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gastrointestinal symptom prevalence depends on disease duration and gastrointestinal region in type 2 diabetes mellitus

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World Journal of Gastroenterology 2017年第36期23卷 6694-6704页

作者： Midori Fujishiro akifumi kushiyama Hiroki Yamazaki Sunao Kaneko Yuko Koketsu Takeshi Yamamotoya Takako Kikuchi Hideyuki Sakoda Ryo Suzuki Takashi Kadowaki Department of Diabetes and Metabolic Diseases Graduate School of Medicine the University of Tokyo Division of Diabetes and Metabolism Institute for Adult Diseases Asahi Life Foundation Department of Diabetes and Metabolic Diseases Shinko Hospital Department of Medical Science Graduate School of Medicine University of Hiroshima Division of Neurology Respirology Endo-crinology and Metabolism Department of Internal Medicine Faculty of Medicine University of Miyazaki

AIM To unravel relationships between gastrointestinal(GI)symptoms impairing quality of life(QOL)and clinical profiles of diabetes mellitus(DM)patients. METHODS We enrolled 134 outpatients with type 2 *** age was 64.7 years,mean body mass index was 24.7 RESULTS Lower abdominal symptoms were found to be more frequent than those affecting the upper *** duration and medications showed associations with GI *** identified differences in peak prevalences of the five ***(P=0.02vs 10-14 years)and total GI symptoms(P=0.01 and P=0.02 vs 5-9 years and 10-14 years,respectively)peaked at a diabetes duration of 15-19 ***(P=0.004)and postprandial fullness(P=0.03)tended to increase with disease *** and diarrhea showed bimodal peaks,with the first early and the second late(e.g.,P=0.03 at 15-19 years vs 10-14years for diarrhea)in the disease ***,GI symptoms showed clustering that reflected the region of the GI tract affected,i.e.,constipation and diarrhea had similar frequencies(P<0.0001). CONCLUSION Our study highlights the importance of questioning patients about QOL impairment due to abdominal symptoms,especially in the early and the late periods of diabetes.

关键词： Gastrointestinal symptoms Questionnaire survey Disease duration Type 2 diabetes Quality of life Gastrointestinal tract regions

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Linking uric acid metabolism to diabetic complications

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World Journal of Diabetes 2014年第6期5卷 787-795页

作者： akifumi kushiyama Kentaro Tanaka Shigeko Hara Shoji Kawazu Division of Diabetes and Metabolism The Institute for Adult DiseasesAsahi Life Foundation2-2-6

Hyperuricemia have been thought to be caused by the ingestion of large amounts of purines, and prevention or treatment of hyperuricemia has intended to prevent gout. Xanthine dehydrogenase/xanthine oxidase(XDH/XO) is rate-limiting enzyme of uric acid generation, and allopurinol was developed as a uric acid(UA) generation inhibitor in the 1950 s and has been routinely used for gout prevention since then. Serum UA levels are an important risk factor of disease progression for various diseases, including those related to lifestyle. Recently, other UA generation inhibitors such as febuxostat and topiroxostat were launched. The emergence of these novel medications has promoted new research in the field. Lifestyle-related diseases, such as metabolic syndrome or type 2 diabetes mellitus, often have a common pathological foundation. As such, hyperuricemia is often present among these patients. Many in vitro and animal studies have implicated inflammation and oxidative stress in UA metabolism and vascular injury because XDH/XO act as one of the major source of reactive oxygen species Many studies on UA levels and associated diseases implicate involvement of UA generation in disease onset and/or progression. Interventional studies for UA generation, not UA excretion revealed XDH/XO can be the therapeutic target forvascular injury and renal dysfunction. In this review, the relationship between UA metabolism and diabetic complications is highlighted.

关键词： Uric acid Xanthine dehydrogenase/xanthine oxidase Diabetes mellitus Diabetic complications Xanthine oxidase inhibitor Metabolism

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Prediction of the effect on antihyperglycaemic action of sitagliptin by plasma active form glucagon-like peptide-1

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世界糖尿病杂志：英文版（电子版） 2016年第11期7卷 230-238页

作者： akifumi kushiyama Takako Kikuchi Kentaro Tanaka Tazu Tahara Toshiko Takao Yukiko Onishi Yoko Yoshida Shoji Kawazu Yasuhiko Iwamoto Division of Diabetes and Metabolism Institute for Adult Diseases Asahi Life Foundation Department of Nephrology School of Medicine Faculty of Medicine Toho University

AIM: To investigate whether active glucagon-like peptide-1(GLP-1) is a prediction Factor of Effect of sitagliptin on patients with type 2 diabetes mellitus(GLP-1 FEST:UMIN000010645). METHODS: Seventy-six patients with type 2 diabetes, who had insufficient glycemic control [Hemoglobin A1c(Hb A1c) ≥ 7%] in spite of treatment with metformin and/or sulfonylurea, were included in the investigation. Patients were divided into three groups by tertiles of fasting plasma active GLP-1 level, before the administration of 50 mg sitagliptin. RESULTS: At baseline, body mass index, serum UA, insulin and HOMA-IR were higher in the high active GLP-1 group than in the other two groups. The high active GLP-1 group did not show any decline of Hb A1c(7.6% ± 1.4% to 7.5% ± 1.5%), whereas the middle and low groups indicated significant decline of Hb A1c(7.4 ± 0.7 to 6.8 ± 0.6 and 7.4 ± 1.2 to 6.9 ± 1.3, respectively) during six months. Only the low and middle groups showed a significant increment of active GLP-1, C-peptide level, a decreased log and proinsulin/insulin ratio after administration. In logistic analysis, the low or middle group is a significantexplanatory variable for an Hb A1 c decrease of ≥ 0.5%, and its odds ratio is 4.5(1.40-17.6)(P = 0.01) against the high active GLP-1 group. This remains independent when adjusted for Hb A1 c level before administration, patients' medical history, medications, insulin secretion and insulin ***: Plasma fasting active GLP-1 is an independent predictive marker for the efficacy of dipeptidyl peptidase 4 inhibitor sitagliptin.

关键词： Dipeptidyl peptidase-4 inhibitor Active form glucagon-like peptide-1 Hemoglobin A1c Regression analysis

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