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Diabetes and Metabolic Diseases

Nephrology and Endocrinology

The prevalence of diabetes, dyslipidemia, obesity disease, and metabolic syndrome is rapidly increasing in number accompanied by changes in lifestyle of the Japanese. The Department of Diabetes and Metabolic Diseases is working on prevention and treatment of these diseases.

Medical services

Outpatient diabetes clinics and outpatient care is provided by diabetes specialists and certified diabetes educators of Japan (CDEJ) who cooperate closely with one another to provide services for individual patients. Specialized outpatient care for diabetes is available every day, and the “Outpatient Obesity Disease Clinic” is open on Thursday mornings and on Friday afternoons. In the “Diabetic Foot Outpatient Clinic”, certified nurse specialists in diabetes offer preventive care, educational support and treatment for foot and leg lesions. ”Prevention of dialysis program” is provided by doctors, registered dietitians, and nurses in an attempt to stop progression of diabetic nephropathy. At the inpatient ward, diet therapy including low-carbohydrate diets, exercise therapy and pharmacotherapy are tailored to individual patient needs, and patients are carefully examined and treated for complications. Our distinctive “self-care” support program includes self-monitoring of blood glucose and four-time daily body weight measurements. The Department also provides diabetes education for patients in which physicians and CDEJs (nurses, registered dietitians, pharmacists and clinical technologists) provide lectures on their specialized fields. The Best-Weight Management Seminar is also held for patients to provide information on obesity disease-associated complications, treatment options, and diet therapy.

Diagnosis and treatment policy

At the first consultation, the physician collects information on the patient’s medical history and lifestyle, and performs a general physical examination, as well as blood tests, altogether to decide on courses of treatment. A more detailed examination is also performed for early detection and treatment of atherosclerotic complications, including microvascular diseases and macrovascular diseases.

Target diseases and specialties

Blood glucose control and lifestyle modifications for patients with type 2 diabetes; lifestyle modifications and medications for patients with other types of diabetes, dyslipidemia, obesity disease, metabolic syndrome, gout, hyperuricemia, and other metabolic disorders in general; close examination and treatment of patients with dyslipidemia, including familial hypercholesteremia.

Advanced treatments/ Specialized treatments

Genetic diagnosis is applied to patients with suspected metabolic disorders caused by genetic abnormalities, including mitochondrial diabetes, maturity onset diabetes of the young (MODY), insulin receptor abnormality, after obtaining consent, to determine the most effective therapeutic strategy. Glucose clamp technique is used for precise estimation of insulin resistance in individual patients.

Frequently performed tests and descriptions

  • Hemoglobin A1c (HbA1c) shows how the blood glucose level has been controlled over the last one or two months.
  • Glycated albumin (GA) shows how the blood glucose level has been controlled over the last two weeks.
  • Oral glucose tolerance test (OGTT) is used to diagnose diabetes and measure the early-phase insulin secretion, as well as insulin resistance.
  • Continuous Glucose Monitoring (CGM) automatically records average glucose levels with a subcutaneous glucose sensor, which identifies plasma glucose fluctuations and trends over a period of 24 hours or more.

Major diseases treated in this department and numbers of in- and outpatients

Disease name Total number of inpatients Annual number of outpatients
1 Diabetes, hypertension, diabetes, and others 8,173
(New patients: 486)
43,883
(New patients: 268)

(2015)

Diseases selectively treated in this department and treatment and examination methods for them

Diseases
  1. Diabetes
  2. Dyslipidemia
  3. Obesity
  4. Metabolic syndrome
Treatment methods
  1. Dietary therapy
  2. Therapeutic exercises
  3. (Oral) pharmacotherapy
  4. Insulin therapy (including intensive insulin therapy and CSII)
  5. Treatment of obesity, based on eating behavior questionnaires and 4-time body weight measurement
  6. Treatment based on the Guidelines for Diabetes Diagnosis and Treatment
  7. Development of new treatment methods based on databases
  8. Diabetes ward classes (daily)
  9. Diabetes classes for outpatients (weekly)
  10. "Best-Body-Weight" Class (12:15 - 12:45 on every Thursday)
Examination methods
  1. Blood sugar measurement and hemoglobin A1c test
  2. Measurement of insulin secretory capacity and resistance
  3. Detailed examination of complications (retinopathy, nephropathy, and neuropathy)
  4. Measurement of lipid, apoprotein, and lipid metabolism-related enzyme levels
  5. Measurement of adipokines (such as leptin and adiponectin)
  6. Exercise tolerance test
  7. Basal metabolism test
  8. Glucose clamp test
  9. Continuous glucose monitoring (CGM)

Number of major operations and treatments performed for outpatients in this department

Name of operation/treatment Number
1 Nursing support for outpatients (by certified diabetes educators) 413
2 Foot care guidance for outpatients by certified diabetes specialist nurses 240
3 Insulin injection guidance for new outpatients (by certified diabetes educators) 63
4 Blood sugar self-monitoring guidance for new outpatients (by certified diabetes educators) 65
5 Nutritional guidance by nutritionists (for both out- and inpatients) 5,533
6 Preventive education against dialysis for outpatients (by certified diabetes specialist nurses and educators and nutritionists) 131

(2015)

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