교육 및 사회경제적 수준과 당대사와의 연관성

엄영실,양선미,오병천,이정현,이기영,김연선,이시훈,임정수,임준,오대규,남문석,박이병 Korean Diabetes Association 2008 Korean diabetes journal Vol.32 No.4

연구 배경: 당뇨병 및 당뇨병 전기의 유병률은 점차 증가하고 있고, 당뇨병 전기의 많은 비율이 당뇨병으로 진행하며 심혈관질환의 유병률을 증가시킨다는 점 등에서 당뇨병 전기의 중요성이 점차 커지고 있다. 당뇨병이 교육 및 사회경제적 수준과 관련성이 있다는 연구들이 보고되어 있으나 당뇨병 전기와의 관련성에 대해서는 알려진 바가 적다. 본 연구에서는 일반인을 대상으로 하여 교육 및 사회경제적 수준과 당뇨병 전기를 포함한 당대사 이상과의 연관성에 대해 알아보고자 하였다. 방법: 2006년 9월부터 11월까지 인천광역시 동구 화수 2동에 거주하는 만 20세 이상의 지역주민을 대상으로 수차례 지역사회 홍보를 시행하여 자발적으로 참여한 주민 1,000명을 모집하였다. 이 중 설문지 조사가 완료된 사람은 총 951명으로, 기존에 당뇨병으로 진단받은 69명을 제외한 882명(남자 241명, 여자 641명)을 대상으로 분석하였다. 교육수준에 따라 무학 및 초등학교 졸업, 중학교 졸업 및 고등학교 졸업, 대학교 이상의 세 그룹으로 나누었으며 주관적인 사회경제적 수준에 따라 "못사는 편", "보통", "잘사는 편"의 세 그룹으로 나누었다. 대상자들은 및 75 g 경구당부하검사를 통해 미국당뇨병학회 기준에 따라 정상, 당뇨병 전기, 당뇨병의 세 그룹으로 분류하였고, 교육 및 사회경제적 수준과 당대사 이상과의 연관성에 대해 분석하였다. 결과: 전체 882명 중에서 정상군은 300명(34.0%, 남자 68명, 여자 232명), 당뇨병 전기군은 470명(53.3%, 남자 138, 여자 332명), 당뇨병군은 112명(12.7%, 남자 35명, 여자 77명)이었다 남자에서는 당뇨병 및 당뇨병 전기 모두 교육수준 및 사회경제적 수준과 관계가 없었으나, 여자에서는 정상군에 비해 당뇨병군 및 당뇨병 전기군에서 저학력군이 더 많았다(P < 0.001, P < 0.001, respectively). 다변량로짓 회기분석을 통한 나이, 교육수준, 사회경제적 수준 및 체질량지수의 보정 후 당뇨병군에서는 고학력에 대한 저학력의 오즈비는 1.88(95% CI 1.01-3.51, P = 0.049)이었고 당뇨병 전기군에서 고학력에 대한 저학력의 오즈비는 2.00(95% CI 1.06-3.78, P = 0.032)으로 모두 통계적인 유의성이 있었다. 여자에서 사회경제적 수준과 당대사 이상과의 관계는 통계학적인 유의성을 나타내지 못했다. 결론: 여자에서 당뇨병뿐만 아니라 당뇨병 전기에서 정상군과 비교 시 저학력군이 더 많다는 것을 알 수 있었으나 사회경제적 수준과 당대사와의 관계는 통계학적 유의성이 명확하지 않았다.

Links between Thyroid Disorders and Glucose Homeostasis

엄영실,Jessica R. Wilson,Victor J. Bernet 대한당뇨병학회 2022 Diabetes and Metabolism Journal Vol.46 No.2

Thyroid disorders and diabetes mellitus often coexist and are closely related. Several studies have shown a higher prevalence of thyroid disorders in patients with diabetes mellitus and vice versa. Thyroid hormone affects glucose homeostasis by impacting pancreatic β-cell development and glucose metabolism through several organs such as the liver, gastrointestinal tract, pancreas, adipose tissue, skeletal muscles, and the central nervous system. The present review discusses the effect of thyroid hormone on glucose homeostasis. We also review the relationship between thyroid disease and diabetes mellitus: type 1, type 2, and gestational diabetes, as well as guidelines for screening thyroid function with each disorder. Finally, we provide an overview of the effects of antidiabetic drugs on thyroid hormone and thyroid disorders.

Notch1 Has an Important Role in β-Cell Mass Determination and Development of Diabetes

엄영실,권아영,곽경민,윤진영,박희경,김광원,김병준 대한당뇨병학회 2021 Diabetes and Metabolism Journal Vol.45 No.1

Background Notch signaling pathway plays an important role in regulating pancreatic endocrine and exocrine cell fate during pancreas development. Notch signaling is also expressed in adult pancreas. There are few studies on the effect of Notch on adult pancreas. Here, we investigated the role of Notch in islet mass and glucose homeostasis in adult pancreas using Notch1 antisense transgenic (NAS). Methods Western blot analysis was performed for the liver of 8-week-old male NAS mice. We also conducted an intraperitoneal glucose tolerance test (IPGTT) and intraperitoneal insulin tolerance test in 8-week-old male NAS mice and male C57BL/6 mice (control). Morphologic observation of pancreatic islet and β-cell was conducted in two groups. Insulin secretion capacity in islets was measured by glucose-stimulated insulin secretion (GSIS) and perifusion. Results NAS mice showed higher glucose levels and lower insulin secretion in IPGTT than the control mice. There was no significant difference in insulin resistance. Total islet and β-cell masses were decreased in NAS mice. The number of large islets (≥250 µm) decreased while that of small islets (<250 µm) increased. Reduced insulin secretion was observed in GSIS and perifusion. Neurogenin3, neurogenic differentiation, and MAF bZIP transcription factor A levels increased in NAS mice. Conclusion Our study provides that Notch1 inhibition decreased insulin secretion and decreased islet and β-cell masses. It is thought that Notch1 inhibition suppresses islet proliferation and induces differentiation of small islets. In conclusion, Notch signaling pathway may play an important role in β-cell mass determination and diabetes.

Propylthiouracil 재복용 후 발생한 ANCA 연관 혈관염 1예

엄영실,최병호,이시훈 대한갑상선학회 2011 International Journal of Thyroidology Vol.4 No.2

Evaluation of Stress in Korean Patients with Diabetes Mellitus Using the Problem Areas in Diabetes-Korea Questionnaire

엄영실,박화선,김세현,양선미,남문석,이형우,이기영,이시훈,김연선,박이병 대한당뇨병학회 2011 Diabetes and Metabolism Journal Vol.35 No.2

Background: It is known that diabetes and stress are directly or indirectly related, and that it is important to evaluate stress in patients with diabetes. The relationship between Korean diabetics and diabetes-related stress has never been reported. The objective of this study was to develop a stress questionnaire suitable for use with Korean diabetics and to evaluate its utility. Methods: This study subjects were 307 Korean diabetics, aged 40 to 74 years old, who visited the Department of Endocrinology and Metabolism at Gachon University Gil Hospital, Yeungnam University Medical Center, and Inha University Hospital in Korea between March 2006 and February 2008. We developed a Korean version of Polonsky’s Problem Areas in Diabetes (PAID) stress questionnaire (PAID-K) and used it to assess degrees of stress in our sample of Korean patients. We evaluated the utility of the questionnaire and analyzed the relationships between clinical characteristics of the study subjects and degrees of stress. Results: Cronbach’s alpha for PAID-K was 0.95, and PAID-K scores were significantly correlated with Hypoglycemia Fear Survey scores (r=0.44, P<0.05) and State Trait Anxiety Inventory-6 scores (r=0.21, P<0.05). PAID-K scores were significantly higher in patients with longer durations of diabetes, patients using insulin, and female patients (P=0.02, P=0.038, and P=0.001, respectively). The score also tended to increase as HbA1c levels increased, except for very high HbA1c levels (above 11%) (P for trend<0.05). Conclusion: We developed the PAID-K questionnaire and demonstrated its utility to evaluate levels of stress in diabetic patients in Korea.

글루카곤양 펩티드-1 유사체

엄영실 ( Young Sil Eom ),김병준 ( Byung Joon Kim ) 대한내과학회 2014 대한내과학회지 Vol.87 No.1

The prevalence of diabetes is increasing worldwide. Glycemic control has been shown to prevent microvascular complications. Many oral hyperglycemic drugs and insulin are being used in the treatment of diabetes, but the effects of those treatments are suboptimal. The two incretin hormones GLP-1 and GIP are released from L- and K-cells, respectively, in response to nutrient intake. GLP-1 stimulates glucose dependent insulin release. Recently, incretin hormone-based therapies, including GLP-1 agonists and DPP-4 inhibitors, have been used as new treatment options to control glucose levels in patients with type 2 diabetes mellitus. The purpose of this article is to review the efficacy and safety of GLP-1 agonists in the treatment of type 2 diabetes. (Korean J Med 2014;87:9-13)

교육 및 사회경제적 수준과 당대사와의 연관성

엄영실 ( Young Sil Eom ),양선미 ( Sun Mee Yang ),오병천 ( Pyung Chun Oh ),이정현 ( Jung Hyun Lee ),이기영 ( Ki Young Lee ),김연선 ( Yeun Sun Kim ),이시훈 ( Si Hoon Lee ),임정수 ( Jung Soo Im ),임준 ( Jun Yim ),오대규 ( Dae Kyu Oh 대한당뇨병학회 2008 Diabetes and Metabolism Journal Vol.32 No.4

그레이브스병 환자에서 발생한 복수 및 심한 복부팽만을 동반한 가역적 폐동맥 고혈압 1예

최병호,엄영실,김세현,최현석,정욱진,이시훈 대한내분비학회 2011 Endocrinology and metabolism Vol.26 No.3

Patients with hyperthyroidism can develop left ventricular dysfunction and heart failure, but severe pulmonary hypertension association with hyperthyroidism is rarely seen. Herein, we describe the case of a 27-year-old female who presented with abdominal distension accompanied by pulmonary arterial hypertension and Graves’ disease. Her pulmonary arterial hypertension was improved by treating the hyperthyroidism and pulmonary artery hypertension. Additionally, the patient’s symptoms of right-side heart failure improved after pulmonary arterial pressure was reduced. Hyperthyroidism should be regarded as a reversible cause of associated pulmonary arterial hypertension.

성인에서 Mycoplasma pneumoniae 폐렴과 동반된 Stevens-Johnson 증후군 1예

이정현,엄영실,한우진,윤규현,이서영,서종구,김진용,김수연,박윤수,서일혜,조용균 대한감염학회 2008 Infection and Chemotherapy Vol.40 No.6

Stevens-Johnson syndrome is an acute mucocutaneous syndrome that is related to drugs and infections. Mycoplasma pneumoniae infection is known as one of the causes of Stevens-Johnson syndrome in children and young adults. In Korea, Mycoplasma pneumoniae infection is rarely reported as a cause of Stevens-Johnson syndrome in adults. We report a case of Stevens- Johnson syndrome associated with Mycoplasma pneumoniae pneumonia in an adult patient. A 34-years old woman was admitted to our hospital and was diagnosed with mycoplasma pneumonia. At the time of admission, she had hemorrhagic crusts on her lips. On the 2nd day of admission, target lesions also developed on her skin. We diagnosed her disease as Stevens- Johnson syndrome associated with Mycoplasma pneumoniae pneumonia. She completely recovered from pneumonia and Stevens-Johnson syndrome after treatment with antibiotics and conservative management.

Genetic and Clinical Characteristics of Korean Patients with Isolated Hypoparathyroidism: From the Korean Hypopara Registry Study

박소영,엄영실,조병호,이현승,유승희,이기영,진현석,정윤석,정태식,이시훈,정태식 대한의학회 2013 Journal of Korean medical science Vol.28 No.10

Isolated hypoparathyroidism (IH) shows heterogeneous phenotypes and can be caused by defects in a variety of genes. The goal of our study was to determine the clinical features and to analyze gene mutations in a large cohort of Korean patients with sporadic or familial IH. We recruited 23 patients. They showed a broad range of onset age and various values of biochemical data. Whole exome sequencing was performed on two affected cases and one unaffected individual in a family. All coding exons and exon-intron borders of GCMB, CASR, and prepro-PTH were sequenced using PCR-amplified DNA. In one family who underwent the whole exome sequencing analysis, approximately 300 single nucleotide changes emerged as candidates for genetic alteration. Among them, we identified a functional mutation in exon 2 of GCMB (C106R) in two affected cases. Besides, heterozygous gain-of-function mutations in the CASR gene were found in other subjects; D410E and P221L. We also found one single nucleotide polymorphism (SNP) in the prepro-PTH gene, five SNPs in the CASR gene, and four SNPs in the GCMB gene. The current study represents a variety of biochemical phenotypes in IH patients with the molecular genetic diagnosis of IH.