{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T10:00:56Z","timestamp":1784368856138,"version":"3.55.0"},"reference-count":20,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T00:00:00Z","timestamp":1754438400000},"content-version":"unspecified","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002241","name":"Japan Science and Technology Agency","doi-asserted-by":"publisher","award":["JPMJPF2203"],"award-info":[{"award-number":["JPMJPF2203"]}],"id":[{"id":"10.13039\/501100002241","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"KAKENHI","doi-asserted-by":"crossref","award":["24K02708"],"award-info":[{"award-number":["24K02708"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001691","name":"KAKENHI","doi-asserted-by":"crossref","award":["JP21K10500"],"award-info":[{"award-number":["JP21K10500"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012627","name":"Japan Diabetes Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100012627","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003478","name":"Ministry of Health, Labour and Welfare of Japan","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003478","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,7,9]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Adherence to treatment strategies is essential for preventing future complications during diabetes management. This study evaluated the association between dropout history, glycated haemoglobin (HbA1c) levels and subsequent risks of dropout (missed appointment)in patients with type 2 diabetes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This was a secondary analysis of a cluster-randomised trial (the Japan Diabetes Outcome Intervention Trial 2 Large-Scale Trial), focusing on the non-intervention group over the study period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Data were obtained from a multisite trial conducted in Japan, encompassing patients with type 2 diabetes who received routine clinical care at participating clinics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 996 patients with type 2 diabetes from the non-intervention group were included in the analysis. Baseline characteristics (eg, age, sex, smoking status, occupational status and diabetes medication use) were recorded at study entry.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>The primary outcome measure was subsequent treatment dropout. The Cox proportional hazards model with the Huber\/White method was used to estimate HRs and 95% CIs, with adjustment for age, sex, smoking status, occupational status and diabetes medication use at baseline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Participants with treatment dropout history had a higher dropout rate than those without dropout history (multivariable-adjusted HR=3.59; 95% CI=2.25 to 5.71). Overall, HbA1c levels were not significantly associated with dropout risk. However, among the 855 participants without dropout history, the dropout risk was higher in the group with HbA1c level \u226510.0% (HR=3.76; CI=1.29 to 10.9) than in the group with HbA1c level of 6.0\u20136.9%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This prospective cohort study of Japanese patients with type 2 diabetes suggests that dropout history is strongly associated with a higher subsequent dropout risk. High HbA1c levels (\u226510%) may be related to a higher dropout risk in patients without a dropout history. These findings may provide actionable indicators for tailored interventions, enhancing targeted healthcare strategies and improving continuity of care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>UMIN000002186.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-092013","type":"journal-article","created":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T07:40:17Z","timestamp":1754552417000},"page":"e092013","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Association of dropout history and HbA1c levels with subsequent dropout risk in patients with diabetes: a secondary analysis of the Japan Diabetes Outcome Intervention Trial-2 Large-Scale Trial 008 (J-DOIT2-LT008)"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0669-654X","authenticated-orcid":false,"given":"Atsushi","family":"Goto","sequence":"first","affiliation":[{"name":"Department of Public Health, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuaki","family":"Hayashino","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Tenri Hospital, Tenri, Nara, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iseki","family":"Takamoto","sequence":"additional","affiliation":[{"name":"Department of Metabolism and Endocrinology, Tokyo Medical University Ibaraki Medical Center, Ami, Ibaraki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hikari","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Diabetes Center, Japan Community Health care Organization Takaoka Fushiki Hospital, Takaoka, Toyama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katsuya","family":"Yamazaki","sequence":"additional","affiliation":[{"name":"Kawai Clinic, Tsukuba, Ibaraki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuo","family":"Izumi","sequence":"additional","affiliation":[{"name":"Center for Clinical Sciences, Japan Institute for Health Security, Shinjuku-ku, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuhiko","family":"Noda","sequence":"additional","affiliation":[{"name":"Department of Diabetes, Metabolism and Endocrinology, International University of Health and Welfare Ichikawa Hospital, Ichikawa, Chiba, Japan"},{"name":"Department of Endocrinology and Diabetes, Saitama Medical University, Moroyama, Saitama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,8,6]]},"reference":[{"key":"2025123106453464000_15.8.e092013.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2021.109119"},{"key":"2025123106453464000_15.8.e092013.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1310799"},{"key":"2025123106453464000_15.8.e092013.3","unstructured":"McEwen LN , Herman WH , et al . 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