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당뇨병(JKD) update

The Journal of Korean Diabetes

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수록범위 : 1권1호(2000)~19권3호(2018) |수록논문 수 : 875
당뇨병(JKD)
19권3호(2018년 09월) 수록논문
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1Opinion : 관찰연구에서 확인된 SGLT2 억제제의 심혈관질환 예방효과: 한국인의 결과를 중심으로

저자 : 하경화 ( Kyoung Hwa Ha ) , 김대중 ( Dae Jung Kim )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 19권 3호 발행 연도 : 2018 페이지 : pp. 135-139 (5 pages)

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The sodium-glucose cotransporter-2 inhibitor (SGLT2i) is a new anti-hyperglycemic agent that have function to concomitantly inhibit the reabsorption of glucose and sodium in the renal proximal convoluting tubule. Recent two cardiovascular outcome trials showed that a lower risk of cardiovascular events with SGLT2i in people with type 2 diabetes. In addition, prior real-world data demonstrated similar SGLT2i effects, but these studies were limited to the United States and Europe. Thus, the CVDREAL (Comparative Effectiveness of Cardiovascular Outcomes in New Users of Sodium-Glucose Cotransporter-2 Inhibitors) 2 Study was investigated cardiovascular outcomes in those initiated on SGLT2i versus other glucose-lowering drugs (oGLDs) across 6 countries in the Asia Pacific, the Middle East, and North American regions. In Korea, 336,644 episodes of initiation in SGLT2i or oGLD group between September 2014 and December 2016 were identified in Korea National Health Insurance database after propensity score matching. SGLT2i users was associated with a lower risk of all-cause death (hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.67~0.77), hospitalization for heart failure (HHF) (HR, 0.87; 95% CI, 0.82~0.92), all-cause death or HHF (HR, 0.81; 95% CI, 0.78~0.85), myocardial infarction (HR, 0.81; 95% CI, 0.74~0.89), and stroke (HR, 0.82; 95% CI, 0.78~0.86) compared with oGLD users. In conclusion, initiation of SGLT2i had a lower risk of cardiovascular events in people with type 2 diabetes compared with oGLDs.

2Statement : 약제에 의한 당뇨병 예방

저자 : 정한나 ( Han-nah Joung ) , 권혁상 ( Hyuk-sang Kwon )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 19권 3호 발행 연도 : 2018 페이지 : pp. 140-146 (7 pages)

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Diabetes mellitus is rapidly increasing worldwide, especially in Africa and Asia. According to the Diabetes Fact Sheet in Korea 2018, the prevalence of diabetes in adults 30 years and older is 14.4% (5.01 million), indicating that nearly 1 in 7 Korean adults have diabetes. Another approximately 25% of adults 30 years and older (8.71 million people) have impaired fasting glucose, so-called “prediabetes.” Thus, 1 in 3 adults are diabetic or at risk for diabetes. The diabetic population is expected to reach approximately 6 million in 2050, representing two-fold growth over the next 40 years. Although the etiology of diabetes mellitus is multifactorial, obesity is suspected to be a main factor for the increasing prevalence in Korea. The average body mass index of diabetics is around 25 kg/m2. Prevention is the best way to decrease the global burden of diabetes. Many trials on the prevention of type 2 diabetes mellitus (T2DM) have been performed. Lifestyle modification is one of the most powerful strategies for the prevention of T2DM, but medications are believed to be effective in certain populations. These preventive effects can vary according to ethnicity, sex, and genetic background. Although there is little evidence of potential pharmacotherapy for diabetes prevention in Korea, this lecture will review available medications in the context of T2DM prevention.

3Focused Issue : 당뇨병성 신경병증의 임상적 중요성

저자 : 박태선 ( Tae Sun Park )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 19권 3호 발행 연도 : 2018 페이지 : pp. 147-152 (6 pages)

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Diabetic neuropathy is a complex and common disorder with multiple etiologies and affects about 43.1% of the Korean diabetes population. Good glycemic control slows progression of diabetic neuropathy in subjects with type 1 diabetes but seems to provide little benefit in subjects with type 2 diabetes. Moreover, neuropathy has been shown to develop in humans at stages of prediabetes and in the absence of overt hyperglycemia. Given the increasing incidence of both type 1 and type 2 diabetes and obesity and the impact of diabetic neuropathy on the quality of life of patients, a strategy for early diagnosis and discovery of an effective treatment is important for prevention and progression of diabetic neuropathy. Approximately 14.4% of Korean diabetics with neuropathy have associated pain, and management of this pain has been unsuccessful for many clinicians and patients. Choice of the correct drug(s), dosage, and patient management seems to be based on individualized conditions and needs. Overall, for good management and prevention for diabetic foot morbidities, early and proper diagnosis of diabetic neuropathy is essential, and simple and precise diagnostic methods must be developed.

4Focused Issue : 당뇨병성 말초신경병증의 진단 및 치료

저자 : 문성수 ( Seong-su Moon )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 19권 3호 발행 연도 : 2018 페이지 : pp. 153-159 (7 pages)

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Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes and is diagnosed as the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes. The prevalence of DPN was reported at 33.5% of type 2 diabetes patients by the Korean diabetes neuropathy study group. Early diagnosis is recommended to prevent diabetic foot ulcers, amputation, or disability. A questionnaire asking about symptoms and neurologic examination of feet is commonly used as a screening tool. However, complete diagnostic tests for DPN are not well established because of incomplete understanding of the pathogenetic mechanisms leading to the nerve injury, the various clinical manifestations, and the unclear natural history. Therefore, DPN has not been paid sufficient attention by clinicians. The roles of glycemic control and management of cardiovascular risk factors in the prevention and treatment of neuropathic complications are well known. Pathogenetically oriented or symptomatic agents are other options, though such treatments do not always produce a satisfactory outcome. Therefore, DPN remains a challenge for physicians to screen, diagnose, and treat. There have been recent advances in understanding the mechanisms underlying DPN and in the development of new diagnostic modalities and treatments. In this review, diagnosis and management of DPN will be discussed.

5Focused Issue : 당뇨병성 자율신경병증의 진단 및 치료

저자 : 김종화 ( Chong Hwa Kim )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 19권 3호 발행 연도 : 2018 페이지 : pp. 160-167 (8 pages)

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Diabetic autonomic neuropathy (DAN) is a serious and common complication of diabetes, although it is often overlooked. Abnormal autonomic function tests are often found in peoples with diabetic peripheral neuropathy. Autonomic neuropathies affect the autonomic neurons (parasympathetic, sympathetic, or both) and are associated with a variety of site-specific symptoms. The symptoms and signs of DAN should be elicited carefully during the medical history and physical examination. Major clinical manifestations of DAN include hypoglycemia unawareness, resting tachycardia, orthostatic hypotension, gastroparesis, constipation, diarrhea, fecal incontinence, erectile dysfunction, neurogenic bladder, and sudomotor dysfunction with either increased or decreased sweating. When a patient has signs and symptoms of DAN, various autonomic function tests should be performed. Recognition and management of DAN may improve symptoms, reduce sequelae, and improve quality of life. Clinically relevant diabetic autonomic neuropathies such as cardiovascular, gastrointestinal, genitourinary, and sudomotor dysfunction should be considered in the optimal care of patients with diabetes. The present review summarizes the latest knowledge regarding clinical presentation, diagnosis, and management of DAN.

6Focused Issue : 당뇨발의 진단 및 치료

저자 : 이창원 ( Chang Won Lee )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 19권 3호 발행 연도 : 2018 페이지 : pp. 168-174 (7 pages)

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Diabetic foot is one of the most significant and serious complications of diabetes, and is defined as the foot of diabetic patients with ulceration, infection and/or destruction of the deep tissues, associated with neurological abnormalities and various degrees of peripheral vascular disease in the lower limb. The most significant risk factors for foot ulceration are diabetic neuropathy, peripheral arterial disease, and consequent traumas of the foot. Most diabetic ulcers can be prevented with good foot care and screening for risk factors for a foot at risk of complications. Active foot examination and foot care education are methods to prevent diabetic foot at a minimum cost. I will focus on the recommendations for diagnosis and treatment of diabetic foot.

7Information Desk : 청소년기 제1형 당뇨병 환자의 관리

저자 : 김영순 ( Yeong Sun Kim )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 19권 3호 발행 연도 : 2018 페이지 : pp. 175-179 (5 pages)

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The number of children diagnosed with type 1 diabetes has been increasing and reached 3.19 per 100,000 in Korea. Children aged 10 to 14 years had the highest rate of 4.46 per 100,000. There are about 1,720 children in Korea with type 1 diabetes under the age of 18 and 1,200 of those are between the ages 13 and 18. The target for type 1 diabetes is HbA1c level of 7.5%. However, due to rapid hormone changes during puberty, controlling blood sugar level can be challenging. Since successful management of blood sugar for patients with type 1 diabetes has many long-term benefits including reduced medical cost and improved quality of life, method to help patients maintain their daily routines such as motivational interviewing should be developed.

8Information Desk : 당뇨병성 위마비 환자의 영양관리

저자 : 이연경 ( Yeon Kyung Lee )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 19권 3호 발행 연도 : 2018 페이지 : pp. 180-185 (6 pages)

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Gastroparesis is one of complications in diabetic patients which need different management with diabetic patients without complication. Diabetic gastroparesis is a chronic disease and has clinical symptoms such as early satiety, nausea, vomiting and abdominal pain. Patients with diabetic gastroparesis have a high risk of malnutrition, which may result in poor quality of life. Therefore, in patients with have a gastrointestinal disorder, such as delayed gastric emptying in the early stages of malnutrition, we should consider diagnosis and management for diabetic gastroparesis. This review focused on diagnosis, symptoms and proper nutritional management of patients with diabetic gastroparesis. To reduce gastrointestinal disorders, patients with diabetic gastroparesis provide information on the type of food, the number of meals, the intake of fats, the intake of dietary fiber, and the intake of vitamin minerals.

9Information Desk : 수용-전념치료를 통한 당뇨병 자가관리와 정신건강 증진

저자 : 임성철 ( Sung-chul Lim )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 19권 3호 발행 연도 : 2018 페이지 : pp. 186-191 (6 pages)

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The purpose of this study was to introduce acceptance and commitment therapy (ACT) for diabetes educators and review its effectiveness on diabetes patient self-care and mental health. ACT can reduce disease burden by reducing cognitive fusion and experiential avoidance. Psychotherapy such as ACT may be a useful intervention for helping diabetes patients to improve self-care and mental health conditions. Diabetes educators should make continuous efforts to practice ACT for patients in clinical settings.

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