Objective: Early prevention of renal dysfunction progression and cardiovascular disease is important in diabetes. We aimed to determine the risk factors for renal dysfunction and cardiovascular disease among medical insurance subscribers between 40 and 74 years of age in Japan. Methods: This retrospective study involved 1585 subjects, including 97 patients with diabetes, who had undergone a specific health checkup in 2013 and 2019. The primary composite outcome included decline in estimated glomerular filtration rate (eGFR) by ≥30%, increase in urine albumin-to-creatinine ratio (UACR) by ≥30 mg/gCre, and increase in the Framingham Risk Score by ≥5%. We categorized the subjects into groups with and without these outcomes. Univariate analysis was conducted using Welch’s t-test, Pearson’s correlation coefficient, and Fisher’s exact test. Based on the univariate analysis, principle component and logistic analyses were performed to determine the predictive risk factors. Results: Significant between-group differences were noted in terms of age, BMI, waist circumference, blood pressure, hemoglobin, hematocrit, triglyceride, HDL-C, LDL-C, AST, ALT, γ-GTP, HbA1c, serum creatinine, eGFR, urine creatinine, UACR, urine protein-to-creatinine ratio, sex, antihypertensive medication, history of anemia, diabetes, smoking, alcohol consumption, weight change, exercise habits, the will to improve and others. Logistic analysis showed that age (odds ratio [95% confidence interval]: 1.04 [1.02-1.06], P <0.0001), HDL-C (0.97 [0.96-0.98], P <0.0001), HbA1c (1.35 [1.12 -1.63], P =0.0015), and male sex (3.90 [2.97-5.11], P <0.0001) were predictive risk factors. Conclusion: Lower HDL-C and higher HbA1c were detected as the risk factors for patients with diabetes and without diabetes. The results of this study indicate that the harmful effects of hyperglycemia and dyslipidemia may have started before the patients actively exhibit metabolic disorders. Disclosure R. Terayama: None. M. Koshizaka: None. T. Shibata: None. T. Ban: None. Y. Maezawa: None. K. Yokote: Research Support; Self; Astellas Pharma Inc., Daiichi Sankyo, Eli Lilly Japan K.K., Kowa Company, Ltd., Kyowa Hakko Kirin Co., Ltd., Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Mochida Pharmaceutical Co., Ltd., Nippon Boehringer Ingelheim Co. Ltd., Novartis Pharma K.K., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Pfizer Japan Inc., Sanofi K.K., Shionogi & Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited. Speaker’s Bureau; Self; Abbott, Astellas Amgen, AstraZeneca K.K., Bayer Inc., FUJIFILM Pharmaceuticals U.S.A., Inc., Kaken Pharmaceutical Co., Ltd., Sanwa Kagaku Kenkyusho.

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BACKGROUNDThe Japanese Diabetes Society has released an algorithm for pharmacotherapy for patients with type 2 diabetes (T2D). 1 It recommends metformin and sodium-glucose co-transporter 2 (SGLT2) inhibitors for patients with obesity. However, there is insufficient evidence to show which patients are more suitable for SGLT2 inhibitors or metformin among patients undergoing primary prevention.Visceral adipose tissue, accurately measured using computed tomography (CT), is an independent risk marker of cardiovascular and metabolic diseases, while visceral fat reduction ameliorates metabolic disorders. 2 Some studies reported that SGLT2 inhibitors significantly reduced visceral fat area (VFA) 3 and metformin reduced visceral fat. 4 We previously reported that the mean percentage reduction in the VFA was significantly greater in the ipragliflozin, an SGLT2 inhibitor, group than in the metformin group. 5 Therefore, a sub-analysis of a prospective, multicenter, blinded-endpoint, randomized controlled study 5 was conducted to identify responders to ipragliflozin and metformin in reducing VFA in patients with T2D. We analysed patient backgrounds between high-reduction responders and low-reduction non-responders, identifying contributing clinical factors. | METHODSThis main study evaluated the efficacy of treatment with ipragliflozin or metformin in reducing VFA in 103 patients with T2D. The study design has been previously described. 6 The study protocol was approved by the relevant ethics committees and conformed to the principles of the Declaration of Helsinki. Participants who provided written informed consent were registered between September 2014 and September 2016. The study was registered at http:// www.umin.ac.jp/ctr/, with registration ID UMIN-ID: UMIN 000015170.Patients with T2D with a body mass index (BMI) of ≥22 kg/m 2 and a glycated hemoglobin (HbA1c) level of ≥7% and <10% were included. The patients were randomized to receive ipragliflozin (50 mg/day) or metformin (1000-1500 mg/day). The primary outcome was the percentage change in the VFA measured using CT after 24 weeks of therapy. Two radiologists blinded to the information analysed the images. The secondary outcomes included changes in subcutaneous fat area; abdominal muscle volume measured using CT; body weight; BMI; waist circumference; HbA1c, fasting blood glucose, fasting insulin, triglyceride, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, urinary

Cushing's disease causes numerous metabolic disorders, cognitive decline, and sarcopenia, leading to deterioration of the general health in older individuals. Cushing's disease can be treated with transsphenoidal surgery, but thus far, surgery has often been avoided in older patients. We herein report an older woman with Cushing's disease whose cognitive impairment and sarcopenia improved after transsphenoidal surgery. Although cognitive impairment and sarcopenia in most older patients show resistance to treatment, our case indicates that normalization of the cortisol level by transsphenoidal surgery can be effective in improving the cognitive impairment and muscle mass loss caused by Cushing's disease.