Hiroaki Satoh

Background: Urinary liver‐type fatty acid‐binding protein (L‐FABP) reflects proximal tubular stress and has been proposed as a biomarker of diabetic kidney disease. We examined whether urinary L‐FABP provides information on longitudinal kidney function beyond urinary albumin‐to‐creatinine ratio (UACR). Methods: This retrospective cohort study included patients with type 2 diabetes who had UACR and urinary L‐FABP measured simultaneously at the initial visit and underwent outpatient follow‐up. The analysis included patients with at least three eGFR measurements over at least 2 years. eGFR trajectories were evaluated using linear mixed‐effects models with random intercepts and slopes. UACR and L‐FABP were analyzed as log(1 + x )‐transformed continuous variables. Results: The analysis included 1,031 patients (age 58.1 years; 65.1% men), with a median follow‐up of 4.76 years and a median of 10 eGFR measurements. Urinary L‐FABP correlated with UACR (Spearman ρ = 0.526; p < 0.001). Both biomarkers were independently associated with lower baseline eGFR. In a model without UACR, higher L‐FABP was associated with faster eGFR decline (−0.98 mL/min/1.73 m²/year per unit increase in log[1 + L‐FABP]; p < 0.001). After adjustment for continuous UACR, the association was attenuated and no longer significant (−0.19; 95% CI, −0.49 to 0.11; p = 0.221), whereas UACR remained independently associated with eGFR decline. Results were unchanged after further adjustment for baseline eGFR and lipid parameters. Conclusions: Urinary L‐FABP was associated with baseline kidney impairment but did not independently predict eGFR trajectory after continuous UACR was taken into account. Urinary L‐FABP reflects kidney injury severity, although its incremental prognostic value beyond quantitatively assessed albuminuria was limited in this cohort.

Low adrenocorticotropic hormone (ACTH) in a patient with an adrenal incidentaloma is usually attributed to ACTH-independent cortisol secretion. A 71-year-old woman with a 20-mm left adrenal mass had no cushingoid features. After a 1-mg dexamethasone suppression test, serum cortisol was 5.59 μg/dL (SI: 154 nmol/L) (cutoff, <1.8 μg/dL [SI: <50 nmol/L]), and ACTH was below 1.5 pg/mL (SI: below 0.33 pmol/L) (reference range, 7-63 pg/mL [SI: 1.5-13.9 pmol/L]). Late-night serum cortisol was 7.29 μg/dL (SI: 201 nmol/L) (cutoff, <5.0 μg/dL [SI: <138 nmol/L]), supporting mild autonomous cortisol secretion. Combined pituitary stimulation testing showed a blunted, delayed ACTH increase from 4.2 (SI: 0.92 pmol/L) to 11.8 pg/mL (SI: 60 pmol/L) without a cortisol response, whereas other anterior pituitary axes were preserved. A short Synacthen test showed an inadequate peak cortisol of 10.8 μg/dL (SI: 298 nmol/L) (adequacy cutoff, ≥18 μg/dL [SI: approximately 500 nmol/L]), and dehydroepiandrosterone sulfate was 37 ng/mL (SI: 0.10 μmol/L) (reference range, 70-495 ng/mL [SI: 0.19-1.34 μmol/L]). Possible isolated ACTH deficiency was diagnosed. Annual testing remained unchanged over 4 years.

Introduction: Type 2 diabetes mellitus and chronic kidney disease are associated with increasing risk of constipation. We previously reported that Bifidobacterium bifidum G9‐1 improved stool consistency, bowel movement, and quality of life of patients with type 2 diabetes mellitus, chronic kidney disease, and constipation. However, the effect of patients' background characteristics on the efficacy of B. bifidum G9‐1 has not yet been investigated. Materials and Methods: This prespecified subgroup analysis of the BIRDIE study investigated the effect of age, sex, and baseline renal function on the efficacy of B. bifidum G9‐1. Results: The primary endpoint, the percentage of participants with normal stool consistency at week 12, significantly increased in participants aged ≥65 years, male, and those with estimated glomerular filtration rate of ≥60 mL/min/1.73 m ² . Regarding the secondary endpoints, although the improved variables differed according to subgroup, the constipation score on the Gastrointestinal Symptom Rating Scale and abdominal bloating among the abdominal symptoms significantly improved in most of the subgroups, except for the subgroup including only a few participants. Metformin users were more likely to experience relief from constipation, whereas insulin users were less likely to experience improvement. Discussion: Patients aged ≥65 years, male, and those with estimated glomerular filtration of ≥60 mL/min/1.73 m ² are more likely to benefit from treatment with B. bifidum G9‐1. These results may provide useful guidance for considering treatment options based on patients' background characteristics upon treatment of constipation in patients with type 2 diabetes mellitus and chronic kidney disease.

A 46-year-old man with a 15-year history of type 2 diabetes had maintained hemoglobin A1c (HbA1c) around 6.5% (SI: 48 mmol/mol) (reference range, 4.7%-6.2% [28-44 mmol/mol]) for approximately 12 years on saxagliptin monotherapy, but glycemic control worsened over 1 year despite additional ipragliflozin and metformin. Abdominal computed tomography (CT), performed after health-screening urine dipstick protein positivity, detected a left adrenal mass. He had tachycardia and weight loss but no palpitations, headache, pallor, or diaphoresis. Biochemical tests showed marked catecholamine excess and elevated 24-hour urinary metanephrines, and iodine-123 metaiodobenzylguanidine (123I-MIBG) scintigraphy showed concordant uptake. Before surgery, fasting C-peptide was 0.64 ng/mL (SI: 0.21 nmol/L) (reference range, 0.80-2.50 ng/mL [SI: 0.26-0.83 nmol/L]), C-peptide index was 0.51, and homeostasis model assessment of beta-cell function (HOMA-beta) was 11.0. After alpha blockade and volume expansion, laparoscopic left adrenalectomy confirmed pheochromocytoma. Antihypertensive and glucose-lowering medications were discontinued postoperatively, and glycemic control remained stable without antidiabetic medication at 6 months. This case highlights pheochromocytoma as a reversible endocrine cause of rapid worsening of previously stable type 2 diabetes.

Aims: For long‐term management of diabetes, patients with type 2 diabetes mellitus require a high level of treatment adherence, which is associated with treatment satisfaction and their quality of life (QOL). To achieve it, patient education about diabetes self‐management is essential. We routinely conduct a 7 day inpatient diabetes education program and administer the diabetes treatment‐related (DTR)‐QOL questionnaire to all participants, both before admission and at discharge. Here, we investigated whether our program improves QOL and post‐discharge glycemic control.Materials and Methods: This retrospective study utilized data from patients with type 2 diabetes mellitus who participated in our program between July 2017 and March 2020 and who had been treated in our outpatient department for more than 1 year. We evaluated the relationship between at admission and at discharge diabetes treatment‐related quality of life scores and glycemic control after discharge.Results: Data from 140 patients were analyzed in this study, which showed a significant improvement in the total, ‘Anxiety and dissatisfaction with treatment’, and ‘Satisfaction‐with‐treatment’ scores. A significant improvement was evident in HbA1c at 12 months after discharge. Multiple regression analysis showed that HbA1c after 12 months was independently associated with gender, duration of diabetes, and HbA1c at admission.Conclusions: Our program effectively improves quality of life and post‐discharge glycemic control in patients with type 2 diabetes mellitus. It is particularly effective in patients of the male gender, with a shorter duration of diabetes mellitus and higher HbA1c at admission.

Residents were forced to evacuate owing to the radiation released after the Fukushima Nuclear Power Plant (NPP) accident following the Great East Japan Earthquake on 11/03/2021; thus, their lifestyles drastically changed. The Comprehensive Health Check (CHC) of the Fukushima Health Management Survey (FHMS) was performed to evaluate health statuses and prevent lifestyle-related diseases in evacuation area residents. The first part of the CHC survey is a retrospective analysis of pre- and post-disaster data on health check-ups of evacuation area residents. The second part is a cross-sectional, prospective analysis of post-disaster (fiscal year (FY) 2011–2017) data on health check-ups. Subjects were men and women living in 13 municipalities in areas surrounding the NPP in Fukushima Prefecture. Post-disaster (FY 2011–2012) overweight, hypertension, dyslipidemia, diabetes mellitus, metabolic syndrome, liver dysfunction, hyperuricemia, polycythemia and atrial fibrillation cases increased from the pre-disaster (FY 2008–2010) levels. This tendency was strongest among residents who were forced to evacuate. Proportion of overweight people remained unchanged, the prevalence of liver dysfunction decreased and the proportion of people with treated hypertension and dyslipidemia increased during FY 2011–2017. Meanwhile, the prevalence of diabetes mellitus and mean levels of HbA1c increased. Furthermore, Evacuees showed higher risks of diabetes mellitus, dyslipidemia, chronic kidney diseases and liver dysfunction than non-evacuees. Therefore, residents in the evacuation area, especially evacuees, are at high risk of developing lifestyle-related diseases, especially cardiovascular diseases; therefore, it is necessary to observe health statuses and implement measures to prevent lifestyle-related diseases.

BackgroundThe Great East Japan Earthquake and the Fukushima Daiichi nuclear disaster forced the evacuation of residents and led to many changes in lifestyle for the evacuees. The Comprehensive Health Check was implemented to support the prevention of lifestyle-related disease and we analyzed the effect of prolonged evacuation (average of 3.0 years) on the new onset of hyper-LDL cholesterolemia.MethodsThe study participants were Japanese adults living near the Fukushima Daiichi nuclear power plant in Fukushima Prefecture. Annual health checkups focusing on metabolic syndromes were conducted for persons ≥ 40 years by the Specific Health Checkup. Based on data from annual checkups from 2011 or 2012, we followed 18,670 non-hyper-LDL cholesterolemia who underwent at least one other annual checkup during 2013-2015.ResultsWe found that the new onset of hyper-LDL cholesterolemia was significantly by 31% higher in evacuees than in non-evacuees. Evacuees had a significantly higher prevalence of obesity, hypertension, and diabetes, and higher frequency of weight change. Furthermore, logistic regression model analysis showed that the evacuation was significantly associated with the new onset of hyper-LDL cholesterolemia after adjusting age, gender, body mass index (BMI), smoking habit, alcohol consumption, diabetes, weight change, sleep deprivation, and exercise.ConclusionsThe findings of the present study suggest that prolonged evacuation after a disaster is a risk factor for the new onset of hyper-LDL cholesterolemia, and lead to an increase in cardiovascular disease. It is therefore important to follow-up evacuees and recommend lifestyle changes where necessary.

Background: Patients with diabetes mellitus (DM) are a high-risk group for coronary artery disease (CAD). In the present study, we investigated predictive factors to identify patients at high risk of CAD among asymptomatic patients with type 2 DM based on coronary computed tomographic angiography (CCTA) findings. Methods: A single-center prospective study was performed on 452 consecutive patients with type 2 DM who were provided with a weekly hospital-based diabetes education program between 3 October 2015, and 31 March 2020. A total of 161 consecutive asymptomatic patients (male/female: 111/50, age: 57.3 ± 9.3 years) with type 2 DM without any known CAD underwent CCTA. Based on conventional coronary risk factors and non-invasive examination, i.e., measurement of intima-media thickness, subcutaneous and visceral fat area, a stress electrocardiogram test, and the Agatston score, patients with obstructive CAD, CT-verified high-risk plaques (CT-HRP), and optimal revascularization within 90 days were evaluated. Results: Current smoking (OR, 4.069; 95% C.I., 1.578–10.493, p = 0.0037) and the Agatston score ≥100 (OR, 18.034; 95% C.I., 6.337–51.324, p = 0.0001) were independent predictive factors for obstructive CAD, while current smoking (OR, 5.013; 95% C.I., 1.683–14.931, p = 0.0038) was an independent predictive factor for CT-HRP. Furthermore, insulin treatment (OR, 5.677; 95% C.I., 1.223–26.349, p = 0.0266) was the only predictive factor that correlated with optimal revascularization within 90 days. Conclusions: In asymptomatic patients with type 2 DM, current smoking, an Agatston score ≥100, and insulin treatment were independent predictive factors of patients being at high-risk for CAD. However, non-invasive examinations except for Agatston score were not independent predictors of patients being at high risk of CAD.