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대한당뇨병학회> 당뇨병(JKD)> 비알코올지방간질환의 약물치료: 당뇨병약

비알코올지방간질환의 약물치료: 당뇨병약

Pharmacological Treatment of Nonalcoholic Fatty Liver Disease: Antidiabetic Agents

김경수 ( Kyung-soo Kim )
  • : 대한당뇨병학회
  • : 당뇨병(JKD) 23권2호
  • : 연속간행물
  • : 2022년 06월
  • : 83-88(6pages)
당뇨병(JKD)

DOI


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서론
본론
결론
REFERENCES

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초록 보기

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.

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)

다운로드

(기관인증 필요)

초록보기

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)

다운로드

(기관인증 필요)

초록보기

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)

다운로드

(기관인증 필요)

초록보기

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)

다운로드

(기관인증 필요)

초록보기

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)

다운로드

(기관인증 필요)

초록보기

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)

다운로드

(기관인증 필요)

초록보기

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)

다운로드

(기관인증 필요)

초록보기

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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(기관인증 필요)

초록보기

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)

다운로드

(기관인증 필요)

초록보기

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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초록보기

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.

1
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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)

다운로드

(기관인증 필요)

초록보기

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)

다운로드

(기관인증 필요)

초록보기

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)

다운로드

(기관인증 필요)

초록보기

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)

다운로드

(기관인증 필요)

초록보기

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)

다운로드

(기관인증 필요)

초록보기

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)

다운로드

(기관인증 필요)

초록보기

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)

다운로드

(기관인증 필요)

초록보기

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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