TY - JOUR
T1 - Combination of disease duration-to-age at diagnosis and hemoglobin A1c-to-serum C-peptide reactivity ratios predicts patient response to glucose-lowering medication in type 2 diabetes
T2 - A retrospective cohort study across Japan (JDDM59)
AU - Japan Diabetes Data Management Study Group (JDDM)
AU - Kanatsuka, Azuma
AU - Sato, Yasunori
AU - Higashi, Yoichiro
AU - Goto, Yoshimasa
AU - Kawai, Koichi
AU - Maegawa, Hiroshi
AU - Abe, Katsunari
AU - Arai, Keiko
AU - Chosa, Riko
AU - Fujii, Nimi
AU - Fukumoto, Yoshihide
AU - Hasegawa, Atsusi
AU - Hayashi, Hiroshi
AU - Hirao, Koichi
AU - Hosokawa, Akiko
AU - Iemitsu, Kotaro
AU - Ishigaki, Yasushi
AU - Iizumi, Tomohiro
AU - Iwamoto, Masahiro
AU - Iwasaki, Koichi
AU - Kanamori, Akira
AU - Kashiwagi, Atsunori
AU - Kato, Masakazu
AU - Kato, Mitutoshi
AU - Kato, Sumio
AU - Kou, Shigetake
AU - Kouno, Yuki
AU - Kudo, Mikihiko
AU - Kuribayashi, Nobuichi
AU - Kurihara, Yoshio
AU - Manaka, Hideo
AU - Minami, Masae
AU - Miyazawa, Kazuhiro
AU - Moriai, Tetsuya
AU - Nakazono, Makoto
AU - Noto, Takasi
AU - Oishi, Mariko
AU - Okada, Akira
AU - Osonoi, Takeshi
AU - Shirabe, Shinichiro
AU - Sugimoto, Hidekatsu
AU - Taguchi, Madoka
AU - Takaki, Masato
AU - Takamura, Hiroshi
AU - Takeda, Hiroshi
AU - Tanaka, Kokichi
AU - Tomonaga, Osamu
AU - Tsuruoka, Akira
AU - Uchida, Daigaku
AU - Wakamatsu, Hideki
N1 - Funding Information:
We are grateful to all members of the JDDM, and to the following members of the JDDM for their help in recruiting the participants: Dr Katsunari Abe, Dr Keiko Arai, Dr Riko Chosa, Dr Nimi Fujii, Dr Yoshihide Fukumoto, Dr Atsusi Hasegawa, Dr Hiroshi Hayashi, Dr Koichi Hirao, Dr Akiko Hosokawa, Dr Kotaro Iemitsu, Dr Yasushi Ishigaki, Dr Tomohiro Iizumi, Dr Masahiro Iwamoto, Dr Koichi Iwasaki, Dr Akira Kanamori, Dr Atsunori Kashiwagi, Dr Masakazu Kato, Dr Mitutoshi Kato, Dr Sumio Kato, Dr Shigetake Kou, Dr Yuki Kouno, Dr Mikihiko Kudo, Dr Nobuichi Kuribayashi, Dr Yoshio Kurihara, Dr Hideo Manaka, Dr Masae Minami, Dr Kazuhiro Miyazawa, Dr Tetsuya Moriai, Dr Makoto Nakazono, Dr Takasi Noto, Dr Mariko Oishi, Dr Akira Okada, Dr Takeshi Osonoi, Dr Shin-ichiro Shirabe, Dr Hidekatsu Sugimoto, Dr Madoka Taguchi, Dr Masato Takaki, Dr Hiroshi Takamura, Dr Hiroshi Takeda, Dr Kokichi Tanaka, Dr Osamu Tomonaga, Dr Akira Tsuruoka, Dr Daigaku Uchida, Dr Hideki Wakamatsu, Dr Katsuya Yamazaki, Dr Noriharu Yagi, Dr Daishiro Yamada, Dr Kouhei Yamaguchi, Dr Mobuki Yano, Dr Hiroki Yokoyama and Dr Naohiko Yoshimura. We thank Editage (www.editage.com) for English language editing. This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Publisher Copyright:
© 2021 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd
PY - 2021/11
Y1 - 2021/11
N2 - Aims/Introduction: Knowing the collective clinical factors that determine patient response to glucose-lowering medication would be beneficial in the treatment of type 2 diabetes. We carried out a retrospective cohort study to explore the combination of clinical factors involved in its therapeutic efficacy. Materials and Methods: The results of cohort studies retrieved using the CoDiC® database across Japan from January 2005 to July 2018 were analyzed based on criterion that using insulin therapy indicates severe type 2 diabetes. Results: A logistic regression analysis showed that age at diagnosis, disease duration, hemoglobin A1c (HbA1c) and serum C-peptide reactivity (CPR) at medication commencement were associated with the probability of insulin treatment. Receiver operating characteristic curve showed that these clinical factors predicted insulin treatment positivity with an area under the curve of >0.600. The area under the curve increased to 0.674 and 0.720 for the disease duration-to-age at diagnosis ratio and HbA1c-to-CPR ratio, respectively. Furthermore, area under the curve increased to 0.727 and 0.750 in the indices (duration-to-age ratio at diagnosis × 43 + HbA1c) and (duration-to-age ration at diagnosis × 21 + HbA1c-to-CPR ratio), respectively. After stratification to three groups according to the indices, monthly HbA1c levels during 6 months of treatment were higher in the upper one-third than in the lower one-third of patients, and many patients did not achieve the target HbA1c level (53 mmol/mol) in the upper one-third, although greater than fourfold more patients were administered insulin in the upper one-third. Conclusions: The combination of disease duration-to-age at diagnosis and HbA1c-to-CPR ratios is a collective risk factor that predicts response to the medications.
AB - Aims/Introduction: Knowing the collective clinical factors that determine patient response to glucose-lowering medication would be beneficial in the treatment of type 2 diabetes. We carried out a retrospective cohort study to explore the combination of clinical factors involved in its therapeutic efficacy. Materials and Methods: The results of cohort studies retrieved using the CoDiC® database across Japan from January 2005 to July 2018 were analyzed based on criterion that using insulin therapy indicates severe type 2 diabetes. Results: A logistic regression analysis showed that age at diagnosis, disease duration, hemoglobin A1c (HbA1c) and serum C-peptide reactivity (CPR) at medication commencement were associated with the probability of insulin treatment. Receiver operating characteristic curve showed that these clinical factors predicted insulin treatment positivity with an area under the curve of >0.600. The area under the curve increased to 0.674 and 0.720 for the disease duration-to-age at diagnosis ratio and HbA1c-to-CPR ratio, respectively. Furthermore, area under the curve increased to 0.727 and 0.750 in the indices (duration-to-age ratio at diagnosis × 43 + HbA1c) and (duration-to-age ration at diagnosis × 21 + HbA1c-to-CPR ratio), respectively. After stratification to three groups according to the indices, monthly HbA1c levels during 6 months of treatment were higher in the upper one-third than in the lower one-third of patients, and many patients did not achieve the target HbA1c level (53 mmol/mol) in the upper one-third, although greater than fourfold more patients were administered insulin in the upper one-third. Conclusions: The combination of disease duration-to-age at diagnosis and HbA1c-to-CPR ratios is a collective risk factor that predicts response to the medications.
KW - Cohort study
KW - Collective risk factor
KW - Type 2 diabetes
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U2 - 10.1111/jdi.13558
DO - 10.1111/jdi.13558
M3 - Article
C2 - 33837666
AN - SCOPUS:85106238394
VL - 12
SP - 1967
EP - 1977
JO - Journal of Diabetes Investigation
JF - Journal of Diabetes Investigation
SN - 2040-1116
IS - 11
ER -