2형 당뇨병에서 Repaglinide의 유용성에 대한 연구

박철영,김영설,이현철,장학철 대한당뇨병학회 2001 임상당뇨병 Vol.2 No.4

연구배경 : 제2형 당뇨병 환자의 치료에 새로운 약제인 repaglinide와 기존에 상용하던 gliclazide를 비교하여 repaglinide의 유효성 및 안정성을 비교 평가 하고자 하였다. 방법 : 154명의 환자를 1:1 비율로 repaglinide와 gliclazide군으로 무작위 배정하였다. 약제 투여 전에 탈락된 2명을 제외한 152명의 환자 중 127명의 환자가 투약을 마쳤다. 투약 방법은 2주간의 약제 중지 기간 후에 4주동안 약제 용량 결정 기간을 통해 결정된 용량을 8주간 지속적으로 투여 하였다. 약제 용량은 repaglinide는 0.5mg, 1mg 또는 2mg 1정을 매 주식사 전에 경구 투여하였으며, gliclazide는 80mg 1정 또는 1/2정으로 시작해 제품 설명서에 따라 투여하였다. 치료 전 후의 당화혈색소, 공복혈당, 식후혈당 및 지질대사 지표 등의 검사로 유효성을, 여러 가지 생화학적,혈액학적 검사 및 저혈당빈도 등으로 안정성을 각각 평가하였다. 결과 : 12주 투여 후 repaglinide군과 gliclazide군 모두에서 당화혈색소 및 공복혈당의 유의한 감소를 보였다. 그러나 당화혈색소 및 공복혈당의 감소 정도는 두 군간의 유의한 차이는 없었다. 60분 및 90분의 식후혈당의 변화값의 평균은 repaglinide군에서는 기저치와 비교하여 유의하게 감소하였지만, gliclazide군에서는 유의한 감소를 보이지 않았다. 그러나 두 군의 60분, 90분 및 120분에서의 식후혈당 감소 정도는 두 치료군간에 유의한 차이는 없었다. 총콜레스테롤의 값의 유의한 감소가 gliclazide군에서 있었지만 변화 정도는 두 치료군간의 차이가 없었다. 체중변화는 두 군간 통계학적으로 유의한 차이가 없었다. 두 군모두 우려할 만한 약제 이상반응은 없었다. 저혈당 증상은 gliclazide군이 repaglinide군보다 많았지만 두 군간에 유의한 차이는 없었다. 결론 : 제2형 당뇨병 환자에서 repaglinide는 혈당조절에 대하여 gliclazide와 동등한 유효성을 가지고 있으며 안전한 것으로 사료된다. Background : This study was designed to compare the efficacy and safety of repag linide with gliclazide in a 12-week open-labelled, randomized, parallel group, multi-center study of outpatients with type 2 diabetes. Methods : A total of 182 patients were screened . 154 patients were randomized in a 1:1 ratio of repaglinide (78 patients) and gliclazide (76 patients). Two randomized patients withdrew from the trial prior to receive any trial medication. At the end of trial, 127 patients completed. The study protocol included a screening visit to assess patient eligibility; a washout period of 2 weeks, a titration period of 4 weeks, and a subsequent 8 week maintenance period. Repaglinide was a dministered preprandially with the three main meals, and gliclazide was taken according to the product labeling . Results : After 12 weeks treatment, both repaglinide and gliclazide resulted in significant reductions in HbA_(1c) (p<0.001; both treatment groups) and fasting blood glucose (FBG) values (p<0 .001; both treatment groups). Significant reductions in postprandial blood glucose (PPBG) values were found in the repaglinide group at 60 minutes (p<0.05) and at 90 minutes (p<0.05). However, no significant treatment differences in HbA 1c, FBG, or PPBG were observed. Both number of patients and frequency of reported hypoglycemic events appeared to be lower in the repaglinide group than in the gliclazide group (not significant). Conclusion: Overall, the results showed that repaglinide is well-to lerated and equally effective in controlling HbA_(1c), FBG and PPBG as gliclazide.

Diabetes and Muscle Dysfunction in Older Adults

Hak-Chul Jang 대한노인병학회 2019 Annals of geriatric medicine and research Vol.23 No.4

Aging and diabetes are both risk factors for functional decline or disability in older adults with diabetes. Recent studies demonstrated that the presence of diabetes significantly increases the risk of sarcopenia, frailty, and geriatric syndrome including fall, hospitalization, disability, and mortality in older adults. They have also suggested that sarcopenia, frailty, and geriatric syndrome should be categorized as a third category of complications in addition to the traditional micro- and macro-vascular complications leading to disability in older adults with diabetes. Prevention of functional decline is a crucial strategy in geriatric management. Recovery of functional independence from dependence or disability is uncommon and lengthy. Assessments of functional status and geriatric syndrome including sarcopenia or frailty should be mandatory in older adults with diabetes to promote early interventions based on physical exercise and nutrition education. This brief review discussed age-associated and diabetes-associated muscle changes and their association with functional decline.

How to Diagnose Sarcopenia in Korean Older Adults?

Hak Chul Jang 대한노인병학회 2018 Annals of geriatric medicine and research Vol.22 No.2

In 2017, Korea became an aged society, with the percentage of the population aged ≥65 years accounting for 14% of the total Korean population. The increasing number of older adults and the current health status of Korean older adults had led to increased medi-cal expenditure and social problems. Sarcopenia, defined as the progressive decrease in skeletal muscle mass and strength, develops as a consequence of aging. Sarcopenia is also associated with a risk of adverse health outcomes such as frailty, physical disability, poor quality of life, and death. Thus, sarcopenia is a serious clinical problem among older adults. The International Classification of Diseases, Tenth Revision, Clinical Modifica-tion code for sarcopenia, M62.84, became available on October 1, 2016, in the United States. The diagnosis and treatment of sarcopenia urgently requires the establishment of an operational definition for sarcopenia in Korean older adults. In this article, I suggest a screening strategy and diagnostic criteria for sarcopenia in this population. (Ann Geriatr Med Res 2018;22:73-79)

한국인 임신부에서 임신성 당뇨병의 임상적 의미와 진단

장학철(Hak Chul Jang) 대한여성건강학회 2002 여성건강 Vol.3 No.1

당뇨병환자의 적혈구막 인지질지방산의 변화

장학철(Hak Chul Jang),박경수(Kyong Soo Park),홍성관(Sung Kwan Hong),신찬수(Chan Soo Shin),한은경(Eun Kyung Han),이문규(Moon Kyu Lee),김성연(Seong Yeun Kim),이홍규(Hong Kyu Lee),고창순(Chang Soon Koh),민헌기(Hun Ki Min),이병두(Byoung 대한내과학회 1990 대한내과학회지 Vol.39 No.5

N/A Several differences in phospholipid fatty acid composition of the erythrocyte membrane have been reported in diabetes mellitus, and these remain controversial. To evaluate the dietary fat intake pattern and the fatty acid metabolism in Korean diabetic patients, fatty acids in the erythrocyte membrane were determined by gas-liquid chromatography in 10 subjects with IDDM, 36 subjects with NIDDM, and 37 control subjects. Significant increases in palmitic acid (p<0.01) and oleic acid (p <005) were observed in erythrocytes from IDDM patients. Significant increases in myristric acid (p<0. 05), palmitic acid (p<0.01), and oleic acid (p<0.05), along with significant decreases in docosahexaenoic acid (p<0.01), were observed in erythrocytes from nonobese NIDDM patients, Similar fatty acid compositions in erythrocytes were noticed in obese NIDDM patients, except for eicosadienoic acid. The P/S ratios in the erythrocyte membrane fatty acids were significantly lower in diabetic patients than in the controls (0.92±0.03 vs 1.01±0.02, p<0.05 in IDDM; 0.85±0.03 vs 0.99±0.02, p<0.01 in nonobese NIDDM; 0.81±0.07 vs 0.99±0.02, p<0.05 in obese NIDDM). The arachidonic: linoleic acid ratio and oleic: stearic acid ratio in the erythrocyte membrane were not different between the diabetic patients and the controls, but the eicosapentaenoic: docosahexaenoic acid ratio was lower in the NIDDM patients than in the controls. These results suggest that an increase in the peroxidation of fatty acids in the erythrocyte membrane might result in a decrease of polyunsaturated fatty acids, especially DHA, and since membrane fatty acids are modified by receut dietary fat intake, we should be concerned about diet therapy, especially fat intake in diabetes. Fish oil supplements in diabetic patients should also be used with caution.

Association of vitamin D deficiency with incidence of type 2 diabetes in high-risk Asian subjects

Lim, Soo,Kim, Min Joo,Lim, Soo,Kim, Min Joo,Choi, Sung Hee,Shin, Chan Soo,Park, Kyong Soo,Jang, Hak Chul,Billings, Liana K,Meigs, James B,Choi, Sung Hee,Shin, Chan Soo,Park, Kyong Soo,Jang, Hak Chul,B Oxford University Press 2013 The American journal of clinical nutrition Vol.97 No.3

관상심장질환과 Homocysteine 대사

장학철 대한당뇨병학회 1999 Diabetes and Metabolism Journal Vol.23 No.5

임신성 당뇨병의 임상연구

장학철 대한당뇨병학회 1996 Diabetes and Metabolism Journal Vol.20 No.4

당뇨병과 임신

장학철 약업신문사 2000 의약정보 Vol.2000 No.4

성인 질환의 원인으로서의 태내 환경

장학철 대한당뇨병학회 2001 Diabetes and Metabolism Journal Vol.25 No.3