Management and prevention of neglected diabetic complications

 

 

Japanese online medical care

specializing in rectifying the incorrect treatment of diabetes

 

Is your diabetes treatment really appropriate?

 

You need to understand the major “misunderstandings” in diabetes treatment

“You believe taking diabetes medication you’ve already bought online has made your diabetes better.”
“You believe that taking diabetes medication will prevent blindness, and the need for dialysis.”
“You believe adjusting the dosage (mg) of your diabetes medication is not necessary.”
“You are not concerned about the risk or dangers that diabetes medications have.”

These are all major mistakes.

Do you think that all you have to do is lower your blood sugar level?

Currently in various regions of Asia many people buy their diabetes medication online and take them at their own discretion. However, those medications have risks such as hypoglycemia (low blood sugar level), and if they are not taken appropriately, can be fatal. Also taking medication is not enough to treat diabetes if diabetic complications are not controlled at the same time.

At Japanese Private Clinic, our concept is to provide “Online medical care to manage and prevent diabetic complications (diabetic nephropathy, diabetic retinopathy, myocardial infarction, and stroke)” while Japanese doctors adjust the dosage of Japanese prescription medication properly.

In order to prevent the tragic situations as described below, doctors, pharmacists, and medical interpreters work together to provide comprehensive service.

• I continued to buy drugs online. Without realizing it, my diabetic nephropathy had progressed to the point where I permanently need dialysis three times a week.
• I continued to buy drugs online. As a result, I lost my eyesight due to diabetic retinopathy.
• Due to the interaction between the drugs bought online and those being taken regularly, the patient developed hypoglycemia. He was transferred to hospital but is still unconscious.

These problems have been occurring in various regions in Asia. While medical devices and medication have been developed, medical services specialized in the prevention and management of diabetic complications (diabetic nephropathy, diabetic retinopathy, stroke, and myocardial infarction) are clearly insufficient. Japan Private Clinic seeks to correct this critical issue.

 

 

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Danger of purchasing diabetes medication online

and practicing self-medication at your own discretion

 

Examples of incorrect medication usage and changes to appropriate treatment

Patients buying diabetes medications online and taking them without medical advice from doctors has become a serious problem. At Japanese Private Clinic (JPC) we have been receiving an increasing number of concerns and questions about whether it is okay to continue taking those medications at your own discretion.

The following are real-world examples of misuse of diabetes medication without appropriate medical care.

Example 1: Despite taking diabetes medication, the patient developed diabetic nephropathy which led to dialysis

■　Patient 1:

The patient was taking diabetes medication but rarely underwent tests for diabetes (blood test or urinalysis). Also, his blood pressure and lipids were not controlled. As a result, he developed diabetic nephropathy. His doctor told him that he would require dialysis next year and would have to continue it six hours a day three times a week permanently.

■　JPC’s advice:

Once the diabetes diagnosis is made, not only blood glucose and HbA1c levels, but also urinary albumin level and glomerular filtration rate should be tested regularly. In addition, antihypertensive therapy and lipid management have to be conducted along with the diabetes treatment. JPC conducts diabetes management in collaboration with laboratories for local blood test and urinalysis in each country and in consultation with Japanese doctors.

Example 2: Despite taking diabetes medication, the patient developed diabetic retinopathy which led to blindness

■　Patient 2:

The patient was taking blood tests and urinalysis, but evaluation and management for diabetic retinopathy were not performed. He saw an ophthalmologist when his eyesight got worse, but the loss of eyesight was irreversible and he is now almost completely blind in his right eye. He has been told that he will eventually also become blind in his left eye.

■　JPC’s advice:

Diabetes patients have to undergo periodic ophthalmoscopy. Management of blood pressure and lipids (especially blood pressure management) is also important as well as that of diabetes. JPC aims to provide overall management regarding diabetic retinopathy while collaborating with local eye doctors, in addition to blood glucose and HbA1c levels in diabetes patients to minimize patient blindness.

Example 3: The patient started diabetes medication at his own discretion, and lost consciousness due to hypoglycemia

■　Patient 3:

The patient started diabetes medication at his own discretion. However, he was unaware that interaction with other medications could potentially affect his diabetes medication. A few days later, after losing consciousness from hypoglycemia, he was transferred to hospital, but never regained consciousness due to severe brain damage.

■　JPC’s advice:

This is not limited to diabetes medication, but when taking two or more medications, patients must know the risk of the interaction between different medications. Especially in the case of diabetes, the risk of hypoglycemia and hyperglycemia due to interaction are especially important. In particularly, hypoglycemia may well be life-threatening therefore guidance given by doctors or pharmacists is essential.

As examples of interaction, it is known that if you are taking fibrate preparations for hyperlipidemia, combination with some diabetes medication increases the risk of developing hypoglycemia. Combination with analgesics, antihypertensive or warfarin also increases the risk of hypoglycemia.

Taking some kinds of diuretics can cause an increase in blood sugar and may result in adverse effects of the diabetes treatment.

It is nearly impossible for an individual patient to know all these facts, so medical consultation by doctors and medication guidance by pharmacists are necessary.

Example 4: The patient started diabetes medication at his own discretion, and he went blind

■　Patient 4:

The patient bought diabetes medications through the internet and started taking them at his own discretion. A sudden improvement in blood sugar occurred, and his diabetic retinopathy, which was present without realizing, worsened and he went blind.

■　JPC’s advice:

Patients with poor management of diabetes for a long period or with a history of treatment discontinuation may already have advanced retinopathy. In that case, rapid blood sugar control may exacerbate retinopathy (post-treatment retinopathy) which could lead to blindness.

When using diabetes medication, it is generally said that “Do not improve HbA1c three percent or more within six months” and it is extremely dangerous for patients to decide their own dosage and start taking those medications at their own discretion. The damage to their eyes is irreversible.

 

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Three reasons why you should choose Japanese Private Clinic

to prevent the incorrect treatment of diabetes

 

1: Online medical care by Japanese doctors who are experts in diabetes

At Japan Private Clinic, Dr. Kawasaki, an expert in diabetes and secondary diseases (diabetic nephropathy, diabetic retinopathy, myocardial infarction, stroke) due to diabetes, examines the patients.

Dr. Kawasaki has qualifications as both a board-certified member of the Japanese Society of Internal Medicine and is a specialist of the Japanese Association for Acute Medicine. In his daily practice he sees patients with lifestyle-related diseases including diabetes, hypertension, hyperlipidemia, and hyperuricemia (gout), while treating patients with acute diseases such as stroke and myocardial infarction.

2: Japanese prescription medication

At Japan Private Clinic, we provide online medical care for overseas patients with the appropriate prescription of Japanese medication. Doctors and pharmacists work together to conduct very detailed prescription medication management, adjusting the dosage (mg) of prescription medication, checking for any interaction with other medication the patient is taking, and monitoring the risk of any side effects.

The online medical care includes medication guidance by pharmacists. Conducting double checks by doctors and pharmacists, evaluating the interaction with other medication already taken and the validity of dosage (mg) dramatically improves safety, and provides more appropriate treatment than online shopping.

3: We fix the patient, not the data

Patients who buy diabetes medication online, despite showing an improvement in their blood sugar levels, can experience an exacerbation of nephropathy due to their diabetes and some have their blood vessels nearly clogged due to progressive arteriosclerosis which can cause myocardial infarction or stroke.

At Japan Private Clinic our patients’ test result data for HbA1c or blood sugar levels often improve with treatment, but simply focusing on improving the test data is not our main goal. Our main goal is to manage diabetic nephropathy and diabetic retinopathy, and to prevent myocardial infarction and stroke by using the test data. To achieve this, we concurrently monitor blood pressure, lipids, and uric acid.

Even if your diabetes test result data are improving, you could still end up needing to endure the extremely painful experience of requiring dialysis, going blind, or having permanent paralysis in a limb due to a stroke.

 

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Differences among options

in receiving appropriate treatment of diabetes

 

Please choose the treatment most suitable for your lifestyle and needs

Currently, there are multiple treatment options for diabetes. The following table summarizes the advantages and disadvantages from the patients’ perspective which should be considered in choosing the preferred option according to your own wishes.

Advantages and disadvantages from the patients’ perspective

One of the advantages of Japan Private Clinic (JPC) is that we offer online medical care. For the appropriate treatment of diabetes, the type and dosage (mg) of medication need to be adjusted every few months. However, it is difficult for patients to visit Japan repeatedly, so we offer online medical care. In addition, the consultation is by appointment only, so patients can take their time and have an in-depth conversation with their doctor.

One of the disadvantages of JPC is the time difference from Japan. To avoid mistakes due to time differences, we ask special caution be taken when making an appointment for consultation. In addition, as doctors and the patients speak different languages, we will arrange for a reliable and experienced medical interpreter (only certified interpreters for medical interpretation) at our clinic, so please rest assured.

 

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JPC service flow

 

Three preliminary documents including a questionnaire are used to gather detailed information

If you would like medical treatment, please contact us and we will send you the three preliminary documents including the questionnaire.

After reviewing the documents, we will decide whether or not we can accept your request.

If the doctor decides treatment is possible, you will receive notification of treatment fee. After confirmation of the payment, we will make a schedule for your first consultation.

Flow from inquiry to the first consultation

Comprehensive consultation by doctors and pharmacists

The consultation is started by three parties, the doctor, the medical interpreter, and the patient. Pharmacists will also participate in the second half of the consultation.

The doctor will generally discuss these points with the patient:

• Identification of chief complaint and other symptoms
• Evaluation of test results
• Consideration of medication types and dosage
• Explanation of expected improvement in the test results and the risk of side effects due to the medication
• Guidance to improve lifestyle
• Next medical target to meet
• Give advice to cover the period until the next consultation

As an example of consideration of medication types and dosage, if you take Zafatek, which is a widespread diabetes medication, the dosage should be adjusted depending on the renal function of the individual patient.

In the second half of the consultation, a pharmacist will join and give medical guidance concerning:

• Guidance on how to take the medication
• Guidance on side effects
• Guidance on the combinations (interaction) of multiple medications

In cases of insufficient fee, an additional fee will be charged. Any excess charge will be used for the next treatment fee.

After the completion of the first consultation, the doctor will issue a prescription. When there is a change in the prescription by the patient’s request or at the doctor’s discretion, the actual fee may differ from the originally planned fee, and the following actions will be taken.

≪In the case of insufficient fee≫
You will be informed of any additional fee. After confirming payment, we will ship the medication based on the prescription.

≪In the case of excess charge≫
When the amount of the prescription medication turns out to be less than the amount which was planned as a result of the consultation, the medication fee may be reduced. In that case, the excess charge will be used for the next treatment fee. The fee once paid, will not be reimbursed for any reason.

To provide appropriate treatment at the next consultation

After the first consultation, the prescription medication will arrive. Please continue to take it appropriately. If tests are required prior to your next consultation, please follow the instructions given during the first consultation.

If you have taken any tests before next consultation, you will be asked to share the test results with our clinic. As with the first consultation, we will conduct a preliminary evaluation. The evaluation includes whether the treatment is going well or whether there are any concerns. In addition, we will consider the prescription details (including the dosage change) expected at the next consultation and send you the notification of treatment fee.

After payment has been confirmed, the flow is the same as for the first consultation.

Flow from after the first consultation to the next consultation

 

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Price

 

Average fee for treatment of diabetes only (the fee will vary depending on prescription)

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Introducing our Medical Director

 

Director of Medicine

Medical Director	Kazuki Kawasaki (44)
Specialty	Board Certified Member of the Japanese Society of Internal Medicine Board Certified Specialist of the Japanese Association for Acute Medicine
Education	Graduated from School of Medicine, Kumamoto University (Japan); Master of Public Health at the Geisel School of Medicine, Dartmouth College (USA); MBA from the Tuck School of Business, Dartmouth College (USA)
Specialty	In his daily practice Dr. Kawasaki is engaged in the treatment of lifestyle-related diseases including diabetes, gout, hypertension, and hyperlipidemia, and the early detection of cancers including lung, pancreatic, and liver cancer.
Publications	“When should we call 119?” (in Japanese) (No.2 on overall rankings on Amazon Japan)

 

Treatment policy of Dr. Kawasaki

■ Treatment policy

Dr. Kawasaki always keeps in mind that he sees the whole patient, not just one disease of the patient.

He has visited medical institutions in many Asian countries, and understands that many of them are always crowded, and “conveyor belt treatment” is conducted, for example, seeing only the disease and not the patient, just prescribing medication, or short three-minute examinations which cause significant anxiety in the patients.

We would like to provide medical care which responds to the patients’ concerns or request for both Japanese and overseas patients, such as “I need a more detailed explanation” or “I want my doctor to take time to listen to me.”

■ Advocacy for upstream medical care

Patients’ greatest concern is having a medical condition which may lead to death. Dr. Kawasaki proposes planning for the prevention and early detection of causes of death which may happen to individual patients by sterically considering the patient’s health status, family history, and the top 10 ranking of causes of death by each country (Upstream medical care).

Dr. Kawasaki hopes to treat overseas patients as he treats his own family.

What is the “upstream medical care” that Japan Private Clinic advocates?

Upstream medical care means to plan for preventing possible causes of death and conducting medical care in accordance with the plan. Dr. Kawasaki has been conducting the prevention of possible causes of death for each of his family members and relatives based on the following three points.

1. Health status of each of his family members (examination, test results)
2. Family history
3. Top 10 causes of death in Japan

The following figure shows the breakdown of causes of death in Vietnam.

Statistics of cause of death in Vietnam (2020)

Causes of myocardial infarction and stroke include hyperlipidemia, diabetes, and hypertension. If we can control such causes and prevent myocardial infarction and stroke, nearly 34% of deaths may be eliminated.

Cancer accounts for more than 19% of all causes of deaths, and from this fact the top 5 cancers are for example, in Vietnam, lung, liver, stomach, colorectal, stomach, and breast cancer.

Prevention and early detection of myocardial infarction, stroke and cancer may prevent 55% of deaths.

Treat patients as you would treat your own family

Dr. Kawasaki has been taking steps to prevent his family members from damaging their brain or cardiac blood vessels due to hyperlipidemia, hypertension, or diabetes, or from late-stage cancer diagnosis and treatment. This means Dr. Kawasaki has been supporting his family members to prevent death.

As we travel upstream far from the sea, rivers become shallow and calm. This is where we can prevent death before it becomes irreversible. Death often suddenly looms in front of us, but by this time we have already travelled downstream from the river, and cannot go back and treat the disease in its early stages.

The upstream medical care, which Dr. Kawasaki provides to his family, can be classified into the following two major approaches.

（１） Prevention of myocardial infarction and stroke

• Controlling hyperlipidemia, hypertension, and diabetes to prevent myocardial infarction and stroke
• There are two points to realize the above; appropriate adjustment of prescription medication and optimization of life style
• Dr. Kawasaki regularly provides guidance regarding the two points, and improvement has been achieved in nearly 100% of his family members and relatives

（２）Early detection of cancer

• Performing imaging tests and blood tests for the early detection of cancer
• For major cancers ranked within the top 10 causes of death, Dr. Kawasaki has been planning carefully by month or by year regarding when the next test should be performed before cancers develop
• If there is the slightest suspicion, he will consider the need for additional testing, and when required, the testing will be performed in one of the leading medical institutions in Japan

At Japan Private Clinic, Dr. Kawasaki treats his patients as responsibly as he treats his own family. Since the medical condition and family history of each patient differ, upstream medical care based on the individual’s unique situation is imperative.

Due to preparation process and longer consultation times to provide attentive care to overseas patients, it may be higher in terms of price compared to the treatment in local medical institutions, however we offer secure and trustworthy medical care to our patients.

 

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Q & A

 

Q1:   Can you provide a long-term prescription at the first consultation?

At the first consultation, we generally prescribe for 30 days.

At the second follow up consultation we generally prescribe for 30 or 60 days, depending on the patient’s symptoms and test results. At the third consultation and subsequently, we generally prescribe for 30, 60, or 90 days, also depending on the patient’s symptoms and test results.

At Japan Private Clinic we are well aware of patients’ requests for long-term prescriptions, but because of the following risks we will adhere to the appropriate prescription period as followed in clinical practice in Japan.

• A rapid improvement of blood sugar levels with diabetes medication may worsen already existing diabetic retinopathy and increase the risk of blindness.
• All medications, including those for hypertension, gout, or hyperlipidemia, have potential side effects. Even if the patient is not aware of the side effect, the doctor may discover it during the examination. We must reduce the risk of the patient continuing such medication while neglecting the side effect.
• Even if the patient’s condition has been improving and the dosage (mg, number) should be reduced, an appropriate adjustment cannot be made if the patient has not been examined for a long period. As a result, an excessive amount of medication may be taken unnecessarily, which brings about excessive effects and proportionally increases the risks of side effects. We will precisely inform the patients of next step, such as “if this test result improves by ●● on the next test, we will reduce the dosage of the medication,” and decide the correct dosage (mg, number) after close communication between the patient and the doctor.