Declining trends of diabetic nephropathy, retinopathy and neuropathy with improving diabetes care indicators in Japanese patients with type 2 and type 1 diabetes (JDDM 46)

• Published in: BMJ open diabetes research & care Vol. 6; no. 1; p. e000521
• Main Authors: Yokoyama, Hiroki, Araki, Shin-ichi, Kawai, Koichi, Yamazaki, Katsuya, Tomonaga, Osamu, Shirabe, Shin-ichiro, Maegawa, Hiroshi
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.05.2018; BMJ Publishing Group
• Subjects: Blood pressure; Body mass index; Cardiovascular disease; Cholesterol; Clinical medicine; Diabetes; Diabetic nephropathy; Diabetic retinopathy; Glucose; Hemoglobin; Kidney diseases; Lipids; Obesity; Pathophysiology/Complications; Patients; Population; Quality; Trends; United States > US; Japan; nephropathy; diabetes care indicators; type 1 diabetes; type 2 diabetes; microvascular complications
• ISSN: 2052-4897; 2052-4897
• DOI: 10.1136/bmjdrc-2018-000521

ObjectiveWe examined changes in prevalence of diabetic microvascular/macrovascular complications and diabetes care indicators for adults in Japan with type 2 and type 1 diabetes over one decade.Research design and methodsTwo independent cohorts were recruited with the same inclusion criteria in 2004 (cohort 1: 3319 with type 2 and 286 with type 1 diabetes) and in 2014 (cohort 2: 3932 with type 2 and 308 with type 1 diabetes). Prevalence of complications and care indicators including achieving treatment targets for glycemia, blood pressure, lipid control, body mass index (BMI), and smoking were compared. In addition, patients in cohort 1 were re-examined in 2014 and their data were compared with the baseline data of each cohort.ResultsIn type 2 diabetes, the prevalence of nephropathy, retinopathy, neuropathy, chronic kidney disease, current smoking and stroke significantly decreased, with improvements in achieving treatment target rates in cohort 2 two as compared with cohort 1. In type 1 diabetes, the prevalence of nephropathy, retinopathy, chronic kidney disease, and hemoglobin A1Cvalues significantly decreased. Decreases in prevalence of microvascular complications in type 2 diabetes were similarly found in each age-matched and sex-matched group, whereas younger patients exhibited marked increase in BMI and lower treatment target achieving rates compared with elderly patients. Regarding normoalbuminuric renal impairment, only a slight increase in the prevalence was observed both in type 2 and type 1 diabetes. In cohort 1, re-examined in 2014, care indicators were significantly improved from 2004, while complications increased with getting 10 years older.ConclusionsWe observed declining trends of diabetic microvascular complications with improvement in diabetes care indicators in type 2 and type 1 diabetes. Younger patients with type 2 diabetes exhibited marked increase in BMI and lower rates of achieving treatment targets compared with elderly patients, which remains a concern.