Effects of a 6-Month Exenatide Therapy on HbA1c and Weight in Korean Patients with Type 2 Diabetes: A Retrospective Cohort Study

신주영,장진선,김헌성,고선희,차봉연,손호영,윤건호,조재형 대한당뇨병학회 2012 Diabetes and Metabolism Journal Vol.36 No.5

Background: While many studies have shown the good efficacy and safety of exenatide in patients with diabetes, limited information is available about exenatide in clinical practice in Korean populations. Therefore, this retrospective cohort study was designed to analyze the effects of exenatide on blood glucose level and body weight in Korean patients with type 2 diabetes mellitus. Methods: We reviewed the records of the patients with diabetes who visited Seoul St. Mary’s Hospital and for whom exenatide was prescribed from June 2009 to October 2011. After excluding subjects based on their race/ethnicity, medical history, whether or not they changed more than 2 kinds of oral hypoglycemic agents with exenatide treatment, loss to follow-up, or whether they stopped exenatide therapy within 6 months, a total of 52 subjects were included in the final analysis. Results: The mean glycated hemoglobin (HbA1c) level and weight remarkably decreased from 8.5±1.7% to 6.7±1.0% (P<0.001) and from 82.3±15.8 kg to 78.6±16.3 kg (P<0.001), respectively. The multiple regression analysis indicated that the reduction in HbA1c level was significantly associated with a shorter duration of diabetes, a higher baseline HbA1c level, and greater weight reduction, whereas weight loss had no significant correlation with other factors. No severe adverse events were observed. Conclusion: These results suggest that a 6-month exenatide injection therapy significantly improved patients’ HbA1c levels and body weights without causing serious adverse effects in Korean patients with type 2 diabetes. Background: While many studies have shown the good efficacy and safety of exenatide in patients with diabetes, limited information is available about exenatide in clinical practice in Korean populations. Therefore, this retrospective cohort study was designed to analyze the effects of exenatide on blood glucose level and body weight in Korean patients with type 2 diabetes mellitus. Methods: We reviewed the records of the patients with diabetes who visited Seoul St. Mary’s Hospital and for whom exenatide was prescribed from June 2009 to October 2011. After excluding subjects based on their race/ethnicity, medical history, whether or not they changed more than 2 kinds of oral hypoglycemic agents with exenatide treatment, loss to follow-up, or whether they stopped exenatide therapy within 6 months, a total of 52 subjects were included in the final analysis. Results: The mean glycated hemoglobin (HbA1c) level and weight remarkably decreased from 8.5±1.7% to 6.7±1.0% (P<0.001) and from 82.3±15.8 kg to 78.6±16.3 kg (P<0.001), respectively. The multiple regression analysis indicated that the reduction in HbA1c level was significantly associated with a shorter duration of diabetes, a higher baseline HbA1c level, and greater weight reduction, whereas weight loss had no significant correlation with other factors. No severe adverse events were observed. Conclusion: These results suggest that a 6-month exenatide injection therapy significantly improved patients’ HbA1c levels and body weights without causing serious adverse effects in Korean patients with type 2 diabetes.

아랍에미레이트연합의 당뇨병 환자에서 당뇨병성 망막증과 망막부종에 대한 검진율 및 치료비용

이승미,장종원,송인명,서동철 한국보건사회약료경영학회 2019 한국보건사회약료경영학회지 Vol.7 No.1

OBJECTIVE Diabetic retinopathy and macular edema were prevalent and a major cause of blind in developed countries. This study was performed to estimate and evaluate the rate of screening, factors associated with screening, and economic impact of diabetic retinopathy or macular edema on patients with diabetes in the United Arab Emirates (UAE). METHODS Retrospective longitudinal cohort study using the Abu Dhabi administrative claims database. A total of 34,629 new diabetic patients were identified and were followed for one-year. The screening and diagnosis rates of diabetic retinopathy and/or macular edema and treatment costs during a follow-up period were measured. The Screening was defined as having any codes related with diagnosis or treatment of diabetic retinopathy or macular edema. Total treatment costs for patients with diabetes were calculated by adding medical service costs and prescription drug costs. Diabetes-related costs were calculated by costs related to diabetes and diabetes-related comorbidities. RESULTS Of eligible patients, 21.7% were screened for diabetic retinopathy or macular edema. Screening was higher in patients aged ≥45 years, women, residents of the Northern Emirates, patients who used insulin at index diagnosis month vs. non-users, and patients with comorbidities (p<0.001). The average total annual treatment costs were significantly different between patients with and without diabetic retinopathy ($4,820 vs. $2,638) and with and without macular edema ($4,045 vs. $2,668). CONCLUSIONS The screening rate for diabetic retinopathy in the UAE was very low and was influenced by demographic, socioeconomic, and clinical characteristics. Diabetic retinopathy and macular edema substantially increased total treatment costs and diabetes-related cost.

우리나라 시군구 단위 당뇨병 유병률과 당뇨병 치료율의 시공간 분포 특성 : 공간 의존성 및 핫스팟 분석을 중심으로

박종호 한국보건복지학회 2022 보건과 복지 Vol.24 No.4

This study aimed to identify the spatial and temporal distribution of the prevalence of diabetes and its treatment rate at the district level in Korea, and suggest public health approach for diabetes management in the community. Data was collected from Community Health Statistics of Korean Centers for Disease Control and Prevention from 2012 to 2021, and analyzed by spatial statistical techniques including spatial dependence analysis and hotspot analysis. The results pointed out that there was a spatial dependence in the prevalence of diabetes at the district level, but there was little spatial dependence in the diabetes treatment rate by spatial autocorrelation analysis. It was confirmed that Gangwon-do was the most urgent region needed to manage the prevalence of diabetes based on hotspot analysis. The presented results suggest that effective interventions for diabetes can be achieved by collaborative efforts between neighboring districts with high diabetes prevalence, whereas, it is important to consider the characteristics of the individual district as for diabetes treatment. 본 연구는 공간통계기법인 공간 의존성 및 핫스팟 분석을 통해 우리나라 시군구 단위의 당뇨병 유병률과 당뇨병 치료율의 시공간 분포 특성을 파악하고, 이를 근거로 지역사회의 당뇨병 관리에 대한 정책적 방안을 제시하기 위해 수행되었다. 이를 위해 2012년부터 2021년까지 최근 10년간 질병관리청 지역건강통계의 우리나라 시군구 단위 당뇨병 유병률과 당뇨병 치료율의 지표 결과를 수집하여 분석하였다. 공간적 자기상관 분석 결과 우리나라 시군구 단위에서 당뇨병 유병률은 공간 의존성이 존재하는 것이 확인되었으며, 당뇨병 치료율은 공간 의존성이 거의 존재하지 않았다. 핫스팟 분석 결과 강원 지역 시군구의 당뇨병 유병률 관리가 가장 시급한 것으로 나타났다. 지역사회의 당뇨병을 효과적으로 관리하기 위해서는 당뇨병 유병률이 높은 서로 인접한 시군구 및 시도 간의 협력, 협업을 통해 당뇨병 유병률 관리 사업을 공동으로 수행하고, 대응하는 등 당뇨병 유병률 관리에 지리적 연관성, 공간적 효과를 반영하는 것이 필요하며, 당뇨병 치료율은 각 시군구의 특성에 맞는 지역사회 맞춤형 당뇨병 치료율 관리 사업이 필요하다.

당뇨병 환자의 약물치료 관련 요인

최선주 ( Sun Ju Choi ),류소연 ( So Yeon Ryu ),박종 ( Jong Park ),최성우 ( Seong Woo Choi ) 한국보건정보통계학회 2021 보건정보통계학회지 Vol.46 No.3

Objectives: The purpose of this study was to identify related factors related to the treatment of diabetic patients. Methods: The subjects of this study were 23,772 diabetic patients aged 30 years and older who participated in the 2016 Community Health Survey. The independent variables were sociodemographic factors, lifestyle and health-related characteristics and diabetes-related characteristics and the dependent variables were related to diabetes treatment. The statistical analysis methods used to find factors related to treatment in diabetic patients were the chi-square test and multiple logistic regression analysis. Results: The drug treatment rate of diabetic patients was 88.7%. Among sociodemographic characteristics, drug treatment for diabetes was significantly related to women, increasing age, higher educational level and living in rural area. Among the characteristics related to lifestyle and health status, walking practice and subjective health status were significantly related and among diabetes related characteristics, there were significant correlations in whether it was blood glucose level, self-cognitive blood glucose control, and diabetes management education. Conclusions: Conclusively, gender, age, education level, residential area, walking practice, self-rated health and knowledge of DM were associated with treatment of DM. An effective diabetes management program that reflects the relevant factors should be applied to the treatment of DM.

당뇨병 치료 이행과 합병증 검사 수검에 영향을 미치는 개인과 지역 요인: 다수준 분석

양경진,양정연,이준협 사단법인 대한보건협회 2023 대한보건연구 Vol.49 No.2

연구목적: 당뇨병의 낮은 치료율과 조절률, 당뇨병 관리에 대한 지역 간 격차 발생에는 환자 개인의 특성 뿐만 아니라 거주하는 지역의 특성이 영향을 미친다. 따라서 본 연구에서는 다수준 분석을 통해 당뇨병 관리에 영향을 미치는 개인과 지역 수준의 특성을 구분하여 분석하고, 영향요인을 파악하고자 한다. 연구방법: 질병관리청이 주관하는 2019 지역사회건강조사 자료를 활용하여 당뇨병을 진단받은 25,831명의 대상자와 229개 시·군·구 지역 자료를 이용하여 다수준 로지스틱 회귀분석을 실시하였다. 연구결과: 당뇨병 치료 이행과 합병증 검사 수행에서 모두 지역 특성에 의한 차이가 존재했다. 개인 특성에서는 연령, 교육 수준, 경제활동 여부, 가구 균등화 소득, 주관적 건강 수준, 저염식이의 실천 여부가 당뇨병 치료 이행과 합병증 검사 수행에 공통으로 영향을 주었다. 지역 특성의 경우 인구 50만 이상의 대도시, 1인 가구 비율이 낮은 지역, 보건기관 이용률이 높은 지역은 당뇨병 치료 이행에 긍정적 영향을 주었다. 고령화 비율이 높은 지역, 병상 수가 많은 지역은 합병증 검사 수행에 부정적인 영향을 주었다. 결론: 당뇨병의 관리 역량을 향상하기 위해서는 개인의 특성뿐만 아니라 지역의 인구 구성, 의료 자원 등을 다각적으로 고려해야 한다. 또한, 지역 보건기관 중심의 공공 일차의료 강화를 통해 지역 간 격차를 감소시킬 수 있을 것이다. Objective: Low treatment and control rates in diabetes management and regional disparities in diabetes care are influenced not only by patient characteristics but also by regional factors. Therefore, this study aimed to identify individual and regional level factors that affect diabetes management through multilevel analysis and to identify influential factors. Methods: A multilevel logistic regression analysis was conducted using data from the 2019 Community Health Survey. The study included 25,831 individuals diagnosed with diabetes and 229 local government areas. Results: Differences in regional characteristics were found to affect both adherence to diabetes treatment and complication testing. In terms of individual characteristics, age, education level, economic activity status, income level, subjective health status, and adherence to a low-sodium diet were identified as common factors influencing both adherence to diabetes treatment and complication testing. Among regional characteristics, areas with populations of more than 500,000, low rates of single-person households, and high rates of health facility utilization had a positive effect on adherence to diabetes treatment. Conversely, areas with high proportions of elderly residents and a high number of hospital beds had a negative effect on complication testing. Conclusion: To improve diabetes management capacity, it is necessary to consider various factors, including individual characteristics and regional factors such as population composition and medical resources. Strengthening public primary healthcare services in local health facilities may help reduce regional disparities.

당뇨병 환자에서 샤르코관절병증의 진단과 치료

정재중 대한의사협회 2021 대한의사협회지 Vol.64 No.8

Background: Charcot joint or neurogenic arthropathy in diabetes is a late complication invading the foot and ankle that results in dislocation, instability, and deformity of the affected area. Sensory neuropathy leads to numbness and malalignment of the foot and ankle or inadequate post-traumatic response, which results in progressive fractures, multiple joint dislocations, ulcerations, osteomyelitis, and amputation. Because of such serious consequences, understanding of pathophysiology is important in determining treatment strategies. Early diagnosis and appropriate treatment can prevent this destructive process. Current Concepts: The number of adults diabetic patients continuously increases. Health care and life expectancy will continue to improve with the development of medicine. As a result, the incidence of diabetes-related complications will increase. Diabetic Charcot joint will have a serious negative impact on the quality of life and financial burden on the diabetic patients. The goal of treatment for Charcot joint is not to build a normal foot, but to make a stable plantigrade foot that can be worn shoes. Therefore, it would be most important to understand the progress and characteristics of the disease and to develop an appropriate plan in order to select the appropriate treatment method. Discussion and Conclusion: Understanding Charcot joint and familiarization with its appropriate treatment should reduce the number of the cases of diabetic Charcot joint patients with disabilities or amputations.

당뇨망막병증으로 유발된 유리체출혈(暴盲)환자 1례에 대한 임상적 고찰

정재호,권강,서형식,Jung Jae-Ho,Kwon Kang,Seo Hyung-Sik 大韓外官科學會 2004 大韓外官科學會誌 Vol. No.

Objective: To carry out the oriental medical treatment on a patient with vitreous hemorrhage in the left eye caused by diabetic retinopathy and record the results of the treatment. Methods: 1. Diagnosis: Fundus photography, Colored paper, Dr. Hahn's standard test chart for 5M, Blood sugar measurement. 2. Treatment: Acupuncture, Electro-Acupuncture, Indirect moxibustion, Western medicines, Oryoungsan(Crude drug preparations) Results: Oriental treatment using Ohaeng-acupuncture, Electro-Acupuncture, Indirect moxibustion resulted in the Unaided visual acuity of 0.1 while it used to be the left eye visual acuity with only light sense I month ago. Looking from Fundus photography result, progress was achieved and diabetic retinopathy was found to be in progress in fluorescein fundus angiography to right eye also by revisiting the patient after treatment. Conclusions: 1. Vitrectomy has many advantages but there are instances where patients do not recover their visual acuity due to complications. Therefore it is necessary to prove the effect oriental medical treatment through more cases in future. 2 For diabetic retinopathy patients, diabetes must be treated together with visual acuity.

제 2형 당뇨병을 동반한 고도 비만환자에 대한 한방 비만치료 증례보고 2례

한효정,김현진,박은영,장정아,안태한,서호석,김진원 한방비만학회 2010 한방비만학회지 Vol.10 No.1

Objectives The purpose of this study is to investigate the clinical effect of oriental obesity therapy on morbid obese patient with Type 2 Diabetes. Methods Two cases of Type 2 Diabetes patient was treated with herbal medicine, electrolipolysis, dietetic therapy, and aerobic exercise during the treatment period. Results The diagnostic index (Weight, BMI, PBF, WHR, FPG, HgbA1C) was improved at the end of treatment. Conclusion The improvement of the patient with Type 2 Diabetes is identified through receiving oriental medical treatments, dietetic therapy, and aerobic exercises. Further research on medical treatments and long-term maintenance of weight loss for obese patients with Type 2 Diabetes should be needed in order to standardize the treatment methodology.

증례 : 제 2형 당뇨병을 동반한 고도 비만환자에 대한 한방 비만치료 증례보고 2례

한효정 ( Hyo Jung Han ),김현진 ( Hyun Jin Kim ),박은영 ( Eun Young Park ),장정아 ( Jeong A Jang ),안태한 ( Tae Han An ),서호석 ( Ho Seok Seo ),김진원 ( Jin Won Kim ) 한방비만학회 2010 한방비만학회지 Vol.10 No.2

The purpose of this study is to investigate the clinical effect of oriental obesity therapy on morbid obese patient with Type 2 Diabetes. Methods Two cases of Type 2 Diabetes patient was treated with herbal medicine, electrolipolysis, dietetic therapy, and aerobic exercise during the treatment period. Results The diagnostic index (Weight, BMI, PBF, WHR, FPG, HgbA1C) was improved at the end of treatment. Conclusion The improvement of the patient with Type 2 Diabetes is identified through receiving oriental medical treatments, dietetic therapy, and aerobic exercises. Further research on medical treatments and long-term maintenance of weight loss for obese patients with Type 2 Diabetes should be needed in order to standardize the treatment methodology.

Effect of night shift work on the control of hypertension and diabetes in workers taking medication

Juha Park,Sang-Yeop Shin,Yangwon Kang,Jeongbae Rhie 대한직업환경의학회 2019 대한직업환경의학회지 Vol.31 No.-

Background: Night shift work induces physiological and psychological stress by altering sleep and biological rhythms and is associated with hypertension, diabetes, obesity, and cardiovascular diseases. Few studies have been conducted on the control of hypertension and diabetes. This study aimed to examine the effect of night shift work on the control rate of hypertension and diabetes. Methods: Subjects comprised workers aged 20–65 years who underwent specific health examination at a single facility in seven different affiliated examination centers from 1 January to 31 December 2016. Workers were categorised into day workers and night shift workers. Demographic and medical history were taken, and physical examination was done. Blood pressure (BP) and fasting glucose were measured. The control rate of each disease was evaluated based on treatment goals presented in the treatment guidelines of the Korean Society of Hypertension and the Korean Diabetes Association (systolic BP < 140 mmHg and diastolic BP < 90 mmHg; fasting glucose ≤ 130 mg/dL). Results: Among 631,418 subjects, 11.2% (70,450) were night shift workers. Of whom 6.1% (4,319) were taking antihypertensive medication and 2.5% (1,775) were taking diabetes medication. Among patients taking antihypertensive medications, the proportion of those whose BP was controlled to suit treatment goals was 81.7% (26,635) of day workers and 77.4% (3,343) of night shift workers, which was significantly different (p < 0.001). Among patients taking diabetes medications, the proportion of those whose blood glucose was controlled to suit treatment goals was 37.4% (4,489) of day workers and 36.5% (647) of night shift workers, but the difference was not significant. The control rates for patients taking antihypertensive medications (odds ratio [OR]: 0.74, 95% confidence interval [CI]: 0.68–0.80) were lower among night shift workers than day workers with adjustment for age, sex, smoking history, alcohol consumption, exercise, and obesity. However, there were no differences in control rates for patients taking diabetes medications (OR: 0.99, 95% CI: 0.87–1.10) between day workers and night shift workers. Conclusions: Night shift work can have an effect on the uncontrolled BP in workers taking antihypertensive medications. Therefore, additional efforts for disease control are necessary for night shift workers with hypertension.