한국인 제2형 당뇨병환자에서 조기 대혈관 합병증 발생과 관련된 위험 인자

이해리 ( Hae Ri Lee ),유재명 ( Jae Myung Yu ),최문기 ( Moon Gi Choi ),유형준 ( Hyung Joon Yoo ),홍은경 ( Eun Gyoung Hong ) 대한당뇨병학회 2009 Diabetes and Metabolism Journal Vol.33 No.2

배경: 대혈관 합병증은 당뇨병환자의 주요 사망 원인으로 미세혈관 합병증과는 달리 유병기간과 비례하지 않는다. 그러나 한국인에서 당뇨병성 대혈관 합병증 발생까지의 당뇨병의 평균 유병기간이나 합병증 발생과 관련된 예측 인자들에 대한 연구는 아직 많이 부족한 실정이다. 따라서 저자들은 제2형 당뇨병에서 대혈관 합병증 발생까지의 평균 유병기간과 대혈관 합병증 발생에 영향을 미치는 요인들, 특히 조기합병증 발생에 관여하는 위험요소들을 조사하고자 하였다. 방법: 대혈관 합병증이 처음 발생하여 입원한 121명의 환자와 대혈관 합병증의 과거력이 없는 115명의 제2형 당뇨병 입원환자를 대상으로 하여 임상적 특성을 후향적으로 조사, 분석하였다. 대혈관 합병증 발생까지의 당뇨병 이환 기간을 5년을 기준으로 조기발생군(54명)과 후기발생군(67명)으로 나누어 비교 분석하였다. 또한 대혈관 합병증 발생군을 성별에 따라 나누어 추가 분석을 시행하였다. 결과: 대혈관 합병증 발생까지의 평균 당뇨병 유병기간은 8.7±7.8년, 평균 연령은 61세, 남녀 각 63명, 58명이었다. 대혈관 합병증 발생군과 대조군과의 비교에서 평균 나이(61.0±11.8 vs. 56.0±14.6세, P=0.004), 수축기와 이완기 혈압 모두 대혈관 합병증 발생군에서 높았고(133.6±20.7/79.8±12.3 vs. 121.8±17.7/76.3±9.6 mm Hg, P<0.05), 흡연력이 있는 환자의 비율이 높았다(42.1 vs. 20.0%, P<0.001). 그러나 당화혈색소는 대조군에서 대혈관 합병증 발생군에 비해 더 높았고(9.5±2.4 vs. 8.2±1.8%, P<0.001), 미세혈관 합병증 동반율도 유의하게 더 높았다. 대혈관 합병증 조기발생군의 평균 연령이 후기발생군보다 더 적었으며(58.2±12.8 vs. 63.4±10.4세, P=0.015), 흡연력은 더 많았다(53.7 vs. 32.8%, P=0.021). 대혈관 합병증 발생군에서 성별에 따른 분석 결과, 남성에서 여성보다 합병증 발생 연령이 보다 적었고(57.5±10.3 vs. 64.9±12.2세, P<0.001), 당뇨병의 가족력이 남성에서 더 많았으며 흡연력은 남성에서 77.8%로 여성의 3.4%에 비해 매우 높았다. 결론: 본 연구를 통하여 제2형 당뇨병에서 대혈관 합병증발생에 고령, 고혈압, 그리고 흡연력이 중요한 위험 인자임을 알 수 있었고 대혈관 합병증 위험도는 미세혈관 합병증 발생 이전부터 높아져 있었다. 특히 흡연력은 한국인 남성 제2형 당뇨병환자에서 대혈관 합병증 조기 발생에 관여하는 중요한 예측 인자로 생각된다. 또한 추가 분석 결과를 미루어볼 때, 같은 당뇨병의 유병기간을 가졌다 하더라도 60세 미만의 상대적으로 젊은 나이의 당뇨병환자들이 고령의 환자들보다 대혈관 합병증 조기 발생 위험도가 상대적으로 높은 것으로 여겨지며, 대혈관 합병증 발생과 관련하여 성별에 따라 연령, 당뇨병의 가족력, 고혈압, 흡연력과 같은 몇 가지 위험 요소들의 차이점이 발견되었다. 이러한 결과들은 제2형 당뇨병환자에서 대혈관 합병증 발생 예방에 효과적으로 이용될 수 있을 것으로 생각된다. Background: The average duration of diabetes and predictive factors of macrovascular complications in Korean diabetic patients remain to be elucidated. This study examines the average duration of diabetes up to the onset of macrovascular complications and clinically important factors of early development of these complications in Korean type 2 diabetic patients. Methods: Clinical characteristics in type 2 diabetics with (n=121) and without macrovascular complications (n=115) were analyzed. In addition, early onset (≤5 years, n=54) and late onset groups (>5 years, n= 67) were compared, as were the clinical characteristics between male and female patients in the macrovascular complications group. Results: The average duration of diabetes was 8.7±7.8 years in the macrovascular complications group. Average age, systolic and diastolic blood pressures and smoking history were all higher in the macrovascular complications group than the control group. However, HbA1c levels and prevalence of microvascular complications were higher in the controls. Average age was lower in the early onset group and many more patients of that group had a smoking history. In the analysis based on sex, marcrovascular complications developed earlier in male patients. In addition, the prevalence of family history of diabetes was higher in males and 77.8% of male patients had a smoking history (female: 3.4%). Conclusion: Our study confirms that older age, high blood pressure and smoking history are major risk factors for the development of macrovascular complications. Moreover, a smoking history in males can be both risk and predictive factors for earlier development of macrovascular complications in Korean type 2 diabetic patients. We also found that several clinical characteristics including age, family history of diabetes, hypertension and smoking history, vary between the sexes, and these findings can provide useful indices for the prevention of macrovascular complications. (Korean Diabetes J 33:134-142, 2009)

당뇨병 환자의 사회경제적 수준과 안질환 및 신장질환 합병증 검사와의 관계

손창우,황종남 한국보건교육건강증진학회 2023 보건교육건강증진학회지 Vol.40 No.5

Objectives: This study aimed to explore the relationship between socioeconomic status (SES) and utilization of diabetic eye and kidney screening services to suggest policy interventions for preventing and managing diabetic retinopathy and diabetic nephropathy. Methods: For the analyses, 24,674 residents over 30 years old who self-reported having diabetes in the Community Health Survey 2020 were included in the final analytic models. Individuals self-reported utilization of diabetic complication screening was used to examine the impacts of SES on the utilization of diabetic eye and kidney screening services. Results: The results indicated that individuals with a high education level of high school diploma were more likely to receive eye and kidney complication screenings. For eye complication screening OR: 1.35, 95% CI: 1.26-1.44; OR: 1.54, 95%CI: 1.41-1.69; for kidney complication screening OR: 1.29, 95% CI: 1.20-1.38; OR: 1.46, 95% CI: 1.33-1.59. Furthermore, those in Q5 household income showed a greater likelihood of using diabetic complication screenings. For eye complication screening, OR: 1.29, 95% CI: 1.15-1.45; for kidney complication screening, OR: 1.28, 95% CI: 1.14-1.43. Conclusions: There is a need to consider implementing health promotion policies addressing disparities in diabetic complication screenings, regardless of an individual’s SES and physical environment in their community. This could contribute to mitigating the gaps in the management of diabetic complications for individuals with diabetes.

당뇨병 환자의 당뇨성 안질환 및 신장질환 합병증 검사 수검 여부에 영향을 주는 요인

강정희(Jeong-Hee Kang) 한국산학기술학회 2020 한국산학기술학회논문지 Vol.21 No.4

연구목적은 당뇨성 안질환 및 신장질환 합병증 검사 수검여부에 영향을 주는 요인을 알아보기 위함이다. 본 연구는 2017년 지역사회 건강조사 전국 자료를 이용하였으며, 연구대상은 의사에게 당뇨병을 진단받은 적이 있다고 응답한 사람 25,829명이다. 당뇨병 환자의 당뇨성 안질환 및 신장질환 합병증 검사 수검여부에 영향을 주는 요인을 알아보기 위해 로지스틱 회귀분석을 실시하였다. 연구결과는 당뇨병 환자 중 당뇨성 안질환 합병증 검사 수검율은 35.6%, 당뇨성 신장질환 합병증 검사 수검률은 39.8%이었다. 걷기실천을 할수록(OR=1.03, OR=1.02), 당화혈색소(OR=2.33, OR=2.33) 및 혈당수치(OR=1.61, OR=1.71)를 인지하는 사람과 현재 당뇨병 치료(OR=2.67, OR=3.05) 및 당뇨병 관리교육(OR=1.45, OR=1.47)을 받는 사람의 당뇨성 안질환 및 신장질환 합병증 검사를 받을 가능성이 많았다. 결론적으로 당뇨성 합병증 검사 수검율을 높이기 위해서는 당뇨병 환자를 대상으로 당뇨성 합병증 검사의 종류와 검사 시기가 포함된 당뇨병 관리 교육체계와 당화혈색소 및 혈당수치를 인지시킬 수 있는 다양한 홍보 방법 등이 개발되어야 할 것으로 생각된다. 그리고 당뇨병 관리를 위한 가이드라인 개발하고, 국가차원에서 국가검진제도에 당뇨성 합병증 검사 선별검사항목을 포함하는 등 시스템이 필요할 것으로 보인다. This study was undertaken to investigate factors that affect the assessment of complications in diabetic eye and kidney diseases. Data was obtained from the National Community Health Survey, 2017. The subjects included were 25,829 respondents who had been diagnosed with diabetes. Logistic regression analysis was applied to determine the factors affecting associated diabetic eye disease (fundus examination) and kidney disease (microalbuminuria examination) complications. The diabetic eye disease complication rate was 35.6%, and diabetic kidney disease complication rate was 39.8%. Complications arising due to diabetes were determined to be 35.6% for eye diseases and 39.8% for kidney related diseases. Ed. Notes: The original sentence is not very lucid. I have suggested an alternate edit. I leave it to the author"s discretion to accept or reject the same. Please delete whichever sentence is not suitable. Walking activity (OR=1.03, OR=1.02), hemoglobin A1c (HbA1c) recognition (OR=2.33, OR=2.33), blood glucose level recognition (OR=1.61, OR=1.71), diabetes drug therapy (OR=2.67, OR=3.05), and diabetic management education (OR=1.45, OR=1.47) were more likely to be evaluated for eye and kidney disease complications. Our results indicate that to increase the rate of screening for diabetic complications, it is necessary to develop a diabetes management system that includes the type and timing of diabetic complications, as well as different promotional methods that recognize HbA1C and blood glucose levels. Ed. Notes: Do you mean "screening" methods? Please revise appropriately, if required. In addition, it is essential to develop a guideline for the management of diabetes mellitus, and to incorporate a screening test for diabetic complications in the national screening system.

당뇨병성 합병증을 가진 환자에서 혈증 Erythropoietin 농도

김동규,유기동,허광식,김상용,윤성호,조영신,권용은,김태원,김건영,정종훈,배학연 조선의대 1998 The Medical Journal of Chosun University Vol.23 No.1

당뇨병성 합병증을 가진 환자에서 혈중 Erythropoietin 농도

김동규,유기동,허광식,김상용,윤성호,조영신,권용은,김태원,김건영,정종훈,배학연 朝鮮大學校 附設 醫學硏究所 1998 The Medical Journal of Chosun University Vol.23 No.1

연구 배경 : 고혈당성에 의한 산화환원반응 이상(가저산소증)이 조절 되지않는 당뇨병의 특징으로 혈관과 신경 기능에 대한 진성 저산소증의 효과와 유사하며, 당뇨 합병증의 병태생리에 중요한 역할을 한다. 고혈당이 있는 인슐린 비의존형 당뇨병 환자에서 인슐린 수준이 정상이듯이, 빈혈이 있는 당뇨병 환자에서 EPO의 농도는 실제 혈색소 농도의 감소비율과 차이가 있을 것이라 추측된다. Friedman 등은 당뇨병성 합병증 원인 인자로 가저산소증(pseudohypoxia) 또는 저산소증(hypoxia)을 제기하였고 이런 인자들이 EPO의 상대적 또는 절대적 결핍에 의한 것임을 보고하였다. 방법 : EPO-Trac^(TM 125)I RIA kit을 이용하여 방사면역측정법으로 EPO 수준을 검사하였다. 전혈 3㎖을 5-10㎖ 시험관에 정맥 채혈하였으며, 용혈과 장기간의 보존을 위하여 원심분리를 즉시 시행하여 혈청을 영하 200C에서 냉동 보관 후 일괄적으로 검사 결과를 얻었다. 결과 : 1996년 9월부터 1997년 2월까지 조선대학교 부속병원 내과에 입원한 2형 당뇨병 환자 63례를 대상으로 하여 다음과 같은 결과를 얻었다. 1) 당뇨병성 합병증이 없는 군과 있는 군간의 혈색소, 혈중 EPO농도의 차이는 유의한 차이가 있었으며 혈색소의 감소율보다 혈중 EPO의 감소율이 더 높았다. 2) 당뇨병성 망막증의 유무에 따른 혈색소 농도의 차이는 유의한 차이가 없었으나 혈중 EPO농도는 유의한 차이가 있었다. 증식성군에서만 혈중 EPO의 감소비율이 혈색소에 비해 높았다. 3) 당뇨병성 신증의 유무에 따른 혈색소, 혈중 EPO농도는 유의한 차이가 있었고 혈색소 감소율에 비해 EPO농도의 감소율이 높았다. 신증의 중증도에 따른 혈색소, EPO의 차이는 미세알부민뇨군을 제외하고는 유의한 차이를 보였고 혈색소 감소율에 비해 EPO의 감소율이 더높았다. 4) 당뇨병성 신경병증의 유무에 따른 혈색소 농도의 차이는 유의한 차이가 없었으며 EPO농도는 유의한 차이를 보였다. 혈색소와 EPO의 감소비율은 비슷하였다. 신경병증의 중등도에 따른 혈색소와 EPO농도의 변화는 유의한 차이가 없었으나 stage 3에서는 혈색소감소율보다 EPO감소율이 더높았다. 결론 : 당뇨병성 합병증을 가진 환자에서 빈혈의 정도는 대부분 혈청 EPO치의 절대적 감소에 의함을 간접적으로 밝혀낼 수 있었으며 차후 더 많은 대상으로 비교 분석이 필요하리라 사료된다. Background: Hyperglycemic-induced redox(pseudohypoxia) imbalance is a characteristic feature of poorly controlled diabetes that mimics the effects of true hypoxia on vascular and neural functions and plays an important role on the pathogenesis of diabetic complications. As is true for apparently "normal" insulin levels typically found in NIDDM even in the presence of hyperglycemia, a "normal" erythropoietin level in an anemic diabetic subject may be disproportionally low for the actual red cell mass. Therefore, Friedman et al suggested that pseudohypoxia or hypoxia as an etiological factor of diabetic complications are due to absolute or relative erythropoietin deficiency Method: EPO-TracTM 125I RIA kit was used for the quantitative determination of erythropoietin(EPO) in serum by radioimmunoassay. An adequate sample of blood (3ml whole blood) was collected aseptically by venipuncture in a 5~10ml glass tube to yield a minimum of 400 L of serum per assay. The serum was promptly removed from the clot by centrifugation in order to avoid hemolysis. Then to increase its storage time it was frozen at -200C in a nonself defrosting freezer. Finally, tests were undertaken simultaneously Results We studied 63 cases with diabetes mellitus, who were admitted to Chosun University Hospital from September, 1996 to February, 1997 at the Department of Internal Medicine. We defined the control group, as diabetic patients who did not have anemia(<13mg/dl), diabetic complications(retinopathy, nephropathy, neuropathy) and the remainders were defined as the experimental group(we excluded anemic patients, who had secondary causes of anemia and diabetic patients with end stage renal disease)Data were as follow 1) The relationship of Hb and the 24hr urine protein between diabetic patients with and without complications significantly differed(p=0.02, < 0.001 respectively), but the Hb level was poorly related between diabetic patients with and without retinopathy(except in preproliferative, proliferative subgroups) and neuropathy. 2) Subgroups of patients with diabetic complications had higher 24hr urine protein than patients without diabetic complications, except stage I diabetic neuropathy 3) The EPO level was significantly different between diabetic patients with and without complications. 4) The correlation between EPO and Hb was significantly different, especially in diabetic patients with retinopathy and nephropathy according to severity of diabetic complications, compared with patients who did not have diabetic complications such as retinopathy and nephropathy. Conclusion: We know that anemia induced by diabetic complications is due to relative EPO deficiency than absolute EPO deficiency, and further evaluation and studies are needed on many cases in the future

당뇨병발의 원인, 진단, 합병증 및 치료

서동교 대한의사협회 2021 대한의사협회지 Vol.64 No.8

Background: Diabetic foot is one of the complications of diabetes mellitus, accompanied by infection, ulcer, deformity, and neuropathic arthropathy. The prevalence of diabetic foot is approximately 10% to 20% in adult diabetic patients over 30 years. Patients with diabetic foot show decreased life quality due to long-term treatment and hospital admission for various complications. Therefore, it is important to understand the etiology of diabetic foot and to prevent the accompanying complications. Current Concepts: Multiple complications of diabetic foot such as ulcers, infections, and deformities are derived from neuropathy (sensory, motor, and autonomic nerves) and angiopathy. Careful physical and radiologic examinations and laboratory evaluations are necessary to diagnose diabetic foot. Dressings, surgical decompressions, antibiotics, and vascular interventions are helpful for the treatment of ulcers in diabetic foot. Maintaining proper blood glucose levels and medication help control the neuropathies. Furthermore, patients should be educated on careful foot care to prevent complications. Discussion and Conclusion: Diabetic foot and its accompanying complications are difficult to treat and decrease patients’ quality of life. To prevent complications of diabetic foot, management of blood glucose, patient education on self-foot care, screening of high-risk factors, and cooperation of various medical specialists are needed.

제2형 당뇨병 환자에서 케모카인 수용체 유전자 다형성과 당뇨병성 신증과의 연관성

전현정 ( Hyun Jeong Jeon ),김옥희 ( Oak Hee Kim ),오태근 ( Tae Keun Oh ) 대한내과학회 2008 대한내과학회지 Vol.75 No.4

목적: 케모카인 수용체 5번은 대표적인 케모카인 수용체 중의 하나로, 정상 T 세포들의 발현 및 분비 등을 조절하는 케모카인(RANTES), MIP-1α, MIP-1β과 결합하여, 단핵세포 및 대식세포 침윤을 증가시켜 염증반응에 관여하는 것으로 알려져 있으며, 또한 죽상경화증 발생에도 영향을 미치는 것으로 보고되고 있다. 케모카인 수용체 5번 유전자 다형성과 당뇨병성 신증과의 연관성이 보고되고 있으나, 현재까지는 명확한 결론이 나와 있지 않으며, 당뇨병성 합병증에 대한 연관성 역시 잘 알려져 있지 않다. 이에 저자들은 이환 기간이 10년 이상된 제2형 당뇨병 환자에서 케모카인 수용체 5번(59029A/G) 유전자 다형성과 당뇨병성 합병증과의 연관성을 알아보고자 하였다. 방법: 대상 환자는 제2형 당뇨병 환자 325명으로 구성되었다. 케모카인 수용체 5번(59029A/G) 유전자 다형성은 PCR 및 Bsp1286I 제한효소 처리에 의하여 분석하였고, 대상환자들의 임상적인 특성과 생화학적 특성을 비교 관찰하였다. 당뇨병성 신증, 망막증과 대혈관 합병증과의 연관성을 조사하였다. 결과: 당뇨병성 신증에 따른 케모카인 수용체 5번(59029A/G) 유전자형의 빈도의 차이는 관찰되지 않았다. 남녀 성별에 따른 차이도 관찰되지 않았다. 당뇨병성 신증 이외에 다른 합병증으로 당뇨병성 망막증과 대혈관 합병증에 따른 케모카인 수용체 5번(59029A/G) 유전자형의 빈도 역시 차이가 관찰되지 않았다. 케모카인 수용체 5번(59029A/G) 유전자형에 따른 임상적 비교에서는 당뇨병성 신증이 발생한 군에서 GG형이 AA/AG형에 비해 저밀도 콜레스테롤이 높은 것으로 관찰되었다. 결론: 케모카인 수용체 5번(59029A/G) 유전자 다형성과 당뇨병성 합병증과의 연관성은 관찰되지 않았다. 그러나 케모카인 수용체 5번(59029A/G) 유전자 다형성과 당뇨병성 합병증과의 연관성과 발생기전을 정확히 파악하기 위해서는 대단위 규모의 연구가 필요할 것으로 여겨진다. Background/Aims: Chemokine receptor 5 (CCR5) is a receptor for several chemokines, including regulated upon activation, normal T-cell-expressed and -secreted (RANTES; also known as CCL5) and macrophage inflammatory protein 1 (MIP-1), and mediates the recruitment of monocytes and their differentiation to macrophages during the inflammatory process. As such, CCR5 plays an important role in the development and progression of atherosclerosis, which has an underlying inflammation component and contributes to the development or progression of diabetic complications. Several studies have reported that a genetic variation of the CCR5 gene with A/G at basepair 59029 (59029 A/G) was associated with diabetic complications, although conflicting data exist. We evaluated the association of the CCR5 59029 A/G polymorphism with diabetic complications in type 2 diabetes patients. Methods: We conducted a case-control study, enrolling 325 patients with type 2 diabetes. We examined the association of CCR5 genotypic variations with diabetic nephropathy, retinopathy, and macrovascular complications such as coronary heart disease and stroke. Genotyping was performed using the polymerase chain reaction and restriction fragment length polymorphism technology with Bsp1286I restriction enzyme. Results: We determined no allelic association of CCR5 59029 A/G with diabetic nephropathy (p=0.500) in the male or female patients. Diabetic retinopathy and macrovascular complications such as coronary heart disease and stroke were not associated with the 59029 A/G polymorphism. Among those patients with diabetic nephropathies, those with the GG genotype showed a tendency toward higher serum levels of LDL-cholesterol. Conclusions: These results suggest that that the 59029 A/G polymorphism of the CCR5 gene is not associated with diabetic complications in type 2 diabetes patients. Further studies are required to understand the role of CCR5 polymorphisms in the development of diabetic complications. (Korean J Med 75:428-435, 2008)

1형 당뇨병 환자에서 미세혈관 합병증의 발생 빈도와 위험 인자

권아름,이슬,채현욱,김덕희,김호성 대한소아내분비학회 2012 Annals of Pediatirc Endocrinology & Metabolism Vol.17 No.1

Purpose: We observed the frequencies of microvascular complications and their related factors in patients with type 1 diabetes. Methods: Two hundred seventy one patients (111 males and 160 females, mean age 21.9 ± 5.8 years) with type 1 diabetes were included. Subjects were all at least 10 years old and had diabetes for at least two years. Three types of microvascular complications (diabetic nephropathy, retinopathy, and neuropathy) were evaluated, and their frequencies and risk factors were analyzed. Results: The overall prevalence of microvascular disease was 83/271 (30.6%). Microalbuminuria had developed in 39 patients (14.4%), persistent microalbuminuria in 31patients (11.4%), and proteinuria in 12 (4.4%). Diabetic retinopathy had developed in 35patients (12.9%) and neuropathy in 39 patients (13.7%). The mean HbA1c for 10 years was significantly higher in the patients with microvascular complications (10.5 ± 2.8%vs. 8.4 ± 1.4%). The rate of intensive management in the non-complication group was higher than in the microvascular complication group. The incidence of microalbuminuria was greater in males than females, but there were no gender differences in either diabetic retinopathy or neuropathy. Puberty and the duration of diabetes may be associated with microvascular complications. Conclusion: The incidence of microvascular complications in type 1 diabetes is declining. Sex, puberty, and the duration of diabetes as well as prolonged hyperglycemia are all related to microvascular complications. Therefore, intensive insulin management and regular screening for microvascular complications should be performed in patients who have either entered into puberty or have had diabetes for more than 5 years. 목적: 본 연구에서는 1형 당뇨병 환자를 대상으로 미세혈관 합병증의 발생 빈도와 이와 관련된 인자들을 알아보고자한다. 방법: 연세대학교 세브란스 병원에서 1형 당뇨병으로 진단받는 환자들 중, 만 10세가 넘고 당뇨병 유병기간이 적어도2년이 넘는, 총 271명의 1형 당뇨병 환자(남자 111명, 여자 160명, 평균 나이 21.9±5.8세)를 대상으로 당뇨병성 신증, 망막병증, 신경병증의 세가지 미세혈관 합병증을 조사하고, 이와 관련된 인자들을 분석하였다. 결과: 미세혈관 합병증은 전체 271명 중 83명(30.6%)에서 발생하였다. 미세알부민뇨는 39명(14.4%)에서, 지속성 미세알부민뇨는 31명(11.4%)에서 발생하였으며, 단백뇨는 12명(4.4%)에서 발생하였다. 또한, 당뇨병성 망막병증은 35명(12.9%)의 환자에서, 신경병증은 39명(13.7%)의 환자에서 발생하였다. 10년 동안의 평균 당화혈색소는 미세혈관합병증이 있는 군에서 합병증이 없는 군 보다 더 높았다(10.5±2.8% vs. 8.4±1.4%). 또한 인슐린 치료법 중 적극적치료법의 비율은 미세혈관 합병증이 없는 군에서 미세혈관 합병증이 있는 군보다 더 높았다. 미세알부민뇨는 여자보다남자에서 더 많이 발생하였으나, 당뇨병성 망막병증이나 신경병증에서는 성별의 차이를 보이지 않았다. 또한, 사춘기및 당뇨병의 유병기간도 미세혈관 합병증의 위험인자로 생각된다. 결론: 1형 당뇨병 환자에서 미세혈관 합병증의 발생률은 점차적으로 낮아지고 있다. 하지만, 지속적인 고혈당뿐만 아니라 성별, 사춘기, 당뇨병의 유병기간도 미세혈관 합병증 발생과 연관된 위험인자이기 때문에, 적극적 인슐린 치료법을 통해 철저히 혈당을 관리하고, 사춘기 연령이거나 당뇨병의 유병기간이 5년이 넘는 환자에서는 미세혈관 합병증에대한 정기적인 선별검사가 필요하다.

Associations Between the Continuity of Ambulatory Care of Adult Diabetes Patients in Korea and the Incidence of Macrovascular Complications

Gong, Young-Hoon,Yoon, Seok-Jun,Seo, Hyeyoung,Kim, Dongwoo The Korean Society for Preventive Medicine 2015 Journal of Preventive Medicine and Public Health Vol.48 No.4

Objectives: The goal of this study was to identify association between the continuity of ambulatory care of diabetes patients in South Korea (hereafter Korea) and the incidence of macrovascular complications of diabetes, using claims data compiled by the National Health Insurance Services of Korea. Methods: This study was conducted retrospectively. The subjects of the study were 43 002 patients diagnosed with diabetes in 2007, who were over 30 years of age, and had insurance claim data from 2008. The macrovascular complications of diabetes mellitus were limited to ischemic heart disease and ischemic stroke. We compared the characteristics of the patients in whom macrovascular complications occurred from 2009 to 2012 to the characteristics of the patients who had no such complications. Multiple logistic regression was used to assess the effects of continuity of ambulatory care on diabetic macrovascular complications. The continuity of ambulatory diabetes care was estimated by metrics such as the medication possession ratio, the quarterly continuity of care and the number of clinics that were visited. Results: Patients with macrovascular complications showed statistically significant differences regarding sex, age, comorbidities, hypertension, dyslipidemia and continuity of ambulatory diabetes care. Visiting a lower number of clinics reduced the odds ratio for macrovascular complications of diabetes. A medication possession ratio below 80% was associated with an increased odds ratio for macrovascular complications, but this result was of borderline statistical significance. Conclusions: Diabetes care by regular health care providers was found to be associated with a lower occurrence of diabetic macrovascular complications. This result has policy implications for the Korean health care system, in which the delivery system does not work properly.

Associations Between the Continuity of Ambulatory Care of Adult Diabetes Patients in Korea and the Incidence of Macrovascular Complications

Young-Hoon Gong,윤석준,김동우 대한예방의학회 2015 Journal of Preventive Medicine and Public Health Vol.48 No.4

Objectives: The goal of this study was to identify association between the continuity of ambulatory care of diabetes patients in South Korea (hereafter Korea) and the incidence of macrovascular complications of diabetes, using claims data compiled by the National Health Insurance Services of Korea. Methods: This study was conducted retrospectively. The subjects of the study were 43 002 patients diagnosed with diabetes in 2007, who were over 30 years of age, and had insurance claim data from 2008. The macrovascular complications of diabetes mellitus were limited to ischemic heart disease and ischemic stroke. We compared the characteristics of the patients in whom macrovascular complications occurred from 2009 to 2012 to the characteristics of the patients who had no such complications. Multiple logistic regression was used to assess the effects of continuity of ambulatory care on diabetic macrovascular complications. The continuity of ambulatory diabetes care was estimated by metrics such as the medication possession ratio, the quarterly continuity of care and the number of clinics that were visited. Results: Patients with macrovascular complications showed statistically significant differences regarding sex, age, comorbidities, hypertension, dyslipidemia and continuity of ambulatory diabetes care. Visiting a lower number of clinics reduced the odds ratio for macrovascular complications of diabetes. A medication possession ratio below 80% was associated with an increased odds ratio for macrovascular complications, but this result was of borderline statistical significance. Conclusions: Diabetes care by regular health care providers was found to be associated with a lower occurrence of diabetic macrovascular complications. This result has policy implications for the Korean health care system, in which the delivery system does not work properly.