• Korean Journal of Clinical Laboratory Science
• /
• v.49 no.2
• /
• pp.114-120
• /
• 2017

There have been many studies to develop methods for predicting diabetes and to prevent diabetes. The validity of glycated hemoglobin (HbA1c), one of the commonly known tools in predicting diabetes, has been verified by many previous studies. In this study, we examined the cutoff value of HbA1c for diabetes and impaired fasting glucose (IFG). Based on this study, we proposed a proper clinical guideline and evaluated the validation of the guideline. Excluding those without blood glucose and HbA1c data, we used the data of 5,161 subjects (2,281 men and 2,880 women) over the age of 20 years from the 2015 Korean National Health and Nutrition Examination Survey. The correlation efficient of fasting plasma glucose (FPG) and HbA1c was 0.79, indicating a strong relationship. Howeve, the correlation efficient of FPG and HbA1c was low, showing 0.27 in non-diabetes, 0.39 in IFG, and 0.66 in diabetes, showing a strong relationship. The cutoff value of HbA1c for predicting diabetes using ROC curve was 6.05% (sensitivity 84.6%, and specificity 92.0%), and AUC was 0.941 (0.937 in men, and 0.946 in women). The cutoff value of HbA1c for predicting IFG using ROC curve was 5.55% (sensitivity 64.5%, and specificity 70.0%), and AUC was 0.733 (0.708 in men, and 0.764 in women). Therefore, it may not be appropriate to apply the guidelines for diagnosing IFG since sensitivity and specificity were below 70%. For future studies retarding the cutoff value of HbA1c in predicting IFG, high sensitivity and specificity are expected if we segment the reference range of IFG.

• Applied Biological Chemistry
• /
• v.44 no.3
• /
• pp.143-147
• /
• 2001

An osmometrical method for determination of the degree of hydrolysis (DH) of hemoglobin was comparatively examined through TNBS (trinitrobenzene) sulfonic acid) method using two experimental variables $({\alpha}\;and\;{\beta})$, which were chosen based on correlation curves between hydrolysis equivalents (h) and $leucine-NH_2$ equivalents. DH values measured through osmometry and TNBS method highly correlated with $R^2$ values of $0.974{\sim}0.991$, irrespective of the reaction pHs and types of enzyme used. $DH_{osm}/DH_{TNBS}$ was >$1.438{\sim}1.656$ depending on the hydrolysis pH $7.5{\sim}10.0)$. Correlation euqations were well fit for measuring DH of Hb hydrolysate at different pH conditions. $DH_{osm}/DH_{TNBS}$ for co-treatment system using Esperase and Flavourzyme was 1.658, in good agreement with that of 1.656 for the single enzyme (Esperase) system. Thus, the osmometrical method was suggested to be a convenient, reliable, and rapid method for determination of DH of hemoglobin hydrolysates.

• Korean Journal of Clinical Pharmacy
• /
• v.24 no.3
• /
• pp.193-198
• /
• 2014

Objective: This study was conducted to compare the adherence, clinical and economical utility of fixed-dose combination tablets of sitagliptin/metformin with concomitant administration of sitagliptin and metformin in patients with type 2 diabetes mellitus. Methods: Adherence was measured as the medication possession ratio (MPR) of ${\geq}80%$, and MPR was calculated as the number of total prescription days divided by the total treatment period. Hemoglobin $A_{1C}$ ($HbA_{1c}$) differences between baseline and predetermined periods were analyzed. Proportions of patients who achieved $HbA_{1c}$ less than 6.5% for three or more consecutive times were compared. To evaluate cost-effectiveness, prices of sitagliptin, metformin and sitagliptin/metformin tablets were investigated. Results: More than 90% of patients showed adherence in both groups (92.0% in fixed-dose combination group vs 95.9% in concomitant administration group), and there was no statistically significant difference (P = 0.113). Proportion of patients with HbA1c less than 6.5% for three or more consecutive times tended to be somewhat higher in fixed dose combination group than in concomitant administration group without a statistically significant difference (32.6% vs. 28.0%, P = 0.344). Total price of metformin and sitagliptin was cheaper up to 222 KRW in the case of fixed-dose combination tablets compared to the case of concomitant administration. Conclusion: The sitagliptin/metformin fixed-dose combination tablet had a similar patient adherence and was not significantly different in efficacy to the concomitant administration of each component. In terms of drug prices, fixed-dose combination tablets were cheaper than concomitant administration of each tablet.

• Clinical Pain
• /
• v.19 no.1
• /
• pp.32-35
• /
• 2020

Treatment-induced neuropathy in diabetes (TIND) is a reversible neuropathy that occurs in patients with diabetes, usually after a fast improvement in glycemic control. TIND is defined as the sudden onset of neuropathic pain or autonomic dysfunction with a large improvement in glycemic control (glycated hemoglobin [HbA1c] level of ≥ 2% over 3 months). We report the first case of a 24-year-old woman with type 1 diabetes mellitus who developed TIND in Korea. Her HbA1c level had decreased from 16.7% to 7.3% within a 3-month period. She developed acute-onset, severe, and continuous burning pain affecting her back and lower extremities. She was administered tapentadol (50 mg), pregabalin (75 mg), and vitamin B with minerals twice daily for neuropathic pain. She complained of orthostatic hypotension; thus, midodrine (2.5 mg) and anti-embolic stockings were prescribed. She almost completely recovered 6 months after the onset. A physician should be aware of TIND and gradually reduce HbA1c levels to prevent the occurrence of TIDN. They must also try to provide relief from severe pain or autonomic dysfunction and emphasize on an almost complete recovery.

• Journal of Gastric Cancer
• /
• v.19 no.3
• /
• pp.365-371
• /
• 2019

The role of surgical intervention in patients with diabetic gastroparesis is unclear. We report a case of a 37-year-old man with a history of recurrent episodes of vomiting and long-standing type 2 diabetes mellitus. Esophagogastroduodenoscopy did not reveal any findings of reflux esophagitis or obstructive lesions. A gastric emptying time scan showed prolonged gastric emptying half-time (344 minutes) indicating delayed gastric emptying. Laboratory tests revealed elevated fasting serum glucose and glycosylated hemoglobin (HbA1c, 12.9%) and normal fasting C-peptide and insulin levels. We performed Roux-en-Y reconstruction after subtotal gastrectomy to treat gastroparesis and improve glycemic control, and the patient showed complete resolution of gastrointestinal symptoms postoperatively. Barium swallow test and gastric emptying time scan performed at follow-up revealed regular progression of barium and normal gastric emptying. Three months postoperatively, his fasting serum glucose level was within normal limits without the administration of insulin or oral antidiabetic drugs with a reduced HbA1c level (6.9%). Long-limb Roux-en-Y reconstruction after subtotal gastrectomy may be useful to treat severe diabetic gastroparesis by improving gastric emptying and glycemic control.

• Nutrition Research and Practice
• /
• v.11 no.1
• /
• pp.57-63
• /
• 2017

BACKGROUND/OBJECTIVES: The level of serum albumin is an index of nourishment care and management. However, the distribution and correlates of serum albumin levels among individuals with motor disorders have not been reported until now. Therefore, we examined the distribution and correlates of serum albumin levels among individuals with motor disorders. SUBJECTS/METHODS: A cross-sectional study on 249 individuals with motor disabilities (144 men, mean age: 51.4 years; 105 women, mean age: 51.4 years) was conducted at five institutions in Ibaraki Prefecture, Japan in 2008. The results were compared with data from the National Health and Nutrition Survey. RESULTS: The mean serum albumin levels were $4.0{\pm}0.4g/dL$ for men and $3.8{\pm}0.5g/dL$ for women. Overall, 17 (11.8%) men and 25 (23.8%) women had hypoalbuminemia (serum albumin level ${\leq}3.5g/dL$); these proportions were greater than those among healthy Japanese adults (${\leq}1%$). Low serum albumin level was related with female sex, older age, low calf circumference, low relative daily energy intake, low hemoglobin (Hb), low blood platelet count, low high-density lipoprotein cholesterol (HDL-C), low $HbA_{1c}$, and high C-reactive protein (CRP) levels. The strongest correlates, based on standardized betas, were Hb (0.321), CRP (-0.279), and HDL-C (0.279) levels. CONCLUSIONS: These results indicate that the prevalence of hypoalbuminemia is higher in individuals with motor disabilities than in healthy individuals and that inflammation is a strong negative correlate of serum albumin levels. Therefore, inflammation should be examined for the assessment of hypoalbuminemia among institutionalized individuals with motor disabilities.

• Journal of Acupuncture Research
• /
• v.38 no.3
• /
• pp.192-199
• /
• 2021

Background: In this retrospective study, we aimed to determine which diagnostic tests were associated with an improvement in Bell's palsy symptoms. Methods: There were 30 patients who visited Kyung Hee University Korean Medicine Hospital from April 1, 2017 to February 29, 2020, and who received East-West collaboration treatment for Bell's palsy. The tests included electroneurography (ENoG), electromyography (EMG), hematology, and heart rate variability (HRV) results which were used to determine if any test correlated with improvement of Bell's palsy symptoms. Results: The initial severity of symptoms did not correlate with the tests performed, with the exception of mean corpuscular hemoglobin concentration (p = 0.013). For both ENoG for oculi degeneration and mean EMG tests, the rate of nerve degeneration showed a significant negative correlation with the improvement of Bell's palsy symptoms. Amongst the HRV test indicators, the square root of the mean of the sum of the squares of differences between the adjacent normal R-R wave interval, the standard deviation of intervals, total power, very low frequency, and high frequency of the wave was negatively correlated with improvement of Bell's palsy symptoms. Similarly, glycosylated hemoglobin Type A1c (HbA1c) and erythrocyte sedimentation rate (ESR) showed a negative correlation with improvement of symptoms of Bell's palsy. With the exception of HbA1c and ESR, the remaining hematology test results showed no significant difference when comparing before and after treatment. Conclusion: ENoG, EMG, HRV test, HbA1c, and ESR negatively correlated with improvements in Bell's palsy symptoms and may determine the prognosis of Bell's palsy.

• International journal of advanced smart convergence
• /
• v.9 no.1
• /
• pp.37-46
• /
• 2020

Cerebral vascular surgery can damage patients' motor and sensory nerves; therefore, neuromonitoring is performed intraoperatively. Patients with diabetes often have peripheral neuropathy and may be prone to nerve damage during surgery. This study aimed to identify factors that should be considered when diabetic patients undergo intraoperative neuromonitoring during brain vascular surgery and to present new criteria. Methods: In patients with and without diabetes who underwent cerebrovascular surgery (n = 30/group), we compared the intraoperative stimulation intensity, postoperative motor power and sensory, glycated hemoglobin (HbA1c) and glucose levels, and imaging findings. Results: Fasting glucose, blood glucose, and HbA1c levels were 10%, 12.1%, and 9.7%, respectively; they were higher in patients with than in patients without diabetes. Two patients with diabetes had weakness, and 10 required increased Somato sensory evoked potential (SSEP) stimulation, while in 16, motor power recovered over time rather than immediately. The non-diabetic group had no weakness after surgery, but 10 patients required more increased SSEP stimulation. The diabetic group showed significantly more abnormal test results than the non-diabetic group. Conclusion: For patients with diabetes undergoing surgery with intraoperative neuromonitoring, whether diabetic peripheral neuropathy is present, their blood glucose level and the anesthetic used should be considered.

• The Korean Journal of Food And Nutrition
• /
• v.21 no.4
• /
• pp.530-535
• /
• 2008

Evidence for the effects of different health behaviors, including diet, in elderly diabetes is currently limited. The aim of this study was to compare the quality of diet and health behaviors in Korean elderly T2DM patients, using a glycemic control. T2DM elders(>65 yr, n=48) were recruited and categorized by the concentration of glycated-hemoglobin HbA1c; subjects with HbA1c<7% were the good control(GC) group, and subjects with $HbA1c{\geq}8%$ constituted the poor control(PC) group. General characteristics, self-management behavior questionnaires, and 3-d diet records were all collected and assessed. No significant differences in general characteristics between GC and PC were detected, with the exception of a higher level of education in GC(p<0.05). A twofold longer duration of diabetes was observed in PC as compared to GC(p<0.01). The GC group did exercise for a longer time(p<0.001), and had an earlier beginning of diabetes self-management education (DSME) by healthcare practitioners using a team teach as compared with the PC group(p<0.05). The total dietary quality index(p<0.001) and individual index for carbohydrate(p<0.001) or vegetables and fruit(p<0.05) were better in GC than in PC. Therefore, the earlier DSME including intensive exercise and balanced diet selection should be expected to improve glycemic control in diabetic Korean elders.

• Journal of Korean Clinical Nursing Research
• /
• v.28 no.3
• /
• pp.277-288
• /
• 2022

Purpose: This study was conducted to evaluate the effects of the insulin therapy adherence program (INSTA GRAM) for patients with type 2 diabetes mellitus. Methods: This study examined a total of 63 patients with type 2 diabetes for whom the initiation of insulin therapy is being considered or within 6 months of undergoing insulin therapy. INSTAGRAM is a stage-specific intervention consisting of strategies for motivating patients to initiate and maintain insulin therapy using the transtheoretical model on the stages of change, the process of change, and self-efficacy. The participants were randomly assigned to either the INSTAGRAM group (experimental group, n=32) or the standard diabetes education group (control group, n=31). The INSTAGRAM group received 6 sessions over 8 weeks(face-to-face education was conducted in the first and last sessions, and telephone coaching was conducted from the second to fifth sessions). The outcomes were measured by psychological insulin resistance, self-efficacy, and glycosylated hemoglobin (HbA1c). Results: Psychological insulin resistance (p<.001), self-efficacy (p<.001), and HbA1c (p=.024) of the participants in the INSTAGRAM group significantly improved compared to those in the control group. Conclusion: INSTAGRAM is effective in overcoming psychological insulin resistance and improving self-efficacy and HbA1c. Therefore, the INSTAGRAM can be recommended as a nursing intervention for type 2 diabetic patients who delay the initiation of insulin therapy.