMCID: PMC9095427 DOI: 10.3389/fgene.2022.810152] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 03/28/2022] [Indexed: 11/21/2022] Open
Abstract
Metabolic syndrome (MetS) is characterized by the concurrence of multiple metabolic disorders resulting in the increased risk of a variety of diseases related to disrupted metabolism homeostasis. The prevalence of MetS has reached a pandemic level worldwide. In recent years, extensive amount of data have been generated throughout the research targeted or related to the condition with techniques including high-throughput screening and artificial intelligence, and with these “big data”, the prevention of MetS could be pushed to an earlier stage with different data source, data mining tools and analytic tools at different levels. In this review we briefly summarize the recent advances in the study of “big data” applications in the three-level disease prevention for MetS, and illustrate how these technologies could contribute tobetter preventive strategies.
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Affiliation(s)
- Xinping Jiang
- Department of United Ultrasound, The First Hospital of Jilin University, Changchun, China
| | - Zhang Yang
- Department of Vascular Surgery, The First Hospital of Jilin University, Changchun, China
| | - Shuai Wang
- Department of Vascular Surgery, The First Hospital of Jilin University, Changchun, China
| | - Shuanglin Deng
- Department of Oncological Neurosurgery, The First Hospital of Jilin University, Changchun, China
- *Correspondence: Shuanglin Deng,
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21
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Real world data and data science in medical research: present and future. JAPANESE JOURNAL OF STATISTICS AND DATA SCIENCE 2022; 5:769-781. [PMID: 35437515 PMCID: PMC9007054 DOI: 10.1007/s42081-022-00156-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/18/2022] [Accepted: 03/20/2022] [Indexed: 10/24/2022]
Abstract
AbstractReal world data (RWD) are generating greater interest in recent times despite being not new. There are various purposes of the RWD analytics in medical research as follows: effectiveness and safety of medical treatment, epidemiology such as incidence and prevalence of disease, burden of disease, quality of life and activity of daily living, medical costs, etc. The RWD research in medicine is a mixture of digital transformation, statistics or data science, public health, and regulatory science. Most of the articles describing the RWD or real-world evidence (RWE) in medical research cover only a portion of these specializations, which might lead to an incomplete understanding of the RWD. This article summarizes the overview and challenges of the RWD analysis in medical fields from methodological perspectives. As the first step for the RWD analysis, data source of the RWD should be comprehended. The progress of the RWD is closely related to the digitization, especially of medical administrative data and medical records. Second, the selection of appropriate statistical and epidemiological methods is highly critical for an RWD analysis than those for randomized clinical trials. This is because it contains greater varieties of bias, which should be controlled by balancing the underlying risk between treatment groups. Last, the future of the RWD is discussed in terms of overcoming limited data by proxy confounders, using unstructured text data, linking of multiple databases, using the RWD or RWE for a regulatory purpose, and evaluating values and new aspects in medical research brought by the RWD.
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YOSHIDA S, TAKEUCHI M, TANAKA-MIZUNO S, MIZUNO K, NAKASHIMA M, FUKASAWA T, KAWAKAMI K. Clinical epidemiology and pharmacoepidemiology studies with real-world databases. PROCEEDINGS OF THE JAPAN ACADEMY. SERIES B, PHYSICAL AND BIOLOGICAL SCIENCES 2022; 98:517-528. [PMID: 36504194 PMCID: PMC9751262 DOI: 10.2183/pjab.98.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/03/2022] [Indexed: 06/17/2023]
Abstract
Hospital-based registry data, including patients' information collected by academic societies or government based research groups, were previously used for clinical research in Japan. Now, real-world data routinely obtained in healthcare settings are being used in clinical epidemiology and pharmacoepidemiology. Real-world data include a database of claims originating from health insurance associations for reimbursement of medical fees, diagnosis procedure combinations databases for acute inpatient care in hospitals, a drug prescription database, and electronic medical records, including patients' medical information obtained by doctors, derived from electronic records of hospitals. In the past ten years, much evidence of clinical epidemiology and pharmacoepidemiology studies using real-world data has been accumulated. The purpose of this review was to introduce clinical epidemiology and pharmacoepidemiology approaches and studies using real-world data in Japan.
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Affiliation(s)
- Satomi YOSHIDA
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Masato TAKEUCHI
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Sachiko TANAKA-MIZUNO
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Kayoko MIZUNO
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Masayuki NAKASHIMA
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Toshiki FUKASAWA
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Koji KAWAKAMI
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
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