抄録
National medical care expenditure in Japan exceeded 43 trillion yen in FY2018, with
over 1.2 trillion yen of this total being spent on diabetes care. The sales of diabetes drugs
continue to increase by several percent every year, and in FY2020 were second only to anti-
cancer drugs. Even with such huge healthcare and drug expenditure on the treatment of
diabetes, the number of patients undergoing dialysis due to diabetes continues to increase,
and the number of chronic dialysis patients in Japan per capita was shown to be by far the
largest in an international comparison. At the end of 2020, there were 275.4 dialysis patients
per 100,000 people in Japan, of which 39.5% of chronic dialysis patients had diabetic nephropathy,
in which the kidneys are damaged due to diabetes.
A previous analysis of the length of hospitalization for diabetes patients in Japan showed
that the average number of days spent in hospital was extremely long, with a cost-benefit
analysis indicating that this is difficult to justify. The results of the data analysis carried out
in this paper suggest that many people suffering from severe diabetes may not actually be
receiving treatment. In contrast with the major diabetes screening programs overseas, it is
clear that the Japanese program (1) does not evaluate the risk of developing diabetes, although
it does include an age limit; (2) carries out annual screening regardless of the risk
and/or blood sugar level; and (3) is not updated by the best available evidence from the latest
clinical research.
Many stakeholders, including local governments, health insurance associations, and the
Ministry of Health, Labour and Welfare, have already pointed out the importance of preventing
diabetes aggravation. In this paper, we explore the reasons why Japan’s efforts to
encourage people at high risk to receive preventive medical care are failing, and propose
nnecessary
measures to achieve organic cooperation between screening programs and healthcare
provision.
https://ror.org/04jqj7p05 
