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We assessed the prescription patterns of oral antidiabetic drugs in Japanese patients with type 2 diabetes between 2002 and 2020 using data from the Computerized Diabetes Care database. Among 172,960 patients treated with oral antidiabetic drugs, both the sulfonylurea prescription rate and dose decreased from 2002 to 2020. Prescriptions of biguanides, dipeptidyl peptidase-4 inhibitors and sodium-glucose cotransporter 2 inhibitors increased; their dose and dose frequency remained relatively stable. Trends in oral antidiabetic drug prescriptions changed over time, reflecting guideline recommendations and existing evidence.

Aims Workplace demands, support, and relationships differ according to employment status (e.g., employment that is full-time, part-time, or self-employed) and may lead to unequal opportunities to keep diabetic appointments. We investigated the association between employment status and outpatient diabetic appointment non-attendance among working-age adults with type 2 diabetes. Methods This was a secondary analysis of a cluster-randomized trial (the Japan diabetes outcome intervention trial 2 large-scale trial). The analysis included 2010 trial participants (40–65 years old) with type 2 diabetes who were regularly followed by primary care physicians (PCPs). The outcome measure was the first non-attendance (defined as a failure to visit a PCP within 2 months of the original appointment) during the one-year follow-up. The association between baseline employment status and non-attendance was examined using Cox proportional hazard model in men and women. Results During the 1279 and 789 person-year follow-up periods, 90 men and 34 women, respectively, experienced their first appointment non-attendance. Among men, self-employed participants had a higher risk of non-attendance compared with full-time employees (adjusted HR, 1.84; 95% CI, 1.15, 2.95). The trial intervention (attendance promotion) was associated with a significantly reduced risk of non-attendance among self-employed participants (HR, 0.51; 95% CI, 0.26, 0.99). Among women, a significant association between employment status and non-attendance was not observed. Conclusions Self-employed men with type 2 diabetes had a twofold increased risk of non-attendance than did full-time employees. Our study suggests that self-employed men with type 2 diabetes should be targeted for interventions promoting appointment adherence.

AIMS: Continuity of diabetes care is relevant among elderly patients. The aim of this study is to investigate the impact of clinical characteristics on continuing outpatient visits to a specialized diabetes clinic in elderly Japanese patients with diabetes. METHODS: We included outpatients with type 2 diabetes aged ≥ 65 years who first visited our clinic from 2006 to 2009. The information of patients’ characteristics was obtained through medical record review from the CoDiC database. We have tracked whether the patients continued to visit the clinic until May 31, 2019. A Cox proportional hazards regression model identified variables related to withdrawal. RESULTS: Among 128 patients, 63 patients (49.2%) were withdrawn during the follow-up periods. The average visit duration of withdrawals was 4.6 (range 1, 10) years. The patients who discontinued to visit were older (72.6 vs. 69.5 years old, p = 0.005) compared with those who continued to visit. No significant differences in clinical conditions such as complication of diabetes, Charlson Comorbidity Index and polypharmacy between the first and last visit were observed in each group. Age (≥ 75 years) was significantly associated with withdrawal (hazard ratio 2.72 [95% confidence interval 1.59, 4.63], p

Few studies have investigated the renoprotective effect of glucagon-like peptide-1 (GLP-1) receptor in patients with chronic kidney disease (CKD). This study evaluated the effect of dulaglutide 0.75 mg on renal function in Japanese patients with type 2 diabetes and CKD stage 3 to 4.Dulaglutide (group A) and non-dulaglutide (group B) were compared using data collected from a computerized diabetes care database. For group B, propensity score weighting based on propensity scores was performed. Evaluation items were a change from baseline in hemoglobin A1c (HbA1c), body weight, urine albumin-to-creatinine ratio (UACR), and estimated glomerular filtration rate (eGFR), for 3 years.In total, the data obtained from 255 patients (125 and 130 patients for group A and B, respectively) were analyzed. Propensity score-adjusted patient background characteristics (group A vs B) were age 70.8 vs 69.4 years, body weight 70.2 vs 72.9 kg, body mass index 27.3 vs 28.1 kg/mDulaglutide slowed the eGFR decline in patients with type 2 diabetes and CKD stage 3 to 4.

OBJECTIVE Nonalbuminuric diabetic kidney disease (DKD) has become the prevailing phenotype in patients with type 2 diabetes. However, it remains unclear whether its prognosis is poorer than that of other DKD phenotypes. RESEARCH DESIGN AND METHODS A total of 2,953 Japanese patients with type 2 diabetes and estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m2, enrolled in an observational cohort study in 2004, were followed until 2015. On the basis of albuminuria (>30 mg/g creatinine) and reduced eGFR ( RESULTS During the mean follow-up of 9.7 years, 113 patients died and 263 developed CVD. In nonalbuminuric DKD, the risks of death or CVD were not higher than those in no-DKD (adjusted hazard ratio 1.02 [95% CI 0.66, 1.60]) and the annual decline in eGFR was slower than in other DKD phenotypes. The risks of death or CVD in nonalbuminuric DKD without prior CVD were similar to those in no-DKD without prior CVD, whereas the risks in nonalbuminuric DKD with prior CVD as well as other DKD phenotypes were higher. CONCLUSIONS Nonalbuminuric DKD did not have a higher risk of mortality, CVD events, or renal function decline than the other DKD phenotypes. In nonalbuminuric DKD, the presence of macrovascular complications may be a main determinant of prognosis rather than the renal phenotype.

This study explored the psychological and situational factors affecting dropout from regular visits to diabetes care using data obtained from the Japan Diabetes Outcome Intervention Trial 2 (J-DOIT2) Large-scale Trial (LT).A total of 2,031 patients with type 2 diabetes who participated in the J-DOIT2-LT were included in the analysis. Responses to a baseline questionnaire with 17 items asking about the experience of dropout from regular visits in diabetes care and its reasons were analyzed using principal component analysis, and factors related to dropout were extracted. Using Cox regression analysis, the association of these factors with the incidence of dropout was investigated.The mean age of the 2,031 patients was 56.4 ± 5.9 years and 742 (36.5%) were women. They were followed for a median of 392 days, and 125 patients dropped out from regular visits during the follow-up period. In the principal component analysis of the questionnaire, there were four latent factors with eigenvalues of1.0, which were labeled as "negative perceptions for regular visits," "social pressure," "lack of perceived necessity," and "environmental obstacles" based on the retained items. The Cox regression analysis demonstrated that patients with high scores of "lack of perceived necessity" and "environmental obstacles" had a significantly increased risk of dropout from regular visits.The present study revealed psychological and situational factors related to dropout, which may be useful for detecting patients at high risk of dropout. Effective measures focusing on such patients to prevent dropouts should be investigated in future studies (The trial registration number: UMIN000002186, registered at the University Hospital Medical Information Network-Clinical Trials Registry).

IntroductionWe investigated trends in the proportion of diabetes treatment and glycemic control, which may be altered by recent advances in insulin and non-insulin drugs, in Japanese patients with type 2 diabetes.Research design and methodsA serial cross-sectional study was performed using a multicenter large-population database from the Japan Diabetes Clinical Data Management study group. Patients with type 2 diabetes who attended clinics belonging to the study group between 2002 and 2018 were included to examine trends in glycated hemoglobin A1c (HbA1c) by treatment group using multivariable non-linear regression model.ResultsThe proportion of patients with insulin only decreased from 15.0% to 3.6%, patients with insulin+non-insulin drugs increased from 8.1% to 15.1%, patients with non-insulin drugs increased from 50.8% to 67.0%, and those with no drugs decreased from 26.1% to 14.4% from 2002 to 2018, respectively. The HbA1c levels of each group, except for no drugs, continued to decrease until 2014 (unadjusted mean HbA1c (%) from 2002 to 2014: from 7.89 to 7.45 for insulin only, from 8.09 to 7.63 for insulin+non-insulin, and from 7.51 to 6.98 for non-insulin) and remained unchanged thereafter. Among insulin-treated patients, use of human insulin decreased, use of long-acting analog insulin increased, and concomitant use of non-insulin drugs increased (from 35.1% in 2002 to 80.9% in 2018), which included increased use of dipeptidyl peptidase 4 inhibitors, sodium-glucose cotransporter 2 inhibitors, and glucagon-like peptide 1 receptor agonists, and the persistently high use of metformin.ConclusionsDuring the past two decades, combined use of insulin and non-insulin drugs increased and glycemic control improved and leveled off after 2014 in Japanese patients with type 2 diabetes. Further studies of the trend in association with age and factors related to metabolic syndrome are necessary to investigate strategies aiming at personalized medicine in diabetes care.

In the analysis of the anisotropy of the galactic cosmic rays caused by the solar modulation below 1 TeV, time series graphs with time on the horizontal axis and cosmic ray intensity as the vertical axis had been widely adopted and other style of the graphs called harmonic vector diagrams had also been used. These methods are the time series analyses, and because of the horizontal axis (time), the graph is often misinterpreted as a “temporal variation,” even though it must be regarded as an intrinsically “spatial distribution.” This paper presents a high-resolution two-dimensional map of the solar time anisotropy using the GRAPES-3 large-area muon telescope at Ooty, south India, which has an excellent capability of observing the muon intensity in 169 directions within a 50 degree zenith angle.

Signs of anisotropy of the ultra-high-energy cosmic ray (UHECR) arrival direction have been reported by The Telescope Array and The Pierre Auger Observatory. Then, it is expected that source of UHECRs will be clarified. However, because of the quite low flux of UHECR, it is inevitable to extend observatory to much larger than existing ones. Cosmic Ray Fluorescence Fresnel lens Telescope (CRAFFT) project has been developed a low cost fluorescence detector to realize the huge observatory for UHECR observation. CRAFFT project reduced the cost to 1/10 against fluorescence detectors now in use, and succeeded to observe UHECR air showers by the prototype of CRAFFT telescope. In this presentation, we report the progress of CRAFFT project such as the result of the test observation and data analysis and discuss the future prospect.

AIMS: The current study evaluated patient demographics and clinical characteristics that associated with HbA1c reduction following addition of one oral antidiabetic drug (OAD) to DPP4i monotherapy. METHODS: A retrospective study was conducted using CoDiC database. Adult T2DM patients treated with sitagliptin monotherapy for ≥ 6 months and adding one OAD were extracted. Association between patient characteristics at the time of add-on OAD and following HbA1c reduction was assessed. RESULTS: Of 444 included patients, mean age was 62 years and 33% were female. All add-on OAD classes demonstrated further HbA1c reduction (p

The Telescope Array (TA) experiment has three fluorescence detector(FD) stations to detect fluorescence emission by extensive air showers induced by Ultra High Energy Cosmic Rays(UHECRs). These fluorescence light is attenuated and lost by aerosols in the atmosphere through the path of propagation to the FD. Calibration of atmospheric attenuation is necessary to estimate the energy of cosmic ray. The Central Laser Facility (CLF) consists of a laser that fires a 355 nm burst vertically with 10 Hz, every half-hour. The Vertical Aerosol Optical Depth(VAOD) which is atmospheric transparency can be measured every 30 minutes by the CLF. Therefore, we can monitor the change of the atmosphere every 30 minutes within the FD observation time. The CLF is located at the center of three FD stations and observes the atmospheric transparency of the TA site. We report the results of atmospheric transparency at the TA site.

It is expected that a large amount of data related to diabetes and other chronic diseases will be generated. However, databases constructed without standardized data item sets can be limited in their usefulness. To address this, the Collaborative Committee of Clinical Informatization in Diabetes Mellitus was established in 2011 by the Japan Diabetes Society and Japan Association for Medical Informatics. The committee has developed core item sets and self-management item sets for diabetes mellitus, hypertension, dyslipidemia, and chronic kidney disease in collaboration with the Japanese Society of Hypertension, Japan Atherosclerosis Society, Japanese Society of Nephrology, and Japanese Society of Laboratory Medicine, as well as a mapping table that aligns the self-management item sets with the Japanese standardized codes for laboratory testing. The committee also determined detailed specifications for implementing the four self-management item sets in personal health record applications to facilitate risk stratification, the generation of alerts using information and communications technology systems, the avoidance of data input errors, and the generation of reminders to input the self-management item set data. The approach developed by the committee may be useful for combining databases for various purposes (such as for clinical studies, patient education, and electronic medical record systems) and for facilitating collaboration between personal health record administrators. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s13340-019-00389-7) contains supplementary material, which is available to authorized users.

Introduction The combined effects of energy intake (EI) and physical activity (PA) on obesity have been poorly investigated. We have investigated the combined effects of EI and PA quantitatively in Japanese men and women with type 2 diabetes. Methods Data on 1395 patients with type 2 diabetes who attended 25 diabetes clinics located throughout Japan, obtained by questionnaire, were analyzed. A logistic regression model was used to calculate the odds ratio for obesity. Results Multi-adjusted odds ratios for the top versus the bottom tertile of EI and the bottom versus the top tertile of PA were 1.39 (95% confidence interval [CI] 1.02–1.89) and 1.64 (95% CI 1.22–2.22), respectively. The combination of EI (kcal/day) ≥ 1967 and PA (metabolic equivalents [METs] h/week) ≤ 9.9 for men and of EI ≥ 1815 and PA ≤ 8.3 for women were significantly associated with obesity. Conclusions The existence of “allowable maximum EI” and “required minimum PA” that is significantly associated with “not being obese” is implied, suggesting the need for lifestyle education for Japanese patients with type 2 diabetes. Electronic Supplementary Material The online version of this article (10.1007/s13300-019-0610-x) contains supplementary material, which is available to authorized users.

Aims/Introduction:Type 2 diabetes mellitus is caused by a relative imbalance between insulin secretion and sensitivity related to the body mass index (BMI). Seven categories of oral antidiabetic drugs (OADs) are available in Japan. It is important to assess the OAD utilization patterns based on patients’ BMI levels., Materials and methods:OAD prescribing patterns from 2002 to 2019 were analyzed using the data collected in the computerized diabetes care database provided by the Japan Diabetes Clinical Data Management Study Group; OAD utilization patterns in 25,751 OAD-treated type 2 diabetes mellitus patients registered in 2019 were analyzed after classifying them into five categories of BMI., Results:Comparing OAD usage between 2002 and 2019, sulfonylureas decreased from 44.5 to 23.2%, and biguanides (BGs) increased from 19.3 to 50.3%. Dipeptidyl peptidase-4 inhibitors (DPP4is) increased to 56.9% in 2019. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) increased to 23.6% in 2019. About 90% of type 2 diabetes mellitus patients had BMI < 30 kg/m2 . DPP4is were the most used OADs in 2019. When BMI exceeded 30 kg/m2 , use of BGs and sodium-glucose cotransporter 2 inhibitors increased, and use of sulfonylureas and DPP4is decreased. Although DPP4is were the most used OADs for patients with BMI 35 kg/m2 after BGs and sodium-glucose cotransporter 2 inhibitors ., Conclusions:DPP4i usage was as high as that of BG in the analysis of Japanese type 2 diabetes mellitus patients with relatively low BMI. This was considered to be a treatment option appropriate for the pathophysiology in Japanese patients.

We aimed to assess whether a triple-faceted intervention program administered in the primary care setting could decrease the risk of insufficient adherence to primary care physician (PCP) appointments among this patient population. We conducted a cluster-randomized controlled study to assess the effects of a 1-year intervention. The primary outcome was insufficient adherence to regular PCP attendance for diabetes treatment, defined as failure to visit a PCP within 2 months of an original appointment date. The intervention consisted of mailing patient reminders of their PCP appointments, providing patients with health education aimed at lifestyle modification and benchmarking PCP procedures. Eleven municipal level district medical associations employing 192 PCPs were divided into two subregions for assignment to intervention and control clusters, with 971 and 1,265 patients assigned to the intervention and control groups, respectively. Primary outcome data were available for 2,200 patients. The intervention reduced insufficient adherence to regular PCP appointments by 63% (hazard ratio, 0.37; 95% confidence interval [CI], 0.23–0.58). In conclusion, a triple-faceted intervention program consisting of health education, appointment reminders, and physician benchmarking may decrease the risk of incomplete adherence to regular PCP appointments by diabetes patients.

We aimed to assess whether a triple-faceted intervention program administered in the primary care setting could decrease the risk of insufficient adherence to primary care physician (PCP) appointments among this patient population. We conducted a cluster-randomized controlled study to assess the effects of a 1-year intervention. The primary outcome was insufficient adherence to regular PCP attendance for diabetes treatment, defined as failure to visit a PCP within 2 months of an original appointment date. The intervention consisted of mailing patient reminders of their PCP appointments, providing patients with health education aimed at lifestyle modification and benchmarking PCP procedures. Eleven municipal level district medical associations employing 192 PCPs were divided into two subregions for assignment to intervention and control clusters, with 971 and 1,265 patients assigned to the intervention and control groups, respectively. Primary outcome data were available for 2,200 patients. The intervention reduced insufficient adherence to regular PCP appointments by 63% (hazard ratio, 0.37; 95% confidence interval [CI], 0.23–0.58). In conclusion, a triple-faceted intervention program consisting of health education, appointment reminders, and physician benchmarking may decrease the risk of incomplete adherence to regular PCP appointments by diabetes patients.

Recent observations by TA and Auger have advanced our understanding of ultra-high energy cosmic rays, but their origin is still unclear. As a future approach, it will be effective to obtain the directional energy spectra and compositional distributions by observing even larger statistics, and there are active discussions on future large-scale experiments. In order to realize such a huge observation area, the Cosmic Ray Air Fluorescence Fresnel lens Telescope (CRAFFT) project has started to develop a cost-effective fluorescence telescope with Fresnel lenses. We have succeeded in observing cosmic ray induced air showers by simultaneous observations with TA using prototype telescope. We are currently working on the development of an event reconstruction method using waveforms, optimization of the focal plane, development of a calibration system, and development of an autonomous observation system for future large-scale deployment. The current status and future prospects of the CRAFFT project are discussed.

The next generation ultra-high energy cosmic ray (UHECR) observatory should be expanded due to the very small flux. In order to realize a huge UHECR observatory, cost reduction of detectors is one of the useful strategy. Then we are developing a Cosmic Ray Air Fluorescence Fresnel lens Telescope (CRAFFT) which is a very simple structure fluorescence detector. CRAFFT detector consists of mainly a $1.4 {\rm m^2}$ Fresnel lens, an UV transmitting filter, an 8 inch photomultiplier tube, an FADC board, and power supply system. We tested CRAFFT detector performance at Telescope Array (TA) site, and succeeded to detect UHECR air showers synchronized with TA Fluorescence Detectors. CRAFFT detector will be deployed as a huge ground array with ∼ 20 km spacing without the enough infrastructure such as in desert. Therefore, CRAFFT detectors can stand alone. We are developing automatic observation and protecting detector system. Additionally, we are studying our detector performance by detector simulation to estimate trigger efficiency, establish a reconstruction procedure, and optimize our detector configuration. In this presentation, we will report the result of the test operation of automatic observation and protecting detector system for CRAFFT detector, and the detector performance and optimization.

The Telescope Array (TA) is the world-largest cosmic ray detectors in the northern hemisphere, with fluorescence detectors (FDs) and a surface detector (SD) array. We have developed a cloud monitoring system for the TA sky to monitor weather condition during FD observation periods. We use a CCD camera with a fisheye lens to evaluate cloud coverages by identifying stars in the TA sky and comparing with a star catalogue. We will report the hardware of the monitoring system and details of the data analysis.

In the future, ultra-high energy cosmic ray (UHECR) observatory will be expanded due to the small flux. Then, cost reduction is useful strategy to realize a huge scale observatory. For this purpose, we are developing a simple structure cosmic ray detector named as Cosmic Ray Air Fluorescence Fresnel-lens Telescope (CRAFFT). We deployed CRAFFT detectors at the Telescope Array site and performed a test observation. We have successfully observed UHECR air showers. We will report the status and the result of the test observation.

We report on a measurement of the cosmic ray composition by the Telescope Array Low-Energy Extension (TALE) air fluorescence detector (FD). By making use of the Cherenkov light signal in addition to air fluorescence light from cosmic ray (CR) induced extensive air showers, the TALE FD can measure the properties of the cosmic rays with energies as low as $\sim 2$ PeV and exceeding 1 EeV. In this paper, we present results on the measurement of $X_{\rm max}$ distributions of showers observed over this energy range. Data collected over a period of $\sim 4$ years was analyzed for this study. The resulting $X_{\rm max}$ distributions are compared to the Monte Carlo (MC) simulated data distributions for primary cosmic rays with varying composition and a 4-component fit is performed. The comparison and fit are performed for energy bins, of width 0.1 or 0.2 in $\log_{10} (E/{\rm eV})$, spanning the full range of the measured energies. We also examine the mean $X_{\rm max}$ value as a function of energy for cosmic rays with energies greater than $10^{15.8}$ eV. Below $10^{17.3}$ eV, the slope of the mean $X_{\rm max}$ as a function of energy (the elongation rate) for the data is significantly smaller than that of all elements in the models, indicating that the composition is becoming heavier with energy in this energy range. This is consistent with a rigidity-dependent cutoff of events from galactic sources. Finally, an increase in the $X_{\rm max}$ elongation rate is observed at energies just above $10^{17}$ eV indicating another change in the cosmic rays composition., 20 pages, 22 figures, accepted for publication in ApJ

A key to understand the origin of the Ultra High Energy Cosmic Ray (UHECR) is higher statistics with the composition information. One of the concepts to realize the future huge observation is an array of simple and low cost fluorescence telescopes. The fluorescence telescope can measure not only the arrival direction and energy spectrum but also the mass composition which is the important information to understand the origin of UHECR. A concept of a simple FD is to reduce the cost by changing from the imaging with multiple PMTs to the time information of a few PMTs, and minimization of the optical system by focusing the high energy events. In order to demonstrate this concept, we are developing Cosmic Ray Air Fluorescence Fresnel lens Telescope (CRAFFT), which further reduces the cost by using Fresnel lens and stand alone system without telescope hut unlike existing fluorescence detector in present UHECR observatory. We have constructed four prototype CRAFFTs and observed air showers by simultaneous observation with Telescope Array. By those study, the cost of a simple FD reaches 1/10 of that of a present FD.

Background: To examine the impact of lifestyle intervention by telephone (TSC) and face-to-face (FFA) according to the stages of lifestyle change (SLC) on the drop-out from regular medical care of diabetes Methods: Secondary analysis was performed on data from the Japan Diabetes Outcome Intervention Trial-2 large trial (J-DOIT2-LT), which was a 1-year, prospective, cluster randomized, intervention trial. 11 district medical associations were divided into two subregions (clusters), in which patients were registered, and then were randomized to an intervention group (TSC or FFA) or control group (CG). Lifestyle advisors reminded patients of medical visits to the primary care physician (PCP) and gave lifestyle advice by TSC or FFA. The CG received usual medical care. The outcome of this analysis was the drop-out rate from regular medical care. We estimated the HR and 95% CI of either TSC or FFA relative to CG according to the SLC (stage 1/2/3/4/5: pre-contemplation/contemplation/preparation/action/maintenance). Results: A total of 2,071 participants (mean age: 57 ± 6 years; 38% female) were studied. 1170, 616, and 285 patients were divided into CG, TSC, and FFA. In the stage 1-3 of diet, TSC (HR:0.47; 95% CI:0.27-0.82) and FFA (HR:0.20; 95% CI:0.07-0.55) were significantly associated with a low risk of the drop-out after adjusting for covariates. The similar association was observed in the stage 1-3 of exercise. In contrast, neither TSC nor FFA reduced the risk for drop-out in the stage 4-5 of diet. TSC (HR:0.12; 95% CI:0.02-0.95) but not FFA (HR:0.37; 95% CI:0.09-1.62) was associated with a low risk for the drop-out in the stage 4-5 of exercise. Conclusions: FFA could be more effective than TSC to reduce the risk for drop-out from regular medical care of diabetes at the stage 1-3. In contrast, TSC may be enough to reduce the risk for the drop-out in the stage 4-5. Disclosure R. Bouchi: None. M. Noda: None. Y. Hayashino: None. K. Yamazaki: None. H. Suzuki: None. A. Goto: None. T.A. Furukawa: None. K. Izumi: None. M. Kobayashi: None.

ObjectiveWe examined changes in prevalence of diabetic microvascular/macrovascular complications and diabetes care indicators for adults in Japan with type 2 and type 1 diabetes over one decade.Research design and methodsTwo independent cohorts were recruited with the same inclusion criteria in 2004 (cohort 1: 3319 with type 2 and 286 with type 1 diabetes) and in 2014 (cohort 2: 3932 with type 2 and 308 with type 1 diabetes). Prevalence of complications and care indicators including achieving treatment targets for glycemia, blood pressure, lipid control, body mass index (BMI), and smoking were compared. In addition, patients in cohort 1 were re-examined in 2014 and their data were compared with the baseline data of each cohort.ResultsIn type 2 diabetes, the prevalence of nephropathy, retinopathy, neuropathy, chronic kidney disease, current smoking and stroke significantly decreased, with improvements in achieving treatment target rates in cohort 2 two as compared with cohort 1. In type 1 diabetes, the prevalence of nephropathy, retinopathy, chronic kidney disease, and hemoglobin A1Cvalues significantly decreased. Decreases in prevalence of microvascular complications in type 2 diabetes were similarly found in each age-matched and sex-matched group, whereas younger patients exhibited marked increase in BMI and lower treatment target achieving rates compared with elderly patients. Regarding normoalbuminuric renal impairment, only a slight increase in the prevalence was observed both in type 2 and type 1 diabetes. In cohort 1, re-examined in 2014, care indicators were significantly improved from 2004, while complications increased with getting 10 years older.ConclusionsWe observed declining trends of diabetic microvascular complications with improvement in diabetes care indicators in type 2 and type 1 diabetes. Younger patients with type 2 diabetes exhibited marked increase in BMI and lower rates of achieving treatment targets compared with elderly patients, which remains a concern.

Aims/Introduction We carried out an observational cohort study to examine the relationship between the efficacy of oral antidiabetic drugs and clinical features in type 2 diabetics. Materials and Methods We analyzed the CoDiC® database of the Japan Diabetes Data Management Study Group across 67 institutions in Japan. In a total of 3,698 drug‐naïve patients who were initiated with metformin, dipeptidyl peptidase‐4 inhibitor (DPP‐4i) or sulfonylurea (SU) from 2007 to 2012, we evaluated body mass index (BMI) and hemoglobin A1c (HbA1c). The patients were stratified according to their clinical features, and matched using a propensity score to adjust for baseline factors. Results HbA1c was reduced with all drugs, with the largest effect elicited by DPP‐4i and the smallest by SU (P = 0.00). HbA1c increased with SU after 6 months in the patients stratified by an age‐of‐onset of 25 (P = 0.00). The reduction in HbA1c was larger in patients with HbA1c of ≥8%, compared with that in patients with HbA1c of

Telescope Array (TA) is an international joint experiment observing ultra-high energy cosmic rays. TA employs the fluorescence detection technique to observe cosmic rays. In this tech- nique, the existence of cloud significantly affects the quality of data. Therefore, cloud monitoring provides important information. We are developing methods for evaluating night sky weather with pictures taken by a charge- coupled device (CCD) camera. We found that there was a change in the brightness of the whole image due to the weather. We tried to judge the weather only by the brightness of the whole image and gained only limited success. On the other hand, it is expected that there will be a correlation between the amount of clouds and the number of stars appearing in the image. We first devised a method to count the number of stars in the image. The stars are clusters of very bright pixels in the image, the method developed focusing on this has worked well. Currently, we are developing evaluation methods to compare detected stars and catalogs.

Supplemental Digital Content is available in the text, Little is known about the relationships between patient factors and the antihyperglycemic agents that have been prescribed as initial therapy by diabetes specialists for patients with type 2 diabetes. Moreover, there has been little clarification of the subsequent usage patterns and related factors that influenced the continuation or discontinuation of the drug or the addition of another drug. To provide information on these issues, we evaluated the clinical characteristics of Japanese patients with type 2 diabetes for whom different types of oral hypoglycemic agents (i.e., either sulfonylureas, biguanides, or DPP-4 inhibitors (DPP-4Is)) were chosen as initial monotherapy by diabetes specialists and evaluated subsequent usage patterns. Prescription data on 3 different antidiabetic agents from December 2009 to March 2015 from diabetes specialists’ patient registries were used to identify variables at baseline related to initial prescriptions; also, the addition of another hypoglycemic drug or discontinuation of the initial therapy was evaluated 1 year after the initial prescription. Analyzed were data on 2666 patients who received initial monotherapy with either a sulfonylurea (305 patients), biguanide (951 patients), or DPP-4I (1410 patients). Patients administered sulfonylureas were older, had a lower body mass index (BMI), longer duration of diabetes, and worse glycemic control than recipients of biguanides. Use of biguanides was related to younger age, short duration of diabetes, and obesity but was negatively associated with poor glycemic control. Older age but neither obesity nor poor glycemic control was associated with DPP-4Is. In all 3 groups a high HbA1c value was related to adding another hypoglycemic agent to the initial therapy. Moreover, adding another drug to a DPP-4I was related to a younger age and higher BMI. Patients’ age, duration of diabetes, obesity, and glycemic control at baseline influenced the choice of hypoglycemic agents. Selection of a biguanide differs greatly from that of a sulfonylurea or DPP-4I with regard to age and obesity.

The Telescope Array (TA) is an international experiment studying ultra-high energy cosmic rays. TA uses the fluorescence detection technique to observe cosmic rays. In order to estimate the energy of cosmic rays with a fluorescence detector (FD), it is necessary to measure the condition of the observation area. Clouds affect the accuracy of the energy estimation. It is necessary to measure the existence of clouds and their direction in the Field Of View (FOV) of the FD. We developed a cloud monitoring system to measure the night sky weather using a CCD camera. In this report, we present our progress on our CCD cloud monitoring system.

Death rate of accidental drowning in the bathtub was the highest among casualties occurring at home, according to the annual report of the Japanese Ministry of Health, Labour and Welfare in 2007. To prevent accidental drowning during bathing at home, we obtained respiratory waveforms from bioelectric impedance (BEI) measurement using non-contact electrodes. The BEI measurement is an involuntary measurement method, from which respiratory waveform during bathing can be extracted. In the present study, to find the most appropriate electrode configuration as well as the optimal measuring frequency, we calculated the frequency dependence of impedance amplitude by numerical technique based on a three-dimensional finite difference method for a composite system consisting of a human body submerged in bath water. The results of model calculation agreed with the experimental results. Next, to obtain respiratory waveforms with large amplitudes, we investigated the optimal frequency experimentally. The frequency of 1MHz was suitable for involuntary measurement of respiratory waveform during bathing.

Regular 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. The 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 40–64 years) 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. The 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.

最近の情報ネットワーク時代の進展を背景に、非公式な組織と個人間の結びつきを元に、大きな社会的流れが生じ、それらが企業再生に結びつき貢献する萌芽が見られている。例えば銚子鉄道における存続が社会的なニュースとなった際には、インターネットにおける公開掲示版や個々人のブログ、あるいはSNS内における議論の活発化により、個々人ができる支援の積み重ねにより、企業側も意図しない大きな動きで資金が集まり、安全更新投資が可能となった。本事例からの示唆として、今後の地方ローカル鉄道は、リアルの乗客に依存するのではなくバーチャルな乗客に依存することで新しい形に再生していくことも望まれること、また、組織の大小を問わず、企業再生には従業員個々人のシャドーワーク、あるいはシャドーワーク的な発想が今後ますます重要になるということの2点をあげることができる。

There is no recent study on the prevalence of overweight and obesity in patients with type 1 diabetes mellitus (T1DM) in Japan. Being overweight has a significant effect on the metabolic condition and glycemic control of such patients. In the present cross-sectional study, we investigated the effects of body mass index (BMI) on lipid profile, blood pressure, and glycemic control in patients with T1DM. In total, 1486 patients with T1DM (including 401 patients with early onset T1DM who were20 years of age at diagnosis) were included. Patients were divided into four groups according to their BMI, and glycosylated hemoglobin (HbA1c), daily insulin dose per kg body weight, lipid profile, and blood pressure were compared between groups. We found that 15.7% of all patients were overweight (BMIor= 25.0 kg/m(2)) and 2.0% were obese (BMIor= 30.0 kg/m(2)), compared with 17.5% and 2.0%, respectively, in the early onset T1DM subgroup. Significant changes in lipid profiles and blood pressure were found with increasing BMI in both the entire population and the early onset T1DM subgroup. In the entire study population HbA1c and the body weight-adjusted daily insulin dose were significantly higher in patients with a BMIor= 23 kg/m(2) compared with those with a BMI23 kg/m(2); however, this was not the case in the early onset T1DM subgroup. This difference may be due to the relatively small number of patients in that subgroup. In conclusion, the prevalence of overweight and obesity in patients with T1DM was less than that in the normal Japanese population. For patients with T1DM, being overweight was associated with higher blood pressure and dyslipidemia. Furthermore, we cannot exclude an association between being overweight and the need for higher daily doses of insulin.

Telmisartan, a new angiotensin II type 1 receptor blocker (ARB), was recently reported to stimulate PPARgamma, and stronger effects of Telmisartan on insulin sensitivity has been expected than the class effect of ARB. In the present study, we examined the effects of Telmisartan on insulin sensitivity and adipokine levels in hypertensive and type 2 diabetic patients. Outpatients with both hypertension and type 2 diabetes mellitus (n=36; male 23, female 13), received 20-40mg Telmisartan orally once daily for 6 months. Physical examinations and blood or urine tests were performed before and 3 or 6 months after starting Telmisartan treatment. Results were statistically compared using Wilcoxon analysis. Telmisartan treatment for 3 or 6 months reduced systolic and diastolic blood pressure and urinary albumin excretion. Fasting plasma glucose, HbA1c, total and HDL-cholesterol, triglyceride, body weight, BMI and waist length were not changed. Fasting IRI and HOMA-IR were significantly decreased after Telmisartan treatment, suggesting the improved insulin sensitivity. Total and high molecular adiponectin were not changed. Interestingly, serum leptin was significantly increased by 3 months Telmisartan treatment, suggesting a possible involvement of leptin in improved insulin sensitivity. In conclusion, Telmisartan improved insulin resistance with increased serum leptin level in hypertensive and type 2 diabetic patients.

The number of diabetic patients has been increasing in Japan and consequently diabetic complications are the most important target to be prevented through improving glycemic control. In order to describe the glycemic control status and treatment of diabetic patients by specialists in Japan over three years, from 2000 to 2002, we examined HbA1c, other laboratory data and the modality of drug therapy in the study population, 8170 in 2000, 11,831 in 2001, and 16,934 in 2002. Patients were registered at clinics and hospitals that were members of the Japan Diabetes Clinical Data Management Study Group (JDDM). HbA1c levels, other laboratory data, and details of drug therapy were collected and analyzed using SPSS and MS Access. The mean HbA1c levels were essentially unchanged during the study periods, ranging from 7.9% to 7.8%, and from 7.1% to 7.0%, in type 1 and type 2 diabetic patients, respectively. In type 2 diabetes, the frequency of oral hypoglycemic agents (OHA) use increased from 44.9% to 51.4%, while the use of diet-only therapy decreased from 29.9% to 25.4% over the study period. Although the systolic blood pressure was slightly above target, the mean blood pressure and the mean lipid profile were mostly within the treatment goals set by the Japan Diabetes Society. This first report from a large scale study of the daily management of diabetes in Japan revealed that the average HbA1c level was superior to most of the results reported from other countries. Nonetheless, 66% of the patients still had HbA1c levels and half of the patients had other laboratory parameters including blood pressure and lipid profile that were greater than those recommended by the Japan Diabetes Society. The nature of diabetes drug therapy in Japan has gradually changed as new drugs have appeared in the market.

In order to improve the accuracy of predicting blood glucose levels, it is necessary to obtain details about the lifestyle and to optimize the input variables dependent on diabetics. In this study, using four subjects who are type 1 diabetics, the fasting blood glucose level (FBG), metabolic rate, food intake, and physical condition are recorded for more than 5 months as a preliminary study. Then, using data mining, an estimation model of FBG is obtained, and subsequently, the trend in fluctuations in the next morning's glucose level is predicted. The subject's physical condition is self-assessed on a scale from positive (1) to negative (5), and the values are set as the physical condition variable. By adding the physical condition variable to the input variables for the data mining, the accuracy of the FBG prediction is improved. In order to determine more appropriate input variables from the biological information reflecting on the subject's glucose metabolism, response surface methodology (RSM) is employed. As a result, using the variables exhibiting positive correlations with the FBG in the RSM, the accuracy of the FBG prediction improved. Conditions could be found such that the accuracy of the predicting trends in fluctuations in blood glucose level reached around 80%. The prediction method of the trend in fluctuations in the next morning's glucose levels might be useful to improve the quality of life of type 1 diabetics through insulin treatment, and to prevent hypoglycemia.

Recent data have indicated that CRP (C-reactive protein) plays a role in atherosclerosis, in addition to being a marker for inflammatory diseases. IL-8 (interleukin-8), a CXC chemokine, is present in human coronary atheroma and promotes monocyte-endothelial cell adhesion. In the present study, we examined the effect of pitavastatin (NK-104), a synthetic statin (3-hydroxy-3-methylglutaryl CoA reductase inhibitor), on IL-8 production induced by CRP in human AoEC (aortic endothelial cells). We also investigated whether CRP can induce IL-8 production and if the activation of signalling pathways are functionally related. The concentrations of IL-8 in the media after stimulation with CRP were measured by ELISA, and the expression of IL-8 mRNA was assessed by Northern blot. The phosphorylation of MAPKs (mitogen-activated protein kinases) was determined by Western blot. The production of IL-8 induced by CRP (10 microg/ml) was enhanced significantly and was inhibited by pitavastatin. The expression of IL-8 mRNA was increased in a dose-dependent manner after stimulation with CRP (1-100 microg/ml), whereas expression of IL-8 mRNA induced by CRP (50 microg/ml) was significantly diminished by 5 microM pitavastatin. Furthermore, specific MAPK inhibitors (PD98059, SB203580 and SP600125) inhibited the expression of IL-8 mRNA induced by CRP (50 microg/ml). The phosphorylation of all three MAPKs [ERK (extracellular-signal-regulated kinase), p38 MAPK and JNK (c-Jun N-terminal kinase)] induced by CRP (10 microg/ml) was also significantly inhibited by pitavastatin. Our results suggest that CRP may play a role in atherosclerosis via IL-8 production and pitavastatin may prevent the progression of atherosclerosis not only by lowering plasma low-density lipoprotein cholesterol levels, but also by suppressing IL-8 production in endothelial cells through the inhibition of MAPK (ERK, p38 MAPK and JNK) pathways.

A minute volume such as a few hundred nano-litres of gingival crevicular fluid (GCF) will evaporate within one minute at room temperature after collection. In order to investigate the feasibility of a method for noninvasive blood glucose measurement using this fluid, a fabricated GCF-collecting device, and the time-course changes of blood and GCF glucose levels in diabetics were evaluated. As a result of improvement in the GCF-collecting device such that the color of a filter paper changed from white to black upon collection of the sample, the completion of the collecting procedure could be visually confirmed. Using this device, we succeeded in collecting 200 nl of GCF within 30 s, despite the fact that GCF is usually secreted at a rate between 2 and 3 microl per tooth per hour. This method could be applicable for collecting small volume of other biological fluids. The time-course changes of blood and GCF glucose levels in ten type 2 diabetic subjects were examined, the correlation coefficient, R, between both glucose levels was 0.878. The result proved to be similar to that for normal healthy subjects in a previous study. A significant time difference between the two glucose levels was not observed. In diabetes period of 4.8 +/- 1.7 years, the influence of the disease on the GCF glucose level was minimal. Furthermore, from the ROC curve analysis, both sensitivity and specificity showed favorable results. It was suggested that the measurement of GCF glucose levels was a promising screening method for diabetics.

We have fabricated calorie-calculating software that calculates and records the total calorific food intake by choosing a meal menu selected using a computer mouse. The purpose of this software was to simplify data collection throughout a person's normal life, even if they were inexperienced computer operators. Three portable commercial devices have also been prepared a blood glucose monitor, a metabolic rate monitor and a mobile-computer, and linked into the calorie-calculating software. Time-course changes of the blood glucose level, metabolic rate and food intake were measured using these devices during a 3 month period. Based on the data collected in this study we could predict blood glucose levels of the next morning (FBG) by modeling using data mining. Although a large error rate was found for predicting the absolute value, conditions could be found that improved the accuracy of the predicting trends in blood glucose level fluctuations by up to 90 %. However, in order to further improve the accuracy of estimation it was necessary to obtain further details about the patients' life style or to optimise the input variables that were dependent on each patient rather than collecting data over longer periods.