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무증상 제2형 당뇨병환자에서 심혈관질환 위험의 비침습적 방법에 의한 평가
이지인 ( Jee In Lee ),손현식 ( Hyun Shik Son ) 대한당뇨병학회 2009 Diabetes and Metabolism Journal Vol.33 No.4
Cardiovascular disease (CVD) is the major cause of mortality in type 2 diabetes mellitus. CVD is a clinical manifestation of atherosclerosis, a chronic and progressive inflammatory disease characterized by a long asymptomatic phase. Progression of atherosclerosis can lead to the occurrence of acute cardiovascular events. Atherosclerosis can be identified during the subclinical phase by several methods, including using biomarkers, pulse wave velocity, augmentation index, flow-mediated dilation, carotid ultrasound, and calcium score. The appropriate criteria for identifying asymptomatic patients with type 2 diabetes who should undergo CVD screening and therapeutic intervention remain controversial. Non-invasive methods, such as markers of subclinical atherosclerosis, may aid in risk stratification and the design of tailored therapies for patients with type 2 diabetes mellitus. (Korean Diabetes J 33:267-275, 2009)
제2형 당뇨병환자에서 족부병변의 발생률 및 위험인자 분석: 5년 관찰연구
박신애 ( Shin Ae Park ),고승현 ( Seung Hyun Ko ),이승환 ( Seung Hwan Lee ),조재형 ( Jae Hyoung Cho ),문성대 ( Sung Dae Moon ),장상아 ( Sang A Jang ),손현식 ( Hyun Shik Son ),송기호 ( Ki Ho Song ),차봉연 ( Bong Yun Cha ),손호영 ( H 대한당뇨병학회 2009 Diabetes and Metabolism Journal Vol.33 No.4
연구배경: 제 2형 당뇨병환자에서 당뇨병성 족부병변에 의한 하지절단은 지속적으로 증가하고 있다. 또한 당뇨병성 족부궤양 단계에서의 적절한 예방과 치료가 하지절단의 위험성을 50%나 감소시킨다고 보고된 바 있다. 본 연구는 당뇨병성 족부병변의 발생률과 임상양상 그리고 위험인자들을 살펴보고자 하였다. 방법: 2003년 1월부터 12월까지 가톨릭대학교 성빈센트병원에 내원한 제2형 당뇨병환자를 2008년까지 5년간 관찰하였다. 족부병변의 위험인자를 확인하기 위해 6개월 마다당화혈색소를 반복 측정하였고, 당뇨병성 합병증을 조사하였다. 자율신경병증은 Ewing 방법에 따라 반복적인 심호흡호기와 흡기 시 (E/I 비), 체위 변화 시(30:15 비), 발살바 수기 시 심박동수의 변화를 측정하였다. 신기능 저하를 확인하기 위해 단백뇨 여부와 MDRD GFR를 이용하였다. 결과: 총 646명의 대상 환자 중에서 연구기간을 완료한 환자는 508명(82.9%)이었고, 이 중 32명(6.3%)에서 당뇨병성 족부병변이 발생하였다. 당뇨병성 족부병변이 발생한 군에서는 당뇨병 유병기간이 길었고, 고혈압 동반률이 높았으며, 망막병증 동반율도 높았다. 연구기간 동안의 평균 당화혈색소도 발생군에서 높게 측정되었다. Lipoprotein (a)가 증가되거나 신기능이 저하된 경우 당뇨병성 족부병변의 발생이 증가함을 확인하였다. 무엇보다 심혈관계 자율신경병증의 동반은 당뇨병성 족부병변의 발생을 4배 가까이 증가시킴을 확인하였고, 이는 말초신경병증 못지않게 중요함을 알 수 있었다. 결론: 당뇨병성 족부병변의 발생과 가장 밀접한 관련이 있는 것은 평균 당화혈색소임을 확인하였다. 또한 신기능의 저하와 심혈관계 자율신경병증이 중요한 유발인자임을 확인하였다. 따라서 당뇨병성 족부병변의 발생을 예방하기 위해서는 엄격한 혈당조절뿐만 아니라 정기적인 신기능과 자율신경병증에 대한 정기적인 평가가 이뤄져야 할 것이다. Background: The frequency of lower extremity amputation due to diabetic foot has been increasing in type 2 diabetic patients. The aim of this study was to observe the incidence, clinical aspects and associated risk factors for diabetic foot. Methods: We evaluated the incidence of diabetic foot through a five-year observation of type 2 diabetic patients who presented to St. vincent`s Hospital between January and December 2003. To identify the risk factors for diabetic foot, we evaluated mean glycosylated hemoglobin A1c (HbA1c) every six months and assessed renal function based on the existence of proteinuria and estimated glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease (MDRD) equation. Patients were also evaluated for retinopathy, peripheral neuropathy and autonomic neuropathy using Ewing`s method. Results: From an initial pool of 613 patients, the observational study of 508 patients (82.9%) was completed. The mean age, duration of diabetes and HbA1c were 50.3±10.6 yrs, 7.2±6.5 yrs and 8.8±2.1%, respectively. Diabetic foot occurred in 32 patients (6.3%). The incidence of diabetic foot increased when diabetic retinopathy (OR=6.707, 2.314~19.439), peripheral neuropathy (OR=2.949, 1.075~8.090), and autonomic neuropathy (OR=3.967, 1.476~10.660) were present and when the MDRD GFR (OR=5.089, 1.712~15.130) decreased. Mean HbA1c (OR=12.013, 1.470~98.179) was found to be an independent risk factor for diabetic foot. Conclusion: The present study confirmed the importance of intensive glycemic control and the role of autonomic dysfunction in the development of diabetic foot. In addition, diabetic retinopathy and impaired renal function proved to be factors associated with the occurrence of diabetic foot. Therefore, intensive glycemic control, as well as periodic examination of renal function, are essential for the prevention of diabetic foot. (Korean Diabetes J 33:315-323, 2009)
제2형 남자 당뇨병환자에서 비만과 비비만에 따른 아디포넥틴의 혈중 농도와 다중결합체의 차이
장상아 ( Sang Ah Chang ),손호영 ( Ho Young Son ),이정민 ( Jung Min Lee ),손태서 ( Tae Seo Sohn ),권혁상 ( Hyuk Sang Kwon ),손현식 ( Hyun Shik Son ),윤건호 ( Kun Ho Yoon ),김희승 ( Hee Seung Kim ),차봉연 ( Bong Yun Cha ),이광우 ( K 대한당뇨병학회 2007 Diabetes and Metabolism Journal Vol.31 No.3
제2형 당뇨병 입원 환자에서 혈당변동성 지표인 Average Daily Risk Range와 관련된 인자
박신애 ( Shin Ae Park ),고승현 ( Seung Hyun Ko ),이승환 ( Seung Hwan Lee ),조재형 ( Jae Hyung Cho ),문성대 ( Sung Dae Moon ),장상아 ( Sang A Jang ),송기호 ( Ki Ho Song ),손현식 ( Hyun Shik Son ),윤건호 ( Kun Ho Yoon ),차봉연 ( Bon 대한당뇨병학회 2009 Diabetes and Metabolism Journal Vol.33 No.1
증례 : 화농성 간농양으로 유발된 당뇨병성 케톤산증 2예
장석태 ( Suk Tae Jang ),오병선 ( Byoung Sun Oh ),손태서 ( Tae Seo Sohn ),손현식 ( Hyun Shik Son ),손호영 ( Ho Young Son ),이광우 ( Kwang Woo Lee ),강성구 ( Sung Ku Kang ) 대한내과학회 2005 대한내과학회지 Vol.69 No.-
저자들은 화농성 간농양으로 유발된 당뇨병성 케톤산증 2예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Diabetic ketoacidosis as the most severe acute metabolic complication of diabetes mellitus, may herald the onset of type 1 diabetes but most often occurs in established diabetic patients as a result of intercurrent illness (e.g., infection), an inappropriate reduction in insulin dosage, or missed insulin injections. Diabetics are more prone to infections than non-diabetics and infection is the most common precipitant of diabetic ketoacidosis. Infection such as pneumonia, urinary tract infection, gastroenteritis and sepsis, is believed to precipitate episodes of diabetic ketoacidosis. We report two cases of diabetic ketoacidosis precipitated by pyogenic liver abscess caused by Klebsiella pneumoniae. (Korean J Med 69:S861-S866, 2005)
국내 3차 의료기관의 당뇨병 조절 상태 및 합병증 보고 - - : 2006~2007 대한당뇨병학회 역학소위원회
임수 ( Soo Lim ),김대중 ( Dae Jung Kim ),정인경 ( In Kyung Jeong ),손현식 ( Hyun Shik Son ),정춘희 ( Choon Hee Chung ),고관표 ( Gwan Pyo Koh ),이대호 ( Dae Ho Lee ),원규장 ( Kyu Chang Won ),박정현 ( Jeong Hyun Park ),박태선 ( Tae 대한당뇨병학회 2009 Diabetes and Metabolism Journal Vol.33 No.1
증례 : 간세포암종의 자연적 파열로 유발된 고삼투압성 고혈당 상태 1예
윤혜은 ( Hye Eun Yoon ),남성민 ( Sung Min Nam ),손태서 ( Tae Seo Sohn ),김창욱 ( Chang Wook Kim ),손현식 ( Hyun Shik Son ),이창돈 ( Chang Don Lee ),차봉연 ( Bong Youn Cha ) 대한내과학회 2005 대한내과학회지 Vol.69 No.-
저자들은 간세포암종의 파열로 유발된 고삼투압성 고혈당 상태 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Ketoacidosis and hyperosmolar hyperglycemia are the two most serious acute metabolic complications of diabetes, even if managed properly. The mortality rate of patients with hyperosmolar hyperglycemic state still remains high at ~15%. Mortality is associated with advanced age and comorbidity and is usually due to an associated catastrophic illness or to acute complications. Treatment of hyperglycemic states depends critically on the detection and treatment of precipitating illness, as well as prompt attention to fluid and electrolyte disturbances. We report a case of hyperosmlar hyperglycemic state precipitated by spontaneous rupture of hepatocelluar carcinoma. (Korean J Med 69:S879-S883, 2005)
다회 인슐린 투여가 당뇨병 환자의 삶의 질, 우울 및 불안 요소에 미치는 영향
박예리 ( Ye Ree Park ),김태석 ( Tae Suk Kim ),박용규 ( Yong Gyu Park ),이성수 ( Seong Su Lee ),김성래 ( Sung Rae Kim ),손현식 ( Hyun Shik Son ),윤건호 ( Kun Ho Yoon ),강무일 ( Moo Il Kang ),차봉연 ( Bong Youn Cha ),이광우 ( Kwang 대한내과학회 2009 대한내과학회지 Vol.77 No.1
Background/Aims: Treatment using multiple daily insulin(MDI) should give diabetic patients many benefits. Nevertheless, few studies have examined the impact of an increased frequency of daily insulin injection on quality of life, anxiety levels, and depression in diabetic patients, and individual`s continued compliance with MDI is unclear. This study examined these issues using standardized questionnaires. Methods: This was a cross-sectional, randomized study. Ninety-nine insulin-treated type 2 diabetic patients (mean age 53.1±12 years, mean duration of diabetes 10.3±6.5 years) were divided a group (n=50) who injected insulin four times daily (mean age 49.6±12.3 years, mean duration of diabetes 6.5±6.4 years) and a group (n=49) who injected insulin once or twice daily (mean age 56.4±11.6 years, mean duration of diabetes 11.5±5.8 years). All patients independently completed the Korean Version of the World Health Organization Quality of Life Scale Abbreviated Version and standardized Hospital Anxiety and Depression Scale for Koreans. Results: No significant differences were evident with respect to age, gender, and duration of diabetes between the two groups (p<0.05). No significant differences were evident in the results of the questionnaires between the two groups, except for the physical health domain (p<0.05). Conclusions: Multiple daily insulin injections had nearly no influence on quality of life, anxiety levels, or depression in type 2 diabetic patients. Therefore, treatment with MDI should be considered for patients who would benefit from this. (Korean J Med 77:60-67, 2009)