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リエゾンラボ研究会
発表内容

Title:
Cardiovascular event prevention in real world of diabetes

 

Hideaki Jinnouchi (Director, Jinnouchi Hospital)

 

Abstract:
We can find the first description of remedy for diabetes on Ebers Papirus BC1500 “ Oil and honey should be eaten by the patient over mornings four times for the suppression of his thirst and for curing his mortal illness. ” Today, diabetes is not mortal, but recognized as mortal from its cardiovascular risk. The first medication of diabetes is insulin(1921), which has only 90 years history in diabetes treatment. Only Insulin, sulfonylurea and biguanides (’50s) are the limited options for physicians for about 50 years. Since ’90s, medical treatment of type2 diabetes have been dramatically and rapidly changed. αGI, TZD, Glinide, DPP4 inhibitor, GLP-1-RA, SGLT2 inhibitor and Insulin analogues are now available. During such a situation, ‘Guidance for Industry; Diabetes Mellutus: Devloping Drugs and Therpeutic Biologics for Treatment and Prevention on new drug development’ was anounced from FDA in 2008. It gave an impact not only to industry but also physicians’ point of view about diabetes treatment. From its guidance, physicians’ mind on macrovascular complication increased and the number of global cardiovascular outcome study by global companies also increased. In addition, medication for risk management such as aspirin, statins, ARBs, CCBs, diuretics and technique such as PCI have been evaluated about their risk reduction effect in a series of cardiovascular adverse event outcome trial. Advance of monitoring technology is also sensational. Continuous Glucose Monitoring (CGM) can give us now important information about patient’s blood glucose profile that we could not obtain in real world before its availability especially about postprandial hyperglycemia and nocturnal asymptomatic hypoglycemia. New parameter MAGE developed for estimation of fluctuation of blood glucose is now widely utilized and importance of association between blood glucose fluctuation and dementia has been recognized. CGM technology still continue to advance, sensor augmented pump (SAP) has been launched recently in Japan. By exploring development of medical imaging enabled us to estimate more precisely the risk of major adverse cardiovascular events in each patient. MDCT, MRI/MRA. Endothelial function monitoring is performed by Endo-PAT2000 which enabled us to measure atherosclerotic risk quantitatively. Considering future diabetes treatment for the prevention of macrovascular event suggest how to cooperate in multidisiplinal situation. Diabetes treatment must be prosperous by collaboration of multidisciplinal technologies and patient-centered team-approach.