Recent treatment results
Approximately two-thirds of patients have HbA1c less than 6.5% after treatment at our hospital
According to recent statistics at our hospital, from August to September 2015, about 60% of outpatients had HbA1c less than 6.5% (NGSP). As shown in the figure below, nearly half of patients who do not receive insulin injections are between 6 and 6.4%. Less than 6% (5% level) is close to 15%.
Even more surprisingly, when it was less than 7%, it accounted for about 80-85%. In other words, it can be seen that many outpatients have succeeded in glycemic control to a level where diabetic complications are unlikely to progress. (However, patients who have not been treated at our hospital for 3 months or more with 7.5% or more at the first visit and patients who are participating in clinical trials are excluded.)
In other words, the majority of patients with HbA1c less than 7% account for about 85%, and conversely, the number of patients with HbA1c 7% or more decreases to about 15%. The opposite of the first visit, the majority of patients have good glycemic control.
Due to our unique treatment policy and the cooperation of each pharmaceutical manufacturer, the number of patients who can stop insulin treatment is increasing rapidly.
Applying DPP4 inhibitor and GLP1 receptor agonist, HbA1c is usually 6.5% or less
Decrease of HbA1c after the treatment of SGLT2 inbititor
Since the start of DPP4 inhibitors, HbA1c has fallen quickly, and reducing the amount and frequency of insulin injections has become commonplace in routine practice. HbA1c also usually decreases by 0.5% on average, and it will definitely decrease as shown in the figure below. There is no difference in HbA1c reduction between the elderly and the young. HbA1c was 7.8% at the first visit due to poor glycemic control, but it decreased to 6.5% or less after half a year by using a DPP4 inhibitor. Even if HbA1c was 7.3% at the first visit, it could be reduced to 6% by adding a DPP4 inhibitor in patients who had decreased to 6.4% without DPP4 inhibitor. .. It was accepted and published in an English magazine called Endocrine Res overseas.
HbA1c changes in GLP1 receptor agonist users
We are actively prescribing a weekly GLP1 receptor agonist (AstraZeneca, GLP1 parking) to many patients. As of July 2015, 42 patients are receiving this treatment. Among them, 33 SGLT2 inhibitors (mean HbA1c decrease was -1.9%). Nine people did not receive the SGLT2 inhibitor prescription (the average decrease in HbA1c was -2.6%. Since the HbA1c was sufficiently reduced, nine people were judged not to need the SGLT2 inhibitor. Most of the patients who were first seen were receiving frequent insulin therapy for insulin, and these patients are now receiving weekly injections. As shown in this figure, HbA1c is normal at 7% or less. About half of them have HbA1c of 6.5% or less.
If you are tired of daily insulin injections, come to our clinic and we will consider whether such treatment is possible. And it is our basic policy to reduce the number of injections as much as possible. I think that this hospital is the only hospital in Japan that has published the treatment results so far.
SGLT2 inhibitor further lowers HbA1c
Decrease of HbA1c after the treatment of SGLT2 inbititor
If SGLT2 inhibitor is treated with DPP4 inhibitor and additional treatment is performed, a further decrease in HbA1c can be observed as shown below. (Quoted from AstraZeneca, materials). Therefore, until now, even if HbA1c does not easily fall below 6.5%, there are few patients who can further reduce HbA1c by 0.5% and HbA1c below 6%. there is no. If you go to a good hospital and lower it by 0.5%, it will be around 6% even for people with poor glycemic control, and it will be less than 6% for people with good glycemic control. At our hospital, the compatibility between GLP1 receptor agonists and SGLT2 inhibitors is extremely good, and most patients have HbA1c of 7% or less. (Especially, the combination of GLP1 weekly preparation and SGLT2 inhibitor is especially frequently used because both of them also have the effect of losing weight.) You can see that this is the result of providing high-level medical care at threats even at diabetes medical facilities in Japan.
This is the clinical results of patients who prescribed our SGLT2 inhibitor. The survey was limited to 136 people who had taken the drug for 6 months or more. As a result, 97.8% of the respondents achieved either HbA1c reduction or weight loss 3 months after oral administration. Both HbA1c and body weight improved with 70%. On average, HbA1c was reduced by 0.7% and weight was reduced by 2.4 kg.
However, after 6 months of oral administration, the percentage of those who achieved either HbA1c decrease or weight loss decreased to 53.4%, and the number of those who lost only weight and did not decrease HbA1c became 31.6%. It was.
In other words, whether or not there is compensatory overeating determines whether weight loss is successful or whether overeating raises HbA1c. However, after 6 months, it has dropped by 0.8% on average. I have lost 3 kg of weight.
Thus, the benefit of SGLT2 inhibitors is that you can fairly certainly guarantee that you will either lower HbA1c or lose weight. And if you adhere to your diet, more people will improve their HbA1c and weight.
6.5% HbA1c when taking SGLT2 inhibitors, 6.3% when not taking
If you are taking SGLT2 inhibitors at our hospital, the median HbA1c is 6.5%. However, if you were not taking SGLT2 inhibitors and you did not need to prescribe SGLT2 inhibitors, the median HbA1c was 6.3%. Especially in summer, it tends to be lower. However, insulin injection patients are excluded. Retinopathy occurs when HbA1c is 6.5% or more. Therefore, it is okay if HbA1c is less than 6.5%.
Introducing an outpatient, unique outpatient system
Special out-patient management system for treatment of diabetes
● In principle, a reservation system is required, and an outpatient reservation system is required once a month. This system allows you to make a reservation by phone or make an appointment for the next outpatient clinic after the outpatient clinic. Medical treatment will be provided about 30 minutes after the reception ends. We will print out the monthly blood sampling data and its graph and give it to you every month. With HbA1c, its changes over time are neatly organized, and it is possible to provide detailed guidance while taking seasonal changes into consideration. It is also recommended for those who think that it is okay to go out once every two weeks. From the experience of the director, the frequency of outpatients for diabetes is high, and the more frequently the outpatients visit, the better the glycemic control. If you prescribe for 2 months or 3 months, most people's glycemic control will worsen.
● For first-time patients You can receive a medical examination without a letter of introduction. In the case of referrals from a hospital, it is helpful to receive a letter of referral when formulating a medical treatment policy. The first visit may take some time, so if possible, please call 03-3234-6060 in advance. The reception staff will guide you to the primary outpatient department, the first visit outpatient department, etc., when the director decides when the time will be available in the week.
● For return visits As a general rule, we visit the hospital once a month. If the pattern of once every few months is mixed, the waiting time will be longer and the glycemic control of diabetes will worsen. Once a month, we go out to outpatients to maintain their motivation, thinking that it is just right. I am grateful that the patients who visit our hospital, which is a diabetic specialist, are all patients with really high compliance. It is located in the center of the city and may be convenient, but you have already read the policy of this hospital on the Internet etc. and come to the clinic after understanding the policy and system configuration of the clinic, its purpose and its contents. Since there are many people, it contributes greatly to outpatient operations. The short waiting time at our hospital is actually due to the support of such patients.
● For those who wish to prescribe a new drug (SGLT2 inhibitor, incretin preparation, for those who wish)
Eighty books have been published by Dr. Suzuki, but if you can use the internet, Amazon will deliver it the next day. If you come to our hospital and wish to have a new drug, please read one of the books by Dr. Suzuki carefully before you come to our hospital. That way, you can start treatment smoothly without any problems until the introduction of treatment. For outpatients who have not read it, we ask that you purchase it and read it.
● Blood collection items
Since we are trying to measure quickly, blood glucose level and hemoglobin A1c will be obtained within 15 minutes. We will give you a medical examination as soon as items such as weight and urine protein appear.
Results such as hyperlipidemia will be explained in the next month. If the medication is changed, a re-examination will be performed 2 weeks later to confirm side effects.
Blood collection items are almost the same as those for the diabetes outpatient department of a diabetes hospital.
Fundus examinations, carotid echo examinations, and cardiovascular examinations are performed regularly by specialists and cardiologists.
● Keio University Hospital: Dr. Irie of the Department of Endocrinology and Metabolism provides outpatient treatment once a week.
From July 2016, Dr. Irie will be able to help us with our diabetes outpatient department and general outpatient department. Our office will be in charge on Tuesday morning. On Tuesday afternoon, I am in charge of the diabetic endocrinology and metabolism outpatient department at Keio University Hospital. Dr. Irie will be the partner hospital to introduce to you if there are serious patients or diabetic patients of unknown cause at our hospital.
● Fundus examination
With a non-mydriatic camera, you can take a picture immediately in an outpatient setting. Your doctor will explain the results on the spot. The photos will be finally checked by an ophthalmologist at Juntendo University. For those with retinopathy, we will introduce the most suitable ophthalmic medical facilities for higher-level medical care.
● Recommended for co-examination with human dock
When examining only diabetes, it is easy to overlook neoplastic diseases such as cancer. Since we have a human dock, we recommend the dock for early detection of neoplastic lesions. Management is centralized with electronic medical records. If you think it is necessary, we will print out the result record and give it to you.
● Diabetic neuropathy test, arteriosclerosis test, nephropathy
For the evaluation of diabetic neuropathy, we always perform a nerve conduction velocity test and make a quantitative evaluation. For arteriosclerosis, we combine carotid echo examination and aortic propagation velocity examination, and for patients with plaque, we recommend examination for prevention of cerebral infarction (brain MRI) and oral administration.
● Patient guidance / education policy that does not require hospitalization for education
While working at Saiseikai Central Hospital in Tokyo, the director has experience in providing patient education and guidance to thousands of diabetic patients. At that time, there was no internet and few books. However, nowadays, information can be searched and obtained at any time, such as online and books. In that case, the value of hospitalization for education is relatively low compared to the past. In line with this historical background, we recommend patient guidance in the form of a fusion of the Internet and books. First of all, we recommend the seven books shown here. When starting a DPP4 inhibitor or GLP1 derivative, we recommend the latest treatment for diabetes and the new era of diabetes treatment shown on the right.
● We will decide the direction of treatment by our own rapid examination and utilize it for treatment with quick judgment.
At our hospital, which is a diabetes specialist, we have built a system so that the following tests, which are essential for diabetes treatment, can be performed immediately at any time during outpatient treatment. Especially at the first visit, most of the tests are completed in one day, and the treatment policy is told to the patient.
In addition, chest X-rays (cardiac enlargement, aortic calcification, chronic pancreatitis calcification), and abdominal X-rays (spine disorders, etc.) will be examined at the first visit to all members to check for systemic complications. At the time of the first visit, these tests will be done in one to one and a half hours at a time, the condition of complications will be judged immediately, and the subsequent treatment policy will be decided.
List of past published books
Publishing of books diabetic relationship Until now 79 books
● Inside story of a new book; book cover
The first general book in Japan that summarizes advanced diabetes medicine, SGLT2 inhibitors, how to take medication, and the latest topics. Dr. Suzuki's prescribing experience of prescribing more than 240 patients is summarized in this book.
A medical writer, based on Dr. Yoshihiko Suzuki's original work, wrote about SGLT2 inhibitors and GLP1 receptor agonists, which are formulated once a week, from an easy-to-understand, but scientifically, fairly advanced point of view. A masterpiece. Recommended for highly intelligent readers.
From DPP4 inhibitors to GLP1 receptor agonists to SGLT2 inhibitors, the latest treatments are explained in an easy-to-understand manner. This book is recommended for those who want to understand advanced medical care through charts, etc., because it has a completely different taste from other books due to the illustrations and manga of SHUFUNOTOMO.
Dr. Yoshihiko Suzuki is a visiting professor at Nippon Medical School. Therefore, I created a textbook for junior doctors. This work is widely used as a textbook for trainees at a certain medical university.
The treatment style for diabetes, one of the most common lifestyle-related diseases in Japan, is about to change dramatically. Therapies centered on frequent insulin injections are a thing of the past, and completely new therapeutic agents are appearing one after another. A leading diabetic clinician will report on the current state of cutting-edge new drug development, and introduce measures to improve the therapeutic effect while reducing the burden on patients and to return to normal life as much as possible. ..
A new "creatine" drug that dramatically improves diabetes test values and saves complications. A specialist will explain in an easy-to-understand manner based on surprising clinical data.
An easy-to-understand explanation of the mechanism of this disease that you should know and the lifestyle that you want to keep in mind.
Introducing life improvement points to prevent diabetes, including the effects of blood sugar levels on the body. Many delicious and low-calorie meal recipes are also posted
It was decided when I was thinking about what to do with the title of this book! I received an email from Asahi Shimbun. When I looked at it, it was "diabetes is cured". To be honest, I was surprised.
With such a title, patients who think that diabetes will be completely cured will rush to our clinic and panic, but even if it is not, the outpatient department is really crowded, so I asked for a change. However, it was already late at that time.
So, I firmly summarized the true purpose of this title in the "Postscript". I think this book is a masterpiece that Asahi Shimbun has put on an excellent medical writer and has been carefully transcribed with the support of various professionals. In particular, GLP1 and DPP4 inhibitors are summarized in a very concise manner, so in my outpatient department, this book is definitely recommended for patients who are starting GLP1 derivatives.
However, if you are reading this book, please read the last "Postscript" carefully so that you do not drink and eat when you are cured.
Modern medicine has not reached the level where diabetes can be cured. There is also an opinion that treatment should be performed according to guidelines established by EBM (evidence-based medicine) and academic societies. It is similar to the Greek philosopher: Plateau's idea.
Plateau's disciple Aristotle, on the other hand, summarizes the idea that each individual's best goals should be set individually and should not be stipulated in the guidelines. Our medical policy is similar to that of Aristotle. The target HbA1c is 5.8% or less.
To express the question, "Is diabetes really an incurable disease?", I put the pose of the Greek philosopher Socrates on the cover. In addition, the model was set to the third grade of elementary school to symbolize the new era and new generation of diabetes medicine. I tried to mean New Generation. Surprise Medication is a coined word of the author. It means a surprising prescription, but I will explain in detail in the outpatient department.
This time, I expressed the question, "Is diabetes really an incurable disease?" In the title of the book. This is a request from the publisher. In fact, at HDC Atlas Clinic, the number of patients with HbA1c of 6% or less is increasing. If HbA1c is in the 5% range, for example below 5.5%, the progression of diabetic complications should be significantly reduced. At our hospital, we are aiming for an outpatient clinic where HbA1c 5% level can be said to be normal. This book is the basis for this.
In addition, it incorporates many new findings that the author has published in papers and so on.
