Hiroaki Suzuki

Background: Maintaining long-term exercise adherence in occupational settings remains a challenge, particularly in remote or unsupervised environments. This study aimed to investigate the effect of individualized feedback on exercise adherence, body composition, and physical function during a remote home-based training intervention utilizing the video-based exercise system “SUKUBARA^®”. Methods: In total, 66 care facility workers were randomly categorized into either a feedback (FB) group or a non-feedback (NF) group. Both groups performed a combined exercise program comprising low-load resistance training (slow squats) and balance exercises (one-leg standing time of closed eye) for approximately 15 min, thrice weekly over 12 weeks. The FB group received individualized feedback sheets visualizing total video play time (TT), exercise frequency, and interruptions, alongside reminder emails. The primary outcome was TT. Secondary outcomes included body composition measures (body weight, fat-free mass, and body fat mass rate) and one-leg standing time of opened eye. Results: The FB group demonstrated significantly greater TT, approximately 1.5 times that of the NF group, indicating enhanced exercise adherence. Moreover, significant improvements in fat-free mass and body fat mass rate were observed in the FB group. A significant correlation was identified between changes in TT and body composition parameters, suggesting TT as a valid proxy for exercise engagement. Conclusions: Individualized feedback within a remote monitoring home exercise program effectively improved exercise adherence and body composition among care workers. The “SUKUBARA^®” system shows promise as a tool to support exercise continuity in occupational health and long-term care settings.

Low lean body mass increases fall risk. Some diabetes medications, specifically SGLT2 inhibitors and GLP-1RAs, can cause muscle and body mass loss. This study assessed their association on falls in type 2 diabetes patients. An annual fall survey was conducted for up to 5 years on individuals with type 2 diabetes admitted to our department. Fall risk factors were identified using discrete-time survival analysis. The study observed 471 participants over a median period of 2 years. The participants had a median age of 64 years, with a fall incidence rate of 17.1 per 100 person-years. Independent fall predictors identified were fall history, SGLT2 inhibitor use, and age. The odds ratios (95% confidence intervals) for using SGLT2 inhibitors only, GLP-1RAs only, and both combined were 1.80 (1.10–2.92), 1.61 (0.88–2.84), and 2.89 (1.27–6.56), respectively. SGLT2 inhibitor use was an independent risk factor for falls, while GLP-1RAs’ effects were not statistically significant. However, the combined use of SGLT2 inhibitors and GLP-1RAs significantly increased the risk of falls. Therefore, it is important to consider this risk when prescribing these medications to people with type 2 diabetes.

Although branched-chain amino acids (BCAA) are known to stimulate myofibrillar protein synthesis and affect insulin signaling and kynurenine metabolism (the latter being a metabolite of tryptophan associated with depression and dementia), the effects of BCAA supplementation on type 2 diabetes (T2D) are not clear. Therefore, a 24-week, prospective randomized open blinded-endpoint trial was conducted to evaluate the effects of supplementation of 8 g of BCAA or 7.5 g of soy protein on skeletal muscle and glycemic control as well as adverse events in elderly individuals with T2D. Thirty-six participants were randomly assigned to the BCAA group (n = 21) and the soy protein group (n = 15). Skeletal muscle mass and HbA1c, which were primary endpoints, did not change over time or differ between groups. However, knee extension muscle strength was significantly increased in the soy protein group and showed a tendency to increase in the BCAA group. Homeostasis model assessment for insulin resistance did not significantly change during the trial. Depressive symptoms were significantly improved in the BCAA group but the difference between groups was not significant. Results suggested that BCAA supplementation may not affect skeletal muscle mass and glycemic control and may improve depressive symptoms in elderly individuals with T2D.

We aimed to investigate the status of falls and to identify important risk factors for falls in persons with type 2 diabetes (T2D) including the non-elderly. Participants were 316 persons with T2D who were assessed for medical history, laboratory data and physical capabilities during hospitalization and given a questionnaire on falls one year after discharge. Two different statistical models, logistic regression and random forest classifier, were used to identify the important predictors of falls. The response rate to the survey was 72%; of the 226 respondents, there were 129 males and 97 females (median age 62 years). The fall rate during the first year after discharge was 19%. Logistic regression revealed that knee extension strength, fasting C-peptide (F-CPR) level and dorsiflexion strength were independent predictors of falls. The random forest classifier placed grip strength, F-CPR, knee extension strength, dorsiflexion strength and proliferative diabetic retinopathy among the 5 most important variables for falls. Lower extremity muscle weakness, elevated F-CPR levels and reduced grip strength were shown to be important risk factors for falls in T2D. Analysis by random forest can identify new risk factors for falls in addition to logistic regression.

Aim. We investigated the relationship between cognitive function and olfactory and physical functions in middle-aged persons with and without type 2 diabetes (T2D) to examine the potential of olfactory and physical functions as biomarkers for early cognitive impairment. Methods. Enrolled were 70 T2D patients (age 40 to 65y) and 81 age-matched control participants without diabetes. Cognitive function was assessed by the Montreal Cognitive Assessment (MoCA), Trail Making Test parts A and B (TMT-A/-B), Wisconsin Card Sorting Test (WCST), Quick Inventory of Depressive Symptomatology Self-Report (QIDS), and Starkstein Apathy Scale (SAS). Multiple linear regression analyses were performed. Results. Odor identification was an independent determinant shown in the results of the TMT-A in the entire participant group and was independently associated with the MoCA and TMT-B in the T2D group. Balance capability assessed with a stabilometer was independently associated with all cognitive function tests except for QISD and SAS in the entire participant group and the T2D group and was independently associated with TMT-A in the control group. Knee extension strength was independently associated with the SAS in the entire participant group and the T2D group. Conclusions. Odor identification, balance capability, and knee extension strength were potential markers for cognitive decline in middle-aged persons with T2D.

Recently, lidocaine topical systems utilizing nonaqueous matrices have been developed and provide efficient lidocaine delivery through the skin, such that lower concentrations of drug provide equivalent or greater drug delivery than drug-in-matrix hydrogel lidocaine patches. This study characterizes drug delivery from a nonaqueous lidocaine topical system with increasing drug load both in vitro and in vivo. Topical systems formulated with either 1.8% or 5.4% lidocaine were applied to healthy volunteers’ backs (n = 15) for 12 h in a single-center, open-label, four-treatment, four-period crossover pharmacokinetic study. Subjects were dosed with either three 1.8% systems or one, two, or three 5.4% systems in each period. Blood was collected for up to 48 h, and plasma lidocaine levels were measured with a validated HPLC method. In parallel, human and mouse skin models characterized the in vitro skin permeation profile. The pharmacokinetic profile was linear between one, two, and three lidocaine 5.4% applications. Application of three lidocaine 1.8% systems (108 mg lidocaine) was bioequivalent to one lidocaine 5.4% system (108 mg lidocaine). Both topical systems remained well adhered to the skin and irritation was mild. The 5.4% system had approximately threefold higher skin permeability than the 1.8% system in the mouse and human skin models. The results indicate increasing the drug load by three times results in triple the drug delivery both in vivo and in vitro. The relationship between the in vitro permeation and in vivo absorption correlates and is nonlinear.