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허규연,김미경,고승현,한미연,이동원,권혁상,Committee of Clinical Practice Guidelines,Korean Diabetes Association and Committee of the Cooperative Studies,Korean Society of Nephrology 대한당뇨병학회 2020 Diabetes and Metabolism Journal Vol.44 No.1
The safety of metformin use for patients with type 2 diabetes mellitus (T2DM) and advanced kidney disease is controversial, and more recent guidelines have suggested that metformin be used cautiously in this group until more definitive evidence concerning its safety is available. The Korean Diabetes Association and the Korean Society of Nephrology have agreed on consensus statements concerning metformin use for patients with T2DM and renal dysfunction, particularly when these patients undergo imaging studies using iodinated contrast media (ICM). Metformin can be used safely when the estimated glomerular filtration rate (eGFR) is ≥45 mL/min/1.73 m2. If the eGFR is between 30 and 44 mL/min/1.73 m2, metformin treatment should not be started. If metformin is already in use, a daily dose of ≤1,000 mg is recommended. Metformin is contraindicated when the eGFR is <30 mL/ min/1.73 m2. Renal function should be evaluated prior to any ICM-related procedures. During procedures involving intravenous administration of ICM, metformin should be discontinued starting the day of the procedures and up to 48 hours post-procedures if the eGFR is <60 mL/min/1.73 m2.
Gut Microbiota and Metabolic Disorders
허규연,이명식 대한당뇨병학회 2015 Diabetes and Metabolism Journal Vol.39 No.3
Gut microbiota plays critical physiological roles in the energy extraction and in the control of local or systemic immunity. Gut microbiota and its disturbance also appear to be involved in the pathogenesis of diverse diseases including metabolic disorders, gastrointestinal diseases, cancer, etc. In the metabolic point of view, gut microbiota can modulate lipid accumulation, lipopolysaccharide content and the production of short-chain fatty acids that affect food intake, inflammatory tone, or insulin signaling. Several strategies have been developed to change gut microbiota such as prebiotics, probiotics, certain antidiabetic drugs or fecal microbiota transplantation, which have diverse effects on body metabolism and on the development of metabolic disorders.
허규연,전지은,최영주,이용호,김대중,박석원,허병욱,이은직,지선하,허갑범,최성희 대한당뇨병학회 2018 Diabetes and Metabolism Journal Vol.42 No.1
Background: The clinical utility of ankle-brachial index (ABI) is not clear in subjects with less severe or calcified vessel. Therefore, we investigated the usefulness of color Doppler ultrasonography for diagnosing peripheral artery disease (PAD) in type 2 diabetes mellitus (T2DM) subjects. Methods: We analyzed 324 T2DM patients who concurrently underwent ABI and carotid intima-media thickness (CIMT) measurements and color Doppler ultrasonography from 2003 to 2006. The degree of stenosis in patients with PAD was determined according to Jager’s criteria, and PAD was defined as grade III (50% to 99% stenosis) or IV stenosis (100% stenosis) by color Doppler ultrasonography. Logistic regression analysis and receiver operating characteristic curve analysis were performed to evaluate the risk factors for PAD in patients with ABI 0.91 to 1.40. Results: Among the 324 patients, 77 (23.8%) had ABI 0.91 to 1.40 but were diagnosed with PAD. Color Doppler ultrasonography demonstrated that suprapopliteal arterial stenosis, bilateral lesions, and multivessel involvement were less common in PAD patients with ABI 0.91 to 1.40 than in those with ABI ≤0.90. A multivariate logistic regression analysis demonstrated that older age, current smoking status, presence of leg symptoms, and high CIMT were significantly associated with the presence of PAD in patients with ABI 0.91 to 1.40 after adjusting for conventional risk factors. CIMT showed significant power in predicting the presence of PAD in patients with ABI 0.91 to 1.40. Conclusion: Color Doppler ultrasonography is a useful tool for the detection of PAD in T2DM patients with ABI 0.91 to 1.40 but a high CIMT.
Clinical Guidelines for the Diagnosis and Treatment of Cushing’s Disease in Korea
허규연,김정희,김병준,김민선,이은직,김성운 대한내분비학회 2015 Endocrinology and metabolism Vol.30 No.1
Cushing’s disease (CD) is a rare disorder characterized by the overproduction of adrenocorticotropic hormone due to a pituitary adenoma that ultimately stimulates excessive cortisol secretion from the adrenal glands. Prior to the detection of pituitary adenomas, various clinical signs of CD such as central obesity, moon face, hirsutism, and facial plethora are usually already present. Uncontrolled hypercortisolism is associated with metabolic, cardiovascular, and psychological disorders that result in increased mortality. Hence, the early detection and treatment of CD are not only important but mandatory. Because its clinical manifestations vary from patient to patient and are common in other obesity-related conditions, the precise diagnosis of CD can be problematic. Thus, the present set of guidelines was compiled by Korean experts in this field to assist clinicians with the screening, diagnoses, and treatment of patients with CD using currently available tests and treatment modalities. Keywords: Adrenocorticotropic hormone; Corticotropin-releasing hormone; Pituitary ACTH hypersecretion; Cushing’s
2021 Clinical Practice Guidelines for Diabetes Mellitus of the Korean Diabetes Association
허규연,문민경,박종숙,김수경,이승환,윤재승,백종하,노정현,이병완,오태정,전숙,양예슬,손장원,최종한,송기호,김남훈,김상용,김진화,이상열,이유빈,진상만,김재현,김종화,김대중,전성완,이은정,김현민,김현정,지동현,김재현,최원석,이은영,윤건호,고승현 대한당뇨병학회 2021 Diabetes and Metabolism Journal Vol.45 No.4
The Committee of Clinical Practice Guidelines of the Korean Diabetes Association (KDA) updated the previous clinical practice guidelines for Korean adults with diabetes and prediabetes and published the seventh edition in May 2021. We performed a comprehensive systematic review of recent clinical trials and evidence that could be applicable in real-world practice and suitable for the Korean population. The guideline is provided for all healthcare providers including physicians, diabetes experts, and certified diabetes educators across the country who manage patients with diabetes or the individuals at the risk of developing diabetes mellitus. The recommendations for screening diabetes and glucose-lowering agents have been revised and updated. New sections for continuous glucose monitoring, insulin pump use, and non-alcoholic fatty liver disease in patients with diabetes mellitus have been added. The KDA recommends active vaccination for coronavirus disease 2019 in patients with diabetes during the pandemic. An abridgement that contains practical information for patient education and systematic management in the clinic was published separately.
허규연,김명수,남재현,강은석,이현주,김소헌,한승진,차봉수,안철우,김순일,김유선,이현철 대한내분비학회 2006 Endocrinology and metabolism Vol.21 No.5
연구배경: 신장이식 후 당뇨병은 매우 중요한 합병증 가운데 하나이지만 신장이식 후 당뇨병의 자연 경과에 대해서는 거의 연구된 바가 없다. 본 연구에서는 신장이식 후 당뇨병(posttransplantation diabetes mellitus, PTDM)의 발생 시기와 영구성의 관점에서 세부적인 자연경과를 관찰하고 다양한 임상 경과를 나타내는데 영향을 미치는 위험인자들을 분석하고자 하였다.방법: 당뇨병이 없는 신장이식 예정자를 대상으로 이식 전 75 g 경구당부하검사를 실시하여 정상 혈당 소견을 보이는 77명을 대상으로 이식 후 1년, 7년 경과 시 반복하여 당부하검사를 실시하여, PTDM의 발생시기 및 영속성에 따라 early PTDM (E-PTDM), late PTDM (L-PTDM), persistent PTDM (P-PTDM), transient PTDM (T-PTDM), 그리고 non-PTMD (N-PTDM)으로 분류하였다.결과: 신장이식 후 당뇨병의 자연경과에 따라 군은 분류하였는데 각각의 발생률은 다음과 같았다: E-PTDM, 39%; L-PTDM, 11.7%; T-PTDM, 15.6%; P-PTDM, 23.4%, N-PTDM, 49.3%. 면역억제제와 성별은 E-PTDM 발생에 관련 있는 인자였으며, 이식 당시 연령은 P-PTDM 발생과, 그리고 신장이식 1년경과 시점에서의 체질량지수는 L-PTDM 발생에 영향을 미치는 인자였다. Background: New onset diabetes is a major complication after kidney transplantation. However, the natural course of posttransplantation diabetes mellitus (PTDM) remains unclear. The aim of this study was to demonstrate the detailed natural courses of PTDM according to the onset and persistency of hyperglycemia, and to investigate risk factors for development of different courses of PTDM in renal allograft recipients.Methods: A total of 77 renal allograft recipients without previously known diabetes were enrolled and performed a serial 75 g oral glucose tolerance test at 0, 1, and 7 years after kidney transplantation. Patients were classified according to the onset and persistency of PTDM: early PTMD (E-PTDM), late PTDM (L-PTDM), persistent PTDM (P-PTDM), transient PTMD (T-PTDM), and non-PTDN (N-PTDM).Results: The incidence of each group was as follows: E-PTDM, 39%; L-PTDM, 11.7%; P-PTDM, 23.4% T-PTDM, 15.6%; N-PTDM, 49.3%. Tacrolimus and female gender were associated with the development of E-PTDM. Among E-PTDM, age at transplantation was a high risk factor for the development of P-PTDM. Higher BMI at year1 was associated with the development of L-PTDM.Conclusion: Different risk factors were associated with various natural courses of PTDM. Since old age and female gender are not modifiable risk factors, it may be important to modify immunosuppressive therapy regimens for the prevention of E-PTDM and control of body weight for L-PTDM. (J Kor Endocrinol Soc 21:373~381, 2006)