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DM foot treatment

박재형
  • : 대한당뇨병학회
  • : 대한당뇨병학회 학술발표논문집 2019권0호
  • : 프로시딩
  • : 2019년 05월
  • : 10-10(1pages)

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당뇨 환자는 계속 증가하고 있어 2040년에는 6억 4천만 명 이상이 될 것이라고 한다. 당뇨족은 당뇨 환자의 2% 이상에서 유병하는데 역시 증가하고 있다. 60세 이상, 남성에 많고, 말초동맥질환이 있을 때 많고, 신부전이나 신경증과 연관이 있다. 상처를 소독하고 말초동맥질환도 치료하고 적절한 항생제와 외과적 치료가 필요하다. 내과적 치료로는 각종 Growth factor와 줄기 세포, 인슐린과 DPP4 저해제 등의 당뇨 약제 등이 사용되고 있다. 항혈소판제도 사용되고 있는데, 혈소판 응집을 감소시켜 혈전의 생성을 줄이는 역할을 할 것으로 보인다. 아스피린 또는 클로피도그렐이 사용되고 있다. 실로스타졸도 역시 항혈소판 작용과 함께 혈관 확장 작용을 통해 당뇨 족과 당뇨성 신경증에서 좋은 효과를 보인다. 당뇨족의 치료는 혈당 조절, 감염 관리, 상처 관리, 약물 치료, 시술과 수술적 치료가 함께 진행되어야 가능하다. 따라서, 당뇨족의 치료는 다학제간의 협진과 소통이 매우 중요하다고 할 수 있다.

						

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  • : 의약학분야  > 내과학
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  • : 학술지
  • : 프로시딩
  • : 2001-2019
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1Bring the spotlight onto a niche in diabetes research

저자 : 김인주

발행기관 : 대한당뇨병학회 간행물 : 대한당뇨병학회 학술발표논문집 2019권 0호 발행 연도 : 2019 페이지 : pp. 3-3 (1 pages)

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In this talk, I would like to introduce and discuss the researches that have mainly been done by our team in the area of diabetes. The main field of my study can be summarized as (1) Oxidative stress and vascular endothelial dysfunction in diabetes (2) Discovery of biomarkers for diabetic kidney disease (3) Epidemiologic studies and randomized clinical trials (RCTs) based on regional multicenter in diabetes.
Vascular complications affect all diabetic patients to some extent and involve both micro- and macro- vessels. Especially, oxidative stress has been implicated in the pathogenesis of diabetes-related vascular complications. Among the vascular complications, diabetic nephropathy remains one of the leading causes of mortality due to end stage of kidney failure and constitutes a significant global health care and socioeconomic burden. To improve the lives of people with diabetic nephropathy and to reduce the impact on society, early identification of the development or progression of diabetic nephropathy using appropriate screening and diagnostic tools is very important in order to provide timely and proper management. Current methods for detecting kidney damage in diabetes may not be specific enough to accurately reflect kidney health. Thus, numerous studies have focused on discovering potential biomarkers for the early detection of diabetic nephropathy. These works are relevant for identifying therapeutics for diabetic nephropathy to reduce the individual and socioeconomic burdens. Meanwhile, type 2 diabetes is a heterogeneous disease among individuals in real practice. Thus, taking a tailored approach to patients with type 2 diabetes requires identification of various their characteristics, management and clinical outcomes. To do this, epidemiological studies based on various cohorts and RCTs on various treatments are essential.

2Roles of adipose tissue remodeling in insulin sensitivity regulation

저자 : 김재범

발행기관 : 대한당뇨병학회 간행물 : 대한당뇨병학회 학술발표논문집 2019권 0호 발행 연도 : 2019 페이지 : pp. 4-4 (1 pages)

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Adipose tissue is a central metabolic organ in the regulation of whole-body energy homeostasis. White adipose tissue (WAT) functions as a key energy reservoir which provides energy sources for other organs. In brown adipose tissue (BAT), accumulated lipids are used for cold-induced adaptive thermogenesis. Moreover, adipose tissues secret various adipokines including hormones, cytokines, and metabolites that are involved in systemic energy balance and metabolism through engaging in the control of appetite in central nerve system as well as various metabolic activities in peripheral tissues. In response to changes in nutritional status, adipose tissue undergoes dynamic remodeling, accompanied with quantitative and qualitative alterations of adipose tissue resident cells. Notably, there is a growing body of evidence that adipose tissue remodeling in obesity is closely associated with changes of adipose tissue functions. In this presentation, I will discuss recent understandings of adipose tissue remodeling processes and their physiological and pathological roles, particularly, in the aspect of insulin sensitivity regulation. In obesity, changes in the numbers and sizes of adipocytes affect microenvironments nearby expanded fat tissues, accompanied with alterations in adipokine secretion, adipocyte death, local hypoxia, and fatty acid fluxes. Concurrently, adipose tissue composing cells including immune cells are involved in numerous adaptive processes such as dead adipocyte clearance, adipogenesis, and angiogenesis, which are regulated for healthy remodeling of adipose tissue. On the contrary, chronic overnutriention brings on uncontrolled inflammatory responses, leading to systemic low-grade inflammation and metabolic disorders such as insulin resistance in obesity. Emerging evidence suggests that adipose tissue would function as a central metabolic regulator via remodeling process for energy homeostasis.

3Should SGLT2 inhibitor be given first priority for patients with type 2 diabetes and ASCVD?

저자 : 김상수

발행기관 : 대한당뇨병학회 간행물 : 대한당뇨병학회 학술발표논문집 2019권 0호 발행 연도 : 2019 페이지 : pp. 7-7 (1 pages)

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Patients with type 2 diabetes have a significantly higher risk for cardiovascular disease (CVD), especially atherosclerotic CVD. Current guidelines for type 2 diabetes management have emphasized the priority of Sodium-glucose cotransporter2 (SGLT2) inhibitor for the type 2 diabetes with established ASCVD. The use of SGLT2 inhibitors were considered compelling in the setting of established CVD, because of the recent evidences for the benefit of SGLT2 inhibitors to reduce mortality, heart failure and progression of renal disease in these setting. Some SGLT2 inhibitors have demonstrated unprecedented cardiovascular and renal benefits in large clinical trials with type 2 diabetic patients and either established CVD or multiple CV risk factors. However, the reductions in CV death were not clearly accounted for by the reductions in atherothrombotic outcomes, specially myocardial infarction and stroke. Importantly, the concept that SGLT2 inhibitors reduced CV events primarily through prevention of heart failure (vs atherothrombotic events) has gained broad acceptance. Collectively, these results served as a wake-up call to review the proposed mechanism for CV benefits and remind the clinical importance of heart failure in diabetes, which have been undervalued as CV outcome. In addition, upcoming trials will provide further insights into whether this benefit might be observed across the spectrum of diabetes with or without established CVD. In spite of the established cardio-renal benefits of SGLT2 inhibitors, clinicians still have to balance the risk and benefit of this agent for patient-centered glycemic management in type 2 diabetes.

4SGLT2 inhibitors in diabetic kidney diseases

저자 : 한상엽

발행기관 : 대한당뇨병학회 간행물 : 대한당뇨병학회 학술발표논문집 2019권 0호 발행 연도 : 2019 페이지 : pp. 8-8 (1 pages)

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지난 수년간 당뇨병 신증 치료와 관련된 다양한 임상연구가 실패하여 많은 실망을 안기고 있다. 최근 SGLT2 (sodium/glucose co-transporter 2) 억제제는 당뇨병 신증 환자에게서 단백뇨를 낮추고 신기능을 보호한다고 보고되고 있다. EMPA-RGE 연구에서는 신대체 치료의 위험성을 55% 줄여주었고, CANVAS 연구에 canagliflozin은 신기능과 관련된 composite outcome을 40% 줄여주었다. 아직 이 약제의 신기능 보호효과 기전인 명확하게 알려져 있지 않지만 당뇨와 동반된 사구체 과여과(glomerular hyperfiltration)을 줄여줄 수 있고, 고혈당으로 인한 세관 세포 손상을 차단할 수 있기 때문으로 보고 있다. 현재 당뇨병 신증 환자를 대상으로 다양한 연구가 진행되고 있으며 추후 이 임상연구 결과들이 발표되면 당뇨병 신증 환자에게 적용할 수 있은 시기가 올 것이라 기대한다.

5Medical treatment for improving cognitive function in diabetic patients

저자 : 박경원

발행기관 : 대한당뇨병학회 간행물 : 대한당뇨병학회 학술발표논문집 2019권 0호 발행 연도 : 2019 페이지 : pp. 9-9 (1 pages)

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Dementia is a major cause of disability among older adults and is the fifth leading cause of death among older adults in the world. Evidence from epidemiologic studies suggest older adults with type 2 diabetes are 50-100% more likely to develop dementia than those without DM. However, studies examining the effect of DM on cognitive decline have been less definitive, and it remains to be determined whether this association reflects a causal relationship between DM and dementia pathogenesis. There are multiple proposed mechanisms through which T2D could cause cognitive decline and dementia, including the effects of insulin dysregulation and chronic hyperglycemia on both Alzheimer's disease and vascular pathology in the brain. Neuropathological and neuroimaging studies suggest that cerebral infarcts and brain atrophy are more common in older adults with DM. Health care providers should be aware that older adults with DM have an increased risk for development of dementia and should be attentive in looking for cognitive problems in older patients with DM. More research is needed to elucidate the link between DM and dementia and to identify strategies to maintain cognitive function among people with DM. The goal of this review is to summarize the existing evidence evaluating the relationship between DM and dementia. We will start with an overview of dementia and a description of potential mechanisms linking DM and dementia. And then, we will present evidence from longitudinal epidemiologic studies examining the relationship between DM and incidence of dementia and cognitive decline, and we will also review evidence from autopsy and brain imaging studies. Finally, we will discuss risk factors and medical treatment for dementia among older adults with DM.

6DM foot treatment

저자 : 박재형

발행기관 : 대한당뇨병학회 간행물 : 대한당뇨병학회 학술발표논문집 2019권 0호 발행 연도 : 2019 페이지 : pp. 10-10 (1 pages)

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초록보기

당뇨 환자는 계속 증가하고 있어 2040년에는 6억 4천만 명 이상이 될 것이라고 한다. 당뇨족은 당뇨 환자의 2% 이상에서 유병하는데 역시 증가하고 있다. 60세 이상, 남성에 많고, 말초동맥질환이 있을 때 많고, 신부전이나 신경증과 연관이 있다. 상처를 소독하고 말초동맥질환도 치료하고 적절한 항생제와 외과적 치료가 필요하다. 내과적 치료로는 각종 Growth factor와 줄기 세포, 인슐린과 DPP4 저해제 등의 당뇨 약제 등이 사용되고 있다. 항혈소판제도 사용되고 있는데, 혈소판 응집을 감소시켜 혈전의 생성을 줄이는 역할을 할 것으로 보인다. 아스피린 또는 클로피도그렐이 사용되고 있다. 실로스타졸도 역시 항혈소판 작용과 함께 혈관 확장 작용을 통해 당뇨 족과 당뇨성 신경증에서 좋은 효과를 보인다. 당뇨족의 치료는 혈당 조절, 감염 관리, 상처 관리, 약물 치료, 시술과 수술적 치료가 함께 진행되어야 가능하다. 따라서, 당뇨족의 치료는 다학제간의 협진과 소통이 매우 중요하다고 할 수 있다.

7Quantifications of metabolic flux in vivo using stable isotope tracers and mass spectrometry

저자 : 김일영

발행기관 : 대한당뇨병학회 간행물 : 대한당뇨병학회 학술발표논문집 2019권 0호 발행 연도 : 2019 페이지 : pp. 11-11 (1 pages)

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The human body is in a dynamic steady state of constant turnover, dysregulation of which however can lead to clinical conditions such as diabetes. For example, hyperglycemia occurs owing to rate of glucose appearance (i.e., endogenous glucose production) exceeding rate of glucose disappearance (i.e., peripheral tissue uptake). Quantification of metabolite concentrations or of molecular signaling pathways provide invaluable but “snap-shot” information, which can limit our complete understanding of “dynamic” nature of complex metabolic architecture. However, the critical information on in vivo dynamics (“kinetics”) of metabolites such as rates of production, appearance or disappearance of metabolites can be quantitatively assessed with stable, nonradioactive isotope tracers, which can be also used in conjunction with molecular and cellular biology tools, thereby providing an in-depth dynamic assessment of metabolic changes, as well as simultaneous investigation of the molecular basis for the observed kinetic responses. In this presentation, I will discuss 1) importance of obtaining kinetic information for a complete understanding of metabolism, 2) basic principles of stable isotope methodology for tracing in vivo kinetics of human or animal metabolism, and 3) clinical studies of quantifying certain aspects of in vivo kinetics of glucose, lipid and protein metabolism.

8BXD mouse genetic reference population, a research tool for metabolic diseases based on phenomics

저자 : 류동렬

발행기관 : 대한당뇨병학회 간행물 : 대한당뇨병학회 학술발표논문집 2019권 0호 발행 연도 : 2019 페이지 : pp. 12-12 (1 pages)

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Phenomics is the systematic study based on phenotypes of a population. Phenotypic variation is generated from cumbersome and massive interactions between genome and environment. Mapping networks and interactions among genome, transcriptome, proteome, phenome, and environment (i.e. Phenomics) will provide a chance to draw a molecular mechanism behind our health and disease. Despite this need, there are several barriers that interfere with us. For instance, validated omics databases including phenomes, genomes, transcriptome, and other omics database originated from a certain population is essential. This talk will introduce the BXD mouse genetic reference population (BXD GRP) as a research tool for metabolic syndrome based on the multilayer omics database. Several recent publications applied multilayered omics databases of BXD GRP will be highlighted as examples.

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The obesity becomes serious threat to public health by creating significant risks for a variety of diseases including type 2 diabetes, cardiovascular diseases and cancers. The endoplasmic reticulum (ER) is the central organelle for protein biosynthesis, folding, and traffic. Perturbations in ER homeostasis (ER stress) and associated signaling cascades (the unfolded protein response, UPR) have been implicated in a variety of metabolic disorders, such as obesity and type 2 diabetes. However, the underlying molecular mechanisms of ER stress on the development of obesity and diabetes remains elusive, which prevents successful therapeutic utilization. We have found that the impaired function of the UPR molecules such as the spliced form of X-Box Binding Protein 1 (XBP1s) leads to increased ER stress in the liver and systematic defect of glucose homeostasis in obese mice. Further, we have demonstrated that the crosstalk of XBP1s with other molecules such as FoxO1 plays a crucial role in glucose homeostasis. Also, we have analyzed a library of small molecules that reduce ER stress with connectivity map (CMAP), and identified celastrol and withaferin A, naturally occurring compounds, as leptin sensitizers. Celastrol or withaferin A treatment suppresses food intake and leads to significant weight loss in diet-induced obese mice by increasing leptin sensitivity. Therefore, intervening in ER stress and modulating signaling components of the UPR would provide promising therapeutics for the treatment of human metabolic diseases. I will also present which methods can be used to study the ER stress.

10Understanding autophagic flux assays and their applications

저자 : 이재만

발행기관 : 대한당뇨병학회 간행물 : 대한당뇨병학회 학술발표논문집 2019권 0호 발행 연도 : 2019 페이지 : pp. 14-14 (1 pages)

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Autophagy is an evolutionarily conserved process of self-cannibalization in which cytoplasmic components are captured and degraded in lysosome upon starvation, or other metabolic and inflammatory conditions. Moreover, autophagy also degrades altered or dysfunctional proteins and organelles, contributing to the maintenance of cellular homeostasis. The resulting breakdown molecules are recycled to generate energy and to build new macromolecules. Recent studies has shown that autophagy also plays a key role in various aspects of metabolism at the levels of cells, tissues, organs, and/or organisms. In this talk, I will introduce some of valuable autophagic flux assays and discuss how they are applied to metabolic researches.

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Tuberculosis and Respiratory Diseases
82권 4호 ~ 82권 4호

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34권 3호 ~ 34권 3호

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13권 5호 ~ 13권 5호

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Gut and Liver
13권 5호 ~ 13권 5호

Korean Journal of Medicine(구 대한내과학회지)
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Gut and Liver
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Diabetes and Metabolism Journal (DMJ)
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Gut and Liver
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Gut and Liver
13권 4호 ~ 13권 4호

KCI등재 SCI SCOUPUS

Gut and Liver
13권 4호 ~ 13권 4호

Korean Journal of Medicine(구 대한내과학회지)
94권 4호 ~ 94권 4호
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