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1고혈압ㆍ당뇨병 복합질환자를 고려한 적정성 평가 개선 방안

저자 : 안보령 , 윤국회 , 권영근

발행기관 : 건강보험심사평가원 심사평가연구소 간행물 : 연구보고서 2022권 8호 발행 연도 : 2022 페이지 : pp. 1-120 (120 pages)

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The Health Insurance Review and Assessment Service(HIRA) has implemented a quality assessment program since 2010 to improve the quality of medical care and reduce the risk of cardio-cerebrovascular disease by improving the management quality of patients with hypertension and diabetes. With the increased prevalence of chronic diseases and aging populations, the modern generation generally suffers from multiple (two or more) chronic conditions simultaneously, regardless of the types of diseases. Among the patients targeted for quality assessment, 23.4% with hypertension and 59.4% with diabetes were identified as patients with multi-morbid conditions in 2019. Thus, this study proposed measures for enhancing quality assessment program and redesigning relevant compensation systems considering muti-morbid patients with hypertension and diabetes. Therefore, this study analyzed the current state of quality assessments program of hypertension and diabetes. It also examined international quality assessments systems, such as indicators for assessments and result analysis methods, to derive implications for assessments model design. Moreover, it designed a quality assessment model that considers patients with hypertension and diabetes, based on implications derived from the analytical results of present conditions and international cases. Specifically, it listed preliminary indicators by reviewing existing literature, such as international quality assessment indicators, and Korean and international clinical practice guidelines. Further, it classified the listed indicators as generic and disease-specific indicators. Subsequently, it established a panel of experts and selected quality assessment indicators based on the panel’s opinions. It also examined a method that uses the selected quality assessment indicators to calculate a score based on the clinic unit and presented a grading method according to the calculated score. Finally, this study developed a method for providing incentives based on the unit of a clinic to replace the existing method of incentivizing based on the disease. The developed method reflects the existing method that incentivizes based on the number of patients managed and sections, to consider acceptance of systems among medical institutions. However, the developed method is distinguished from the existing method in that it differentiates the level of compensation according to grades and disease types(e.g., a single disease and multiple diseases). Additionally, this study presented a mid- and long-term direction for quality assessment indicators and compensation systems. quality assessment indicators are constantly required for implementing outcome indicators. Consequently, further research should be conducted to develop a method that reduces clinical burdens on data submission other than the claim data and to adjust the assessment results based on each medical institution by reflecting the patients’ characteristics. The results of this study may be used as the base data for further research on quality assessment improvement.

23제 병합요법에 실패한 당뇨병 환자의 치료

저자 : 이승환

발행기관 : 대한내과학회 간행물 : 대한내과학회 춘계학술발표논문집 2022권 0호 발행 연도 : 2022 페이지 : pp. 79-87 (9 pages)

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3신장기능이 저하된 노인의 당뇨병 치료

저자 : 김수경

발행기관 : 대한내과학회 간행물 : 대한내과학회 춘계학술발표논문집 2022권 0호 발행 연도 : 2022 페이지 : pp. 393-404 (12 pages)

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4코로나19 범유행 기간 고혈압·당뇨병 환자의 질환 관리와 미충족 의료 현황

저자 : 박은자

발행기관 : 한국보건사회연구원 간행물 : 보건·복지 Issue&Focus 422권 0호 발행 연도 : 2022 페이지 : pp. 1-8 (8 pages)

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연구목적 : 본 연구는 2019년 지역사회 건강 조사 자료 중 고혈압 또는 당뇨병을 진단받은 925명의 청년들(19-34세)을 대상으로 건강행위, 질병관리 상태 파악 및 건강관련 삶의 질에 영향을 미치는 요인을 분석하였다. 연구방법 : 본 연구는 2019년 지역사회건강조사를 활용한 이차자료 연구이다. 총 대상자는 925명이며, 고혈압군(n=616), 당뇨병군(n=194), 그리고 복합군(n=115)의 세 그룹으로 구성되었다. 자료 분석을 위해 기술분석, 일원분산분석, 다중회귀분석이 사용되었다. 연구결과 : 세 그룹은 건강 행위의 항목 중 흡연 여부(p =.049), 음주 여부(p <.001), 음주의 양(p <.001), 격렬한 신체활동의 일수(p <.001)와 시간(p =.001), 걷기 활동의 일수(p <.001), 아침식사 일수(p =.014), 평상시 소금 섭취 수준(p =.002), 영양표시 독해(p =.022), 본인인지체형(p <.001), 그리고 수면시간(p =.003)에서 유의미한 차이를 보였다. 세 그룹의 건강관리를 확인한 결과, 세 군 모두 비약물 치료보다는 약물치료를 하고 있는 비율이 높았으며, 질병 관리 교육을 받지 않은 비율이 높았다. 세 그룹을 비교하였을 때, EQ-5D의 영역 중 운동 능력(p <.001)와 자기 관리(p <.001)에서 유의미한 차이를 보였다. 세 그룹의 건강관련 삶의 질에 공통적으로 영향을 미치는 요인은 주관적 스트레스 수준 이었으며, 수준이 증가할수록 삶의 질이 낮아지는 것으로 확인되었다. 연구결론 : 본 연구 결과를 통해서, 청년층의 고혈압 및 당뇨병의 심각성을 깨닫고, 관리 프로그램 개발과 적용을 위한 기초자료로서 활용할 것을 제언한다.


Purpose : This study aimed to explore health behavior, disease management, and identify factors related to health-related quality of life in Korean young adults (19-34 years) with hypertension and/or diabetes. Methods : This study used public data of 2019 community health survey. The total number of sample was 925 consisting hypertension group(n=616), diabetes group(n=194), combined group(n=115). Descriptive statistics, one-way ANOVA, multiple linear regression were used to analyze data. Results : There were significant differences in the variables of smoking(p =.049), drinking(p < .001), amount of drinking(p < .001), frequency(p < .001) and time (p =.001) of strenuous physical activity, frequency of walking(p < .001), frequency of breakfast(p =.014), amount of salt intake(p =.002), nutrition information literacy(p =.022), self-awareness of body shape(p < .001), and sleep time(p =.003) between three groups. In all three groups, the rate of taking medicine rather than non-medication was higher, and the rate of not receiving disease management education was higher. Also, there were significant differences in mobility(p < .001) and self-care(p < .001) among the EQ-5D domains. For all three groups, the subjective stress level higher showed the lower the quality of life. Conclusions : It is important to realize the seriousness of hypertension or/and diabetes among young adults. It suggests that the results of this study can be used as basic data for the development and application of management programs.

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6코로나바이러스감염증-19 유행기간 중 소득에 따른 고혈압ㆍ당뇨병 환자의 미충족 의료

저자 : 송은솔 ( Song Eunsol ) , 박은자 ( Park Eunja ) , 최슬기 ( Choi Seul Ki )

발행기관 : 한국보건사회연구원 간행물 : 보건사회연구 42권 3호 발행 연도 : 2022 페이지 : pp. 246-259 (14 pages)

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2020년 1월 국내에서 첫 코로나바이러스감염증-19(이하, 코로나19) 환자가 보고된 이후 2년 넘게 코로나19 대유행이 지속되고 있다. 이 연구는 우리나라의 대표적 만성질환인 고혈압ㆍ당뇨병 환자의 코로나19 유행기간 중 미충족 의료 경험을 조사하고 미충족 의료 경험과 소득과의 관련성을 살펴보고자 하였다. 2021년 8월 전국 17개 시도에 거주하는 만 19세 이상 고혈압ㆍ당뇨병 환자를 대상으로 지난 1년간 미충족 의료 경험과 그 이유를 전화면접 방식으로 조사하고 미충족 의료 경험을 종속변수로, 소득 수준을 독립변수로 로지스틱 회귀분석을 수행하였다. 연구에 참여한 고혈압ㆍ당뇨병 환자 중 최근 1년간 미충족 의료를 경험한 비율은 17.8%였다. 고혈압ㆍ당뇨병 환자의 5.0%는 경제적 부담으로 필요한 병의원 이용을 하지 못한 것으로 나타났다. 로지스틱 회귀분석 결과 가구 균등화 소득 수준이 ‘상’인 그룹에 비해 소득 수준이 ‘하’인 그룹은 미충족 의료를 경험할 가능성이 4.95배(95% CI 1.91-12.87) 높았으며 지난 1년간 소득이 감소하였다고 응답한 고혈압ㆍ당뇨병 환자들이 미충족 의료를 경험할 가능성이 소득 수준이 증가하거나 변화가 없는 환자들에 비해 2.24배(95% CI 1.23-4.07) 높았다. 연구 결과는 감염병 유행기간 동안 만성질환자의 미충족 의료를 줄이기 위해 미충족 의료 발생의 원인을 고려한 정책적 개입이 필요함을 보여준다.


COVID-19 pandemic has continued in South Korea for over two years since 2020. This study aimed to examine the prevalence of unmet healthcare needs among patients with hypertension or diabetes during the COVID-19 pandemic and to analyze the relationship between unmet healthcare needs and household income. We examined the unmet needs of 382 patients with hypertension or diabetes aged 19 or older using a telephone survey conducted in August 2021. About 17.8% of patients experienced unmet healthcare needs during the previous year. Moreover, 5.0 % answered that they did not use medical services due to the economic burden of medical service use. Logistic regression results showed that patients with a low household income had a significantly higher probability of unmet needs experience than those with high household income(OR: 4.95, 95% CI 1.91-12.87). Decreased household income during the COVID-19 pandemic also influenced the unmet needs in healthcare(OR: 2.24, 95%CI 1.23-4.07). These results indicate that policy intervention considering various causes of unmet needs is required to decrease unmet healthcare needs during the COVID-19 pandemic.

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7건조 온도에 따른 와송의 항산화 및 항당뇨 활성

저자 : 유민영 ( Minyoung Yu ) , 김명현 ( Myunghyun Kim ) , 한영실 ( Youngsil Han )

발행기관 : 한국식품조리과학회 간행물 : 한국식품조리과학회지 38권 4호 발행 연도 : 2022 페이지 : pp. 227-234 (8 pages)

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Purpose: This study evaluates the antioxidant and antidiabetic activities of Orostachys japonicus by considering the drying temperature. Methods: Orostachys japonicus powder was prepared by drying at room temperature (72 h), 40℃ (24 h), 60℃ (12 h), 80℃ (6 h), and 100℃ (4 h), indicated as S1, S2, S3, S4, and S5, respectively. Results: Total polyphenol content, total flavonoid content, DPPH free radical scavenging activity, ABTS radical scavenging activity, and reducing power were evaluated to clarify the antioxidant activities and antidiabetic activities of Orostachys japonicus. In all the assays, the highest values were obtained for S4 (80℃, 6 h): total polyphenol content 152.28 mg GAE/g; flavonoid content 96.01 mg RE/g; DPPH activity 71.86%, and ABTS free radical scavenging activity 42.24%. Conclusion: Our results indicate that the optimal drying conditions for obtaining the highest antioxidant and antidiabetic activities of Orostachys japonicus are 80℃ for 6 h.

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8Streptozotocin으로 유발된 흰쥐의 당뇨 증상 개선에 미치는 한약재 첨가 청국장 추출물의 영향

저자 : 조창숙 ( Chang Suk Jo ) , 김소영 ( So Young Kim ) , 최문열 ( Moon-yeol Choi ) , 김미형 ( Mi Hyung Kim ) , 고경아 ( Kyung A Ko ) , 김미려 ( Mi Ryeo Kim ) , 서부일 ( Bu-il Seo )

발행기관 : 대한본초학회 간행물 : 대한본초학회지(본초분과학회지) 37권 4호 발행 연도 : 2022 페이지 : pp. 49-57 (9 pages)

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Objective : This study was conducted to investigate antidiabetic effects of chunggugjang with medicinal herbal complex (CJ) in streptozotocin (STZ)-induced animal models. Method : STZ (65 mg/kg) was injected intraperitoneally to induce diabetes. Then rats were divided into 5 groups ; NG (normal diet + 0.9% saline), COS (STZ +saline 5 mL/kg), COB (STZ + fermented soybean(100 mg/kg), CJ 100/200 (STZ+CJ(100 and 200 mg/kg), CJ 300/600 (STZ+CJ(300 and 600 mg/kg). 4 weeks later, oral glucose tolerance test (OGTT) was performed. After sacrificing rats, serum levels of blood urea nitrogen (BUN), creatinine, aspartate amino transferase (AST), alanine amino transferase (ALT), total cholesterol (TC), and triglyceride (TG) were measured and histological changes were observed. Result : Body weight change and food efficiency ratio (FER) were decreased in the CJ 300/600 group than in the COS group. But, there was no change in water intake. Serum levels of glucose, AST, ALT and BUN were lower in the CJ 300/600 group than in the COS group. Also, TG, TC, and creatinine were decreased in the CJ 300/600 group than in the COS group. According to OGTT, 120 minutes postprandial glucose levels were lower in the CJ 300/600 group than in the COS group. In addition, administration of CJ extracts restored histopathological damage. Conclusion : The results suggest that CJ can be used as a functional material for diabetes treatment as it has the effect to improve pathological symptoms in STZ-induced diabetic rats.

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9한약재 함유 대두발효 추출물이 streptozotocin으로 유발된 당뇨 흰쥐의 혈당 및 조직형태학적 변화에 미치는 영향

저자 : 조창숙 ( Chang Suk Jo ) , 김소영 ( So Young Kim ) , 최문열 ( Moon-yeol Choi ) , 김미형 ( Mi Hyung Kim ) , 김미려 ( Mi Ryeo Kim ) , 서부일 ( Bu-il Seo )

발행기관 : 대한본초학회 간행물 : 대한본초학회지(본초분과학회지) 37권 1호 발행 연도 : 2022 페이지 : pp. 1-9 (9 pages)

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Objective : This study was designed to investigate anti-diabetic effects of fermented soy bean extract with herbal medicines (Godjang) in diabetic rat models induced by streptozotocin (STZ) injection. Method : Changes in body weight, drinking water, and food intake were observed for 4 weeks before and after induction of diabetes mellitus in rats. The anti-diabetic capacity of Godjang was analyzed by fasting blood glucose (FBG) every week. Also, after 4 weeks of administration, the oral glucose tolerance test (OGTT) was performed, and then blood levels of insulin were checked. And serum levels of total cholesterol and triglycerides were determined. Histomorphological changes of liver, kidney and pancreatic tissues were also observed in STZ-induced diabetic rats and Godjang administered rats. Result : In Godjang administered group, body weight and water intake were more lower than that of STZ-induced diabetic rats. FBG was decreased in the Godjang administered group than STZ-induced diabetic group. According to OGTT, blood glucose levels at 30 minutes and 60 minutes significantly decreased in Godjang administered group than in STZ-induced diabetic control group. Administration of Godjang extract for 4W significantly decreased levels of serum glucose, total cholesterol (TC), triglycerides (TG) in diabetic rats. In histomorphological analysis of kidney, liver, Godjang administrated groups showed the inhibition of pathological damage. Conclusion : These results suggest that Godjang extract has an anti-diabetic action through decrease in serum glucose, TC, TG levels and recovery of the morphological changes in kidney and liver in STZ-induced diabetic rats.1)

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10보조 혼합 샘플링을 이용한 베이지안 로지스틱 회귀모형 : 당뇨병 자료에 적용 및 분류에서의 성능 비교

저자 : 이은희 ( Eun Hee Rhee ) , 황범석 ( Beom Seuk Hwang )

발행기관 : 한국통계학회 간행물 : 응용통계연구 35권 1호 발행 연도 : 2022 페이지 : pp. 131-146 (16 pages)

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로지스틱 회귀 모형은 다양한 분야에서 범주형 종속 변수를 예측하거나 분류하기 위한 모형으로 많이 사용되고 있다. 로지스틱 회귀 모형에 대한 전통적인 베이지안 추론 기법으로 메트로폴리스-헤이스팅스 알고리즘이 많이 사용되었지만, 수렴의 속도가 느리고 제안 분포에 대한 적절성을 보장하기 어렵다. 따라서, 본 논문에서는 모형에 대한 베이지안 추론 방법으로 Frühwirth-Schnatter와 Frühwirth (2007)에서 제안된 보조 혼합 샘플링(auxiliary mixture sampling) 기법을 사용하였다. 이 방법은 모형의 선형성과 정규성을 만족시키기 위해 두 단계에 거쳐 잠재변수를 도입하며, 결과적으로 깁스 샘플링을 통한 추론을 가능하게 한다. 제안한 모형의 효과를 검증하기 위해 2020년 지역사회 건강조사 당뇨병 자료에 적용하여 메트로폴리스-헤이스팅스를 사용한 모형과 추론 결과를 비교 분석하였다. 또한, 다양한 분류 모형들과 본 논문에서 제안한 모형의 분류 성능을 비교한 결과 제안된 모형이 분류 분석에서도 좋은 성능을 보이는 것을 확인할 수 있었다.


Logit models are commonly used to predicting and classifying categorical response variables. Most Bayesian approaches to logit models are implemented based on the Metropolis-Hastings algorithm. However, the algorithm has disadvantages of slow convergence and difficulty in ensuring adequacy for the proposal distribution. Therefore, we use auxiliary mixture sampler proposed by Frühwirth-Schnatter and Frühwirth (2007) to estimate logit models. This method introduces two sequences of auxiliary latent variables to make logit models satisfy normality and linearity. As a result, the method leads that logit model can be easily implemented by Gibbs sampling. We applied the proposed method to diabetes data from the Community Health Survey (2020) of the Korea Disease Control and Prevention Agency and compared performance with Metropolis-Hastings algorithm. In addition, we showed that the logit model using auxiliary mixture sampling has a great classification performance comparable to that of the machine learning models.

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