Yoshio Kurihara

Should sulfonylurea be discontinued or maintained at the lowest dose when starting ipragliflozin? A multicenter observational study in Japanese patients with type 2 diabetes

We investigated the difference in efficacy and safety between discontinuation and maintaining of sulfonylurea when adding a sodium–glucose cotransporter 2 inhibitor.

Improvement in treatment satisfaction after switching from liraglutide to dulaglutide in patients with type 2 diabetes: A randomized controlled trial

We compared treatment satisfaction in type 2 diabetes patients taking daily and weekly glucagon‐like peptide‐1 receptor agonists.

Current status of achieving blood pressure target and its clinical correlates in Japanese type 2 diabetes (JDDM45)

To investigate the current status of achieved blood pressure levels in association with the number of antihypertensive drug classes as of 2013, and to explore the clinical correlates with achievement of target blood pressure in a large‐scale cohort of Japanese individuals with type 2 diabetes.

Reduction in glucose fluctuations in elderly patients with type 2 diabetes using repaglinide: A randomized controlled trial of repaglinide vs sulfonylurea

Glinides are antidiabetic drugs that enhance the early phase of insulin secretion, but have been considered to be less effective at lowering blood glucose than sulfonylureas. However, glinides show a lower risk of hypoglycemia and a greater effect on postprandial hyperglycemia, and are particularly recommended for use in elderly patients with type 2 diabetes. We investigated the efficacy and safety of repaglinide compared with sulfonylurea for the treatment of elderly patients.

Effect of switching from pioglitazone to the SGLT2 inhibitor dapagliflozin on body weight and metabolism-related factors in patients with type-2 diabetes mellitus: An open-label, prospective, randomized, parallel-group comparison trial

The effects of dapagliflozin (DAP) and pioglitazone (PIO) on body weight and glycaemic control were compared in patients with type 2 diabetes mellitus. Seventy‐one patients on PIO were either switched to DAP (n = 36) at 5 mg per day or continued on PIO (n = 35). Primary endpoints were superiority of body weight loss and non‐inferiority of HbA1c level after 24 weeks with DAP. Body weight decrease was greater with DAP than with PIO (75.3 ± 14.9 to 71.3 ± 15.1 kg vs. 74.7 ± 13.8 to 75.2 ± 13.9 kg; P < 0.01). Change in the HbA1c level was comparable (P = 0.64). The level of N‐terminal prohormone of brain natriuretic peptide (NT‐proBNP) and urinary albumin : creatinine ratio (ACR) decreased only with DAP (NT‐proBNP, P < 0.01; ACR, P = 0.02), and the change in NT‐proBNP correlated negatively with baseline NT‐proBNP level (ρ = −0.68, P < 0.01) and log‐converted ACR (ρ = −0.35, P < 0.05). DAP promotes body weight loss in type 2 diabetes mellitus and may decrease fluid retention, thus reducing the occurrence of cardiovascular events.

Satisfaction and efficacy of switching from daily dipeptidyl peptidase-4 inhibitors to weekly trelagliptin in patients with type 2 diabetes —Randomized controlled study—

We compared treatment satisfaction between daily dipeptidyl peptidase-4 (DPP-4) inhibitors and a weekly DPP-4 inhibitor in patients with type 2 diabetes. The study was a 12-week, open-label, randomized, multicenter, controlled trial. Participants were Japanese patients with type 2 diabetes who had received daily DPP-4 inhibitors for more than 3 months. Patients were randomly assigned to a treatment cohort: (1) a group that continued taking daily DPP-4 inhibitors (daily group); or (2) a group that switched from daily DPP-4 inhibitors to a weekly DPP-4 inhibitor, trelagliptin (weekly group). The primary outcome was the change in treatment satisfaction levels from baseline to 12 weeks between the two groups, according to Diabetes Treatment Satisfaction Questionnaire (DTSQ) and Diabetes Therapy-Related Quality of Life (DTR-QOL) questionnaire scores. The changes in glycemic control and body weight were also assessed. Of 49 patients initially enrolled in the study, 47 completed the study. The change in DTSQ scores in the weekly group was not significantly different from that in the daily group. However, the improvements in total score and subscale domains 1 and 2 in the DTR-QOL analysis, which relate to burden on social/daily activities and anxiety/dissatisfaction with treatment, were significantly greater in the weekly group than the daily group (p = 0.048, 0.013 and 0.045, respectively). Mean changes in glycated hemoglobin levels and body weight were comparable between the groups. Switching from daily DPP-4 inhibitors to a weekly DPP-4 inhibitor, trelagliptin, could partially improve treatment satisfaction levels in patients with type 2 diabetes without affecting glycemic control.

Impact of incretin-related agents on endothelial cell function

Incretin-related drugs, such as dipeptidyl peptidase-4 (DPP-4) inhibitors and glucagon-like peptide-1 (GLP-1) analogues, have been clinically available and widely used to treat patients with type 2 diabetes mellitus. Accumulating evidence indicates that these agents exert glycemic control and have various other favorable effects, including prevention of atherosclerosis. It is important to assess and manage early-phase atherosclerosis, but whether diabetic therapeutics including incretin-related drugs improve or maintain vascular endothelial cell function has not been fully determined. We previously published prospective clinical trials focused on flow-mediated dilation in patients with type 2 diabetes, who did not have severe atherosclerosis, using two different incretin-related drugs: a DPP-4 inhibitor and a GLP-1 analogue. These trials showed that these therapeutic agents did not improve endothelial cell function. In this article, we discuss how incretin-related drugs contribute, if at all, to vascular endothelial cell function, atherosclerosis, and beta-cell function, based on our clinical trials and previous evidence.

A CASE OF MACROAMYLASEMIA

IgA(λ)と結合したmacroamylasemiaの1例を報告する.症例は胆石と糖尿病を有する52才の女性で,腹痛のため血清amylaseを測定したところ663 Somogyi単位と高値を示した,しかし尿中amylase排泄は正常から低値を示し,腎,肝機能は正常で,唾液腺疾患も認めず, Cam/Ccr ratioが0.40～0.52と低値を示したのでmacroamylasemiaを疑い, amylaseの検索を行なつた. Hendersonらの測定温度によるamylase活性値比(45°C/25°C)にて正常者血清が4.9,急性膵炎患者血清が5.7,耳下腺炎患者血清が6.3であつたのに比し,本例では8.6と高値を示した. Sephadex G-100による血清ゲル〓過で大分子部分にamylaseの溶出を認め, Sephadex G-200で19S～7Sの間にpeakを認めた.寒天電気泳動法による血清amylase isozymでは正常amylaseよりやや陽極よりに幅広い活性を認め,免疫学的検索にてIgA (light chain λ型)との結合を認めた,最後に本邦で報告された33例のmacroamy-lasemiaについて考案を加えた.