BACKGROUND:Motorization and supermarket-proliferation affect lifestyles. About 15 years ago, Okinawans went to several shops on foot, but now they go to supermarkets by car. The influences of these changes on the prevalence of diabetes are uncertain. OBJECTIVE AND MEASUREMENTS: The influence of motorization and supermarket-proliferation on the prevalence of diabetes was studied in the inhabitants of a town on Okinawa, Japan. Measurements were composed of anthropometry and blood chemistry. Participants were asked where they buy food and daily necessities (several shops or a supermarket) and how they get there (by car or on foot).DESIGN:Serial cross-sectional.PARTICIPANTS:Inhabitants of the island of Okinawa were studied.RESULTS:In 1991, 24% went to several shops and 20% to a supermarket. However, in 2004, only 3.1% went to several shops and 83% to a supermarket. In 1991, 55% went to shopping places on foot and 38% by car. However, in 2004, only 14% went on foot and 76% by car. The prevalence of diabetes in Okinawa increased from 4.7% in 1991 to 8.4% in 2004. The prevalence of diabetes correlated positively with the percent of inhabitants going to supermarkets, and those going there by car. In 1991, the prevalence of type 2 diabetes was 4.7% in men and 4.6% in women; no difference was noted between men and women. In 2004, the prevalence of type 2 diabetes increased to 9.2% in men and to 7.5% in women. The increase in the prevalence of type 2 diabetes from 1991 to 2004 was higher in men than in women.CONCLUSIONS:About 15 years ago, Okinawans went to shops on foot, but now they go to supermarkets by car. The prevalence of diabetes is increasing. Motorization and supermarket-proliferation are associated with the increases of the prevalence of diabetes. The increase in diabetes prevalence was higher in men than in women.

We previously reported that mortality is worse for pubertal-onset type 1 diabetes than for the prepubertal-onset variety (1). Other studies have disparately reported that the risk for incipient microangiopathy in type 1 diabetic patients is higher during puberty than before puberty (2–4) or that the risk is similar (5,6). However, evidence regarding the relationship between puberty and advanced microangiopathy is limited (7). We therefore investigated the incidence of blindness and renal replacement therapy (RRT) by pubertal status at diagnosis. A total of 1,408 type 1 diabetic patients diagnosed at <18 years of age were placed on insulin therapy within 1 month of diagnosis. They were chosen from two nationwide type 1 diabetes surveys (1,8,9). The patients were either 1 ) diagnosed between 1965 and 1969 and alive as of 1 January 1970 (the 1960s cohort) or 2 ) diagnosed between 1970 and 1979 and alive as of 1 January 1980 (the 1970s cohort). Follow-up for the 1960s and 1970s cohorts was initiated on 1 January in 1970 or 1980, respectively. Diagnosis in males aged ≥12 years and females aged ≥11 years was defined as pubertal onset, as earlier reported (1,2,5,9–11). The cohorts accounted for ∼75% of all type 1 diabetic subjects in Japan (1,8,12). Status of blindness and …

BACKGROUND:The suppressive effect of dietary protein restriction on the progression of diabetic nephropathy remains controversial. We investigated the effects of protein and energy restrictions on both albuminuria and morphology using diabetic-prone Otsuka Long-Evans Tokushima fatty (OLETF) rats.METHODS:In this study, male OLETF rats were divided into two groups according to their energy intake. They were then further divided into three subgroups based on their amount of dietary protein, which ranged between 10% and 30% of their total intake. Urinary albumin excretion (UAE) was used as a marker of renal impairment, and body weight fasting (F) and postchallenge (P), blood glucose (BG) levels, and systolic blood pressure (SBP) were all measured during various experimental periods up to 28 weeks of age.RESULTS:The OLETF rats fed with the high-calorie diet started to gain weight at 12 weeks, and their FBG and PBG were elevated at 22 weeks, while SBP did not differ between the two groups. In addition, UAE increased significantly in the rats fed with the high-calorie diet. However, the increasing rates of UAE with age were higher in the rats with a higher protein diet within the same energy groups. UAE correlated well with the amounts of dietary energy and protein at 16 and 28 weeks of age, while it correlated with both the FBG and PBG at only 28 weeks of age. A linear regression analysis, using the data obtained at 28 weeks, showed that the amount of protein intake and FBG explained 63.4% and 23.9% of the variation in UAE, respectively. Histological studies revealed that protein and energy restriction markedly reduced the sclerotic changes of the glomeruli.CONCLUSION:Dietary protein restriction starting very early in the life of OLETF rats, in combination with energy restriction, clearly suppressed UAE and the typical morphological changes that otherwise occurred at around 16 weeks of age. This method also seemed to be more effective than energy restriction alone in slowing down any increase in UAE. The influence of BG levels on UAE was lower at an early age, while it became an increasingly important factor at later ages in the experimental rat model.

Aims To examine incidence and trends of Type 1 diabetes worldwide for the period 1990-1999.Methods The incidence of Type 1 diabetes (per 100 000/year) was analysed in children aged <= 14 years from 114 populations in 112 centres in 57 countries. Trends in the incidence of Type 1 diabetes were analysed by fitting Poisson regression models to the dataset.Results A total of 43 013 cases were diagnosed in the study populations of 84 million children. The age-adjusted incidence of Type 1 diabetes among 112 centres (114 populations) varied from 0.1 per 100 000/year in China and Venezuela to 40.9 per 100 000/year in Finland. The average annual increase in incidence calculated from 103 centres was 2.8% (95% CI 2.4-3.2%). During the years 1990-1994, this increase was 2.4% (95% CI 1.3-3.4%) and during the second study period of 1995-1999 it was slightly higher at 3.4% (95% CI 2.7-4.3%). The trends estimated for continents showed statistically significant increases all over the world (4.0% in Asia, 3.2% in Europe and 5.3% in North America), except in Central America and the West Indies where the trend was a decrease of 3.6%. Only among the European populations did the trend in incidence diminish with age.Conclusions The rising incidence of Type 1 diabetes globally suggests the need for continuous monitoring of incidence by using standardized methods in order to plan or assess prevention strategies.

There was a rubella epidemic in 1964–1965 in Okinawa, Japan. By 2004, 280 subjects were diagnosed with congenital rubella syndrome (CRS). All 280 patients followed over this 40-year period developed cataracts, sensory deafness, and/or heart disease. We measured islet cell surface antibody (ICSA), islet cell antibody (ICA), and anti-GAD65, IA-2, and insulin antibodies. Three (1.1%) (patients 1, 2, and 3) of these 280 CRS patients developed type 1 diabetes (positive autoantibodies to pancreatic β-cells). Patients 1 and 2 had diabetic ketoacidosis and type 1 diabetes. Patient 3 was diagnosed with diabetes at 18 years of age …

The study group of the Japan Diabetes Society (JDS) carried out nationwide hospital-based and population-based surveys of childhood type 1 diabetes mellitus (DM) in Japan. According to the nationwide population-based survey, the incidence of childhood type 1 DM in Japan was 1.5 (1.4-1.6)/10(5), which did not differ for the 5 years from 1986-1990. Predisposition for DM and autoimmunity were studied in the first-degree relatives of the patients, including older and later cohorts. The prevalence of type 1 DM was 3.3% (12/369) among siblings and 2.2% (8/369) among parents, while the prevalence of type 2 DM was 0% among siblings and 4.3% (16/369) among parents. The risk of type 1 DM among siblings of the patients was 330 times higher than that among the general population in the Japanese population. The rate of positivity for autoantibodies, including ICA, IAA, GAD and IA-2, was 1.4-2.9% in parents (n=140) and 2.0-3.9% in siblings (n=203). The genetic susceptibility for type 1 DM is far lower in Japanese children than in Caucasian children, but predisposition to the disease and positive autoimmunity are almost the same in Japanese families of patients as in Caucasian families. The quality of life of Japanese parents of children with type 1 DM was less satisfactory that that of the Caucasian parents previously reported, which might be a result of the low incidence of type 1 DM in Japan.

Aims To detect the incidence of childhood Type 1 diabetes mellitus (DIM) (0-14 years) in Japan and to find out whether there is a seasonal pattern in the onset of disease and month of birth of children with diabetes.Methods Ascertained data for the period 1986-1990 could be collected in 35 out of 47 local government areas representing 69.4% of the childhood population (aged 0-14 years) of japan.Results A total of 1260 children with Type 1 DM were identified (738 girls, 522 boys). With age there was a progressive increase in incidence from 0.7 to 2.1/10(5) in boys and from 0.6 to 3.5/10(5) in girls. With the exception of 1987, when a coxsackie B3 virus epidemic was registered, no seasonal variation in the month of onset was observed, nor was a seasonal pattern of the month of birth registered in this cohort.Conclusions Compared to European countries, the USA and Israel, the Japanese cohort of children with diabetes presents the following differences: the incidence is much lower, there is a preponderance of girls and there is (with one exception) no seasonal pattern.

Background Studies of immigrant populations are useful for analysis of the effects of environmental factors on cardiovascular disease. We have examined the association between dietary habit of fish intake and cardiovascular risk. Methods Population-based samples of 433 middle-aged Japanese men and women in Japan (Shimane (group JS) and Okinawa (group JO)) and 269 Japanese immigrants in Brazil (Sao Paulo (group BS) and Campo Grande (group BC)), who had originally moved to Brazil mainly from Shimane and Okinawa, were recruited to the study. They underwent blood pressure measurement, 24-h urine collection, blood tests and electrocardiographic examination, and completed a dietary questionnaire. Results There was a significant gradient through the groups, from JS to JO, BS and BC with respect to the prevalence of obesity, hypertension, increased glycohaemoglobin concentrations and ST-T segment change on the electrocardiogram (prevalences for men and women combined: Group JS 2.0%, group JO 3.8%, group BS 3.9% and group BC 9.0%; P< 0.025). The prevalence of hypercholesterolemia was noted more frequently in groups BS and BC. Twenty-four-hour urinary taurine excretion in both sexes and n-3 polyunsaturated fatty acids (n-3 PU FA) in plasma phospholipids in men were significantly higher in groups JS and JO than in groups BS and BC. A striking negative gradient in the frequency of fish intake per week was found from group JS (men/women, 4.7/4.8) to groups JO (3.8/3.6), BS (1.9/1.6) and BC (0.5/0.5). Conclusions This study suggests a possible association between fish intake and reduced cardiovascular risk, through the beneficial effects of taurine and n-3 PU FA and a habitual low intake of calories and fat.

Differential survival associated with insulin-dependent diabetes mellitus (IDDM) was evaluated in a crosscountry study using four population-based IDDM cohorts from Japan (n = 1,374), Israel (n = 610), Allegheny County, Pennsylvania (n = 995), and Finland (n = 5,144). For the purpose of this cross-country comparison, the Allegheny County cohort was taken to be representative of the United States, The mortality status as of January 1, 1990, was determined for all individuals who were diagnosed with diabetes at the age of less than 18 years between 1965 and 1979 and who were taking insulin at the time of hospital discharge. The results showed that the mortality experience for IDDM individuals in Japan and the United States was much worse than that in Finland and Israel. The age-adjusted mortality rates (per 100,000 person-years) for the four cohorts were 760 (Japan), 158 (Israel), 408 (Allegheny County), and 250 (Finland). By using the mortality data from Allegheny County, Pennsylvania, to extrapolate to the US IDDM mortality experience, the authors estimated 2,396 deaths among individuals with IDDM in the United States. It was calculated that 1,261 (53%) of these deaths would not have occurred in the United States given Finland's mortality rates. It is critical to determine why individuals with IDDM in the United States have a poorer outcome.

Troglitazone, a newly developed oral antidiabetic agent, improves hyperglycemia, and has been reported to improve insulin resistance and to decrease hepatic glucose production in diabetic animals. However, the exact mechanism of Troglitazone on the improvement of insulin resistance is not known. Chronic administration of fructose to normal rats leads to hyperglycemia, and hyperinsulinemia; it induces insulin resistance. To reveal the mechanism of Troglitazone, we studied the effect of Troglitazone on serum glucose and insulin in the fructose-induced, insulin-resistant rats. Male Sprague-Dawley (SD) rats were fed either on standard chow or one containing fructose. Troglitazone was administrated as a food admixture (150 mg/kg/day) for 8 weeks. The rats were fed on (1) standard chow, (2) standard chow and Troglitazone, (3) fructose-enriched chow, or (4) fructose-enriched chow and Troglitazone. Blood samples were obtained every two weeks, and the levels of serum glucose and insulin were measured. Fructose-enriched chow increased serum glucose and insulin levels and insulin-to-glucose ratios. Troglitazone improved the fructose-induced increases in serum glucose, insulin levels, and insulin/glucose ratios. In conclusion, Troglitazone improved the fructose-induced insulin resistance.

The first summer camp in Japan was held at a site near Tokyo in 1963. The guide book was edited by Japan Diabetes Society in 1984. In 1992, 1012 children with diabetes participated at 36 sites all across Japan. The programme is characterized by the smooth combination between education for the children and their experience of recreation. The term of the camp, staff member issues, camp operating fund are discussed. A pan-pacific international diabetes summer camp was successfully held at the Ehime prefecture site in 1989 with 56 patients from eight countries. The summer camp is evaluated for the achievement of good psycho-physical growth of the participating children and the maintenance of good control of diabetes. The problems include the term length of the camp, finding a camp site and the national and local governmental subsidy. Finally, a more effective operation with a minimum number of educators should be another concern in the future.

1. A 6-week gliclazide treatment improved left ventricular developed pressure and left ventricular end-diastolic pressure, left ventricular pressure-rate products in isolated working hearts from streptozotocin-induced diabetic rats. 2. Post-ischemic recovery in heart rate, left ventricular developed pressure, left ventricular end-diastolic pressure, left ventricular pressure-rate products and cardiac work were also shown in gliclazide-treated diabetic rats. 3. Gliclazide treatment did not modify the degree of insulinopenia and hyperglycemia, nor the myocardial energy metabolism during ischemia-reperfusion. 4. The results suggest that the gliclazide treatment has a cardioprotective effect on basal and post-ischemic cardiac functions of chronic diabetes.