We evaluated the cost-effectiveness of sulfonylurea combined with metformin (SU+Met) or pioglitazone (SU+Pio). The simulation model we developed to predict long-term prognosis and medical costs in a case of type 2 diabetes mellitus uses UKPDS regression equations and estimates annual risk for eight complications. Medical costs for individual complications were set based on information from the literature. Long-term prognosis was evaluated using quality-adjusted life years for Japanese subjects by adjusting the difference in incidence for ischemic heart disease and stroke between those observed using JDCS and using UKPDS regression equations. SU+Met had better QALYs at lower cost than SU+Pio. This model should be updated as new epidemiological data in Japan becomes available.

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We analyzed left ventricular (LV) diastolic dysfunction prevalence and features in 142 subjects with type 2 diabetes without valvular disease, atrial fibrillation, or ischemic heart disease history. The E/A ratio before and during the Valsalva maneuver was assessed with pulsed doppler and the E/Ea ratio (early transmitral to early diastolic annular velocity ratio) with pulsed tissue doppler imaging. The ejection fraction exceeded 50% in all subjects. LV diastolic function was normal in 75 (52.8%) and LV diastolic dysfunction found in 67 (47.2%) , of whom 16 (11.3%) showed a pseudonormal pattern. Those with LV diastolic dysfunction were older than those with normal function. Multiple logistic regression analysis showed that age ≥65 years [ (Odds ratio: 5.67 (95% CI, 2.48-12.96) , p<0.0001], resting heart rate ≥70 bpm [ (2.18 (1.02-4.65) , p<0.0441) ], and short-duration diabetes [ (0.49 (0.27-0.88) , p<0.0163) ] were at risk for LV diastolic dysfunction. Those with diastolic dysfunction were older even in their diabetes-duration subgroup than those without of less than 10 years. These findings suggest that diastolic dysfunction in type 2 diabetes is prevalent in those older and considerably influenced by aging.

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We studied urinary albumin, renal function decline, and arteriosclerosis in 505 outpatients with diabetes-54% men, mean age: 65 years. The albumin creatinine ratio (ACR) of spot-urine samples showed normoalbumiuria in 58%, microalbuminuria in 31%, and macroalbuminuria in 11%. Normoalbuminuria and microalbuminuria subjects were respectively classified into lower and higher groups by their median levels of urinary ACR. Annual change in estimated glomerular filtration rate (eGFR) and level of pulse wave velocity (PWV) were compared among the five groups, i.e., lower and higher normoarubuminuria, lower and higher microalbuminuria, and macroalbuminuria. Average eGFR changes (ml/min/1.73 m²/year) were -1.8, -3.3, -3.3, -3.9, and -4.3. Average levels of PWV (cm/s) were 1642, 1810, 1869, 1957, and 2018. Compared to the subjects with lower normoalbuminuria, those with higher had faster eGFR decline and more increased PWV, together with increased levels of diabetes duration, HbA1c, BMI, and blood pressure which are associated with both renal function and arteriosclerosis. Our results indicate that faster decline in renal function and increased arteriosclerosis are found from normoalbuminuria in those with diabetes.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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