BackgroundThe extent of medication adherence in patients with type 2 diabetes mellitus (T2DM) several years after starting treatment with hypoglycemic agents remains unknown. Most previous work on medication adherence targeting this group of patients has been undertaken across a single year or is questionnaire based. This study aimed to determine medication adherence status and factors affecting adherence 3 years after initiation of hypoglycemic agents, using a nationwide medical claim-based database in Japan.MethodsThis retrospective study was conducted on data from 884 subjects with T2DM to better understand medication adherence, the effects of polypharmacy, and other factors. We also investigated the effects of medication nonadherence on hemoglobin A1c levels. Proportion of days covered was defined as the number of days for which a hypoglycemic agent was prescribed and in the patient’s possession to the number of days in the observation period. A proportion of days covered ≥0.8 were considered adherent, and those with a value <0.8 as nonadherence. Polypharmacy was defined as taking ≥5 medications.ResultsOf the 884 patients investigated, 440 were considered adherent during the study period. Significant factors related to adherence included number of medications (3 or 4, or ≥5), male sex, age 50–<60 years, and total number of visits ≥17. Medication adherence was also a factor related to patients with hemoglobin A1c values < 7.0% at the end of the observation period.ConclusionsWe surveyed medication adherence for 3 years with post medication initiation, and found that subjects aged 50–<60 years, those with ≥3 concomitant medications, and those with a total number of visits ≥17 were more likely to be adherent and persistent, and more likely to continue their hypoglycemic agents. A high degree of medication adherence was found to have a positive influence on hemoglobin A1c levels.

Aim. To determine the diabetic foot ulcer incidence and examine its association with microangiopathy complications, including diabetic retinopathy (DR) and albuminuria (Alb), in type 2 diabetes patients. Methods. This was a retrospective cohort study of 1,305 patients with type 2 diabetes who were assigned to the following groups: Category 1, normoalbuminuria without DR (n = 712); Category 2, Alb without DR (n = 195); Category 3, normoalbuminuria with DR (n = 185); and Category 4, Alb with DR (n = 213). Cox proportional hazard models were used to compare the risks of developing diabetic foot ulcers across the categories. Results. During 14,249 person-years of follow-up, 50 subjects developed diabetic foot ulcers, with incidence rates of 1.6/1,000, 1.5/1,000, 3.4/1,000, and 12.5/1,000 person-years in Categories 1, 2, 3, and 4, respectively. After adjusting for the presence of diabetic neuropathy and macroangiopathy, the hazard ratios and 95% confidence intervals (CIs) for the risk of diabetic foot ulcer development were 0.66 (95% CI, 0.18–2.36), 1.72 (95% CI, 0.67–4.42), and 3.17 (95% CI, 1.52–6.61) in Categories 2, 3, and 4, respectively, compared with Category 1. Conclusion. The presence of DR and Alb significantly increases the risk of diabetic foot ulcer development.

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Objective The associations of insulin resistance and glycemic control with the risk of kidney stones were explored. Methods Generally healthy Japanese (n=2,171) who visited Saiseikai Central Hospital (Tokyo, Japan) for a health check were included in a cross-sectional study. We calculated odds ratios (OR) of having kidney stones in terms of four measures: fasting serum insulin, homeostasis model assessment of insulin resistance (HOMA-IR), fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c), adjusting for possible risk factors for kidney stones. Results Fasting serum insulin and HOMA-IR were non-significantly associated with the risk of kidney stones, whereas FPG and HbA1c were significantly associated. Compared with those with an FPG of <100 mg/dL, the ORs in those with an FPG of 100 to <126 mg/dL and !126 mg/dL were 1.38 (95% confidence interval [CI] =0.95-2.00) and 1.83 (95% CI =1.09-3.06) (p for trend =0.016). In relation to those with an HbA1c of <5.5%, the ORs in those with an HbA1c of 5.5 to <6.0%, 6.0% to <6.5% and !6.5% were 1.16 (95% CI =0.76-1.79), 1.25 (95% CI =0.70-2.23) and 1.98 (95% CI =1.11-3.52), respectively (p for trend = 0.027). The significant associations between glycemic control measures and the risk of kidney stones were preserved even after the adjustment for factors related to insulin resistance. Conclusion Glycemic control could be an independent risk factor for kidney stones.

Background: Percutaneous coronary intervention (PCI) is safe and effective in very elderly patients, defined as those who are age ≥85 years, with acute coronary syndrome (ACS). However, the prognostic factors remain unknown. The association between activities of daily living (ADL) and the prognosis after PCI has not yet been investigated. Hypothesis: Better ADL is associated with better 1-year prognosis. Methods: This retrospective study included 91 consecutive very elderly patients with ACS. We calculated the Barthel Index (BI) as an indicator for ADL. Patients were classified into 2 groups according to BI: high BI (≥85) and low BI (<85). The BI was assessed both on admission (pre-BI) and at discharge (post-BI). Results: In the 91 patients (mean age, 88.2 ± 3.0 years, 52% male), 1-year mortality was 33%. The Cox regression model demonstrated that low pre-BI was not a risk factor for 1-year mortality (hazard ratio: 0.73, 95% confidence interval [CI]: 0.30-1.78, P = 0.490). However, post-BI was significantly associated with 1-year mortality (hazard ratio: 0.25, 95% CI: 0.11-0.57, P = 0.001). The 1-year mortality of the high and the low post-BI group was estimated as 21% (95% CI: 12%-35%) and 62% (95% CI: 42%-82%), respectively. A 5-unit decrease in post-BI was related to a 1.10-fold increased risk for 1-year mortality (95% CI: 1.05-1.15, P < 0.001). Conclusions: Activities of daily living at discharge, although not before admission, may be a useful predictor for 1-year mortality in very elderly patients undergoing PCI for ACS. IntroductionIn elderly patients who are affected by comorbidities, primary percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) seems to be a promising strategy. 1 As PCI has become a safer and less invasive procedure, the very elderly population-defined as those age ≥85 years-is increasingly being referred for PCI, particularly in the setting of ACS. Although evidence on ACS in very elderly patients is scarce, a few studies have reported clinical outcomes related to this topic. A retrospective cohort study reported that long-term survival of patients age ≥90 years who underwent PCI was not inferior to those who were included in a Minnesota cohort matched by age and sex.2 Other studies have also reportedThe authors have no funding, financial relationships, or conflicts of interest to disclose.that PCI for patients with ACS who were ≥85 years was safe, feasible, and effective. 3,4 However, most patients with advanced age have disabilities such as dementia, cerebral infarction sequelae, and muscle weakness, all of which can influence their prognosis. This study aimed to confirm the hypothesis that better activities of daily living (ADL) is associated with better prognosis in very elderly patients with ACS who underwent PCI. Methods Study DesignThis study retrospectively included 91 consecutive patients, age ≥85 years, who were admitted to our hospital for ACS and underwent primary PCI between January 2007 and January 2014. We reviewed the medical records of all patients ...

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128HIGUCHI S et al. Circulation JournalOfficial Journal of the Japanese Circulation Society http://www. j-circ.or.jp he J wave, also known as the Osborn wave, 1 is a positive deflection at the terminal part of the QRS complex. Although J waves are often observed in hypothermic patients, 2 few reports have revealed the relationship between the presence of J waves and body temperature (BT). The exact BT at which J waves develop in clinical settings has not yet been determined.The J wave is noted not only in hypothermia but also in some nonhypothermic conditions such as Brugada and early repolarization syndromes. The presence of J waves in such syndromes is related to the occurrence of ventricular fibrillation (VF), leading to sudden death. However, whether hypothermic patients with J waves are susceptible to fatal ventricular arrhythmia or ventricular tachycardia (VT)/VF remains undetermined. Indeed, some previous reports have shown that the incidence of VT/VF is unexpectedly low in hypothermic patients with J waves, varying from 0% to 2%. 3-5 The augmentation of J waves following a long R-R interval is reported to be a marker for VF 6,7 because the heterogeneity of membrane potentials is expressed as augmentation of J waves and can induce VF due to phase 2 reentry. 8 A previous report demonstrated that VF developed after sudden augmentation of J waves in idiopathic VF, which was induced following a long coupling interval. 6 Such an event in hypothermic patients would serve as a warning sign for identifying patients at high risk of developing VF.In the present study, we sought to clarify the relationship between the incidence of J waves and BT, as well as the clinical implications of J waves in patients with accidental hypothermia. We also attempted to determine the augmentation of J waves following a long R-R interval in patients with atrial fibrillation (AF). Methods Study DesignWe studied 64 consecutive patients who were admitted to hospital for accidental hypothermia between 2002 and 2012. Of these, 63 were homeless people admitted during the winter. The remaining patient was not homeless, but succumbed to hypothermia in a cold house because of depression. We reviewed all the patients' medical records to evaluate clinical characteristics such as age, sex, vital signs, cause of hypothermia, ECG findings, and laboratory data on admission. Hypothermia was defined as a rectal temperature <35.0°C.