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당뇨병(JKD) update

The Journal of Korean Diabetes

  • : 대한당뇨병학회
  • : 의약학분야  >  내과학
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  • : 임상 당뇨병(~2010)→ 당뇨병(JKD)(2011~)

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수록범위 : 1권1호(2000)~20권2호(2019) |수록논문 수 : 904
당뇨병(JKD)
20권2호(2019년 06월) 수록논문
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1시론 : 삭센다 열풍, 내분비대사내과 전문의로서의 의견

저자 : 김성래 ( Sungrae Kim )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 20권 2호 발행 연도 : 2019 페이지 : pp. 63-66 (4 pages)

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Globally, the problem of obesity is increasing, and the prevalence of obesity in Korea is also rising rapidly. Obesity is a risk factor for cardiometabolic diseases including type 2 diabetes mellitus, hypertension, cardiovascular disease, and some types of cancer. Therefore, prevention of various metabolic diseases or symptom relief through effective treatment of obesity is a very important problem. According to the obesity guidelines of the Obesity Society of Korea in 2018, obesity medication is recommended for patients with a body mass index (BMI) of 30 kg/m2 or more or a BMI of 27 kg/m2 or more, and one or more obesity accompanying diseases (type 2 diabetes, hypertension, dyslipidemia). In this case, it is recommended that the basic treatment for obesity (diet, exercise, and behavior therapy) should be performed in parallel with Saxenda treatment. The glucagon-like peptide 1 analogue, Saxenda, has been validated as a long-term effective and safe treatment for obesity, and is expected to be a promising drug for the treatment of obesity and the prevention of pre-diabetes in the future. However, in Korea, where non-standard obesity treatments are widely practiced, it is necessary to improve the health of obese patients by being treated with Saxenda along with diet, exercise and behavior therapy.

2Statement : 당뇨병과 인지기능장애

저자 : 이승환 ( Seung-hwan Lee )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 20권 2호 발행 연도 : 2019 페이지 : pp. 67-73 (7 pages)

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Dementia, a clinical syndrome affecting memory, thinking, and social abilities primarily caused by neurodegeneration, is becoming one of the greatest health and socioeconomic burdens in the aging society. The age-standardized prevalence of dementia for people aged 60 or older was 5% to 7% in most world regions, affecting 47 million people in 2015. This number is expected to almost double every 20 years. Although aging is the greatest but non-modifiable risk factor, approximately 35% of the risk has been attributed to the combination of potentially modifiable risk factors including education, diet and lifestyle factors, psychiatric factors, and metabolic factors. There is ample evidence that people with glucose intolerance, insulin resistance, and metabolic syndrome are at higher risk for cognitive impairment and dementia compared to age- and sex-matched controls. Meta-analyses and large-scaled pooled analyses demonstrate that diabetes is associated with an approximately 60% to 70% increased risk of all types of dementia. In this article, the associations of hyperglycemia, hypoglycemia, and glucose variability with cognitive dysfunction and dementia are demonstrated. Also, the underlying mechanism of this connection and possible effects of anti-diabetic medications are discussed.

3특집 : Sodium-Glucose Cotransporter 2 억제제의 작용 기전 및 다양한 효과

저자 : 김경수 ( Kyung-soo Kim )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 20권 2호 발행 연도 : 2019 페이지 : pp. 74-80 (7 pages)

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The basic action mechanism of sodium-glucose cotransporter 2 (SGLT2) inhibitor is to lower the glucose burden by excreting the glucose filtered by the kidney into the urine. Although SGLT2 inhibitors are primarily indicated as glucose-lowering agents, they have a broad range of effects on renal function and plasma volume homeostasis, as well as on adiposity and energy metabolism across the entire body. That might be why SGLT2 inhibition causes spill-over of sodium and glucose beyond the proximal tubule, triggering dynamic and reversible realignment of energy metabolism, renal filtration, and plasma volume. A better understanding of SGLT2 inhibition in the kidney and the entire body will lead to more benefits in people with and without diabetes.

4특집 : Sodium-Glucose Cotransporter 2 억제제의 심혈관 질환 예방 효과 유발 기전

저자 : 전재한 ( Jae-han Jeon )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 20권 2호 발행 연도 : 2019 페이지 : pp. 81-86 (6 pages)

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The potential mechanism by which sodium-glucose cotransporter 2 (SGLT2) inhibitors prevent cardiovascular disease (CVD) is being widely investigated. Improved insulin resistance, along with decreased body fat mass associated with SGLT2 inhibitor treatment is consistent with previously wellestablished factors contributing to the prevention of CVD. These factors are responsible for reduction of oxidative stress as well as improvement of systemic inflammation. Because heart failure was one of the most dramatically improved cardiovascular events in various clinical trials and because SGLT2 inhibitors promote osmotic diuresis and natriuresis, hemodynamic changes are considered as a critical mechanism responsible for the cardioprotective effect of SGLT2 inhibitors. Restored tubuloglomerular feedback by SGLT2 inhibitors might play a role in renoprotection, which in turn, leads to fewer CVDs. Finally, blood ketone body increments in response to SGLT2 inhibition might act as a “super-fuel” for salvaging the failing diabetic heart.

5특집 : Sodium-Glucose Cotransporter 2 억제제의 심혈관 질환 및 신기능악화 예방 효과

저자 : 홍준화 ( Jun Hwa Hong )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 20권 2호 발행 연도 : 2019 페이지 : pp. 87-91 (5 pages)

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Management of hyperglycemia limits progression of microvascular complications in type 2 diabetes mellitus (T2DM). According to large-scale randomized control studies to demonstrate the cardiovascular safety of sodium-glucose cotransporter 2 (SGLT2) inhibitors, SGLT2 inhibitors showed not only cardiovascular safety, but also cardiovascular benefits. Heart failure is adequately prevented by SGLT2 inhibitors regardless of history of heart failure. Additionally, SGLT inhibitors also showed renal protective benefits in slowing the decline of glomerular filtration rate and reducing proteinuria. SGLT2 inhibitors are beneficial to T2DM patients with established cardiovascular disease, high risk of heart failure, and renal impairment. As oral hypoglycemic agents, SGLT2 inhibitors not only control the serum glucose level, but also reduce the macrovascular complications of T2DM.

6특집 : 제1형 당뇨병 환자에서 Sodium-Glucose Cotransporter 2 억제제 사용

저자 : 김중희 ( Choong Hee Kim ) , 문준성 ( Jun Sung Moon )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 20권 2호 발행 연도 : 2019 페이지 : pp. 92-98 (7 pages)

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Althowgh intensive insulin regimen is the main treatment in people with type 1 diabetes, glucose variability and weight gain remain as challenges for this treatment. Sodium-glucose cotransporter (SGLT) inhibitors (including the SGLT1/2 inhibitors) have emerged as an add-on therapy for insulin treatment in peoples with type 1 diabetes due to their insulin-independent mechanism. Recent clinical trials have consistently reported that SGLT inhibition provides additive benefits in glycemic control, including lower insulin dose and weight loss. However, there is concern that an increase in ketone-related adverse events such as diabetic ketoacidosis is higher in SGLT1/2, as well as SGLT2 inhibitors. Despite safety issues that require further evaluation, SGLT2 inhibitors used with caution may provide an adjunctive therapy in people with type 1 diabetes.

7당뇨병 교육을 위한 정보광장 : 당뇨병 환자의 말초혈관질환 간호

저자 : 윤혜령 ( Hye Ryoung Yun )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 20권 2호 발행 연도 : 2019 페이지 : pp. 99-105 (7 pages)

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Peripheral artery disease (PAD) and diabetes increase the risk of significant morbidity and mortality and can affect quality of life. PAD is a progressive disease, and the presence of diabetes mellitus increases the risk of adverse outcomes among patients with PAD. Diabetes patients should undergo an initial screening for PAD that evaluates walking speed, leg fatigue, claudication, and pedal pulses. Healthcare providers should discuss with their patients controllable risk factors for PAD that can be modified. A comprehensive care plan for patients with PAD and diabetes mellitus is important and may include smoking cessation, structured exercise therapy, foot care, glycemic control and management of other cardiovascular risk factors (weight management, diet, and control of blood pressure and cholesterol). PAD with diabetes mellitus is a lifelong chronic medical condition, and prompt identification and treatment of PAD are crucial. Patient education is needed to prevent complications and to encourage a healthy and active lifestyle.

8당뇨병 교육을 위한 정보광장 : 당뇨병 환자의 과일 섭취: Why and How Much?

저자 : 이은영 ( Eun Young Lee )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 20권 2호 발행 연도 : 2019 페이지 : pp. 106-111 (6 pages)

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Fruits are universally promoted as healthy. Fruits supply dietary fiber, vitamins, minerals and phytochemicals that function as antioxidants. But many people often have concerns that fruit intake has a negative impact on glycemic control in patients with diabetes. The results of a related study showed fruit intake may have no overall effect on fasting glucose and HbA1c. Also increased fresh fruit intake in ranges commonly consumed was associated with reduced risks of death and development of major vascular complications in diabetic patients. Korean Diabetes Association and American Diabetes Association recommend carbohydrate intake from whole grains, vegetables, fruits, legumes, and dairy products. Fruit intake for diabetics should be included as part of a balanced diet and individual meal composition within the range of two exchanges (100~300 g).

9당뇨병 교육을 위한 정보광장 : 멘토, 사회적 지지 그리고 당뇨병

저자 : 박유정 ( Yu Jeong Park )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 20권 2호 발행 연도 : 2019 페이지 : pp. 112-116 (5 pages)

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In countries with advanced health practices, it is important to note the importance of social capital and social support as social determinants in patient health as early as possible, while minimizing the constraints on self-management and reducing health inequalities. Beyond the individual, we offer mentoring and a social support system for individuals using community resources. We examined the growth of mentors and mentees through mentoring effectiveness and mentoring, and discussed the issues to be considered when applying such in the field. Ultimately, educators who are accustomed to 1:1 education or communicative group education should have the opportunity for recognition reconstruction.

10원저 : 인슐린 사용에 제한을 가진 제2형 당뇨병 환자에서 경구혈당강하제 4제요법의 유용성

저자 : 유원상 ( Won Sang Yoo ) , 김도희 ( Do Hee Kim ) , 김희진 ( Hee Jin Kim ) , 정현경 ( Hyun Kyung Chung )

발행기관 : 대한당뇨병학회 간행물 : 당뇨병(JKD) 20권 2호 발행 연도 : 2019 페이지 : pp. 117-126 (10 pages)

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Background: Insulin therapy is the treatment of choice in type 2 diabetes mellitus (T2DM) patients who are not achieving glycemic goals despite triple oral hypoglycemic agent (OHA) combination therapy. However, there is still no additional treatment option for patients who cannot afford insulin therapy or who have various clinical limitations. The purpose of this study was to evaluate the clinical efficacy and safety of four OHA combination therapy in poorly controlled T2DM patients who could not afford insulin therapy.
Methods: Forty-seven T2DM patients were enrolled according to the following criteria: 1) glycosylated hemoglobin [HbA1c] > 8.5%, 2) ongoing treatment with 3 OHA combination therapy (metformin, sulfonylurea, dipeptidyl peptidase-4 inhibitor), or 3) combined limitations for applying insulin therapy. Patients were given the fourth OHA (pioglitazone) in addition to their previous treatment for 12 months. We evaluated changes in HbA1c, body weight, hypoglycemic events, and side effects.
Results: At study completion, mean HbA1c and fasting plasma glucose were significantly reduced from 9.6% to 8.04% and from 198.4 mg/dL to 161.5 mg/dL, respectively (P < 0.001). Mean body weight was significantly increased from 66.7 kg to 69.3 kg. Hypoglycemia and side effects were observed 18 times and only 3 cases showed abnormal liver function tests or edema. In addition, subjects with higher initial HbA1c levels and HOMA-beta showed an independent association with a greater reduction in HbA1c.
Conclusion: The 4 OHA combination therapy is effective and safe when insulin is not feasible.

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