Purpose: This study was conducted to identify factors influencing fundus examination to prevent diabetic retinopathy in diabetes patients to provide basic data to improve screening rates of fundus examinations. Methods: Raw data from the 6th Korea National Health and Nutrition Examination Survey, which is a cross-sectional and nationally representative survey, were used in this study. The subjects of the study were 1,029 adult diabetes patients over the age of 19 years who had been diagnosed with diabetes. The demographic characteristics, diabetes and disease-related characteristics and health behavior characteristics according to the fundus examinations were analyzed by the chi-squared test and logistic regression analyses were used to examine the factors influencing fundus examination. Results: A total of 333 patients underwent fundus examination at a screening rate of 32.2%. We identified factors influencing fundus examination in patients with diabetes as level of education, type of diabetes care, period of diabetes, and smoking. Conclusion: A multiple approach is required to raise the low screening rate of fundus examination, including specialized education for low-education groups. Moreover, nursing intervention should focus on subjects who do not engage in insulin and oral hypoglycemic agents and with diabetes for a long period.
Transient neonatal diabetes mellitus (TNDM) is a rare form of diabetes mellitus that presents within the first 6 months of life with remission in infancy or early childhood. TNDM is mainly caused by anomalies in the imprinted region on chromosome 6q24; however, recently, mutations in the ABCC8 gene, which encodes sulfonylurea receptor 1 (SUR1), have also been implicated in TNDM. Herein, we present the case of a male child with TNDM whose mutational analysis revealed a heterozygous c.3547C>T substitution in the ABCC8 gene, leading to an Arg1183Trp mutation in the SUR1 protein. The parents were clinically unaffected and did not show a mutation in the ABCC8 gene. This is the first case of a de novo ABCC8 gene mutation in a Korean patient with TNDM. The patient was initially treated with insulin and successfully switched to sulfonylurea therapy at 14 months of age. Remission of diabetes had occurred at the age of 16 months. Currently, the patient is 21 months old and is euglycemic without any insulin or oral hypoglycemic agents. His growth and physical development are normal, and there are no delays in achieving neurological and developmental milestones.
The purpose of this study was to identify clinical characteristics of type 2 diabetic patients with hypertension. The subjects were 209 type 2 diabetic patients who visited at the endocrine center at Kangnam St. Mary's Hospital of Catholic University in Seoul from beginning of March through the end of April in 2001. The patient's clinical laboratory data were assessed at medical record review. The data were analyzed using for t-test, $x^2$ test. The results were as follows: 1) There were no significant differences in age, body mass index, sex, family history of diabetes and oral hypoglycemic agents between hypertensive group and normotensive group, However, percentage of patients receiving insulin treatment was higher significantly in the hypertensive group. 2) Creatinine and microalbuminuria levels were higher significantly in the hypertensive group. However, fasting blood glucose levels were lower significantly in the hypertensive group. There were no significant differences in $HbA_1c$, 2-hour postprandial blood glucose, total cholesterol, triglyceride, high density lipoprotein cholesterol, lipoprotein(a) and blood urea nitrogen between two groups. Our present study supports that Creatinine and microalbuminuria levels were higher significantly in the hypertensive group.
An in vivo oral glucose tolerance test (OGTT) was performed on hyperglycemic male Sprague-Dawley rats to assess the effect of fruits and vegetables ($1g{\cdot}kg^{-1}$ body weight) on blood glucose levels (${\Delta}BGLs$) at different time intervals of 0, 5, 15, 30, 60, 90 and 120 min. The areas under glucose curve (${\Delta}AUCs$) were calculated at 120 min of OGTT by trapezoid method. Total phenolic content (TPC) and anti-oxidant activity (AOA) of fruits and vegetables were assayed in vitro by Folin Ciocalteu and DPPH (2, 2-diphenyl-1-picrylhydrazyl) methods, respectively. At the end of the experiment the correlations among the parameters TPC, AOA and ${\Delta}AUC$ was estimated by Pearson's correlations. Among fruit crops, tangerine, plum, grape and pear and among vegetables, blue leaf mustard, cabbage, chicory, broccoli and others exhibited significant hypoglycemic effects by reducing ${\Delta}BGLs$ with significant ${\Delta}AUC$. The effective ${\Delta}AUC$ ranged from $5548.2{\pm}462.1$ to $3823.3{\pm}282.0mg-min{\cdot}dL^{-1}$. The TPC and AOA ranged from $0.063{\pm}0.00$ to $0.913{\pm}0.14mg{\cdot}g^{-1}$ GAE and $01.05{\pm}0.08$ to $75.46{\pm}0.06%$, respectively. Overall, six fruits and fifteen vegetables exhibited higher TPC and one fruit and four vegetables exhibited higher AOA. There was a better correlation among TPC, AOA and ${\Delta}AUC$ of fruits and TPC & AOA of vegetables. We report that hypoglycemically significant fruits and vegetables investigated in this study have pharmacological importance which reduced ${\Delta}BGLs$ through insulin like activity and AOA in prevention of type-2 diabetes.
The importance of dietary intake in the treatment of type 2 diabetes was emphasized. This study was performed to investigate the dietary intakes of Korean type 2 diabetes patients according to the treatment and duration of diabetes and to examine the relationships between their diet and serum lipid profiles. The subjects were 111 type 2 diabetic patients who were treated by medical nutrition therapy only, oral hypoglycemic agents (OHA), or insulin with medical nutrition therapy. Dietary intake was assessed by a registered dietitian using semi-quantitative food frequency questionnaires Comparisons according to treatment type were made using covariance analyses. General linear models identified the independent effects of the different treatments after covarying for age, duration of diabetes, and 2-way interactions. There were no significant differences in age and BMI but was in duration of diabetes according to treatment type in these subjects. Carbohydrate to energy ratio was higher in the OHA group (P < 0.05), whereas the fat to energy ratio was higher in the insulin group for males (P < 0.05). Carbohydrate ($R^2$ = 0.24, P = 0.005) and fat ($R^2$ = 0.26, P = 0.02) to energy ratios were independently associated with the duration of diabetes after covarying for age, sex, treatment, and 2-way interactions. The levels of triglyceride (TG; $R^2$ = 0.32, P = 0.02) and total cholesterol (TC) were associated independently with energy intake and the carbohydrate ($R^2$ = 0.15, P = 0.02) and fat ($R^2$ = 0.15, P = 0.01) to energy ratios, respectively. The concern that the independent association of dietary intake with either duration of diabetes or dietary factors affects blood lipid levels could suggest that specific dietary recommendations may work better for identifiable groups of diabetes patients.
Extracapsular cataract extraction with posterior chamber intraocular lens in 24 eyes of 24 diabetics, with and without diabetic retinopathy, were followed up postoperatively for an average of 14 months to determine the incidence of progression of diabetic retinopathy, the final visual acuity and factors predictive of progression of retinopathy and final visual acuity. Overall, retinopathy progressed in 52% of operated-on eyes. Cataract extraction was highly associated with progression of diabetic retinopathy. Women had a significantly increased risk of progression of retinopathy in the operated-on eye compared to men. Visual acuity improved in 22 of 24 orerated-on eyes : however, only 11 eyes achieved a visual acuity of 0.5 or better and only 7 eyes achieved a visual acuity of 0.7 or better. Patients treated with oral hypoglycemic agents had a worse visual prognosis than those treated with insulin. The prognosis of patients with diabetic retinopathy about to undergo cataract surgery, even extracapsular cataract extraction with placement of a posterior chamber lens, is guarded.
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.
Drug interactions with food, on occasion, lead to serious nutritional and functional changes in the body as well as alternations of pharmacological effect. It, therefore, should be necessary to take drug interactions with food into consideration for effective and safe therapeutics. Diabetes mellitus is a heterogeneous group of disorders characterized by abnormal glucose homeostasis, resulting in hyperglycemia, and is associated with increased risk of micovascular, macrovascular, and neuropathic complications. However, the precise mechanism of diabetes mellitus remains unclear. Three basic objectives in the care of diabetic patients are maintaining optimal nutrition, avoiding hypo- or hyperglycemia and preventing complications. The purpose of this study was to investigate thε effect of Laminaria japonica diet on the absorption, distribution, metabolism and excretion of glipizide which are frequently used in the treatment of diabetes. Diabetic rats induced by streptozotocin were employed in this study. Blood concentrations of oral hypoglycemic agents were measured by HPLC and resultant pharmacokinetic parameters were calculated by RSTRIP. The mechanisms of drug interaction with food were evaluated on the basis of pharmacokinetic parameters such as $k_{a},\;t_{1/2},\;C_{max},\;t_{max}$ and AUC. Administration of glipizide in normal rats treated with Laminaria japonica diet showed significant increase in AUC, $k_{a},\;t_{1/2},\;t_{max}$ and decrease in $C_{max}$, compared to those without Laminaria japonica diet. This might result from adsorption of glipizide on components of Laminaria japonica, causing delayed absorption. Administration of glipizide in diabetic rats treated with Laminaria japonica diet showed significant increase in $t_{1/2}\;and\;t_{max}$, and decrease in $C_{max}$, compared to those without Laminaria japonica diet. This might also result from adsorption of glipizide on components of Laminaria japonica, causing delayed absorption and flattened blood concentration of glipizide. The oral glucose test showed that Laminaria japonica diet could lower blood glucose level probably through either inhibiting the activity of disaccharidases, intestinal digestive enzymes, or delaying the absorption of glucose. More studies should be followed to fully understand pharmacokinetic changes of glipizide caused by long-term Laminaria japonica diet.
To develop the diet for Korean type 2 diabetic patients, a consumer survey was conducted (N=35) and was analyzed statistically. The survey compared the results of a questionnaire, somatometry, and blood parameters before and 8 weeks after the experiment. It was divided into Diabetic diet enforcement group (DDE) vs. Non diabetic diet enforcement group (NDDE). There was no significant difference in body weight, body mass index (BMI), body fat, triglyceride (TG) and low density lipoprotein cholesterol (LDL-C) of the subjects before and 8 weeks after the experiment. DDE's average fasting glucose (FBG) and post prandial 2 hours blood glucose (PP2) were significantly decreased before and after the experiment (p<0.05). NDDE's average FBG and PP2 showed no significant difference. In terms of Hemoglobin $A_lC\;(HbA_1C)$ content, DDE's had significantly decreased level both before and after the experiment (p<0.05), while there was no significant difference in the NDDE group. Cholesterol and High density lipoprotein cholesterol (HDL-C) were significantly different in DDE (p<0.05) both before and after the experiment. Whereas in the case of NDDE, there was no significant difference on the cholesterol and HDL-C, while DDE's showed a significant difference before and after the experiment. In terms of patients distribution depending on their treatment (p<0.05), NDDE had no significant difference before and after the experiment. For an item asking blood glucose control, DDE had significant difference before and after the experiment (p<0.01), while NDDE had no significant difference. For program satisfaction (p<0.05) and health (p<0.001), both the groups changed significantly after the experiment. But there was no significant difference in applying it to their real life after the experiment. Based on these results, DDE had the decreased blood glucose levels, $HbA_1C$, and cholesterol and increased HDL-C, with decreased rate of the patients taking oral hypoglycemic agents. In addition, many of the patients who participated in the experiment were found to be satisfied with the program, in terms of having less trouble in glucose control and exhibited improvement in health. Hence, based on the above results it was concluded that program was a very successful one for the treatment of diabetes.
Lee, Won Chul;Shin, Gil Cho;Park, Seong Sik;Lim, Seong Woo;Kim, Kyung Ho;Keum, Dong Ho;Choi, Yun Jung
The Journal of Dong Guk Oriental Medicine
/
v.4
/
pp.53-66
/
1995
After 394 inpatients examined as to the result of combined treatment of Oriental and Western medicine on Dongguk Incheon oriental medicine hospital and Dongincheon Gil hospital from july/21/1994 to june/21/1995 for 11 months, the results were obtained as follows : 1. Distribution of sex ; male 187(47.5%), female 207(52.5%) 2. Distribution of age ; 60-69 years 110(28%), 50-59 years 88(22.3%), 70-79 years 84(21.3%), 40-49 years 39(9.9%), 30-39 years 34(8.6%) and the others 39(9.9%) 3. Distribution of disease ; cardiovascular disease 234(59.5%), musculoskeletal disease 62(15.7%) and the others 98(24.3%) 4. Distribution of consult from Oriental medicine to Western medicine ; internal medicine 373(87.4%), Orthopedic 32(7.5%) and the others 22(5.1%) 5. Distribution of test ; routine laboratory test 364(31.7%), chest X-ray 189(16.5%), LFT 177(15.4%), brain CT 129(11.2%) and the others 290(25.2%) 6. Distribution of Western medicine treatment ; fluid therapy 163(35.5%), antihypertensiv 100(21.8%), antibiotics 53(11.6%), oral hypoglycemic agents and insulin preperations 46(10.1%) and the others 95(20.8%) 7. Distribution of disease of consult from Western medicine to Oriental medicine ; obesity 14(34.2%), liver disease 13(31.7%), lumbago 8(19.5%) and the others 6(14.6%) Distribution of Oriental medicine treatment ; Acupuncture and Moxibustion 25(38.5%), astarvation cure 22(33.8%), Oriental herbs 18(27.7%) 8. Distribution of the admission period ; 1-10 days 148(37.6%), 11-20 days 105(26.6%), 21-30 days 69(17.5%) and the others 72(18.3%).
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