Association between nutritional guidance or ophthalmological examination and discontinuation of physician visits in patients with newly diagnosed diabetes: A retrospective cohort study using a nationwide database

Implementation rate of diabetic self-management education and support for Japanese people with diabetes using the National Database

People with diabetes are encouraged to receive diabetes self-management education and support (DSMES) appropriately. However, in Japan, the implementation rates of DSMES are not known. DSMES implementation rates were calculated using the National Database of claims data, which included nearly all insurance-covered medical procedures. The study enrolled participants who received regular antidiabetic medications between April 2017 and March 2018. The implementation rates of DSMES-related care were calculated by characteristics, visiting medical facilities and prefectures. In 4,465,513 participants receiving antidiabetic medications (men, 57.8%; insulin use, 14.1%), nutrition guidance (5.6%) was the most frequently provided care type. Insulin users and participants visiting Japan Diabetes Society-certified and large medical institutions had higher implementation rates of nutrition guidance. DSMES-related care might not be provided adequately for Japanese people with diabetes. Further studies are needed to develop an optimal diabetes care system.

Does nutritional guidance reduce cardiovascular events in patients with type 2 diabetes mellitus? A retrospective cohort study using a nationwide claims database

AIM

To examine the effect of nutritional guidance (NG) provided by a registered dietitian under the direction of a physician on the development of subsequent cardiovascular events in patients with early-stage type 2 diabetes mellitus (T2DM).

MATERIALS AND METHODS

This retrospective cohort study used the JMDC claims database to explore patients aged 18 years or older who first met the diagnostic criteria for T2DM at a health checkup between January 2011 and January 2019. The last day of the observation period was set for 28 February, 2021. Exposure was defined as receiving NG within 180 days of diagnosis of T2DM. The primary outcome was a composite endpoint of coronary artery disease (CAD) and cerebrovascular disease, and the secondary outcomes were each event, and time to event was compared. The propensity score weighting method was used for adjusting the distribution of confounding variables. Cox regression was conducted to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

Overall, 31,378 patients met the eligibility criteria at an annual health checkup. 9.6% received NG (n = 3013). Patients who attended ≥ 1 NG after diagnosis had significantly reduced risk of cardiovascular composite (adjusted HR 0.75, 95% CI 0.58-0.97) and cerebrovascular disease (adjusted HR 0.65, 95% CI 0.47-0.90) during approximately 3.3 years of follow-up. In contrast, no difference was observed for CAD.

CONCLUSIONS

Receiving NG in early-stage diabetes may reduce the incidence of cardiovascular events, especially cerebrovascular events.

Gemcitabine plus nab-paclitaxel for pancreatic cancer and interstitial lung disease: A nationwide longitudinal study

Interstitial lung disease (ILD) is an adverse event associated with gemcitabine administration. Gemcitabine plus nab-paclitaxel, which is now a first-line chemotherapy regimen for pancreatic cancer (PC), may increase the risk of ILD; however, large-scale clinical data on this are limited. Thus, this study aimed to elucidate the incidence and risk factors of ILD in patients with PC receiving gemcitabine plus nab-paclitaxel. Through the Diagnosis Procedure Combination database, a Japanese nationwide inpatient database with outpatient data, we identified consecutive patients with PC who received gemcitabine-based chemotherapy between July 2010 and March 2019 at 205 hospitals. Competing-risk analysis was used to examine the cumulative incidence and risk factors of ILD. Among the 6163 patients who received gemcitabine plus nab-paclitaxel, we documented 168 patients (2.7%) who developed ILD with cumulative incidence rates (95% confidence intervals [CIs]) of 2.0% (1.6%-2.4%), 2.7% (2.2%-3.1%), and 3.1% (2.6%-3.6%) at 3, 6, and 12 months, respectively. Compared with patients with PC who received gemcitabine monotherapy, those who received gemcitabine plus nab-paclitaxel had an adjusted subdistribution hazard ratio (SHR) for ILD of 1.93 (95% CI: 1.51-2.47). Older age was associated with a high risk of ILD in patients receiving gemcitabine plus nab-paclitaxel (adjusted SHR comparing ≥75 to ≤74 years, 1.61; 95% CI: 1.16-2.24). In conclusion, this study demonstrated the clinical course of gemcitabine plus nab-paclitaxel-associated ILD in patients with PC. When gemcitabine plus nab-paclitaxel is administered to elderly patients with PC, symptoms associated with ILD must be monitored.

Glucose emission spectra through mid-infrared passive spectroscopic imaging of the wrist for non-invasive glucose sensing

Non-invasive blood glucose sensing can be achieved using mid-infrared spectroscopy, although no practical device based on this method has yet been developed. Here, we propose mid-infrared passive spectroscopic imaging for glucose measurements from a distance. Spectroscopic imaging of thermal radiation from the human body enabled, for the first time in the world, the detection of glucose-induced luminescence from a distance. In addition, glucose emission spectra of the wrist acquired at regular intervals up to 60 min showed that there was a strong correlation between the glucose emission intensity and blood glucose level measured using an invasive sensor. Thus, the new technology proposed here is expected to be applied to real-time monitoring of diabetic patients to detect hypoglycemic attacks during sleep and to detect hyperglycemia in a population. Moreover, this technology could lead to innovations that would make it possible to remotely measure a variety of substances.

A Machine Learning-Based Predictive Model to Identify Patients Who Failed to Attend a Follow-up Visit for Diabetes Care After Recommendations From a National Screening Program

OBJECTIVE

Reportedly, two-thirds of the patients who were positive for diabetes during screening failed to attend a follow-up visit for diabetes care in Japan. We aimed to develop a machine-learning model for predicting people's failure to attend a follow-up visit.

RESEARCH DESIGN AND METHODS

We conducted a retrospective cohort study of adults with newly screened diabetes at a national screening program using a large Japanese insurance claims database (JMDC, Tokyo, Japan). We defined failure to attend a follow-up visit for diabetes care as no physician consultation during the 6 months after the screening. The candidate predictors were patient demographics, comorbidities, and medication history. In the training set (randomly selected 80% of the sample), we developed two models (previously reported logistic regression model and Lasso regression model). In the test set (remaining 20%), prediction performance was examined.

RESULTS

We identified 10,645 patients, including 5,450 patients who failed to attend follow-up visits for diabetes care. The Lasso regression model using four predictors had a better discrimination ability than the previously reported logistic regression model using 13 predictors (C-statistic: 0.71 [95% CI 0.69-0.73] vs. 0.67 [0.65-0.69]; P < 0.001). The four selected predictors in the Lasso regression model were lower frequency of physician visits in the previous year, lower HbA1c levels, and negative history of antidyslipidemic or antihypertensive treatment.

CONCLUSIONS

The developed machine-learning model using four predictors had a good predictive ability to identify patients who failed to attend a follow-up visit for diabetes care after a screening program.

Factors associated with the degree of glycemic deterioration among patients with type 2 diabetes who dropped out of diabetes care: A longitudinal analysis using medical claims and health checkup data in Japan

AIMS/INTRODUCTION

To identify factors associated with worsening glycemic control after discontinuing diabetes care among patients with type 2 diabetes.

MATERIALS AND METHODS

This retrospective cohort study combined medical claims and health checkup data between January 2005 and April 2018. Adult Japanese workers with type 2 diabetes who had dropped out from diabetes care for ≥4 months after receiving ≥18 months of non-intermittent care and had health checkup information both before and after the dropout were included. Factors associated with changes in HbA1c during the dropout period were identified using multiple linear regression analyses and depicting restricted cubic spline (RCS) curves.

RESULTS

A total of 1,125 patients (mean age: 51.2 years, baseline HbA1c: 6.8%, and number of males: 93.7%) whose follow-up HbA1c increased to 7.6% after a mean 9.3-month dropout period were included. Deterioration in HbA1c was associated with higher baseline HbA1c and sulfonylurea or insulin use. The RCS curves illustrated that patients without antidiabetic medication had small changes in HbA1c (+0.5% from a baseline HbA1c of 7.0%), whereas those using sulfonylureas or insulin had an approximately 2% or more increase in HbA1c even when maintaining reasonable glycemic control before dropping out.

CONCLUSIONS

Overall in this study, glycemic control worsened during treatment interruptions among patients who were mainly male employees. However, changes in HbA1c greatly varied based on baseline HbA1c and antidiabetic medication type. Caring for patients at risk of worsening glycemic control due to treatment dropout, especially those using sulfonylurea and insulin, is imperative.