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To estimate uptake of the 75 g oral glucose tolerance test (OGTT) at 6–12 weeks postpartum among women with gestational diabetes mellitus (GDM) in Japan, and to explore the demographic and clinical characteristics associated with screening uptake.
Retrospective cohort study using administrative claims data.
Data from a nationwide employees’ health insurance claims database (Japan Medical Data Center; JMDC) during the fiscal years 2012–2020 were assessed.
2282 women with GDM in the JMDC claims database (April 2012–January 2021), ascertained using the International Classification of Diseases 10th revision (ICD-10) codes cross-validated with a high-risk GDM management fee.
Primary outcome: completion of a 75 g OGTT at 6–12 weeks postpartum. Secondary outcomes: completion of a 75 g OGTT at 4–12 weeks postpartum and cumulative completion up to 1 year postpartum.
We included 2282 women in the analysis. The overall screening rate was 28.7% (654/2282) from 2012 to 2020. Even in 2020, the year with the highest reported screening rate, it remained low at 33.2% (181/546). After expanding the range to include 4 weeks to ≤1 year postpartum, the cumulative screening rate reached 64.9% by 1 year postpartum. The screening rate was lower when childbirth and GDM were managed at different facilities than when both were managed within the same facility.
We report suboptimal screening rates for women with a GDM history in Japan. This study highlights the need for continuous monitoring and the development of effective strategies for early screening and intervention in this high-risk group. These strategies should include system-level improvements in screening methods and enhance patient awareness through antenatal education prior to delivery.
by Tetsuo Ichikawa, Tomoya Koda, Mio Kitamura, Takahiro Kishimoto, Takashi Matsuda, Takaharu Goto, Masayuki Domichi, Akiko Suganuma, Shinji Fujiwara, Yasuhiko Shirayama, Kazuhiko Kotani, Naoki Sakane
Sensory decline in older adults significantly affects quality of life and contributes to cognitive decline, depression, falls, and injuries. Although several studies exist in this area, most were focused on individual senses, with few being conducted on comprehensive assessments of all five senses. The aim of this study was to investigate the relationship between subjective sensory assessment and oral function, to developing health strategies. This study was conducted as part of the Mima-SONGS Study for examining relationships between oral, cognitive, and physical functions, social factors, nutrition, and health, in older adults living in a mountainous region of Japan. The cohort included 62 participants (40 women and 22 men; mean age: 80.8 yrs.) as of December 2023. Participants completed a questionnaire assessing sensory perception and eating enjoyment rated on a four-point scale. Oral health was evaluated based on the conditions of remaining teeth, tongue coating, oral dryness, occlusal force, oral diadochokinesis, and repetitive salivary swallow test. Sensory assessments indicated minimal overall issues, with auditory problems scoring the highest and taste/tactile issues scoring the lowest. Males scored higher in hearing and maximum occlusal force. Eating enjoyment was generally high and negatively correlated with olfactory and taste problems. Subjective sensory issues were less strongly associated with oral function and age. Most older adults were not subjectively aware of sensory problems, especially olfaction, taste, and tactile problems. Subjective sensory problems showed a moderate but meaningful association with oral health conditions and age. The findings might be valuable data developing future support measures.
by Masayoshi Terayama, Yu Imamura, Toru Kitazawa, Naoki Miyazaki, Misuzu Ishii, Kumi Takagi, Kengo Kuriyama, Naoki Takahashi, Masahiro Tamura, Akihiko Okamura, Jun Kanamori, Masayuki Watanabe
BackgroundPostoperative hyperglycemia in diabetic patients is a widely known risk factor for postoperative infectious complications (PICs) after esophagectomy; however, the significance of glycemic control in non-diabetic patients is less clear. In diabetic patients, early postoperative management of esophagectomy favors low-carbohydrate enteral nutrition (EN) over standard EN to suppress the risk of glycemic spike. Our single-center, randomized phase II trial seeks to test the hypothesis that low-carbohydrate EN can suppress hyperglycemia in non-diabetic patients who undergo esophagectomy. Herewith we present the study protocol.
MethodsA total of 50 patients will be enrolled and randomly assigned (1:1 ratio) to standard or low-carbohydrate EN. Randomization will be stratified by operation time (≥560 vs. blood glucose level of 180 mg/dL), and is indicative of the frequency and duration of hyperglycemia. AUC, which identifies periods of hyperglycemia and provides a comprehensive picture of glucose variability and control in diabetes management, is defined as the area under the curve over blood glucose level of 180 mg/dL on CGM monitoring.
DiscussionThis study is the first to investigate the impact of a low-carbohydrate EN formula on hyperglycemic control during perioperative nutritional management of esophageal cancer. These results will help to outline whether glycemic control should be also considered for non-diabetic patients during hospital care.
Trial registrationThis trial has been registered in the Japanese Registry of Clinical Trials (jRCTs031240081).
by Kenji Sato, Eri Otaka, Kenichi Ozaki, Kenta Shiramoto, Rie Narukawa, Takeshi Kamiya, Masaki Kamiya, Daiki Shimotori, Chiaki Kamizato, Naoki Itoh, Hitoshi Kagaya, Izumi Kondo
BackgroundHome-based rehabilitation involves professional rehabilitation care and guidance offered by physical, occupational, and speech therapists to patients in their homes to help them recuperate in a familiar living environment. The effects on the patient’s motor function and activities of daily living (ADLs), and caregiver burden for community-dwelling patients are well-documented; however, little is known about the immediate benefits in patients discharged from the hospital. Therefore, we examined the effects of continuous home-based rehabilitation immediately after discharge to patients who received intensive rehabilitation during hospitalization.
MethodsWe retrospectively reviewed 150 patients [mean (standard deviation, SD) = 81 (9) years] discharged from the convalescent rehabilitation and community-based integrated care wards undergoing tailored home-based rehabilitation for 6 months (provided by physical or occupational therapists: 1–2 sessions of 40–60 min each per week). The outcome measures at baseline and after 3 and 6 months were compared.
ResultsThe participants included in this study had orthopedic (n = 76), cerebrovascular (n = 50), neuromuscular (n = 11), cardiovascular (n = 5), respiratory (n = 3), cancer (n = 3) and other diseases (n = 2). The mean (SD) time from discharge to the start of rehabilitation was 4 (4) days. One-way analysis of variance and post-hoc comparisons showed significant improvements at 3 months from baseline in grip strength (p = 0.002), 5-repetition sit-to-stand test (p Conclusions
Home-based rehabilitation improves motor function, ADLs, and instrumental ADLs even after intensive inpatient rehabilitation and decreases the burden of the caregiver in the long term. Hence, tailored home-based rehabilitation should be continuously implemented after the completion of intensive inpatient rehabilitation.
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