XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

Background in 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a sarcopenia definition that aimed to foster advances in identifying and caring for people with sarcopenia. In early 2018, the Working Group met again (EWGSOP2) to update the original definition in order to reflect scientific and clinical evidence that has built over the last decade. This paper presents our updated findings. Objectives to increase consistency of research design, clinical diagnoses and ultimately, care for people with sarcopenia. Recommendations sarcopenia is a muscle disease (muscle failure) rooted in adverse muscle changes that accrue across a lifetime; sarcopenia is common among adults of older age but can also occur earlier in life. In this updated consensus paper on sarcopenia, EWGSOP2: (1) focuses on low muscle strength as a key characteristic of sarcopenia, uses detection of low muscle quantity and quality to confirm the sarcopenia diagnosis, and identifies poor physical performance as indicative of severe sarcopenia; (2) updates the clinical algorithm that can be used for sarcopenia case-finding, diagnosis and confirmation, and severity determination and (3) provides clear cut-off points for measurements of variables that identify and characterise sarcopenia. Conclusions EWGSOP2's updated recommendations aim to increase awareness of sarcopenia and its risk. With these new recommendations, EWGSOP2 calls for healthcare professionals who treat patients at risk for sarcopenia to take actions that will promote early detection and treatment. We also encourage more research in the field of sarcopenia in order to prevent or delay adverse health outcomes that incur a heavy burden for patients and healthcare systems.

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Sarcopenia: Revised European consensus on definition and diagnosis

https://science.sciencemag.org/content/sci/5/110/206.full.pdf

The american psychological association.

Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment

Human intervention trials have provided evidence for protective effects of various (poly)phenol-rich foods against chronic disease, including cardiovascular disease, neurodegeneration, and cancer. While there are considerable data suggesting benefits of (poly)phenol intake, conclusions regarding their preventive potential remain unresolved due to several limitations in existing studies. Bioactivity investigations using cell lines have made an extensive use of both (poly)phenolic aglycones and sugar conjugates, these being the typical forms that exist in planta, at concentrations in the low-μM-to-mM range. However, after ingestion, dietary (poly)phenolics appear in the circulatory system not as the parent compounds, but as phase II metabolites, and their presence in plasma after dietary intake rarely exceeds nM concentrations. Substantial quantities of both the parent compounds and their metabolites pass to the colon where they are degraded by the action of the local microbiota, giving rise principally to small phenolic acid and aromatic catabolites that are absorbed into the circulatory system. This comprehensive review describes the different groups of compounds that have been reported to be involved in human nutrition, their fate in the body as they pass through the gastrointestinal tract and are absorbed into the circulatory system, the evidence of their impact on human chronic diseases, and the possible mechanisms of action through which (poly)phenol metabolites and catabolites may exert these protective actions. It is concluded that better performed in vivo intervention and in vitro mechanistic studies are needed to fully understand how these molecules interact with human physiological and pathological processes.

Dietary (Poly)phenolics in Human Health: Structures, Bioavailability, and Evidence of Protective Effects Against Chronic Diseases

The Editorial by Arai et al. signifies a major advance in sarcopenia research in Asia, and the members of the Asian Working Group for Sarcopenia (AWGS) should be praised for their attempt to develop an Asian consensus on sarcopenia diagnosis. The Asian consensus put forth by AWGS is similar to the European consensus by the European Working Group on Sarcopenia in Older People (EWGSOP), and requires the measurement of muscle strength (handgrip strength) and physical performance (usual gait speed) in addition to muscle mass for the diagnosis of sarcopenia, but differs in some important ways. One of the important differences is that AWGS suggests cut-off values for each of these three components, whereas EWGSOP proposes a cutoff value for usual gait speed only. However, AWGS also allows the use of a young reference group or the lowest quintile of sample distribution in each study to determine countryor study-specific cut-off values for grip strength and muscle mass. This approach is prudent and appropriate in my view, considering the large heterogeneity of Asian countries and scarcity of outcomeoriented studies in Asia. In contrast, AWGS proposes a single cut-off value for usual gait speed, 0.8 m/s. Gait speed is affected by muscle strength and body composition, but there appears to be cross-national differences in gait speed beyond the

Re: Growing research on sarcopenia in Asia: Letters to the Editor

Maintaining a level of functional capacity is essential for healthy aging. In this research, the association between the change in the level of functional capacity and social network typology was explored over a two-year period. Participants were recruited from a community-based cohort study within Kashiwa City, Japan, and data from the years 2016 and 2018 were used. Cognitive functions, functional capacity, and social network typology were assessed using the Mini-Mental State Examination, the Japan Science and Technology Agency Index of Competence, and the Lubben Social Network Scale, respectively. Binomial logistic regression analysis was then conducted to evaluate the association of individuals' personal network and their functional capacity.Results showed that, when compared to the group with both a high family and friend network, the group of community-dwelling older adults with both a low family and friend network (OR: 0.58, 95% CI: 0.34-1.00), and the group with a high family but low friend network demonstrated a lower functional capacity (OR:0.47, 95% CI: 0.26-0.85). Active social participation, facilitated by a friend network, could be a contributing factor to the maintenance of functional capacity. 

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Functional capacity in community-dwelling older adults maintained by a higher friend network than family network: implications from a two-year longitudinal study

Effectiveness of Continuous Grip Strength Measurement Using Social Assistive Robots on Older Adults at Home

Ph.D. Candidate, Dept. of Archit., Grad. School of Eng., The Univ. of Tokyo, M. of Eng. Project Assistant Prof., Institute of Gerontology, The Univ. of Tokyo, Ph.D. Med Project Assistant Prof., Dept. of Mechano-Informatics, Grad. School of Information Science and Technology, The Univ. of Tokyo, Ph.D. Dept. of Geriatric Medicine, Grad. School of Medicine, The Univ. of Tokyo, Ph.D. Med. Ph.D. Candidate, Dept. of Geriatric Medicine, Grad. School of Medicine, The Univ. of Tokyo, MD Ph.D. Candidate, Dept. of Community Health Nursing, Div. of Health Sci. and Nursing, Grad. School of Medicine, The Univ. of Tokyo, M. of H.Sc Ph.D. Candidate, Div. of Clinical Psychology, Dept. of Integrated Educational Sciences, Grad. School of Education, The Univ. of Tokyo, M.Ed. Prof., Institute of Gerontology, The Univ. of Tokyo, Dr. of Eng. Prof., Institute of Gerontology, The Univ. of Tokyo, Ph.D. Med. Prof., Dept. of Archit., Grad. School of Eng., The Univ. of Tokyo, Dr. of Eng. 転倒・大腿骨近位部骨折で入院した高齢者の環境移行事例から見た 多職種による建築的な転倒予防対策の検討 <1>: 自宅内の転倒原因となる建築的要因の解明

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The measures against fall prevention at home by multidisciplinary specialists for elderly people who experienced fall and femoral fractures based on their environmental changes : to clarify the architectural factors on reasons of falls at home

Vascular calcification causes management of hemodynamics more difficult and finally leads to cardiovascular events in the clinical setting. Thinking about the crucial mechanisms of vascular calcification, recent researches reveal the evidence of a biological linkage between bone and vascular calcification. Accumulating evidences show that vascular calcification is attributable to an active 'cell-mediated process' resembling osteogenesis in bone rather than passive mineral precipitation, so called calcium shift theory, as a previous hypothesis. Especially, major mechanism shows the importance of phenotypic transformation of vascular smooth muscle cells into osteo/chondrocytic-like cells under correlation of bone morphogenetic proteins, potent osteo/chondrogenic transcription factors Runx2, and so on. The detailed understanding of the complex mechanisms may lead to new opportunity to find the therapeutic strategies, concordantly enhancing bone mineral density and preventing vascular calcification.

Katsuya Iijima

Papers

Re: Growing research on sarcopenia in Asia: Letters to the Editor

Functional capacity in community-dwelling older adults maintained by a higher friend network than family network: implications from a two-year longitudinal study

Effectiveness of Continuous Grip Strength Measurement Using Social Assistive Robots on Older Adults at Home

The measures against fall prevention at home by multidisciplinary specialists for elderly people who experienced fall and femoral fractures based on their environmental changes : to clarify the architectural factors on reasons of falls at home

[An active, cell-mediated process, resembling osteogenesis in molecular mechanism of vascular calcification].