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🏥 | Relationship between gallbladder disease and medicines Diabetes medicine increases the risk of cholecystitis by 40%

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Relationship between Gallbladder Disease and Drugs Diabetes Drugs Increase Cholecystitis Risk by 40%

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This is a widely used diabetic drug called a DPP4 inhibitor, and analysis of previous data reports that it increases the risk of cholecystitis by more than 40%.

[New common sense of medicine that doctors do not know] The gallbladder is an organ like a bag that stores bile that digests fat. … → Continue reading

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DPP4 inhibitor

    Diabetes mellitus

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    Of the worldDisease burden(WHO, 2019)[2]
    Rankingcause of deathDALYs (XNUMX)DALYs (%)DALYs
    (Per 10 people)
    1Neonatal disease20,182.18.02,618
    2Ischemic heart disease18,084.77.12,346
    4Lower respiratory tract infection10,565.24.21,371
    5diarrheaSexual illness7,931.13.11,029
    6Traffic accident7,911.63.11,026
    8Diabetes mellitus7,041.12.8913
    10Birth defects5,179.72.0672
    11Back and neck pain4,653.21.8604
    12depressionSexual dysfunction4,635.91.8601
    14Trachea, bronchi, lung cancer4,137.81.6537
    15Kidney disease4,057.11.6526
    16HIV / AIDS4,014.71.6521
    20Refractive error of the naked eye3,198.11.3415

    Diabetes mellitus(diabetes,English-German-Latin: diabetes mellitus, abbreviation:DM) IsBlood glucose level,Hemoglobin A1c(HbA1c) is a chronic condition in which the value is higher than the appropriate value,bloodInGlucoseThe細胞deliver toInsulinIt develops due to insufficient or abnormal secretion of[3].Blood glucose level measured on an empty stomach in the morning is 126Milligram (mg)/Deciliter (dL)If both of the above and a blood sugar level of 200 mg/dl or more are met regardless of whether or not a meal is taken, a definitive diagnosis of "diabetes" is made.

    Diabetes has two bigcomplicationsThere is a group, the first is "".DetailedBlood vesselOf sugarOxideClogged and caused angiopathy,Neuropathy,Retinopathy,cause. The second is "", the footgangrene,cerebral infarction,AnginaAccompanied byMyocardial infarctioncause[4].With high blood sugar levelsPeeBecause of the pathology that sugar comes out fromHyperglycemiaIs said to be[4].

    Oriental medicineThen.DepletionIs called.In addition, it should be notedkidneyUrinary sugar is produced due to impaired reabsorption inGlycosuriaIs another phenomenon.Diabetes can be a symptom of hyperglycemia itself, as well as high blood levels over the long term.glucoseIs thatAldehyde groupDue to the high reactivity of the vascular endotheliumproteinCombineToSaccharification reaction, And the microvessels in the body are gradually destroyed,Diabetic neuropathy,Diabetic retinopathy,Diabetic nephropathyIt causes three major complications.Also, for diabetic complications,Alzheimer's dementiaからPeriodontal diseaseAnd so on.

    Depending on the cause of diabetes,Type 1 diabetesType 2 diabetes, Other,Gestational diabetesare categorized.Over 95% of diabetics are type 2This is more common in middle-aged and older people and is preventableLifestyle-related diseasesIs[3][5][6].. To prevent or reduce type 2 diabetes, a healthy and balanced diet, moderate exercise, proper weight management,Non smokingIs valid[5].

    Adults (20 to 80 years old) in the worldPrevalenceIs 9% and 4 million people[7][8],Of the worldDaly8th place (2.8%)[9], 2019 killed 149.6 people from diabetes[10].8% of the deaths from diabetes are in low- and middle-income countries, andwho(WHO) estimates that 2030 will be the seventh leading cause of death in the world[5][11].

    Alzheimer's dementiaIs strongly associated with diabetesType 3 diabetesAlso called[12].


    In the bloodglucoseconcentration(Blood glucose level, blood sugar)hormone(Insulin,Glucagon,CortisolEtc.), it is always adjusted within a certain range.When this regulatory mechanism breaks down for a variety of reasons, the sugar content in the blood increases abnormally, leading to diabetes.There are two types of diabetes, type 1 and type 2, which represent the difference in the mode of failure of this regulatory mechanism.

    Type 1 diabetesThen.pancreas OfBeta cellsis destroyed for some reason, insulin, which is one of the hormones that regulate blood sugar levels, is depleted, leading to hyperglycemia and diabetes.on the other handType 2 diabetesHowever, due to obesity, etc., insulin secretion from β cells in the islets of Langerhans (pancreatic islets) in the pancreas decreases, and the ability to take in glucose into muscle and adipose tissue decreases (insulin resistance increases). As a result, blood glucose is not stored as glycogen in the liver or adipose tissue, and blood glucose deviates from the normal range and has a high blood sugar level (fasting blood sugar ≥ 126 mg/dL, HbA1c ≥ 6.5%,Oral glucose tolerance test(75gOGTT)で2時間値が200mg/dL以上など)となり、糖尿病となる(正常値:空腹時血糖60〜100mg/dL、HbA1c4.6〜6.2%、75gOGTTの2時間値が140mg/dL以下)。HbA1cは、1〜2か月前の血糖コントロール状態が反映される。その他にも、Gestational diabetesBecause gestational diabetes has impaired glucose tolerance that does not lead to diabetes for the first time after pregnancy, there is a high risk of perinatal period due to overgrowth of the fetus, and there is also a high risk of developing diabetes after childbirth. Strict blood glucose control is performed.It is also said that a woman who was diagnosed with diabetes before pregnancy became pregnant.

    The name "diabetes" comes from the excretion of sugar in the urine as a result of increased blood sugar. In the case of type 1 diabetes, if left untreated, it easily causes rapid hyperglycemia and life-threatening disturbance of consciousness.Diabetic ketoacidosisBecause it happensInsulinThe basic therapeutic goal is to control the blood sugar level by injection or the like.On the other hand, in type 2 diabetes, if left untreated for a long period of time,Diabetic neuropathy,Diabetic retinopathy,Diabetic nephropathySuch asChronic complications of diabetesBecause the frequency of occurrence of lifestyle-related diseases increases, lifestyle-related habits should be corrected.Oral hypoglycemic drugThe therapeutic goal is to prevent complications by controlling blood glucose levels by injecting insulin or insulin.DiabetesHeart disease,Cerebrovascular diseaseIs also a risk factor for the onset of[13]..In type 1 diabetes, which has been calm for a long time, the treatment goals are similar to those for type 2.In gestational diabetes, the frequency of hyperglycemia in pregnant women may increase, so treatment to lower the blood glucose level is performed to prevent it.


    Comparison of type 1 and type 2 diabetes[14]
    要素Type 1 diabetesType 2 diabetes
    Age of onsetMany in childhoodMany are adults
    Body shapeSkinny or normal[15]Many are obese
    AutoantibodyUsually existsMissing
    Endogenous insulinLow or missingOrdinary
    Increase or decrease
    Identical twins
    Match rate in
    Prevalence~ 10%~ 90%[5]

    Diabetes is classified according to the onset mechanism (mechanism) as listed below.In the past, it was classified as "insulin-dependent diabetes" or "non-insulin dependent diabetes" depending on the treatment method.Even earlier, it was classified using Roman letters as type I diabetes and type II diabetes.However, as of 2010, almost all of the world uses the following classifications based on the cause of the disease:Here, they are classified according to the classification criteria of the Japan Diabetes Society (1999).

    Type 1 diabetes

    Type 1 diabetes(Ichigata Tonyobyo,ICD-10: E10) ispancreas OfLangerhans IslandInsulinIt is a disease in which β-cells that secrete the disease die.The cause is thought to be mainly because one's immune cells attack one's pancreas (Autoimmune), Rarely, type 1 diabetes with no evidence of autoimmune response is also seen (Idiopathic).

    Generally, most patients develop this in their teens.An abnormally high level of sugar in the blood due to an extremely low or almost no production of insulin, the hormone that lowers blood sugarDiabetic ketoacidosisThere is a high risk of causing.Therefore, in most cases, strong treatment such as insulin injection is always required.

    Type 2 diabetes

    Type 2 diabetes(Nigatato Nyobyo,ICD-10:E11) is diabetes mellitus with dual causes of hyposecretion and hyposensitivity of insulin.WesternThen decreased sensitivity (Insulin resistanceHowever, in Japan, decreased ability of the pancreas to secrete insulin is also an important cause.At least initially, the former leads to fat diabetes and the latter leads to lean diabetes.HeredityIt is a lifestyle-related disease that develops due to a combination of social factors and lifestyle habits, and accounts for 9% of all diabetes in Japan.

    Chronic pancreatitis[16]The cause of type 2 diabetes is not completely clear regardless of pancreatic diseases such as malignant tumors of pancreatitis and pancreatitis. It is thought that type 2 diabetes is caused by living a lifestyle that makes it easy to become ill (environmental factor).The ratio that can be explained by heredity when the cause is divided into heredity and environment (Heritability) Is estimated to vary from 25% to 80% in different studies[17]..Particularly high estimates have been obtained in studies with long follow-up periods.[17]..As a genetic cause,[18][19],PPARG,,[20][21][22]It is becoming clear that there is a difference in the fact that some people are more likely to have diabetes and others are less likely to have diabetes, even if they have similar lifestyles, due to differences in genetic sequences such as.In addition, as a causal gene for lean diabetes, which is mainly caused by decreased insulin secretory capacity, which is more common in Japan than in Europe and the United States.It has been reported that the sequence that is a risk factor for this gene found in Japanese is extremely rare in Westerners.[23].

    Chronic hyperglycemia impairs pancreatic β-cell function and causes excessive blood glucoseglycogenConvert to and store筋肉,liver, Convert to fat and storeAdipose tissueInsulin resistance also develops and causes further hyperglycemia, which further exacerbates insulin deficiency and insulin resistance, and a condition that further exacerbates the diabetic condition is taken up as glucose toxicity.[24].Insulin resistanceA large amount of hyperglycemic condition caused by such factors occurs in pancreatic β cells.Active oxygenSeed generation andproteinglucoseWithSaccharification reactioncause.This phenomenon, commonly referred to as glycotoxicity, is thought to cause a decrease in the insulin content of β-cells and a decrease in the number of β-cells.[25].

    Further bloodFree fatty acidsIs seen to riseobesityThen it became bloatedFat cellsFrom variousCytokine,fatty acidIs secreted, free fatty acids impair pancreatic β-cell function, and insulin resistance is enhanced, which has been taken up as lipotoxicity.[24].


    Prediabetes is considered to be the pre-stage of type 2 diabetes.Strictly not diabetes in the sense that it does not meet the diagnostic criteria for diabetesReserve armyMay be written as[26]..However, as with diabetes, there is a high risk of macroangiopathy, that is, myocardial infarction.diet remedy,Exercise therapyother thanOral hypoglycemic drugIt has been suggested that drug therapy using the drug may prevent chronic complications. Similar to type 2 diabetesLifestyle-related diseasesIs[27].

    A genetic abnormality identified as a genetic factor

    The causes of type 1 and type 2 diabetes have not been completely clarified.On the other hand, the diseases classified into this item are diabetes whose cause is known that diabetes is caused by dysfunction of a specific gene.The frequency is extremely rare.Both develop at a relatively young age (generally 25 years or younger), are not as severe as type 1, and are characterized by strong family onset, but clinical findings are significantly different.

    Maturity onset diabetes[Annotation 1]
    Mendelian inheritance that causes purely diabetes, autosomalDominant inheritanceIs shown.Treatment with oral medication is often effective.
    There are six known types of MODY, MODY 1-6. Hepatocyte nuclear factor (HNF) 6α in MODY1 and MODY4Glucokinase, HNF3α in MODY1, insulin promoter factor (IPF) 4 in MODY1, HNF5β in MODY1, and neuroD6 in MODY1.
    MitochondriaGenetic abnormality
    According to the mechanism (Reference: Mitochondrial DNA) Inherited only from the mother's side,DeafnessMIDD with[Annotation 2], In the most severe typestroke-Lactic acidosisAnd so onMELASIt presents a variety of disease images.
    There are several mutation points in mitochondrial gene abnormalities, but the most common is the 3243A-> G mutation.
    Insulin receptorAbnormality
    It has a characteristic physique such as thick hair and thick hair.Diabetes is diagnosedHeterojunction typePatient andHomozygotesThen it does not survive until after infancy.Since the pancreas has sufficient insulin secretory capacity, a large amount of insulin is secreted in an attempt to lower the blood sugar level, and the insulin concentration in the blood shows an abnormally high level.Unlike other types, insulin administration is ineffective,Insulin-like growth factorIt is possible to lower the blood glucose level by administration of.
    Insulin receptor genetic abnormality
    Reported but extremely rare.Insulin administration is effective.

    Both are for diagnosisgenomeDNAAnd special tests using mitochondrial DNA as a sample are required.

    Secondary diabetes

    Secondary diabetes (Zokuhatsuseiito Nyobyo, secondary diabetes) (ICD-10: E13) is diabetes caused by other diseases.The following are typical diseases, and there are other causative diseases.

    Steroid diabetes

    Steroid diabetesCollagen disease[Secondary diabetes mellitus caused by long-term oral administration of steroids.It is believed that steroid (glucocorticoid) actions are involved in hepatic gluconeogenesis-enhancing action, insulin resistance enhancement in peripheral tissues, and appetite-enhancing action.If the dose of steroids is reduced, the symptoms will be relieved.Unlike normal diabetes, steroid diabetes is less likely to cause vascular complications such as retinopathy.Postprandial hyperglycemia is common, and oral agents such as insulin and αGI are often used during hospitalization.

    Gestational diabetes

    Pancreatic diabetes

    Diabetes caused by decreased insulin secretion due to decreased pancreatic function due to chronic pancreatitis or pancreatic cancer[16].


    Early diabetic patients usuallySubjective symptomsno.Numbness in the hands and feet, such as those listed belowconstipationIn fact, there are things like that, but sometimes they don't think of it as a special symptom.When the blood sugar level becomes very high, typical symptoms such as dry mouth, polydipsia and polyuria occur.Since these symptoms directly reflect high blood sugar levels, these symptoms subside when blood sugar levels are lowered through treatment.Higher blood sugar levels can lead to seriousDiabetic comaIt may cause disturbance of consciousness and abdominal pain.On the other hand, only with the high blood glucose level at the beginning of the onsetCrouchingSpecific neuropathy such as may occur.In addition, when the blood glucose level rises sharply in the early stage of onset, the body weight often decreases (because there is a lot of sugar in the blood, while fat cells are depleted of sugar).

    Other symptoms are usuallyChronic complications of diabetesIt is due to.

    Impact on life expectancy

    Comparing the average life expectancy of diabetic patients and Japanese in general from 1971 to 1980, it was found that the life expectancy was shortened by about 10 years for men and about 15 years for women.[28][29].As a mechanism for this, hyperglycemia nonenzymatically saccharifies proteins in the body, impairing the original functions of proteins and causing disorders.This glycative effect is a major component of blood vessels, for example.collagen,Crystalline lensproteinCrystallinThe longer the life of the protein, the greater the effect. For example白内障 TheAgeingThis aging phenomenon will be more advanced in high blood sugar conditions.[28].. By a similar mechanismArteriosclerosisAnd microangiopathy also progresses.Also, it was generated by the saccharification reaction.Free radicalsBy etc.Oxidative stressAlso increase[30].

    From the results of analyzing 1991 cases during the 2000 years from 10 to 18,385 in Japan, the number one cause of death isMalignant neoplasm 34.1% (of which liver cancer is 8.6%), 2nd place is vascular disorder (diabetic nephropathy, ischemic heart disease, cerebrovascular disorder) 26.8%, 3rd place is infectious disease 14.3%, diabetic coma 1.2%. Have been[31]..In addition, the quality of glycemic control affected the age at death, which was 2.5 years for men and 1.6 years for women.[31]..Furthermore, the average age at death of diabetic patients was 68.0 years for men and 71.6 years for women, which was 9.6 years for men and 13.0 years for women, which was shorter than the average life expectancy of Japanese people of the same age.[31].

    Diabetic complications

    Diabetic complications are three complications (Diabetic neuropathy,Diabetic retinopathy,Diabetic nephropathy) Is characteristic, and collectivelyMicroangiopathyIs called.In addition, as an acute complication that causes hyperglycemia,Diabetic ketoacidosisas well as the Hyperosmolar hyperglycemic syndromeThere is.

    Diabetic neuropathy
    Of the three complications, it often appears first, with numbness and decreased sensation at the tips of limbs due to peripheral neuropathy, and constipation / lightheadedness (orthostatic hypotension) due to autonomic neuropathy.Erectile dysfunctionAnd so on.In addition, the sensation of warm pain may be dull and the subjective symptoms of other diseases may be poor.ClinicallyMyocardial infarction OfChest pain, Severeappendicitisperitoneal irritation, low temperaturescaldEtc. are important.
    Diabetic retinopathy
    When onset,Vitreous,retinaBleeding begins to occur, and eyesight deteriorates with each repetition.Not life-threatening,QOLIt is an important complication from the viewpoint of.Also suddenblindnessBecause of the danger of sickness, intense exercise therapy is contraindicated, which also hinders the treatment itself.[32].
    Diabetic nephropathy
    It appears at the latest of the three complications, but it has a great impact on the final lifespan.Initially, only a very small amount of albuminuria appears, but gradually obvious urinary protein and edema (swelling) appear, and finallykidney failureBecomeHemodialysisWill be required.

    Myocardial infarction,Arteriosclerosis obliterans,cerebral infarctionIt is also important to increase the risk of vascular diseases such as, in contrast to microangiopathy.Large angiopathyCalled.

    OtherFatty liver[33], Skin symptoms (diabetic lipoid necrosis), decreased wound healing ability, immunocompromised (end imagesepticemia) And other symptoms are likely to occur[32][34].

    Alzheimer's dementia

    Diabetes isAlzheimer's dementiaIs a risk factor for[34]..Carbohydrate-based diets that increase insulin secretion, lack of exercise, and excess visceral fat cause Alzheimer's diseaseAmyloid betaIt is said that it is hindering the disassembly of.Because insulin-degrading enzymes, which are also capable of degrading amyloid beta, act intensively on insulin in the blood due to a carbohydrate-based diet.Human brainIt is said that the concentration of insulin-degrading enzyme will decrease in Japan, and the decomposition of amyloid beta will be unmanageable and accumulated.

    Malignant tumor

    1998 yearsFukuokaHisayama TownIn a study, diabetes wasMalignant tumorSignificantly increases the risk of deathHigh blood sugarIndicates the degree ofHemoglobin A1cThe higher the priceStomach cancerThe incidence was high.Diabetes and hyperglycemia are important risk factors for malignant tumors[34]..About 20-30% of people who have never been diagnosed with diabetes are more likely to get cancer later, and in menLiver cancer,Kidney cancer,Pancreatic cancer,Colon cancer,Stomach cancer, For womenStomach cancer,Liver cancer,Ovarian cancerThis tendency was strong[35].C-peptideIt is,InsulinIt refers to the portion cut off from proinsulin, which is a precursor of insulin during production, but in men, high C-peptide levelsColorectal cancerThe risk is high. C-ペプチドは男性の結腸癌と関連があるC-peptide is associated with male colon cancer[36]..A new malignant tumor was pointed out in 6.85% of diabetic patients hospitalized due to deterioration of glycemic control, which is considered to be higher than the prevalence of the general population.[37].


    In addition to blood tests, various tests are performed to diagnose diabetes and determine the therapeutic effect.It may also be used to treat chronic complications.

    Inositol(myo-inositol) Is a sugar alcohol with a structure similar to glucose.PhosphatidylinositolIt is obtained by hydrolyzing.[38]Inositol is normally excreted from the glomerulus and reabsorbed in the renal tubules, but in hyperglycemic conditions, inositol competes with glucose, so that it is not reabsorbed and its urinary excretion increases.As a result, the amount of inositol in the body decreases,PolyolMetabolic disorders cause neurosis[39].


    Japan Diabetes SocietyImplemented new diagnostic criteria in July 2010 (conventional diagnostic criteria were enforced in 7).

    Under the new standard, not only blood sugar levelsHemoglobin A1c(HbA1c) standards have also been established, and blood sugar levels (fasting blood sugar levels,Oral glucose tolerance test(75g OGTT) 2 hours later, blood glucose level, blood glucose level at any time) and HbA1c test results are used for judgment.

    Criteria for glucose tolerance test
    Normal typeBorderline typeDiabetic type
    Fasting blood glucose(Less than)(that's all)
    Blood glucose level after 2 hours(Less than)(that's all)
    Judgment conditionHungry and after 2 hours
    or or
    Cases diagnosed with diabetes by the first judgment
    • If both blood glucose and HbA1c are diabetic
    • If only the blood glucose level is diabetic and there are typical diabetic symptoms such as dry mouth, polydipsia, and polyuria, and diabetic retinopathy.
    Cases diagnosed with diabetes by the second judgment
    • At the first time, only the blood glucose level is diabetic.If either (or both) blood glucose and HbA1c are diabetic in the second time
    • At the first time, only HbA1c is diabetic.If the blood glucose level is diabetic the second time

    If either blood sugar level or HbA1c is diabetic type, but diabetes is not diagnosed in cases other than the above, it is considered "suspected diabetes".People with suspected diabetes are recommended to be retested within 3 to 6 months, at which point they will be reassessed.


    The outline is as follows.Treatment of diabetes depends on the classification or severity (progression).

    • In type 1 diabetes, there is no choice but to supplement insulin that can no longer be secreted, so insulin treatment (subcutaneous injection of various insulin preparations) is performed for a lifetime from an early stage.
    • Various patterns of treatment are given for type 2 diabetes.
      • First of alldiet remedyExercise therapyIs done[40]..Specifically, make the diet pattern regular, refrain from alcohol that promotes appetite, and keep the amount of energy intake below the value according to body weight.[41]..The use of foods developed for diabetics is also recommended[41]..If this normalizes your blood sugar, that's okay.
      • If diet and exercise do not normalize your blood sugar, or if your blood sugar is very high from the beginning and you think these treatments are not enoughOral hypoglycemic drugOrGLP-1Concomitant use of receptor agonists.
      • If blood glucose levels do not normalize with oral hypoglycemic agents or GLP-1 receptor agonistsInsulinStart self-injection.However, there is also the idea of ​​self-injecting insulin from the beginning without going through an oral hypoglycemic agent.
        • In the case of type 2 diabetes, even if insulin is introduced once, it is often possible to normalize the blood glucose level and stop self-injection of insulin by improving eating behavior and lifestyle, but the insulin secretory capacity is affected by hyperglycemia. May be lost and you may have to continue self-injecting insulin for the rest of your life.
      • Once you have good glycemic control, you will not be able to continue the treatment for the rest of your life, lifestyle, risk of hypoglycemia, kidney function, liver function, etc.prognosisIt is necessary to make adjustments while considering determinants, the possibility of continuing treatment, and economic efficiency.
      • If hyperglycemia is the cause of binge eating,Duodenal switchSurgery such as手術May reduce appetite and be part of the treatment of obesity and type 2 diabetes[42]. "Diabetes Management Guidelines 2016" (Japan Diabetes Society)[43]Then,Periodontal diseaseThe Japanese Society of Periodontology, which explains the relationship with and is supposed to treat as needed, has also issued guidelines.[44].


    According to the International Diabetes Federation (IDF), there are about 2019 million diabetics worldwide as of 4.The number of patients is increasing rapidly, reaching 6300 million by 2030 and 5 million by 7800.There are diabetic patients all over the world, but the more developed countries, the greater the number of (type 2045) patients.However, the regions with the highest growth rates are expected to be Asia and Africa, with the highest number of cases expected by 7.Diabetes in developing countries tends to increase with urbanization and lifestyle changes, and develops after a long period of unbalanced dietary intake and exercise, rather than westernization of the diet. there is a possibility.From this, it is considered that changes in the living environment (such as diet) are greatly involved in diabetes.

    Diabetes has become the 10th (or 5th) disease in developed countries, and its impact is increasing in other countries.米 国For example,North AmericaThe prevalence of diabetes in the United States has been increasing for at least the last 20 years. In 2005, there were approximately 2080 million people with diabetes in the United States alone.American Diabetes Association[Annotation 3]According to the report, 620 million people have not yet been diagnosed and the prediabetes army reaches 4100 million.UKEnglandWalesIn, the prevalence ranges from 6% to 6.7% and has 320 million patients.[32].

    Prevalence in Japan

    The number of patients in Japan has increased from about 40 to about 3 million in the last 700 years.PrediabetesIt is said that the number of people including (prediabetes) is 2000 million.According to the Ministry of Health, Labor and Welfare's announcement, from the survey data as of November 2006, an estimated 11 million people in Japan are highly suspected of having diabetes.

    Ministry of Health, Labor and WelfareOf 2006Demographic statisticsAccording to the report, the number one prefecture with the worst mortality rate in Japan has been for 1 consecutive years since 1993.Tokushima(10 per 19.5, by the way, the lowest isAichi7.5 people).specificdiseaseBy etc.mortality rateIt is rare that the same prefecture is ranked first and has a difference of nearly 10 times from the lowest value for more than 1 years (as a high rate in other regions,PsychiatricIn the field ofAkitaIs 1995 years in a row from 2006 to 12suicideIt can be mentioned that it is the first place in the rate.The suicide rate in Akita Prefecture, that is, the number of suicides per 1 population is 10, and the national average is 42.7).DiabetesLifestyle-related diseasesBecause it is a kind of, from therapeutic type to health guidance typePreventive medicineIt will be difficult to dramatically reduce the mortality rate unless a shift toTokushimaIs a prefecture where the number of medical institutions and doctors is higher than the national average, so Tokushima PrefectureMedical associationIt is pointed out every year that the low knowledge and awareness of diabetes prevention among medical institutions, Tokushima prefecture and other government agencies and local residents is a factor.Tokushima Prefecture declared the "Diabetes Emergency Declaration" in November 2005, but the mortality rate per 11 people deteriorated from 2006 in the previous year to 10 in 18.0, and improved to 19.5 in 2007. ..In Tokushima Prefecture, 14.2% of men over the age of 20 are obese, which is higher than the national average of 37.2%.

    According to the 2007 vital statistics (approximate number) of the Ministry of Health, Labor and Welfare, Tokushima Prefecture has surpassed the worst 1st place for the first time in 15 years, and has become the worst 14.2th place with an average of 10 people (mortality rate per 6 population) (nationwide). The average is 11.1 people).

    In 2006, Tokushima Prefecture ranked second.Kagoshima(14.2 people), 3rd placeFukushima(14.1 people), 4rd placeTottori(13.7 people), 5rd placeAomori(13.6 people) are the worst 5, and converselyTokyoBesides (9.9 people)Gifu(9.5 people),Nagasaki(9.5 people),Oita(9.5 people),Miyazaki(9.3 people),Shiga(9.1 people),Saitama(8.9 people),Nara(8.5 people),Kanagawa8.4 prefectures (7.5 people) and Aichi (10 people) have less than 10 deaths per 10 people.

    According to a survey conducted by the Ministry of Health, Labor and Welfare in 14, the percentage of people strongly suspected of having diabetes was 2002% for men aged 20 and over, and 12.8% for women aged 20 and over. rice field.The proportion of people with strongly suspected diabetes who are currently undergoing treatment who have comorbidities isNeuropathy15.6%,Retinopathy13.1%,Nephropathy15.2%, feetgangreneWas 1.6%.also,Agingと糖尿病は関連があり、糖尿病が強く疑われる男性の割合は、20歳から29歳で0%、30歳から39歳で0.8%、40歳から49歳で4.4%、50歳から59歳で14.0%、60歳から69歳で17.9%、70歳以上で21.3%であった。さらに、肥満と糖尿病は関連があり、40歳から59歳の男性で、糖尿病が強く疑われる人の割合は、Body mass index(BMI) 18.5から22で5.9%、BMI22から25で7.7%、BMI25から30で14.5%、BMI30以上で28.6%であった。なお、加齢を重ねていない20歳から39歳の男性ではこのような大きな差は出ていなかった[13].

    Research on the risk of developing the disease

    List examples of studies in which various studies have been conducted.

    1. Obesity is an overwhelming risk factor as an environmental factor that makes people more likely to have diabetes.[45]Besides smoking[46]And lack of exercise[47]and so on.
    2. Increased risk of developing diabetes in groups who gained more than 20 kg from age 5[48].
    3. Cohort studies report that people who do not work hard or do intense sports increase their risk of diabetes by consuming large amounts of cooked rice.[49].
    4. zincThere are reports that deficiency increases the risk of developing diabetes[50].
    5. "magnesiumIntake is involved "[51][52]In patients with insulin resistance, chronic inflammation, and drinking habits, increased intake is said to be effective in suppressing the onset.However, on the other hand, there are reports that magnesium intake is not associated with the onset of diabetes.[53].
    6. Harvard UniversityBy 2010Systematic reviewMeta-analysisred meat, especiallyHam,sausageincreased processed meat intake is associated with increased risk of diabetes and coronary artery disease[54]. A 2010 Harvard study cohort survey of about 20 people per dayWhite riceThebrown ricereplacing 50 grams of 2% lower risk of type 16 diabetes[55]..Also, before pregnancyFast foodFrequent eating has been reported to increase the risk of developing diabetes[56].
    7. For womenCola,juiceSuch asSoft drinkIt has been reported that the higher the dose of diabetes, the higher the risk of developing diabetes.Ingestion of large amounts of soft drinks is rapidblood sugar・ It causes an increase in insulin concentration,Impaired glucose tolerance,Insulin resistanceIt has been pointed out that it may also lead to[57].PET bottle syndromeSee also
    8. Vegetables,fruitOverall, there is no association with the risk of developing diabetes, but vegetables, especially those with overweight (BMI 25 or higher) or smoking habits in men.BrassicaceaeIt was suggested that the risk of diabetes was slightly reduced in the group that consumed a lot of vegetables.[58].
    9. Periodontal diseaseIt is,Myocardial infarction,Buerger's disease, Intercostal neuralgia, trigeminal neuralgia, and diabetes have been found in a very recent study.In diabetesPorphyromonas gingivalisInfection promotes secretionTumor necrosis factor(TNF-α) exacerbates diabetes, creating a negative chain of exacerbation of periodontal disease.This is called the "periodontal disease chain" or "periodontal disease chain".[59].
    10. coffeePeople who drank a lot of alcohol tended to have a lower risk of developing diabetes[60].
    11. Due to repeated postprandial hyperglycemia and insulin hypersecretion due to repeated sugar and carbohydrate-based dietsInsulin resistanceIt is known that insulin becomes less effective, hyperglycemia is maintained, and sugar is excreted in urine.In addition, by repeating postprandial hyperglycemia and excessive insulin secretion,pancreas OfLangerhans IslandBeta cells die little by little and insulin secretory capacity declines.
    12. Eating fruits lowers the risk of developing type 2 diabetes, but juice increases the risk of developing it.[61].
    13. 7 to 9 hoursSleepIs desirable. If you sleep less than 1 hours a night, your risk of diabetes increases[62].


    World Diabetes Day

    As mentioned above, diabetes is currently present in about 5 to 6 percent of the world's adult population, and the number is steadily increasing.The number of deaths due to diabetes isAcquired immunodeficiency syndrome(AIDS), and diabetes-related deaths are estimated to exceed those of AIDS.Considering this situationUnited NationsThe International Diabetes Federation (IDF) requested the ``Resolution Recognizing the Global Threat of Diabetes'' at the United Nations General Assembly on December 2006, 12, and is the discoverer of insulin.Frederick Bantingit's doctor's birthday11/14Was designated as "World Diabetes Day".Even in Japan, on November 2007, 11Tokyo Tower,Great Buddha of Kamakura,Tsūtsukenetc. in blue, which is the symbol color of "World Diabetes Day"light upAwareness-raising activities were also conducted to encourage diabetes prevention, treatment, and recuperation.

    The United Nations said,World XX DayIt was the day of enlightenment that bears the name of the disease.12/1"World Diabetes Day" is the second one following "World AIDS Day".


    1674, British clinical physicianThomas willisWas doing research on what was considered a strange disease in Europe at the time.Willis wanted to know the ingredients contained in urine at all costs, and when he licked the patient's urine, it was sweet, which is said to be the trigger for confirming this disease.[63].


    Clinical guidelines


    • "Super fast effect! Diabetes medical treatment express (first volume)"ISBN 4903331032
    • "Super fast effect! Diabetes medical treatment express (second volume)"ISBN 4903331040
    • "Dr. Higashida's Pathophysiology, Volume XNUMX" ISBN 4903331083
    • Toshiaki Watanabe and Toru Fukui, "Study on the relationship between serum biotin and blood glucose in those who are subject to detailed diabetes screening," 1995, 12th Micronutrient Research Symposium PDF
    • "History of Diabetes in Stamps" Hotta N. Life Science Publishing ISBN-978 4897753126
    • Masaaki Miyamoto "A story about diabetes that is scary if you don't know it"PHP Institute, 2011.ISBN 978 – 4569799346. 
    • "Diabetes Hyperglycemia, Hemoglobin A1c, Complications: The Comprehensive Guide to the Best Treatments from a Diabetes Treatment Specialist's Honest Answers to 142 Questions I Wanted to Ask But Couldn't!" Masato Odawara Bunkyosha April 2020

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    注 釈

    1. ^ British: maturity onset diabetes of young, MODY
    2. ^ British: maternally inherited diabetes and deafness
    3. ^ British: American Diabetes Association


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