Akira Sasaki

Causes of death in Japanese diabetics. A 20-year study of death certificates

Death certificates filed between 1960 and 1979 in Osaka, Japan were analyzed to study causes of death in diabetic patients. It was observed that diseases of the circulatory system increased continuously from 15.2% in 1960-1964 to 27.2% in 1975-1979. Cerebrovascular disease and disease of heart were the leading causes of death throughout the study period. The rate of increase was much faster for disease of heart than for cerebrovascular disease, and there was only a small difference between them as cause of death in diabetic patients at the end of the observation period. Malignant neoplasms, cirrhosis of the liver, and pneumonia and bronchitis increased, whereas tuberculosis decreased sharply according to age-adjusted mortality rate during the 20-year period. Analysis based on O/E ratios suggested higher risk of dying from ischemic heart disease, tuberculosis and cirrhosis of the liver in Japanese diabetics than in the general population in this country.

Survival rates and causes of death of diabetics in Japan: A 10-yr follow-up study

Abstract Although the prognosis of diabetes has been largely improved since the introduction of insulin to the treatment of diabetes, the longevity of diabetic patients still appears to be shorter than that of the general population. Most studies on the prognosis of diabetes, however, have been carried out in Western countries. The present study was carried out to determine the survival rate of diabetics in Japan. A 10-yr follow-up study was performed on subjects in the town of No-se, Osaka, Japan, who showed postprandial glycosuria in a screening test. Overt glucose intolerance was found to be associated with excess mortality. In particular, the 10-yr relative survival was decreased in groups that had serum glucose levels above 160 mg/dl at fasting, 300 mg/dl at 1 hr and 260 mg/dl at 2 hr, and glucose area above 750 mg · hr/dl during the OGTT. Cardiovascular complications at the baseline of the follow-up period were also related to a decrease in the survival rate, especially when glucose intolerance coexisted. Disease of heart and cerebrovascular disease were major causes of death in subjects with glucose intolerance. The prognosis of diabetes in Japan was compared to that of diabetes in the West.

Studies on normal blood glucose level—Statistical approach to interpretation of glucose tolerance test

Abstract In an attempt to establish diagnostic criteria for diabetes mellitus applicable to the Japanese people, a study was made of distribution of normal blood glucose values on subjects admitted for a multiphasic health examination at the Center for Adult Diseases, Osaka. Five hundred and eighty-six subjects were selected who were without abnormal values on certain standards for various examinations. (1) On an assumption that blood glucose values are distributed normally, it was tried to exclude an abnormal group, and a ‘normal range’, i.e. 98 percentile of the distribution, was computed for each age group. (2) The normal range thus obtained showed that the levels in fasting and at three hours were equal to or rather lower than the so far accepted criteria and that the 1- or 2-hr level, 180–190 mg 100 ml , and 140–150 mg 100 ml , respectively, was considerably higher, showing an increase as age advanced. (3) A follow-up examination of 272 subjects was performed five to seven yr after the initial test to confirm the above values. The blood glucose level in GTT varied rather widely, but in the same trend with the regression phenomenon. The upper limits of the normal blood glucose level estimated presently were included in this range of variation. This fact means that these levels are not abnormal but within a range of normal variation. (4) The number of subjects showing deterioration of glucose tolerance during the seven yr follow-up period increased markedly when the value of the initial test exceeded 110 mg 100 ml fasting, and 160, 120, and 110 mg 100 ml at 1, 2 and 3 hr respectively. Therefore, these figures were considered to be on a predictive diagnostic level.

“Expected Age” Used in Evaluating Results of Multiple Health Examination

人間ドックなどにおける多種目の検査による健康診断成績の評価の方法の一つとして“期待年令”(いわゆる“生物学的年令”) を利用することを試みた.対象として大阪府立成人病センター人間ドック入院者中から, 各種検査において明らかな異常を認めない男子425名を用いた. まず約90種類の検査項目のうちから24項目を選んで年令に対する偏相関係数を求め, その結果からさらに10項目を選定し, 次のような年令に対する重回帰式を得た.期待年令=74.140+0.108〔最大血圧〕-0.266〔一秒率〕+0.158〔クンケル反応〕+0.032〔コレステロール〕+0.040〔GTT 2h〕-0.83〔GFR〕-0.034〔RBC〕-0.261〔網状赤血数〕+6.234〔Scheie As〕+0.244〔聴力損失〕正常群159例についてこの回帰式によって期待年令を求めると, その平均は56.57才となり, 実年令との差の分散は21.35となった. しかし個々の症例については, かなり差の大きいものもみられた.次に肝障害, 糖尿病, 冠硬化, 高血圧などの症例について, この計算式で期待年令を求めると, 実年令より5～8才高くなり, とくに合併症を伴う高血圧でその差は約10才に達し, 疾患を期待年令という形で表現することができた.最後に糖尿病, 肝障害, 高コレステロール血症, 高血圧の模擬的症例を設定し, 期待年令式の個人における診断能力について検討した. その結果, 検査所見の軽度の変化でも期待年令にきわめて鋭敏に反映されることが認められた.

Arteriosclerosis in Japanese Diabetics

糖尿病患者には動脈硬化症の合併が高率であるが, 一方動脈硬化症は加令とともにその頻度が高くなる. 糖尿病患者の動脈硬化症について検討する場合, 同様な集団の糖代謝正常のグループと比較することが必要である. 成人病センターを受診した糖尿病患者 (初発見のものが多い) 1205名について, ブドウ糖50g経口負荷試験 (オートアナライザー法) で2時間後の血糖値200mg/dl以上のもの, 140～199mg/dlのもの, 120～139mg/dlのものの3群に分かち, 一方ドック入院者で2時間後の血糖値119mg/dl以下のもの313名を対照として, 年代別 (40～59才と60才以上の2群) および高血圧の有無 (収縮期血圧150以上または拡張期血圧90以上を高血圧, 収縮期血圧149以下および拡張期血圧89以下を正常血圧) によって組別けし, それぞれについて動脈硬化の頻度を比較検討した. その結果糖尿病患者には高血圧が比較的早期に発症し, その合併頻度は対照群に比してかなり高く, しかも糖代謝の悪化とともに高血圧合併の割合が高くなる. 一方網膜血管硬化症発症の頻度は糖代謝異常の強いものに高率となるが, 高血圧, 加令もその発症の大きな因子として影響している. また尿蛋白の出現も糖代謝の増悪とともに高率となるが高血圧の影響も強い. しかしPSP, 腎クリアランス (GFR, RPF) 異常の頻度は糖代謝異常との間に関係は認められず, 高血圧, 加令が強い影響を及ぼしている. また心電図も高血圧群に異常率が高く糖代謝異常による影響は認められない.すなわちわが国の糖尿病患者については高血圧, 尿蛋白陽性の合併が高率であるが, 眼底, 心, 腎の動脈硬化症の合併は高血圧, 加令なども重要な因子として作用しており, これらの影響による部分が強く, 比較的軽度の糖代謝異常ではそれが動脈硬化に関与する因子は少ないものと考える.