Machine Learning Approach to Drug Treatment Strategy for Diabetes Care

Globally, the number of people with diabetes mellitus has quadrupled in the past three decades, and approximately one in 11 adults worldwide have diabetes mellitus. Since both microvascular and macrovascular diseases in patients with diabetes predispose them to a lower quality of life as well as higher rates of mortality, managing blood glucose levels is of clinical relevance in diabetes care. Many classes of antihyperglycemic drugs are currently approved to treat hyperglycemia in patients with type 2 diabetes mellitus, with several new drugs having been developed during the last decade. Diabetes-related complications have been reduced substantially worldwide. Prioritization of therapeutic agents varies according to national guidelines. However, since the characteristics of participants in clinical trials differ from patients in actual clinical practice, it is difficult to apply the results of such trials to clinical practice. Machine learning approaches became highly topical issues in medicine along with rapid technological innovations in the fields of information and communication in the 1990s. However, adopting these technologies to support decision-making regarding drug treatment strategies for diabetes care has been slow. This review summarizes data from recent studies on the choice of drugs for type 2 diabetes mellitus focusing on machine learning approaches.

EFFECT OF EXERCISE TRAINING ON SERUM HIGH-SENSITIVITY C-REACTIVE PROTEIN CONCENTRATION IN HEALTHY MIDDLE-AGED AND ELDERLY SUBJECTS / 体力科学

High-sensitivity C-reactive protein (CRP) is a novel risk factor for coronary artery disease. It is well known that body weight loss is effective in reducing serum CRP concentration ; however, the effect of exercise training on serum CRP concentration has not been fully elucidated. The purpose of this study was to examine the effect of a 24-week exercise training program on serum CRP concentration in 169 healthy middle-aged and elderly subjects (65.9±6.4 years). Each subject underwent baseline testing (peak oxygen uptake, daily physical activity, body weight, and serum CRP levels), and repeated these tests on completion of the training program. The subjects were classified into 2 groups based on initial CRP levels : normal<1.0 mg/L, n=139, and high≥1.0mg/L, n=30. On completion of the program, both daily physical activity and peak oxygen uptake increased significantly (+33.9±72.4%, p<0.0001, +5.4±14.7%, p=0.014, respectively). However, body weight did not change significantly. In addition, CRP levels of the entire group did not change significantly. However, CRP levels significantly decreased among the high baseline CRP group (from 1.82±0.81 mg/L to 0.98±0.59 mg/L, p<0.0001). It was concluded that serum CRP levels are reduced without body weight loss in response to exercise training in healthy middle-aged and elderly subjects with high initial CRP levels.

EFFECTS OF AEROBIC TRAINING ON VISCERAL FAT AND GLUCOSE METABOLISM IN OLDER ADULTS / 体力科学

Excess accumulation of visceral fat is reported to promote insulin resistance. However, it is not known whether or not insulin resistance improves without reducing visceral fat. Recent studies have reported, however, that exercise can improve insulin resistance. The aim of this study was to examine the effects of low-intensity exercise training on insulin resistance and visceral fat. Participants were 26 older adults, aged 63.9 ± 3.9 years, who were divided into two groups based on visceral fat area (VFA, cm²) measured by X-ray computed tomography. Eight men (153.4 ± 49.4 cm²) and 5 women (151.9 ± 45.5 cm²) were classified as having a VFA of 100 cm² or more (VFO group), and 6 men and 6 women as having less than 100 cm² (C group). After a 14-week exercise training program, VFA in women of the VFO group was significantly reduced (126.3 ± 40.0 cm²) ; though it did not reach 100 cm². However, homeostasis model assessment (HOMA-IR), an index of insulin resistance, significantly improved from 4.6 ± 1.9 to 2.2 ± 1.1 among women in the VFO group. These data suggest that improvements in insulin resistance for women with relatively high VFA are weakly associated with exercise-induced reductions in VFA. Based on these results, the activation of skeletal muscle with physical activity has the possibility of being independently associated with an improvement in insulin resistance without a significant decrease of VFA.

Experiences of Australian heart and liver transplantations as a Japanese medical student / 医学教育

During my clinical cler ship course as a medical student in Australia from April, 1989, I have learned and experienced with liver and heart transplantations which have not performed in Japan. I have accompanied with liver transplant team of Royal Prince Alfred Hospital and heart transplant team of St. Vincent Hospital, both in Sydney, in order to perform operations and bring organs by airplane or police cars. I have also visited the office and laboratory of the New South Wales Red Cross in Sydney and learned much about social supporting systems for organ transplantation by transplant co-ordinators. Through this significant and precious experiences, I could understand a matured system of Australian organ transplantation.

Experiences of medical education which can never be seen in Japan: Our own experiences in the university of newcastle, faculty of medicine, Australia / 医学教育

We visited the University of Newcastle to take clinical clerkships from April to June 1989. We tried to experience what we had not had in our medical educational system; for example, geriatrics or medical ethics. We also compared the difference of medical educational program between Japan and Australia, especially, the way of examining students.