Article: Short duration of diabetes and disuse of sulfonylurea have any association with insulin cessation of the patients with type 2 diabetes in a clinical setting in Japan (JDDM 30).[show abstract] [hide abstract]
ABSTRACT: Insulin therapy is often required to achieve good glycemic control for the patients with type 2 diabetes mellitus (T2DM), while protraction of glycemic control without insulin therapy may be preferable for patients. To determine the characteristics of and therapeutic regimen in outpatients with T2DM who were able to stop insulin therapy with satisfactory glycemic control in a real clinical practice setting in Japan by a case-control study. The present study was performed on 928 patients with T2DM who started insulin therapy in 2007. Data regarding age, sex, body mass index, duration of diabetes, HbA1c, postprandial plasma glucose, plasma fasting C-peptide immunoreactivity and treatment modality were compared between patients who were able to stop insulin therapy and those who continued with insulin. Of the 928 patients, 37 had stopped insulin therapy within 1 year. In the patients who stopped insulin therapy, the duration of diabetes was significantly shorter and the daily insulin dosage at initiation and the prevalence of sulfonylurea pretreatment significantly lower compared with patients who continued on insulin. In conclusion, almost 4% of T2DM patients were able to stop insulin therapy with satisfactory glycemic control in a real clinical practice setting in Japan. Shorter duration of diabetes and disuse of sulfonylureas prior to insulin may associate with stopping insulin therapy as a near-normoglycemic remission in outpatients with T2DM in Japan.Endocrine Journal 11/2012; · 2.03 Impact Factor
Article: Multifaceted intervention to promote the regular visiting of patients with diabetes to primary care physicians: rationale, design and conduct of a cluster-randomized controlled trial. The Japan Diabetes Outcome Intervention Trial-2 study protocolKazuo Izumi, Yasuaki Hayashino, Katsuya Yamazaki, Hikari Suzuki, Naoki Ishizuka, Masashi Kobayashi, Mitsuhiko Noda, The Study Group[show abstract] [hide abstract]
ABSTRACT: BackgroundRegular clinic visits are essential for keeping diabetes well controlled. Nevertheless, about half of the known diabetic patients do not receive regular medical care, as estimated by the National Survey in Japan. From the viewpoint of medical resources, primary care physicians (PCPs) should provide regular medical care to the many diabetic patients in Japan. Therefore, maintaining regular care and improving care quality are expected for diabetes treatment at the PCP level. Methods/designThe Japan Diabetes Outcome Intervention Trial-2 (J-DOIT2) is a cluster-randomized two-armed intervention study. Fifteen district medical associations (DMAs) and 300 PCPs will participate. The PCPs in each DMA will be divided into two groups and randomized, with each group acting as a cluster within the DMA. Then, 3,750 type 2 diabetes patients (aged 40–64years) will be recruited. In the intervention group, patients will receive reminders for medical visits to their PCP and lifestyle advice over the telephone or face to face. The PCPs will be provided with benchmark indicators of his/her own diabetes treatment activities. In the control group, the PCPs will provide ordinary medical treatment to his/her patients. With a 1-year intervention and follow-up period, the primary outcome will be the rate of patient dropout from regular medical care of both groups. The quality of diabetes treatment provided by the PCPs will also be evaluated. DiscussionThe J-DOIT2 is a large-scale trial for improvement of diabetes care in an ordinary primary care setting and is expected to contribute to establishing widely adoptable countermeasures for diabetes. KeywordsDiabetes–Dropout–Regular medical care–Primary care physician–Quality of diabetes care05/2012; 1(2):83-89.
Article: Telmisartan improves insulin resistance and modulates adipose tissue macrophage polarization in high-fat-fed mice.Shiho Fujisaka, Isao Usui, Yukiko Kanatani, Masashi Ikutani, Ichiro Takasaki, Koichi Tsuneyama, Yoshiaki Tabuchi, Agussalim Bukhari, Yu Yamazaki, Hikari Suzuki, Satoko Senda, Aminuddin Aminuddin, Yoshinori Nagai, Kiyoshi Takatsu, Masashi Kobayashi, Kazuyuki Tobe[show abstract] [hide abstract]
ABSTRACT: Diet-induced obesity is reported to induce a phenotypic switch in adipose tissue macrophages from an antiinflammatory M2 state to a proinflammatory M1 state. Telmisartan, an angiotensin II type 1 receptor blocker and a peroxisome proliferator-activated receptor-γ agonist, reportedly has more beneficial effects on insulin sensitivity than other angiotensin II type 1 receptor blockers. In this study, we studied the effects of telmisartan on the adipose tissue macrophage phenotype in high-fat-fed mice. Telmisartan was administered for 5 wk to high-fat-fed C57BL/6 mice. Insulin sensitivity, macrophage infiltration, and the gene expressions of M1 and M2 markers in visceral adipose tissues were then examined. An insulin- or a glucose-tolerance test showed that telmisartan treatment improved insulin resistance, decreasing the body weight gain, visceral fat weight, and adipocyte size without affecting the amount of energy intake. Telmisartan reduced the mRNA expression of CD11c and TNF-α, M1 macrophage markers, and significantly increased the expressions of M2 markers, such as CD163, CD209, and macrophage galactose N-acetyl-galactosamine specific lectin (Mgl2), in a quantitative RT-PCR analysis. A flow cytometry analysis showed that telmisartan decreased the number of M1 macrophages in visceral adipose tissues. In conclusion, telmisartan improves insulin sensitivity and modulates adipose tissue macrophage polarization to an antiinflammatory M2 state in high-fat-fed mice.Endocrinology 03/2011; 152(5):1789-99. · 4.46 Impact Factor
Article: [JDCP study].Katsuya Yamazaki, Masashi KobayashiNippon rinsho. Japanese journal of clinical medicine 11/2010; 68 Suppl 9:91-6.
Kazuki Nakajima, Katsuhisa Sekine, Katsuya Yamazaki, Atsushi Tampo, Yuuichirou Omote, Hiroshi Fukunaga, Yasuko Yagi, Kyoji Ishizu, Masanori Nakajima, Kazuyuki Tobe, Masashi Kobayashi, Kazuo Sasaki[show abstract] [hide abstract]
ABSTRACT: The aim of this study is to develop a method for measuring the respiratory waveform using non-contact electrodes during bathing. To determine the most appropriate electrode arrangement, we modeled a composite system consisting of a body submerged in bath water. We calculated the frequency dependence of the impedance amplitude using a three-dimensional finite difference method (3D-FDM). The simulation results showed that an increase in chest size due to inspiration caused a decrease in the impedance amplitude in the frequency range of 0.1 Hz to 1 MHz. Next, bioelectric impedance (BEI) was measured in the frequency range of 4 kHz to 4 MHz at the maximum-end-expiration and maximum-end-inspiration stages. BEI results were consistent with those obtained from the model simulations. We found that 1 MHz was the appropriate frequency for measuring the respiratory waveform, and the time dependence of the impedance amplitude was measured at 1 MHz. The impedance amplitude agreed well with the respiratory waveform obtained from rubber strain gauge plethysmography, which was used as a reference.Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 01/2010; 2010:911-4.