Effect of Teneligliptin versus Sulfonylurea on Major Adverse Cardiovascular Outcomes in People with Type 2 Diabetes Mellitus: A Real-World Study in Korea

서다혜,하경화,김소헌,김대중 대한내분비학회 2021 Endocrinology and metabolism Vol.36 No.1

Background: Results regarding the cardiovascular (CV) effects of dipeptidyl peptidase-4 (DPP-4) inhibitors are inconsistent. This study aimed to assess the effects of teneligliptin, a DPP-4 inhibitor, on the risk of major CV outcomes in type 2 diabetes mellitus (T2DM) patients compared to sulfonylurea. Methods: From January 1, 2015 to December 31, 2017, we conducted a retrospective cohort study using the Korean National Health Insurance Service database. A total of 6,682 T2DM patients who were newly prescribed DPP-4 inhibitors or sulfonylurea were selected and matched in a 1:1 ratio by propensity score. The hazard ratios (HRs) for all-cause mortality, hospitalization for heart failure (HHF), all-cause mortality or HHF, myocardial infarction (MI), stroke, and hypoglycemia were assessed. Results: During 641 days of follow-up, the use of teneligliptin was not associated with an increased risk of all-cause mortality (HR, 1.00; 95% confidence interval [CI], 0.85 to 1.19), HHF (HR, 0.99; 95% CI, 0.86 to 1.14), all-cause mortality or HHF (HR, 1.02; 95% CI, 0.90 to 1.14), MI (HR, 0.90; 95% CI, 0.68 to 1.20), and stroke (HR, 1.00; 95% CI, 0.86 to 1.17) compared to the use of sulfonylurea. However, it was associated with a significantly lower risk of hypoglycemia (HR, 0.68; 95% CI, 0.49 to 0.94) compared to sulfonylurea therapy. Conclusion: Among T2DM patients, teneligliptin therapy was not associated with an increased risk of CV events including HHF, but was associated with a lower risk of hypoglycemia compared to sulfonylurea therapy.

국내외 칡 제거 방법에 대한 비교 고찰

서다혜,김기우,박준형,박지현,이상태 경상국립대학교 농업생명과학연구원 2023 농업생명과학연구 Vol.57 No.1

The removal methods of kudzu were compared to find efficient ones between Korea and other countries. Kudzu was used to preventslope erosion in barren land for its rapid growth. However, kudzu vines wrap around forest plants, leading to plant death. There isa growing interest in the damage to urban trees caused by kudzu. Kudzu is commonly controlled by physical, chemical, or biologicalmethods. Physical or chemical methods are mostly used in Korea, whereas chemical ones are usually employed in other countries. Thereis low environmental pollution by physical methods; however, labor and cost are their limiting factors. Despite rapid control efficacy,chemical methods are restricted by environmental pollution and weather conditions. While biological methods have been developed toreduce the environmental concern, their effects are slow and possibly hazardous to forest plants and understory vegetation. Further studiesare required for eco-friendly methods and their implementation with higher control efficacy and lower labor input. 본 연구에서는 칡의 효율적인 제거 방법을 모색하기 위해 국내외의 사례를 비교하였다. 칡은 척박한 토지에서도 생장이 왕성한 특성을 가져사면침식을 억제하는 식물로 이용되기도 하였다. 그러나 칡은 덩굴을 형성하여 조림목을 감고 올라가 생장하므로 심할 경우에는 조림목의 고사를유발한다. 최근에는 생활권 수목에 대한 관심의 증가로 조경수에 대한 피해가 주목을 받고 있다. 칡은 물리적, 화학적 및 생물학적 방법으로 제거한다. 국내에서는 덩굴 및 주두부 제거 등 물리적 제거 방법과 제초제를 사용하는 화학적 방법을 주로 사용하고 국외에서는 화학적 방법에 주로 의존한다. 물리적 방법은 환경오염이 적은 이점이 있으나 상당한 노동력과 비용이 소요된다. 화학적 방법은 즉각적으로 제거 효과가 나타나지만 약제 사용에의한 환경오염과 기상조건의 제약이 있다. 생물학적 방법은 화학적 방법의 환경오염을 해결하기 위해 개발되었으나 제거 효과가 느리게 나타나고조림지에 적용 시 조림목과 하층식생에 미치는 영향에 대한 우려가 있다. 향후 고효율성을 담보하며 친환경적인 생력화 칡 제거 기술에 대한연구와 적용이 필요하다.

Serum Levels of Adipocyte Fatty Acid-Binding Protein Are Associated with Rapid Renal Function Decline in Patients with Type 2 Diabetes Mellitus and Preserved Renal Function

서다혜,남문석,정미혜,서영주,안승희,홍성빈,김소헌 대한당뇨병학회 2020 Diabetes and Metabolism Journal Vol.44 No.6

Background Recent studies have demonstrated that the levels of adipocyte fatty acid-binding protein (A-FABP) are closely associated with diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM). This study aimed to examine the association between serum A-FABP level and rapid renal function decline in patients with T2DM and preserved renal function. Methods This was a prospective observational study of 452 patients with T2DM and preserved renal function who had serial measurements of estimated glomerular filtration rate (eGFR). Rapid renal function decline was defined as an eGFR decline of >4% per year. The association between baseline serum A-FABP level and rapid renal function decline was investigated. Results Over a median follow-up of 7 years, 82 participants (18.1%) experienced rapid renal function decline. Median A-FABP levels were significantly higher in patients with rapid renal function decline, compared to non-decliners (20.2 ng/mL vs. 17.2 ng/mL, P=0.005). A higher baseline level of A-FABP was associated with a greater risk of developing rapid renal function decline, independent of age, sex, duration of diabetes, body mass index, systolic blood pressure, history of cardiovascular disease, baseline eGFR, urine albumin creatinine ratio, total cholesterol, glycosylated hemoglobin, high-sensitivity C-reactive protein and use of thiazolidinedione, insulin, angiotensin-converting-enzyme inhibitors and angiotensin II-receptor blockers and statin (odds ratio, 3.10; 95% confidence interval, 1.53 to 6.29; P=0.002). Conclusion A high level of serum A-FABP is associated with an increased risk of rapid renal function decline in patients with T2DM and preserved renal function. This suggests that A-FABP could play a role in the progression of DKD in the early stages.

Effect of Dapagliflozin in Combination with Lobeglitazone and Metformin in Korean Patients with Type 2 Diabetes in Real-World Clinical Practice

서다혜,서영주,조용인,안성희,서성하,홍성빈,이용호,최영주,이은직,김소헌 연세대학교의과대학 2022 Yonsei medical journal Vol.63 No.9

Purpose: This study aimed to evaluate the efficacy and tolerability of dapagliflozin as an add-on or a switch therapy to lobegli-tazone plus metformin (MFM) in Korean patients with inadequately controlled type 2 diabetes mellitus (T2DM) in real-worldclinical practice. Materials and Methods: The study included 109 patients who started dapagliflozin as add-on or switch therapy to lobeglitazoneplus MFM. The primary outcome was a change in glycated hemoglobin (HbA1c) level from baseline after 12 months of treatment. Secondary outcomes included changes in fasting plasma glucose (FPG), lipid profiles, body weight, visceral fat area (VFA), andblood pressure after 12 months of treatment. Results: The baseline HbA1c was 8.3±1.3% (8.7±1.5% in the add-on group and 8.1±1.0% in the switch group). After 12 months,mean HbA1c decreased (-0.91%) in all patients (p<0.05) (-1.39% in the add-on group and -0.63% in the switch group). Significantreductions in FPG were also observed in both the add-on and switch groups (-54.37 mg/dL and -24.68 mg/dL, respectively). Over-all, there was a significant improvement in serum triglyceride (-24.74 mg/dL), low density lipoprotein cholesterol (-7.92 mg/dL),body weight (-2.98 kg), VFA (-9.00 cm2), and systolic blood pressure (-8.67 mm Hg). Approximately 35.8% of patients achievedHbA1c <7.0% after 12 months. Conclusion: Dapagliflozin, as an add-on or a switch therapy to lobeglitazone plus MFM, can be a suitable alternative for Korean pa-tients with inadequately controlled T2DM. The combination therapy resulted in significant reductions in HbA1c levels, body weight,and blood pressure.

Advanced Liver Fibrosis Is Associated with Chronic Kidney Disease in Patients with Type 2 Diabetes Mellitus and Nonalcoholic Fatty Liver Disease (Diabetes Metab J 2022;46:630-9)

서다혜,김소헌 대한당뇨병학회 2022 Diabetes and Metabolism Journal Vol.46 No.6

Current Management of Type 2 Diabetes Mellitus in Primary Care Clinics in Korea

서다혜,강신애,이용호,하정윤,박종숙,이병완,강은석,안철우,차봉수 대한내분비학회 2019 Endocrinology and metabolism Vol.34 No.3

Background: This study investigated the overall status of diabetes control and screening for diabetic microvascular complications inpatients with type 2 diabetes mellitus attending primary care clinics in Korea. Methods: In this cross-sectional observational study, 191 primary care clinics were randomly selected across Korea from 2015 to2016. In total, 3,227 subjects were enrolled in the study. Results: The patients followed at the primary care clinics were relatively young, with a mean age of 61.4±11.7 years, and had a relatively short duration of diabetes (mean duration, 7.6±6.5 years). Approximately 14% of subjects had diabetic microvascular complications. However, the patients treated at the primary care clinics had suboptimal control of hemoglobin A1c levels, blood pressure,and serum lipid levels, along with a metabolic target achievement rate of 5.9% according to the Korean Diabetes Association guidelines. The screening rates for diabetic nephropathy, retinopathy, and neuropathy within the past 12 months were 28.4%, 23.3%, and13.3%, respectively. Conclusion: The overall status of diabetes management, including the frequency of screening for microvascular complications, wassuboptimal in the primary care clinics. More efforts should be made and more resources need to be allocated for primary care physicians to promote adequate healthcare delivery, which would result in stricter diabetes control and improved management of diabeticcomplications.

아토피 피부 개선을 위한 Hydrogel Mask sheet의 제조

서다혜,임용환,이철태 한국공업화학회 2014 한국공업화학회 연구논문 초록집 Vol.2014 No.1

Hydrogel은 다량의 수분을 함유할 수 있는 3차원 망상구조를 가진 고분자물질로, 구성 성분과 제조 방법에 따라 다양한 형태와 성질을 가진다. 본 연구에서는 생체적합성 고분자로 잘 알려진 PVA와 천연 고분자인 한천을 주요 성분으로 하여 Hydrogel을 제조하였다. 아토피는 전 세계 인구의 20%가 겪는 피부염으로, 종래의 아토피 치료 제품들 대다수가 연고형태로 피부에 바를 때 통증을 수반하게 되고 외부와의 접촉으로 인해 치료 효과를 감소시킨다. 그래서 본 연구에서는 뛰어난 방충ㆍ살균효과, 면역력 강화, 스트레스 호르몬 분비 억제로 아토피 치료 개선에 효과가 있는 피톤치드를 Hydrogel에 함침 시켰다. 피톤치드를 함유하는 하이드로겔의 경우 피부에 자극이 가지 않으며 마스크 팩으로 사용 시 미용 효과와 아토피 피부 개선 두 가지를 동시에 만족한다. 제조된 하이드로겔의 형태를 SEM을 통해 확인하였고 팽윤도, 함수율 등의 물성을 측정하였으며 피톤치드를 함침 시킨 Hydrogel의 서방성을 확인하고자 시간에 따른 피톤치드 방출거동을 UV-vis를 통해 확인하였다.

대학생의 인권의식이 자아존중감을 경유하여 진로결정효능감에 미치는 영향에서 그릿의 조절된 매개효과

서다혜,이창식 사단법인 한국융합기술연구학회 2024 아시아태평양융합연구교류논문지 Vol.10 No.3

본 연구의 목적은 대학생의 인권의식이 진로결정효능감에 미치는 영향에서 자아존중감의 매개효과, 그릿의 조절 및 조절된 매개효과를 검증하는 데에 있다. 자료는 충청남도 C시에 소재한 H대학교에서 유의표집을 통하여 선정된 대학생300명으로부터 설문조사를 통하여 수집하였다. 자료는 SPSS PC+ Win ver. 25.0과 SPSS PROCESS macro ver. 4.2를 활용하여 분석하였다. 적용된 통계방법은 빈도분석, 신뢰도 분석, 평균차이분석(t-test, ANOVA), 상관분석, 매개효과분석, 조절효과분석 및 조절된 매개효과분석이었다. 연구의 결론은 첫째, 주요 변인들 간 상관분석을 실시한 결과, 인권의식, 자아존중감, 그릿 및 진로결정효능감 간에는 정적인 유의미한 상관관계를 보였다. 둘째, 인권의식과 진로결정효능감의 관계에서 자아존중감의 단순 매개효과를 검증한 결과, 자아존중감은 인권의식과 진로결정효능감의 관계에서 단순 매개하였다. 셋째, 자아존중감이 진로효능감에 미치는 영향을 그릿이 조절하는 역할을 하였다. 넷째, 그릿은 인권의식이 자아존중감을 경유하여 진로결정효능감에 미치는 영향에서 조절된 매개효과가 검증되었다. 이러한 연구결과를 토대로 인권의식과 진로결정효능감의 관계를 설명해 줄 다른 변인들에 대한 연구가 필요하고, 이러한 연구에서도 그릿이 보호나 통제 변인으로 대안 역할을 하는 지를 제언하였다. This study aims to verify the mediating effect of self-esteem and the moderating and moderated mediating effect of grit in the effect of university students' human rights awareness on career decision efficacy. Data were collected through a survey from 300 college students selected through purposive sampling at H University, located in C City, Chungcheongnam-do, and the data was analyzed using SPSS PC+ Win ver. 25.0 and SPSS PROCESS macro ver. 4.2. The applied statistical methods were frequency analysis, reliability analysis, mean difference analysis (t-test, ANOVA), correlation analysis, mediation effect analysis, moderation effect analysis, and moderated mediation effect analysis. As a result of the study, first, as a result of conducting a correlation analysis between major variables, a significant positive correlation was found between human rights awareness, self-esteem, grit, and career decision efficacy. Second, as a result of verifying the simple mediating effect of self-esteem in the relationship between human rights awareness and career decision efficacy, self-esteem mediated in the relationship between human rights awareness and career decision efficacy. Third, grit played a role in moderating the effect of self-esteem on career decision efficacy. Fourth, the moderated mediating effect of grit was verified in the effect of human rights awareness on career decision efficacy through self-esteem. Based on these research results, the study's limitations and follow-up research suggestions are as follows. Research is needed on other variables that can explain the relationship between human rights awareness and career decision efficacy, and such research should also verify whether grit plays an alternative role as a protection or control variable.

Presence of Carotid Plaque Is Associated with Rapid Renal Function Decline in Patients with Type 2 Diabetes Mellitus and Normal Renal Function

서다혜,김소헌,송준호,홍성빈,서영주,안성희,우정택,백세현,박용수,이관우,김영설,남문석 대한당뇨병학회 2019 Diabetes and Metabolism Journal Vol.43 No.6

Background: Recent evidences indicate that early rapid renal function decline is closely associated with the development and progression of diabetic kidney disease. We have investigated the association between carotid atherosclerosis and rapid renal function decline in patients with type 2 diabetes mellitus and preserved renal function. Methods: In a prospective, multicenter cohort, a total of 967 patients with type 2 diabetes mellitus and preserved renal function were followed for 6 years with serial estimated glomerular filtration rate (eGFR) measurements. Common carotid intima-media thickness (CIMT) and presence of carotid plaque were assessed at baseline. Rapid renal function decline was defined as an eGFR decline >3.3% per year. Results: Over a median follow-up of 6 years, 158 participants (16.3%) developed rapid renal function decline. While there was no difference in CIMT, the presence of carotid plaque in rapid decliners was significantly higher than in non-decliners (23.2% vs. 12.2%, P<0.001). In multivariable logistic regression analysis, presence of carotid plaque was an independent predictor of rapid renal function decline (odds ratio, 2.33; 95% confidence interval, 1.48 to 3.68; P<0.0001) after adjustment for established risk factors. The model including the carotid plaque had better performance for discrimination of rapid renal function decline than the model without carotid plaque (area under the receiver operating characteristic curve 0.772 vs. 0.744, P=0.016). Conclusion: Close monitoring of renal function and early intensive management may be beneficial in patients with type 2 diabetes mellitus and carotid plaques.

Advanced Liver Fibrosis Is Associated with Chronic Kidney Disease in Patients with Type 2 Diabetes Mellitus and Nonalcoholic Fatty Liver Disease

서다혜,서영주,Cho Yongin,안성희,Seo Seongha,홍성빈,이용호,최영주,이은직,김소헌 대한당뇨병학회 2022 Diabetes and Metabolism Journal Vol.46 No.4

Background: Nonalcoholic fatty liver disease (NAFLD) is associated with chronic kidney disease (CKD). However, the causal relationship between NAFLD and CKD is uncertain, particularly in patients with type 2 diabetes mellitus (T2DM). We aimed to investigate the association between the presence and severity of NAFLD and incident CKD in patients with T2DM.Methods: In this longitudinal cohort study of patients with T2DM, 3,188 patients with preserved renal function were followed up for the occurrence of incident CKD. NAFLD was defined as the presence of hepatic steatosis on ultrasonography, without any other causes of chronic liver disease. Advanced liver fibrosis of NAFLD was defined as a fibrosis-4 index ≥2.67. CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m².Results: At baseline, 1,729 (54.2%) patients had NAFLD, of whom 94 (5.4%) had advanced liver fibrosis. During the follow-up of 8.3±3.6 years, 472 (14.8%) patients developed incident CKD: 220 (15.1%) in the non-NAFLD group, 231 (14.1%) in the NAFLD without advanced fibrosis group and 28 (31.1%) in the NAFLD with advanced fibrosis group. There was no increased risk of incident CKD in the NAFLD group compared to the non-NAFLD group (<i>P</i>=0.435). However, among patients with NAFLD, advanced liver fibrosis was associated with an increased risk of CKD (adjusted hazard ratio, 1.75; 95% confidence interval, 1.15 to 2.66; <i>P</i>=0.009).Conclusion: Advanced liver fibrosis in patients with NAFLD is independently associated with an increased risk of incident CKD in patients with T2DM.