Korean Diabetic Patients Research Articles

Effects of insulin resistance and β-cell function on diabetic complications in Korean diabetic patients.

Diabetes mellitus is characterized by insulin resistance (IR) and dysfunctional insulin secretion from pancreatic β-cells. However, little research has been conducted on the relationship between IR and β-cell function in relation to diabetic complications among Korean diabetic patients. This study aimed to examine the differential associations between IR and β-cell function and various diabetic complications among Korean diabetic patients. The analysis employed a common data model (CDM). IR and β-cell function were quantified using the homeostasis model assessment for insulin resistance (HOMA-IR) and β-cell function (HOMA-β), respectively. Hazard ratios for diabetic nephropathy, diabetic retinopathy, and cardiovascular disease (CVD) events were calculated. The study cohort consisted of 2,034 diabetic patients aged over 20 years who visited EUMC between January 2001 and December 2019. Among diabetic patients in the highest quartile of HOMA-IR, the adjusted hazard ratio for total CVD events was 1.76 (95% confidence interval [CI], 1.20-2.57) compared with those in the lowest quartile of HOMA-IR (P = 0.004). In contrast, diabetic patients in the lowest quartile of HOMA-β exhibited an adjusted hazard ratio of 3.91 (95% CI, 1.80-8.49) for diabetic retinopathy compared to those in the highest quartile of HOMA-β (P = 0.001). Insulin resistance and β-cell function exhibited different associations with diabetic complications among Korean diabetic patients. Specifically, lower β-cell function was associated with an increased risk of diabetic retinopathy, whereas higher IR was associated with an increased risk of CVD events. Individuals with pronounced IR should prioritize CVD prevention measures, and those with significant β-cell dysfunction may benefit from early, intensive surveillance for diabetic retinopathy.

1084-P: The Trend of Korean Diabetes Patients’ Foot EMG Wave Pattern Age over 65

Depending on the healthcare system, ethnicity, and diet, delaying complications related to diabetes differ in each country. Diabetic ulcer accompanied by neuropathy of the foot is the key indicator for the development of complications. Therefore finding the total number of impaired feet with foot muscle dystrophy may understand how the diabetes progression of the patients is controlled by public health organization structures. Korea is one of the nations which adopted a national wide government-organized healthcare insurance system compared with private. In this study, we examined how Korean diabetic feet are controlled by the Korean public health care system. To figure out this, diabetes subjects' foot EMG were examined by STEMG-2 (STUFProject EMG Device-2) by checking 3-second foot up and down movement. Age over 65 who suffered from 50 male and female diabetes patients and 50 male and female nondiabetic patients the foot EMG was tested. After finishing the test results EMG was converted into a digital signal by 1024 arbitrary units and plotted wave pattern with subtracting reference. As a result, 98% of nondiabetics showed constant wave patterns corresponding to muscle relaxation and contraction. Whereas, 86% of diabetes patients have constant EMG wave patterns and only 14% have inconsistent EMG wave patterns. 84% of male and 78% of female diabetes patients have similar wave patterns to nondiabetes individuals Also patients who are BMI less than 23 have 96% of constant patterns. 80% of patients' glucose levels below 180 mg/dl have constant wave patterns. However, 60% of patients over 180mg/dl glucose level have inconsistent patterns. In the conclusion, 86% of Korean diabetes patients are controlling muscle destruction could happen a chronic effect of diabetes. Even 13% of diabetes patients who showed abnormal wave patterns, may have some acute cramp with the foot but visually all toes are intact. This may means the progression of diabetic complications is controlled by the Korean national health system. Disclosure W. Kim: None. M. Park: None. Funding National Research Foundation of Korea (HNU X-Corps)

Correlation of advanced glycation end products and heme oxygenase-1 in Korean diabetic patients

Correlation of advanced glycation end products and heme oxygenase-1 in Korean diabetic patients

Blood Biochemical Characteristics, Dietary Intake, and Risk Factors Related to Poor HbA1c Control in Elderly Korean Diabetes Patients: Comparison between the 4th(2007-2009) and the 7th(2016-2018) Korea National Health and Nutrition Examination Surveys

Blood Biochemical Characteristics, Dietary Intake, and Risk Factors Related to Poor HbA1c Control in Elderly Korean Diabetes Patients: Comparison between the 4^th(2007-2009) and the 7^th(2016-2018) Korea National Health and Nutrition Examination Surveys

Association between Inflammatory Markers and Glycemic Control in Korean Diabetic Patients

Objectives: This study evaluated the association between inflammatory markers and glycemic control in Korean patients with diabetes mellitus.Methods: Using data from the 2007-2018 Korean National Health and Nutritional Examination, 4,186 diabetic subjects aged between 19 and 80 years were included in this study. Poor glycemic control was defined as level of HbA1c higher than 7%. Inflammation was measured by inflammatory markers including white blood cell (WBC) count and high-sensitivity C-reactive protein (hsCRP), and those inflammatory markers were categorized into 4 groups by quartiles. A multiple logistic regression analysis was performed to evaluate the association between quartile of inflammatory markers and poor glycemic control after adjusting for demographic factors, lifestyle, and comorbidities.Results: Levels of WBC count and hsCRP were positively associated with the risk of poor glycemic control even after fully adjusting for potential confounders. For WBC count, compared with the first quartile, the second quartile was 1.50 (95% confidence interval, CI: 1.26-1.78), 1.71 (95 % CI:1.43-2.05) for the third, 2.00 (95% CI: 1.67-2.40) for the fourth. In case of hsCRP, compared with the first quartile, the second quartile was 1.15 (95% CI: 0.87-1.53), 1.59 (95% CI: 1.20-2.11) for the third, and 1.59 (95% CI: 1.19-2.12) for the fourth. There was significant age difference in the association between hsCRP and glycemic control. The association was more evident in the younger group than in the elderly group. Conclusions: High level of WBC and hsCRP were positively associated with the risk of poor glycemic control. These results suggest that in a Korean diabetic patient, inflammation was significantly associated with poor glycemic control.

Study of hospitalization and mortality in Korean diabetic patients using the diabetes complications severity index

BackgroundThe prevalence of type 2 diabetes mellitus (T2DM) is expected to increase from 7.7% in 2017 to 8.4% in 2045 worldwide. Diabetes complications contribute to morbidity and mortality. To evaluate whether the diabetes complications severity index (DCSI) was associated with increased risks of mortality and hospitalization.MethodsA retrospective cohort study was conducted using the National Health Insurance Database (NHID) sample cohort of 1,102,047 patients (2002–2015) in Korea. Diabetes complications were evaluated at 2 years after the initial diagnosis and during the subsequent follow-up period (mean duration 6.56 ± 2.81 years). The type and severity of complications were evaluated on the basis of the International Classification of Disease Ninth (ICD-9) codes used in DCSI with 7 categories and 55 subcategories of complications. The Cox proportional hazard and Poisson regression models were used to evaluate the mortality and hospitalization rates. The incidence and relative risk of diabetes complications as well as the risk of mortality and hospitalization were the main outcome measures.ResultsA total of 27,871 patients were finally included and grouped by the number of complications present at 2 years. Four hundred ninety patients (5.37%) died without complications, 659 (7.31%) died with one complication and 1153 (11.85%) died with two or more complications. As DCSI at index date increased, the risk of additional new diabetes complications increased by 26% [relative risk (RR) 1.26, 95% CI 1.25–1.27]. The risks of mortality and hospitalization were linearly related to DCSI [hazard ratio 1.13 (95% CI 1.11–1.16), relative risk 1.04 (95% CI 1.03–1.06)].ConclusionsPatients with higher incidence and severity of diabetes complications have increased risks of mortality and hospitalization.

No effect of vitamin D supplementation on metabolic parameters but on lipids in patients with type 2 diabetes and chronic kidney disease.

Background/Aims: Trials on the effects of cholecalciferol supplementation in type 2 diabetes with chronic kidney disease patients were underexplored. Therefore, the aim of this study was to investigate the effects of two different doses of vitamin D supplementation on serum 25-hydroxyvitamin D [25(OH)D] concentrations and metabolic parameters in vitamin D-deficient Korean diabetes patients with chronic kidney disease. Methods: 92 patients completed this study: the placebo group (A, n=33), the oral cholecalciferol 1,000IU/day group (B, n=34), or the single 200,000IU injection group (C, n=25, equivalent to 2,000IU/day). 52% of the patients had less than 60 mL/min/1.73m2 of glomerular filtration rates. Laboratory test and pulse wave velocity were performed before and after supplementation. Results: After 12 weeks, serum 25(OH)D concentrations of the patients who received vitamin D supplementation were significantly increased (A, -2.4±1.2ng/mL vs. B, 10.7±1.2ng/mL vs. C, 14.6±1.7ng/mL; p<0.001). In addition, the lipid profiles in the vitamin D injection group (C) showed a significant decrease in triglyceride and a rise in HDL cholesterol. However, the other parameters showed no differences. Conclusions: Our data indicated that two different doses and routes of vitamin D administration significantly and safely increased serum 25(OH)D concentrations in vitamin D-deficient diabetes patients with comorbid chronic kidney disease. In the group that received the higher vitamin D dose, the lipid profiles showed significant improvement, but there were no beneficial effects on other metabolic parameters.

Association between Food Label Unawareness and Loss of Renal Function in Diabetes: A Cross-Sectional Study in South Korea.

Objectives: To examine sex differences in the association between food label unawareness and loss of renal function among South Korean diabetic patients aged ≥30 year and determine whether reading food labels when choosing which food products to consume plays a potential role in slowing the progression of renal disease. Methods: Data from the 2016–2017 Korea National Health and Nutrition Examination Survey were used for the analysis. Renal function was determined by the Modification of Diet in Renal Disease estimated glomerular filtration rate, and food label unawareness was defined as being unaware of the food label when choosing a food product for consumption. Multiple regression analysis was used to investigate the association between food label unawareness and loss of renal function among South Korean diabetic patients. Results: Four hundred and eighty-seven diabetic patients (men: 274; women: 213) were enrolled. Loss of renal function was associated with food label unawareness in only male diabetic patients (men: β = –10.01, standard error (SE) = 5.08, p = 0.0506; women: β = –0.30, SE = 5.14, p = 0.9528). A strong association was found between loss of renal function and food label unawareness among socially isolated male diabetic patients who lived in a one-generational household, did not have a spouse, and ate alone. Conclusion: Cultivating habits of reading food labels and inducing social facilitation may play a potential role in managing loss of renal function among male diabetic patients.

Effect of prescribing metformin according to eGFR instead of serum creatinine level: A study based on Korean National Health and Nutrition Examination Survey (KNHANES) 2009-2014.

BackgroundThe metformin label has recently been changed from serum creatinine (sCr)-based to estimated glomerular filtration rate (eGFR)-based indication, which is expected to expand its use for patients with mild renal insufficiency. However, because the sCr level is lower in Asians than in Caucasians at the same level of renal function, this change might not expand metformin use in the Asian population. We investigated the effect of this change among Korean patients with diabetes.MethodsData from the Korean National Health and Nutrition Examination Survey 2009 to 2014 were used and included 4,127 adult patients with diabetes. The metformin eligibility was assessed by the sCr level (1.4 mg/dL for women and 1.5 mg/dL for men) or by eGFR categories (contraindicated, <30; indeterminate, ≥30, <45; likely safe, ≥45 mL/min/1.73 m2) calculated by various eGFR equations including MDRD equation. We designated the ‘expanding’ and ‘contracting’ population as those who are likely safe according to eGFR among sCr-ineligible patients and those contraindicated according to eGFR among sCr-eligible patients, respectively. Results were weighted to the whole Korean adult population.ResultsAll eGFR equations showed expansion in the population for whom metformin is likely safe, ranging from 14.3% to 19.9% of the sCr-ineligible population. With the MDRD equation, the expanding population was 15,264 (15.8%) and the contracting population was 0 (0.0%). Male sex and younger age were significantly associated with the expanding population.ConclusionsContrary to our concern, prescribing metformin according to eGFR substantially expanded the indication of its use among the Korean diabetic patients.

Characteristics of the nutritional status of the Korean diabetic patients by the nutritional care process model

Characteristics of the nutritional status of the Korean diabetic patients by the nutritional care process model

Usefulness of carotid ultrasonography as a screening test for coronary artery disease in Korean diabetic patients

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Inverse association between serum total bilirubin levels and diabetic peripheral neuropathy in patients with type 2 diabetes.

Several studies have suggested that bilirubin, a potent innate antioxidant, plays a protective role against cardiovascular and microvascular disease. This study investigated the association between serum concentrations of total bilirubin (TB) and the presence of diabetic peripheral neuropathy (DPN) in Korean diabetic patients. This cross-sectional study involved 1207 patients aged more than 30 years with type 2 diabetes. DPN was assessed according to clinical symptoms and physical examinations using Michigan Neuropathy Screening Instrument examination score, 10-g monofilament sensation, and current perception threshold. The subjects were stratified into gender-specific tertiles based on TB values, and the relationship between the TB values and DPN was analyzed. Compared with patients within the lowest TB tertile, those with higher TB levels consisted of patients with shorter duration of diabetes, lower HbA1c, better renal function, and less autonomic neuropathy, retinopathy, and albuminuria. Serum TB levels were inversely associated with DPN. In multivariate analysis for the development of DPN after adjusting for potential confounding factors including retinopathy, albuminuria, and autonomic neuropathy, the TB levels were inversely associated with the presence of DPN, both as a continuous variable [odds ratio (OR) per log standard deviation (SD) 0.79; 95% confidence interval (CI) 0.65-0.97; P = 0.022] and when categorized in tertiles (the highest vs. the lowest tertile; OR 0.63; 95% CI 0.40-0.99; P = 0.046). Low serum bilirubin levels are significantly associated with DPN, independently of classic risk factors and other microvascular complications. Further investigation is necessary to determine whether serum bilirubin has a prognostic significance on DPN.

Association between Bsm1 Polymorphism in Vitamin D Receptor Gene and Diabetic Retinopathy of Type 2 Diabetes in Korean Population.

BackgroundType 2 diabetes is one of the most common diseases with devastating complications. However, genetic susceptibility of diabetic complications has not been clarified. The vitamin D endocrine system is related with calcification and lipolysis, insulin secretion, and may be associated with many complicated disease including diabetes and cardiovascular disease. Recent studies reported that single nucleotide polymorphisms of vitamin D receptor (VDR) gene were associated with diabetic complications.MethodsIn present study, we evaluated the association of BsmI polymorphism of VDR with diabetic complications in Korean diabetes patients. Total of 537 type 2 diabetic subjects from the Endocrinology Clinic of Chungbuk National University Hospital were investigated. Polymerase chain reaction-restriction fragment length polymorphism was used to test the genotype and allele frequency of BsmI (rs1544410; BB, Bb, bb) polymorphisms.ResultsMean age was 62.44±10.64 years and mean disease duration was 13.65±7.39 years. Patients with B allele (BB or Bb) was significantly associated with lower risk of diabetic retinopathy (severe non-proliferative diabetic retinopathy or proliferative retinopathy; 7.4%, 5/68) compared with patients without B allele (bb; 17.3%, 81/469; P=0.035). This association was also significant after adjusting for hemoglobin A1c level, body mass index, age, sex, and diabetes mellitus duration, concurrent dyslipidemia and hypertension (odds ratio, 2.99; 95% confidence interval, 1.08 to 8.29; P=0.035) in logistic regression analysis.ConclusionOur findings suggest that B allele of Bsm1 polymorphism in VDR gene is associated with lower risk of diabetic retinopathy in type 2 diabetic patients. Bsm1 genotype could be used as a susceptibility marker to predict the risk of diabetes complication.

Comments on Statistical Issues in November 2015.

In this section, we explain the definition and solution to avoid the multi-collinearity in multivariate analysis, which appeared in the articles titled, Time to first cigarette and hypertension in Korean male smokers and Barrier factors to the completion of diabetes education in Korean diabetic adult patients: Korea National Health and Nutrition Examination Surveys 2007-2012, published in September 2015 by Lee et al.1) and by Kim et al.,2) respectively.

Letter: Increased Risk of Hospitalization for Heart Failure with Newly Prescribed Dipeptidyl Peptidase-4 Inhibitors and Pioglitazone Using the Korean Health Insurance Claims Database (Diabetes Metab J 2015;39:247-52).

Dipeptidyl peptidase-4 (DPP-4) inhibitors are now being widely used for the treatment of type 2 diabetes, and preclinical studies and short-term clinical studies suggested that DPP-4 inhibitors as well as GLP-1 receptor agonists have cardiovascular (CV) benefits beyond the glycemic effects [1]. However, two randomised clinical trials (RCTs) with saxagliptin [2] and alogliptin [3], separately, in patients with type 2 diabetes at high CV risk showed a rather disappointing neutral CV effect. In the saxagliptin RCT (saxagliptin assessment of vascular outcomes recorded in patients with diabetes mellitus-thrombolysis in myocardial infarction [SAVOR-TIMI]), more patients in the saxagliptin than in the placebo group were hospitalized for heart failure (HF), whereas in the Examination of Cardiovascular Outcomes with Alogliptin vs. Standard of Care (EXAMINE) trial, alogliptin did not increase the risk of HF outcomes in patients with type 2 diabetes and recent acute coronary syndromes [4]. Then, concerns about HF associated with the use of DPP-4 inhibitors led to many systematic reviews and meta-analyses. In addition to many previous studies, the largest meta-analysis study of recent years showed that a long-term treatment with DPP-4 inhibitors significantly increased the risk of HF [5]. Another way of studying the risk of HF associated with DPP-4 inhibitors is to analyze real-world clinical data. In this issue, Suh et al. [6] report data entitled Increased risk of hospitalization for heart failure with newly prescribed dipeptidyl peptidase-4 inhibitors and pioglitazone using the Korean Health Insurance Claims Database. They collected data from the Korean Health Insurance claims database about newly prescribed sitagliptin, vildagliptin, and pioglitazone between January 1, 2009 and December 31, 2012 (mean follow-up of 336.8 days). Interestingly, they used poisson regression to model the relationship and generate hazard ratios (HRs) and 95% confidence intervals comparing days 0 to 30 with days 31 to 360 after pioglitazone or DPP-4 inhibitor prescription. In another comparison, they used pioglitazone group as the reference group to compare the HRs rather than control. The hospitalization rate for new HF was greatest in the first 30 days after starting the medication, which corresponded to a significantly higher incidence at days 0 to 30 compared with days 31 to 360 for all three drugs. The HRs were 1.85 (pioglitazone), 2.00 (sitagliptin), and 1.79 (vildagliptin) without statistical differences between the three drugs. This study showed an increase in hospitalization for HF in the initial 30 days' use of the DPP-4 inhibitor and pioglitazone com-pared with the subsequent follow-up period. The study has the merits of analyzing a large number of type 2 diabetic patients (n=233,790 for pioglitazone, n=481,255 for sitagliptin, and n=220,484 for vildagliptin) with a mean follow-up of 336.8 days. Furthermore, this study included the entire population of patients with type 2 diabetes receiving the Korean National Health Insurance Service, suggesting that the data are from the nearly representative Korean diabetic patients in real-world practice settings. Although these kinds of data may have intrinsically limited information on comorbidity, family history, past illness, duration of diabetes, and other CV risks, it has been suggested positive predictive values >70% for diabetes and CV diseases [7]. In accordance with this data, the rate of hospitalization for HF was also higher in the earlier period (≤180 days) of saxagliptin use [2]. Although major CV outcomes are not affected by DPP-4 inhibitors or even slightly decreased by the drug [8], the risk of HF seems to be real [2,7]. However, the presence of HF at baseline did not further increase the hospitalization for HF nor other major CV endpoints in SAVER-TIMI 53 trial [2]. Back to the Suh et al. [6], the risk of DPP-4 inhibitor for HF was similar to that of pioglitazone, a well-known positive control [9]. However, it would be better to determine adjusted HRs, because some studies showed only borderline risk of these drugs for HF after adjustment for risk factors [7,10]. A comparison with metformin is also important, because it is the drug of first choice and the most combined drug with other antidiabetic agents. If more data are accessible, it would be very interesting to evaluate the interaction with angiotensin-converting enzyme inhibitor, as the authors suggested. In conclusion, this study suggested that vigilance in the early period of drug use may be helpful for the management of patients with type 2 diabetes if a DPP-4 inhibitor is added on to other drug(s) or is newly started on, until further information through RCTs, including Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS) study, is available in the near future (at the time of this writing).

Response: Increased Risk of Hospitalization for Heart Failure with Newly Prescribed Dipeptidyl Peptidase-4 Inhibitors and Pioglitazone Using the Korean Health Insurance Claims Database (Diabetes Metab J 2015;39:247-52).

We appreciate your interest and comments on our article entitled Dipeptidyl peptidase-4 inhibitors and hospitalization for heart failure using the Korean Health Insurance Claims Database which was published in Diabetes and Metabolism Journal [1]. The objective of this study was to assess the association of the most widely used dipeptidyl peptidase-4 inhibitors (DPP4i) and thiazolidinediones (TZDs) with heart failure (HF) hospitalization using the National Health Insurance System (NHIS) database. We observed a 1.8- to 2.0-fold increase in hospitalization for HF in the initial 30 days of medication (pioglitazone, sitagliptin, and vildagliptin) compared with the subsequent follow-up period. The strengths of this study include the large population of patients with type 2 diabetes mellitus (T2DM) with a mean follow-up of 337 days. These data were taken from the database of representative Korean diabetic patients in real-world clinical settings because the NHIS is a compulsory and universal health care system in Korea [2]. We acknowledge that we could not adjust for confounding variables because of limited information on known HF risk factors. As we already mentioned in the paper, further study with full data regarding medications and co-existing illness is needed. Recent re-analysis of saxagliptin assessment of vascular outcomes recorded in patients with diabetes mellitus-thrombolysis in myocardial infarction (SAVOR-TIMI) 53 found that the increased risk of HF hospitalization was heightened among patients with elevated levels of natriuretic peptides, previous HF, or chronic kidney disease [3]. Sitagliptin also showed significantly increased risk of HF-related hospitalizations among patients with T2DM and HF [4]. Thus, one may suspect that undiagnosed HF might have given rise to the increase in HF hospitalization during the initial 30 days. However, we reduced these possibilities by eliminating those with a prior diagnosis of HF. We agree with Lee DH that the comparison with metformin is important because it is the drug of first choice and is used the most in combination with other antidiabetic agents. However, characteristics of diabetic patients on metformin alone group and those on metformin along with DPP4i or TZD group are different. On the other hand, characteristics of groups treated with metformin and DPP4i or TZD are similar because NHIS allows reimbursement of these drug combinations in the same clinical settings. Therefore, we have chosen pioglitazone as a comparator for the analysis which is known to increase the risk of edema and HF [5,6]. In addition, we used a poisson regression to model the relationship and generate hazard ratios and 95% confidence intervals comparing days 0 to 30 with days 31 to 360 after prescription because these groups share the same baseline characteristics. However, we did not find a significant difference of HF hospitalization between the DPP4i and TZD. Collectively, our results indicate a class effect and a relatively acute drug effect on HF during the earlier period of medication. In conclusion, our study suggested that vigilance in the early period of DPP4i prescription may be helpful for the management of patients with T2DM. We are awaiting the results of the ongoing trials with cardiovascular disease as a main endpoint. We sincerely appreciate Lee DH for his interest in our study and knowledgeable comments.

Effects of diet modification on meal quality and quality of life in korean diabetic patients: data from Korea national health and nutrition examination survey (2007-2011).

It is generally accepted that diet modification provides beneficial effects on the management of diabetes. In the present study, we evaluated the effects of diet modification on nutrient intake and quality of life in a large sample of diabetic patients. This study was conducted using data from the Korea National Health and Nutrition Examination Survey IV and V (2007-2010). A total of 2,484 of diabetic patients were included in the analysis. Then, we compared the overall quality of dietary intake between diabetic patients with diet modification and those without dietary modification. The result showed that subjects on diabetic diet (DDG) showed lower levels of total cholesterol, triglyceride, and AST before and after the adjustment for covariates (all p < 0.05). The results of nutrient assessment showed that DDG had lower intakes of total energy, fat, and carbohydrate (all p < 0.05), but higher intakes of energy from protein, vitamin B1, vitamin B2, niacin and vitamin C than NDG. (all p < 0.05). In addition, nutritional adequacy ratio of calcium and vitamin B2 were significantly higher in DDG than those in normal diet group (NDG) (p < 0.05). However, we observed no significant differences in quality of life between two groups. In conclusion, diet modification in diabetic patients seemed to be effective to improve blood lipid profile and the adequacy of nutrient intake without sacrificing the quality of life.

Lifestyle, Diet, Self-care, and Diabetes Fatalism of Diabetic Patients with and without Diabetic Foot

This study was to determine diabetes fatalism of diabetic patients with and without diabetic foot and its association with lifestyle, diet, and self-care. Methods: The subjects were diabetic patients with (male/female 48/21) and without diabetic foot (male/female 33/26). We administered the questionnaires which were designed to determine diabetes fatalism, lifestyle, diet, and self-care. Diabetes fatalism was determined by Diabetes fatalism scale (DFS), which consisted of total 12 items in three subscales namely, emotional stress, religiou·spiritual coping, and perceived selfefficacy. Results: The patients with diabetic foot had undesirable diets more frequently (1.37 and 0.91 days/week respectively) and their desirable diets (2.74 and 3.61 days/week respectively) and foot care (4.61 and 5.53 days/week respectively) were less frequent than those without diabetic foot (p < 0.05). An item analysis of the 12 DFS items revealed a Chronbach`` α of 0.614 and 0.869, respectively in diabetic patients with and without diabetic foot. Perceived self-efficacy related DFS of subjects without diabetic foot was positively associated with smoking (r = 0.350, p < 0.01), undesirable diet (r = 0.295, p < 0.05), and drinking (r = 0.257, p < 0.05), while its negative association with exercise (r = -0.224, p < 0.088) and foot care (r = -0.247, p < 0.059) did not reach to statistical significance. Conclusions: This work was the first study reporting the potential usefulness of DFS, especially perceived self-efficacy related subscale as a predictor of lifestyle, diet and self-care on the Korean diabetic patients, at least those without severe diabetic foot to screen those who should be the first target for diabetes education. Korean J Community Nutr 19(3): 241~249, 2014

Metformin and Cancer in Type 2 Diabetes

Metformin and Cancer in Type 2 Diabetes

The effect of duodenojejunal bypass for type 2 diabetes mellitus patients below body mass index 25 kg/m2: one year follow-up

PurposeThe goals of this study are to evaluate the effect of duodenojejunal bypass (DJB) for type 2 diabetes mellitus (T2DM) patients below body mass index (BMI) 25 kg/m2 in one year follow-up, and to compare the results of 1 week which we have reported in 2011.MethodsIn this prospective observational study, there were 31 type 2 diabetic patients who underwent DJB at Inha University Hospital from July 2009 to January 2011. We did laboratories such as 75-g oral glucose tolerance test (OGTT), insulin level and hemoglobin A1c (HbA1c), etc. and compared their changes of preoperative, a week, 3 months, and 12 months.ResultsMean BMI was 23.1 ± 1.3 kg/m2, mean duration of T2DM was 8.3 ± 4.7 and mean age was 46.6 ± 7.7 years. There were a significant decrease of 75-g OGTT levels and increase of insulin secretion after 3 months. 13.3% showed diabetic remission (HbA1c < 6.0, medication cessation) and 26.7% showed diabetic improvement. The rates of remission and improvement much declined comparing with that of postoperative 1 week although those were determined by fasting and postprandial 2 hour level of glucose.ConclusionThis is the first study of metabolic surgery in Korean diabetes patients in the healthy weight range. DJB exerted positive influences on insulin resistance as well as beta cell function. Early effects on T2DM after DJB could be estimated as one of good modalities, although the effectiveness seems to be unacceptable. Further studies are mandatory for evaluation of the effectiveness of metabolic surgery and finding prognostic factors.