目的：近年，高齢糖尿病（DM）患者が増加しているが，高齢者でもインスリン治療を要する2型DM例が少なくない．後期高齢者医療制度施行により，"かかりつけ医"の治療する後期高齢DM患者増加が予想されるが，それら患者の日常外来診療で判断できる，簡明なインスリン治療導入基準が求められる．後期高齢2型DMで，インスリン治療必要性を決める要因である内因性インスリン分泌能をグルカゴン負荷試験（以下G負荷試験）にて調べ，インスリン治療要否を判断する指標を検討した．方法：公立つるぎ病院に入院した75歳以上の2型DM患者でG負荷を施行できた例のうち，肥満，進行した肝疾患，腎機能低下を除外した43例が対象である．G負荷は前·空腹時，6分後で血糖，血中Cペプチド（以下CPR）を測定した．その後，血糖コントロールの改善に努め，退院後12カ月目に治療法を調べた．結果：HbA1cを8.0%以下とするためインスリン治療を必要とした18例をI群，経口血糖降下剤治療でコントロール可能であった25例をOHA群とした．空腹時CPR，CPRインデックス（空腹時CPR/空腹時血糖×100，以下CPI），負荷6分後CPRおよび6分後CPR増加量がI群で有意に低値であった（p<0.001）．ROC解析にて，曲線下面積はCPI 0.973，6分後CPR 0.964，空腹時CPR 0.922，CPR増加量0.858と，CPIが最大でI群識別に最も有効であり，6分後CPRがほぼ同等だった．CPI 0.9未満でインスリン治療が必要とすると，有効度（（真陽性数+真陰性数）/全体数）が93.0%，感度（88.9%）+特異度（96.0%）が184.9%といずれも各指標中で最高だった．CPIと6分後CPRは強く相関した（r=0.801,p<0.001）．結論：後期高齢2型DM患者で，CPIはG負荷を施行せず，日常外来診療で安全，容易に，空腹時検査のみで測定可能な，インスリン治療要否を示す有効な指標であり，CPI 0.9未満の例はインスリン治療必要性の高いことが示唆された．

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This paper examines the relationship between the empirical policy research and the education finance and education policy process, and clarifies the agenda of future research.

“Evidence based policy” has been advocated in the context of today's political decision making everywhere. The area of education policy is no exemption. At the end of 2015, The Council on Economic and Finance Policy announced the “Action Program for Economic and Fiscal Revitalization” that emphasized the necessities of visualization of the financial input and policy output, concretization of “key performance indicators”, and research between inputs and outputs.

High quality data and empirical research are the necessary conditions of evidence based policy but not sufficient conditions. We can learn lessons from the past experience of the US education policy process. The politicization of policy research and evidence has been frequently observed in the context of the plural democracy of the US. We can find some reasons for the politicization of the empirical policy research. First, the evidence on education policy and finance is fragile, the policy effects are subtle, and this indecisiveness urges the political actors to take advantage of the evidence. Second, the methodology of quantitative analysis is much easier than in the past because of the lower cost of computers and easy-touse statistical packages. In spite of the greater technical sophistication, the risk and danger of misuse of the statistical techniques has become more pervasive. Third, as the outstanding nature of the field of education, the discrepancy of the knowledge between the policy researchers and the practitioners has been a serious problem.

The methodology of the policy evaluation, especially the analysis of treatment effects on the program evaluation, is too sophisticated for outsiders today to understand. However, this does not mean that the arguments about it are merely technical, or not the concern of persons on the street and practitioners because they has important policy implications. At least, the significant issues we seriously have to consider are the objects for evaluation―program or organization, which do we intend to evaluate?―, the difference between the (quasi-) experimental methods and the theory based “structural” methods, the relationship between internal validity and external validity, the consideration of noncognitive skills as the policy outputs.

Based on the above, for sound“ informed democracy” and controlling the politicization of the empirical policy research, we need to consider both the object-level issues regarding the implications of methodology and meta-level issues regarding evidence based education policy process.

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