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대한당뇨병학회> 당뇨병(JKD)> Statement : 마이크로바이옴, 그리고 당뇨병

Statement : 마이크로바이옴, 그리고 당뇨병

Statement : Microbiome and Diabetes

김진화 ( Jin Hwa Kim )
  • : 대한당뇨병학회
  • : 당뇨병(JKD) 23권1호
  • : 연속간행물
  • : 2022년 03월
  • : 7-11(5pages)
당뇨병(JKD)

DOI


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서론
본론
결론
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초록 보기

The prevalence of metabolic diseases such as obesity, type 2 diabetes, and insulin resistance continues to rise. These conditions are associated with multiple social, genetic, and environmental risk factors, including the human gut microbiota, which has emerged as a critical mediator linked to metabolic disease. Recent evidence suggests that the gut microbiota has personalized effects on the gut-brain axis, which controls metabolic function. Gut microbiota can be a great source of prognostic biomarkers and therapies for metabolic diseases. The microbiome also influences immune system development and homeostasis. In this review, I summarize recent findings regarding the association between the gut microbiome and type 2 diabetes. These findings will inform future diabetes mellitus prevention, diagnosis, and treatment strategies.

UCI(KEPA)

간행물정보

  • : 의약학분야  > 내과학
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  • : 계간
  • : 2233-7431
  • : 2714-0547
  • : 학술지
  • : 연속간행물
  • : 2000-2022
  • : 1029


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23권3호(2022년 09월) 수록논문
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1당뇨병 약제의 역할은 어디까지인가?

저자 : 홍준화 ( Jun Hwa Hong )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 3호 발행 연도 : 2022 페이지 : pp. 153-156 (4 pages)

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In management of diabetes, glucose lowering is the basic target of treatment. Insulin is essential to type 1 diabetes. Non-insulin therapy in type 2 diabetes is very diverse and continuously developing to improve glucose control and prevent diabetes-related complications. In the recent 30 years, recommended specifications of anti-diabetic drugs are high glucose-lowering efficacy, low risk of hypoglycemia, less burden of weight gain, and cardiovascular safety. With development of SGLT2 inhibitors (sodium glucose cotransporter 2 inhibitors) and GLP-1RA (glucagon-like peptide-1 receptor agonist), the clinical benefits also include risk reduction of diabetes-related complications (hospitalization for heart failure, chronic kidney disease, atherosclerotic cardiovascular disease), even in non-diabetic patients. Anti-diabetic medication can have a role in holistic management for prevention and treatment of diabetes and diabetes-related complications, as well as an improvement of mortality.

2MODY 당뇨병

저자 : 박승신 ( Seung Shin Park ) , 곽수헌 ( Soo Heon Kwak )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 3호 발행 연도 : 2022 페이지 : pp. 157-164 (8 pages)

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앞으로 정밀의료는 개인별 특성에 맞게 당뇨병의 진단, 분류, 치료를 보다 구체화시키는 데 일조할 것이다. 단일유전자 당뇨병에 있어서는 이러한 변화가 이미 두드러지게 나타나고 있다. MODY 아형은 MODY의 원인 유전자에 따라 HNF1α-, GCK-, HNF4α-, HNF1β-MODY 등으로 구분되고 있으며 MODY 진단에 있어서도 원인 유전변이를 ACMG-AMP 지침을 통해 검증하는 것이 일반화되고 있다. 정확한 진단이 이루어지면 MODY 아형에 따라 설포닐유레아, GLP-1수용체 작용제, 인슐린, 혹은 치료 없이 경과 관찰 등 개별화된 치료 방법을 적용할 수 있다. MODY에서 적용되고 있는 이러한 정밀의료로의 변화는 단일유전자당뇨병뿐 아니라 전체 당뇨병의 분류, 진단, 치료에 있어서도 큰 변화를 가져올 수 있는 계기가 될 것으로 기대된다. 아직 국내에서는 MODY에 대한 진단 검사 및 발견이 적은 편이다. 이를 높이기 위해서는 임상에 널리 적용 가능한 분자유전학적 검사의 확대 및 보험 적용이 바탕이 되어야 하며 임상의를 대상으로 임상유전체의학에 대한 교육이 확대될 필요가 있다.


Precision medicine, which optimizes diagnosis and treatment of diseases according to individualized characteristics, is becoming a reality in the field of diabetes, especially for monogenic diabetes. Maturity-onset diabetes of the young (MODY) is a type of monogenic diabetes characterized by early onset, relative non-obesity, non-insulin dependence, and autosomal dominant inheritance. With the trend toward precision medicine and improvement in genetic testing, there have been advances in the classification, diagnosis, and treatment of MODY. MODY accounts for about 1% of diabetes in Korea, with GCK (glucokinase)-MODY, HNF1α (hepatocyte nuclear factor-1 alpha)-MODY, and HNF4α (hepatocyte nuclear factor-4 alpha)-MODY being most common. In the diagnosis of MODY, applying guidelines for interpretation of variant pathogenicity is important. For the treatment of MODY, individualized treatment strategies according to the causative gene of MODY should be applied when available. Still, the majority of MODY is misdiagnosed and more genetic testing is required in Korea. We review updates regarding the classification, diagnosis, and treatment of MODY.

3인지장애와 당뇨병

저자 : 정찬희 ( Chan-hee Jung ) , 목지오 ( Ji-oh Mok )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 3호 발행 연도 : 2022 페이지 : pp. 165-177 (13 pages)

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Diabetes mellitus and cognitive dysfunction are highly prevalent in the aging population. In the aging society, clinicians will be increasingly tasked with managing elderly patients who have both cognitive dysfunction and diabetes. A growing number of epidemiological and clinical studies confirmed that diabetes is associated with an increase in the risk of cognitive dysfunction and dementia. Cognitive dysfunction is of particular importance because it is associated with poor self-management ability, poor diabetes management with more frequent severe hypoglycemic episodes, and increased risk of cardiovascular morbidity and mortality. Current diabetes guidelines recommend screening for cognitive dysfunction in older and high-risk patients and providing individualized guidance for patients with cognitive dysfunction. Nonetheless, there is limited awareness among clinicians regarding this subject compared to other diabetic micro- and macrovascular complications. Recently, there has been increasing understanding in this field through multimodal neuroimaging and biomarkers for early detection of cognitive dysfunction in diabetes. In addition, new agents such as glucagon-like peptide 1 receptor agonists showed promising protective effects against cognitive dysfunction and dementia in patients with type 2 diabetes. In this review, we summarize the relationship between diabetes and cognitive dysfunction, especially dementia, and some contributing factors and pathogenesis of dementia in diabetes. We also review how anti-diabetic medications may influence cognitive dysfunction and clinical management guidance.

4우울장애와 당뇨병

저자 : 전언주 ( Eonju Jeon )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 3호 발행 연도 : 2022 페이지 : pp. 178-184 (7 pages)

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As a result of their increasing prevalence, diabetes and depression, together with population growth and aging, are growing public health concerns. Diabetes and depressive disorder may occur on the basis of a common pathophysiology and interact with each other. Complex environmental, social, behavioral, and emotional factors influence diabetes care. In particular, maintaining psychological well-being for people with diabetes is the foundation for achieving diabetes treatment goals and satisfactory quality of life. An improved understanding of depressive disorder and diabetes may potentially lead to early detection, and timely treatment planning may simultaneously prevent the onset of depression. Ultimately, this can build positive health behaviors and optimizing medical outcomes for living with diabetes.

5수면장애와 당뇨병

저자 : 이정안 ( Jung An Lee ) , 이정구 ( Jung Goo Lee )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 3호 발행 연도 : 2022 페이지 : pp. 185-191 (7 pages)

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Sleep problems and diabetes mellitus are increasing in prevalence. Although it is unclear if they are related, a number of related studies implicate such a relationship. A number of related studies implicate such a relationship. In this review, the significance of sleep in diabetes mellitus will be reviewed by summarizing the relationships between sleep, circadian rhythm, sleep disorders, and diabetes mellitus. Also, the mechanisms of influence will be reviewed. In addition, although the relationship between sleep and diabetes mellitus mainly has focused on type 2 diabetes mellitus, this review also summarizes the relationship between type 1 diabetes mellitus and sleep. In clinical practice, sleep problems have not been emphasized in management or prevention of diabetes mellitus. Considering their close relationship and impact on prognosis, mental health and physical health study will need to be integrated for treatment and prevention of diabetes mellitus.

6음주, 흡연과 당뇨병

저자 : 정우영 ( Wooyoung Jung )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 3호 발행 연도 : 2022 페이지 : pp. 192-200 (9 pages)

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Many patients with diabetes continue smoking and high-risk drinking during diabetes treatment. Some patients try and fail to stop alcohol drinking and smoking because of the addictive and habitual effects. Considering the high lifetime prevalence of alcohol and nicotine use disorders, the percentage of people who actively use treatment services is low. Smoking is related to increased vascular complications and mortality as well as development of diabetes. A small amount of alcohol is allowed in the diabetes treatment guidelines, but the limit can be difficult to maintain in reality. Therefore, it is necessary for a medical doctor to evaluate the alcohol and smoking problems of diabetic patients, and it may be helpful to use screening and evaluation tools such as AUDIT (alcohol use disorders identification test) for alcohol drinking and FTND (Fagerstrom Test for Nicotine Dependence) for smoking. It is important that patients are provided necessary information and a brief intervention and that they are recommended a professional treatment such as active treatment with anti-craving medications and structural psychosocial treatment programs. Many patients are worried about the harmful effects of alcohol drinking and smoking and think they should quit it, but at the same time, they may have their own reasons for not being able to quit drinking and smoking, and may be suffering from ambivalent ideas about alcohol drinking and smoking. Therefore, rather than criticizing the patient's alcohol drinking and smoking behavior, it is important to show understanding of patient difficulties and to encourage the patient to stop drinking and smoking.

7노인당뇨병 환자의 인슐린주사교육

저자 : 이기연 ( Gi Yeon Lee )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 3호 발행 연도 : 2022 페이지 : pp. 201-205 (5 pages)

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The number of elderly diabetes patients continues to increase. These patients experience decline in physical functions related to aging and various accompanying disease. These interrupt insulin self-injection and self-management of diabetes. Therefore, it is necessary to understand the characteristics of elderly diabetes patients in order to provide proper insulin injection education.

8비만한 당뇨병환자의 체중 조절을 위한 임상영양요법

저자 : 김미향 ( Mihyang Kim )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 3호 발행 연도 : 2022 페이지 : pp. 206-212 (7 pages)

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Clinical Practice Guidelines for Diabetes recommend that overweight or obese adults lose more than 5% of their body weight and reduce their total caloric intake to maintain the reduced body weight. In diabetic patients, the goal of weight control is not simply to lose weight, but to achieve health benefits by controlling blood sugar well and reducing the risk of complications and other comorbidities. An extremely calorie-restricted diet, whose long-term effectiveness has not been verified, is not recommended as it may increase the risk of hypoglycemia and ketoacidosis. For weight control in obese diabetic patients, it is important to follow diabetic diet guidelines while setting actionable energy goals that prevent hypoglycemia and do not increase health risks. The energy target should be adjusted in consideration of individual conditions such as daily intake, body size, and activity level.

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1시론 : 혈당강하제와 COVID-19

저자 : 강아름 ( Ah Reum Khang )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 1호 발행 연도 : 2022 페이지 : pp. 1-6 (6 pages)

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Coronavirus disease 2019 (COVID-19) is continuing to spread around the world despite the introduction of vaccines. Individuals with diabetes have been reported to have more severe clinical outcomes of COVID-19 infection. As there is potential that glucose-lowering agents can influence the clinical outcomes in diabetic patients with COVID-19, a number of studies are ongoing to explore the differences in clinical outcomes related to glucose-lowering agents. In this article, I summarize the published research on the relationship between glucose-lowering agents and clinical outcomes of diabetic patients with COVID-19 and suggest clinical consideration for usage of glucose-lowering agents.

2Statement : 마이크로바이옴, 그리고 당뇨병

저자 : 김진화 ( Jin Hwa Kim )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 1호 발행 연도 : 2022 페이지 : pp. 7-11 (5 pages)

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The prevalence of metabolic diseases such as obesity, type 2 diabetes, and insulin resistance continues to rise. These conditions are associated with multiple social, genetic, and environmental risk factors, including the human gut microbiota, which has emerged as a critical mediator linked to metabolic disease. Recent evidence suggests that the gut microbiota has personalized effects on the gut-brain axis, which controls metabolic function. Gut microbiota can be a great source of prognostic biomarkers and therapies for metabolic diseases. The microbiome also influences immune system development and homeostasis. In this review, I summarize recent findings regarding the association between the gut microbiome and type 2 diabetes. These findings will inform future diabetes mellitus prevention, diagnosis, and treatment strategies.

3혈당변동성과 당뇨병

저자 : 장한나 ( Han Na Jang ) , 정혜승 ( Hye Seung Jung )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 1호 발행 연도 : 2022 페이지 : pp. 12-20 (9 pages)

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Not only mean blood glucose, but also 'glycemic variability,' the degree of fluctuation in blood glucose, has been suggested to contribute to diabetic complications. Glycemic variability can be expressed with various indices, such as standard deviation, coefficient of variation (CV), mean amplitude of glycemic excursion, etc.; however, standard indicators have not been established. Recently, CV was designated in cases of application of continuous glucose monitoring system according to international consensus. In this review, clinical implications of glycemic variability are dealt with respect to micro- and macrovascular complications of diabetes, and clinical evidence of new anti-diabetics are summarized about efficacy on the glycemic variability.

4혈압변동성과 당뇨병

저자 : 정채호 ( Chaiho Jeong ) , 손태서 ( Tae-seo Sohn )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 1호 발행 연도 : 2022 페이지 : pp. 21-27 (7 pages)

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Increased blood pressure variability (BPV) has been found to significantly increase the risk of cardiovascular morbidity and mortality in the non-diabetic population. The prognostic importance of increased BPV for the development of micro- and macrovascular complications in type 2 diabetes has been investigated. Type 2 diabetes can increase BPV through different mechanisms, including increased arterial stiffness and autonomic dysfunction. Several studies in type 2 diabetic patients showed inconclusive results regarding all-cause mortality, microvascular complication, and extended major adverse cardiovascular events (MACE). However, some trials showed that BPV might be regarded as a potentially important therapeutic target in the management of type 2 diabetes regarding MACE. For now, the primary goal of antihypertensive treatment in patients with type 2 diabetes shall remain to controll mean blood pressure levels. However, when future studies show consistent results, BPV might be regarded as a therapeutic target in type 2 diabetic patients.

5지질변동성과 당뇨병

저자 : 이정민 ( Jeongmin Lee ) , 이승환 ( Seung-hwan Lee )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 1호 발행 연도 : 2022 페이지 : pp. 28-34 (7 pages)

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Diabetic dyslipidemia is characterized by hypertriglyceridemia, low HDL (high-density lipoprotein)- cholesterol, elevated LDL (low-density lipoprotein)-cholesterol, and predominance of small dense LDL particles caused by insulin resistance in type 2 diabetes or insulin deficiency in type 1 diabetes. Dyslipidemia is a major risk factor for atherosclerotic cardiovascular disease in diabetes, and lowering lipid levels can reduce its morbidity and mortality. Current guidelines for dyslipidemia management recommend that the LDL-C goal be lower than 55~100 mg/dL depending on the underlying risk factors. However, higher visit-to-visit variability in cholesterol levels might be an independent predictor of major adverse cardiovascular events and poor renal outcomes in diabetes. In this review, we focused on clinical implications of lipid variability in diabetes.

6체중변동성과 당뇨병

저자 : 이은정 ( Eun Jung Rhee )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 1호 발행 연도 : 2022 페이지 : pp. 35-42 (8 pages)

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Dieting has multiple meanings including 'intentional weight loss' or 'a specific eating pattern.' Although obesity is considered a deleterious health problem worldwide, there are many problems caused by 'too strict' weight control and distorted body image ideals. Many people want to lose weight and repeat weight loss and gain multiple times throughout their lives. This is called 'weight cycling.' Recent studies report the negative impact of obesity and the danger of weight cycling for cardiometabolic health. Many experimental studies show that weight cycling can cause fluctuations in cardiovascular risk factors, such as blood pressure, heart rate, sympathetic activity, and circulating levels of glucose, lipids, and insulin. These repeated fluctuations during periods of weight regain put additional stress on the cardiovascular system. This study reviews current evidence for the effects of weight cycling on diabetes mellitus.

7당뇨병 교육을 위한 정보광장 : 연속혈당측정 사용에 따른 피부 부작용 발생과 관리

저자 : 이정화 ( Jung Hwa Lee )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 1호 발행 연도 : 2022 페이지 : pp. 43-49 (7 pages)

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The use of continuous glucose monitoring (CGM) for blood glucose control is increasing and is effective in changing treatment methods and improving lifestyle by identifying problems in blood sugar patterns. However, adverse skin events are increasing due to the insertion of invasive tools or attachment of sensors to the skin for 14 days for intermittent CGM. These adverse events can be the reason for the discontinuation of CGM. Therefore, this paper aims to determine methods to identify and manage skin irritation and side effects caused by CGM accessories.

8당뇨병 교육을 위한 정보광장 : 당뇨병 약물치료에 따른 개별화된 맞춤형 임상영양요법

저자 : 박주연 ( Juyeon Park )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 1호 발행 연도 : 2022 페이지 : pp. 50-56 (7 pages)

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Medical nutrition therapy (MNT) plays an important role in diabetes management. For effective MNT, not only an individualized meal plan considering daily eating habits and preferences, but also overall management strategies and adjustments on drug therapy and physical activity are required. In particular, an individualized meal plan is needed based on an understanding of the medicine's mechanism and side effects, because glucose is controlled well only when prescription medicines and diet are in harmony.

9당뇨병 교육을 위한 정보광장 : 동기면담 교육훈련이 당뇨병교육자의 상담기술과 자기효능감에 미치는 영향

저자 : 임성철 ( Sung-chul Lim )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 1호 발행 연도 : 2022 페이지 : pp. 57-63 (7 pages)

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The purpose of this study was to examine the effects of motivational interviewing (MI) training on diabetes educators' counseling skills and self-efficacy. Diabetes educators were randomly allocated to the MI training group or control group. The experimental group was provided with a one-day course on MI. Pre-, post-, and follow-up (F/U) measurements were compared. Twenty-four diabetes educators participated in this study. Scores on the counseling skills post-test and F/U-test increased significantly compared to pre-test in the MI training group, as did scores on the helping skill self-efficacy post-test and F/U-test. Session management self-efficacy post-test scores also increased significantly compared to pre-test in the MI training group. There were no significant differences in pre-post and pre-F/U scores in the control group. Diabetes educator-patient communication is an important factor affecting the management of diabetes. MI training increases the counseling skills & self-efficacy of diabetes educators. Diabetes educators should use MI to facilitate patient health behavior changes in diabetes education.

10국내 종합병원의 2형당뇨병 환자의 당뇨병관리 실태: 5년 추적 연구

저자 : 정진희 ( Jin Hee Jung ) , 이정화 ( Jung Hwa Lee ) , 장향미 ( Hyang Mi Jang ) , 나영 ( Young Na ) , 최희선 ( Hee Sun Choi ) , 이연희 ( Yeon Hee Lee ) , 강양교 ( Yang Gyo Kang ) , 김나래 ( Na Rae Kim ) , 이정림 ( Jeong Rim Lee ) , 송복례 ( Bok Rye Song ) , 심강희 ( Kang Hee Sim )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 1호 발행 연도 : 2022 페이지 : pp. 64-75 (12 pages)

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Background: This study aimed to explore the long-term management of diabetes patients in domestic general hospitals by reviewing 2013 and 2018 data on diabetes management status.
Methods: Of 1,802 type 2 diabetes patients who received outpatient treatment at nine general hospitals in Korea and who participated in the 2013 study, 1,124 were enrolled in this study. General characteristics, comorbidities, complications, and management were investigated through medical records.
Results: The average age of the subjects was 65.4 ± 10.6 years, the average duration of diabetes mellitus was 15.6 ± 8.0 years, and 58.2% of the subjects had a family history of diabetes. Concomitant diseases were hypertension in 63.0% and dyslipidemia in 78.8%. Diabetic retinopathy was observed in 31.5%, nephropathy in 24.6%, and neuropathy in 24.5%. The mean glycosylated hemoglobin (HbA1c) level was 7.4 ± 2.2% and according to Korean Diabetes Association guidelines, 20.4% of patients with diabetes achieved a HbA1c level of < 6.5%, 70.1% achieved a blood pressure of < 140/85 mm Hg, and 77.1% achieved a low density lipoprotein cholesterol level of < 100 mg/dL. The target achievement rate was 12.5% for blood sugar, blood pressure, and lipid parameters.
Conclusion: In diabetes management, blood sugar control was poor compared to blood pressure and lipid control. A systematic management plan is needed to ensure proper blood sugar control.

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