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Anjana et al. (1) analyzed the rate of worsening of glucose metabolism in subjects with normal glucose tolerance (NGT) and impaired fasting glucose (IFG)/impaired glucose tolerance (IGT), the rate of regression from abnormal glucose metabolism to NGT, and the risk factors for the worsening in an Asian Indian cohort. The study may be a valuable addition to the previously accumulated knowledge in the epidemiology of the diabetes evolution. However, we are afraid that the classification of glucose tolerance categories and terminology were confusing and misleading in their study. Namely, the current definition of prediabetes by the American Diabetes Association is …

OBJECTIVE— The goal of this study was to know the fate of albuminuria in Japanese patients with type 2 diabetes under tight blood pressure and glycemic control. RESEARCH DESIGN AND METHODS— Patients having normoalbuminuria (urinary albumin excretion RESULTS— Development occurred in 27 (15%) of the normoalbuminuric patients and progression and regression in 16 (17%) and 20 (21%), respectively, of the microalbuminuric patients. Significant independent relationships existed between development and higher achieved mean systolic blood pressure (SBP) and regression and lower achieved mean SBP. In the patients with achieved mean SBP CONCLUSIONS— Development and progression were low and regression was high with SBP of 120 mmHg, provided A1C was maintained at 6.5%.

OBJECTIVE—To clarify mortality and morbidity of intensively managed elderly diabetic individuals and to explore factors predicting mortality and diabetes-related end points. RESEARCH DESIGN AND METHODS—A total of 390 elderly (≥65 years of age) outpatients with type 2 diabetes ( 173 men and 217 women, mean age 73.0 years) were analyzed. The mean HbA1c upon entry was 6.8% (332 receiving oral hypoglycemics and/or insulin) and blood pressure upon entry was 136/74 mmHg (219 receiving antihypertensive drugs). The patients have been followed-up for 3 years with HbA1c RESULTS—The mortality rate, 2.9% per year, was comparable to that of the age- and sex-matched general population. Stroke was a leading cause of mortality after malignancy. By the univariate Cox proportional hazards model, only high serum creatinine and prior stroke were highly significant and strong risks for both end points. In those without prior stroke and receiving antihypertensive agents, the incidence of the diabetes-related end point based on their systolic blood pressure (SBP) quartile was U-shaped, with the nadir at the 3rd (SBP, 137–147 mmHg) and the peak at the 1st (SBP ≤ 125 mmHg) quartile. CONCLUSIONS—In well-controlled elderly diabetic subjects, there was no excessive mortality compared to the age- and sex-matched general population. Renal dysfunction and prior stroke were independent risks for mortality and morbidity. In those without prior stroke, a risk of too much lowering of blood pressure was suggested.

The goal of this study was to know the fate of albuminuria in Japanese patients with type 2 diabetes under tight blood pressure and glycemic control.Patients having normoalbuminuria (urinary albumin excretion30 mg/g creatinine, n = 179) or microalbuminuria (albumin excretion 30-299 mg/g creatinine, n = 94) at baseline have been followed up for 8 years: ratio of men to women was 160/113, the mean age was 58 years, pretreatment HbA(1c) (A1C) was 8.8%, and blood pressure was 136/76 mmHg. A1C6.5% and blood pressure130/80 mmHg were targeted, and the A1C of 6.5 +/- 0.7% (mean +/- SD) and blood pressure of 127 +/- 11/72 +/- 6 mmHg have been maintained during the 8 years. Development of microalbuminuria or macroalbuminuria (albumin excretionor =300 mg/g creatinine) in initially normoalbuminuric patients and progression to macroalbuminuria or regression to normoalbuminuria in initially microalbuminuric patients were assessed at year 8.Development occurred in 27 (15%) of the normoalbuminuric patients and progression and regression in 16 (17%) and 20 (21%), respectively, of the microalbuminuric patients. Significant independent relationships existed between development and higher achieved mean systolic blood pressure (SBP) and regression and lower achieved mean SBP. In the patients with achieved mean SBP120 mmHg, development was 3%, progression was 11%, and regression was 44% during 8 years. Prediction for nephropathy by blood pressure and glycemia alone was limited. Nevertheless, albumin excretion at year 8 was positively correlated with achieved mean SBP and baseline albuminuria.Development and progression were low and regression was high with SBP of 120 mmHg, provided A1C was maintained at 6.5%.

To clarify mortality and morbidity of intensively managed elderly diabetic individuals and to explore factors predicting mortality and diabetes-related end points.A total of 390 elderly (or=65 years of age) outpatients with type 2 diabetes ( 173 men and 217 women, mean age 73.0 years) were analyzed. The mean HbA(1c) upon entry was 6.8% (332 receiving oral hypoglycemics and/or insulin) and blood pressure upon entry was 136/74 mmHg (219 receiving antihypertensive drugs). The patients have been followed-up for 3 years with HbA(1c)7.0% and blood pressure145/80 mmHg as targets, with mortality and an aggregate of fatal and nonfatal diabetes-related events as end points. Mortality rate and causes of mortality, as well as risk factors for mortality and morbidity, were determined.The mortality rate, 2.9% per year, was comparable to that of the age- and sex-matched general population. Stroke was a leading cause of mortality after malignancy. By the univariate Cox proportional hazards model, only high serum creatinine and prior stroke were highly significant and strong risks for both end points. In those without prior stroke and receiving antihypertensive agents, the incidence of the diabetes-related end point based on their systolic blood pressure (SBP) quartile was U-shaped, with the nadir at the 3rd (SBP, 137-147 mmHg) and the peak at the 1st (SBPor= 125 mmHg) quartile.In well-controlled elderly diabetic subjects, there was no excessive mortality compared to the age- and sex-matched general population. Renal dysfunction and prior stroke were independent risks for mortality and morbidity. In those without prior stroke, a risk of too much lowering of blood pressure was suggested.

Recently, hypoadiponectinemia was found to be associated with coronary artery disease in humans (1). Conversely, hyperadiponetinemia caused by a transgenic overexpression of the adiponectin gene prevented atherosclerosis in the mouse with genetic preponderance to it (2,3). The facts suggest adiponectin has a direct antiatherogenic effect in vivo, as suggested in in vitro studies (4). However, adiponectin is an insulin-sensitizing adipocytokine, and increased insulin resistance (IR) is a well-established atherogenic factor. Therefore, it is possible that the observed correlations (1–3) with adiponectin and atherosclerosis occurred through its insulin-sensitizing effect (3,5). To know if adiponectin possesses a direct antiatherogenic effect beyond its insulin-sensitizing action in an apparently healthy population, we analyzed the relationship among serum adiponectin, heart rate–corrected QT interval (QTc), …

Harrison et al. (1) analyzed pancreatic β-cell function in drug-naive patients with type 2 diabetes before and 42 months after treatment with insulin plus metformin or a combination of metformin, glyburide, and pioglitazone. The pretreatment evaluation was not exactly “before” the treatment. It was carried out after 3 months of the run-in period with insulin plus metformin therapy for all participants. The study is well designed, the analysis is appropriate, and the data are straightforward except for two potential drawbacks: absence of a wash-out period prior to the final meal …

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE), first described by McCarty (1), is characterized by symmetrical pitting edema of the hands and feet; tenderness, swelling, and/or limited motion of the joints; fatigue; and fever (1,2). It commonly occurs in elderly people (1,2). We have recently encountered two cases of RS3PE that developed shortly after the initiation of a dipeptidyl peptidase-4 (DPP4) inhibitor and resolved markedly upon cessation of it. Case 1 was a 74-year-old woman with a 30-year history of type 2 diabetes who presented with edema of the hands, low grade fever, and malaise, which developed 5 weeks after switching from 20 mg gliclazide to 50 mg sitagliptin. Physical examination revealed severe pitting edema …

The correlation between diabetic retinopathy and blood pressure was analyzed in 742 type II diabetic patients. Systolic and pulse blood pressures were significantly higher in the patients with retinopathy than in those without (mean systolic pressure 142 vs. 139 mmHg, P < .01; mean pulse pressure 60.5 vs. 56.4 mmHg, P < .001). There was no difference in the diastolic blood pressure between these two groups. The correlation between blood pressure and the components of retinopathy (including microaneurysms, hemorrhages, and exudates) was also analyzed. Even when the patient with microaneurysms or dot hemorrhages, blot hemorrhages, or hard or soft exudates were separately evaluated, systolic and pulse blood pressures were higher in those with one of these diabetic changes than in patients without them. To avoid the influence of nephropathy, the patients were divided into nonproteinuric or proteinuric groups. In the nonproteinuric group, pulse blood pressure was higher in patients with retinopathy than in those without. In the proteinuric group, systolic blood pressure was also higher in patients with retinopathy than in those without. However, these observed differences in blood pressure were slight after the division of the patients. With respect to the components of retinopathy, systolic and pulse blood pressures were significantly higher in the patient with blot hemorrhages than in those without in both nonproteinuric and proteinuric groups (nonproteinuric: systolic pressure 142 vs. 137 mmHg, P < .005, and pulse pressure 60.4 vs. 55.5 mmHg, P < .001; proteinuric: systolic pressure 155 vs. 146 mmHg, P < 0.01, and pulse pressure 69.0 vs. 63.5 mmHg, P < .05) In regard to other components (microaneurysms, dot hemorrhages, or hard or soft exudates), no significant difference was found in blood pressure when analyzed in both nonproteinuric and proteinuric patients. Systolic, diastolic, and pulse blood pressures did not correlate with blood glucose level in any of our patients. These data revealed that systolic hypertension is a risk for diabetic retinopathy, especially for blot hemorrhage.