The status of diabetes control and antidiabetic drug therapy in Japan—A cross-sectional survey of 17,000 patients with diabetes mellitus (JDDM 1)
Introduction
The incidence and prevalence of type 2 diabetes mellitus are rapidly increasing worldwide in both developing and developed nations [1], [2]. The WHO projected the number of adults with diabetes to increase from 135 million in 1995 to 300 million in 2025, with the prevalence predicted to increase from 4.0% in 1995 to 5.4% in 2025 [1]. Such a dramatic rise in the prevalence of diabetes will have a great impact on the socioeconomic status of nations around the world.
The number of diabetic patients is also increasing in Japan. A recent national survey showed that between 1997 and 2002 the number of probable diabetic patients has increased from 6.9 million to 7.4 million and the number of probable impaired glucose tolerance (IGT) patients has increased from 6.8 million to 8.8 million [3]. Thus, 16.2 million people out of a total population of 120 million, or 13.5% of the population, are diabetic or have IGT. The prevalence of diabetes and IGT in adults of more than 40 years of age is around 23.8% [3]. These patients are at a significantly higher risk of diabetic complications if adequate medical care and patient education are not provided. The cost of treating diabetic complications, especially diabetic nephropathy that requires hemodialysis, continues to increase. Therefore, it is vital that diabetes mellitus is adequately managed to prevent such complications.
The effectiveness of medical care provided to diabetic patients can be estimated from an outcome study that analyzes the level of glucose control. Such outcome studies are necessary to determine the present status of diabetes medical care and the level of diabetic complications that may emerge in the future. A large-scale survey of the effectiveness of medical care in diabetes has not been performed in Japan. Therefore, we addressed this deficiency by surveying 38 clinics and hospitals. Laboratory data relating to diabetic medical treatment and complications, such as HbA1c and other clinical data, were collected and analyzed. The data show that Japan's medical performance in diabetes care is comparable or slightly superior to that of other countries.
Section snippets
Patients and methods
In 1998, we developed software (CoDiC) to store patient clinical data on personal computers [4], standardized the data format including the definition of type 1 and type 2 diabetes and complications, and recruited clinics and hospitals to join our Japan Diabetes Clinical Data Management Study Group (JDDM). The number of institutes recruited was 21 by the end of 2000, 25 by the end of 2001 and 38 by the end of 2002. At the end of January 2004, the total number of institutes stood at 61. The
Demographics
The clinical characteristics of the patients are summarized in Table 1. The majority of patients (95%) were diagnosed as having type 2 diabetes. The mean age of all the patients in 2002 was 61.9 ± 11.9 years, with the majority (59.2%) aged between 50 years and 70 years. The percentages of male and female patients were 60.5% and 39.5%, respectively. The mean body mass index (BMI, kg/m2) in 2002 was 24.0 kg/m2 with 46.9% exceeding the Japanese criteria for obesity (BMI ≥ 25 kg/m2) [7].
HbA1c values, patient type and treatment modality
As shown in Table
Discussion
Diabetic outcome studies were important for understanding the current management of diabetes and thereby improving the diabetic treatment. For example, in Asia, the glycemic control of a significant number of diabetic patients is poor [9], [10]. Consequently, these patients will develop more severe diabetic complications if further intervention is not taken [9], [10]. Collecting clinical data is not simple because of potential biases in selecting patients. The Japan Diabetes Clinical Data
Acknowledgments
This study was supported by a grant from Japan Diabetes Foundation. The software system ‘CoDiC’ was constructed by a support of Novo Nordisk Pharma Ltd. (Tokyo, Japan).
References (20)
- et al.
The Committee of the Japan Diabetes Society on the diagnostic criteria of diabetes mellitus, Report of the Committee on the classification and diagnostic criteria of diabetes mellitus
Diab. Res. Clin. Pract.
(2002) - et al.
Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections
Diab. Care
(1998) - et al.
The rising global burden of diabetes and its complications: estimates and projections to the year 2010
Diab. Med.
(1997) - Ministry of Welfare, Japan, Report of national survey of Diabetes,...
- et al.
Diabetes Campaign in Toyama prefecture and development of computerized diabetes care
Int. Diab. Monit.
(1999) - et al.
Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation
Diab. Med.
(1998) The Examination Committee of criteria for ‘Obesity Disease’ in Japan
Circ. J.
(2004)Guideline Committee of the Japan Diabetes Society: Japan Diabetes Society Guidelines for the Management of Diabetes based on Scientific Evidences
(2004)- et al.
The Diabcare-Asia 1998 study outcomes on control and complications in type 1 and type 2 diabetic patients
Curr. Med. Res. Opin.
(2002) - et al.
The status of diabetes control in Asia—a cross-sectional survey of 24317 patients with diabetes mellitus in 1998
Diab. Med.
(2002)
Cited by (130)
Annual trends in glycemic control and prescribing patterns in diabetic treatment according to age in Japanese patients with type 2 diabetes between 2012 and 2019 (JDDM 71)
2023, Diabetes Research and Clinical PracticeBody mass index and mortality among middle-aged Japanese individuals with diagnosed diabetes: The Japan Public Health Center-based prospective study (JPHC study)
2020, Diabetes Research and Clinical PracticeIncidence and predictors of remission and relapse of type 2 diabetes mellitus in Japan: Analysis of a nationwide patient registry (JDDM73)
2023, Diabetes, Obesity and Metabolism