S-421 Mortality prediction model of Korean diabetic patients

( Joonyub Lee ),( Hae Kyung Yang ),( Jin-hee Lee ),( Kyungdo Han ),( In-young Choi ),( Hun-sung Kim ),( Seung-hwan Lee ),( Jae-hyoung Cho ),( Bong-yun Cha ),( Kun-ho Yoon ) 대한내과학회 2016 대한내과학회 추계학술발표논문집 Vol.2016 No.1

Background:?Subjects with diabetes are at increased risk of mortality than normal population. Only a few researches had been performed to predict mortality in patients with diabetes and its clinical applicability has been unsatisfactory. The purpose of this study was to propose a mortality prediction model in Korean subjects with diabetes.?Methods:?Subjects with diabetes who visited Seoul St. Mary hospital from 2009 to 2013 were enrolled in the study (n=7,137). Subjects who missed data in major variables were excluded from the study (n=1,423). Seventy percent of the remaining population (n=4,000) were randomly selected to develop mortality prediction model using multivariate logistic regression analysis in men and women, separately. Validity of the model was measured through AUC of ROC (Receiver Operating Characteristic) curve in remaining 30% of study population (n=1,714). A satisfactory survey was conducted in 38 volunteered patients to measure clinical efficacy of the model.?Results:?Among total of 5,714 subjects, 249 deaths occurred during the follow-up. Age ≥65 years, BMI <18.5 kg/m2, presence of hypertension, GFR <90 ml/min/1.73㎡ and standard deviation of serially measured HbA1c (HbA1c-SD) ≥0.1% were associated with higher risk for death in men. Age ≥60 years, presence of hypertension and HbA1c-SD) ≥0.3% were significantly associated with higher risk for death in women. The AUCs of ROC for mortality prediction were 0.75 and 0.74 in men and women, respectively. The satisfaction survey revealed that the model helped patients to understand their disease status (89.13%) and motivated them to change their lifestyle (86.85%)?Conclusions:?Our research group has successfully established a mortality prediction model of diabetes patients. The model would assist physicians to make better clinical decision and motivate patients to modify their lifestyle. More precise estimation of health care outcome in diabetes patients would result in reduction of social healthcare expense.

S-430 Effect of dapagliflozin on metabolic parameters in patient with diabetes

( Joonyub Lee ),( Yeoree Yang ),( Borami Kang ),( Eunyoung Lee ),( Jae-hyoung Cho ) 대한내과학회 2016 대한내과학회 추계학술발표논문집 Vol.2016 No.1

Introduction: Sodium-glucose cotransporter-2 (SGLT2) inhibitor is a novel therapeutic strategy in patients with diabetes mellitus. Due to SGLT2 inhibitor’s novel glucose lowering mechanism and beneficial CV outcome, the proportion of diabetic patients using SGLT2 inhibitor is increasing. Dapagliflozin is one of the most commonly used SGLT2 inhibitor. The aim of our study is to measure a clinical effect of dapagliflozin in Korean patients. Method Subjects who visited Seoul St. Mary’s hospital from December 2014 to April 2015 and used dapagliflozin were enrolled in the study (n=194). Height, body weight, blood pressure FBS, PP2hr, HbA1c, total cholesterol, triglyceride, HDL, LDL, BUN, Cr., AST, ALT were measured. Patients who used dapagliflozin less than 3 months and those who failed visiting the clinic were excluded (n=56). A total of 138 patients were retrospectively analyzed. Paired Student’s t-test was performed to compare the data before and after (3 and 6 month) using dapagliflozin. Result Systolic/diastolic blood pressure, body weight, HbA1c level, fasting plasma glucose, 2 hour postprandial glucose, BUN decreased after using dapagliflozin for 3 months (p<0.05). Systolic/diastolic blood pressure, FBS remained decreased after 6 months usage of dapagliflozin (p<0.05). Most of the changes were made in early 3months. Conclusion Dapagliflozin is associated with early decrease of systolic/diastolic blood pressure, fasting plasma glucose, body weight. The use of dapagliflozin should be encouraged in Korean subjects with diabetes mellitus. Large number prospective multicenter double blind randomized control trial would solidify our data.

총담관에서 발생한 혈관육종 1예

이준엽 ( Joonyub Lee ),문윤권 ( Yoon Gwon Mun ),장상언 ( Sang Eon Jang ),김대중 ( Dae Jung Kim ),유영욱 ( Young Wook Yoo ),이종률 ( Jong Riul Lee ),전호욱 ( Howook Jeon ),음상훈 ( Sang Hoon Eum ) 대한췌담도학회 2016 대한췌담도학회지 Vol.21 No.2

혈관육종은 연부조직에서 기원하는 매우 드문 종양인데 간담도계에서 발생하는 혈관육종은 더욱 드물다. 혈관육종은 증상이 비특이적이고 진단도 어렵기 때문에 발견 당시 이미 병기가 진행된 경우가 많으며 예후도 나쁘다. 저자들은 우측 상복부 통증으로 내원하여 총담관 혈관육종으로 진단된 증례를 경험하였다. 총담관에서 기원한 혈관육종은 현재까지 보고된 바가 없기에 문헌고찰과 함께 보고하는 바이다. Angiosarcoma is a very rare form of neoplasm derived from soft tissue. It is reported even more rarely in hepatobiliary system. Because of its nonspecific symptoms and difficulty in diagnosis, angiosarcoma is often presented in a progressed state and often results in poor prognosis. To our best knowledge, there has been no report regarding angiosarcoma in common bile duct worldwide. We report a case of 77-year-old-woman presented with right upper abdominal pain diagnosed as angiosarcoma in common bile duct.

Effects of statin use on serum creatinine phosphokinase levels in normal thyroid function

Jeonghoon Ha,Joonyub Lee,Jin Yu,Hakyoung Park,Jiwon Shinn,Seung-Hwan Lee,Jae-Hyoung Cho,Hun-Sung Kim 대한내과학회 2024 The Korean Journal of Internal Medicine Vol.39 No.4

Background/Aims: Statins are common lipid-lowering agents used in dyslipidemia. However, they increase serum creatinine phosphokinase (CPK) levels. Currently, there are no studies on the effect of thyroid-stimulating hormone (TSH) levels on CPK levels after statin administration. Therefore, this study aimed to investigate CPK level alterations after statin administration according to TSH quartiles in participants with euthyroidism. Methods: This retrospective analysis included 25,047 patients with euthyroidism. CPK levels were measured before and 6 months after statin administration. Normal TSH levels were divided into four quartiles, and the CPK levels and proportions of patients with normal CPK levels after statin administration for each TSH quartile were evaluated. Results: The baseline CPK level was significantly higher in the lowest TSH quartile (Q1) compared to the other quartiles but decreased after statin administration. Thus, the difference between the CPK levels and the other quartile groups was not significant. The proportion of patients with normal CPK levels was also significantly lowest in Q1 before statin administration; however, no significant difference was noted in the ratio among each group after statin administration. These findings were consistent with the findings of the analysis according to statin intensity. Conclusions: In patients in the lowest TSH quartile of the normal TSH range, the CPK level decreased, and the proportion of normal CPK levels increased significantly after statin administration. However, similar changes were not observed in other TSH quartiles. Therefore, further studies are required to mechanistically confirm these conclusions.

Multiparity increases the risk of diabetes by impairing the proliferative capacity of pancreatic β cells

Moon Joon Ho,Lee Joonyub,Kim Kyun Hoo,Kim Hyun Jung,Kim Hyeongseok,Cha Hye-Na,Park Jungsun,Lee Hyeonkyu,Park So-young,Jang Hak Chul,Kim Hail 생화학분자생물학회 2023 Experimental and molecular medicine Vol.55 No.-

Pregnancy imposes a substantial metabolic burden on women, but little is known about whether or how multiple pregnancies increase the risk of maternal postpartum diabetes. In this study, we assessed the metabolic impact of multiple pregnancies in humans and in a rodent model. Mice that underwent multiple pregnancies had increased adiposity, but their glucose tolerance was initially improved compared to those of age-matched virgin mice. Later, however, insulin resistance developed over time, but insulin secretory function and compensatory pancreatic β cell proliferation were impaired in multiparous mice. The β cells of multiparous mice exhibited aging features, including telomere shortening and increased expression of Cdkn2a. Single-cell RNA-seq analysis revealed that the β cells of multiparous mice exhibited upregulation of stress-related pathways and downregulation of cellular respiration- and oxidative phosphorylation-related pathways. In humans, women who delivered more than three times were more obese, and their plasma glucose concentrations were elevated compared to women who had delivered three or fewer times, as assessed at 2 months postpartum. The disposition index, which is a measure of the insulin secretory function of β cells, decreased when women with higher parity gained body weight after delivery. Taken together, our findings indicate that multiple pregnancies induce cellular stress and aging features in β cells, which impair their proliferative capacity to compensate for insulin resistance.