論文 Efficacy and Safety of Low-dose Spironolactone for Chronic Kidney Disease in Type 2 Diabetes The Journal of Clinical Endocrinology & Metabolism,Advance access publication 14 March 2023 2023 Author:Ako Oiwa, Dai Hiwatashi, Teiji Takeda, Takahide Miyamoto, Iori Kawata, Masayoshi Koinuma, Masanori Yamazaki, and Mitsuhisa Komatsu Abstract:Context: Although adding spironolactone to renin-angiotensin system blockers reduces albuminuria in adults with chronic kidney disease and
type 2 diabetes, it increases the risk of hyperkalemia.
Objective: To assess whether a lower dose of spironolactone (12.5 mg/d) reduces the risk of hyperkalemia while maintaining its effect on
reducing albuminemia.
Design: Multicenter, open-label, randomized controlled trial.
Setting: This study was conducted from July 2016 to November 2020 in ambulatory care at 3 diabetes medical institutions in Japan.
Patients: We enrolled 130 Japanese adults with type 2 diabetes and albuminuria (≥30 mg/gCre), estimated glomerular filtration rate ≥30 mL/
min/1.73 m2, and serum potassium level <5.0 mEq/L.
Interventions: The participants were randomly assigned to the spironolactone-administered and control groups.
Main outcome measures: Changes in urine albumin-to-creatinine ratio (UACR) from baseline over the 24-week interventional period.
Results: The spironolactone group showed a significant reduction in UACR from baseline (mean decrease, 103.47 ± 340.80 mg/gCre) compared
with the control group, which showed an increased UACR (mean increase, 63.93 ± 310.14 mg/gCre; P = .0007, Wilcoxon rank-sum test and
t test). Although the spironolactone group had a statistically significant increase in serum potassium levels, none of the participants had a
potassium level ≥5.5 mEq/L at 24 weeks. Further, participants with a higher initial serum potassium level tended to have a smaller increase
(estimate, −0.37, analysis of covariance).
Conclusions: Low-dose spironolactone administration reduced albuminuria without causing hyperkalemia. Spironolactone administration, the
oldest known and most cost-effective mineralocorticoid receptor antagonist, at lower doses should be reconsidered.
Interval walking training in type 2 diabetes: A pilot study to evaluate the applicability as exercise therapy PLOS ONE,PLoS ONE 18(5): e0285762. 2023 Author:Kouhei Kitajima, Ako Oiwa, Takahiro Miyakoshi, Manami Hosokawa, Mayuka Furihata, Masaaki Takahashi, Shizue Masuki, Hiroshi Nose, Yosuke Okubo, Ai Sato, Masanori Yamazaki, Mitsuhisa Komatsu Abstract:There are few established easy-to-perform exercise protocols with evidence-based effects
for individuals with type 2 diabetes (T2D). A unique exercise regimen, interval walking training
(IWT), has been reported to be beneficial for improving metabolic function, physical fitness
and muscle strength in adults of overall health. This pilot study aims to demonstrate
descriptive statistics of IWT adherence and changes in various data before and after the
intervention of IWT in adults with T2D, perform statistical hypothesis testing, and calculate
effect sizes. We performed a single-arm interventional pilot study with IWT for 20 weeks.
We enrolled 51 participants with T2D aged 20–80 years with glycohemoglobin (HbA1c) levels
of 6.5–10.0% (48–86 mmol/mol) and a body mass index of 20–34 kg/m2, respectively.
The target was 60 min/week of fast walking for 20 weeks. The participants visited the hospital
and were examined at 4-week intervals during this period. Between the start of IWT and
after 20 weeks, we measured and evaluated changes in glucose and lipid metabolism data,
body composition, physical fitness, muscle strength, dietary calorie intake, and daily exercise
calories. All included participants completed IWT, with 39% of them reaching the target
length of fast walking over 1,200 minutes in 20 weeks. In the primary outcome, HbA1c levels,
and in the secondary, lipid metabolism and body composition, no significant changes
were observed except for high-density lipoprotein cholesterol (HDL-C) (from 1.4 mmol/L to
1.5 mmol/L, p = 0.0093, t-test). However, in the target achievement group, a significant
increase in VO2 peak by 10% (from 1,682 mL/min to 1,827 mL/min, p = 0.037, t-test) was
observed. Effect sizes were Cohen’s d = 0.25 of HDL-C, -0.55 of triglyceride, and 0.24 of
VO2 peak in the target achievement group, which were considered to be of small to medium
clinical significance. These results could be solely attributed to IWT since there were no significant
differences in dietary intake and daily life energy consumption before and after the
study. IWT could be highly versatile and was suggested to have a positive effect on lipid
metabolism and physical fitness. In future randomized controlled trial (RCT) studies, the
detailed effects of IWT, focusing on these parameters, will be examined.
A patient with mild respiratory COVID-19 infection who developed bilateral non-hemorrhagic adrenal infarction. Nagoya Journal of Medical Science,83巻(4号):883-891 2021 Author:5. Asano Y, Koshi T, Sano A, Maruno T, Kosaka M, Yamazaki Y, Oiwa A, Nishii Y. Abstract:上気道症状はほとんど認めなかったにも関わらず、副腎梗塞を併発したCOVID-19患者の症例報告。
Changes in serum uric acid levels as a predictor of future decline in renal function in older adults with type 2 diabetes. Medicine,8(100):e27420 2021 Author:4. Shibata Y, Yamazaki M, Kitahara J, Okubo Y, Oiwa A, Sato A, Komatsu M.
Aldosterone to Potassium Ratio after Adrenocorticotropin Stimulation in Unilateral Primary Aldosteronism Diagnosis 信州医学雑誌,68(3):159-168 2020(Jun. 10) Author:Kitahara, Junichiro; Ohkubo, Yousuke; Kitajima, Kouhei; Nishio, Shin-ichi; Oiwa, Ako; Sato, Ai; Yamazaki, Masanori; Sakuma, Takahiro; Sano, Asami; Nishii, Yutaka; Komatsu, Mitsuhisa
Implications of thyroid autoimmunity in infertile women with subclinical hypothyroidism in the absence of both goiter and anti-thyroid antibodies: lessons from three cases Endocrine Journal,66巻(2号):193-198 2018(Dec. 18) Author:Ako Oiwa, Kesami Minemura, Shin-ichi Nishio, Masanori Yamazaki, Mitsuhisa Komatsu
Long-term Effects of Ipragliflozin on Adipose Tissue in Japanese Patients with Obese Type 2 Diabetes 信州医学雑誌,66(1):29-37 2018(Feb. 10) Author:Nishio Shin-ichi, Sekido Takash, Ohkubo Yohsuke, Oiwa Ako, Komatsu Mitsuhisa