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Shibahashi E, Abe T, Kamishima K, Ebihara S, Moriyama T, Shimazaki K, Saito K, Uchigata Y, Jujo K. Direct Oral Anticoagulants Affect Activated Clotting Time During and Bleeding Events After Percutaneous Coronary Intervention. Am J Cardiol 2023; 204:1-8. [PMID: 37531715 DOI: 10.1016/j.amjcard.2023.07.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/18/2023] [Accepted: 07/14/2023] [Indexed: 08/04/2023]
Abstract
Inappropriately high activated clotting time (ACT) during percutaneous coronary intervention (PCI) is associated with an increased risk of bleeding events. However, whether the prescription of direct oral anticoagulants (DOACs) affects ACT kinetics during heparin use and adverse clinical events in patients who underwent PCI remains unclear. We aimed to evaluate the relations between ACT changes during and adverse clinical events after PCI in patients who were prescribed DOAC. This observational study included 246 patients who underwent PCI at the 2 cardiovascular centers who were not receiving warfarin and whose ACT was recorded immediately before and 30 minutes after injection of unfractionated heparin. Patients were divided into 2 groups according to DOAC prescription at the time of the index PCI: DOAC users (n = 31) and nonusers (n = 215). Any bleeding and systemic thromboembolic events were investigated until 30 days after PCI. The average age of this population was 70.5 years, and 66.3% were male. Average ACT was significantly higher in DOAC users than nonusers both before and 30 minutes after unfractionated heparin induction (157.2 ± 30.1 vs 131.8 ± 25.1 seconds, p <0.001; 371.1 ± 122.2 vs 308.3 ± 82.2 seconds, p <0.001; respectively). The incidence of systemic thromboembolism after PCI was low and comparable between the 2 groups (0% vs 3.7%, p = 0.60). However, the rate of any bleeding event was significantly higher in DOAC users than in nonusers (16.1% vs 4.7%, p = 0.028). Patients receiving DOAC have higher ACT during PCI and higher incidence of bleeding events than those not receiving DOAC.
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Affiliation(s)
- Eiji Shibahashi
- Department of Cardiovascular Intervention, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Takuro Abe
- Department of Cardiology, Nishiarai Heart Center Hospital, Tokyo, Japan
| | | | | | - Tetsu Moriyama
- Department of Cardiology, Nishiarai Heart Center Hospital, Tokyo, Japan
| | - Kensuke Shimazaki
- Department of Cardiology, Nishiarai Heart Center Hospital, Tokyo, Japan
| | - Katsumi Saito
- Department of Cardiology, Nishiarai Heart Center Hospital, Tokyo, Japan
| | - Yasuko Uchigata
- Department of Cardiovascular Intervention, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Kentaro Jujo
- Department of Cardiovascular Intervention, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan; Department of Cardiology, Nishiarai Heart Center Hospital, Tokyo, Japan.
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Hirose A, Maeda Y, Goto A, Minami M, Kitano S, Uchigata Y. ƩexcessA1C index, the sum of yearly excess HbA1c values during the total period of diabetes, may have the potential to predict retinopathy by a linear regression setting regardless of duration in type 1 diabetes: a subgroup analysis of DCCT/EDIC data. Diabetol Int 2023; 14:440-444. [PMID: 37781457 PMCID: PMC10533424 DOI: 10.1007/s13340-023-00654-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/27/2023] [Indexed: 10/03/2023]
Abstract
Aims To find an index of glycemic exposure that predicts retinopathy by a simple regression setting regardless of duration in type 1 diabetes which might be useful for the care of diabetes. Materials and methods To exclude the possible disturbing effect of metabolic memory, we examined a subgroup of patients with glycohemoglobin A1c (A1C) data for the total period of type 1 diabetes selected from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications data. Three indices-(1) mean value of yearly A1C (mA1C), (2) sum of yearly A1C values (ƩA1C), and (3) sum of yearly A1C values above 6.5% (ƩexcessA1C)-were assessed as potential candidates. Development of retinopathy was defined by ≥ 3-steps' progression of retinopathy from baseline. Results The areas under the receiver operating characteristics curves of the indices for development of retinopathy at years 5, 9, and 13 after the onset of diabetes were the same: 0.8481, 0.8762, and 0.8213, respectively, indicating that each index was substantially capable of predicting development of retinopathy at each timepoint. Linear regression analyses showed that each index had significant and substantial linear relations to retinopathy at each timepoint: all P < 0.0001 for slopes; contribution rate R2 = 0.21 (year 5), 0.46 (year 9), and 0.48 (year 13) for each index. But only ƩexcessA1C index appeared to have similar linear relations to retinopathy at all three timepoints (interactions by timepoint: for slopes: P = 0.1393; for intercepts: P = 0.9366). Conclusion ƩexcessA1C may have the potential to predict retinopathy by just one linear regression setting regardless of duration in type 1 diabetes.
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Affiliation(s)
- Akira Hirose
- Minami Diabetes Clinical Research Center, Fukuoka, Japan
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Tenjin Eye Clinic, Ohshima Eye Hospital, Fukuoka, Japan
| | - Yasutaka Maeda
- Minami Diabetes Clinical Research Center, Fukuoka, Japan
- Clinic Masae Minami, Fukuoka, Japan
| | - Atsushi Goto
- Department of Public Health, School of Medicine, Yokohama City University, Yokohama, Japan
| | | | | | - Yasuko Uchigata
- Tokyo Women’s Medical University Adachi Medical Center, Tokyo, Japan
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Hirose A, Maeda Y, Goto A, Minami M, Kitano S, Uchigata Y. Correction: ƩexcessA1C index, the sum of yearly excess HbA1c values during the total period of diabetes, may have the potential to predict retinopathy by a linear regression setting regardless of duration in type 1 diabetes: a subgroup analysis of DCCT/EDIC data. Diabetol Int 2023; 14:445. [PMID: 37781460 PMCID: PMC10533749 DOI: 10.1007/s13340-023-00660-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
[This corrects the article DOI: 10.1007/s13340-023-00654-w.].
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Affiliation(s)
- Akira Hirose
- Minami Diabetes Clinical Research Center, Fukuoka, Japan
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Tenjin Eye Clinic, Ohshima Eye Hospital, Fukuoka, Japan
| | - Yasutaka Maeda
- Minami Diabetes Clinical Research Center, Fukuoka, Japan
- Clinic Masae Minami, Fukuoka, Japan
| | - Atsushi Goto
- Department of Public Health, School of Medicine, Yokohama City University, Yokohama, Japan
| | | | | | - Yasuko Uchigata
- Tokyo Women’s Medical University Adachi Medical Center, Tokyo, Japan
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Kawasaki M, Arata N, Sugiyama T, Moriya T, Itakura A, Yasuhi I, Uchigata Y, Kawasaki E, Sone H, Hiramatsu Y. Risk of fetal undergrowth in the management of gestational diabetes mellitus in Japan. J Diabetes Investig 2023; 14:614-622. [PMID: 36734310 PMCID: PMC10034960 DOI: 10.1111/jdi.13977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 12/07/2022] [Accepted: 01/08/2023] [Indexed: 02/04/2023] Open
Abstract
AIMS/INTRODUCTION In Japan, the increasing frequency of underweight among women of reproductive age and the accompanying increase in the rate of low birth weight (LBW) are social issues. The study aimed to establish a prospective registry system for gestational diabetes mellitus (GDM) in Japan and to clarify the actual status of GDM according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. MATERIALS AND METHODS Pregnant women with gestational diabetes mellitus and those in the normal glucose tolerance (NGT) group were enrolled in the Diabetes and Pregnancy Outcome for Mother and Baby study from October 2015. Pregnant women with positive glucose screening in early and mid-to-late pregnancy underwent a 75 g oral glucose tolerance test by gestational week 32. Gestational diabetes mellitus was diagnosed according to IADPSG criteria. Women with a positive glucose screening test at mid-to-late pregnancy but NGT were enrolled as references (NGT group). Treatment for gestational diabetes mellitus and maternal and neonatal pregnancy data were prospectively collected on outcomes. RESULTS In total 1,795 singleton pregnancies (878 women with GDM and 824 NGT women) were analyzed. The risk of LBW and small-for-gestational age in the GDM group was significantly higher than in the NGT group. A similar relationship was found for LBW risk in the non-overweight/obese group but not in the overweight/obese group. CONCLUSIONS We established a prospective GDM registry system in Japan. In the management of GDM in Japan, suppression of maternal weight gain may be associated with reduced fetal growth, especially in non-overweight/obese women with GDM; however, further investigation is required.
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Affiliation(s)
- Maki Kawasaki
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
- Division of Maternal Medicine, Center for Maternal-Fetal, Neonatal, and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Naoko Arata
- Division of Maternal Medicine, Center for Maternal-Fetal, Neonatal, and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Takashi Sugiyama
- Department of Obstetrics and Gynecology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Tatsumi Moriya
- Health Care Center, Kitasato University, Sagamihara, Japan
| | - Atsuo Itakura
- Department of Obstetrics and Gynecology, School of Medicine, Juntendo University, Tokyo, Japan
| | - Ichiro Yasuhi
- Department of Obstetrics and Gynecology, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Yasuko Uchigata
- Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Eiji Kawasaki
- Department of Diabetes and Endocrinology, Shin-Koga Hospital, Kurume, Fukuoka, Japan
| | - Hirohito Sone
- Department of Hematology, Endocrinology, and Metabolism, Niigata University Faculty of Medicine, Niigata, Japan
| | - Yuji Hiramatsu
- Okayama City General Medical Center, Okayama City, Japan
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Miura J, Uchigata Y. Update information on type 1 diabetes in children/adolescents and adults. J Diabetes Investig 2023; 14:531-534. [PMID: 36659815 PMCID: PMC10034952 DOI: 10.1111/jdi.13961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 01/21/2023] Open
Affiliation(s)
- Junnosuke Miura
- Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Yasuko Uchigata
- Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
- Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
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Shibahashi E, Jujo K, Mizobuchi K, Nakao M, Uchigata Y, Yamaguchi J. Prognostic Impact of Statins on Patients With Peripheral Artery Disease With Elevated C-Reactive Protein Levels. Am J Cardiol 2023; 186:142-149. [PMID: 36257842 DOI: 10.1016/j.amjcard.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/04/2022] [Accepted: 09/22/2022] [Indexed: 12/24/2022]
Abstract
This study aimed to elucidate the prognostic influence of statins in relation to the degree of inflammation at the time of endovascular therapy (EVT) for patients with peripheral artery disease (PAD). This observational study included patients with PAD who underwent EVT, including 285 statin users and 275 statin non-users. They were assigned into four groups depending on C-reactive protein (CRP) level at the time of EVT: low CRP (<0.1 mg/dL), intermediate-low CRP (0.1-0.3 mg/dL), intermediate-high CRP (0.3-1.0 mg/dL), and high CRP (>1.0 mg/dL). A composite of death and major amputation as the primary endpoint was compared between statin users and non-users in each CRP category. Overall, statin users showed a lower event rate than non-users (log-rank, p=0.02). However, the event rates did not differ significantly between statin users and non-users in the low, intermediate-low, and intermediate-high CRP categories. In the high CRP category, statin users showed a lower event rate than non-users (p=0.002). In this population, multivariate Cox regression analysis revealed that statin use was independently associated with the primary endpoint (hazard ratio: 0.28 [95% confidence interval: 0.14-0.55]). Statins may exert favorable prognostic effects in PAD patients with highly elevated CRP levels, but not in those with low-to-moderate CRP levels.
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Affiliation(s)
- Eiji Shibahashi
- Department of Cardiovascular Intervention, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan; Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kentaro Jujo
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan; Department of Cardiology, Saitama Medical University, Saitama Medical Center, Saitama, Japan.
| | - Keiko Mizobuchi
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masashi Nakao
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yasuko Uchigata
- Department of Cardiovascular Intervention, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Junichi Yamaguchi
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
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Marshall S, Imada H, Kimura A, Ito T, Ogasawara T, Kazama H, Yoshinaga K, Tanaka J, Uchigata Y, Ogawa T. [Successful treatment of acute promyelocytic leukemia with all-trans retinoic acid on hemodialysis for acute renal failure]. Rinsho Ketsueki 2023; 64:193-197. [PMID: 37019672 DOI: 10.11406/rinketsu.64.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
All-trans retinoic acid (ATRA) is used as standard induction therapy for acute promyelocytic leukemia (APL), but it is contraindicated for patients on hemodialysis. We present a case of a patient with APL on hemodialysis, intubated, and with marked disseminated intravascular coagulation (DIC) who was successfully treated with ATRA. A 49-year-old man was transferred to our hospital and admitted into the intensive care unit due to renal dysfunction, DIC, and pneumonia. Promyelocytes were noted in the peripheral blood, and he was diagnosed with APL after bone-marrow examination. Because of renal dysfunction, only Ara-C was used but with a reduced dose. The patient's condition improved, and he was extubated and withdrawn from dialysis on the 5th day of hospitalization. The patient suffered from APL syndrome during induction therapy, which necessitated ATRA withdrawal and steroid administration. Remission was achieved after induction therapy, and the patient is currently on maintenance therapy. There are few cases of patients with APL on hemodialysis who were treated with ATRA; hence, it is necessary to review the treatment plan for these patients.
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Affiliation(s)
- Shoko Marshall
- Department of Medicine, Tokyo Women's Medical University, Adachi Medical Center
| | - Hiroshi Imada
- Department of Medicine, Tokyo Women's Medical University, Adachi Medical Center
| | - Ayako Kimura
- Department of Medicine, Tokyo Women's Medical University, Adachi Medical Center
| | - Toshimasa Ito
- Pharmaceutical Department, Tokyo Women's Medical University, Adachi Medical Center
| | - Toshie Ogasawara
- Department of Medicine, Tokyo Women's Medical University, Adachi Medical Center
| | - Hiroshi Kazama
- Department of Medicine, Tokyo Women's Medical University, Adachi Medical Center
| | | | - Junji Tanaka
- Department of Hematology, Tokyo Women's Medical University
| | | | - Tetsuya Ogawa
- Department of Medicine, Tokyo Women's Medical University, Adachi Medical Center
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Sakurai A, Marshall S, Ogasawara T, Ogasawara T, Aoka Y, Sakura H, Uchigata Y, Ogawa T. REGN-COV2 antibody cocktail in patients with SARS-CoV-2: Observational study from a single institution in Japan. J Infect Chemother 2022; 28:943-947. [PMID: 35414436 PMCID: PMC8986486 DOI: 10.1016/j.jiac.2022.03.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/16/2022] [Accepted: 03/30/2022] [Indexed: 12/15/2022]
Abstract
Introduction A new treatment for coronavirus disease (COVID-19), REGN-COV2, a cocktail consisting of two neutralizing antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been approved for patients at a risk of developing more severe disease. Methods We retrospectively reviewed patients recently diagnosed with COVID-19 with risk factors for severe infection, who were treated with the REGN-COV2 antibody cocktail between July and September 2021. The REGN-COV2 antibody cocktail was administered to patients within 7 days of disease onset, with an oxygen saturation of >93%, and with at least one comorbidity. We investigated the percentage of patients with COVID-19-related hospitalization or death, the duration of symptoms after treatment, and the adverse effects of treatment. Results A total of 108 patients were reviewed. Of them, 64% were aged ≥50 years, 31% had obesity, 36% had hypertension, and 18% had diabetes. In addition, 49% had multiple risk factors for severe COVID-19. Overall, 12 patients (11%) needed COVID-19-related hospitalization. No adverse effects of treatment were observed. Conclusions This study shows that treatment with the REGN-COV2 antibody cocktail is safe and beneficial in patients at a risk of developing severe COVID-19.
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Kawamura R, Miyao S, Onuma H, Uchigata Y, Kawasaki E, Ohashi J, Shiraishi S, Nishida W, Yokomoto-Umakoshi M, Takata Y, Osawa H, Makino H. Recurrent Hypoglycemia Due to a High Titer of Insulin Antibody in Response to Exogenous Insulin Administration in Two Cases of Type 1 Diabetes. Intern Med 2022; 61:687-695. [PMID: 34471020 PMCID: PMC8943391 DOI: 10.2169/internalmedicine.7647-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
In the first case, a 60-year-old man who was using continuous subcutaneous insulin infusion (CSII), developed recurrent hypoglycemia due to insulin antibodies. This is the first report of such a case using CSII. In the second case, a 70-year-old man was follow-up case who developed hypoglycemia while using human insulin. In both cases, the hypoglycemia subsided after switching to multiple daily insulin injection and/or insulin preparation. The results of Scatchard analyses of the two cases were similar to those of cases of insulin autoimmune syndrome (IAS) that improved after recovery from hypoglycemia.The clinical characteristics and Scatchard analysis data were essentially the same as those for IAS, except for the presence of insulin administration.
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Affiliation(s)
- Ryoichi Kawamura
- Department of Diabetes and Molecular Genetics, Ehime University Graduate School of Medicine, Japan
| | | | - Hiroshi Onuma
- Department of Diabetes and Molecular Genetics, Ehime University Graduate School of Medicine, Japan
- Department of Diabetes, Endocrine and Metabolic Disease, Tokyo Women's Medical University Yachiyo Medical Center, Japan
| | | | - Eiji Kawasaki
- Department of Diabetes and Endocrinology, Shin-Koga Hospital, Japan
| | - Jun Ohashi
- Department of Biological Sciences, Graduate School of Science, The University of Tokyo, Japan
| | | | - Wataru Nishida
- Department of Diabetes and Molecular Genetics, Ehime University Graduate School of Medicine, Japan
| | - Maki Yokomoto-Umakoshi
- Department of Diabetes and Molecular Genetics, Ehime University Graduate School of Medicine, Japan
| | - Yasunori Takata
- Department of Diabetes and Molecular Genetics, Ehime University Graduate School of Medicine, Japan
| | - Haruhiko Osawa
- Department of Diabetes and Molecular Genetics, Ehime University Graduate School of Medicine, Japan
| | - Hideichi Makino
- Department of Diabetes and Molecular Genetics, Ehime University Graduate School of Medicine, Japan
- Shiraishi Hospital Diabetes Center, Japan
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Marshall S, Ishikawa M, Tanaka H, Sakura H, Uchigata Y. Universal testing for SARS-CoV-2 infection on admission among hospitalized emergency patients: A survey report from a single facility in Tokyo. Infect Dis Health 2021; 27:58-60. [PMID: 34627745 PMCID: PMC8450279 DOI: 10.1016/j.idh.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Shoko Marshall
- Department of Medicine, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawaku, Tokyo, 116-8567, Japan
| | - Motonao Ishikawa
- Department of Medicine, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawaku, Tokyo, 116-8567, Japan.
| | - Hiroaki Tanaka
- The Medical Training Centre for Graduates, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawaku, Tokyo, 116-8567, Japan
| | - Hiroshi Sakura
- Department of Medicine, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawaku, Tokyo, 116-8567, Japan
| | - Yasuko Uchigata
- Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawaku, Tokyo, 116-8567, Japan
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Ishikawa M, Ogasawara T, Takahashi K, Ono T, Matsui K, Marshall S, Sakurai A, Aoka Y, Otsubo T, Sato Y, Sakura H, Uchigata Y. Psychological Effects on Healthcare Workers during the COVID-19 Outbreak: A Single-center Study at a Tertiary Hospital in Tokyo, Japan. Intern Med 2021; 60:2771-2776. [PMID: 34219107 PMCID: PMC8479219 DOI: 10.2169/internalmedicine.7207-21] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective The present study analyzed the psychological status of healthcare workers in Japan and the influencing factors during the 2019 coronavirus disease pandemic. Methods An online survey was conducted from July 22 to August 21, 2020. A total of 328 of the 1,029 medical staff members in our university hospital participated in the study. Their mental health was assessed using the 12-item General Health Questionnaire. A multivariate regression analysis was performed to identify the factors associated with the mental health outcomes. Results Of the respondents, 78.0% reported psychological distress. Overall, we found that women, non-physicians, those who lived alone, and younger respondents had significantly greater psychological distress than their counterparts. The multivariate regression analysis showed that four factors were extracted as independent 12-item General Health Questionnaire-related factors: the lack of a sense of mission as a medical professional, the burden of the change in the quality of work, the lack of understanding about virus infectivity, and a strong sense of duty. Conclusion In summary, we found a high prevalence of psychological distress among healthcare workers during the 2019 coronavirus disease outbreak in Japan. Independent risk factors for psychological distress were the burden of the change in the quality of work, the lack of understanding about virus infectivity, a sense of responsibility, and the lack of a strong motivation and drive to help.
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Affiliation(s)
- Motonao Ishikawa
- Department of Medicine, Tokyo Women's Medical University, Medical Center East, Japan
| | - Tomoko Ogasawara
- Department of Medicine, Tokyo Women's Medical University, Medical Center East, Japan
| | - Kenichiro Takahashi
- Department of Pediatrics, Tokyo Women's Medical University, Medical Center East, Japan
| | - Takuya Ono
- Department of Medicine, Tokyo Women's Medical University, Medical Center East, Japan
| | - Kazuhiro Matsui
- Department of Medicine, Tokyo Women's Medical University, Medical Center East, Japan
| | - Shoko Marshall
- Department of Medicine, Tokyo Women's Medical University, Medical Center East, Japan
| | - Ayana Sakurai
- Department of Medicine, Tokyo Women's Medical University, Medical Center East, Japan
| | - Yoshikazu Aoka
- General Medical Department, Tokyo Women's Medical University, Medical Center East, Japan
| | - Tempei Otsubo
- Department of Psychiatry, Tokyo Women's Medical University, Medical Center East, Japan
| | - Yasuto Sato
- Department of Public Health, School of Medicine, Tokyo Women's Medical University, Japan
| | - Hiroshi Sakura
- Department of Medicine, Tokyo Women's Medical University, Medical Center East, Japan
| | - Yasuko Uchigata
- Director, Tokyo Women's Medical University, Medical Center East, Japan
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Yoshida N, Hanai K, Murata H, Uchigata Y, Babazono T. Cross-sectional and longitudinal associations between dipstick hematuria and chronic kidney disease in patients with type 2 diabetes. Diabetes Res Clin Pract 2021; 172:108519. [PMID: 33096189 DOI: 10.1016/j.diabres.2020.108519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 10/01/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Abstract
AIMS To examine the association of dipstick hematuria with kidney function and albuminuria in patients with type 2 diabetes (T2D). METHODS A total of 7,945 patients with T2D were studied. In the cross-sectional study, patients were classified into 6 groups based on the stage of albuminuria and estimated glomerular filtration rate (eGFR) of 60 mL/min/1.73 m2 at baseline. In the longitudinal study where patients were classified by the presence of hematuria, the primary composite endpoint was a 30% decrease in eGFR from baseline or the initiation of kidney replacement therapy. Other outcomes included eGFR slope and stage progression of albuminuria. RESULTS Cross-sectionally, hematuria was more prevalent in patients with more advanced stages of albuminuria and with lower eGFR, independently of each other. In the longitudinal study, patients with hematuria experienced 50% increased incidence of the primary endpoint (p < 0.001). The eGFR slope was steeper in patients with hematuria than in those without hematuria (p < 0.001). On the other hand, hematuria was unlikely to be associated with the progression of albuminuria. CONCLUSIONS In patients with T2D, dipstick hematuria was associated with prevalent albuminuria and reduced eGFR, as well as faster decline in kidney function but not higher risk of development or progression of albuminuria.
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Affiliation(s)
- Noriko Yoshida
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Ko Hanai
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
| | - Hidekazu Murata
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Yasuko Uchigata
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Tetsuya Babazono
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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Hanai K, Tauchi E, Nishiwaki Y, Mori T, Yokoyama Y, Uchigata Y, Babazono T. Effects of uric acid on kidney function decline differ depending on baseline kidney function in type 2 diabetic patients. Nephrol Dial Transplant 2020; 34:1328-1335. [PMID: 29860523 DOI: 10.1093/ndt/gfy138] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 04/19/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Most existing data regarding effects of uric acid (UA) on diabetic kidney disease have considered patients with preserved kidney function. We examined a hypothesis that there are differences in the effects of serum UA levels on the decline in kidney function depending on baseline kidney function in diabetic patients. METHODS In this historical cohort study, 7033 type 2 diabetic patients were analyzed and classified into two groups as follows: nonchronic kidney disease (non-CKD), with an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 (n = 4994), and CKD, with an eGFR <60 mL/min/1.73 m2 (n = 2039). The composite endpoint was a ≥30% decrease in eGFR from baseline or the initiation of renal replacement therapy. The hazard ratio (HR) of serum UA levels at baseline was estimated using multivariate Cox proportional hazards models. RESULTS There was a significant interaction between UA levels and baseline eGFR with respect to the endpoint (P < 0.001). The HRs of 1 mg/dL increase in UA levels were 1.13 [95% confidence interval (CI) 1.05-1.22, P = 0.002] and 0.93 (95% CI 0.88-0.99, P = 0.02) in the non-CKD and CKD groups, respectively. When patients were classified by quintile of UA levels, the HRs of those in the 5th quintile (versus 1st quintile) were 1.64 (95% CI 1.23-2.18, P < 0.001) and 0.76 (95% CI 0.58-0.99, P = 0.05) in the non-CKD and CKD groups, respectively. CONCLUSIONS The effects of UA on kidney function decline might differ depending on baseline kidney function in type 2 diabetic patients. High UA levels are the prognostic factor only in patients with preserved kidney function.
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Affiliation(s)
- Ko Hanai
- Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Eriko Tauchi
- Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Yui Nishiwaki
- Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Tomomi Mori
- Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Yoichi Yokoyama
- Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Yasuko Uchigata
- Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.,Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Tetsuya Babazono
- Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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14
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Kameda Y, Hanai K, Uchigata Y, Babazono T, Kitano S. Vitreous hemorrhage in diabetes patients with proliferative diabetic retinopathy undergoing hemodialysis. J Diabetes Investig 2020; 11:688-692. [PMID: 31618517 PMCID: PMC7232265 DOI: 10.1111/jdi.13161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/24/2019] [Accepted: 10/14/2019] [Indexed: 11/29/2022] Open
Abstract
AIMS/INTRODUCTION For diabetes patients undergoing hemodialysis, vitreous hemorrhage seems to be a hemodialysis-induced hemorrhagic complication because of the effect of systemic anticoagulation. However, it is unclear whether hemodialysis is associated with vitreous hemorrhage in diabetes patients. We therefore carried out this cohort study to clarify the relationship between hemodialysis and vitreous hemorrhage in diabetes patients with proliferative diabetic retinopathy. MATERIALS AND METHODS This was a single-center, retrospective, cohort study. We compared the incidence of vitreous hemorrhage in non-vitrectomized proliferative diabetic retinopathy eyes between the hemodialysis group (145 eyes) and peritoneal dialysis group (36 eyes), which does not require the use of systemic anticoagulation (parallel-group study), and in hemodialysis patients in the 12-month period before and after the start of hemodialysis (before-after study). We also determined the risk factors for vitreous hemorrhage after the start of hemodialysis based on the patients' systemic and ophthalmic characteristics. RESULTS There was no significant difference in the first-year incidence of vitreous hemorrhage between the hemodialysis (23.4%) and peritoneal dialysis groups (22.2%, P = 1.000). The incidence of vitreous hemorrhage in the dialysis period (23.4%) was significantly lower than that in the predialysis period (35.2%, P = 0.008). Only application of panretinal photocoagulation within the 6 months immediately before hemodialysis was significantly associated with the incidence of vitreous hemorrhage after the start of hemodialysis (P < 0.001). CONCLUSIONS Hemodialysis therapy does not seem to be associated with a higher risk of vitreous hemorrhage in diabetes patients with proliferative diabetic retinopathy.
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Affiliation(s)
- Yusuke Kameda
- Department of OphthalmologyDiabetes CenterSchool of MedicineTokyo Women’s Medical UniversityTokyoJapan
| | - Ko Hanai
- Department of MedicineDiabetes CenterSchool of MedicineTokyo Women’s Medical UniversityTokyoJapan
| | - Yasuko Uchigata
- Department of MedicineDiabetes CenterSchool of MedicineTokyo Women’s Medical UniversityTokyoJapan
- Tokyo Women’s Medical University Medical Center EastTokyoJapan
| | - Tetsuya Babazono
- Department of MedicineDiabetes CenterSchool of MedicineTokyo Women’s Medical UniversityTokyoJapan
| | - Shigehiko Kitano
- Department of OphthalmologyDiabetes CenterSchool of MedicineTokyo Women’s Medical UniversityTokyoJapan
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15
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Hanai K, Akamatsu M, Fujimori A, Higashi H, Horie Y, Itaya Y, Ito M, Kanamaru T, Kawaguchi H, Kikuchi K, Kobayashi H, Komatsu M, Kubota T, Kudo K, Kurihara S, Masakane I, Mera J, Mizuiri S, Moriyama K, Nagasawa J, Nagata S, Nakagawa Y, Nakazato S, Nishi T, Noma Y, Odaguchi N, Okuno S, Osada S, Ozasa H, Sato S, Sawada T, Shimajiri T, Shimamoto Y, Suda M, Suzuki T, Suzuki H, Takahashi M, Takahashi H, Takahashi T, Takebayashi Y, Takeda M, Tamura H, Tanaka Y, Tokunaka S, Tsuda S, Ueda M, Yamaguchi I, Yamamoto H, Uchigata Y, Babazono T. Usefulness of glycated albumin as a predictor of mortality in chronic hemodialysis patients with diabetes: a multi-center, prospective cohort study. Ren Replace Ther 2020. [DOI: 10.1186/s41100-020-00264-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The association of glycated albumin (GA) with mortality is unclear in chronic hemodialysis patients with diabetes. We investigated the usefulness of GA by comparing it with hemoglobin A1c (HbA1c) in this patient population.
Research design and methods
This was a multi-center, prospective cohort study of 841 Japanese chronic hemodialysis patients with diabetes. There were 235 women and 606 men included, with a mean age of 64 years. The primary and secondary endpoints were the incidence of all-cause and cause-specific mortality, respectively. The hazard ratios of GA and HbA1c for the endpoints were estimated using the values at baseline and during the study period.
Results
During the mean follow-up period of 3.1 years, there were 184 deceased cases, in which 30 and 154 resulted from atherosclerotic cardiovascular disease (ASCVD) and non-ASCVD, respectively. The hazard ratio for a 1% increase in GA was 1.033 (95% confidence interval 1.006–1.060, p = 0.017) for all-cause mortality with a statistical significance when GA was treated as a time dependent variable, but not when the baseline levels or the mean levels during the follow-up period were used in the analysis (p = 0.815 and 0.517, respectively). GA was a significant predictor for ASCVD-related mortality in the above 3 models, but was not for non-ASCVD mortality. Higher levels of HbA1c were only associated with ASCVD-related mortality when HbA1c was treated as a time-dependent variable.
Conclusions
GA may be useful compared to HbA1c for predicting all-cause and ASCVD-related mortality in Japanese patients with diabetes undergoing chronic hemodialysis.
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16
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Araki E, Watada H, Uchigata Y, Tomonaga O, Fujii H, Ohashi H, Okabe T, Asano M, Thoren F, Kim H, Yajima T, Langkilde AM. Efficacy and safety of dapagliflozin in Japanese patients with inadequately controlled type 1 diabetes (DEPICT-5): 52-week results from a randomized, open-label, phase III clinical trial. Diabetes Obes Metab 2020; 22:540-548. [PMID: 31742898 PMCID: PMC7078973 DOI: 10.1111/dom.13922] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/10/2019] [Accepted: 11/14/2019] [Indexed: 12/16/2022]
Abstract
AIMS To investigate the safety and tolerability of 5 and 10 mg dapagliflozin added to insulin therapy over 52 weeks in Japanese patients with inadequately controlled type 1 diabetes mellitus (T1DM). MATERIALS AND METHODS This randomized, open-label, parallel-group, multicentre phase III clinical trial was conducted from October 26, 2015 to June 15, 2017. The primary endpoint was the occurrence of adverse events such as hypoglycaemia and diabetic ketoacidosis. Secondary endpoints included changes in glycaemic parameters, total daily insulin dosage and body weight over time. The efficacy of dapagliflozin in patients stratified by body mass index (BMI) <25.0 and ≥25.0 kg/m2 was evaluated in a subgroup analysis. RESULTS In total, 151 patients received 5 mg (n = 76) or 10 mg (n = 75) dapagliflozin once daily for 52 weeks. Adverse events were observed in 88.2% and 73.3% of patients in the 5 and 10 mg dapagliflozin groups, respectively. Severe hypoglycaemia was reported in 2.6% (n = 2) and 6.7% (n = 5) of patients, and diabetic ketoacidosis in 2.6% (n = 2) and 1.3% (n = 1) of patients in the 5 and 10 mg dapagliflozin groups, respectively. The adjusted mean (95% confidence interval) changes in glycated haemoglobin at week 52 were -0.33% (-0.50, -0.15) and -0.36% (-0.53, -0.18) in the 5 and 10 mg dapagliflozin groups, respectively. There were no differences in efficacy parameters when stratified by BMI. CONCLUSIONS This study demonstrated the long-term safety and tolerability of dapagliflozin added to insulin therapy in Japanese patients with inadequately controlled T1DM.
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Affiliation(s)
- Eiichi Araki
- Department of Metabolic Medicine, Faculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Hirotaka Watada
- Department of Metabolism and EndocrinologyJuntendo University Graduate School of MedicineTokyoJapan
| | - Yasuko Uchigata
- Diabetes Center, Tokyo Women's Medical University School of MedicineTokyoJapan
| | - Osamu Tomonaga
- Diabetes and Lifestyle Center, Tomonaga ClinicTokyoJapan
| | - Hitomi Fujii
- Internal Medicine, Tama‐center Mirai ClinicTokyoJapan
| | | | | | | | - Fredrik Thoren
- Global Medicine Development, AstraZeneca GothenburgMölndalSweden
| | - Hyosung Kim
- Research & Development, AstraZeneca K.K.OsakaJapan
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17
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Takagi S, Miura J, Hoshina S, Uchigata Y, Babazono T. Clinical and genetic characteristics of people with type 1 diabetes who have discrepancies in titers of anti-glutamic acid decarboxylase antibody measured by radioimmunoassay and enzyme-linked immunosorbent assay. J Diabetes Investig 2020; 11:356-362. [PMID: 31267698 PMCID: PMC7078079 DOI: 10.1111/jdi.13111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/12/2019] [Accepted: 07/01/2019] [Indexed: 11/03/2022] Open
Abstract
AIMS/INTRODUCTION The aim of the present study was to compare the clinical and genetic characteristics between people with type 1 diabetes who were positive and negative for autoantibodies against glutamic acid decarboxylase (GADA) measured by enzyme-linked immunosorbent assay (ELISA) with low-titer GADA measured by radioimmunoassay. MATERIALS AND METHODS Among Japanese people with type 1 diabetes in whom GADA were measured by both ELISA and radioimmunoassay, those who had low titers of GADA measured by radioimmunoassay (1.5-10 U/mL), regardless of positivity for GADA measured by ELISA, were studied. There were 65 participants with acute-onset type 1 diabetes and 30 participants with slowly progressive insulin-dependent diabetes mellitus. Clinical characteristics and human leukocyte antigen types were compared in ELISA-positive (≥5 U/mL) and ELISA-negative participants. Endogenous insulin secretion was evaluated by C-peptide index. RESULTS Among participants with slowly progressive insulin-dependent diabetes mellitus, postprandial C-peptide index was significantly higher in ELISA-negative participants than in ELISA-positive participants (r = 0.619, P = 0.002). Among 52 participants whose human leukocyte antigen typing was carried out, all of the participants with slowly progressive insulin-dependent diabetes mellitus who had DRB1*09:01 were positive by GADA-ELISA (P = 0.021). In acute-onset type 1 diabetes participants, there were no significant differences for the C-peptide index and human leukocyte antigen genotypes. CONCLUSIONS The difference in the positivity for GADA-ELISA might reflect cytotoxicity toward pancreatic β-cells and preservation of endogenous insulin secretion in people with slowly progressive insulin-dependent diabetes mellitus. We also suggest that the difference in the GADA-ELISA-specific epitope depends on the human leukocyte antigen genotype.
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Affiliation(s)
- Satoshi Takagi
- Diabetes CenterTokyo Women's Medical University School of MedicineTokyoJapan
| | - Junnosuke Miura
- Diabetes CenterTokyo Women's Medical University School of MedicineTokyoJapan
| | - Sari Hoshina
- Diabetes CenterTokyo Women's Medical University School of MedicineTokyoJapan
| | - Yasuko Uchigata
- Diabetes CenterTokyo Women's Medical University School of MedicineTokyoJapan
- Tokyo Women's Medical University Medical Center EastTokyoJapan
| | - Tetsuya Babazono
- Diabetes CenterTokyo Women's Medical University School of MedicineTokyoJapan
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18
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Otani T, Yokoyama H, Hanai K, Miura J, Uchigata Y, Babazono T. Rapid increase in the incidence of end-stage renal disease in patients with type 1 diabetes having HbA1c 10% or higher for 15 years. Clin Pediatr Endocrinol 2019; 28:113-125. [PMID: 31666764 PMCID: PMC6801355 DOI: 10.1297/cpe.28.113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/17/2019] [Indexed: 12/19/2022] Open
Abstract
The incidence of end-stage renal disease (ESRD) in Japanese patients with type 1 diabetes
mellitus (T1DM) was investigated regarding the association between mean HbA1c values
during follow-up and the duration of follow-up/illness. The study includes 988 patients
diagnosed at ages younger than 30 yr. These patients were initially examined between 1962
and 1999, and HbA1 and/or HbA1c measurements were taken for at least 3 yr after 1980. The
follow-up period was from the date of the first HbA1 or HbA1c measurement to the final
measurement day, or HbA1c measurement day immediately before the development of ESRD. The
condition progressed to ESRD in 63 patients (mean duration of illness: 23.6 yr). Cox
regression analysis revealed that patients with HbA1c of ≥ 10% had a significantly
increased higher risk than those with HbA1c under 8% (P < 0.0001). The HbA1c cut-off
point was 10.0%. The HbA1c value was ≥ 10% at baseline and during follow-up in 128
patients. Assuming that HbA1c of ≥ 10% persisted since the time of diagnosis in these
patients, the cumulative incidence of ESRD abruptly increased after 15 yr of illness.
Thus, the incidence of ESRD increased after the persistence of HbA1c of ≥ 10% for 15
yr.
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Affiliation(s)
- Toshika Otani
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.,Omiya Kyoritsu Hospital, Saitama, Japan
| | | | - Ko Hanai
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Junnosuke Miura
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Yasuko Uchigata
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.,Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Tetsuya Babazono
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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19
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Hasegawa Y, Nakagami T, Oya J, Takahashi K, Isago C, Kurita M, Tanaka Y, Ito A, Kasahara T, Uchigata Y. Body Weight Reduction of 5% Improved Blood Pressure and Lipid Profiles in Obese Men and Blood Glucose in Obese Women: A Four-Year Follow-up Observational Study. Metab Syndr Relat Disord 2019; 17:250-258. [PMID: 30839239 DOI: 10.1089/met.2018.0115] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Body weight reduction (BWR) of at least 3% in obese Japanese individuals through lifestyle interventions has improved the risk factors for cardiovascular disease (CVD). We aimed to assess the relation between body weight change (BWC) and CVD risk change and to identify lifestyle improvement related to BWR in obese Japanese individuals. Methods: Subjects were 2579 health checkup examinees without medicated diabetes, hypertension or dyslipidemia, and a body mass index ≥25 kg/m2 who completed lifestyle questionnaires in 2008 and 2012. The 4-year changes in fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), lipids, and blood pressure (BP) levels were compared across the five groups based on the 4-year BWC, and presented as <-5%, -5% to -3%, -3% to -1%, -1% to 1%, and ≥1%. Multivariable logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CI) for lifestyle improvement related to BWR. Results: Comparing the groups to the reference group (BWC ranging from -1% to +1%), we observed that FPG and HbA1c levels were lower in women in the <-5% group; BP levels were also lower in the <-5% group; triglyceride levels had improved in the <-3% group, and low-density lipoprotein cholesterol levels in the <-5% group; high-density lipoprotein cholesterol levels had improved in men in the <-5% group. In men, the adjusted OR (95% CI) for BWR related to lifestyle improvement pertaining to "over 30 min exercise" was 2.6 (2.0-3.6). In women, the adjusted ORs for BWR related to "walking or physical activity," "drinking alcohol," and "drinking more than a glass of sake" were 1.7 (1.1-2.7), 1.9 (1.1-3.5), and 1.8 (1.1-3.0), respectively. Conclusions: A 5% BWR improved FPG and HbA1c levels in obese women, and BP and lipid levels in obese men. Improvements in exercise and alcohol consumption habits were associated with BWR in this population.
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Affiliation(s)
- Yukiko Hasegawa
- 1 Department of Diabetology and Metabolism, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Tomoko Nakagami
- 1 Department of Diabetology and Metabolism, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Junko Oya
- 1 Department of Diabetology and Metabolism, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Kanako Takahashi
- 1 Department of Diabetology and Metabolism, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.,2 Department of Internal Medicine, Yoyogi Hospital, Tokyo, Japan
| | - Chisato Isago
- 1 Department of Diabetology and Metabolism, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Moritoshi Kurita
- 1 Department of Diabetology and Metabolism, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.,3 Department of Internal Medicine, Saitama-ken Saiseikai Kurihashi Hospital, Saitama, Japan
| | - Yuki Tanaka
- 1 Department of Diabetology and Metabolism, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.,4 Department of Internal Medicine, Josai Hospital, Tokyo, Japan
| | - Arata Ito
- 1 Department of Diabetology and Metabolism, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Tadasu Kasahara
- 4 Department of Internal Medicine, Josai Hospital, Tokyo, Japan
| | - Yasuko Uchigata
- 1 Department of Diabetology and Metabolism, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.,5 Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
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20
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Kawabata Y, Nishida N, Awata T, Kawasaki E, Imagawa A, Shimada A, Osawa H, Tanaka S, Takahashi K, Nagata M, Yasuda H, Uchigata Y, Kajio H, Makino H, Yasuda K, Kobayashi T, Hanafusa T, Tokunaga K, Ikegami H. Genome-Wide Association Study Confirming a Strong Effect of HLA and Identifying Variants in CSAD/lnc-ITGB7-1 on Chromosome 12q13.13 Associated With Susceptibility to Fulminant Type 1 Diabetes. Diabetes 2019; 68:665-675. [PMID: 30552108 DOI: 10.2337/db18-0314] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 12/05/2018] [Indexed: 11/13/2022]
Abstract
The first genome-wide association study of fulminant type 1 diabetes was performed in Japanese individuals. As previously reported using a candidate gene approach, a strong association was observed with multiple single nucleotide polymorphisms (SNPs) in the HLA region, and the strongest association was observed with rs9268853 in the class II DR region (P = 1.56 × 10-23, odds ratio [OR] 3.18). In addition, rs11170445 in CSAD/lnc-ITGB7-1 on chromosome 12q13.13 showed an association at a genome-wide significance level (P = 7.58 × 10-9, OR 1.96). Fine mapping of the region revealed that rs3782151 in CSAD/lnc-ITGB7-1 showed the lowest P value (P = 4.60 × 10-9, OR 1.97 [95% CI 1.57-2.48]). The risk allele of rs3782151 is a cis expression quantitative trait locus for ITGB7 that significantly increases the expression of this gene. CSAD/lnc-ITGB7-1 was found to be strongly associated with susceptibility to fulminant, but not classical, autoimmune type 1 diabetes, implicating this locus in the distinct phenotype of fulminant type 1 diabetes.
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Affiliation(s)
- Yumiko Kawabata
- Department of Endocrinology, Metabolism and Diabetes, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Nao Nishida
- Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Chiba, Japan
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takuya Awata
- Department of Diabetes, Metabolism and Endocrinology, International University of Health and Welfare Hospital, Tochigi, Japan
| | | | - Akihisa Imagawa
- Department of Internal Medicine (I), Osaka Medical College, Osaka, Japan
| | - Akira Shimada
- Department of Endocrinology and Diabetes, Saitama Medical University, Saitama, Japan
| | - Haruhiko Osawa
- Department of Laboratory Medicine, Ehime University School of Medicine, Ehime, Japan
| | | | - Kazuma Takahashi
- Faculty of Nursing and Graduate School Nursing, Iwate Prefectural University, Iwate, Japan
| | - Masao Nagata
- Department of Internal Medicine, Takasago Municipal Hospital, Hyogo, Japan
| | - Hisafumi Yasuda
- Division of Health Sciences, Department of Public Health, Kobe University Graduate School of Health Sciences, Hyogo, Japan
| | - Yasuko Uchigata
- Diabetes Center, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroshi Kajio
- Department of Diabetes, Endocrinology and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Kazuki Yasuda
- Department of Metabolic Disorder, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | | | | | - Katsushi Tokunaga
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Ikegami
- Department of Endocrinology, Metabolism and Diabetes, Faculty of Medicine, Kindai University, Osaka, Japan
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21
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Hasegawa Y, Nakagami T, Oya J, Isago C, Kurita M, Tanaka Y, Ito A, Tsuzura R, Hirota N, Miura J, Uchigata Y. Serum lipid management in patients with type 1 and type 2 diabetes: a hospital-based cohort study. Diabetol Int 2019; 10:67-76. [PMID: 30800565 PMCID: PMC6357242 DOI: 10.1007/s13340-018-0365-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 07/26/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Serum lipid management is important for patients with diabetes; however, it has not been examined in our specialized diabetes clinic. AIMS The aim of the study was to assess the percentage of patients who did not achieve management targets (MT) for low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C) and triglycerides (TG), and explore factors related to failure to achieve lipid MT in Japanese patients with type 1 (T1D) and type 2 diabetes (T2D). METHODS This cross-sectional study included 795 patients (35% men) with T1D and 4018 patients (60% men) with T2D attending our diabetes center. MTs for serum lipids were in accordance with the guidelines of the Japan Atherosclerosis Society. Logistic regression analysis was performed to identify factors related to failure to achieve MTs for serum lipids. RESULTS The percentages of men/women who did not achieve MT for LDL-C were 34.1/31.8% in T1D and 40.5/52.7% in T2D. The corresponding values for TG were 35.1/14.0% in T1D and 50.1/47.9% in T2D, and for HDL-C were 2.5/0% in T1D and 8.6/2.9% in T2D. Increase in body mass index (BMI) and glycated hemoglobin (HbA1c) were significantly and independently associated with failure to achieve lipid MT in patients with T1D and T2D for both sexes. CONCLUSIONS The percentages of our patients who did not achieve serum lipid MT were relatively high in T1D and T2D, and higher HbA1c and BMI were associated with failure to achieve serum lipid MTs. More attention should be paid to lipid management in patients with diabetes especially who have higher HbA1c and BMI in our facility.
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Affiliation(s)
- Yukiko Hasegawa
- Diabetes Center, Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku, Tokyo, 162-8666 Japan
| | - Tomoko Nakagami
- Diabetes Center, Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku, Tokyo, 162-8666 Japan
| | - Junko Oya
- Diabetes Center, Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku, Tokyo, 162-8666 Japan
| | - Chisato Isago
- Diabetes Center, Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku, Tokyo, 162-8666 Japan
| | - Moritoshi Kurita
- Diabetes Center, Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku, Tokyo, 162-8666 Japan
| | - Yuki Tanaka
- Diabetes Center, Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku, Tokyo, 162-8666 Japan
| | - Arata Ito
- Diabetes Center, Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku, Tokyo, 162-8666 Japan
| | - Reika Tsuzura
- Diabetes Center, Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku, Tokyo, 162-8666 Japan
| | - Naoki Hirota
- Diabetes Center, Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku, Tokyo, 162-8666 Japan
| | - Junnosuke Miura
- Diabetes Center, Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku, Tokyo, 162-8666 Japan
| | - Yasuko Uchigata
- Diabetes Center, Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku, Tokyo, 162-8666 Japan
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22
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Shimura K, Miura J, Kawamoto M, Kawaguchi Y, Yamanaka H, Uchigata Y. Genetic differences between type 1 diabetes with and without other autoimmune diseases. Diabetes Metab Res Rev 2018; 34:e3023. [PMID: 29762907 DOI: 10.1002/dmrr.3023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 04/16/2018] [Accepted: 04/26/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Clusters of autoimmune diseases (ADs) are present in some people with type 1 diabetes. This clustering suggests the existence of common genetic backgrounds for abnormal autoimmunity in these individuals. However, the genetic differences between type 1 diabetes patients with and without other ADs are not well known. METHODS To investigate the clinical background and genetic differences between type 1 diabetes patients with and without other ADs, single nucleotide polymorphisms (SNPs) in the CTLA4, SUMO4, PTPN22, IRF5, STAT4, and BLK genes were analysed by using either a TaqMan assay or direct sequencing. The frequencies of alleles, genotypes of each gene, and the human leukocyte antigen (HLA) haplotype were analysed to investigate differences among 3 groups: type 1 diabetes with systemic ADs (group A), type 1 diabetes with other organ-specific ADs (group B), and type 1 diabetes without other ADs (group C). RESULTS The frequency of the C allele in the -1123G > C SNP in the PTPN22 gene promoter was significantly higher in groups A and B than in group C (P = .0258 and .0207, respectively). The allele frequencies of the other SNPs were comparable. The frequency of HLA DRB1*0405-DQB1*0401 was significantly higher in groups A and B than in group C (P = .021 and .0395, respectively). CONCLUSIONS The -1123G > C SNP in the PTPN22 gene promoter and HLA DRB1*0405-DQB1*0401 might influence the concurrence of systemic and organ-specific ADs in patients with type 1 diabetes.
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Affiliation(s)
- Kanako Shimura
- Diabetes Center, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Junnosuke Miura
- Diabetes Center, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Manabu Kawamoto
- Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Yasushi Kawaguchi
- Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Hisashi Yamanaka
- Institute of Rheumatology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Yasuko Uchigata
- Diabetes Center, Tokyo Women's Medical University Hospital, Tokyo, Japan
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23
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Kameda Y, Babazono T, Uchigata Y, Kitano S. Renal function after intravitreal administration of vascular endothelial growth factor inhibitors in patients with diabetes and chronic kidney disease. J Diabetes Investig 2018; 9:937-939. [PMID: 29108104 PMCID: PMC6031523 DOI: 10.1111/jdi.12771] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/26/2017] [Accepted: 10/18/2017] [Indexed: 12/21/2022] Open
Abstract
The present study aimed to determine whether intravitreal administration of vascular endothelial growth factor inhibitors is associated with deterioration of renal function, as seen with systemic administration, in patients with diabetes and chronic kidney disease. Estimated glomerular filtration rates before and after 160 intravitreal injections of vascular endothelial growth factor inhibitors (aflibercept, bevacizumab or ranibizumab) were compared in 69 patients with diabetes and with a baseline estimated glomerular filtration rate <60 mL/min/1.73 m2 . We also determined the incidence of acute kidney injury. The data showed no significant difference in the estimated glomerular filtration rate before and after vascular endothelial growth factor inhibitor administration in all patients and in patient subgroups based on each inhibitor. Furthermore, no episodes of acute kidney injury occurred. In conclusion, intravitreal administration of vascular endothelial growth factor inhibitors is unlikely to be associated with a deterioration of renal function in patients with diabetes and chronic kidney disease.
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Affiliation(s)
- Yusuke Kameda
- Departments of OphthalmologyDiabetes CenterTokyo Women's Medical University School of MedicineTokyoJapan
| | - Tetsuya Babazono
- MedicineDiabetes CenterTokyo Women's Medical University School of MedicineTokyoJapan
| | - Yasuko Uchigata
- MedicineDiabetes CenterTokyo Women's Medical University School of MedicineTokyoJapan
| | - Shigehiko Kitano
- Departments of OphthalmologyDiabetes CenterTokyo Women's Medical University School of MedicineTokyoJapan
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24
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Kato Y, Iwata T, Washio K, Yoshida T, Kuroda H, Morikawa S, Hamada M, Ikura K, Kaibuchi N, Yamato M, Okano T, Uchigata Y. Creation and Transplantation of an Adipose-derived Stem Cell (ASC) Sheet in a Diabetic Wound-healing Model. J Vis Exp 2017. [PMID: 28809824 DOI: 10.3791/54539] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Artificial skin has achieved considerable therapeutic results in clinical practice. However, artificial skin treatments for wounds in diabetic patients with impeded blood flow or with large wounds might be prolonged. Cell-based therapies have appeared as a new technique for the treatment of diabetic ulcers, and cell-sheet engineering has improved the efficacy of cell transplantation. A number of reports have suggested that adipose-derived stem cells (ASCs), a type of mesenchymal stromal cell (MSC), exhibit therapeutic potential due to their relative abundance in adipose tissue and their accessibility for collection when compared to MSCs from other tissues. Therefore, ASCs appear to be a good source of stem cells for therapeutic use. In this study, ASC sheets from the epididymal adipose fat of normal Lewis rats were successfully created using temperature-responsive culture dishes and normal culture medium containing ascorbic acid. The ASC sheets were transplanted into Zucker diabetic fatty (ZDF) rats, a rat model of type 2 diabetes and obesity, that exhibit diminished wound healing. A wound was created on the posterior cranial surface, ASC sheets were transplanted into the wound, and a bilayer artificial skin was used to cover the sheets. ZDF rats that received ASC sheets had better wound healing than ZDF rats without the transplantation of ASC sheets. This approach was limited because ASC sheets are sensitive to dry conditions, requiring the maintenance of a moist wound environment. Therefore, artificial skin was used to cover the ASC sheet to prevent drying. The allogenic transplantation of ASC sheets in combination with artificial skin might also be applicable to other intractable ulcers or burns, such as those observed with peripheral arterial disease and collagen disease, and might be administered to patients who are undernourished or are using steroids. Thus, this treatment might be the first step towards improving the therapeutic options for diabetic wound healing.
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Affiliation(s)
- Yuka Kato
- Diabetic Center, Tokyo Women's Medical University School of Medicine;
| | - Takanori Iwata
- The Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University;
| | - Kaoru Washio
- The Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University
| | - Toshiyuki Yoshida
- The Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University
| | - Hozue Kuroda
- The Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University
| | - Shunichi Morikawa
- The Department of Anatomy and Developmental Biology, Tokyo Women's Medical University School of Medicine
| | - Mariko Hamada
- Diabetic Center, Tokyo Women's Medical University School of Medicine
| | - Kazuki Ikura
- Diabetic Center, Tokyo Women's Medical University School of Medicine
| | - Nobuyuki Kaibuchi
- The Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University
| | - Masayuki Yamato
- The Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University
| | - Teruo Okano
- The Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University;
| | - Yasuko Uchigata
- Diabetic Center, Tokyo Women's Medical University School of Medicine
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Nyumura I, Babazono T, Tauchi E, Yamashita S, Toyonaga A, Yoshida N, Takemura S, Takagi M, Yoshida N, Hanai K, Tanaka N, Koyama I, Nakajima I, Fuchinoue S, Tanabe K, Uchigata Y. Quality of life in Japanese patients with type 1 diabetes and end-stage renal disease undergoing simultaneous pancreas and kidney transplantation. Diabetol Int 2017; 8:268-274. [PMID: 30603332 PMCID: PMC6224885 DOI: 10.1007/s13340-017-0306-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 01/20/2017] [Indexed: 10/20/2022]
Abstract
We conducted this cross-sectional study to assess quality of life (QOL) in Japanese patients with type 1 diabetes mellitus (T1DM) and end-stage renal disease (ESRD) undergoing simultaneous pancreas and kidney transplantation (SPK). Japanese patients with T1DM without diabetic nephropathy (N = 10), and those undergoing chronic dialysis (N = 52), kidney transplantation alone (KTA, N = 25), and SPK (N = 16) were studied. Comprehensive health-related QOL was assessed using the Short Form 36 version 2 (SF-36v2). Emotional functioning in diabetes was measured by the Problem Area In Diabetes (PAID) scale. Severity of impaired hypoglycemic awareness was assessed using the Clarke hypoglycemic score. SPK patients had significantly higher (or tended to have higher) subscale and summary SF-36 scores than dialysis patients and KTA patients. PAID scores were significantly lower in SPK patients than in dialysis patients and KTA patients. Clarke hypoglycemic scores were also significantly lower in SPK patients than dialysis patients. In KTA and dialysis patients, there were no significant differences in the SF-36 subscale/summary scores, PAID scores, or Clarke hypoglycemic scores. In conclusion, QOL for Japanese patients receiving SPK may be superior to that of dialysis patients and KTA patients. Whether SPK actually improves QOL needs to be clarified in longitudinal studies.
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Affiliation(s)
- Izumi Nyumura
- Department of Medicine, Diabetes Center, Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
| | - Tetsuya Babazono
- Department of Medicine, Diabetes Center, Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
| | - Eriko Tauchi
- Department of Medicine, Diabetes Center, Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
| | - Shinpei Yamashita
- Department of Medicine, Diabetes Center, Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
| | - Aiko Toyonaga
- Department of Medicine, Diabetes Center, Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
| | - Noriko Yoshida
- Department of Medicine, Diabetes Center, Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
| | - Shunsuke Takemura
- Department of Medicine, Diabetes Center, Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
| | - Michino Takagi
- Department of Medicine, Diabetes Center, Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
| | - Naoshi Yoshida
- Department of Medicine, Diabetes Center, Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
| | - Ko Hanai
- Department of Medicine, Diabetes Center, Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
| | - Nobue Tanaka
- Department of Medicine, Diabetes Center, Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
| | - Ichiro Koyama
- Department of Surgery, Kidney Center, Tokyo Women’s Medical University School of Medicine, Tokyo, Japan
| | - Ichiro Nakajima
- Department of Surgery, Kidney Center, Tokyo Women’s Medical University School of Medicine, Tokyo, Japan
| | - Shohei Fuchinoue
- Department of Surgery, Kidney Center, Tokyo Women’s Medical University School of Medicine, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Kidney Center, Tokyo Women’s Medical University School of Medicine, Tokyo, Japan
| | - Yasuko Uchigata
- Department of Medicine, Diabetes Center, Tokyo Women’s Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 Japan
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26
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Oikawa Y, Shimada A, Awata T, Fukui T, Ikegami H, Imagawa A, Kajio H, Kawabata Y, Kawasaki E, Miura J, Osawa H, Takahashi K, Tanaka S, Uchigata Y, Yasuda H, Yasuda K, Hanafusa T, Kobayashi T. Clinical features of cases of seroconversion of anti-glutamic acid decarboxylase antibody during the clinical course of type 2 diabetes: a nationwide survey in Japan. Diabetol Int 2017; 8:306-315. [PMID: 30603336 PMCID: PMC6224891 DOI: 10.1007/s13340-017-0312-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 02/03/2017] [Indexed: 10/20/2022]
Abstract
The pathogenesis of type 1 diabetes is different from that of type 2 diabetes, and anti-glutamic acid decarboxylase antibody (GADA) helps to diagnose autoimmune type 1 diabetes. Some studies reported that GADA seroconversion occurs during the clinical course of type 2 diabetes, leading to development of "type 1 on type 2 diabetes". To clarify the clinical characteristics and triggers of GADA seroconversion, we performed a nationwide questionnaire survey for clinical cases identified by literature search, and obtained information on 38 cases (24 with insulin therapy and 14 without it). The diabetes duration up to determination of GADA seroconversion was significantly longer in the group with insulin therapy than that without it. This finding was particularly noted in insulin-treated non-obese patients with lower serum C-peptide levels. In these patients, insulin therapy could have masked sudden increases in plasma glucose and HbA1c levels, possibly leading to delayed determination of GADA seroconversion. In non-obese patients without insulin therapy, an abrupt rise in the plasma glucose and HbA1c levels was observed at immediately before the determination, a finding which may help to predict GADA seroconversion. From the results of the present survey, we could not determine apparent triggers of GADA seroconversion. Thus, physicians may need to consider the possibility of concurrent type 1 diabetes during the therapeutic course of type 2 diabetes; GADA measurement should be considered when non-obese type 2 diabetic patients not receiving insulin therapy experience unexpected abrupt hyperglycemia and when those receiving insulin therapy show low serum C-peptide levels.
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Affiliation(s)
- Yoichi Oikawa
- Department of Internal Medicine, Tokyo Saiseikai Central Hospital, 1-4-17 Mita, Minato, Tokyo, 108-0073 Japan
| | - Akira Shimada
- Department of Endocrinology and Diabetes, School of Medicine, Saitama Medical University, Saitama, 350-0495 Japan
| | - Takuya Awata
- Division of Diabetes and Endocrine, Internal Medicine, International University of Health and Welfare Hospital, Tochigi, 324-8501 Japan
| | - Tomoyasu Fukui
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Showa University School of Medicine, Tokyo, 142-8666 Japan
| | - Hiroshi Ikegami
- Department of Endocrinology, Metabolism and Diabetes, Kinki University Faculty of Medicine, Osaka, 589-8511 Japan
| | - Akihisa Imagawa
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, 565-0871 Japan
| | - Hiroshi Kajio
- Department of Endocrinology, Diabetes, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, 162-8655 Japan
| | - Yumiko Kawabata
- Department of Endocrinology, Metabolism and Diabetes, Kinki University Faculty of Medicine, Osaka, 589-8511 Japan
| | - Eiji Kawasaki
- Department of Diabetes and Endocrinology, Shin Koga Hospital, Fukuoka, 830-8577 Japan
| | - Junnosuke Miura
- Diabetes Center, Tokyo Women’s Medical University School of Medicine, Tokyo, 162-8666 Japan
| | - Haruhiko Osawa
- Department of Diabetes and Molecular Genetics, Ehime University Graduate School of Medicine, Ehime, 791-0295 Japan
| | - Kazuma Takahashi
- Faculty of Nursing and Graduate School of Nursing, Iwate Prefectural University, Iwate, 020-0693 Japan
| | | | - Yasuko Uchigata
- Diabetes Center, Tokyo Women’s Medical University School of Medicine, Tokyo, 162-8666 Japan
| | - Hisafumi Yasuda
- Division of Health Sciences, Department of Community Health Sciences, Kobe University Graduate School of Health Sciences, Hyogo, 654-0142 Japan
| | - Kazuki Yasuda
- Department of Metabolic Disorder, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, 162-8655 Japan
| | - Toshiaki Hanafusa
- Department of Internal Medicine (I), Osaka Medical College, Osaka, 569-8686 Japan
| | - Tetsuro Kobayashi
- Department of Health Management Center, Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, 105-8470 Japan
| | - Research Committee on Type 1 Diabetes of the Japan Diabetes Society
- Department of Internal Medicine, Tokyo Saiseikai Central Hospital, 1-4-17 Mita, Minato, Tokyo, 108-0073 Japan
- Department of Endocrinology and Diabetes, School of Medicine, Saitama Medical University, Saitama, 350-0495 Japan
- Division of Diabetes and Endocrine, Internal Medicine, International University of Health and Welfare Hospital, Tochigi, 324-8501 Japan
- Division of Diabetes, Metabolism and Endocrinology, Department of Medicine, Showa University School of Medicine, Tokyo, 142-8666 Japan
- Department of Endocrinology, Metabolism and Diabetes, Kinki University Faculty of Medicine, Osaka, 589-8511 Japan
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, 565-0871 Japan
- Department of Endocrinology, Diabetes, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, 162-8655 Japan
- Department of Diabetes and Endocrinology, Shin Koga Hospital, Fukuoka, 830-8577 Japan
- Diabetes Center, Tokyo Women’s Medical University School of Medicine, Tokyo, 162-8666 Japan
- Department of Diabetes and Molecular Genetics, Ehime University Graduate School of Medicine, Ehime, 791-0295 Japan
- Faculty of Nursing and Graduate School of Nursing, Iwate Prefectural University, Iwate, 020-0693 Japan
- Ai Home Clinic, Tokyo, 170-0005 Japan
- Division of Health Sciences, Department of Community Health Sciences, Kobe University Graduate School of Health Sciences, Hyogo, 654-0142 Japan
- Department of Metabolic Disorder, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, 162-8655 Japan
- Department of Internal Medicine (I), Osaka Medical College, Osaka, 569-8686 Japan
- Department of Health Management Center, Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, 105-8470 Japan
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27
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Ogata M, Iwasaki N, Ide R, Takizawa M, Tanaka M, Tetsuo T, Sato A, Uchigata Y. Role of vitamin D in energy and bone metabolism in postmenopausal women with type 2 diabetes mellitus: A 6-month follow-up evaluation. J Diabetes Investig 2017; 9:211-222. [PMID: 28371517 PMCID: PMC5754515 DOI: 10.1111/jdi.12666] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 03/02/2017] [Accepted: 03/23/2017] [Indexed: 12/15/2022] Open
Abstract
AIMS/INTRODUCTION Resting energy expenditure was associated with a serum bone turnover marker in postmenopausal women with type 2 diabetes (T2DMPW) in the present cross-sectional study. To clarify the fundamental pathological factor for the correlation of bone metabolism and basal metabolism in type 2 diabetes, a 6-month prospective follow-up study was carried out with supplementation of vitamin D. MATERIALS AND METHODS A total of 44 T2DMPW were enrolled. The following factors were evaluated at the beginning and the end of the summer: procollagen type 1 N-terminal propeptide, carboxy-terminal collagen crosslinks-1, intact parathyroid hormone and 25-hydroxyvitamin D (25[OH]D), as well as diabetic complications, body composition, respiratory quotient and resting energy expenditure. A total of 23 patients with low 25(OH)D levels (˂20 ng/mL) were instructed to increase vitamin D levels by lifestyle change. Among them, 15 patients with osteoporosis were also administered alfacalcidol. RESULTS Serum 25(OH)D increased in 25 patients and decreased in 19 patients. Patients who did not receive the study intervention at the start tended to have a decreased 2525(OH)D level; therefore, the average 25(OH)D level of all patients was not changed. Changes in resting energy expenditure were positively correlated with those of procollagen type 1 N-terminal propeptide/carboxy-terminal collagen crosslinks-1. Changes in the respiratory quotient correlated with the mean glycated hemoglobin levels; procollagen type 1 N-terminal propeptide levels positively correlated with serum 25(OH)D after the intervention. These correlations were prominent in patients with increased 25(OH)D and those with alfacalcidol supplementation. CONCLUSIONS Restoration of vitamin D level might be a prerequisite for a normal correlation between bone and basal metabolism in T2DMPW. Lifestyle intervention for retention of vitamin D level is important even in summer, in T2DMPW.
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Affiliation(s)
- Makiko Ogata
- Diabetes Center, Tokyo Women's Medical University, Tokyo, Japan.,Department of Nutrition, Faculty of Nursing and Nutrition, Shukutoku University, Chiba, Japan
| | - Naoko Iwasaki
- Diabetes Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Risa Ide
- Diabetes Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Miho Takizawa
- Diabetes Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Mizuho Tanaka
- Diabetes Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Tamaki Tetsuo
- Diabetes Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Asako Sato
- Clinical Laboratory, Tokyo Women's Medical University, Tokyo, Japan
| | - Yasuko Uchigata
- Diabetes Center, Tokyo Women's Medical University, Tokyo, Japan
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28
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Katagiri M, Shoji J, Inada N, Kato S, Kitano S, Uchigata Y. Evaluation of vitreous levels of advanced glycation end products and angiogenic factors as biomarkers for severity of diabetic retinopathy. Int Ophthalmol 2017; 38:607-615. [DOI: 10.1007/s10792-017-0499-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 03/09/2017] [Indexed: 12/26/2022]
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29
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Omori Y, Yanagisawa K, Sato A, Uchigata Y. The importance of nonstop treatment after delivery for pregnant women with type 2 diabetes. Diabetes Metab Res Rev 2017; 33. [PMID: 27667505 DOI: 10.1002/dmrr.2860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 09/07/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND There are no reports of very long follow-up studies of pregnant women with type 2 diabetes after delivery. Here we describe cases of Japanese women whom we treated for 20 to 50 years after deliveries to investigate the relationship between blood glucose control and diabetic complications. METHODS In Japan, the prevalence of type 1 diabetes is very low, and we have very few long-term follow-up cases with type 1 diabetes. Therefore, we chose to describe subjects with type 2 diabetes only. We present data on a total of 80 deliveries, 68 cases, treated by one of us (Y.O.) for more than a 50-year period. They are divided into 4 groups based on duration of treatment after delivery: more than 50 years (1 delivery, 1 patient), 40 to 49 years (13 deliveries, 11 patients), 30 to 39 years (19 deliveries, 16 patients), and 20 to 29 years (47 deliveries, 40 patients). Their present average ages in these 4 groups are 77, 72.4, 65.9, and 55.5 years, respectively. Their average HbA1c levels at last visit, in May 2014, are 8.2%, 7.6%.,7.2%, and 8.3%, respectively. RESULTS Despite elevated HbA1c levels, they had relatively few complications: 40% (no retinopathy), 43.8% (simple retinopathy), and 12.5% (treated with photocoagulation); 67.5% (no albuminuria), 26.3% (albuminuria), and 6.3% (treated with renal transplantation or hemodialysis). Therefore, even if glycemic control is not ideal, nonstop treatment of Japanese women for type 2 diabetes after deliveries is effective to prevent diabetic complications. CONCLUSIONS Long-term attention to care of diabetes after pregnancy may be preventive of diabetic complications in other populations as well.
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Affiliation(s)
- Yasue Omori
- Diabetes Center, Ebina General Hospital, Ebina, Japan
| | | | - Asako Sato
- Diabetes Center, Tokyo Women's Medical University, Tokyo, Japan
- Department of Clinical Laboratory, Tokyo Women's Medical University, Tokyo, Japan
| | - Yasuko Uchigata
- Diabetes Center, Tokyo Women's Medical University, Tokyo, Japan
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30
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Ikarashi Y, Kogiso T, Hashimoto E, Yamamoto K, Kodama K, Taniai M, Torii N, Takaike H, Uchigata Y, Tokushige K. Four cases of type 1 diabetes mellitus showing sharp serum transaminase increases and hepatomegaly due to glycogenic hepatopathy. Hepatol Res 2017; 47:E201-E209. [PMID: 27027269 DOI: 10.1111/hepr.12713] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/18/2016] [Accepted: 03/22/2016] [Indexed: 02/06/2023]
Abstract
Poorly controlled diabetes mellitus (DM) patients sometimes show serum transaminase elevations due to steatohepatitis. However, we experienced four cases with type 1 DM with sharp elevations in serum transaminases that could not be explained by steatohepatitis alone and showed bright liver. They were diagnosed with glycogenic hepatopathy (GH) clinicopathologically. The four patients had a median age of 22.5 years (range, 19-29 years) and 12.5 (4-15)-year histories of type 1 DM and showed marked increases in serum transaminases (aspartate aminotransferase, 698 U/L [469-2763 U/L]; alanine transaminase, 255 U/L [216-956 U/L]). Diabetes mellitus control was poor and hemoglobin A1c was 12.7% (11-16.5%). Three cases had a past history of diabetic ketoacidosis. Hepatomegaly and hyperdense liver were seen on computed tomography scans. Magnetic resonance imaging showed low intensity in T2-weighted images. The pathological findings revealed pale and swollen hepatocytes and glycogenated nuclei. The architecture of the liver was preserved, and steatosis and fibrosis were mild. The cytoplasm of hepatocytes stained densely positive with periodic acid-Schiff, and the positive staining disappeared after diastase digestion, suggesting glycogen deposition. No other cause of hepatitis was evident, and the diagnosis was GH. Elevated transaminases improved within 1 month with good glycemic control. Transaminase elevations were observed several times in three cases with poor glycemic control. Glycogenic hepatopathy is rare, but extremely high serum elevations of transaminases are important to identify clinically. Despite showing a good clinical course in general, GH sometimes recurs and requires strict glycemic control. Clinicians should be aware of and recognize GH when dealing with uncontrolled DM patients.
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Affiliation(s)
- Yuichi Ikarashi
- Institute of Gastroenterology, Department of Internal Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Tomomi Kogiso
- Institute of Gastroenterology, Department of Internal Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Etsuko Hashimoto
- Institute of Gastroenterology, Department of Internal Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Kuniko Yamamoto
- Institute of Gastroenterology, Department of Internal Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuhisa Kodama
- Institute of Gastroenterology, Department of Internal Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Makiko Taniai
- Institute of Gastroenterology, Department of Internal Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Nobuyuki Torii
- Institute of Gastroenterology, Department of Internal Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroko Takaike
- Diabetes Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Yasuko Uchigata
- Diabetes Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Katsutoshi Tokushige
- Institute of Gastroenterology, Department of Internal Medicine, Tokyo Women's Medical University, Tokyo, Japan
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Nakagami T, Takahashi K, Suto C, Oya J, Tanaka Y, Kurita M, Isago C, Hasegawa Y, Ito A, Uchigata Y. Diabetes diagnostic thresholds of the glycated hemoglobin A1c and fasting plasma glucose levels considering the 5-year incidence of retinopathy. Diabetes Res Clin Pract 2017; 124:20-29. [PMID: 28081449 DOI: 10.1016/j.diabres.2016.12.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/09/2016] [Accepted: 12/19/2016] [Indexed: 12/21/2022]
Abstract
AIMS As retinopathy is used as a defining threshold of diabetes, we assessed the glycated hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG) values associated with an increased risk of 5-year incidence of retinopathy. METHODS We studied HbA1c, FPG, and optic fundus findings of 2605 individuals without previously diagnosed diabetes annually during a 5-year period. Retinopathy was examined using non-mydriatic, 45° digital fundus photography. Baseline levels were stratified as <5.3 [34], 5.3-5.6 [34-38], 5.7-6.0 [39-42], 6.1-6.4 [43-47], and ⩾6.5% [48mmol/mol] for HbA1c and <5.0, 5.0-5.5, 5.6-6.0, 6.1-6.9, and ⩾7.0mmol/L for FPG. Cox proportional hazard models were used to analyze hazard ratios (HRs) associated with HbA1c or FPG for incident retinopathy. RESULTS During a total of 11845 person-years, we identified 50 (1.9%) cases of incident retinopathy. The adjusted HRs for incident retinopathy associated with a one-standard deviation increase in HbA1c and FPG were 1.2 (95% confidence intervals: 1.1-1.4) and 1.2 (1.1-1.4), respectively. These HRs were significantly higher for a HbA1c level ⩾6.5% (48mmol/mol) (3.4 [1.1-10.2]) or FPG level ⩾7.0mmol/L (3.6 [1.1-11.6]) than for a HbA1c level <5.3% (34mmol/mol) or FPG level <5.0mmol/L. CONCLUSIONS A HbA1c value of 6.5% (48mmol/mol) and FPG value of 7.0mmol/L might be proper as diabetes diagnostic thresholds that indicate a high risk of future retinopathy.
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Affiliation(s)
- Tomoko Nakagami
- Diabetes Center, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku 162-8666, Tokyo, Japan.
| | - Kanako Takahashi
- Diabetes Center, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku 162-8666, Tokyo, Japan; Internal Medicine, Yoyogi Hospital, 1-30-7, Sendagaya, Shibuya-ku, Tokyo 151-8556, Japan
| | - Chikako Suto
- Department of Ophthalmology, Tokyo Women's Medical University Medical Center East, 2-1-10, Nishiogu, Arakawa-ku, Tokyo 116-8567, Japan; Department of Ophthalmology, Saitama-ken Saiseikai Kurihashi Hospital, 714-6, Kouemon, Kuki, Saitama 349-1105, Japan
| | - Junko Oya
- Diabetes Center, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku 162-8666, Tokyo, Japan
| | - Yuki Tanaka
- Diabetes Center, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku 162-8666, Tokyo, Japan
| | - Moritoshi Kurita
- Diabetes Center, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku 162-8666, Tokyo, Japan
| | - Chisato Isago
- Diabetes Center, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku 162-8666, Tokyo, Japan
| | - Yukiko Hasegawa
- Diabetes Center, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku 162-8666, Tokyo, Japan
| | - Arata Ito
- Diabetes Center, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku 162-8666, Tokyo, Japan
| | - Yasuko Uchigata
- Diabetes Center, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku 162-8666, Tokyo, Japan
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Hoshina S, Miura J, Uchigata Y. Relationship between HLA haplotype and BMI change in Japanese slowly progressive type 1 diabetes patients. Diabetes Res Clin Pract 2017; 124:81-83. [PMID: 28110239 DOI: 10.1016/j.diabres.2016.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 12/07/2016] [Accepted: 12/10/2016] [Indexed: 10/20/2022]
Abstract
We investigated the association between susceptible HLA and BMI change rate from diagnosis of diabetes to diagnosis of slowly progressive type 1 diabetes in Japanese diabetic patients. Subjects with the HLA DRB1*04:05-DQB1*04:01 haplotype were more likely to show weight loss than those without. This HLA haplotype might affect weight loss.
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Affiliation(s)
- Sari Hoshina
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Japan
| | - Junnosuke Miura
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Japan.
| | - Yasuko Uchigata
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Japan
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Toya K, Babazono T, Murata H, Hanai K, Uchigata Y. Association of serum bilirubin levels with mortality in patients with diabetes initiating chronic hemodialysis: a competing risks analysis of a single-center cohort. Ren Replace Ther 2016. [DOI: 10.1186/s41100-016-0065-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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Abstract
PURPOSE Total pancreatectomy (TP) for pancreatic neoplasms is associated with high morbidity and mortality rates. However, with recent advances in surgical techniques and improved postoperative management, the number of cases with clinical indications for TP is increasing. Here, we evaluated the clinical outcomes post-TP. MATERIALS AND METHODS Patients (n = 41) who underwent TP between 2004 and 2011 at Tokyo Women's Medical University were retrospectively examined. Pre- and postoperative clinicophysiological data were collected up to 12 months post-TP and then analyzed. RESULTS Only glycated hemoglobin (HbA1c), percentage of lymphocytes and hepatic Hounsfield unit level on computed tomography (CT) were significantly different between the preoperative state and at 12 months post-TP, while other clinicophysiological parameters remained unchanged. The quantity of the pancreatic enzyme administered significantly influenced glycemic control at 12 months post-TP (p < 0.05). CONCLUSIONS All clinicophysiological parameters except for HbA1c were temporarily decreased after TP but normalized by 12 months. Thus, TP is a feasible surgical approach to treating pancreatic neoplasms with the potential to spread across the entire pancreas when adequately supplemented by synthetic insulin and pancreatic enzymes.
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Affiliation(s)
- Shuji Suzuki
- a Department of Gastroenterological Surgery , Tokyo Women's Medical University , Tokyo , Japan.,b Department of Gastroenterological Surgery , Ibaraki Medical Center, Tokyo Medical University , Ibaraki , Japan
| | - Junnosuke Miura
- c Diabetes Center , Tokyo Women's Medical University , Tokyo , Japan
| | - Kyoko Shimizu
- d Department of Gastroenterology , Tokyo Women's Medical University , Tokyo , Japan
| | - Katsutoshi Tokushige
- d Department of Gastroenterology , Tokyo Women's Medical University , Tokyo , Japan
| | - Yasuko Uchigata
- c Diabetes Center , Tokyo Women's Medical University , Tokyo , Japan
| | - Masakazu Yamamoto
- a Department of Gastroenterological Surgery , Tokyo Women's Medical University , Tokyo , Japan
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Nakagami T, Tanaka Y, Oya J, Kurita M, Isago C, Hasegawa Y, Ito A, Hirota N, Tsuzura R, Uchigata Y. Associations of HbA1c and fasting plasma glucose with incident diabetes: Implications for pre-diabetes thresholds in a Japanese population. Prim Care Diabetes 2016; 10:407-414. [PMID: 27515716 DOI: 10.1016/j.pcd.2016.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 07/02/2016] [Accepted: 07/16/2016] [Indexed: 02/03/2023]
Abstract
AIMS This study assessed pre-diabetes (pre-DM) cutoffs for HbA1c and fasting plasma glucose (FPG) that were associated with an increased risk of incident DM. METHODS We evaluated 2267 non-diabetic Japanese health-check examinees (HbA1c: <6.5% [<48mmol/mol] and FPG: <7.0mmol/L) who were 30-79 years old and were followed-up for 5 years. Incident DM was defined as HbA1c of ≥6.5% (≥48mmol/mol), FPG of ≥7.0mmol/L, or physician-diagnosed DM. RESULTS During 11047 person-years, we identified 99 incident DM cases (4.3%). The incidence of DM increased with increasing baseline HbA1c or FPG levels, and the change points (95% confidence intervals) were 5.7% (5.6-5.7%; 39mmol/mol [38-39mmol/mol]) for HbA1c and 5.5mmol/L (5.5-5.6mmol/L) for FPG. The adjusted hazard ratios (HRs) for incident DM per one standard deviation-increase in HbA1c and FPG were 5.5 (4.4-6.8) and 4.0 (3.2-4.8), respectively. The adjusted HRs for incident DM were significantly higher at HbA1c of 5.7-6.4% (39-46mmol/mol) or FPG of 5.5-6.9mmol/L, compared to HbA1c of <5.7% (<39mmol/mol) or FPG of <5.5mmol/L. CONCLUSION The lower cut-offs for pre-DM may be 5.7% (39mmol/mol) for HbA1c and 5.5mmol/L for FPG in this Japanese population.
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Affiliation(s)
- Tomoko Nakagami
- Department of Medicine III, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
| | - Yuki Tanaka
- Department of Medicine III, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Junko Oya
- Department of Medicine III, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Moritoshi Kurita
- Department of Medicine III, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Chisato Isago
- Department of Medicine III, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Yukiko Hasegawa
- Department of Medicine III, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Arata Ito
- Department of Medicine III, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Naoki Hirota
- Department of Medicine III, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Reika Tsuzura
- Department of Medicine III, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Yasuko Uchigata
- Department of Medicine III, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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Kameda Y, Hirose A, Iida T, Uchigata Y, Kitano S. Giant retinal pigment epithelial tear associated with fluid overload due to end-stage diabetic kidney disease. Am J Ophthalmol Case Rep 2016; 5:44-47. [PMID: 29503946 PMCID: PMC5758016 DOI: 10.1016/j.ajoc.2016.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 10/05/2016] [Accepted: 11/10/2016] [Indexed: 11/26/2022] Open
Abstract
Purpose To report a case of a giant retinal pigment epithelial (RPE) tear associated with fluid overload in a patient with diabetic macular edema (DME) and kidney disease. Observations A 60-year-old man with type 2 diabetes mellitus and end-stage diabetic kidney disease who had gained weight because of fluid overload complained of a visual disturbance in the left eye that had started a few days earlier. The left fundus showed a RPE defect in two temporal quadrants under an extensive serous retinal detachment (SRD) with exacerbation of the original DME. Seven days later, he was admitted for severe edema and pleural effusion. No overt signs of congestive heart failure were noted. On admission, the RPE defect had markedly widened to involve the macula. Spectral-domain optical coherence tomography images showed substantial intraretinal fluid and an extensive SRD with rolled edges of the retinal pigment epithelium, which led to the diagnosis of a RPE tear. The fluid under the SRD was absorbed on the fourth hospital day and the substantial intraretinal fluid resolved on the eleventh day after systemic management of fluid overload only without ophthalmic treatment. The change in the appearance of the RPE area was minimal and the visual field defect remained even after 6 months. Conclusions and importance A RPE tear may develop in association with fluid overload in patients with diabetes.
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Affiliation(s)
- Yusuke Kameda
- Department of Ophthalmology, Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan
- Corresponding author. Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.Diabetes CenterTokyo Women's Medical University School of Medicine8-1 Kawada-choShinjuku-kuTokyo162-8666Japan
| | - Akira Hirose
- Department of Ophthalmology, Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan
| | - Tomohiro Iida
- Department of Ophthalmology, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan
| | - Yasuko Uchigata
- Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan
| | - Shigehiko Kitano
- Department of Ophthalmology, Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan
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37
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Katagiri M, Shoji J, Kato S, Kitano S, Uchigata Y. Relationships between vitreous levels of soluble receptor for advanced glycation end products (sRAGE) and renal function in patients with diabetic retinopathy. Int Ophthalmol 2016; 37:1247-1255. [PMID: 27830398 DOI: 10.1007/s10792-016-0389-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 11/01/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE We investigated the relationship between vitreous levels of soluble receptor for advanced glycation end products (sRAGE) and vascular endothelial growth factor (VEGF) and renal function, and correlations between vitreous sRAGE levels and proliferative diabetic retinopathy (PDR) activity. METHODS We examined 33 eyes from 33 patients with diabetes mellitus who underwent a vitrectomy (eight patients in the non-PDR [NPDR] group and 25 in the PDR group). Serum creatinine levels and estimated glomerular filtration rate (eGFR) were measured and classified according to the chronic kidney disease (CKD)-staging method. Enzyme-linked immunosorbent assay (ELISA) was performed to quantify vitreous sRAGE and VEGF levels. RESULTS Vitreous sRAGE levels were significantly higher in PDR group compared to NPDR group (p = 0.00003). Vitreous sRAGE levels were significantly higher in patients with CKD stage 5 (end-stage renal failure or hemodialysis) than in patients with CKD stage 1 or 2 (p < 0.01) and 3 or 4 (p < 0.05), and were significantly correlated with eGFR (r = - 0.490, p = 0.007) and creatinine levels (r = 0.484, p = 0.006). Within the PDR group, patients with low (<27 pg/mL) sRAGE levels required repeat vitreous surgeries for early postoperative vitreous hemorrhage significantly more frequently than those with high (≥27 pg/mL) sRAGE levels (p = 0.0067). CONCLUSIONS Vitreous sRAGE levels were significantly correlated with renal function, and low vitreous sRAGE levels in patients with PDR were associated with postoperative vitreous hemorrhage. Vitreous sRAGE may be a useful biomarker for renal dysfunction associated with diabetic retinopathy.
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Affiliation(s)
- Makiko Katagiri
- Department of Ophthalmology, Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Jun Shoji
- Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine, Tokyo, Japan
| | - Satoshi Kato
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Shigehiko Kitano
- Department of Ophthalmology, Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Yasuko Uchigata
- Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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Uchigata Y. Can restoring immune balance be the ultimate therapy for type 1 diabetes? J Diabetes Investig 2016; 7:819-821. [PMID: 27181881 PMCID: PMC5089942 DOI: 10.1111/jdi.12501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 02/10/2016] [Accepted: 02/12/2016] [Indexed: 11/30/2022] Open
Affiliation(s)
- Yasuko Uchigata
- Diabetes Center Department of Medicine III Tokyo Women's Medical University School of Medicine Tokyo Japan
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Ikura K, Hanai K, Oka S, Watanabe M, Oda Y, Hamada M, Kato Y, Shinjyo T, Uchigata Y. Brachial-ankle pulse wave velocity, but not ankle-brachial index, predicts all-cause mortality in patients with diabetes after lower extremity amputation. J Diabetes Investig 2016; 8:250-253. [PMID: 27422213 PMCID: PMC5334322 DOI: 10.1111/jdi.12554] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 06/13/2016] [Accepted: 07/07/2016] [Indexed: 12/01/2022] Open
Abstract
We examined whether brachial‐ankle pulse wave velocity (baPWV) and ankle‐brachial pressure index (ABI) are predictors for mortality in diabetic patients after lower extremity amputation. This was an observational historical cohort study of 102 Japanese diabetic patients after first non‐traumatic lower extremity amputation, with a mean age of 63 years (standard deviation 12 years). The end‐point was all‐cause mortality. During the mean follow‐up period of 3.3 years, 44 patients reached the end‐point. In both univariate and multivariate analyses, baPWV (m/s) (hazard ratio [HR] 1.05 and 1.04, both P < 0.01, respectively), but not ABI (HR 0.38 and 0.89, P = 0.08 and 0.86, respectively), was a significant predictor for the end‐point. When baPWV (above or below the median [21.8 m/s]) and ABI (normal [0.9–1.4] or not) were analyzed as categorical variables, the results were similar. In conclusion, baPWV, but not ABI, might be a predictor for all‐cause mortality in diabetic patients after lower extremity amputation.
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Affiliation(s)
- Kazuki Ikura
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Ko Hanai
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Seiji Oka
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Makiko Watanabe
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Yuri Oda
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Mariko Hamada
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Yuka Kato
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Takamichi Shinjyo
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Yasuko Uchigata
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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Ichihara Y, Utoh R, Yamada M, Shimizu T, Uchigata Y. Size effect of engineered islets prepared using microfabricated wells on islet cell function and arrangement. Heliyon 2016; 2:e00129. [PMID: 27441299 PMCID: PMC4946309 DOI: 10.1016/j.heliyon.2016.e00129] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 05/29/2016] [Accepted: 06/23/2016] [Indexed: 01/02/2023] Open
Abstract
Pancreatic islets are heterogeneous clusters mainly composed of α and β cells, and these clusters range in diameter from 50 to several hundred micrometers. Native small islets are known to have a higher insulin secretion ability in vitro and to provide better transplantation outcomes when compared with large islets. In this study, we prepared microengineered pseudo-islets from dispersed rat islet cells using precisely-fabricated agarose gel-based microwells with different diameters (100, 300, or 500 μm) to investigate the function and survival of islet cell aggregates with well-controlled sizes. We observed that dead cells were rarely present in the small pseudo-islets with an average diameter of ∼60 μm prepared using 100 μm microwells. In contrast, we observed more dead cells in the larger pseudo-islets prepared using 300 and 500 μm microwells. The relative amount of hypoxic cells was significantly low in the small pseudo-islets whereas a hypoxic condition was present in the core region of the larger pseudo-islets. In addition, we found that the small-sized pseudo-islets reconstituted the in vivo-tissue like arrangement of the α and β cells, and restored the high insulin secretory capacity in response to high glucose. These results clearly suggest that precise size control of pseudo-islets is essential for maintaining islet cell function and survival in vitro. The small-sized pseudo-islets may be advantageous for providing a better therapeutic approach for treating type 1 diabetes mellitus via islet reorganization and transplantation.
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Affiliation(s)
- Yumie Ichihara
- Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Rie Utoh
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
- Department of Applied Chemistry and Biotechnology, Graduate School of Engineering, Chiba University, 1-33 Yayoi-cho, Inage-ku, Chiba 263-8522, Japan
- Corresponding author at: Research Fellow of the Japan Society for the Promotion of Science (JSPS). Department of Applied Chemistry and Biotechnology, Graduate School of Engineering, Chiba University, 1–33 Yayoi-cho, Inage-ku, Chiba 263–8522, Japan.Department of Applied Chemistry and BiotechnologyGraduate School of EngineeringChiba University1-33 Yayoi-choInage-kuChiba263-8522Japan
| | - Masumi Yamada
- Department of Applied Chemistry and Biotechnology, Graduate School of Engineering, Chiba University, 1-33 Yayoi-cho, Inage-ku, Chiba 263-8522, Japan
| | - Tatsuya Shimizu
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Yasuko Uchigata
- Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
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Yasui J, Kawasaki E, Tanaka S, Awata T, Ikegami H, Imagawa A, Uchigata Y, Osawa H, Kajio H, Kawabata Y, Shimada A, Takahashi K, Yasuda K, Yasuda H, Hanafusa T, Kobayashi T. Clinical and Genetic Characteristics of Non-Insulin-Requiring Glutamic Acid Decarboxylase (GAD) Autoantibody-Positive Diabetes: A Nationwide Survey in Japan. PLoS One 2016; 11:e0155643. [PMID: 27177031 PMCID: PMC4866691 DOI: 10.1371/journal.pone.0155643] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/02/2016] [Indexed: 11/21/2022] Open
Abstract
Aims Glutamic acid decarboxylase autoantibodies (GADAb) differentiate slowly progressive insulin-dependent (type 1) diabetes mellitus (SPIDDM) from phenotypic type 2 diabetes, but many GADAb-positive patients with diabetes do not progress to insulin-requiring diabetes. To characterize GADAb-positive patients with adult-onset diabetes who do not require insulin therapy for >5 years (NIR-SPIDDM), we conducted a nationwide cross-sectional survey in Japan. Methods We collected 82 GADAb-positive patients who did not require insulin therapy for >5 years (NIR-SPIDDM) and compared them with 63 patients with insulin-requiring SPIDDM (IR-SPIDDM). Clinical and biochemical characteristics, HLA-DRB1-DQB1 haplotypes, and predictive markers for progression to insulin therapy were investigated. Results Compared with the IR-SPIDDM group, the NIR-SPIDDM patients showed later diabetes onset, higher body mass index, longer duration before diagnosis, and less frequent hyperglycemic symptoms at onset. In addition, C-peptide, LDL-cholesterol, and TG were significantly higher in the NIR-SPIDDM compared to IR-SPIDDM patients. The NIR-SPIDDM group had lower frequency of susceptible HLA-DRB1*04:05-DQB1*04:01 and a higher frequency of resistant HLA-DRB1*15:01-DQB1*06:02 haplotype compared to IR-SPIDDM. A multivariable analysis showed that age at diabetes onset (OR = 0.82), duration before diagnosis of GADAb-positive diabetes (OR = 0.82), higher GADAb level (≥10.0 U/ml) (OR = 20.41), and fasting C-peptide at diagnosis (OR = 0.07) were independent predictive markers for progression to insulin-requiring diabetes. An ROC curve analysis showed that the optimal cut-off points for discriminating two groups was the GADAb level of 13.6 U/ml, age of diabetes onset of 47 years, duration before diagnosis of 5 years, and fasting C-peptide of 0.65 ng/ml. Conclusions Clinical, biochemical and genetic characteristics of patients with NIR-SPIDDM are different from those of IR-SPIDDM patients. Age of diabetes onset, duration before GADAb-positivity, GADAb level, and fasting C-peptide at diagnosis must be carefully considered in planning prevention trials for SPIDDM.
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Affiliation(s)
- Junichi Yasui
- Department of Endocrinology and Metabolism, Nagasaki University Hospital, Nagasaki, Japan
| | - Eiji Kawasaki
- Department of Endocrinology and Metabolism, Nagasaki University Hospital, Nagasaki, Japan
- Department of Diabetes and Endocrinology, Shin-Koga Hospital, Kurume, Japan
- * E-mail:
| | - Shoichiro Tanaka
- Third Department of Internal Medicine, University of Yamanashi, Yamanashi, Japan
| | - Takuya Awata
- Department of Diabetes, Endocrinology and Metabolism, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Hiroshi Ikegami
- Department of Endocrinology, Metabolism and Diabetes, Kinki University Faculty of Medicine, Osaka, Japan
| | - Akihisa Imagawa
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yasuko Uchigata
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Haruhiko Osawa
- Department of Laboratory Medicine, Ehime University School of Medicine, Ehime, Japan
| | - Hiroshi Kajio
- Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yumiko Kawabata
- Department of Endocrinology, Metabolism and Diabetes, Kinki University Faculty of Medicine, Osaka, Japan
| | - Akira Shimada
- Department of Internal Medicine, Saiseikai Central Hospital, Tokyo, Japan
| | - Kazuma Takahashi
- Department of Diabetes and Metabolism, Iwate Medical University, Iwate, Japan
| | - Kazuki Yasuda
- Department of Metabolic Disorder, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hisafumi Yasuda
- Division of Health Sciences, Department of Community Health Sciences, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Toshiaki Hanafusa
- Department of Internal Medicine (I), Osaka Medical College, Takatsuki, Japan
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Ishizawa K, Babazono T, Horiba Y, Nakajima J, Takasaki K, Miura J, Sakura H, Uchigata Y. The relationship between depressive symptoms and diabetic complications in elderly patients with diabetes: Analysis using the Diabetes Study from the Center of Tokyo Women's Medical University (DIACET). J Diabetes Complications 2016; 30:597-602. [PMID: 26987919 DOI: 10.1016/j.jdiacomp.2016.02.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/16/2016] [Accepted: 02/02/2016] [Indexed: 11/24/2022]
Abstract
AIMS To investigate the association between likelihood or severity of depression and symptoms associated with diabetic complications in elderly Japanese patients with diabetes. METHODS This single-center cross-sectional study included 4283 patients with diabetes, 65 years and older (mean age was 73 ± 6 years, 38.7% were women, 3.9% had type 1 diabetes). Participants completed a self-administered questionnaire including items on subjective symptoms associated with diabetic microangiopathy, frequency of clinical visits due to vascular diseases (heart diseases, stroke, or gangrene), hospitalization, and the Patient Health Questionnaire-9 (PHQ-9), a simple but reliable measure of depression. The associations between severity of depression and diabetic complications were examined using logistic regression analysis. RESULTS According to the PHQ-9 scores, patients were classified into the following 3 categories: 0-4 points (n=2975); 5-9 points (n=842); and 10 or more points (n=466). Higher PHQ-9 scores were associated with increased odds ratios for retinopathy, symptoms related to peripheral polyneuropathy and autonomic neuropathy, and end-stage renal disease requiring dialysis after adjustment for age, gender, smoking status, and HbA1c (all p<0.05). CONCLUSIONS Significant relationships were found between depression severity and chronic diabetic complications among elderly Japanese patients with diabetes.
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Affiliation(s)
- Kaya Ishizawa
- Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
| | - Tetsuya Babazono
- Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
| | - Yu Horiba
- Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
| | - Junko Nakajima
- Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
| | - Keiko Takasaki
- Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
| | - Junnosuke Miura
- Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
| | - Hiroshi Sakura
- Department of Medicine, Medical Center East, Tokyo Women's Medical University School of Medicine, 2-1-10 Nishiogu, Arakawa-ku, Tokyo 116-0011, Japan.
| | - Yasuko Uchigata
- Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
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Uchigata Y. [Insulin autoimmune syndrome]. Nihon Rinsho 2016; 74 Suppl 2:602-605. [PMID: 27266161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Uchigata Y. [Pathogenesis, diagnosis, and treatment of type 2 diabetes in adolescence]. Nihon Rinsho 2016; 74 Suppl 2:517-522. [PMID: 27266145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Nyumura I, Honda K, Babazono T, Horita S, Murakami T, Fuchinoue S, Uchigata Y. Recurrence of diabetic kidney disease in a type 1 diabetic patient after kidney transplantation. Nephrology (Carlton) 2016; 20 Suppl 2:90-2. [PMID: 26031596 DOI: 10.1111/nep.12454] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2015] [Indexed: 01/31/2023]
Abstract
Post-transplant hyperglycaemia of diabetic patients may cause recurrent diabetic kidney disease (DKD) in kidney allografts. We report a patient with slowly progressive DKD with calcineurin inhibitor toxicity (CNI) toxicity after the kidney transplantation. A 28-year-old female with type 1 diabetes mellitus underwent successful kidney transplantation from her mother in April 2003, and the kidney graft survived for more than 10 years. She was treated with combined immunosuppressive therapy consisting of cyclosporine and mycophenolate mofetil. After transplantation, she continued to take insulin injection four times per day, but her glycosylated haemoglobin (HbA1c) was above 10%. Protocol allograft kidney biopsies performed 5 and 10 years after transplantation revealed the recurrence of slowly progressive diabetic kidney disease. In addition, arteriolar hyalinosis partly associated with calcineurin inhibitor toxicity (CNI) was detected with progression. Post-transplant hyperglycaemia causes recurrent diabetic kidney disease (DKD) in kidney allografts, but its progression is usually slow. For long-term management, it is important to prevent the progression of the calcineurin inhibitor arteriolopathy, as well as maintain favourable glycaemic control.
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Affiliation(s)
- Izumi Nyumura
- Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.,Department of Pathology, Kidney Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Kazuho Honda
- Department of Pathology, Kidney Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Tetsuya Babazono
- Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Shigeru Horita
- Department of Pathology, Kidney Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Toru Murakami
- Department of Surgery, Kidney Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Shohei Fuchinoue
- Department of Surgery, Kidney Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Yasuko Uchigata
- Department of Medicine, Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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Abstract
In 1981, a 48-year old man was diagnosed with insulin autoimmune syndrome. In 2005, he experienced a substantial increase in his monoclonal insulin antibody levels; in 2006 and 2007, serum monoclonal gammopathy and an 11% marrow plasmacyte ratio were confirmed. In 2012, asymptomatic multiple myeloma was diagnosed based on an increased γ-globulin fraction and serum M-protein (IgG) levels. The insulin antibody binding rate was 75.4% in 2005 and 78.8% in 2012. In 2012, he was hospitalized for ileus and died. Autopsy identified multiple myeloma and no endocrinological tumors in the pancreas.
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Otani T, Yokoyama H, Ohashi Y, Uchigata Y. Improved incidence of end-stage renal disease of type 1 diabetes in Japan, from a hospital-based survey. BMJ Open Diabetes Res Care 2016; 4:e000177. [PMID: 27110369 PMCID: PMC4838665 DOI: 10.1136/bmjdrc-2015-000177] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/29/2016] [Accepted: 03/04/2016] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To explore whether the incidence of end-stage renal disease (ESRD) in type 1 diabetes (T1DM) was lowered over time, and how the baseline characteristics and risk factor management during follow-up were associated with the incident ESRD. RESEARCH DESIGN AND METHODS An observational cohort study was performed in 1014 patients with T1DM diagnosed from 1961 to 1999, who were admitted to the diabetes center. The incidence of ESRD up to 2010 and the effect of risk factors, including annual mean glycated haemoglobin (HbA1c) and blood pressure, were investigated. RESULTS During a mean follow-up of 19.3 years, with 88.3% follow-up rate, the incidence of ESRD was significantly lower in T1DM diagnosed in 1985-1999 than in 1961-1984 (0.8 vs 5.0 per 1000 person-years, p<0.0001), which was not precluded by preceding death. Multivariate Cox regression analysis indicated that the former group (vs the latter) was associated with a significantly reduced risk of ESRD independent of baseline variables of age, duration and gender (p<0.01). The continuous variable of year of T1DM diagnosis remained significant after adjustment for the above variables plus baseline proteinuria and retinopathy (p=0.02). Time-dependent Cox regression analysis indicated that ESRD was associated with annual mean HbA1c (p<0.01), systolic blood pressure (p<0.001) and baseline proteinuria (p<0.001), followed by continuous variable of year of T1DM diagnosis (p=0.09). CONCLUSIONS Our data indicate that incidence of ESRD is decreasing over time, coinciding with enhanced glycemic and blood pressure controls. The incidence of ESRD in recently diagnosed T1DM appears to be much lower than previously reported ESRD incidence.
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Affiliation(s)
- Toshika Otani
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
- Saitama Memorial Hospital, Saitama, Japan
| | - Hiroki Yokoyama
- Department of Internal Medicine, Jiyugaoka Medical Clinic, Obihiro, Japan
| | - Yasuo Ohashi
- Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan
| | - Yasuko Uchigata
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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Takasaki K, Babazono T, Ishizawa K, Miura J, Uchigata Y. Relationship between diabetic nephropathy and depression: a cross-sectional analysis using the Diabetes Study from the Center of Tokyo Women's Medical University (DIACET). BMJ Open Diabetes Res Care 2016; 4:e000310. [PMID: 28074142 PMCID: PMC5179608 DOI: 10.1136/bmjdrc-2016-000310] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 09/21/2016] [Accepted: 11/06/2016] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE We conducted this cross-sectional study to investigate the relationship between stage of diabetic nephropathy and likelihood or severity of depression in patients with diabetes. RESEARCH DESIGN AND METHODS We studied 2212 patients with diabetes (mean age 60.9 years; 928 women; 1838 patients with type 2 diabetes). Presence and severity of depression was examined using the Patient Health Questionnaire-9 (PHQ-9). Patients were classified into 5 stages of nephropathy, according to albuminuria and estimated glomerular filtration rate (eGFR); patients in stage 5 undergoing dialysis and kidney transplantation were analyzed separately (stages 5D and 5T). The relationship between stage of nephropathy and depression was examined using analysis of covariance and multivariate logistic regression analysis. RESULTS Both least square mean PHQ-9 scores and prevalence of patients with PHQ-9 scores ≥5 points (mild depression) and ≥10 points (moderate or severe depression) increased from stage 1 to 5D, and then declined in stage 5T. Multivariate ORs for mild or greater depression increased in patients in stages 3, 4, and 5D in reference to those in stage 1, which declined in patients in stage 5T. Albuminuria was significantly, but eGFR was not, associated with higher PHQ-9 scores and the PHQ-9 scores ≥5 or ≥10 after adjustment for clinical findings. CONCLUSIONS In patients with diabetes, progression of nephropathy is likely to be associated with increased risk and severity of depression, which may be reduced after successful kidney transplantation. Albuminuria may be more strongly associated with depression than eGFR.
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Affiliation(s)
- Keiko Takasaki
- Department of Medicine , Diabetes Center, Tokyo Women's Medical University School of Medicine , Shinjuku-ku , Japan
| | - Tetsuya Babazono
- Department of Medicine , Diabetes Center, Tokyo Women's Medical University School of Medicine , Shinjuku-ku , Japan
| | - Kaya Ishizawa
- Department of Medicine , Diabetes Center, Tokyo Women's Medical University School of Medicine , Shinjuku-ku , Japan
| | - Junnosuke Miura
- Department of Medicine , Diabetes Center, Tokyo Women's Medical University School of Medicine , Shinjuku-ku , Japan
| | - Yasuko Uchigata
- Department of Medicine , Diabetes Center, Tokyo Women's Medical University School of Medicine , Shinjuku-ku , Japan
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Takagi M, Babazono T, Uchigata Y. Differences in risk factors for the onset of albuminuria and decrease in glomerular filtration rate in people with Type 2 diabetes mellitus: implications for the pathogenesis of diabetic kidney disease. Diabet Med 2015; 32:1354-60. [PMID: 25968955 PMCID: PMC4745025 DOI: 10.1111/dme.12793] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2015] [Indexed: 12/16/2022]
Abstract
AIMS To determine differences in predictors of albuminuria and decreased estimated GFR in Japanese people with Type 2 diabetes mellitus without chronic kidney disease. METHODS This single-centre observational cohort study involved 1802 Japanese people with Type 2 diabetes with normoalbuminuria and estimated GFR ≥ 60 ml/min/1.73 m(2) (740 women; mean ± sd age 58 ± 12 years). Two separate outcomes were evaluated: onset of albuminuria ( ≥ 30 mg/g creatinine, albuminuria cohort; n = 1655) and decrease in estimated GFR ( < 60 ml/min/1.73 m(2) ; estimated GFR cohort; n = 1777). A Cox proportional hazards model was used to identify significant predictors for each outcome. RESULTS During a median follow-up period of 6.9 years for the albuminuria cohort and 8.0 years for the estimated GFR cohort, 181 and 316 individuals reached the respective outcome. The 5-year cumulative incidence of albuminuria was 8.3%, and that of decreased estimated GFR was 10.4%. In the multivariate Cox model, greater urinary albumin-to-creatinine ratio, presence of diabetic retinopathy and higher HbA1c levels were associated with both outcomes. Unique risk factors for onset of albuminuria were male gender and higher uric acid levels; those for decreased estimated GFR were older age, greater systolic blood pressure, and lower baseline estimated GFR and HDL cholesterol levels. CONCLUSIONS Identification of both common and distinct predictive factors for onset of albuminuria and decreased estimated GFR support the hypothesis that both common and distinct pathophysiological mechanisms are involved in the development of these two manifestations of chronic kidney disease in diabetes.
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Affiliation(s)
- M Takagi
- Department of Medicine, Diabetes Centre, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - T Babazono
- Department of Medicine, Diabetes Centre, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Y Uchigata
- Department of Medicine, Diabetes Centre, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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Otani T, Yokoyama H, Uchigata Y. Changes in the prognosis of Japanese patients who developed type 1 diabetes before the age of 30 years. Diabetes Res Clin Pract 2015; 109:434-9. [PMID: 26036954 DOI: 10.1016/j.diabres.2015.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 03/06/2015] [Accepted: 04/15/2015] [Indexed: 11/24/2022]
Abstract
AIMS We investigated changes in vital prognosis according to the year at diagnosis of type 1 diabetes mellitus (T1DM) in a hospital-based survey. METHODS Of 1054 Japanese subjects diagnosed as T1DM between 1952 and 1999 before the age of 30 and consulted the diabetes center between 1962 and 1999, the survival status up to 2010 or 20 years of follow-up was investigated. Subjects were divided by the year at diagnosis of T1DM: before 1979 (Group A: n = 359), 1980 to 1989 (Group B: n = 400), and 1990 to 1999 (Group C: n = 295). The mortality (/100,000 person years) and standardized mortality ratio (SMR) were calculated, and the effect of year at diagnosis of T1DM was explored by the Cox proportional hazard model. RESULTS The survival status was confirmed in 90.0%. The mortality rate (95%CI) and age and sex adjusted SMR (95%CI) were 457 (288-627) and 3.0 (1.9-4.2) in Group A, 265 (143-387) and 2.2 (1.2-3.2) in Group B, and 144 (29-259) and 1.6 (0.3-2.9) in Group C, respectively. The cumulative survival rate was significantly different according to the year at diagnosis of T1DM (p = 0.0239). Cox's proportional hazard model revealed that Groups B and C had significantly lower risks of death than Group A after adjustment for gender and age at diagnosis of T1DM (HR 0.48 [95%CI 0.26-0.87] for Group B and HR 0.25 [95%CI 0.09-0.60] for Group C). CONCLUSION This study indicated that vital prognosis is improving according to the year at diagnosis of T1DM and suggested the need of a nationwide survey.
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Affiliation(s)
- Toshika Otani
- Saitama Memorial Hospital, Saitama, Japan; Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Hiroki Yokoyama
- Jiyugaoka Medical Clinic, Internal Medicine, Obihiro, Japan.
| | - Yasuko Uchigata
- Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
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