Abstract
BackgroundWe examined the long-term changes in the management of diabetes at a single institution in Japan.MethodsTwo repeated cross-sectional studies and a retrospective cohort study were conducted among patients who visited our institution between 2001 and 2013. We examined the changes in glycated hemoglobin (HbA1c) and glycated albumin levels, the prescription frequencies, and the daily doses of each antidiabetic agent among patients treated regularly for diabetes during the 13-year study period. The trends in control and treatment parameters were analyzed using Spearman’s rank correlation coefficient.ResultsIn the first repeated cross-sectional studies, 200,298 patients had their glucose metabolism indicators measured, and diabetologists prescribed medications to 193, 445 patients. Of these, 170 patients were included in the retrospective cohort study. The patients’ diabetic control tended to improve over the study period. The mean HbA1c level improved from 7.9 to 7.6% (from 63 to 60 mmol/mol) (rs = −0.11, p < 0.01) in the cross-sectional study, corresponding to a change from 8.2 to 7.7% (from 66 to 61 mmol/mol) (rs = −0.22, p < 0.01) in the retrospective study. The mean GA level improved from 22.7 to 20.7% (rs = −0.13, p < 0.01) in the cross-sectional study and from 23.5 to 21.5% (rs = −0.14, p < 0.01) in the retrospective study. Over the study period, prescription frequencies and daily doses of antidiabetic agents changed as treatment guidelines were altered.ConclusionsThe present study revealed a tendency toward long-term improvements in diabetic control, with changes in the prescription patterns consistent with research and guideline evidence.Electronic supplementary materialThe online version of this article (doi:10.1186/s13098-016-0187-8) contains supplementary material, which is available to authorized users.
Highlights
We examined the long-term changes in the management of diabetes at a single institution in Japan
The repeated cross‐sectional study of diabetic control Table 1 shows extracted glycated hemoglobin and extracted glycated albumin data for changes in the parameters of diabetic control observed in the repeated cross-sectional study
Similar to the results for glycated hemoglobin (HbA1c), the mean glycated albumin level tended to decrease from 22.7% in 2003 to 20.7% in 2013
Summary
We examined the long-term changes in the management of diabetes at a single institution in Japan. The incidence of diabetes is rising globally. In Japan, 16.2% of men and 9.2% of women either have or are strongly suspected of having diabetes [2]. As the number of patients with diabetes increases, the associated medical costs rise in tandem. Glycated hemoglobin (HbA1c) levels are affected by anemia, age, and other factors, and when used in isolation, they are not very accurate for monitoring diabetes in patients with conditions such as impaired renal function or in those who are pregnant [4,5,6]. Glycated albumin levels, which reflect blood glucose levels over the previous two weeks and are useful in managing diabetes with chronic renal dysfunction [7,8,9].
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