title: Impact on short-term glycaemic control of initiating diabetes care versus leaving diabetes untreated among individuals with newly screening-detected diabetes in Japan.
abstract: BACKGROUND
  The impact of early initiation of diabetes care soon after the identification of hyperglycaemia rather than leaving diabetes untreated on changes in glycaemic control has not been fully clarified. We aimed to quantify the effect of initiating and continuing diabetes care compared with not starting management of diabetes on short-term changes in glycaemic control among the Japanese with newly screening-detected diabetes.
  
  
  METHODS
  We retrospectively reviewed data from a nationwide claims database to assess histories of physician-diagnosed diabetes or hyperglycaemia, as well as the use of antidiabetic agents, blood testing for hyperglycaemia or dietary advice among individuals without a history of diabetes care. Changes in glycated haemoglobin (HbA1c) concentrations were evaluated using baseline data and data from a health examination during the following year.
  
  
  RESULTS
  Among 1393 individuals with newly screening-detected diabetes, 62% (n=864) did not initiate diabetes management during the follow-up period; 49.2% (n=425) of the untreated group had poor glycaemic control (HbA1c ≥7%) at the baseline examination. Only 38% (n=529) began diabetes management in medical settings. Individuals who remained untreated had a 1.87 (95% CI 1.38 to 2.52) or 1.63 (1.10 to 2.41) times higher risk of absolute increases in HbA1c ≥0.5% or ≥1%, respectively, compared with the treated patients, a difference that was significant. Making more frequent clinic visits especially after the first visit was dose-dependently associated with improved HbA1c levels compared with no diabetes management.
  
  
  CONCLUSIONS
  In comparison with a lack of management of diabetes, immediately initiating and continuing diabetes care after identification of hyperglycaemia in a screening setting would contribute to clinically meaningful, improved glycaemic control in the Japanese.
authors.affiliation: Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan.
authors.forename: Yoriko
authors.initials: Y
authors.lastname: Heianza
authors.affiliation: Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Suzuki
authors.affiliation: Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan Department of Internal Medicine, University of Tsukuba Institute of Clinical Medicine, Ibaraki, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Fujihara
authors.affiliation: Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Kodama
authors.affiliation: Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Hanyu
authors.affiliation: Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan.
authors.forename: Hirohito
authors.initials: H
authors.lastname: Sone
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis*; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007564:Japan; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D061665:Time-to-Treatment; D016312:Treatment Refusal
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human
keywords: Clinical epidemiology; DIABETES; SCREENING