About 2,205,000 Japanese people have dyslipidemia, one of the most common disorders identified in health checkups. 12.9% of men and 22.4% of women have total cholesterol levels of 240 mg/dL or above. The guidelines for preventing atherosclerotic illnesses advocate managing dyslipidemia and other risk factors as the major therapeutic target. The 2022 Guidelines for the Prevention of Atherosclerotic Disease define hypertriglyceridemia as a fasting triglyceride level of 175 mg/dL or greater, highlighting the significance of monitoring triglycerides at all times. Based on the Hisayama-cho study, the score was also accepted. Ischemic heart disease and atherothrombotic stroke can be used as endpoints to estimate risk. LDL-C management targets in high-risk populations for atherosclerotic disorders were also altered. Diabetes with peripheral-arterial disease, microvascular disease, and smokers should have LDL-C levels below 100 mg/dL for secondary prevention of coronary artery disease and atherothrombotic stroke, acute coronary syndrome, familial hypercholesterolemia, and diabetes mellitus. Patients with acute coronary syndromes, familial hypercholesterolemia, diabetes, or both coronary artery disease and atherothrombotic stroke should have LDL-C below 70 mg/dL. Familial hypercholesterolemia has a high risk of coronary artery disease, although early identification and treatment are lacking. In recent years, new medications, diagnostic improvements, and epidemiological knowledge have made health checkups crucial for early detection and specialist referral. Lipid management for atherosclerotic disease prevention will be discussed in this section.

 According to the "2019 National Health and Nutrition Survey" released by the Ministry of Health, Labour and Welfare, it is estimated that, as of 2019, there are 22.51 million people aged 20 and older in Japan at risk of developing diabetes. On the other hand, the "Goals of Diabetes Treatment" set forth by the Japan Diabetes Society emphasize achieving a lifespan and quality of life (QOL) comparable to those without diabetes. This includes not only preventing the onset and progression of complications but also addressing the prevention and management of comorbidities that are increasing due to aging, as well as the removal of stigma, social disadvantages, and discrimination.

 It has been reported that the risk of cardiovascular events begins to increase from the stage of impaired glucose tolerance, even before the onset of diabetes. Moreover, good glycemic control from the early stages of diabetes not only contributes to preventing the onset and progression of complications but also reduces the risk of developing comorbidities, such as dementia. It is also reported that at the time of diagnosis of type 2 diabetes, pancreatic beta-cell function has decreased by approximately 50%. Therefore, early therapeutic intervention, while pancreatic beta-cell function remains, is believed to alleviate the decline in insulin secretion capacity and help maintain good glycemic management in the future.

 Since fiscal 2008, specific health checkups and specific health guidance have been mandatory for insured persons and dependents aged 40 to 75, aiming to prevent and detect lifestyle-related diseases early. Through early diabetes treatment, including lifestyle improvement, efforts have been made to prevent the progression of the disease. However, it is reported that only about 35% of those recommended for medical consultation due to abnormal glucose metabolism actually visit a medical institution, and the treatment discontinuation rate is approximately 8% per year. The underlying reasons are presumed to include the fact that diabetes often has no symptoms, insufficient awareness of the significance of preventing complications and comorbidities, and the negative image (stigma) associated with being diagnosed with diabetes.

 Recently, evidence has been accumulating on the effectiveness of early introduction of diabetes medications, such as SGLT2 inhibitors and GLP-1 receptor agonists, in suppressing the onset and progression of complications and comorbidities. Additionally, it has become possible to achieve high-quality glycemic control using advanced devices, such as Continuous Glucose Monitoring (CGM). If the consultation rate after health checkups improves, the potential to prevent complications and comorbidities increases, ultimately contributing to the extension of healthy life expectancy.

 This article provides an overview, from the perspective of a diabetes metabolism specialist, on the importance of early therapeutic intervention and the continuation of treatment for diabetes, with a focus on recent advancements in diabetes treatment.

 In 2023, the term "non-alcoholic fatty liver disease" was changed to "metabolic dysfunction-associated steatotic liver disease" (MASLD) to emphasize the significance of metabolic disease and include moderate alcohol consumption within its classification. The prognosis of MASLD encompasses both liver-related and cerebrovascular and cardiovascular events, as well as cancers in organs other than the liver. The progression of liver fibrosis in patients with MASLD is associated with diabetes and the presence of risk alleles in the patatin-like phospholipase domain-containing 3 gene. Noninvasive diagnostic methods are investigated to diagnose fibrosis, in order to provide alternatives to liver biopsy. The cornerstone of MASLD treatment is diet and exercise therapy, with no currently approved drugs covered by insurance. Several clinical trials are ongoing for the development of new medications.

 With glaucoma, diabetic retinopathy, and age-related macular degeneration among the leading causes of visual impairment, the ophthalmologic significance of medical checkup lies in the early detection of glaucoma and macular and other ocular fundus diseases. However, there are limitations to detection by color fundus photographs and intraocular pressure measurement in the regular medical checkup. Remarkable progress has been made in optical coherence tomography (OCT), which can sensitively detect changes in the optic nerve papilla and macular retina, and can now detect even very early glaucoma. In addition, early stages of age-related macular degeneration and macular epiretinal membrane are often left untreated until they progress because they are difficult to discern on regular fundus photographs. When this happens, recovery of visual function after treatment is poor. Currently, these diseases can also be detected relatively easily with the examination such as OCT and OCT angiography (OCTA). And some diseases are overlooked because the lesions are not seen within the range of a regular fundus photograph. This can be found with an ultra-wide-angle fundus camera, which can pick up lesions in the periphery. Furthermore, capillary occlusion and retinal neovascularization in diabetic retinopathy can also be detected with wide-angle OCTA. Thus, there is a significant difference in disease detection capability between ophthalmological inspection in medical checkups and ophthalmic examinations using advanced ophthalmic optical equipment. For this reason, the Kurashiki Medical Checkup Center began Eye Dock in September 2022 at the Kurashiki Medical Center Eye Center outpatient erea, where examination using highly accurate equipment is combined with ophthalmologist's examination using slit-lamp microscopy. The following includes the short-term results to date.