1. Journal Club 亀田メディカルセンター 糖尿病内分泌内科 Diabetes and Endocrine Department, Kameda Medical Center 松田 昌文 Matsuda, Masafumi 2009 年 2 月 5 日 8:20-8:50 B 棟８階 カンファレンス室 Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven PD, Zieve FJ, Marks J, Davis SN, Hayward R, Warren SR, Goldman S, McCarren M, Vitek ME, Henderson WG, Huang GD; VADT Investigators. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009 Jan 8;360(2):129-39. Epub 2008 Dec 17. Shai I, Schwarzfuchs D, Henkin Y, Shahar DR, Witkow S, Greenberg I, Golan R, Fraser D, Bolotin A, Vardi H, Tangi-Rozental O, Zuk-Ramot R, Sarusi B, Brickner D, Schwartz Z, Sheiner E, Marko R, Katorza E, Thiery J, Fiedler GM, Blüher M, Stumvoll M, Stampfer MJ; Dietary Intervention Randomized Controlled Trial (DIRECT) Group. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008 Jul 17;359(3):229-41.

2. Original Article Glucose Control and Vascular Complications in Veterans with Type 2 Diabetes William Duckworth, M.D., Carlos Abraira, M.D., Thomas Moritz, M.S., Domenic Reda, Ph.D., Nicholas Emanuele, M.D., Peter D. Reaven, M.D., Franklin J. Zieve, M.D., Ph.D., Jennifer Marks, M.D., Stephen N. Davis, M.D., Rodney Hayward, M.D., Stuart R. Warren, J.D., Pharm.D., Steven Goldman, M.D., Madeline McCarren, Ph.D., M.P.H., Mary Ellen Vitek, William G. Henderson, Ph.D., Grant D. Huang, M.P.H., Ph.D., for the VADT Investigators N Engl J Med Volume 360(2):129-139 January 8, 2009

3. Study Overview In this study, 1791 military veterans with poorly controlled type 2 diabetes were randomly assigned to receive either standard or intensive glucose control Other cardiovascular risk factors were treated uniformly The glycated hemoglobin goal was an absolute reduction of 1.5 percentage points in the intensive- therapy group There was no significant difference between the two groups for the rates of major cardiovascular events, death, or microvascular complications

4. Duckworth W et al. N Engl J Med 2009;360:129-139 Enrollment and Outcomes

5. Characteristics of the Patients at Baseline and Follow-up Duckworth W et al. N Engl J Med 2009;360:129-139

6. Changes in Median Glycated Hemoglobin Levels from Baseline through 78 Months Duckworth W et al. N Engl J Med 2009;360:129-139

7. Kaplan-Meier Curves for the Time until the First Occurrence of a Primary or Secondary Outcome Duckworth W et al. N Engl J Med 2009;360:129-139

8. Hypoglycemic Episodes Duckworth W et al. N Engl J Med 2009;360:129-139

9. Microvascular Outcomes Duckworth W et al. N Engl J Med 2009;360:129-139

10. Conclusion Intensive glucose control in patients with poorly controlled type 2 diabetes had no significant effect on the rates of major cardiovascular events, death, or microvascular complications

11. Myocardial Infarction Mannucci E et al: NMCD 2009 in press

12. Stroke Mannucci E et al: NMCD 2009 in press

14. Original Article Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet Iris Shai, R.D., Ph.D., Dan Schwarzfuchs, M.D., Yaakov Henkin, M.D., Danit R. Shahar, R.D., Ph.D., Shula Witkow, R.D., M.P.H., Ilana Greenberg, R.D., M.P.H., Rachel Golan, R.D., M.P.H., Drora Fraser, Ph.D., Arkady Bolotin, Ph.D., Hilel Vardi, M.Sc., Osnat Tangi-Rozental, B.A., Rachel Zuk-Ramot, R.N., Benjamin Sarusi, M.Sc., Dov Brickner, M.D., Ziva Schwartz, M.D., Einat Sheiner, M.D., Rachel Marko, M.Sc., Esther Katorza, M.Sc., Joachim Thiery, M.D., Georg Martin Fiedler, M.D., Matthias Blüher, M.D., Michael Stumvoll, M.D., Meir J. Stampfer, M.D., Dr.P.H., for the Dietary Intervention Randomized Controlled Trial (DIRECT) Group N Engl J Med Volume 359(3):229-241 July 17, 2008

15. Study Overview This 2-year trial, which took place in an isolated workplace that facilitated retention in the study, randomly assigned 322 moderately obese subjects to one of three diets: a low-fat, restricted-calorie diet; a Mediterranean, restricted-calorie diet; or a low-carbohydrate, non-restricted-calorie diet The results suggest that the Mediterranean and low-carbohydrate diets are effective alternatives to low-fat diets and that personal preferences and metabolic considerations might inform individualized tailoring of dietary interventions

16. Baseline Characteristics of the Study Population Shai I et al. N Engl J Med 2008;359:229-241

17. Enrollment of the Participants and Completion of the Study

20. Changes in Dietary Intake, Energy Expenditure, and Urinary Ketones during 2 Years of Intervention Shai I et al. N Engl J Med 2008;359:229-241

21. Changes in Dietary Intake, Energy Expenditure, and Urinary Ketones during 2 Years of Intervention Shai I et al. N Engl J Med 2008;359:229-241

22. Weight Changes during 2 Years According to Diet Group

23. Changes in Cholesterol and Triglyceride Biomarkers According to Diet Group during the Maximum Weight-Loss Phase (1 to 6 Months) and the Weight-Loss Maintenance Phase (7 to 24 Months) of the 2-Year Intervention Shai I et al. N Engl J Med 2008;359:229-241

24. Changes in Biomarkers According to Diet Group and Presence or Absence of Type 2 Diabetes Shai I et al. N Engl J Med 2008;359:229-241

25. Conclusion Mediterranean and low-carbohydrate diets may be effective alternatives to low-fat diets The more favorable effects on lipids (with the low-carbohydrate diet) and on glycemic control (with the Mediterranean diet) suggest that personal preferences and metabolic considerations might inform individualized tailoring of dietary interventions