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Kim, Sin Gon,Kim, Nam Hoon,Ku, Bon Jeong,Shon, Ho Sang,Kim, Doo Man,Park, Tae Sun,Kim, Yong‐,Seong,Kim, In Joo,Choi, Dong Seop John Wiley & Sons Ltd 2017 Journal of diabetes investigation Vol.8 No.3
<P><B>Abstract</B></P><P><B>Aims/Introduction</B></P><P>To assess the time to initiation of insulin therapy, and concurrently investigate both patient‐ and physician‐related factors associated with delaying insulin therapy in Korean patients with type 2 diabetes uncontrolled by oral hypoglycemic agents (OHAs).</P><P><B>Materials and Methods</B></P><P>This prospective, observational disease registry study was carried out across 69 centers in Korea. Type 2 diabetes patients who had received two or more OHAs within the past 5 years, had a glycated hemoglobin ≥8% in the past 6 months and had not received insulin were included. Data recorded on data collection forms during a 12‐month period were analyzed.</P><P><B>Results</B></P><P>Of 2168 patients enrolled, 1959 were evaluated and classified as the insulin‐initiated or insulin‐delayed group. Insulin was prescribed for just 20% of the patients during a 1‐year follow‐up period, and less than half (44.5%) of the patients who were taking two OHAs started insulin after 6 years. Patient‐related factors for delay in insulin initiation included older age, shorter duration of diabetes and lower glycated hemoglobin. Physician‐related factors included age (~50 to <60 years), sex (women) and number (<1000) of patients consulted per month. Patient refusal (33.6%) and physicians’ concerns of patient non‐compliance (26.5%) were the major physician‐reported reasons for delaying insulin therapy. Inconvenience of insulin therapy (51.6%) and fear of injection (48.2%) were the major reasons for patient refusal.</P><P><B>Conclusions</B></P><P>Insulin initiation is delayed in patients with type 2 diabetes uncontrolled by two or more OHAs in Korea. Patient‐ and physician‐related factors associated with this delay need to be addressed for better diabetes management.</P>
Diagnosis and Management of Metabolic Syndrome and Obesity in Chronic Liver Disease
( Sin Gon Kim ) 대한간학회 2016 Postgraduate Courses (PG) Vol.2016 No.1
The co-occurrence of metabolic risk factors for both type 2 diabetes and CVD (abdominal obesity, hyperglycemia, dyslipidemia, and hypertension) suggested the existence of a “metabolic syndrome”. Other names applied to this constellation of findings have included syndrome X, the insulin resistance syndrome, the deadly quartet, or the obesity dyslipidemia syndrome. There are several definitions for the metabolic syndrome. Non-alcoholic liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome, with insulin resistance as the main pathogenetic mechanism. Recent data indicate that hyperinsulinemia is probably the consequence rather than cause of NAFLD and NAFLD can be considered an independent predictor of cardiovascular disease. Furthermore, chronic liver disease by hepatitis C or B superimposed with components of metabolic syndrome also may be associated with the increased risk of mortality and/or liver-related mortality. The key clinical implication of a diagnosis of metabolic syndrome is identification of a patient who needs aggressive lifestyle modification focused on weight reduction and increased physical activity. Also, it is needed to treat cardiovascular risk factors if they persist despite lifestyle modification. In this lecture, I will focus on diagnosis and management of metabolic syndrome and obesity in chronic liver disease.
Kim, Sin Gon,Hahm, Jong Ryeal,Kim, Duk Kyu,Cho, Sung Rae,Choi, Dong Seop John Wiley & Sons Ltd 2015 Journal of diabetes investigation Vol.6 No.3
<P><B>Aims/Introduction</B></P><P>To assess the current status of glycemic control in patients with type 2 diabetes treated with a combination of metformin and sulfonylurea for >3 months, as measured by glycosylated hemoglobin (HbA1c).</P><P><B>Materials and Methods</B></P><P>Data on patient demographics, diabetic complications, HbA1c, fasting plasma glucose (FPG) and type of treatment were collected in this multicenter, cross-sectional, non-interventional study.</P><P><B>Results</B></P><P>From April 2008 to February 2009, 5,628 patients were recruited from 299 centers in Korea. Patients characteristics (mean ± SD) were as follows: age 58.4 ± 10.8 years, duration of diabetes 6.1 ± 4.7 years, body mass index 24.7 ± 2.9 kg/m<SUP>2</SUP>, HbA1c 7.77 ± 1.22%, FBG 147.4 ± 46.5 mmol/L and FPG 164.0 ± 54.3 mmol/L. The most common diabetic complication was neuropathy (22.5%), followed by retinopathy (18.3%) and microalbuminuria (16.1%). Just 1,524 (27.1%) patients achieved HbA1c ≤7%. A higher number of patients (32.6%) treated by endocrinologists achieved HbA1c ≤7% than those treated by internists (24.4%) and primary care physicians (23.2%). In multivariate analyses, diabetic retinopathy (odds ratio 0.455, 95% confidence interval 0.341–0.606), nephropathy (odds ratio 0.639, 95% confidence interval 0.43–0.949), diabetes for ≥5 years (odds ratio 0.493, 95% confidence interval 0.4–0.606) and older age added by 1 year (odds ratio 1.019, 95% confidence interval 1.01–1.029) was significantly associated with achieving target HbA1c. In addition, treatment by endocrinologists rather than internists significantly increased chances of achieving target HbA1c (odds ratio 1.417, 95% confidence interval 1.146–1.751).</P><P><B>Conclusions</B></P><P>The majority of patients with type 2 diabetes in Korea had inadequate glycemic control, despite receiving a combination of metformin and sulfonylurea.</P>
Body size phenotypes and low muscle mass: the Korean sarcopenic obesity study (KSOS).
Kim, Tae Nyun,Park, Man Sik,Yang, Sae Jeong,Yoo, Hye Jin,Kang, Hyun Joo,Song, Wook,Seo, Ji A,Kim, Sin Gon,Kim, Nan Hee,Baik, Sei Hyun,Choi, Dong Seop,Choi, Kyung Mook Issued for the Endocrine Society by the Williams W 2013 The Journal of clinical endocrinology & metabolism Vol.98 No.2
<P>Unique subsets of body size phenotypes seem to be more prone or more resistant to the development of obesity-associated metabolic disorders, although the underlying mechanism is not yet clearly understood.</P>
Kim, Tae Nyun,Park, Man Sik,Yang, Sae Jeong,Yoo, Hye Jin,Kang, Hyun Joo,Song, Wook,Seo, Ji A.,Kim, Sin Gon,Kim, Nan Hee,Baik, Sei Hyun,Choi, Dong Seop,Choi, Kyung Mook American Diabetes Association 2010 Diabetes care Vol.33 No.7
<P><B>OBJECTIVE</B></P><P>We examined prevalence of sarcopenia in Korean patients with type 2 diabetes and compared body compositional parameters between subjects with and without type 2 diabetes.</P><P><B>RESEARCH DESIGN AND METHODS</B></P><P>The Korean Sarcopenic Obesity Study (KSOS) included 810 subjects (414 patients with diabetes and 396 control subjects) who were examined using dual-energy X-ray absorptiometry. Prevalence of sarcopenia was defined using the skeletal muscle index (SMI).</P><P><B>RESULTS</B></P><P>Prevalence in patients with diabetes and in the control group was 15.7 and 6.9%, respectively. In both men and women, SMI values were significantly decreased in patients with diabetes compared with subjects without diabetes. Furthermore, multiple logistic regression analysis showed that type 2 diabetes was independently associated with sarcopenia.</P><P><B>CONCLUSIONS</B></P><P>Type 2 diabetes was associated with increased risk of sarcopenia. These characteristics may contribute to physical disability and metabolic disorders in older adults with diabetes.</P>
Kim, Tae Nyun,Park, Man Sik,Lim, Kang Il,Yang, Sae Jeong,Yoo, Hye Jin,Kang, Hyun Joo,Song, Wook,Seo, Ji A.,Kim, Sin Gon,Kim, Nan Hee,Baik, Sei Hyun,Choi, Dong Seop,Choi, Kyung Mook Elsevier 2011 Diabetes research and clinical practice Vol.93 No.2
<P><B>Abstract</B></P> <P><B>Aims</B></P> <P>Sarcopenia measured as appendicular skeletal muscle mass (ASM), and central obesity measured as visceral fat area (VFA) may act synergistically to influence metabolic syndrome and atherosclerosis. However, several previous studies reported that metabolic risk is higher in non-sarcopenic obesity groups than in sarcopenic obesity groups because of the close relationship between muscle mass and body fat. We investigated the association of the ASM to VFA ratio, which we have termed the muscle-to-fat ratio (MFR), with metabolic syndrome and arterial stiffness.</P> <P><B>Methods</B></P> <P>This study was performed in 526 apparently healthy adults enrolled in the Korean Sarcopenic Obesity Study, an ongoing prospective observational cohort study. ASM was evaluated with dual energy X-ray absorptiometry and VFA with computed tomography. Arterial stiffness was measured using brachial-ankle pulse wave velocity (baPWV).</P> <P><B>Results</B></P> <P>MFR was significantly associated with waist circumference, blood pressure, lipid profiles, glucose and baPWV. By multiple logistic regression analysis, the odds ratio for metabolic syndrome was 5.43 (lowest versus highest tertile of MFR, 95% confidence interval, 2.56–13.34). Multiple stepwise regression analysis showed that MFR was an independent determinant of baPWV (<I>R</I> <SUP>2</SUP> =0.57).</P> <P><B>Conclusions</B></P> <P>MFR, a new index of sarcopenic obesity, showed an independent negative association with metabolic syndrome and arterial stiffness.</P>
Kim, Nam Hoon,Kim, Tae Joon,Kim, Nan Hee,Choi, Kyung Mook,Baik, Sei Hyun,Choi, Dong Seop,Park, Yousung,Kim, Sin Gon Williams & Wilkins Co 2016 Medicine Vol.95 No.30
<▼1><P>Supplemental Digital Content is available in the text</P></▼1><▼2><P><B>Abstract</B></P><P>Both low socioeconomic status (SES) and diabetes mellitus (DM) are important risk factors for mortality. However, little is known about their combined effects and relative contribution to the mortality risk.</P><P>From a nationwide cohort provided by the National Health Insurance Service in Korea, 153,075 subjects who were over 30 years of age from 2003 to 2004 were followed-up until 2010. The SESs of the subjects in the DM and non-DM (NDM) groups were categorized into 3 groups (highest 30% as S1, middle 40% as S2, and lowest 30% as S3) based on the subjects’ income levels.</P><P>During the 7.9-year follow-up, 3933 deaths occurred. When the subjects were stratified into 6 groups by their socioeconomic and diabetes status, a linearly increasing pattern of the hazard ratio (HR) of mortality from the higher SES without diabetes group (NDM-S1, as a reference) to the lower SES with diabetes group (DM-S3; HR, 2.04, 95% confidence interval (CI), 1.80–2.36) was observed (<I>P</I> for trend < 0.001). Notably, subjects with DM in the highest SES group (DM-S1) had a significantly higher mortality risk than did non-DM subjects in the lowest SES group (NDM-S3). This pattern was maintained in cause-specific mortality but was more prominent in cardiovascular disease (CVD) and less prominent in cancer mortality. The association was not affected by gender; however, in individuals <60 years of age, the combined effects of SES and DM on mortality were more prominent (DM-S3; HR, 3.68, 95% CI, 2.95–4.60) than in those ≥60 years of age.</P><P>Low SES and DM were major determinants of mortality and synergistically increased the risks of all-cause, CVD, and cancer mortality.</P></▼2>