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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)
  1. Hiroki Yokoyama1,
  2. Shin-ichi Araki2,
  3. Koichi Kawai3,
  4. Katsuya Yamazaki3,
  5. Osamu Tomonaga4,
  6. Shin-ichiro Shirabe5,
  7. Hiroshi Maegawa2
  8. for the JDDM study group
  1. 1 Internal Medicine, Jiyugaoka Medical Clinic, Obihiro, Japan
  2. 2 Department of Medicine, Shiga University of Medical Science, Otsu, Japan
  3. 3 Kawai Clinic, Tsukuba, Japan
  4. 4 Tomonaga Clinic, Tokyo, Japan
  5. 5 HEC Science Clinic, Yokohama, Japan
  1. Correspondence to Dr Hiroki Yokoyama; hiroki{at}


Objective We 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 methods Two 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.

Results In 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.

Conclusions We 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.

  • microvascular complications
  • type 2 diabetes
  • type 1 diabetes
  • nephropathy
  • diabetes care indicators

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  • Contributors HY, SA and HM designed the study. HY, KK, KY, OT and SS generated data. HY and SA performed the statistical analysis. All authors contributed to the interpretation of the data. HY, SA and HM drafted the manuscript. HY takes responsibility for the statistical methods and organised the multivariate analysis. All authors critically reviewed the manuscript. HY is the guarantor of this work and as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding The present study was supported by research programme grant from the Japan Diabetes Society and the Manpei Suzuki Diabetes Foundation.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Ethical committee of the Japan Diabetes Clinical Data Management Study and each participating clinic.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

  • Collaborators The following clinics from the JDDM study group contributed to the present study. Both cohorts; Fukumoto Clinic (Ibusuki), HEC Science clinic (Yokohama), Iwasaki Naika Clinic (Iwakuni), Jiyugaoka Medical Clinic (Obihiro), Kawai Clinic (Tsukuba), Sugimoto Clinic (Kitakyusyu), Minami Masae Clinic (Fukuoka), Oishi Naika Clinic (Kyoto), Takamura Naika Clinic (Fussa), Miyazawa Naika Clinic (Hokkaido) Cohort 1; Akasaka Chuo Clinic (Tokyo), Doi Clinic (Uji), Fuji Oyama Hospital (Gotenba), Kudo Clinic (Aomori), Takai Clinic (Ofuna), Takeda Clinic (Sagamihara), Toyo Kohan Clinic (Kure), Cohort 2; Abe Clinic (Oita), Hasegawwa Naika Clinic (Chitose), Hikari Clinic (Nara), Hotaruno Central Clinic (Kisarazu), Iwamoto Clinic (Zenkoji), JCHO Takaoka Fushiki Hospital (Takaoka), Kurihara Naika Clinic (Hokkaido), Misaki Naika Clinic (Funabashi), Okada Naika Clinic (Fukuoka), Okuguchi Naika Clinic (Sendai), Takaki Naika Clinic (Niigata), Tama Center Clinic Mirai (Tama), Tanaka Naika Clinic (Kurume), Tomonaga Clinic (Tokyo), Wakamatsu Kinen Hospital (Kagoshima), Wakamatsu Naika Clinic (Yurihonjo), Yagi Clinic (Naha), Yamada Naika Clinic (Obihiro).

  • Correction notice Please insert (JDDM 46) at the end of the title, as follows “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)”.

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