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대한당뇨병학회> 당뇨병(JKD)> 당뇨병 교육을 위한 정보광장 : 연속혈당측정 사용에 따른 피부 부작용 발생과 관리

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

Information Desk : The Occurrence and Management of Adverse Skin Events due to Continuous Glucose Monitoring

이정화 ( Jung Hwa Lee )
  • : 대한당뇨병학회
  • : 당뇨병(JKD) 23권1호
  • : 연속간행물
  • : 2022년 03월
  • : 43-49(7pages)
당뇨병(JKD)

DOI


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서론
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초록 보기

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.

UCI(KEPA)

간행물정보

  • : 의약학분야  > 내과학
  • :
  • :
  • : 계간
  • : 2233-7431
  • : 2714-0547
  • : 학술지
  • : 연속간행물
  • : 2000-2022
  • : 1021


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12형당뇨병에서의 정밀의료

저자 : 전언주 ( Eonju Jeon )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 2호 발행 연도 : 2022 페이지 : pp. 77-82 (6 pages)

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Precision medicine is an innovative approach to tailoring disease prevention and treatment that takes into account differences in people's genes, environments, and lifestyle patterns. The aim of such an approach is to lead a shift in the clinical treatment paradigm from a trial-and-error or perceptive approach to the right drug, for the right patient, at the right time. The characterization of human biology and behaviors is now possible at scale owing to advances in biomarkers, bioimaging, and wearable technologies. In addition, big data from electronic medical records, health insurance databases, and other platforms have become available. These have enabled the generation of new insights into the phenotype known as diabetes. Precision medicine in diabetes (PMD) refers to an approach to optimize the diagnosis, prediction, and prevention or treatment of diabetes by integrating multi-dimensional data accounting for individual differences. The potential for precision treatment in diabetes is vast and should be considered cost-effective. Compared to precision medicine of monogenic diabetes, precision medicine of type 2 diabetes is difficult due to the polygenic condition in which environment as well as thousands of etiological genetic variants play an important role. Although there are the great concerns about PMD, which is complex and difficult to do, is required much time, we look forward to clinical utility in the treatment of patients based on their effects on different classes of markers, including race, metabolic status, other phenotypic markers, and omics data for each class of antihyperglycemic medication in the near future.

2비알코올지방간질환의 약물치료: 당뇨병약

저자 : 김경수 ( Kyung-soo Kim )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 2호 발행 연도 : 2022 페이지 : pp. 83-88 (6 pages)

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Nonalcoholic fatty liver disease (NAFLD) is the most common liver disorders and is associated with various metabolic diseases, including type 2 diabetes mellitus (T2DM). There are no approved drugs for NAFLD, and the only approved treatment option is weight reduction. However, it is not easy to maintain weight loss by lifestyle modification alone; pharmacological treatments are helpful in this regard. As insulin resistance plays an important role in the development of NAFLD, many antidiabetic drugs have been evaluated for treatment of NAFLD. Pioglitazone could be a first-line option to improve nonalcoholic steatohepatitis (NASH) in patients with T2DM to produce some improvement in fibrosis. Glucagonlike peptide-1 receptor agonists show evidence of improving NAFLD/NASH with fibrosis. Metformin and dipeptidyl peptidase-4 inhibitors are not recommended for treating NAFLD in patients with T2DM. Evidence that sodium-glucose cotransporter 2 inhibitors improve NAFLD/NASH with fibrosis in patients with T2DM is emerging.

3식욕조절 기전과 비만

저자 : 노은 ( Eun Roh )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 2호 발행 연도 : 2022 페이지 : pp. 89-96 (8 pages)

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Dysregulated energy homeostasis leads to obesity. The brain, particularly hypothalamus and brain stem, plays a key role in the control of food intake and homeostatic regulation of energy metabolism. Food reward-related hedonic controls integrate with homeostatic controls to regulate body weight. The brain determines energy status by receiving peripheral signals, such as nutrients, gut-derived satiety signals, and adiposity-related hormones, via the circulation or through afferent fibers of the vagus nerve. Significant advances in understanding of the molecular mechanisms of appetite control and energy metabolism drove the pursuit of anti-obesity drugs in recent years. The development of incretins as drugs for type 2 diabetes provided unprecedented results in body weight loss. Recently, clinical study results with incretin-based poly-agonists reported mean weight loss greater than 10%, inspiring confidence in development of anti-obesity medications. Here, I briefly review how brain and peripheral signals integrate and interact to regulate homeostatic and hedonic eating behavior and discuss the mechanism of action of recently developed anti-obesity drugs.

4만성질환 관리에서 이중에너지방사선흡수측정기 사용

저자 : 김태년 ( Tae Nyun Kim )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 2호 발행 연도 : 2022 페이지 : pp. 97-105 (9 pages)

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Aging and chronic disease are often accompanied by changes in body composition that lead to decreased muscle mass and increased fat mass, even in weight-stable individuals. Both obesity and sarcopenia are important causes of frailty, disability, morbidity, and mortality. Diminished skeletal muscle and expanded visceral fat can act synergistically, which might maximize their effects on physical impairments and metabolic disorders. Dual-energy X-ray absorptiometry (DEXA) was regarded as one of the most versatile imaging techniques for evaluation of sarcopenia and obesity as well as osteoporosis. Whole-body DEXA allows total and regional assessment of the three compartments for fat mass, non-bone lean mass, and bone mineral content. Moreover, DEXA is accurate, reproducible, fast, relatively inexpensive, and involves very low radiation dose to the patient. Developments in DEXA equipment and software allow an accurate and differential estimate of visceral adipose tissue. This review summarizes the clinical practical application of whole-body DEXA values, with use of muscle and fat mass indices in the diagnostic workup of low muscle mass, sarcopenia, and sarcopenic obesity according to the most recent studies and guidelines.

5신체조성 분석에 있어서 생체전기저항분석을 이용한 방법의 유용성

저자 : 임수 ( Soo Lim )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 2호 발행 연도 : 2022 페이지 : pp. 106-112 (7 pages)

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People with obesity are at high risk of type 2 diabetes, cardiovascular diseases, and certain types of malignancy. A significant reduction in muscle mass is also associated with increased risk of developing sarcopenia. In general, body composition is affected by several factors, including ethnicity, environment, genetics, and lifestyle patterns. Assessment of body composition is an important tool for maintaining good general health and longevity, and is utilized by physicians and researchers to monitor disease severity and nutritional status. It can also be used to monitor the effectiveness of dietary and drug interventions. Dual energy X-ray absorptiometry is regarded as the gold standard method for analyzing body composition. However, there is an associated risk of a small amount of radiation exposure. In addition, severely obese people are not candidates for this method. Recently, bioelectrical impedance analysis (BIA) has been developed. BIA poses no radiation hazard, is easy applicable and relatively inexpensive. Thus, BIA is widely used in fitness centers as well as in hospitals. Several studies have been conducted to assess the effectiveness of BIA for measuring body composition, but most have focused on subjects of European descent. Of note, body composition differs among ethnic groups: Asians have a greater tendency toward obesity at a lower body mass index than Caucasians. Therefore, an ethnicityspecific approach is required for precise estimation of body composition using BIA. In conclusion, healthcare providers should have a thorough understanding of body composition assessment and the advantages and disadvantages of different measurement methods.

6비만 약물치료의 최신지견

저자 : 손장원 ( Jang Won Son )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 2호 발행 연도 : 2022 페이지 : pp. 113-127 (15 pages)

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Obesity is a chronic, complex, and heterogeneous disease that is affected by genetic, developmental, biological, and environmental factors; thus, it is necessary to approach obesity with an integrated and comprehensive treatment strategy. Because it is difficult to achieve and maintain successful long-term weight loss through lifestyle modifications in most obese patients, a pharmacological approach to the treatment of obesity should be considered as adjuvant therapy. According to the Korean Society for the Study of Obesity guidelines, patients who fail to lose weight with comprehensive lifestyle modifications and who have a body mass index of ≥ 25 kg/m2 are eligible for weight loss medication treatment. Four drugs (orlistat, naltrexone extended-release [ER]/bupropion ER, phentermine/topiramate controlledrelease, and liraglutide) have been approved for long-term use (> 12 weeks) to promote weight loss in Korea. Here, I will discuss these currently available anti-obesity agents as well as upcoming anti-obesity agents including semaglutide, setmelanotide, and tirzepatide in terms of obesity management.

7노인당뇨병 관리

저자 : 김선영 ( Sun Young Kim )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 2호 발행 연도 : 2022 페이지 : pp. 128-132 (5 pages)

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As the aging population increases, the number of elderly diabetic patients continues to increase. Elderly diabetic patients are more likely to develop cardiovascular and cerebrovascular diseases than other age groups because of the increased susceptibility to other diseases caused by diabetes. As a result, the quality of life is reduced and the death rate is increasing, which is considered a social problem. Therefore, in order to manage such patients, it is necessary to understand the characteristics of the elderly and solve problems that can occur in elderly diabetic patients.

8탄수화물계산을 활용한 임상영양요법

저자 : 김미라 ( Mi Ra Kim )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 2호 발행 연도 : 2022 페이지 : pp. 133-137 (5 pages)

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Improved postprandial glucose management requires careful monitoring of carbohydrate counting and consideration of the blood glucose response to dietary carbohydrate. Furthermore, learning how to use insulin-to-carbohydrate ratios for meal planning might help people successfully adjust insulin dose from meal to meal to enhance glycemic control. Regular education to raise knowledge of the link between carbohydrate intake and insulin requirements is critical for those whose meal schedules or carbohydrate consumption are unpredictable. Medical nutrition therapy is an important part of total diabetes management, and each person with diabetes should participate actively in education, self-management, and treatment planning with their health care team, including creation of a personalized food plan.

9당뇨병 환자 건강관리의 사회적 결정요인

저자 : 유빈 ( Been Yoo )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 2호 발행 연도 : 2022 페이지 : pp. 138-143 (6 pages)

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Diabetic patients must exert continuous self-management in areas such as diet, exercise, and medications to control blood sugar. However, such habits are greatly influenced by lifestyle; socioeconomic, cultural, and environmental conditions; as well as individual will. In vulnerable groups, the prevalence of diabetes is higher than in non-vulnerable groups, and difficulties in diabetes management are more common. Health is impacted by age; gender; genetics; lifestyle; social and community networks; living and working conditions; and socioeconomic, cultural, and environmental conditions. Among these various factors, five 'social determinants of health' highly affect the health management of diabetic patients: socioeconomic status, physical environment (housing environment, transportation), food insecurity, family and social support, and health literacy. It is important address these social determinants of health, starting with identification of individualized social needs of patients. Efforts should be made to improve quality of life through use of community resources and to further contribute to alleviating health inequality.

10소적혈구성 빈혈을 동반한 2형당뇨병 환자에서 진단된 무세룰로플라스민혈증

저자 : 박범균 ( Beomkyun Pak ) , 유은애 ( Eun Ae Yoo ) , 박효숙 ( Hyo Sook Park ) , 김지혜 ( Ji Hye Kim )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 23권 2호 발행 연도 : 2022 페이지 : pp. 144-152 (9 pages)

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Aceruloplasminemia (ACP) is a rare genetic disorder characterized by the triad of diabetes mellitus, retinal degeneration, and neurological symptoms. The patient's clinical and biochemical features highlight substantial phenotype heterogeneity, contributing to the difficulties and delay in diagnosing ACP. We described a patient presenting with diabetes and abnormal iron studies due to ACP with typical neuroradiologic abnormality. A 56-year-old female patient visited our hospital with complaints of weight loss and anxiety. The leading cause of unintentional weight loss was uncontrolled diabetes. She was treated with oral hypoglycemic agents. Initial blood tests revealed unexplained microcytic anemia and high ferritin levels. We performed magnetic resonance imaging (MRI) of the brain to alleviate her excessive concerns about normal memory loss. We suspected that she might have ACP, based on the results of cortical pencil lining sign of the brain MRI and microcytic anemia with decreased ceruloplasmin (CP) and increased ferritin levels. Sequence analysis of the CP gene revealed homozygosity for c.2630 G>A, confirming the clinical diagnosis of ACP. The patient was started on deferasirox with progressive normalization of ferritin. In conclusion, unexplained anemia, often with microcytosis, diabetes, and typical neuroradiologic findings, is the best clue for early diagnosis of ACP.

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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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