Prevalence and Clinical Characteristics of Recently Diagnosed Type 2 Diabetes Patients with Positive Anti-Glutamic Acid Decarboxylase Antibody

황보율,김진택,김은기,강아람,오태정,장학철,박경수,김성연,이홍규,조영민 대한당뇨병학회 2012 Diabetes and Metabolism Journal Vol.36 No.2

Background: Latent autoimmune diabetes in adults (LADA) refers to a specific type of diabetes characterized by adult onset, presence of islet auto-antibodies, insulin independence at the time of diagnosis, and rapid decline in β-cell function. The prevalence of LADA among patients with type 2 diabetes varies from 2% to 20% according to the study population. Since most studies on the prevalence of LADA performed in Korea were conducted in patients who had been tested for anti-glutamic acid decarboxylase antibody (GADAb), a selection bias could not be excluded. In this study, we examined the prevalence and clinical characteristics of LADA among adult patients recently diagnosed with type 2 diabetes. Methods: We included 462 patients who were diagnosed with type 2 diabetes within 5 years from the time this study was performed. We measured GADAb, fasting insulin level, fasting C-peptide level, fasting plasma glucose level, HbA1c, and serum lipid profiles and collected data on clinical characteristics. Results: The prevalence of LADA was 4.3% (20/462) among adult patients with newly diagnosed type 2 diabetes. Compared with the GADAb-negative patients, the GADAb-positive patients had lower fasting C-peptide levels (1.2±0.8 ng/mL vs. 2.0±1.2 ng/mL, P=0.004). Other metabolic features were not significantly different between the two groups. Conclusion: The prevalence of LADA is 4.3% among Korean adult patients with recently diagnosed type 2 diabetes. The Korean LADA patients exhibited decreased insulin secretory capacity as reflected by lower C-peptide levels. Background: Latent autoimmune diabetes in adults (LADA) refers to a specific type of diabetes characterized by adult onset, presence of islet auto-antibodies, insulin independence at the time of diagnosis, and rapid decline in β-cell function. The prevalence of LADA among patients with type 2 diabetes varies from 2% to 20% according to the study population. Since most studies on the prevalence of LADA performed in Korea were conducted in patients who had been tested for anti-glutamic acid decarboxylase antibody (GADAb), a selection bias could not be excluded. In this study, we examined the prevalence and clinical characteristics of LADA among adult patients recently diagnosed with type 2 diabetes. Methods: We included 462 patients who were diagnosed with type 2 diabetes within 5 years from the time this study was performed. We measured GADAb, fasting insulin level, fasting C-peptide level, fasting plasma glucose level, HbA1c, and serum lipid profiles and collected data on clinical characteristics. Results: The prevalence of LADA was 4.3% (20/462) among adult patients with newly diagnosed type 2 diabetes. Compared with the GADAb-negative patients, the GADAb-positive patients had lower fasting C-peptide levels (1.2±0.8 ng/mL vs. 2.0±1.2 ng/mL, P=0.004). Other metabolic features were not significantly different between the two groups. Conclusion: The prevalence of LADA is 4.3% among Korean adult patients with recently diagnosed type 2 diabetes. The Korean LADA patients exhibited decreased insulin secretory capacity as reflected by lower C-peptide levels.

혈당 조절이 되지 않는 제2형 당뇨병환자에서 로지글리타존과 메트포르민 병합요법의 유효성

손태서,이지인,김인주,민경완,손현식 대한당뇨병학회 2008 Diabetes and Metabolism Journal Vol.32 No.6

Background: Obese type 2 diabetic subjects are recently increasing in Korea, indicating the importance of insulin resistance rather than insulin secretory defects in the pathophysioloy of type 2 diabetes. The purpose of this study is to evaluate the safety and efficacy of fixed dose rosiglitazone/metformin combination therapy in poorly controlled subjects with type 2 diabetes mellitus. Methods: 12 type 2 diabetic subjects who had a HbA1c > 11% or fasting plasma glucose > 15 mmol/L were included. After a 2 week screening period, the subjected took the fixed does rosiglitazone/metformin for 24 weeks. The treatment with rosiglitazone/metformin began at week 0 with an initial dose of 4 mg/1000 mg and, unless tolerability issues arose, subjects would be increased to 6 mg/1500 mg at week 4 and at week 8 to the maximum dose of 8 mg/2000 mg. The primary object of this study was to characterize the magnitude of HbA1c reduction from baseline after 24 weeks of rosiglitazone and metformin treatment in poorly controlled type 2 diabetics. Results: The mean age of the subjects was 48.9 ± 10.6 years old, body mass index was 25.0 ± 3.5 kg/m2, HbA1c was 12.0 ± 1.0%, and fasting plasma glucose was 16.3 ± 3.1 mmol/L. HbA1c was reduced to 7.54 ± 1.45% and fasting plasma glucose reduced to 7.96 ± 2.38 mmol/L at week 24. The proportion of HbA1c responder who showed the reduction from baseline of ≥ 0.7% or HbA1c < 7% was 11 among 12 subjects (91.7%). 41% of the subjects (5 among 12 subjects) achieved HbA1c level < 7.0% and 75% (9 among 12 subjects) achieved HbA1c level < 8.0%. Conclusions: In this study, rosiglitazone and metformin combination therapy was effective in glycemic control in poorly controlled subjects with type 2 diabetes mellitus. (KOREAN DIABETES J 32:506-512, 2008) Background: Obese type 2 diabetic subjects are recently increasing in Korea, indicating the importance of insulin resistance rather than insulin secretory defects in the pathophysioloy of type 2 diabetes. The purpose of this study is to evaluate the safety and efficacy of fixed dose rosiglitazone/metformin combination therapy in poorly controlled subjects with type 2 diabetes mellitus. Methods: 12 type 2 diabetic subjects who had a HbA1c > 11% or fasting plasma glucose > 15 mmol/L were included. After a 2 week screening period, the subjected took the fixed does rosiglitazone/metformin for 24 weeks. The treatment with rosiglitazone/metformin began at week 0 with an initial dose of 4 mg/1000 mg and, unless tolerability issues arose, subjects would be increased to 6 mg/1500 mg at week 4 and at week 8 to the maximum dose of 8 mg/2000 mg. The primary object of this study was to characterize the magnitude of HbA1c reduction from baseline after 24 weeks of rosiglitazone and metformin treatment in poorly controlled type 2 diabetics. Results: The mean age of the subjects was 48.9 ± 10.6 years old, body mass index was 25.0 ± 3.5 kg/m2, HbA1c was 12.0 ± 1.0%, and fasting plasma glucose was 16.3 ± 3.1 mmol/L. HbA1c was reduced to 7.54 ± 1.45% and fasting plasma glucose reduced to 7.96 ± 2.38 mmol/L at week 24. The proportion of HbA1c responder who showed the reduction from baseline of ≥ 0.7% or HbA1c < 7% was 11 among 12 subjects (91.7%). 41% of the subjects (5 among 12 subjects) achieved HbA1c level < 7.0% and 75% (9 among 12 subjects) achieved HbA1c level < 8.0%. Conclusions: In this study, rosiglitazone and metformin combination therapy was effective in glycemic control in poorly controlled subjects with type 2 diabetes mellitus. (KOREAN DIABETES J 32:506-512, 2008)

소아발병과 성인발병 제1형 당뇨병 환자의 체액성 면역표지자

윤현대,김재홍,오정현,박진철,남상엽,윤지성,원규장,이충기,조인호,박중열,홍성관,이기업,이형우 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.24 No.4

연구배경:제1형 당뇨병의 진단 및 예측에 사용되고 있는 자가항체로서는 ICA, GADA 및 IA2 항체 등이 있다. 이러한 자가항체의 양성률은 서양인 제1형 당뇨병환자에 비해 한국인이나 동양인 제1형 당뇨병환자에서 낮은 유병률이 보고되고 있다. 제1형 당뇨병은 발병연령에 따라 그 경과가 다르게 나타날 수 있으며, 특히 성인 발병 제1형 당뇨병의 경우는 전형적인 소아 발병 제1형 당뇨병의 경우에 비해 발병시 임상적 및 자가면역적 차이도 명확하게 규명되어 있지 않다. 제1형 당뇨병 환자를 소아발병과 성인발병으로 나누어 각 환자군에 대한 임상적 지표 및 자가항체의 빈도의 차이를 관찰하여 한국인 제1형 당뇨병 환자들의 소아 및 성인발병 형태의 차이 와 각각 병인에 자가면역이 관련하는지를 알아보기 위해 본 연구를 시행하였다. 방법:소아발병 제1형 당뇨병환자 32명과 성인발병 제1형 당뇨병 환자 40명을 연구 대상으로 하였고, 이들을 다시 전형적인 제1형 당뇨병 39명과 비전형적인 제1형 당뇨병33명으로 분류하였다. ICA는 간접 면역 형광법을 사용하여 측정하였고, GAD 항체과 IA2 항체는 방사성면역측정법을 이용하여 측정하였다. 결과:소아발병 제1형 당뇨병 환자군과 성인발병 제1형 당뇨병 환자군의 평균연령은 각각15±3세, 47±14세 이었으며, 평균 발병 연령은 각각 11±2세, 39±12세이었다. 체질량지수는 소아발병 제1형 당뇨병 환자군에서는 19.1±2.2㎏/㎡, 성인발병 제1형 당뇨병 환자군에서는 21.4±3.2㎏/㎡이었으며, 공복시 혈장 C­펩타이드는 소아발병 제1형 당뇨병 환자군은 0.18±0.19nmol/L이었고, 성인발병 제1형 당뇨병 환자군은 0.23±0.19nmol/L이었으나 유의한 차이는 없었다. 소아발병 제1형 당뇨병 환자 32명의 ICA, GAD항체 및 IA2 항체의 빈도는 각각 50%(16/32), 38%(12/32), 31%(4/13)이었다. 성인발병 제1형 당뇨병 환자 40명의 ICA, GAD항체 및 IA2 항체의 빈도는 각각 30%(12/40)25%(10/40)18%(7/40)로 세 항체 모두 소아발병 제1형 당뇨병 환자군보다 낮았으나 두군간의 유의한 차이는 없었다. 소아발병 제1형 당뇨병 환자군의 경우 각각의 작가 항체들이 양성인 경우와 음성인 경우로 나누었을 때, 각 환자군의 임상적 특징을 연령, 병의 이환기간, 체질량지수, 공복시 혈장 C­펩타이드에 따라 비교하여 보면, 연령에 따른 GAD 항체와 IA2 항체가 유의한 차이를 보였다(p<0.05)성인 발병 제1형 당뇨병 환자군의 경우 각각의 자가 항체들이 양성인 경우와 음성인 경우로 나누었을때, 각 환자군의 임상적 특징을 연령, 병의 이환기간, 체질량지수, 공복시 혈장 C­펩타이드에 따라 비교하여 보면, 연령에 따른 ICA, 체질량지수에 따른 ICA, 공복시 혈중 C­펩타이드에 따른 GAD 항체와 IA2 항체가 유의한 차이를 보였다(P<0.05). 결론:한국인 소아 발병 제1형 당뇨병 환자의 자가항체 빈도는 성인 발병형보다는 높았으며, 중국인과는 유사하게, 서양인에 비해서는 낮게 나타났다. 결론적으로, 한국인 소아 및 성인 발병 제1형 당뇨병 환자의 병인에는 자가면역 기전이 중요한 역할을 하나 자가 면역을 제외한 다른 인자들도 중요한 역할을 할 것으로 생각된다. Background : Type 1 diabetes melitus is autoimmune disease in which serum antibodies against islet antigens have been recognized. These antibodies include cytoplasmic islet cell antibodies (ICA), and glutamic acid decarboxylase (GAD) 65 antibodies and IA 2 antibodies. It has been reported that the prevalence of these autoantibodies is different among Caucacian and Asian and Korean type 1 diabetes patients. And the natural course of type 1 diabetes can differ according to the age of onset. But, in contrast to the classic juvenile onset type 1 diabetes, the adult onset type 1 diabetes is poorly characterized about clinical and autoimmune differences at presentation. Thus, this study was perfomed to evaluate clinical and autoimmune characteristics at presentation in subjects with either child onset or adult onset type 1 diabetes and to establish an autoimmune pathogenesis in Korean type 1 diabetes. Method : We examined the clinical characteristics of child onset type 1 diabetes (n=32) and adult onset type 1 diabetes (n=40) retrospectively. At the same time, ICA from these patients was measured by standard indirect immunofluorescence, GADA and IA2A fro these patients were measured by radio immunoassay. Results : The mean duration of disease was longer in the adult onset and their serumfasting C-peptide concentration at diagnosis were higer. The prevalence of ICA, GADA, IA2A in sera from 32 patients with child onset type 1 diabetes was 50%, 38% and 31% respectively. And, the prevalence of ICA, GADA and IA2A in sera from 40 patients with adult onset type 1 diabetes was 30%, 25% and 18% respectively. The prevalence of ICA, GADA and IA2A in sera from 39 patients with typicaltype 1 diabetes was 46%, 30% and 16% respectively. And, the prevalence of ICA, GADA and IA2A in sera from 33 patients with a typicaltype 1 diabetes was 30%, 30% and 25% respectively. The concordance rate of ICA and GADA in child onset and adult onset diabetes was 81% (26/32), 80% (32/40) respectively. In a subset of these patients with recent onset type 1 diabetes (duration of diabetes ≤ 1 year), the prevalence of ICA, GADA and IA2A was 75% (3/4), 75% (3/4), 100% (1/1) respectively, in the child onset type 1 diabetes. Conclusion : These observations show that autoantibodies in Korean patients with child onset type 1 diabetes is similar compaired with other Asian groups but is lower than Caucasian patients with type 1 diabetes and the prevalence of humoral immunologic markers in child onset type 1 diabetes was higher than that of adult onset diabetes. These results suggest that autoimmune response is a significant cause of Korean type 1 diabetes but other factors except autoimmunity may play an important role in the pathogenesis of Korean type 1 diabetes (J Kor Diabetes Asso 444~456, 2000)

제2형 당뇨병 환자에서 고혈압 유무에 따른 경동맥 죽상경화증 및 죽상경화증 위험인자들의 비교

박병현,정진원,조정구 대한당뇨병학회 2000 임상당뇨병 Vol.1 No.1

Background: Atherosclerosis is importantly associated with cardiovascular morbidity and mortality in type 2 diabetes mellitus. It has been reported that intima-media thickness (IMT) of common carotid artery (CCA) measured by ultrasound B-mode scan is capable of quantitatively evaluating atherosclerotic changes in a safe and reproducible way. However, little information currently exists on the difference of carotid atherosclerosis and atherosclerotic risk factor between type 2 diabetes with hypertension and type 2 diabetes without hypertension. Thus, current study was undertaken to investigate the association between hypertension and IMT of CCA, measured by ultrasound B-mode scan, in type 2 diabetes and to find the difference of atherosclerotic risk factors and the prevalence of macrovascular complication between type 2 diabetes with hypertension and type 2 diabetes without hypertension. Method: High resolution B-mode ultrasonography was peformed in 21 type 2 diabetes without hypertension and 20 type 2 diabetes with hypertension to determine the correlation between hypertension and degree of carotid artery atherosclerosis by measurement of common carotid intima-media thickness (IMT) and carotid atherosclerotic plaques. Concurrently serum total cholesterol, HDL cholesterol, LDL cholesterol, triglyceride, lipoprotein (a), HbA_(1c), C-peptide levels and body mass index(BMI) were measured and history of hypertension, smoking and duration of diabetes were investigated. Presence of macrovcscular complications such as cerebral infraction, angina pectoris, myocardia infration and peripheral artery occlusion were examined by medical recording during the last 6 months. Results: 1) Common carotid artery IMT values for type 2 diabetes with hypertension (1.O1 0.25㎜,n=20) were significantly greater than type 2 diabetes without hypertension (0.85±0.25㎜, n=21). But, weak correlation was existed between hypertension and common carotid IMT (r=O.31, p=0.047). 2)Presence of carotid artery atherosclerotic plaque was more common in hypertensive diabetes than normotensive diabetes (18/20:90% vs 18/21: 52.4%, p=0.007). 3) Most common involving site of atherosclerotic plaque was carotid bulb and it was not different between two groups. 4) Macrovascular complication was more common in hypertensive diabetes group than normotensive diabetes group(11/20; 55% vs 5/21: 24%, p=0.042). 5) Serum triglyceride level for hypertensive type 2 diabetes group were significantly greater than normotensive type 2 diabetes group (2.31±1.60 mmol/L, vs 1.48 0.76mmol/L; p=0.039). 6) Age, sex, duration of diabetes, smoking. BMI, HbAlc, C-peptide, total cholesterol, HDL cholesterol, LDL cholesterol, and lipoprotein(a) were not different in two groups. Conclusion: There was week correlation between hypertension and carotid intima-media thickness in type 2 diabetes. Type 2 diabetes with hypertension were greater carotid IMT, more presence and extent of atherosclerotic plaque, higher level of serum triglyceride, and higher macrovascular complication than type 2 diabetes without hypertension. 연구배경: 죽상경화증은 제2형 당뇨병 환자의 심혈관 질환 유병률과 사망률에 중요한 영향을 미친다. 고해상도 B-mode 초음파를 이용한 경동맥 내중막두께 측정은 죽상경화증의 초기변화를 관찰하는데 도움되는 것으로 알려져 있다. 최근 제2형 당뇨병 환자에서 경동맥 내중막두께 측정과 이와 연관된 죽상경화증 위험인자에 대해 보고되고 있으나 고혈압 동반에 따른 차이에 대해서는 잘 알려져 있지 않다. 본 연구에서는 제2형 당뇨병 환자들을 대상으로 고혈압 동반군과 정상 혈압군으로 구분하여 고해상도 B-mode 초음파를 이용 경동맥 내중막 두께를 측정하고 죽상경화반을 관찰하였으며, 고혈압 동반 여부에 따른 경동맥 내중막두께의 변화, 죽상경화반 유무, 죽상경화증 위험요소의 차이 및 대혈관 합병증 발생률을 조사하였다. 방법: 고혈압이 동반된 제2형 당뇨병 환자20명, 정상혈압의 제2형 당뇨병환자 21명물 대상으로 고해상도 B-mode 초음파를 이용하여 경동맥 내중막두께를 측정하고 죽상경화반의유무, 석회화 유무, 죽상경화반 위치 및 수를 관찰하였으며, 동시에 혈장내 총콜레스테롤, 중성지방, HDL 콜레스테롤, LDL 콜레스테롤, lipoprotein(a), 당화혈색소, 체질량지수, 당뇨병의 유병기간, 흡연력, 대혈관 합병증 등을 조사하여 두 군간에 비교 분석하였다. 결과: 1) 고혈압 동반군 (1.01 ±0.25㎜)에서 정상 혈압군(0.85±0.25㎜)에 비하여 경동맥 내중막두께가 증가되어 있었으며 고혈압과 경동맥 내중막두께는 약한 상관관계를 보였다(r=0.31, p=O.049). 2) 경동맥 죽상경화반은 정상 혈압군이 11/21명 (52.4%), 고혈압 동반군이 18/2O명 (90%)으로 의미 있는 차이를 보였으나 (p=0.007), 죽상경화반의 석회화는 의미 있는 차이는 없었다. 또한 총경동맥과 내,외경동맥에서 50%이상의 혈관 내경 협착 유무를 관찰하였으나 두 군에서의 차이는 없었다(1/21명 vs 3/20명). 3)경동맥 죽상경화반의 발생 장소는 두 군에서 경동맥이 분지 하는 지점인 구부가 가장 많았다. 4) 대혈관 합병증의 발생은 정상 혈압군 보다 고혈압 동반군에서 유의하게 높았다(5/21명:24 % vs 11/20명: 55 %; p=0.042). 5) 고혈압 동반군에서 정상 혈압군에 비해 혈중 지질 성분 중 중성지방이 높았다(2.31±1.60mmol, vs 1.48 ±0.76 mmol/L; p=0.039). 6) 그외 나이, 성별, 당뇨병의 유병기간, 당화혈색소, 총콜레스테롤, LDL 콜레스레롤, HDL 콜레스테롤, lipoprotein(a), C-peptide, 흡연, 체질량지수 등은 두 군에서 차이가 없었다. 결론: 당뇨병 환자에서 고혈압은 경동맥 내중막두께와 약한 상관관계를 보였으며, 고혈압을 동반한 당뇨군에서 정상혈압 당뇨군에 비하여 두꺼운 경동맥 내중막두께, 죽상경화반의 존재 증가, 높은 중성지방 및 대혈관 합병증의 증가를 볼 수 있었다.

Demographic and diagnostic markers in new onset pediatric type 1 and type 2 diabetes: differences and overlaps

Nieto Teresa,Castillo Beatriz,Nieto Jacobo,Redondo Maria J. 대한소아내분비학회 2022 Apem Vol.27 No.2

but the frequency of type 2 diabetes (T2D) is increasing rapidly. Classification of diabetes is based on a constellation of features that vary by type. We aimed to compare demographic, clinical, and laboratory characteristics at diagnosis of pediatric T1D and T2D. Methods: We studied children who visited a large academic hospital in Houston, Texas (USA) with a new diagnosis of T2D (n=753) or T1D (n=758). We compared age, sex, race/ethnicity, presence of obesity, glucose, hemoglobin A1c, islet autoantibody positivity, C-peptide, and presence of diabetic ketoacidosis (DKA) at diabetes diagnosis. Results: At diagnosis, children with T2D, compared with those with T1D, were older (13.6 years vs. 9.7 years), more likely female (63.2% vs. 47.8%), of racial/ethnic minority (91.1% vs. 42.3%), and obese (90.9% vs. 19.4%) and were less likely to have DKA (7.8% vs. 35.0%) and diabetes autoantibodies (5.5% vs. 95.4%). Children with T2D also had significantly lower glucose, lower hemoglobin A1c and lower C-peptide level (all comparisons, P<0.0001). In multiple logistic regression analysis, older age, racial/ethnic minority, obesity, higher C-peptide, and negative islet autoantibodies were independently associated with T2D (all, P<0.05), while sex, glucose, hemoglobin A1c, and DKA were not (model P<0.0001). Conclusion: There are important demographic, clinical, and laboratory differences between T1D and T2D in children. However, none of the characteristics were unique to either Purpose: Type 1 diabetes (T1D) is the most common type of diabetes in children, but the frequency of type 2 diabetes (T2D) is increasing rapidly. Classification of diabetes is based on a constellation of features that vary by type. We aimed to compare demographic, clinical, and laboratory characteristics at diagnosis of pediatric T1D and T2D.Methods: We studied children who visited a large academic hospital in Houston, Texas (USA) with a new diagnosis of T2D (n=753) or T1D (n=758). We compared age, sex, race/ethnicity, presence of obesity, glucose, hemoglobin A1c, islet autoantibody positivity, C-peptide, and presence of diabetic ketoacidosis (DKA) at diabetes diagnosis.Results: At diagnosis, children with T2D, compared with those with T1D, were older (13.6 years vs. 9.7 years), more likely female (63.2% vs. 47.8%), of racial/ethnic minority (91.1% vs. 42.3%), and obese (90.9% vs. 19.4%) and were less likely to have DKA (7.8% vs. 35.0%) and diabetes autoantibodies (5.5% vs. 95.4%). Children with T2D also had significantly lower glucose, lower hemoglobin A1c and lower C-peptide level (all comparisons, p<0.0001). In multiple logistic regression analysis, older age, racial/ethnic minority, obesity, higher C-peptide, and negative islet autoantibodies were independently associated with T2D (all, p<0.05), while sex, glucose, hemoglobin A1c, and DKA were not (model p<0.0001).Conclusion: There are important demographic, clinical, and laboratory differences between T1D and T2D in children. However, none of the characteristics were unique to either diabetes type, which poses challenges to diabetes classification at diagnosis.

Osteoporosis and Fracture among Patients with Type 1 and Type 2 Diabetes

홍서유,박은주 대한골다공증학회 2010 Osteoporosis and Sarcopenia Vol.8 No.1

Diabetes mellitus is a major risk factor for osteoporotic fractures. The occurrence of Osteoporosis among patients who have diabetes mellitus further increases both economically and physically their burden of disease. Nevertheless, osteoporotic screening or prophylactic treatment for all patients with type 1 and type 2 diabetes mellitus is not being recommended at present. The reason is that neither the relationship between diabetes and osteoporosis and nor differences between type 1 and type 2 diabetes mellitus are clear. At present, while low bone mineral density (BMD) is consistently observed in type 1 diabetes mellitus, the relationship is less clear for type 2 diabetes mellitus, with some studies reporting modestly increased or an unchanged BMD. Both type 1 and type 2 diabetes mellitus have been associated with a higher risk of fractures. The presence of micro- and macro-vascular diabetic complications as a result of long standing poor glycemic control, rather than long duration predict low BMD in patients with type 1 diabetes mellitus. In type 2 diabetes mellitus patients, obesity protects bone loss and increases BMD. Nevertheless, hypoglycemic episodes under insulin therapy with commonly established risk factors of falls such as advanced age, impaired balance, a history of coronary heart disease or arthritis and peripheral neuropathy may have contributed to the increased risk for falls and result in fractures. We suggest that osteoporosis screening and prophylactic treatment for all patients with type 1 and 2 diabetes mellitus needs to be recommended along with considerations of each individual’s risk profile for osteoporotic fractures.

소아연령에서의 2형 당뇨병의 임상적 고찰

박지민,유은경,김덕희,Park, Jee Min,Yoo, Eun Gyong,Kim, Duk Hee 대한소아청소년과학회 2002 Clinical and Experimental Pediatrics (CEP) Vol.45 No.5

목 적 : 최근에 비만증의 증가와 함께 소아에서 2형 당뇨병의 발생 빈도가 증가하는 경향이 있어 우리나라 소아 연령에서 2형 당뇨병의 발생빈도 및 그 특성을 규명하고자 본 연구를 시행하였으며 자궁내 성장지연과의 관계도 분석하였다. 방 법 : 1990년 3월에서 2000년 12월까지 연세의료원 소아과에서 2형 당뇨병으로 진단받은 소아 25명을 대상으로 분석하였다. 결 과 : 소아에서 1형 당뇨병과 2형 당뇨병은 1990년 이후에 모두 증가하였으며 소아에서 발병한 당뇨병 중 2형이 차지하는 비율은 연도별로 볼 때 1990년에 5.3%(1/19)였던 것이 2000년에 21.0%(8/38)로 급격히 증가하였다. 총 25명 중 비만군이 68%(17/25)였고 비비만군이 32%(8/25)였다. 진단 당시의 주증상은 다음, 다뇨, 다식 증상이 48%(12/25), 학교 신체 검사에서 무증상 당뇨로 발견된 경우가 40%(10/25)였고 그외 체중 감소, 비만으로 우연히 발견된 경우였다. 진단당시 평균 연령은 $12.9{\pm}1.8$세였다. 25명 중 64%(16/25)에서 당뇨병의 가족력이 있었다. 자가항체 검사는 18.1%(4/22)에서 양성이었다. 총 7례에서 동반 질환이 있었으며 비만과 관련하여 지방간 등이 있었다. 치료는 모두 진단 후 경구용 혈당 강하제를 사용하였고 혈당 조절이 잘 되지 않았던 3명에서 인슐린을 추가하였다. 장기 합병증은 4명에서 발생하였다. 자궁내 성장지연은 9명에서 있었고 이들 중 8명은 비 비만군 당뇨병이었다. 결 론 : 최근 비만증과 관련되어 소아에서 2형 당뇨병이 증가하는 추세이고 비비만군 당뇨병 환아에서는 자궁내 성장 지연이 상관관계가 있으리라고 생각되며 소아에서 2형 당뇨병은 국가적인 차원에서 예방 및 치료책이 제시되어야 할 것이다. Purpose : The incidence of type 2 diabetes mellitus in children has been increasing worldwide recently, which is thought to be related to the increasing prevalence of obesity. We investigated to evaluate the incidence and the characteristics of type 2 diabetes mellitus in children and also analysed the relationship between intrauterine growth retardation and type 2 diabetes mellitus. Methods : We investigated 25 children diagnosed as type 2 diabetes mellitus between March 1990 and December 2000. The analysis was performed retrospectively with medical records based on the clinical characteristics and laborotory findings. Results : Incidence of type 1 and type 2 diabetes mellitus in children has been increasing since 1990. We demonstrated an increase in the percentage of type 2 diabetes mellitus children from 5.3% in 1990 to 21.0% in 2000. Sixty eight percent of patients(17/25) were classified as obese group. Initial symptoms at first visit were polyuria, polydipsia and polyphagia 48%(12/25), asymptomatic glycosuria 40% (10/25), weight loss 8%(2/25) and obesity 4%(1/25). The mean age at diagnosis was $12.9{\pm}1.8$ years. 64%(16/25) of patients had positive family history of type 2 diabetes mellitus. Autoanti-bodies were positive in 18.1%(4/22) of patients. Twenty eight percent (7/25) of patients had an associated disease and two patients had fatty liver in association with obesity. Treatment consisted of diet, exercise, education and oral hypoglycemic agents. Three patients were treated with insulin as well as oral hypoglycemic agents because of poor blood glucose control. Long-term diabetic complications occurred in 4 patients. Intrauterine growth retardtion was found in 34.6%(9/25); 88.9% (8/9) of these patients were non-obese group. Conclusion : The increase in the incidence of type 2 diabetes mellitus in children is thought to be related to the increasing prevalence of obesity. The non-obese group of patients might be associated with intrauterine growth retardation.

2형 당뇨병 환자에서 불면증과 우울 증상의 관련성

이진환,전진숙,최영식,김호찬,오병훈 한국정신신체의학회 2019 정신신체의학 Vol.27 No.1

Objectives:Many of the patients with type 2 diabetes are associated with sleep problems, and the rate of insomnia is known to be higher in the general population. The aims of this study were to know the frequency and clnical characteristics of insomnia, and related variables to insomnia in patients diagnosed with type 2 diabetes. Methods:For 99 patients from 18 to 80 years of age (65 males and 34 females) with type 2 diabetes, interviews were performed. Total sleep time and sleep latency was evaluated. Insomnia was evaluated using the Korean Version of the Insomnia Severity Index (ISI-K). Severity of depressive symptoms were evaluted using the Korean version of the Hamilton Depression Scale (K-HDRM). According to the cutoff score of 15.5 on the ISI-K, subjects were divided into the group of type 2 diabetics with insomnia (N=34) and those without insomnia (N= 65) at first, and then statistically analyzed. Results:TInsomnia could be found in 34.34% of type 2 diabetics. Type 2 diabetics with insomnia had significantly more single or divorced (respectively 11.8%, p<0.05), higher total scores of the K-HDRS (11.76±5.52, p< 0.001), shorter total sleep time (5.35±2.00 hours, p<0.001), and longer sleep latency (50.29±33.80 minutes, p< 0.001). The all item scores of the ISI-K in type 2 diabetics with insomnia were significantly higher than those in type 2 diabetics without insomnia, that is, total (18.38±2.69), A1 (Initial insomnia) (2.97±0.76), A2 (Middle insomnia) (3.06±0.69), A3 (Terminal insomnia) (2.76±0.61), B (Satisfaction) (3.18±0.72), C (Interference) (2.09±0.97), D (Noticeability) (2.12±1.09) and E (Distress) (2.21±0.81) (respectively p<0.001). Variables associated with insomnia in type 2 diabetics were as following. Age had significant negative correlation with A3 items of the ISI-K (β=-0.241, p<0.05). Total scores of the K-HDRS had significant positive correlation, while total sleep time had significant negative correlation with all items of the ISI-K (respectively p<0.05). Sleep latency had significant positive correlation with total,, A1, B and E item scores of the ISI-K (respectively p<0.05). Conclusions:Insomnia was found in about 1/3 of type 2 diabetics. According to the presence of insomnia, clinical characteristics including sleep quality as well as quantity seemed to be different. Because depression seemed to be correlated with insomnia, clinicians should pay attention to early detection and intervention of depression among type 2 diabetics. 연구목적: 2형 당뇨병을 지닌 환자의 다수에서 수면문제가 동반되며, 이들에서 불면증의 비율은 일반 인구에 비해서높다고 알려져 있다. 본 연구의 목적은 2형 당뇨병 환자에서 불면증의 발생빈도, 불면증의 임상적 특징 및 이에 연관되는 변인을 알아보기 위함이다. 방법: 2형 당뇨병으로 진단받은 18세에서 80세 이하의 99명(남자 65명, 여자 34명)을 대상으로 연구자 1인(제1저자)가 면담을 시행하였다. 면담으로 수면 잠복기, 총 수면시간을 조사하였고, 한국판 불면증 심각도 지수(Korean Version of Insomnia Severity Index, ISI-K) 평가하고, 우울증상의 심각도는 한국판 Hamilton 우울증평가 척도(Korean Version of the Hamilton Depression Rating Scale, K-HDRS)로 평가하였다. ISI-K의 절취점 15.5점을 기준으로 불면증 있는 군(N=34명)과 불면증 없는 군(N=65)으로 양분하여 불면증군과 대조군의여러 변인과의 연관성을 상관분석하고 다중 로지스틱 회귀분석을 사용하여 검토하여 다음의 결과를 얻었다. 결과: 2형 당뇨병 환자의 34.34%(N=34)에서 불면증이 있었다. 불면증이 있는 2형 당뇨병 환자군은 불면증이 없는2형 당뇨병 환자군보다 유의하게 미혼(11.8%)이나 이혼(11.8%)이많았고(p<0.05), K-HDRS 총점(11.76±5.52 점)이 높았으며(p<0.001), 총수면시간(5.35±2.00시간)이 짧았고(p<0.001), 수면잠복기(50.29±33.80분)가 길었다(p<0.001). 불면증이 있는 2형 당뇨병 환자군은 불면증이 없는 2형 당뇨병 환자군보다 ISI-K 검사상 합계(18.38±2.69점), A1 (입면)(2.97±0.76점), A2 (수면유지)(3.06±0.69점), A3 (일찍 깸)(2.76±0.61점), B (수면만족도)(3.18±0.72점), C (수면장애로 인한 기능방해)(2.09±0.97점), D (남이 알아차림)(2.12±1.09점), E (수면장애에 대한 걱정)(2.21±0.81점) 등 모든 항목의 점수가 유의하게 높았다(각각 p<0.001). 2형 당뇨병 환자에서 불면증에 영향을 미치는 요인들은 다음과 같다. 나이는 ISI-K A3 항목과 유의한 역상관관계가 있었고(β= -0.241, p<0.05), K-HDRS 총점은 ISI-K 모든 항목과 유의한 순상관관계가 있었으며(각각 p<0.05), 총수면시간은 ISI-K 모든 항목과 유의한 역상관관계가 있었다(각각 p<0.05). 수면잠복기는 ISI-K 합계, A1, B, E 항목과 유의한 순상관관계가 있었다(각각 p<0.05). 결 론: 2형 당뇨병 환자의 약 1/3에서 불면증이 존재하며, 불면증이 없는 2형 당뇨병 환자군과 수면의 양적 및 질적차이가 있음을 시사한다. 우울증상의 심각도는 2형 당뇨병 환자의 불면증과 상관관계가 있으므로 우울증의 조기 발견과 치료가 요구된다.

Maternal and Neonatal Outcomes in Korean Women with Type 1 and Type 2 Diabetes

김희숙,장혜정,박정은,김문영,고선영,김성훈 대한당뇨병학회 2015 Diabetes and Metabolism Journal Vol.39 No.4

Background: The purpose of this study was to evaluate maternal and neonatal outcomes in Korean women with type 1 diabetes and type 2 diabetes. Methods: We performed a retrospective survey of 163 pregnancies in women with type 1 diabetes (n=13) and type 2 diabetes (n=150) treated from 2003 to 2010 at Cheil General Hospital & Women’s Healthcare Center, Korea. We compared maternal characteristics as well as maternal and neonatal outcomes between groups. Results: Differences in glycosylated hemoglobin between type 1 and type 2 diabetes were not significant. Birth weight (3,501±689.6 g vs. 3,366±531.4 g) and rate of major congenital malformations (7.7% vs. 5.6%) were not significantly different. However, women with type 1 diabetes had higher rates of preeclampsia (38.5% vs. 8.2%, P=0.006), large for gestational age (LGA; 46.2% vs. 20.4%, P=0.004), macrosomia (38.5% vs. 13.4%, P=0.032), and admission for neonatal care (41.7% vs. 14.8%, P=0.03) than women with type 2 diabetes. Conclusion: Maternal and neonatal outcomes for women with type 1 diabetes were poorer than for women with type 2 diabetes, especially preeclampsia, LGA, macrosomia and admission to the neonatal intensive care unit.

Comparison of Insulin-Treated Patients with Ambiguous Diabetes Type with Definite Type 1 and Type 2 Diabetes Mellitus Subjects: A Clinical Perspective

Insa Laspe,Juris J. Meier,Michael A. Nauck 대한당뇨병학회 2023 Diabetes and Metabolism Journal Vol.47 No.1

In clinical practice, the distinction between type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) can be challenging, leaving patients with “ambiguous” diabetes type. Insulin-treated patients (n=115) previously diagnosed with T2DM had to be re-classified based on clinical phenotype and laboratory results, and were operationally defined as having an ambiguous diabetes type. They were compared against patients with definite T1DM and T2DM regarding 12 clinical and laboratory features typically different between diabetes types. Characteristics of patients with ambiguous diabetes type, representing approximately 6% of all patients with T1DM or T2DM seen at our specialized clinic, fell in between those of patients with definite T1DM and T2DM, both regarding individual features and with respect to a novel classification based on multi-variable regression analysis (<i>P</i><0.0001). In conclusion, a substantial proportion of diabetes patients in a tertiary care centre presented with an “ambiguous” diabetes type. Their clinical characteristics fall in between those of definite T1DM or T2DM patients.