27 7 800
24
/
1
2013 31
38,024
Q
OL 1.
5
4
21
WG
CKD
2013 CKD G3b
2015
2
2
( )
2
KDB
64 2
P14 15
10
4 (1 ) 1 2
2
1 1 P10 13
4 (RCT)
30 79
2 2 ( 60 ) 3 1
( 56 ) 1 (
519 )
0.8 0.91g/kg/
1.2g/kg/ 1
5 2
1 1)(12 ) 6
-0.05 0.21g/kg
+0.03 0.19g/kg(p=0.02)
14
11 (p=0.01)
2
(28 ) 1 2)
6
0.08g/kg/
3
1 3)( 3.5 )
HbA1c sCr eGFR
(
1 1 )
3
8RCT 4
eGFR CC
(p=0.003)
1 5 (
32 ) 2
2
130/85( Hg)
2 1 10 /
2 1 6)
1 7)
( bupropion)
12
193 120
22.5 72.6
52 11
(17 )
0 eGFR
-1.79 -1.30
-1.54
2 8)9 eGFR15 59(ml/
min/1.73 ) 2
12
8) sCr
eGFR
9
QOL
/
10 40 74
CKD
(1,206 ) CKD
(2 ) 6
IT 3
(1,
211 ) CKD
3.5
88.5 83.2
34.3 16.0 eGFR
CKD 1 2 4 5
CKD
Cr 4.4
6.7 eGFR50
5.6 8.1
5 8
12
12
203
181
240 4 P18
578 53
2 1
710 27
4
5
3 P
16 17
3
eGFR
210
181
HbA1c
2
4
HbA1c
HbA1c
30
2
20
20
6 HbA1c eGFR
52
6 60 95.6
6 HbA1c
eGFR
1
2
O 2011
P40 42
40 74
7,956
126 /dl HbA1c6.5
3 61
24
1 2 646 311
372 37
HbA1c
HbA1c
5
HbA1c
HbA1c7.0
35.6 HbA1c8.0
37.2 22.6
P 23 43
P23 24
5
P19 20
P25 28
2
126 /dl 200 /dl
HbA1c6.5
+
eGFR 30 4
P28 31
6
P32 34
QOL
KDB
P35 42
2
(
)
/
2
CCr eGFR
(1 10) )
1 10)
(
)
HbA1c eGFR
1
2 3
4
7
3
1
2
28
( )
40
2016.02.27
58
2015.5
2
( ) 62
2015.9
22
2015.10
Kazawa K., Yamane K., Yorioka N.,Moriyama M. Development and Evaluation of
Disease Management Program and ServiceFramework for Patients with Chronic Diseases.Health, 7(6), 729-740, 2015.(DOI:10.4236/health.2015.76087)
8
1
2
3
1) Loek T, J Pijls, Hendrik de Vries et al.: The effect
of protein restriction on albuminuria in patients
with type 2 diabetes mellitus: a randomized trial.
Nephrol Dial Transplant 1999, 14:1445-1453.
2) LTJ Pijls, H de Vries, JThM van Eijk et al.: Protein
restriction, glomerular filtration rate and albuminuria
in patients with type 2 diabetes mellitus: a randomized
trial. European Journal of Clinical Nutrition 2002, 56:
1200-1207.
3) Koya M, Haneda S, Inomata Y et al.: Long-term
effect of modification of dietary protein intake on the
progression of diabetic nephropathy: a randomized
controlled trial. Diabetologia 2009, 52:2037-2045.
4) Yu pan, Li Li Guo, Hui Min Jin et al.: Low- protein
diet for diabetic nephropqthy: a meta-analysis of
randomized controlled trials. Am J Clin Nutr 2008, 88:
660-6.
5) Masahito Imanishi, Takashi Morikawa, Katsunobu
Yoshioka et al.: Sodium Sensitivity Related to
Albuminuria Appearing Before Hypertension in Type
2 Diabetic Patients 2001, 24: 111-115.
6) Voulgari C, Katsilambros N, Tentolouris N et al.:
Smoking cessation predicts amelioration of
microalbuminuria in newly diagnosed type 2 diabetes
mellitus: a 1-year prospective study. Metabolism 2011,
60:1456-64.
7) Phisitkul K, Hegazy K, Chuahirum T et al.:
Continued smoking exacerbates but cessation
ameliorates progression of early type 2 diabetic
nephropathy. Am J Med Sci 2008, 335:284-91.
8) Kana Kazawa, Yae Takeshita, Noriaki Yorioka et
al.: Efficacy of a disease management program
focused on acquisition of self-management skills in
pre-dialysis with diabetic nephropathy: 24 months
follow-up. J Nephrol 2015, 28: 329-38.
9) Kana Kazawa, Kiminori Yamane, Noriaki Yorioka
et al.: Development and Evaluation of Diease
Management Program and Service Framework for
Patients with Chronic Disease. Health 2015, 7:
729-740.
10) .:
/
2014
9
1 LPDKoya D.et al.
2009
2 LPDPijls LT,
et al.1999
RCT
3 LPDPijls LT,
et al.2002
RCT
4 LPDPan Y, et
al.2008
RCT
5ImanishiM, et al. 2001 cross-over
6VoulgariC, et al.
2011
7PhisitkulK, et al.
2008
NO
10
HbA1c
sCreGFR
Alb
ESRD
0.19g/kg(p=0.02)
2
- - - - -ECGhs-CRP
- - - - -
11
8KazawaK et al.
2014
non-randomized, controlled trial
9KazawaK et al.
2015
>6.5%, FBS> >30mg/dl,eGFR<60
single-group pre-test and post-test design
10
NO
2012,2014
12
HbA1c
sCreGFR
Alb
primary
endpoint
BUN, Hgb, TP, alb, K, P, nonHDL-c,
primary
endpoint
primary
endpoint
primary
endpoint
BUN, Hgb, TP, alb, K, P, nonHDL-c,
50- - -
50
13
1 Renal function following three distinct weight loss dietary strategies during 2 years of a randomized controlledtrial. DIRECT Diabetes Care Tirosh A, et al.
2 Altered dietary salt intake for preventing and treating diabetic kidney disease. Cochrane Database Syst Suckling RJ, et al.
3 Sodium restriction and blood pressure in hypertensive type II diabetics:Randomised blind controlled and crossover studies of moderate sodium restriction and sodium supplementation BMJ Dodson PM, et al
4 Salt-sensitive blood pressure-an intermediate phenotype predisposing to diabetic nephropathy? Nephrol Dial Transplant Strojek K, et al.5 A Low-Sodium Diet Potentiates the Effects of Losartan in Type 2 Diabetes Diabetes Care Houlihan CA, et al.
6 Long-term effect of modification of dietary protein intake on the progression of diabetic nephropathy: arandomised controlled trial. Diabetologia Koya D, et al
7 Prevalence and correlates of post-prandial hyperglycaemia in a large sample of patients with type 2 diabetesmellitus. Diabetologia E Bonora, et al
8 Contributions of fasting and postprandial plasma glucose increments to the overall diurnalhyperglycemia of type 2 diabetic patients: variations with increasing levels of HbA(1c). Diabetes Care Monnier L, et al
9 The Loss of Postprandial Glycemic Control Precedes Stepwise Deterioration of Fasting With Worsening Diabetes Diabetes Care Monnier L, et al
10 Impact of fasting and postprandial glycemia on overall glycemic control in type 2 diabetes Importance ofpostprandial glycemia to achieve target HbA1c levels. GL24 Diabetes Res Clin Pract Woerle HJ, et al.
11 Prospective Analysis of Mortality,Morbidity, and Risk Factors in Elderly Diabetic Subjects Diabetes Care M Katakura,et al.
12 Prevalence and determinants of anemia in older people with diabetes attending an outpatient clinic: a cross-sectional audit. Clinical Diabetes Trevest K, et al
13 Effects of dietary protein restriction on albumin and fibrinogen synthesis macroalubuminuric type 2 diabeticpatients Diabetologia M. Giordano, et al
15 Weight-loss diets in people with type 2 diabetes and renal disease:a randomized controlled trial of the effect ofdifferent dietary protein amounts Am J Clin Nutr David R Jesudason, Eva Pedersen,
and Peter M Clifton
16 Age Affects Outcomes in Chronic Kidney Disease Clin Epidemiol
17 Impact of Age and Overt Proteinuria on Outcomes of Stage 3 to 5 Chronic Kidney Disease in a Referred Cohort Am Soc Nephrol Yoshitsugu Obi, et al
18 Risks for glomerular filtration rate decline in association with progression of albuminuria in type 2 diabetes Nephrol Dial Transplant Hiroki Yokoyama, et al
182 6 (Outcomes
of 6 years of activities by the Tokushima Medical Association's Steering Committee for Diabetes Prevention toprevent type 2 diabetes in the general population of Tokushima Prefecture)
Diabetology International Shima Kenji, et al
19
20 ( )
21
22 Long-term effects of a randomised trial of a 6-year lifestyle intervention in impaired glucose torelance on diabetesrelated microvascular complications:the China Da Qing Diabetes Prevention Outcome Study
Diabetologia Q Gong, et al.
23 The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes PreventionStudy: a 20 year follow-up study Lancet Li G, et al
24 A simple meal plan emphasizing healthy food choices is as effective as an exchanged-based meal plan for urbanAfrican Americabs with type 2 diabetes Diabetes Care Ziemer DC, et al.
25 Translating lifestyle intervention to practice in obese patients with type 2 diabetes: improving Control withActivity and Nutrition (ICAN) study Diabetes Care Wolf AM, et al.
26 Nutritional intervention in patients with type 2 diabetes who are hyperglycaemic despite optimised drugtreatment-Lifestyle Over and Above Drugs in Diabetes(LOADD) study: randomised controlled trial BMJ Coppell KJ, et al.
27 Low-protein diet for diabetic nephropathy: ameta-analysis of randomized cntrolled trials Am J Clin Nutr Pan Y, et al.
28 Smoking cessation predicts amelioration of microalbuminuria in newly diagnosed type 2 diabetes mellitus: a 1-year prospective study Metabolism Voulgari C, et al.
29 Continued smoking exacerbates but cessation ameliorates progression of early type 2 diabetic nephropathy Am J Med Sci Phisitkul K, et al.
30 Prediction of Cardiovasucular Disease Mortality by Proteinuria and Reduced Kidney Function: Pooled Analysisof 39,000 Individuals From 7 Cohort Studies in Japan
American Journal ofEpidemiology Nagata N et al.
31 Smoking increases the risk of all-cause and cardiovascular mortality in patients with chronic kidney disease International Society ofNephrology Nakamura K et al.
32 Impact of kidney Disease and Blood Pressure on the Development of Cardiovasucular Disease Circulation Ninomiya T et al.
33 Revisit frequency and its association with quality of care among diabetic patients: Translating Research IntoAction for Diabetes(TRIAD) J Diabetes Complications Asao K
34 Effects of long- term behavioural weight loss intervention on nephropathy in overweight or obese adults with type2 diabetes: a secondary analysis of the Look AHEAD randomised clinical trial
Lancet DiabetesEndocrinol
The look AHEADResearch Group
35 Risk of developing end-stage renal disease in a cohort of mass screening. Kidne Int Iseki K, et al36 Proteinuria and the risk of developing end-stage renal disease. Kidne Int Iseki K, et al
14
37 Chronic kidney disease and cardiovascular disease in a general Japanese population: the Hisayama Study. Kidne Int Ninomiya T, et al
38 The relationships of proteinuria, serum creatinine, glomerular filtration rate with cardiovascular disease mortalityin Japanese general population. Kidne Int Irie F, et al
39 Chronic kidney disease is a risk factor for cardiovascular death in a community-based population in Japan:NIPPON DATA90. Circ J Nakamura K, etal
40 Kidney dysfunction as a risk factor for first symptomatic stroke events in a general Japanese population--theOhasama study. Nephrol Dial Transplant Nakayama M, et al
41 Slower decline of glomerular filtration rate in the Japanese general population: a longitudinal 10-year follow-upstudy. Hypertens Res Imai E, et al
42 Relationship between blood pressure category and incidence of stroke and myocardial infarction in an urbanJapanese population with and without chronic kidney disease: the Suita Study. Stroke Kokubo Y, et al
43 Albuminuria is an independent predictor of all-cause and cardiovascular mortality in the Japanese population: theTakahata study.
Clin Exp Nephrol;17:805-10, 2013. Konta T, et al
44Comparison of predictability of future cardiovascular events between chronic kidney disease (CKD) stage basedon CKD epidemiology collaboration equation and that based on modification of diet in renal disease equation inthe Japanese general population--Iwate KENCO Study.
Circ J Ohsawa M, et al
45 Prediction of cardiovascular disease mortality by proteinuria and reduced kidney function: pooled analysis of39,000 individuals from 7 cohort studies in Japan. Am J Epidemiol Nagata M, et al
46 Clinical impact of albuminuria and glomerular filtration rate on renal and cardiovascular events, and all-causemortality in Japanese patients with type 2 diabetes Clin Exp Nephrol Wada T, et al.
47 Diabetic Nephropahty remission and regression Team Trial in Japan(DNETT-Japan):Rationale and study design Diabetes Researech andClinical Practice Shikata K. et al
48 Development and progression of nephropathy in type 2 diabetes :the United Kingdom Prospective DiabetesStudy UKPDS 64 Kidne Int Adler AI, et al
49 Remission to normoalbuminuria during multifactorial treatment preserves kidney function in patients with type 2diabetes and microalbuminuria Nephrol Dial Transplant Gaede P, et al
50 Protein restriction, glomerular filtration rate and albuminuria in patients with type 2 diabetes mellitus: arandomized trial
European Journal ofClinical Nutrition LTJ Pijls, et al
51 The effect of protein restriction on albuminuria in patients with type 2 diabetes mellitus: a randomized trial Nephrol Dial Transplant LTJ Pijls, et al
52 Sodium Sensitivity Related to Albuminuria Appearing Before Hypertension in Type 2 Diabetic Patients Diabetes Care M Imanishi, et al
53 Develoment and Evaluation of Diease Management Program and Service Framework for Patients with ChronicDiease Health K Kazawa, et al
54 Efficacy of a disease management program focused on acquisition of self-management skills in pre-dialysispatients with diabetic nephropathy:24 months follow-up J Nephrol K Kazawa, et al
55 /
56 Disease Management Diabetes Journal
57 -5859 Japanese model of Disease Management Medinfo Nakashima N,60 - - Diabetes Journal6162 / Disease Management63 Disease Management64 Diabetes Frontier
15
2
16
22.57
28.02
17
1 2013(H25)
2 2014-2015
3 2013-2015
4 2013-2015
5 2013-2015
6 2013-2015
7 2013-2015
8 2013-2015
9 2014-2015
10 2014-2015
11 2014-2015
12
13 2011
14
15
16 2012
17
18
19 2010
20 2011
21 2012
22 2013
23 2014
24 2015
25
26
27
28
29
30
31
32
33 2015
34 2015
35 2015
36 2015
37 2015
38 2015
39 2015
40 2012
41
42
43
44
45 2016
46 2015
47
48
49
50
51 2010
52
53 2011
54 2011
55 2013
56 2014
57 2014
58 2015
59
60
240
18
5
19
20
2
2020 800 24
23
KDB
2014 15,809
43.5 67.2 5 1.4 10
2.6
4 2014
CKD 2013 CKD G3b
2015
CKD
eGFR
( )
24
2014
2 126mg/dl ( 200mg/dl)
HbA1c 6.5%
+
3
2
CVD
eGFR
CVD (CKD
2013 P80)
25
4
eGFR 30 44ml/ /1.73m2 CKD G3b
eGFR
4
QOL
4
1
26
eGFR
27
3
HbA1c7.0 1
3 4
1 2
HbA1c
28
3 4
1 2
1
29
75
1
30
3 HbA1c7.0 1
CKD 2012/Cr 0.50g/gCr
GFR50mL/ /1.73m2
31
KDB
32
HbA1c eGFR
QOL
KDB
10
HbA1c 8.0
33
34
HbA1c 6.5
HbA1c 8.0
8.0
2
4 eGFR<30ml/min/1.73m2
KDB
KDB
HbA1c 5.6 100mg/dl
eGFR<60ml/min/1.73m2
CSV
35
REACH-J 2015
eGFR
QOL
1 3 6
2 1 1 3 6
1
ICT
36
3
or
QOL
HbA1c eGFR
1
HbA1c LDL
non-HDL
* eGFR* *
QOL
eGFR HbA1c
10
37
38
39
40 74 7,956
3 61 24
2 646 311 HbA1c
2
HbA1c 169 147
eGFR CKD
372 37
75 2,037
3 33 9
130 24
FPG 126 or HbA1c NGSP 6.5 372 4.68% UP 37 0.47% 335 4.21% UP 24 0.30% UP 61 0.77%
n=707) UP 335 4.21% UP 311 3.91% UP 646 8.12%
FPG 126 & HbA1c(NGSP) 6.5 150 1.89% UP 22 0.28% 7,099 89.23% UP 147 1.85% UP 169 2.12%
n=7,249 UP 127 1.60% UP 6,952 87.38% UP 7,079 88.98%
7,956
O 2011 40 64 n=3,367
FPG 126 or HbA1c NGSP 6.5 105 3.12% UP 13 0.39% 114 3.39% UP 6 0.18% UP 19 0.56%
n=219) UP 92 2.73% UP 108 3.21% UP 200 5.94%
FPG 126 & HbA1c(NGSP) 6.5 30 0.89% UP 3 0.09% 3,118 92.60% UP 53 1.57% UP 56 1.66%
n=3,148 UP 27 0.80% UP 3065 91.03% UP 3,092 91.83%
3,367
O 2011 65 74 n=4,589
FPG 126 or HbA1c NGSP 6.5 267 5.82% UP 24 0.28% 221 4.82% UP 18 0.39% UP 42 0.92%
n=488) UP 243 5.30% UP 203 4.42% UP 446 9.72%
FPG 126 & HbA1c(NGSP) 6.5 120 2.61% UP 11 0.24% 3,981 86.75% UP 94 2.05% UP 105 2.29%
n=4,101 UP 109 2.38% UP 3,887 84.70% UP 3,996 87.08%
4,589
O 2011 75 n=2,037
FPG 126 or HbA1c NGSP 6.5 UP 24 0.64% UP 9 0.44% UP 33 1.62%
n=244) UP 106 5.20% UP 105 5.15% UP 211 10.36%FPG 126 & HbA1c(NGSP) 6.5 UP 9 0.44% UP 83 4.07% UP 92 4.52%
n=1,793 UP 51 2.50% UP 1,650 81.00% UP 1,701 83.51%
2,037
O 2011 75-79 n=1,231
FPG 126 or HbA1c NGSP 6.5 UP 11 1.06% UP 7 0.57% UP 18 1.46%
n=158) UP 70 5.69% UP 70 5.69% UP 140 11.37%
FPG 126 & HbA1c(NGSP) 6.5 UP 6 0.49% UP 35 2.84% UP 41 3.33%
n=1073 UP 34 2.76% UP 998 81.07% UP 1,032 83.83%
1,231
O 2011 80 n=806
FPG 126 or HbA1c NGSP 6.5 UP 13 1.61% UP 2 0.25% UP 15 1.86%
n=86) UP 36 4.47% UP 35 4.34% UP 71 8.81%
FPG 126 & HbA1c(NGSP) 6.5 UP 3 0.37% UP 48 5.96% UP 51 6.33%
n=720 UP 17 2.11% UP 652 80.89% UP 669 83.00%806
81 6.58% 77 6.26%
40 3.25% 1033 83.92%
49 6.08% 37 4.59%
130 6.38% 114 5.60%
60 2.95% 1,733 85.08%
20 2.48% 700 86.85%
40
40-74 n=7,938HbA1 5.6 5.6 <6.5 6.5 <7.0 7.0 <7.9 8.0 <8.9 9.0
UP 76 90 13 25 11 7 222
UP 3,984 3,114 287 214 71 46 7,716
4,060 3,204 300 239 82 53 7,938
40 64 n=3,359
HbA1 5.6 5.6 <6.5 6.5 <7.0 7.0 <7.9 8.0 <8.9 9.0UP 35 22 5 3 5 5 75
UP 1,976 1,119 90 58 19 22 3,284
2,011 1,141 95 61 24 27 3,359
65 74 n=4,579
HbA1 5.6 5.6 <6.5 6.5 <7.0 7.0 <7.9 8.0 <8.9 9.0UP 41 68 8 22 6 2 147
UP 2,008 1,995 197 156 52 24 4,432
2,049 2,063 205 178 58 26 4,579
75 n=2,052HbA1 5.6 5.6 <6.5 6.5 <7.0 7.0 <7.9 8.0 <8.9 9.0
UP 32 61 9 10 11 2 125
UP 823 887 87 75 26 14 1,912
855 948 96 85 37 16 2,037
75 79 n=1,231
HbA1 5.6 5.6 <6.5 6.5 <7.0 7.0 <7.9 8.0 <8.9 9.0UP 17 21 5 6 6 1 125
UP 494 544 59 48 17 10 1,912
511 568 64 54 23 11 1,231
80 n=806
HbA1 5.6 5.6 <6.5 6.5 <7.0 7.0 <7.9 8.0 <8.9 9.0UP 15 37 4 4 5 1 59
UP 329 343 28 27 9 10 1,172
344 380 32 31 14 5 806
HbA1c
HbA1c
HbA1c 6.5 7.9 7.1
8.0 13.3
HbA1c 6.5 7.9 9.9
8.0 24.5
41
HbA1c 7.0
134 /376 35.6
HbA1c 8.0
51 /137 37.2 12 /53 22.6
40-74 n=7,953HbA1
12 0.29% 149 4.64% 120 40.00% 156 65.27% 62 75.61% 24 43.64% 523 6.58%
4,057 99.71% 3,059 95.36% 180 60.00% 83 34.73% 20 24.39% 31 56.36% 7,430 93.42%
4,069 3,208 300 239 82 55 7,953
40 64 n=3,366
HbA13 0.15% 33 2.89% 32 33.68% 40 65.57% 16 66.67% 12 42.86% 136 4.04%
2,014 99.85% 1,108 97.11% 63 66.32% 21 34.43% 8 33.33% 16 57.14% 3,230 95.96%
2,017 1,141 95 61 24 28 3,366
65 74 n=4,587
HbA1
9 0.44% 116 5.61% 88 42.93% 116 65.17% 46 79.31% 12 44.44% 387 8.44%
2,043 99.56% 1,951 94.39% 117 57.07% 62 34.83% 12 20.69% 15 55.56% 4,200 91.56%
2,052 2,067 205 178 58 27 4,587
75 n=2,052HbA1
6 0.70% 58 6.07% 36 37.11% 52 61.18% 29 78.38% 12 75.00% 193 9.41%
856 99.30% 897 93.93% 61 62.89% 33 38.82% 8 21.62% 4 25.00% 1,859 90.59%
862 955 97 85 37 16 2,052
75 79 n=1,237
HbA14 0.78% 37 6.49% 24 36.92% 32 59.26% 18 78.26% 8 72.73% 123 9.94%
510 99.22% 533 93.51% 41 63.08% 22 40.74% 5 21.74% 3 27.27% 1,114 90.06%
514 570 65 54 23 11 1,237
80 n=815
HbA1
2 0.57% 21 5.45% 12 37.50% 20 64.52% 11 78.57% 4 80.00% 70 8.59%
346 99.43% 364 94.55% 20 62.50% 11 35.48% 3 21.43% 1 20.00% 745 91.41%
348 385 32 31 14 5 815
UP n
9.05.6 5.6 <6.5 6.5 <7.0 7.0 <7.9 8.0 <8.9
9.0
5.6 5.6 <6.5 6.5 <7.0 7.0 <7.9 8.0 <8.9 9.0
5.6 5.6 <6.5 6.5 <7.0 7.0 <7.9 8.0 <8.9
9.0
5.6 5.6 <6.5 6.5 <7.0 7.0 <7.9 8.0 <8.9 9.0
5.6 5.6 <6.5 6.5 <7.0 7.0 <7.9 8.0 <8.9
5.6 5.6 <6.5 6.5 <7.0 7.0 <7.9 8.0 <8.9 9.0
HbA1c
42
43
44
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