Diabetology

Clinical impact of sarcopenia and dynapenia on diabetes Abstract Sarcopenia as a progressive and generalized skeletal muscle disorder that is associated with an increased likelihood of adverse outcomes, including falls, fractures, physical disability, and mortality. On the other hand, an age-related decline in muscle strength prior to the reduction of muscle mass, is proposed to be "dynapenia". Sarcopenia and dynapenia have recently been recognized as a diabetic complications in type 2 diabetes. We firstly indicated that sarcopenia was frequently observed in 16.6% of patients with type 1 diabetes aged even over 40 years. Additionally, we recently reported that the prevalence rate of dynapenia was higher than sarcopenia in patients with type 2 diabetes. Chronic hyperglycemia accelerates accumulation of advanced glycation end products (AGEs), which causes diabetic vascular complications through oxidative stress and chronic inflammation. We also demonstrated that skin autofluorescence (AF) as a marker of AGEs, was the independent determinant for skeletal muscle mass and strength in patients with type 2 diabetes and muscle strength in type 1 diabetes. Therefore, the early diagnosis of muscle weakness is essential for patients with diabetes and sustained good glycemic control with exercise and dietary intervention might be beneficial to prevent the progression of muscle weakness in these patients.

Proposal of classification of "chronic kidney disease (CKD) with diabetes" in clinical setting Abstract The natural history of typical and classical "diabetic nephropathy" has been described as high levels of albuminuria and subsequent renal function decline. However, recent decades, the cases, who show the reduced glomerular filtration rate (GFR) without the progression of albuminuria, has been increased. "Diabetic kidney disease (DKD)" is a concept that widely recognizes the pathophysiological change induced by diabetes as the onset and progressive factor of renal injury and renal function decline, regardless of the level of albuminuria. However, we may confuse that "chronic kidney disease (CKD) with diabetes" is "DKD". Therefore, to choose the appropriate treatment that should be prioritized in the clinical setting, we propose that "CKD with diabetes" is classified as "DKD", "non-DKD (NDKD) with diabetes" or "combined disease of DKD and NDKD".

Clinical characteristics of Japanese diabetic patients with critical limb ischemia presenting Fontaine stage IV Abstract The aim of the current study was to reveal the clinical characteristics of Japanese diabetic patients with critical limb ischemia (CLI) presenting ischemic unhealed ulcer/gangrene (Fontaine stage IV) in the real-world settings. The current retrospective cross-sectional study included consecutive 282 Japanese diabetic patients who underwent endovascular therapy for CLI presenting Fontaine stage IV. The prevalence of diabetes-related complications was estimated adopting multiple imputation (50 times). The patients were aged 70 ± 10 years. Median duration of diabetes was 21 (interquartile range 12–31) years. The prevalence of proliferative diabetic retinopathy, end-stage renal disease on regular dialysis, stroke, coronary artery disease, and chronic heart failure was estimated at 48% (95% confidence interval 39–56%), 52% (46–58%), 34% (28–39%), 48% (42–54%), and 35% (29–41%), respectively. The prevalence of stroke, coronary artery disease, and chronic heart failure was not significantly associated with the duration of diabetes (all p > 0.05). On the other hand, the prevalence of proliferative diabetic retinopathy and end-stage renal disease on regular dialysis was significantly positively associated with the duration of diabetes (both p < 0.05). However, these prevalences reached as high as ~ 30% even in patients with duration of diabetes < 10 years. In conclusion, the advanced stage of diabetes-related complications was prevalent in patients with CLI presenting Fontaine stage IV.

Self-management behavior concerning physical activity of Japanese type 2 diabetes patients, characterized by sex, daily energy intake and body mass index Abstract Objectives We assess differences in physical activity self-management behavior in association with dietary intake and BMI between the sexes in patients with type 2 diabetes. Methods Patients with type 2 diabetes (n = 145) completed a self-administrated questionnaire. Patients were classified into four groups by BMI and dietary intake: non-obesity and non-overeating (NO/NOE); non-obesity and overeating (NO/OE); obesity and non-overeating (O/NOE); obesity and overeating (O/OE). Differences in physical activity self-management behavior between the four groups were determined by the analysis of variance using a Tukey–Kramer post hoc test. Results Male O/OE group showed higher HbA1c (p = 0.001) than the other groups. Male NO/OE group had higher steps/day than O/NOE (p = 0.036) and score of "Exercising to stimulate the enjoyment of eating" was higher than O/OE (p = 0.031). Female NO/OE group showed higher HbA1c (p = 0.001) than NO/NOE and O/NOE. Conclusions BMI and dietary intake were associated with frequencies of physical activity self-management strategies in men. Self-management behavior peculiar to male NO/OE group is "Exercising to stimulate the enjoyment of eating". Health professionals should assess sex, BMI, and dietary intake of patients and endeavor to improve individuals' ability to regulate their caloric balance based on physical activity level.

The association between glycemic control and lung function impairment in individuals with diabetes: the Saku study Abstract Aim Though diabetes is a risk factor for lung function impairment, whether the glycemic control level affects lung function in individuals with diabetes remains unclear. The present study aimed to assess the association between glycemic control level and restrictive or obstructive lung function impairment in individuals with diabetes. Methods This cross-sectional study included 1028 individuals with diabetes, aged 40–69 years, who underwent a medical checkup between April 2008 and March 2014. Hemoglobin A1c (HbA1c) was categorized as  < 6.9%, 7.0–7.9%, and  ≥ 8.0%. Restrictive and obstructive lung function impairment was defined by a forced vital capacity (FVC) < 80% predicted and a forced expiratory volume in 1 s to FVC ratio < 0.70. Results Of the participants, 8.7% and 6.3% were classified as having restrictive and obstructive lung function impairment, respectively. The multivariable-adjusted odds ratios and 95% confidence intervals for restrictive lung function impairment were 1.43 (0.84–2.42) in individuals with HbA1c 7.0–7.9%, and 2.42 (1.38–4.26) in individuals with HbA1c ≥ 8.0%, compared with those who had HbA1c < 6.9% (p for trend = 0.002). In contrast, glycemic control level was not associated with obstructive lung function impairment (p for trend = 0.749). Conclusions Poor glycemic control was associated with restrictive lung function impairment in individuals with diabetes. Good glycemic control would be important to minimize restrictive lung function impairment in individuals with diabetes.

Evaluation of the Diabetes Regional Coordination Path using the Diabetes Coordination Notebook in community-based diabetes care Abstract Aims A number of epidemiologic surveys have demonstrated that improving lifestyle habits, providing patient education, and regular screening of patients for early diabetic symptoms and complications through multidisciplinary collaboration are crucial for the management of diabetes. Methods To evaluate the Diabetes Coordination Notebook and the Diabetes Regional Coordination Path in management of diabetes, 217 community pharmacies conducted a survey by questionnaire in Gifu Prefecture, Japan. Results A reply to the questionnaire was obtained from 27,016 individuals, of whom 5,572 claimed to have diabetes or prediabetes. The rate of usage of the Diabetes Coordination Notebook and the Diabetes Regional Coordination Path was 40% and 7%, respectively. Interestingly, patients using the Diabetes Regional Coordination Path more frequently visited an ophthalmic clinic (p < 0.001) and a dental clinic (p < 0.05) than those not using it. Furthermore, multivariate logistic regression analysis revealed that use of the Diabetes Regional Coordination Path was the only factor associated with control of HbA1c < 7.0% (OR: 0.613, 95% CI: 0.395–0.951, p = 0.029). Conclusions The usage of the Diabetes Regional Coordination Path together with the Diabetes Coordination Notebook is associated not only with regular visits to both an ophthalmic clinic and a dental clinic but also with the maintenance of appropriate HbA1c.

Trends in the prevalence of type 2 diabetes and prediabetes in a Japanese community, 1988–2012: the Hisayama Study Abstract Objective We estimated secular trends in the prevalence of type 2 diabetes (T2DM) and prediabetes, and examined potential explanatory factors for these trends in a Japanese community. Methods 4 cross-sectional examinations were conducted among subjects aged 40–79 years in 1988 (n = 2,490), 2002 (n = 2,856), 2007 (n = 2,761), and 2012 (n = 2,644). Glucose tolerance status was defined by a 75g oral glucose tolerance test. Results The age-standardized prevalence of T2DM increased significantly in both sexes from 1988 to 2002, and thereafter it remained stable in men, and decreased nonsignificantly in women from 2002 to 2012. The age-standardized prevalence of prediabetes in men increased significantly between 1988 and 2002, but then decreased significantly. A similar trend was observed in women. The age-specific prevalence of T2DM increased greatly in men aged 60–79 years and women aged 70–79 years from 1988 to 2002, and then plateaued at a high level, while a significant decreasing trend was observed in women aged 40–49 years. The mean values of body mass index (BMI) increased steeply in these elderly subjects from 1988 to 2002, and remained at a high level, whereas those in middle-aged women decreased appreciably over the study period. Conclusions Our findings suggest that in Japanese, there was no further increase in the prevalence of T2DM or prediabetes in either men or women in the 2000s. Secular change in the BMI level was likely to contribute to trends in the prevalence of T2DM, and thus the management of obesity may be important to reduce the prevalence of T2DM.

Small-intestinal necrosis due to non-occlusive mesenteric ischemia with diabetic ketoacidosis after quetiapine treatment Abstract We report a 66-year-old male who developed diabetic ketoacidosis (DKA) and necrosis of the small intestine due to non-occlusive mesenteric ischemia (NOMI), 3 months after starting quetiapine treatment. He was transferred to our hospital and diagnosed as diabetic for the first time, associated with DKA. Despite improvement in DKA, abdominal pain worsened gradually 10 h after hospitalization. Computed tomography (CT) revealed bowel emphysema, and gas out of the gut wall, in the mesenteric veins and the intrahepatic portal vein, suggesting intestinal necrosis. He survived because of resection of necrotic small-intestinal tissue and he finally required no diabetes treatment. Mesenteric arteries were patent with good palpitation without occlusion or thrombosis, and pathological findings showed ischemic enteritis, which is consistent with NOMI. DKA is a rare but serious side effect of second-generation antipsychotic medications (SGAMs) such as quetiapine, which can result in NOMI: a life-threatening complication. We must keep in mind that the plasma glucose concentration may increase in patients taking SGAMs, or that NOMI may occur concurrently if DKA develops.

Diabetes care providers' manual for disaster diabetes care Abstract To ensure that experiences and lessons learned from the unprecedented 2011 Great East Japan Earthquake are used to improve future disaster planning, the Japan Diabetes Society (JDS) launched the "Research and Survey Committee for Establishing Disaster Diabetes Care Systems Based on Relevant Findings from the Great East Japan Earthquake" under the supervision of the Chairman of the JDS. The Committee conducted a questionnaire survey among patients with diabetes, physicians, disaster medical assistance teams (DMATs), nurses, pharmacists, and nutritionists in disaster areas about the events they saw happening, the situations they found difficult to handle, and the needs that they felt required to be met during the 2011 Great East Japan Earthquake. A total of 3,481 completed questionnaires were received. Based on these and other experiences and lessons reported following the 2011 Great East Japan Earthquake and the 2004 Niigata-Chuetsu Earthquakes, the current "Manual for Disaster Diabetes Care" has been developed by the members of the Committee and other invited authors from relevant specialties. To our knowledge, the current Manual is the world's first to focus on emergency diabetes care, with this digest English version translated from the Japanese original. It is sincerely hoped that patients with diabetes and healthcare providers around the world will find this manual helpful in promoting disaster preparedness and implementing disaster relief.

Low muscle mass and inflammation among patients with type 2 diabetes mellitus in Indonesia Abstract Introduction Chronic inflammation, as observed in type 2 diabetes mellitus (T2DM), is associated with complications. How chronic inflammation influences body composition in patients with T2DM remains to be investigated. Our study aimed to evaluate the difference of skeletal muscle mass between patients with and without inflammation indicated by plasma high sensitivity C-reactive protein (hs-CRP). Methods Patients with T2DM were recruited from primary health care in Sleman district, Indonesia. Measurements were performed to obtain information on body weight, body mass index, waist circumference, waist-to-height ratio, total body fat, subcutaneous fat, visceral fat, mid-upper arm circumference, and muscle mass. Spearman's rank correlation was performed to test the correlation between hs-CRP level and several components of body composition. To test the difference of percent skeletal muscle mass between subjects with and without inflammation (hs-CRP ≥ 3 or < 3 mg/dL), general linear model was utilized with adjustment for several variables. Analysis with p value of less than 0.05 is considered statistically significant. Result In all subjects, hs-CRP is correlated with skeletal muscle mass (r: − 0.343; p = 0.04), total body fat (r: 0.353; p = 0.04), and subcutaneous fat (r: 0.369; p = 0.02) but not visceral fat (p: − 0.065; p = ns). Significant difference of skeletal muscle mass between subjects with and without inflammation was found in all and female subjects after adjustment for covariates. Conclusion There was a negative correlation between skeletal muscle mass percentage and inflammation indicated by hs-CRP in type 2 diabetes patients.

Alexandros Sfakianakis
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