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당뇨병(JKD) update

The Journal of Korean Diabetes

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  • : 임상 당뇨병(~2010)→ 당뇨병(JKD)(2011~)

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수록범위 : 1권1호(2000)~23권4호(2022) |수록논문 수 : 1,040
당뇨병(JKD)
23권4호(2022년 12월) 수록논문
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저자 : 김수경 ( Soo Kyoung Kim )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 4호 발행 연도 : 2022 페이지 : pp. 213-216 (4 pages)

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Mounjaro® (tirzepatide) was approved by the U.S. Food and Drug Administration for type 2 diabetes treatment in August 2022. Tirzepatide, a synthetic peptide consisting of 39 amino acids, is a dual GLP-1 (glucagon-like peptide-1)/GIP (glucose-dependent insulinotropic polypeptide) receptor agonist. Tirzepatide showed marked reductions in glycated hemoglobin and body weight in the SURPASS study among participants with type 2 diabetes that surpassed existing diabetes drugs. Other benefits included blood pressure reduction and lipid lowering effects. On meta-analysis and post-hoc analysis, tirzepatide did not increase the risk of major cardiovascular events and is expected to have cardiovascular benefits in future studies. In addition, it showed a protective effect on the kidney by slowing the rate of renal function decline and reducing new-onset macroalbuminuria. However, the fact that it is an injectable drug, the cost of the drug, and the high rate of gastrointestinal side effects are disadvantages to tirzepatide. Considering the superior degree of glucose reduction and weight reduction observed in tirzepatide clinical trials compared to clinical trials of other anti-diabetic drugs, we expect tirzepatide to bring about a paradigm shift in the treatment of obese type 2 diabetes patients.

저자 : 진상만 ( Sang-man Jin )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 4호 발행 연도 : 2022 페이지 : pp. 217-221 (5 pages)

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In contrast to Europe and the United States (US), conventional insulin pumps have not been widely used in East Asia, even among people with type 1 diabetes. Clinical experiences in Europe and the US indicate that automated insulin delivery (AID) can successfully improve the quality of glucose control even in people with type 1 diabetes who do not have experience with conventional insulin pumps. Therefore, prior use of a conventional insulin pump was not a requirement for successful introduction of AID. However, use of AID still requires full understanding of conventional insulin pump management, and AID-specific education as well. Besides basic information on continuous glucose monitoring and conventional insulin pumps, people with type 1 diabetes starting AID should understand the difference between closed-loop and open-loop insulin delivery, should have reasonable expectations for AID, and should be motivated to engage in clinical follow-up to prevent discontinuation of the use of AID devices. Failure to provide AID-specific education before and after the introduction of AID would result in discontinuation of the use of AID devices, which would in turn result in suboptimal glucose control. In this review, I summarize lessons from clinical experience where AID is already in clinical use, and discuss what preparations should be made for successful introduction of AID in Korean clinical practice.

저자 : 강선미 ( Seon Mee Kang )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 4호 발행 연도 : 2022 페이지 : pp. 222-229 (8 pages)

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Diabetic neuropathy is the most common chronic complication of both type 1 and type 2 diabetes mellitus. Diabetic peripheral neuropathy (DPN), especially, distal symmetric polyneuropathy is the most common form of diabetic neuropathy. Pathogenesis of the DPN is associated with glycemic dysregulation, which results in activation of polyol, aldose reductase, hexosamine, and protein kinase C pathway and leads to downstream inflammation, generation of reactive oxygen species, and decreased blood flow to peripheral nerves. Furthermore, metabolic syndrome components such as obesity, insulin resistance, and dyslipidemia result in mitochondrial dysfunction and endoplasmic reticulum stress, eventually contributing to axonal failure and apoptosis of nerve cells. Despite its high prevalence, DPN is still underdiagnosed. Among DPN symptoms, neuropathic pain is challenging to manage, resulting in increased risk of associated problems such as sleep disturbance, reduced quality of life, and socioeconomic consequences. Therefore, early diagnosis and active multidisciplinary treatment of DPN is needed.

저자 : 문지연 ( Jee Youn Moon )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 4호 발행 연도 : 2022 페이지 : pp. 230-237 (8 pages)

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Peripheral neuropathy is one of the most common complications of both type 1 and type 2 diabetes. The most common diabetic neuropathy (DN) is distal symmetric polyneuropathy, with characteristic glove- and stocking-like presentation of distal sensory or motor function loss. Because painful DN is associated with increased mortality and morbidity, early recognition and preventive measures are essential. Nevertheless, diagnosing DN or painful DN is challenging, particularly in patients with early and mild neuropathy, and there is no established gold standard. Furthermore, there is no established DN treatment other than improved glycemic control, and only symptomatic management is available for painful DN. However, thanks to health-conscious living, almost one-third of patients with painful DN derive sufficient pain relief with existing pharmacotherapies. These include antidepressants (tricyclic acid, serotonin-norepinephrine reuptake inhibitor), anticonvulsants (calcium-channel blocker, sodium channel blocker), and others (sarpogrelate). A more precise and distinct symptom profile from patients with painful DN may help identify patients more responsive to one treatment versus another. In addition to pharmacological, physical, cognitive, or educational management for painful DN, large randomized clinical trials are needed to identify the most effective minimally invasive interventions. Transcutaneous electrical nerve stimulation, pain scrambler therapy, sympathetic ganglion block, and botulinum toxin injections have been investigated as alternative therapeutic outcomes.

저자 : 현정근 ( Jung Keun Hyun )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 4호 발행 연도 : 2022 페이지 : pp. 238-244 (7 pages)

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Peripheral polyneuropathy is one of the most common complications in patients with diabetes mellitus, and it results in neuropathic pain, falling tendency, and foot ulcers as well as sensory and motor impairments. Numerous risk factors for diabetic neuropathy had been revealed through statistical analysis; however, statistics draw population inferences and might not be suitable for providing real-time prediction for each patient in clinical practice. Machine learning techniques were developed to find any predictive patterns based on input data. Such strategies can help predict neuropathy in diabetic patients, enabling prevention or early treatment to increase quality of life in diabetic patients. This article summarizes recent studies concerning the prediction of diabetic neuropathy using machine learning techniques, and suggests approaches for useful translation of these methods in the medical field.

저자 : 윤재승 ( Jae-seung Yun )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 4호 발행 연도 : 2022 페이지 : pp. 245-250 (6 pages)

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Neuropathy is a common complication of diabetes that can appear in the early stages of diabetes or even in the prediabetes stage. The relationship between autonomic neuropathy and cardiovascular disease (CVD) is well established. Resting tachycardia, exercise intolerance, and non-dipping/reverse dipping caused by the relative overactivity of the sympathetic nervous system are the main factors that lead to the increased risk of CVD and cardiovascular mortality. Little is known, however, about the cardiovascular consequences of peripheral neuropathy (PN). Two recent major studies suggested the possibility of a significant association between PN and CVD and mortality; thus, cardiovascular risk management for patients with PN may be necessary. Positive results on MNSI (Michigan Neuropathy Screening Instrument) questionnaires and 10-g monofilament test are convenient methods for early screening and management of PN that may also be useful in evaluating PN-related CVD risk.

저자 : 이정림 ( Jeong Rim Lee )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 4호 발행 연도 : 2022 페이지 : pp. 251-257 (7 pages)

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Globally, chronic diseases have a high burden and are a significant factor affecting society, such as through economic productivity and deepening social inequality. Deaths from chronic diseases in Korea accounted for 79.6% of all deaths as of 2021, and medical expenses from chronic diseases in Korea accounted for 85.0% of all national medical expenses as of 2020. Since the 1970s, chronic disease management in Korea has focused on projects such as acute infectious diseases, maternal and child health, and family planning by region, sporadically centered on universities. Since then, the importance of prevention and management of chronic diseases has been highlighted, and a comprehensive plan for national health promotion was established in 2002 to provide policy support. Here, we looked at the progress of the chronic disease management project and its effects and review suggestions for efficient establishment of a primary medical chronic disease management project to be carried out in the future.

저자 : 김민지 ( Min Ji Kim )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 4호 발행 연도 : 2022 페이지 : pp. 258-261 (4 pages)

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Recently, the prevalence of diabetic mellitus patients in Korea has been increasing, and it increasing with age. The treatment goal of diabetes is to prevent complications through blood sugar management, for which it is important to maintain an appropriate nutritional state. Unbalanced diet refers to excessive or insufficient nutrition, which can be generally confirmed through weight conditions. Therefore, medical nutrition therapy in diabetic patients with unbalanced diet aims to maintain a moderate body mass index. Older people with diabetes have a higher risk of unbalanced diet than those without diabetes. Clinical nutritional intervention in diabetic patients should shift from strict dietary restrictions for treatment of metabolic syndrome/obesity to diet for prevention of frailty and sarcopenia with age. Therefore, clinical nutrition therapy for diabetic patients with unbalanced diet should be individualized in consideration of age, gender, and medical condition. Medical nutrition therapy tailored for each patient can contribute to improving the nutritional status of diabetic patients, prolonging healthy life expectancy and improving quality of life.

저자 : 이제연 ( Jea Yeon Lee )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 4호 발행 연도 : 2022 페이지 : pp. 262-265 (4 pages)

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Diabetes patients are steadily increasing. As such, the importance of diabetes education is being emphasized as the number of diabetic patients continues to increase. Diabetes education is being conducted by experts in most hospitals. Medical social workers are part of the diabetes education team and are conducting educational counseling to help patients manage diabetes. The purpose of this article is to examine educational counseling for adult diabetic patients from the viewpoint of medical social workers.

저자 : 이경옥 ( Kyung-ock Yi ) , 강윤희 ( Youn-hee Kang ) , 홍영선 ( Young-sun Hong ) , 권오란 ( Oran Kwon ) , 김재원 ( Jae-won Kim ) , Yin-zhu Jin

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 4호 발행 연도 : 2022 페이지 : pp. 266-277 (12 pages)

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The purpose of this study was to explore the variables of foot pressure according to glycated hemoglobin level during walking in diabetic patients with pes rectus. The subjects of this study were 39 people (78 feet) in their 40s and 60s, and they were divided into 11 pre-diabetic patients (22 feet) and 14 diabetic patients (28 feet) based on glycated hemoglobin; 14 patients without diabetes (28 feet) was used as a control. Foot pressure was measured using the EMED-LE Measurement system. The sole of the foot was divided into 12 parts, each of which was analyzed for pressure, force, contact area, and grounding time. For statistics, nonparametric Kruskal-Wallis and Wilcoxon signed rank test were used. Prediabetic and diabetic patients had lower hindfoot and second and third metatarsal foot pressure but higher first and third toe pressure compared to those without diabetes. In addition, the maximum and minimum force were high in all parts of the sole, and the contact time was long, signifying strong downward force for a long duration. Measurement of foot pressure by parts allowed detailed analysis of abnormal foot pressure and is valuable as basic data for diagnosis, prediction, and treatment of diabetic foot. Based on these data, maximum and minimum pressure better explain the problem of plantar pressure distribution rather than mean maximum pressure.

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