Therapeutic Research

Background：A large proportion of people with type 2 diabetes（T2DM）remain uncontrolled on basal insulin. To investigate gaps in perception between patients and health care providers, we surveyed doctors, nurses, and diabetic patients under basal insulin therapy, and assessed differences in perception and behaviour regarding glycemic control and insulin therapy. Methods：We implemented a web‒based internet questionnaire between March 25 and April 18, 2016. Participants included 712 adult men and women patients 20 years of age or older who were being treated with basal insulin（81 with type 1 diabetes；631 with type 2 diabetes）, 221 physicians treating diabetic patients with basal insulin, and 110 nurses working with insulin therapy in departments of internal medicine or specialized diabetes/endocrinology departments. Results：A total of 30.2％ of patients had satisfactory glycemic control, and 37.2％ of those had experienced hypoglycemia within the previous 3 months. Only 55％ of patients were satisfied with their glycemic control, lower than the 69％ estimated by physicians. A total of 93.2％ of patients desired improvement of glycemic control, higher than estimated by physicians（73.3％）or nurses（64.9％）. About half of the patients had concerns about their condition: 72.5％ worried about complications, 48.9％ about hypoglycemia, and 43.0％ about glycemic variability. This suggests that physicians and nurses underestimate patient interest in diabetes management and overestimate treatment satisfaction. Patients wanted information on new treatment methods and basal insulin formulations, but physicians felt no need for such explanations. Conclusions：Patients were more concerned about hypoglycemia risk, wanted more stable glycemic control, and desired more information on new treatment methods and basal insulin formulations than physicians expected. Health care providers may be able to improve diabetes care by better understanding patient thoughts and hopes and by sharing that understanding with other team members. Funding：This survey was funded by Sanofi K. K.

SGLT2 阻害薬の長期における臨床効果を正確に検討するため，2 型糖尿病症例に24 時間蓄尿を行いつつtofogliflozin 20 mg を48 週間投与した。結果，24 時間蓄尿量（mL/日）は1880±750 から2710±520，尿糖排泄量（g/日）は20±22 から138±61，体重（kg）は80.7±12.3 から75.3±11.8 と著明な変化を認めた。HbA1c（％）は7.88±0.94 から7.25±1.03，外来収縮期および拡張期血圧（mmHg）は135.1±15.2/77.3±10.2 から125.3±12.6/74.8±8.3，HDL コレステロール（mg/dL）は47.1±7.9 から52.3±10.7と有意な改善を認めた。体重減少には個人差が大きく，経過途中より，いったん減少した体重が増加に転じたリバウンド群5 例と，それ以外の体重減少維持群5 例にて検討を行った。48 週投与後の体重減少量はリバウンド群2.8 kg，減少維持群7.9 kg であったが，24 時間蓄尿における尿糖排泄量，塩分排泄量，尿量では両群間に差は認めなかった。24 時間蓄尿中尿糖排泄量と統計的に有意な相関を認めた因子は，24 時間蓄尿量，投与前HbA1c，投与前24 時間内因性クレアチニンクリアランス，投与前体表面積，24時間蓄尿中塩分排泄量であった。1 年にわたる蓄尿データはこれまでに報告はなく，体重減少の個人差含め，今後さらなる検討が望まれる。