IntroductionTo investigate factors affecting glycemic control, oral antidiabetic drug (OAD) treatment distribution and self-care activities among patients with type 2 diabetes mellitus (T2DM) who newly initiate OAD monotherapy in a real-world setting in Japan.Research design and methodsA Real-world Observational Study on Patient Outcomes in Diabetes (RESPOND) is an ongoing, prospective, observational cohort study with follow-up at 6, 12, 18 and 24 months. Primary objectives include OAD treatment patterns (cross-sectional and longitudinal) among diabetes specialists versus non-specialists; adherence to diabetes self-care activities; quality of life; treatment satisfaction among patients and target attainment rates of parameters, including glycated hemoglobin. Here, we present the study design and baseline data.ResultsOf 1506 patients enrolled (June 2016–May 2017; 174 sites in Japan), 1485 were included in the baseline analysis (617 treated by specialists, 868 by non-specialists). Most patients were prescribed dipeptidyl peptidase-4 inhibitors (DPP-4Is) (specialist vs non-specialist, 54.1% vs 57.1%), then sodium-glucose cotransporter 2 inhibitors (13.9% vs 22.2%), metformin (20.3% vs 12.9%) and other OADs (<5% individually in both groups). Regardless of age, body mass index and glycated hemoglobin, DPP-4Is were the most commonly prescribed OADs by both specialists and non-specialists. About one-fifth and one-third of patients visiting specialists and non-specialists, respectively, received no advice on diet and exercise. The proportion of patients following self-care recommendations for diet and exercise (2/5 items on the Summary of Diabetes Self-Care Activities) was significantly higher among those visiting specialists than non-specialists.ConclusionThe use of newer OAD was common across a broad range of clinical characteristics in patients with T2DM who newly initiated monotherapy in Japan. However, patient-related and physician-related factors could affect the treatment changes during the following course of treatment. In addition, treatment outcome could vary with the observed difference in the level of patient education provided by diabetes specialists versus non-specialists.

Aims/Introduction: This 6-month, single-center, prospective, open-labeled, randomized trial was designed to investigate whether physicians' diabetes self-management education using an education tool developed by the Japan Association of Diabetes Education and Care and a self-monitoring of blood glucose (SMBG) analyzer improves glycemic control in individuals with type 2 diabetes receiving insulin and SMBG. Materials and Methods: Participants were randomized into intervention (I) and control (C) groups. Both groups received physicians' diabetes self-management education at each hospital visit, whereas the Japan Association of Diabetes Education and Care education tool and the SMBG readings analyzer was used in group I, but not group C. All participants filled out a diabetes treatment-related quality of life form and an original questionnaire on SMBG use with five questions (Q1-Q5) before and after the study period. Results: A total of 76 individuals were recruited and randomized. Glycated hemoglobin (HbA1c) was significantly improved during the study period in group I, whereas no significant change was observed in group C. The change in HbA1c was greater in group I, although it did not reach statistical significance. The diabetes treatment-related quality of life total score was not changed in either group. Interestingly, the score of Q1 ("How important is SMBG to you?") in the SMBG questionnaire was unchanged in group I,

Aims/Introduction The aim of this study was to develop a scale to evaluate disease stigma in patients with lifestyle‐related chronic non‐communicable diseases (LCNCDs), which we named the Kanden Institute Stigma Scale (KISS), and to consider its possible clinical application for patients with diabetes. Materials and methods An initial 90 questions were drafted and categorized into six subscales according to the manifestations of stigma. The final version of the KISS was developed as a 24‐item questionnaire comprising four items for each subscale. Results A total of 539 outpatients including 452 patients with diabetes and 87 patients without diabetes were recruited. Construct validity was confirmed by assessing the correlation with previously established measures. Confirmatory factor analysis showed the KISS to have good model fitness (adjusted goodness‐of‐fit index = 0.856). Test–retest reproducibility analysis showed that the intraclass coefficient of the first and a second KISS was 0.843 (P < 0.001), indicating excellent reproducibility. The KISS showed higher scores for patients with diabetes than for patients without diabetes (12.23 ± 0.49 vs 5.76 ± 0.73, P < 0.05). The KISS score was significantly higher in type 1 and type 2 diabetes patients taking insulin therapy than in type 2 diabetes patients not taking insulin (P < 0.05). Conclusion The KISS is a validated and reliable questionnaire for assessment of stigma among patients with diabetes as well as other lifestyle‐related chronic non‐communicable diseases, and might contribute to identifying and rectifying diabetes stigma, as well promoting awareness among health care professionals of this very consequential health problem.

We have experienced dysphagia rehabilitation by SpeechLanguage-Hearing Therapists (SLHTs) under nutritional management (nutrition support team, NST) which has been effective for patients' recovery especially in the acute stage. However, available information on the relation among recovery status, rehabilitation by SLHTs, and NST in the acute stage is limited. Hospitals where are not any or are only a few SLHTs, even in some urban areas of Japan still exist. Our aim of this study is to clarify the efficacy of dysphagia rehabilitation under nutritional management in an acute care hospital. The data of 750 patients admitted in a tertiary care hospital provided for this study. They were divided into four groups; SLHT group who were rehabilitated by SLHTs, both SLHT and NST (Abreast) group who were rehabilitated by SLHTs under NST, NST only (NST) group and Nonintervention (NI) group. The patients in SHLT and Abreast groups were older, more demented and with lower scores of FIM on average than the other two groups. 55.4% of SLHT group and 46.7% of Abreast group showed moderate to severe dysarthria. The percentage of tube fed patients was significantly higher in SLHT and Abreast group than others. However their inpatient periods and FIM score improvements did not show significant differences from others. The rate of their secession from tube feeding was significantly higher than others. We concluded that Dysphagia rehabilitation by SLHTs under nutritional management is effective for patients' recovery not only in convalescent stage but also in the acute stage. Medicine, Hebrew Home at Riverdale, Bronx, New York Improving the quality of care to the elderly is a fundamental cornerstone of the practice of geriatric medicine. Reducing the frequency of avoidable hospitalizations is an area of particular focus. Inpatient hospitalizations in the elderly population are often also associated with the development of multiple complications, which, in turn, increase lengths-of-stay. These include hospital-acquired infections, development of new decubiti, physical declines resulting from prolonged immobility, and the untoward effects of acute adjustment reaction from an unfamiliar hospital environment. The development of well-designed interventions in the nursing home can significantly reduce the number of potentially avoidable hospitalizations in this population. "Development of an Outpatient Transfusion Protocol to Reduce Avoidable Hospitalizations" is a quality improvement initiative that was implemented at The Hebrew Home at Riverdale, a skilled nursing facility in Bronx, NY. The objective of this program was to develop a favorable alternative to the hospitalization of postacute and long-term care patients requiring blood transfusion. In our experience, all patients being sent to the hospital for blood transfusion were being admitted as an inpatient, irrespective of the goals of care. This program is being successfully utilized for the patient who is evaluated for anemia at the skilled nursing facility and a clinical decisio...

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