Status of Diabetes Treatment in Japanese Adults: An Analysis of the 2009 Japan Society of Ningen Dock Database

Abstract

Objective The Japan Diabetes Society (JDS) has recommended target levels of glycemic control based on guidelines for the management of diabetes mellitus (DM). The Japan Society of Ningen Dock created a database of subjects receiving annual health examinations nationwide. Using this database, we evaluated the efficacy of current treatment for patients with DM based on the JDS recommendations. Methods This multicenter, retrospective study was conducted using data obtained from 21 institutions across Japan. In order to assess the level of glycemic control in the Japanese population, we analyzed previously obtained measurements of HbA1c in 7,180 patients 20 to 79 years of age (mean age: 57.9±8.7 years, 6,007 men and 1,173 women) taking DM medications. Results According to the JDS guidelines, 44.7% of the patients fell into the good glycemic control group, with an HbA1c level of <7.0% while 22.4% were classified into the poor glycemic control group, with an HbA1c level of ! 8.0%. The control of other arteriosclerosis risk factors deteriorated as the glycemic control deteriorated. Lifestyle factors were strongly found to be associated with glycemic control in the patients receiving DM treatment. Conclusion Aggressive lifestyle modification is needed to improve glycemic control in patients with DM.

Hba1c, Blood Pressure, and Lipid Control in People with Diabetes: Japan Epidemiology Collaboration on Occupational Health Study

“…Regarding HbA1c, less than half of the participants in our study reached the HbA1c target. This finding is similar to that in a previous Japanese study of patients who received anti-diabetic drugs (HbA1c < 7.0%, 44.7%) [ 19 ]. Similar achievement rates for HbA1c have also been reported from other countries [ 12 , 15 , 33 ].…”

“…We analyzed the correlates of poor glycemic control (HbA1c ≥ 8.0%) compared with optimal control defined as HbA1c <7.0% [ 8 , 9 ]. HbA1c of 8.0% is considered as a “take action” threshold in the ADA and JDS guidelines [ 8 , 9 ] and was treated as a cut-off point of poor glycemic control in previous studies [ 12 , 19 , 31 , 32 ]. Thus, HbA1c ≥ 8.0% is considered as poor glycemic control in our study.…”

“…Despite evidence showing the benefits of simultaneous control of HbA1c, BP, and LDL-C in reducing the risk of diabetes complications and death [ 10 , 11 ], studies from Western [ 12 – 14 ] and Asian [ 15 – 17 ] countries showed that attainment of all three goals simultaneously was low (10–30%). In Japan, there are limited data on treatment and/or achieving rates for patients with diabetes with respect to these risk factors [ 18 , 19 ]. In a clinic- and hospital-based study, 34% of patients had HbA1c < 6.5% and half of the patients had BP < 130/80 mmHg [ 18 ].…”

“…In a clinic- and hospital-based study, 34% of patients had HbA1c < 6.5% and half of the patients had BP < 130/80 mmHg [ 18 ]. In a study of health check-up attendants, 44.7% of patients under treatment of anti-diabetic drugs achieved HbA1c (< 7.0%), 51.8% for BP (< 130/80 mmHg), and 58.1% for LDL-C (< 120 mg/dL) [ 19 ]. However, these studies did not report the proportion of patients meeting all three targets [ 18 , 19 ].…”

“…In a study of health check-up attendants, 44.7% of patients under treatment of anti-diabetic drugs achieved HbA1c (< 7.0%), 51.8% for BP (< 130/80 mmHg), and 58.1% for LDL-C (< 120 mg/dL) [ 19 ]. However, these studies did not report the proportion of patients meeting all three targets [ 18 , 19 ]. In addition, no study assessed diabetes control status in the Japanese working population, in which 8.0% of men and 3.3% of women had diabetes [ 20 ].…”