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Kim SY, Kim S. Therapeutic Effects of Switching to Anagliptin from Other DPP-4 Inhibitors in T2DM Patients with Inadequate Glycemic Control: A Non-interventional, Single-Arm, Open-Label, Multicenter Observational Study. Diabetes Ther 2023; 14:109-121. [PMID: 36417158 PMCID: PMC9880082 DOI: 10.1007/s13300-022-01339-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/02/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The effects of switching DPP-4 inhibitors in type 2 diabetes mellitus (T2DM) patients are being widely studied. However, information of which factors affect the therapeutic response is limited. We evaluated the difference in HbA1c lowering effect by comorbidity and other variables after switching to anagliptin in patients with T2DM inadequately controlled by other DPP-4 inhibitors. METHODS In a multicenter, open-label, single-arm, prospective observational study, patients with T2DM, HbA1c ≥ 7.0% who have taken DPP-4 inhibitors other than anagliptin, either alone or in combination (DPP-4 inhibitors + metformin/sulfonylurea (SU)/thiazolidinedione (TZD)/insulin), for at least 8 weeks were enrolled. After the switch to anagliptin, HbA1c and available clinical characteristics were determined. RESULTS The change in HbA1c levels from baseline to week 12 and 24 was - 0.40% and - 0.42% in all patients. However, comparing the subgroups without and with comorbidities, the change in HbA1c levels at weeks 12 and 24 was - 0.68% and - 0.89% vs. - 0.27% and 0.22%, respectively. In addition, the proportion of patients achieving HbA1c < 7% from baseline to week 12 and 24 was increased to 70% and 70% vs. 20% and 24%, respectively. Duration of T2DM and different subtype classes of DPP-4 inhibitor did not significantly contribute to the change in HbA1c. CONCLUSION In patients with T2DM poorly controlled by other DPP-4 inhibitors, HbA1c levels were significantly decreased after switching to anagliptin. Given that the change in HbA1c was greater in patients without comorbidities than in patients with comorbidities, switching to anagliptin before adding other oral hypoglycemic agents (OHAs) may be an option in patients without comorbidities.
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Affiliation(s)
- Sang-Yong Kim
- Division of Endocrinology, Department of Internal Medicine, College of Medicine, Chosun University, 365 Pilmun-daero, Dong-gu, Gwangju, 61453, Korea
| | - Sungrae Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 327 Sosa-ro, Wonmi-gu, Bucheon, 14647, Korea.
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Basit A, Waris N, Fawwad A, Tahir B, Siddiqui IA. Glycemic status and general characteristics among individuals with undiagnosed diabetes; findings from second National Diabetes Survey of Pakistan 2016-2017 (NDSP 08). Diabetes Metab Syndr 2022; 16:102535. [PMID: 35700662 DOI: 10.1016/j.dsx.2022.102535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/20/2022] [Accepted: 06/02/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM To observe the glycemic status among individuals with undiagnosed diabetes in urban and rural areas of all four provinces of Pakistan. METHODS The findings of this study are obtained from the second National Diabetes Survey of Pakistan (NDSP) 2016-2017, a nationwide epidemiological survey. Out of 12,486 individuals approached, 10,834 participants agreed to be included in the second NDSP. An oral glucose tolerance test was used to assess undiagnosed diabetes individuals according to World Health Organization criteria. RESULTS The overall weighted prevalence of undiagnosed diabetes was 7.1% (2.4% in urban and 4.7% in rural areas). Based on isolated fasting plasma glucose or 2-h post 75 gm glucose load or combining both, the weighted prevalence of undiagnosed diabetes was 43.5%, 17.6%, and 38.9%, respectively. Out of the 43.5% of individuals, 15.3% had fasting plasma glucose higher than 250 mg/dl at the time of presentation. Among all the individuals, 23.7% were found to be of less than 40 years of age, 29.2% had a positive family history of diabetes, 80.8% were abdominal obese, 53.8% were hypertensive, and 98% were dyslipidemic. In comparison to the elder group, poor glycemic control of ≥10% HbA1c was observed in most of the younger age groups (p < 0.05). CONCLUSION A significant number of people remain undiagnosed in this part of the world. The glycemic status along with the other associated risk factors at the time of presentation is alarming. Thus, for the early detection of diabetes, awareness and education in the community are crucial. Hence, long-term complications of diabetes can be prevented.
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Affiliation(s)
- Abdul Basit
- Research Department, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan.
| | - Nazish Waris
- Research Department, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan; Clinical Biochemistry and Psychopharmacology Research Unit, Department of Biochemistry, University of Karachi, Pakistan.
| | - Asher Fawwad
- Research Department, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan; Biochemistry Department, Baqai Medical University, Karachi, Pakistan.
| | - Bilal Tahir
- Research Department, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan.
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Joy T, Najeeb S, Sreedevi A, Vijayakumar K. Glycemic control and its determinants among people with type 2 diabetes mellitus in Ernakulam district, Kerala. Indian J Public Health 2022; 66:S80-S86. [DOI: 10.4103/ijph.ijph_1104_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kim J, Seong H, Son KJ, Chung EJ. Declined incidence of patients treated for vision-threatening diabetic retinopathy in South Korea: a 12-year nationwide population-based study. Graefes Arch Clin Exp Ophthalmol 2021; 260:101-111. [PMID: 34410486 DOI: 10.1007/s00417-021-05365-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To determine the age- and sex-specific annual incidence rates of patients treated for VTDR and the factors associated with increased treatment rates in patients with type 2 diabetes mellitus (T2DM) in South Korea. METHODS This was a nationwide, retrospective, 12-year, population-based study. Patients aged over 30 years who were diagnosed with T2DM between 2006 and 2017 were included in this study. We evaluated the national health claims data acquired from the Korean National Health Insurance Service database. Main outcome measures were the annual incidence rates of patients treated for VTDR and the associated risk factors. RESULTS The age-adjusted annual incidence rate of patients treated for VTDR significantly decreased from 10.05 per 1000 T2DM patients in 2006 to 6.11 in 2017 (β = - 0.3192, P < 0.0001). The sex-adjusted annual incidence rate also significantly decreased in both men (β = - 0.2861, P < 0.0001) and women (β = - 0.3666, P < 0.0001). Cox hazard analysis showed that factors such as insulin use, young age, chronic kidney disease and male sex were significantly associated with increased rate of treatments for VTDR. In addition, the risk was lower for rural than for metropolitan residents. CONCLUSIONS Despite the increase in the number of T2DM patients in South Korea, the incidence rate of patients treated for VTDR decreases with early diagnosis and appropriate treatment. Therefore, it is important to detect and manage high-risk groups early to prevent visual impairment due to VTDR.
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Affiliation(s)
- Jiwon Kim
- Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, #100 Ilsan-ro, Ilsandong-gu, Gyeonggi-do, 410-719, Goyang, Korea
| | - Hyojin Seong
- Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, #100 Ilsan-ro, Ilsandong-gu, Gyeonggi-do, 410-719, Goyang, Korea.,Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Kang Ju Son
- Department of Research and Analysis, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Eun Jee Chung
- Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, #100 Ilsan-ro, Ilsandong-gu, Gyeonggi-do, 410-719, Goyang, Korea.
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de Cleva R, Kawamoto F, Borges G, Caproni P, Cassenote AJF, Santo MA. C-peptide level as predictor of type 2 diabetes remission and body composition changes in non-diabetic and diabetic patients after Roux-en-Y gastric bypass. Clinics (Sao Paulo) 2021; 76:e2906. [PMID: 34378729 PMCID: PMC8311643 DOI: 10.6061/clinics/2021/e2906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/11/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Several predictors of type 2 diabetes mellitus (T2DM) remission after metabolic surgery have been proposed and used to develop predictive scores. These scores may not be reproducible in diverse geographic regions with different baseline characteristics. This study aimed to identify predictive factors associated with T2DM remission after Roux-en-Y gastric bypass (RYGB) in patients with severe obesity. We hypothesized that the body composition alterations induced by bariatric surgery could also contribute to diabetes remission. METHODS We retrospectively evaluated 100 patients with severe obesity and T2DM who underwent RYGB between 2014 and 2016 for preoperative factors (age, diabetes duration, insulin use, HbA1c, C-peptide plasma level, and basal insulinemia) to identify predictors of T2DM remission (glycemia<126 mg/dL and/or HbA1c<6.5%) at 3 years postoperatively. The potential preoperative predictors were prospectively applied to 20 other patients with obesity and T2DM who underwent RYGB for validation. In addition, 81 patients with severe obesity (33 with T2DM) underwent body composition evaluations by bioelectrical impedance analysis (InBody 770®) 1 year after RYGB for comparison of body composition changes between patients with and those without T2DM. RESULTS The retrospective analysis identified only a C-peptide level >3 ng/dL as a positive predictor of 3-year postoperative diabetes remission, which was validated in the prospective phase. There was a significant difference in the postoperative body composition changes between non-diabetic and diabetic patients only in trunk mass. CONCLUSION Preoperative C-peptide levels can be useful for predicting T2DM remission after RYGB. Trunk mass is the most important difference in postoperative body composition changes between non-diabetic and diabetic patients.
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Affiliation(s)
- Roberto de Cleva
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
| | - Flavio Kawamoto
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Georgia Borges
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Priscila Caproni
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Alex Jones Flores Cassenote
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marco Aurelio Santo
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Larry M, Alizadeh S, Naderi S, Salekani B, Mansournia MA, Rabizadeh S, Esteghamati A, Nakhjavani M. Inadequate achievement of ABC goals (HbA1c, blood pressure, LDL-C) among patients with type 2 diabetes in an Iranian population, 2012-2017. Diabetes Metab Syndr 2020; 14:619-625. [PMID: 32422446 DOI: 10.1016/j.dsx.2020.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 11/24/2022]
Abstract
AIMS This study was designed to evaluate the meeting of ABC goals in patients with type 2 diabetes. The ABC goals were defined as meeting the HbA1c <7%, systolic blood pressure <130 mmHg and diastolic blood pressure <80 mmHg, and LDL-C <100 mg/dL. We also determined the associated factors with meeting the ABC goals, as well as the effectiveness of statin therapy. METHODS We designed a cross-sectional study of 2008 type 2 diabetes patients attending the diabetes clinics of Valiasr Hospital of Imam Khomeini Hospital Complex. Meeting ABC goals and their associated factors were analyzed from the registered data. RESULTS At the end of the year 2014, 61.3% of patients met the HbA1c goal, which increased to 77.8% in 2017. Blood pressure of 79.5% of patients met the ADA recommendations by the end of the year 2014, reaching 86.6% in 2017. Moreover, 84.5% and 93.8% could reach the LDL-C goal in 2014 and 2017, respectively. The proportion for the patients meeting all three ABC goals were 23.2% and 42.1% in 2014 and 2017, respectively. CONCLUSIONS The level of achievement of ABC goals in Iran is lower than expected and it requires a lot of programming effort and follow-up. As patients are followed over the years, controlling ABC becomes much more favorable.
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Affiliation(s)
- Mehrdad Larry
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Saeid Alizadeh
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sina Naderi
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Bahareh Salekani
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Soghra Rabizadeh
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Kim SK, Jang JY, Kim DL, Rhyu YA, Lee SE, Ko SH, Han K, Song KH. Site-specific cancer risk in patients with type 2 diabetes: a nationwide population-based cohort study in Korea. Korean J Intern Med 2020; 35:641-651. [PMID: 32392663 PMCID: PMC7214364 DOI: 10.3904/kjim.2017.402] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 04/01/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS We aimed to evaluate site-specific cancer risk in diabetic patients and to investigate causal and temporal relationships by analyzing organ-specific cancer risk according to the duration of diabetes. METHODS Using a database provided by the Korean National Health Insurance Service, we conducted a retrospective, population-based cohort study of adults aged ≥ 30 years from January 2005 to December 2013. To verify the possibility of detection bias or reverse causation, we compared hazard ratios (HRs) for each cancer according to the following duration of diabetes: less than 6 months, 6 months to 3 years, and more than 3 years. RESULTS The incidence of overall cancer per 1,000 person-years was higher in patients with diabetes than in those without diabetes (20.36 vs. 10.83). The overall cancer risk according to the duration of diabetes was the highest within the first 6 months after diagnosis (HR, 2.03; 95% confidence interval [CI], 1.99 to 2.07), and the HR decreased with the duration of diabetes, ranging from 1.19 (95% CI, 1.18 to 1.21) between 6 months and 3 years to 1.12 (95% CI, 1.11 to 1.13) after 3 years. Both overall cancer risk and HR remained significantly higher in patients with diabetes than in those without diabetes. The risk for prostate cancer was higher in men with diabetes than in those without diabetes (HR, 1.12; 95% CI, 1.10 to 1.14). In women, the risk for endometrial cancer was significantly higher in patients with diabetes than in those without diabetes throughout the duration of diabetes. CONCLUSION The risk for stomach, colorectum, liver, pancreas, and kidney cancer appeared to be higher in patients with diabetes than in those without diabetes regardless of the sex or duration of diabetes.
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Affiliation(s)
- Suk Kyeong Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Ju-Young Jang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Dong-Lim Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Young A Rhyu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Suh Eun Lee
- Graduate School of Medicine, Konkuk University, Seoul, Korea
| | - Seung-Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyungdo Han
- Department of Biostatistic, The Catholic University of Korea, Seoul, Korea
| | - Kee-Ho Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
- Correspondence to Kee-Ho Song, M.D. Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Korea Tel: +82-2-2030-7533 Fax: +82-2-2030-7748 E-mail:
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Moon SJ, Yu KS, Kim MG. An Assessment of Pharmacokinetic Interaction Between Lobeglitazone and Sitagliptin After Multiple Oral Administrations in Healthy Men. Clin Ther 2020; 42:1047-1057. [PMID: 32362346 DOI: 10.1016/j.clinthera.2020.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/16/2020] [Accepted: 04/07/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Patients with type 2 diabetes mellitus require strict blood glucose control, and combination therapy with a thiazolidinedione and dipeptidyl peptidase-4 inhibitors, such as lobeglitazone and sitagliptin, is one of the recommended treatments. The objective of this study was to investigate a possible pharmacokinetic interaction between lobeglitazone and sitagliptin after multiple oral administrations in healthy Korean men. METHODS Two randomized, open-label, multiple-dose, 2-way crossover studies were conducted simultaneously in healthy men. In study 1, men were randomly assigned to 1 of 2 sequences, and 1 of the following treatments was administered in each period: 1 tablet of lobeglitazone sulfate (0.5 mg) once daily for 5 days and or 1 tablet each of lobeglitazone sulfate (0.5 mg) and sitagliptin (100 mg) once daily for 5 days. In study 2, men were also randomly assigned to 1 of 2 sequences and the treatments were as follows: 1 tablet of sitagliptin (100 mg) once daily for 5 days or 1 tablet each of sitagliptin (100 mg) and lobeglitazone sulfate (0.5 mg) once daily for 5 days. Serial blood samples were collected up to 48 h after dosing on the fifth day. Plasma drug concentrations were measured by LC-MS/MS. Pharmacokinetic parameters, including Cmax,ss and AUC0-τ , were determined by noncompartmental analysis. The geometric least-square mean (GLSM) ratios and associated 90% CIs of log-transformed Cmax,ss and AUC0-τ for separate or coadministration were calculated to evaluate pharmacokinetic interactions. FINDINGS Nineteen men from study 1 and 17 from study 2 completed the pharmacokinetic sampling and were included in the analyses. The GLSM ratios of Cmax,ss and AUC0-τ were 0.9494 (95% CI, 0.8798-1.0243) and 1.0106 (95% CI, 0.9119-1.1198) for lobeglitazone (from study 1) and 1.1694 (95% CI, 1.0740-1.2732) and 1.0037 (95% CI, 0.9715-1.0369) for sitagliptin (from study 2), respectively. IMPLICATIONS Except for the slight 17% increase in the sitagliptin Cmax,ss value, the pharmacokinetic parameters of lobeglitazone and sitagliptin met the pharmacokinetic equivalent criteria when administered separately or in combination. The increase in Cmax of sitagliptin when coadministered with lobeglitazone would not be clinically significant in practice. ClinicalTrials.gov Identifier: NCT02824874 and NCT02827890.
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Affiliation(s)
- Seol Ju Moon
- Center for Clinical Pharmacology and Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, Republic of Korea; Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Kyung-Sang Yu
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Min-Gul Kim
- Center for Clinical Pharmacology and Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Republic of Korea; Department of Pharmacology, School of Medicine, Jeonbuk National University, Jeonju, Republic of Korea.
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Rasmussen MF. The development of oral semaglutide, an oral GLP-1 analog, for the treatment of type 2 diabetes. Diabetol Int 2020; 11:76-86. [PMID: 32206477 PMCID: PMC7082439 DOI: 10.1007/s13340-019-00423-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 12/19/2019] [Indexed: 12/24/2022]
Abstract
Glucagon-like peptide-1 receptor agonists (GLP-1RA) are effective agents for achieving glycemic control. Oral semaglutide is the first oral formulation of a GLP-1RA to be approved in the USA. This agent may lead to earlier initiation of GLP-1RA therapy in the type 2 diabetes continuum of care, and represents a valuable treatment option for patients with a preference for oral therapy. The efficacy and safety of oral semaglutide was assessed in the PIONEER clinical trial program, which included 9543 patients (1293 Japanese). The program included 10 trials, two of which were conducted specifically in Japan. Across the whole program, oral semaglutide was shown to be effective in helping patients achieve glycemic control and reducing body weight. The highest approved dose of oral semaglutide (14 mg) reduced glycated hemoglobin significantly more than placebo, empagliflozin, dulaglutide, and sitagliptin, and was non-inferior to liraglutide. Superior reductions in body weight were also observed with oral semaglutide 14 mg compared with placebo, sitagliptin, and liraglutide, and similar body weight reductions were seen vs. empagliflozin. In all the PIONEER trials, oral semaglutide was well tolerated; there were no unexpected safety concerns and the safety profile was consistent with other GLP-1RAs. Oral semaglutide also demonstrated a favorable cardiovascular safety profile, and significant reductions in cardiovascular death and all-cause mortality vs. placebo in the PIONEER 6 trial. Oral semaglutide, therefore, represents an effective treatment option, that may lead to earlier initiation of GLP-1RA therapy in the diabetes treatment landscape.
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Lee M, Sun J, Han M, Cho Y, Lee JY, Nam CM, Kang ES. Nationwide Trends in Pancreatitis and Pancreatic Cancer Risk Among Patients With Newly Diagnosed Type 2 Diabetes Receiving Dipeptidyl Peptidase 4 Inhibitors. Diabetes Care 2019; 42:2057-2064. [PMID: 31431452 DOI: 10.2337/dc18-2195] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 07/29/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Dipeptidyl peptidase 4 inhibitors (DPP-4i) are useful incretin-based antidiabetes drugs. However, there is a concern that DPP-4i may adversely impact the exocrine pancreas, owing to their pleiotropic effects. In this study, we investigated whether DPP-4i are associated with pancreatitis and pancreatic cancer using a nationwide population-based cohort study. RESEARCH DESIGN AND METHODS We included patients newly diagnosed with type 2 diabetes who were treated with antidiabetes drugs (n = 33,208) from 2007 to 2013. The data were obtained from the Korean National Health Insurance Service-Health Screening Cohort database (n = 514,866). Risk was estimated using a Cox proportional hazards model with time-dependent covariates. A 6-month lag time was used to account for a possible latency time. The risk across various time segments since the first prescription of DPP-4i was also analyzed. RESULTS Out of 33,208 subjects, 10,218 were new users of DPP-4i and 22,990 were new users of other antidiabetes drugs. DPP-4i significantly increased the risks of pancreatitis (adjusted hazard ratio [aHR] 1.24, 95% CI 1.01-1.52; P = 0.037) and pancreatic cancer (aHR 1.81, 95% CI 1.16-2.82; P = 0.009) with a 6-month drug use lag period. The risk of pancreatitis and pancreatic cancer was generally consistent in the first 12 months and 1 year after the initial prescription without showing an increasing trend according to exposure duration. CONCLUSIONS DPP-4i use is associated with increased risks of pancreatitis and pancreatic cancer in patients with newly diagnosed type 2 diabetes. However, the absence of increasing trend according to exposure duration suggests the chances of reverse causality, and long-term pancreatic safety of DPP-4i has to be further investigated.
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Affiliation(s)
- Minyoung Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jiyu Sun
- Biostatistics and Computing, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Minkyung Han
- Department of Public Health, Graduate School, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yongin Cho
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji-Yeon Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chung Mo Nam
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Seok Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea .,Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Republic of Korea
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Kim BY, Won JC, Lee JH, Kim HS, Park JH, Ha KH, Won KC, Kim DJ, Park KS. Diabetes Fact Sheets in Korea, 2018: An Appraisal of Current Status. Diabetes Metab J 2019; 43:487-494. [PMID: 31339012 PMCID: PMC6712228 DOI: 10.4093/dmj.2019.0067] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 05/26/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The objective of this study was to investigate the prevalence, management, and comorbidities of diabetes among Korean adults aged 30 years and older. METHODS This study used 2013 to 2016 data from the Korea National Health and Nutrition Examination Survey, a nationally-representative survey of the Korean population. Diabetes was defined as fasting glucose ≥126 mg/dL, current use of antidiabetic medication, a previous history of diabetes, or glycosylated hemoglobin (HbA1c) ≥6.5%. RESULTS In 2016, 14.4% (approximately 5.02 million) of Korean adults had diabetes. The prevalence of impaired fasting glucose was 25.3% (8.71 million). From 2013 to 2016, the awareness, control, and treatment rates for diabetes were 62.6%, 56.7%, and 25.1%, respectively. People with diabetes had the following comorbidities: obesity (50.4%), abdominal obesity (47.8%), hypertension (55.3%), and hypercholesterolemia (34.9%). The 25.1%, 68.4%, and 44.2% of people with diabetes achieved HbA1c <6.5%, blood pressure <140/85 mm Hg, and low density lipoprotein cholesterol <100 mg/dL. Only 8.4% of people with diabetes had good control of all three targets. CONCLUSION This study confirms that diabetes is as an important public health problem. Efforts should be made to increase awareness, detection, and comprehensive management of diabetes to reduce diabetes-related morbidity and mortality.
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Affiliation(s)
- Bo Yeon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jong Chul Won
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cardiovascular and Metabolic Disease Center, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jae Hyuk Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Myongji Hospital, Goyang, Korea
| | - Hun Sung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Hwan Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Kyoung Hwa Ha
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Kyu Chang Won
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea.
| | - Kyong Soo Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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12
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Shin JY. Trends in the prevalence and management of diabetes in Korea: 2007-2017. Epidemiol Health 2019; 41:e2019029. [PMID: 31319658 PMCID: PMC6702122 DOI: 10.4178/epih.e2019029] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 07/04/2019] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES This study analyzed Korea National Health and Nutrition Examination Survey data from 2007 to 2017 to assess trends in the prevalence, treatment, and control of diabetes in Korean adults ≥30 years of age. METHODS Prevalent diabetes was defined as a fasting plasma glucose level ≥126 mg/dL, self-reported use of anti-diabetic treatment (insulin or oral anti-diabetic drugs), or diabetes diagnosis by a physician. Target levels were defined as glycosylated hemoglobin <6.5% or <7.0%, blood pressure <130/80 mmHg, and total cholesterol <200 mg/dL. All survey waves were age-standardized to the 2005 Korean census population. RESULTS Diabetes prevalence increased from 9.6% in 2007-2009 to 10.8% in 2016-2017 (p<0.001). Impaired fasting glucose prevalence significantly increased in both genders and almost every age group. Diabetes awareness and glycemic control did not show an increasing trend; however, the treatment rate and proportion of people diagnosed with diabetes achieving target blood pressure and total cholesterol levels improved from 57.2% to 63.5% (p=0.008), from 41.1% to 53.2% (p<0.001), and from 65.0% to 78.0% (p<0.001), respectively. CONCLUSIONS From 2007 to 2017, the prevalence of diabetes increased moderately in Korea, whereas the diabetes treatment rate and the proportion of people diagnosed with diabetes achieving target blood pressure and total cholesterol levels improved. However, awareness of diabetes and glycemic control require significant improvements. A national-level action plan is required to raise awareness about diabetes and prediabetes, with the goal of improving glycemic control and minimizing the occurrence of adverse health outcomes.
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Affiliation(s)
- Ji-Yeon Shin
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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13
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Gu MO. Factors Influencing Glycemic Control among Type 2 Diabetes Mellitus Patients: The Sixth Korea National Health and Nutrition Examination Survey (2013~2015). ACTA ACUST UNITED AC 2019. [DOI: 10.7475/kjan.2019.31.3.235] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Mee Ock Gu
- Professor, College of Nursing, Gerontological Health Research Center in Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
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14
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Park JY. Prediction of Type 2 Diabetes Remission after Bariatric or Metabolic Surgery. J Obes Metab Syndr 2018; 27:213-222. [PMID: 31089566 PMCID: PMC6513303 DOI: 10.7570/jomes.2018.27.4.213] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 11/15/2018] [Accepted: 11/19/2018] [Indexed: 12/17/2022] Open
Abstract
Bariatric surgery has evolved from a surgical measure for treating morbid obesity to an epochal remedy for treating metabolic syndrome as a whole, which is represented by type 2 diabetes mellitus. Numerous clinical trials have advocated bariatric or metabolic surgery over nonsurgical interventions because of markedly superior metabolic outcomes in morbidly obese patients who satisfy traditional criteria for bariatric surgery (body mass index [BMI] >35 kg/m2) and in less obese or simply overweight patients. Nevertheless, not all diabetes patients achieve the most desirable outcomes; i.e., diabetes remission after metabolic surgery. Thus, candidates for metabolic surgery should be carefully selected based on comprehensive preoperative assessments of the risk-benefit ratio. Predictors for diabetes remission after metabolic surgery may be classified into two groups based on mechanism of action. The first is indices for preserved pancreatic beta-cell function, including younger age, shorter duration of diabetes, and higher C-peptide level. The second is the potential for an insulin resistance reduction, including higher baseline BMI and visceral fat area. Several prediction models for diabetes remission have been suggested by merging these two to guide the joint decision-making process between clinicians and patients. Three such models, DiaRem, ABCD, and individualized metabolic surgery scores, provide an intuitive scoring system and have been validated in an independent external cohort and can be utilized in routine clinical practice. These prediction models need further validation in various ethnicities to ensure universal applicability.
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Affiliation(s)
- Ji Yeon Park
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu,
Korea
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15
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Lee EH, Lee YW, Lee KW, Nam M, Kim SH. A new comprehensive diabetes health literacy scale: Development and psychometric evaluation. Int J Nurs Stud 2018; 88:1-8. [DOI: 10.1016/j.ijnurstu.2018.08.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 08/08/2018] [Accepted: 08/08/2018] [Indexed: 02/04/2023]
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16
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Yang T, Zheng R, Chen Q, Mao Y. Current status of treatment of type 2 diabetes mellitus in Ningbo, China. J Clin Lab Anal 2018; 33:e22717. [PMID: 30461061 DOI: 10.1002/jcla.22717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/18/2018] [Accepted: 10/19/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The treatment status of type 2 diabetes mellitus (T2DM) in Ningbo has not been reported in the past. To evaluate the current status of T2DM in Ningbo and provide evidence to formulate more policies, a multicenter investigation was needed. METHODS The Ningbo Clinical Research Group of Diabetes constituted nine hospitals. Participants included 3015 patients who visited the nine hospitals from June to December 2016. General characteristics, the medication situation, the laboratory indexes in nearly 3 months consisting of glycosylated hemoglobin level (HbA1c), low-density lipoprotein cholesterol (LDL-C), and fasting blood glucose (FBG), and the results of ophthalmologic examination were investigated. The evaluation criteria were defined based on 2013 China guideline for T2DM. RESULTS The 3015 subjects included 1685 men and 1330 women. The average age was 63.3 ± 13.0 years. The prevalence of hypertension and dyslipidemia was 58.7% and 56.7%, respectively. In the examinees, nephropathy appeared in 11.6% and retinopathy in 14.5%. More than half (50.9%) of the subjects were overweight. The achievement rate of blood pressure (BP) was 39.6% (<140/80 mm Hg), FBG was 46.0% (4.4-7.0 mmol/L), HbA1c was 41.7% (<7.0%), and LDL-C was 51.7% (<1.8 mmol/L; and if accompanied by CHD, <2.6). CONCLUSION Ningbo City T2DM status is not optimistic, and there is a big gap with the indicators.
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Affiliation(s)
- Tianmeng Yang
- Department of Endocrinology, the Affiliated Hospital of Medical School of Ningbo University, Ningbo, China.,Ningbo University School of Medicine, Ningbo, China
| | | | - Qingmei Chen
- Department of Endocrinology, the Affiliated Hospital of Medical School of Ningbo University, Ningbo, China.,Ningbo University School of Medicine, Ningbo, China
| | - Yushan Mao
- Department of Endocrinology, the Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
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Kim KJ, Kwon TY, Yu S, Seo JA, Kim NH, Choi KM, Baik SH, Choi DS, Kim SG, Park Y, Kim NH. Ten-Year Mortality Trends for Adults with and without Diabetes Mellitus in South Korea, 2003 to 2013. Diabetes Metab J 2018; 42:394-401. [PMID: 29885109 PMCID: PMC6202563 DOI: 10.4093/dmj.2017.0088] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 03/14/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND To estimate and compare the trends of all-cause and cause-specific mortality rates for subjects with and without diabetes in South Korea, from 2003 to 2013. METHODS Using a population-based cohort (2003 to 2013), we evaluated annual mortality rates in adults (≥30 years) with and without diabetes. The number of subjects in this analysis ranged from 585,795 in 2003 to 670,020 in 2013. RESULTS Age- and sex-adjusted all-cause mortality rates decreased consistently in both groups from 2003 to 2013 (from 14.4 to 9.3/1,000 persons in subjects with diabetes and from 7.9 to 4.4/1,000 persons in those without diabetes). The difference in mortality rates between groups also decreased (6.61 per 1,000 persons in 2003 to 4.98 per 1,000 persons in 2013). The slope associated with the mortality rate exhibited a steeper decrease in subjects with diabetes than those without diabetes (regression coefficients of time: -0.50 and -0.33, respectively; P=0.004). In subjects with diabetes, the mortality rate from cardiovascular disease decreased by 53.5% (from 2.73 to 1.27 per 1,000 persons, P for trend <0.001). Notably, the decrease in mortality from ischemic stroke (79.2%, from 1.20 to 0.25 per 1,000 persowns) was more profound than that from ischemic heart disease (28.3%, from 0.60 to 0.43 per 1,000 persons). CONCLUSION All-cause and cardiovascular mortality rates decreased substantially from 2003 to 2013, and the decline in ischemic stroke mortality mainly contributed to the decreased cardiovascular mortality in Korean people with diabetes.
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Affiliation(s)
- Kyeong Jin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Tae Yeon Kwon
- Department of International Finance, Hankuk University of Foreign Studies, Yongin, Korea
| | - Sungwook Yu
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Ji A Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Nan Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sei Hyun Baik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Dong Seop Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yousung Park
- Department of Statistics, Korea University, Seoul, Korea.
| | - Nam Hoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
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18
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Azizul Islam SKM, Chung JW, Lee YS, Cho H, Moon SS. Negative Association of Hepatitis B Virus With Hearing Impairment. Am J Audiol 2018; 27:324-332. [PMID: 30167657 DOI: 10.1044/2018_aja-17-0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 05/07/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Hearing impairment is one of the most common chronic diseases causing deterioration of the quality of life in elderly individuals. Several viral infections have been suggested to cause hearing impairment. We investigated association of hepatitis B virus (HBV) infection with hearing impairment using a representative sample of the Korean population. METHOD Participants included 6,583 men and 8,702 women, who were ≥ 20 years of age from the Korea National Health and Nutritional Examination Surveys of the Korean population (2010-2012). Air-conduction pure-tone thresholds were measured in a soundproof booth using an automatic audiometer for each ear at 6 frequencies (500, 1000, 2000, 3000, 4000, and 6000 Hz). An audiometric test and a laboratory examination, including an HBV surface antigen (HBsAg) test, were performed. RESULTS Subjects who are HBsAg positive had lower average of pure-tone thresholds and lower prevalence of hearing impairment at both low/mid and high frequency compared with those without. Adjusted means of hearing thresholds were also lower among subjects who are HBsAg positive compared with subjects who are HBsAg negative. After the adjustment for age and gender, the odds of high-frequency mild hearing impairment were lower for subjects with HBV infection. In the multiple logistic regression analyses adjusting for confounding variables, the significant negative association between HBV infection and high-frequency mild hearing impairment still remained. CONCLUSIONS Contrary to previous reports, subjects who are HBsAg positive had a lower prevalence of hearing impairment compared with subjects who are HBsAg negative. Further studies are warranted to investigate the underlying mechanism regarding their negative relationship.
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Affiliation(s)
- SKM Azizul Islam
- Medical Institute of Dongguk University, Gyeongju, South Korea
- Department of Internal Medicine, College of Medicine, Dongguk University, Gyeongju, South Korea
| | - Jin Wook Chung
- Department of Internal Medicine, College of Medicine, Dongguk University, Gyeongju, South Korea
| | - Young-Sil Lee
- Department of Internal Medicine, College of Medicine, Dongguk University, Gyeongju, South Korea
| | - HoChan Cho
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Seong-Su Moon
- Medical Institute of Dongguk University, Gyeongju, South Korea
- Department of Internal Medicine, College of Medicine, Dongguk University, Gyeongju, South Korea
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19
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Choe SA, Kim JY, Ro YS, Cho SI. Women are less likely than men to achieve optimal glycemic control after 1 year of treatment: A multi-level analysis of a Korean primary care cohort. PLoS One 2018; 13:e0196719. [PMID: 29718952 PMCID: PMC5931663 DOI: 10.1371/journal.pone.0196719] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 04/18/2018] [Indexed: 12/14/2022] Open
Abstract
We investigated differences in the achievement of glycemic control among newly diagnosed type-2 diabetes patients according to gender using a multi-clinic retrospective cohort study. Optimal glycemic control was defined as hemoglobin A1c (HbA1c) of less than 6.5% after 1 year of diabetes management. A generalized linear mixed model, which controlled for the fixed effects of baseline characteristics and prescribed oral hypoglycemic agent (OHA), was used to calculate the probability of achieving the target HbA1c. The study included 2,253 newly diagnosed type-2 diabetes patients who completed 1 year of diabetic management, including OHA, in the 36 participating primary clinics. Within the study population, the women had an older average age, were less likely to smoke or drink alcohol, and showed lower levels of fasting blood glucose and HbA1c at the time of diagnosis. There were no significant differences by sex in prescribed OHA or median number of visits. After 1 year of diabetes management, 38.9% of women and 40.6% of men achieved the target HbA1c-a small but significant difference. This suggests that type-2 diabetes is managed less well in women than in men.
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Affiliation(s)
- Seung-Ah Choe
- Department of Obstetrics and Gynecology, CHA University, School of Medicine, Gyeonggi-do, Republic of Korea
- Department of Epidemiology, Graduate School of Public Health, Brown University, Providence, RI, United States of America
| | - Joo Yeong Kim
- Department of Emergency Medicine, Korea University Ansan Hospital, Gyeonggi-do, Republic of Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Sung-Il Cho
- Department of Epidemiology, Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
- * E-mail:
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20
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Comparison of Adherence to Glimepiride/Metformin Sustained Release Once-daily Versus Glimepiride/Metformin Immediate Release BID Fixed-combination Therapy Using the Medication Event Monitoring System in Patients With Type 2 Diabetes. Clin Ther 2018; 40:752-761.e2. [DOI: 10.1016/j.clinthera.2018.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/23/2018] [Accepted: 04/02/2018] [Indexed: 01/10/2023]
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21
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Ko SH, Han K, Lee YH, Noh J, Park CY, Kim DJ, Jung CH, Lee KU, Ko KS. Past and Current Status of Adult Type 2 Diabetes Mellitus Management in Korea: A National Health Insurance Service Database Analysis. Diabetes Metab J 2018; 42:93-100. [PMID: 29676539 PMCID: PMC5911525 DOI: 10.4093/dmj.2018.42.2.93] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/04/2018] [Indexed: 01/21/2023] Open
Abstract
Korea's National Healthcare Program, the National Health Insurance Service (NHIS), a government-affiliated agency under the Korean Ministry of Health and Welfare, covers the entire Korean population. The NHIS supervises all medical services in Korea and establishes a systematic National Health Information database (DB). A health information DB system including all of the claims, medications, death information, and health check-ups, both in the general population and in patients with various diseases, is not common worldwide. On June 9, 2014, the NHIS signed a memorandum of understanding with the Korean Diabetes Association (KDA) to provide limited open access to its DB. By October 31, 2017, seven papers had been published through this collaborative research project. These studies were conducted to investigate the past and current status of type 2 diabetes mellitus and its complications and management in Korea. This review is a brief summary of the collaborative projects between the KDA and the NHIS over the last 3 years. According to the analysis, the national health check-up DB or claim DB were used, and the age category or study period were differentially applied.
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Affiliation(s)
- Seung Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Kyungdo Han
- Department of Biostatistics, The Catholic University of Korea, Seoul, Korea
| | - Yong Ho Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Junghyun Noh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Cheol Young Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Chang Hee Jung
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki Up Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Soo Ko
- Department of Internal Medicine, Cardiovascular and Metabolic Disease Center, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
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The effectiveness, reproducibility, and durability of tailored mobile coaching on diabetes management in policyholders: A randomized, controlled, open-label study. Sci Rep 2018; 8:3642. [PMID: 29483559 PMCID: PMC5827660 DOI: 10.1038/s41598-018-22034-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 02/15/2018] [Indexed: 12/23/2022] Open
Abstract
This randomized, controlled, open-label study conducted in Kangbuk Samsung Hospital evaluated the effectiveness, reproducibility, and durability of tailored mobile coaching (TMC) on diabetes management. The participants included 148 Korean adult policyholders with type 2 diabetes divided into the Intervention-Maintenance (I-M) group (n = 74) and Control-Intervention (C-I) group (n = 74). Intervention was the addition of TMC to typical diabetes care. In the 6-month phase 1, the I-M group received TMC, and the C-I group received their usual diabetes care. During the second 6-month phase 2, the C-I group received TMC, and the I-M group received only regular information messages. After the 6-month phase 1, a significant decrease (0.6%) in HbA1c levels compared with baseline values was observed in only the I-M group (from 8.1 ± 1.4% to 7.5 ± 1.1%, P < 0.001 based on a paired t-test). At the end of phase 2, HbA1c levels in the C-I group decreased by 0.6% compared with the value at 6 months (from 7.9 ± 1.5 to 7.3 ± 1.0, P < 0.001 based on a paired t-test). In the I-M group, no changes were observed. Both groups showed significant improvements in frequency of blood-glucose testing and exercise. In conclusion, addition of TMC to conventional treatment for diabetes improved glycemic control, and this effect was maintained without individualized message feedback.
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Hwang YC, Kim A, Jo E, Yang Y, Cho JH, Lee BW. Effectiveness and safety of exenatide in Korean patients with type 2 diabetes inadequately controlled with oral hypoglycemic agents: an observational study in a real clinical practice. BMC Endocr Disord 2017; 17:68. [PMID: 29065865 PMCID: PMC5655957 DOI: 10.1186/s12902-017-0220-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 10/16/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Randomized clinical trials have shown the efficacy and safety of short-acting exenatide in patients with type 2 diabetes mellitus (T2DM). The aim of this observational study was to investigate the effectiveness and safety of exenatide twice a day in Korean patients with T2DM who are suboptimally controlled with oral hypoglycemic agents. METHODS This study was a post hoc analysis of multi-center (71 centers), prospective, observational, single-arm, post-marketing study of short-acting exenatide 5 to 10 μg twice a day from March 2008 to March 2014 and analyzed those who finished the follow-up over 20 weeks of medication. Changes of hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), and body weight values before and after exenatide treatment were analyzed. Adverse events and adverse drug reactions were estimated in patients who were treated with exenatide at least once and for whom follow-up for safety has been completed. RESULTS After 20 weeks treatment with exenatide, mean HbA1c and body weight were significantly reduced from 8.4% to 7.7% and from 83.4 kg to 80.2 kg, respectively (both p < 0.001). Subjects with higher baseline glucose and HbA1c levels showed an independent association with a greater reduction in glucose level. In addition, short duration of diabetes less than 5 years was an independent predictor for the improvement in glucose level. The majority of study subjects showed a reduction in both body weight and glucose level (63.3%) after exenatide treatment. In terms of safety profile, exenatide treatment was generally well-tolerated and the incidence of severe adverse event was rare (0.8%). The gastrointestinal side effects were most common and hypoglycemia was reported in 1.7% of subjects. CONCLUSION In real clinical practice, 20 weeks treatment with short-acting exenatide was well tolerated and showed a significant body weight and glucose reduction in Korean patients with T2D who are suboptimally controlled with oral hypoglycemic agents. TRIAL REGISTRATION ClinicalTirals.gov , number NCT02090673 , registered 14 February 2008.
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Affiliation(s)
- You-Cheol Hwang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Ari Kim
- AstraZeneca, Seoul, South Korea
| | - Euna Jo
- AstraZeneca, Seoul, South Korea
| | - Yeoree Yang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seoul, Seocho-gu 06591 South Korea
| | - Jae-Hyoung Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seoul, Seocho-gu 06591 South Korea
| | - Byung-Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seoul, Seodaemun-Gu 03722 South Korea
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24
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Kim HY, Sohn TS, Seok H, Yeo CD, Kim YS, Song JY, Lee YB, Lee DH, Lee JI, Lee TK, Jeong SC, Hong M, Chae HS. Prevalence and risk factors for reduced pulmonary function in diabetic patients: The Korea National Health and Nutrition Examination Survey. Korean J Intern Med 2017; 32:682-689. [PMID: 28142231 PMCID: PMC5511936 DOI: 10.3904/kjim.2016.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 04/11/2016] [Accepted: 05/03/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND/AIMS An association between reduced pulmonary function and diabetes has been observed. Our aim was to evaluate the prevalence and risk factors associated with reduced pulmonary function in diabetic patients. METHODS We analyzed data from the Korea National Health and Nutrition Examination Survey 2011 to 2013. The study population included data from 8,784 participants (including 1,431 diabetics) aged ≥ 40 years. Reduced pulmonary function was defined as patients with restrictive (forced expiratory volume in 1 second/forced vital capacity [FEV1/FVC] ≥ 0.7 and FVC < 80% of predicted value) or obstructive (FEV1/FVC < 0.7) patterns. RESULTS Subjects with diabetes had a higher prevalence of restrictive (18.4% vs. 9.4%, p < 0.001) and obstructive impairments (20% vs. 12.6%, p < 0.001) than those without diabetes. The adjusted odds ratios (aORs) (95% confidence interval [CI]) for obstructive and restrictive pulmonary impairment were 0.91 (0.75 to 1.11) and 1.57 (1.30 to 1.89), respectively. In the diabetes population, age (aOR, 1.04; 95% CI, 1.02 to 1.06), male sex (aOR, 1.40; 95% CI, 1.04 to 1.88), and body mass index (aOR, 1.15; 95% CI, 1.10 to 1.21) were independently associated with restrictive pulmonary impairment. Age (aOR, 1.12; 95% CI, 1.09 to 1.14), male sex (aOR, 4.24; 95% CI, 2.42 to 7.44), and smoking at any point (ever-smoker: aOR, 1.96; 95% CI, 1.16 to 3.33) were independent risk factors for obstructive pulmonary impairment in diabetics. Diabetes duration or glycated hemoglobin had no association with pulmonary impairment in diabetes. CONCLUSIONS Subjects with diabetes had a higher risk of restrictive pulmonary impairment than those without diabetes after adjusting for confounding factors. Older age, male sex, body mass index, and smoking were associated with reduced lung function in diabetes.
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Affiliation(s)
- Hee Yeon Kim
- Epidemiology Study Cluster of Uijeongbu St. Mary’s Hospital, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Tae Seo Sohn
- Epidemiology Study Cluster of Uijeongbu St. Mary’s Hospital, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Hannah Seok
- Epidemiology Study Cluster of Uijeongbu St. Mary’s Hospital, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Chang Dong Yeo
- Epidemiology Study Cluster of Uijeongbu St. Mary’s Hospital, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Young Soo Kim
- Epidemiology Study Cluster of Uijeongbu St. Mary’s Hospital, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jae Yen Song
- Epidemiology Study Cluster of Uijeongbu St. Mary’s Hospital, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Young Bok Lee
- Epidemiology Study Cluster of Uijeongbu St. Mary’s Hospital, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Dong-Hee Lee
- Epidemiology Study Cluster of Uijeongbu St. Mary’s Hospital, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jae-Im Lee
- Epidemiology Study Cluster of Uijeongbu St. Mary’s Hospital, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Tae-Kyu Lee
- Epidemiology Study Cluster of Uijeongbu St. Mary’s Hospital, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Seong Cheol Jeong
- Epidemiology Study Cluster of Uijeongbu St. Mary’s Hospital, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Mihee Hong
- Epidemiology Study Cluster of Uijeongbu St. Mary’s Hospital, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Hiun Suk Chae
- Epidemiology Study Cluster of Uijeongbu St. Mary’s Hospital, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
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Kim TM, Kim H, Jeong YJ, Baik SJ, Yang SJ, Lee SH, Cho JH, Lee H, Yim HW, Choi IY, Yoon KH, Kim HS. The differences in the incidence of diabetes mellitus and prediabetes according to the type of HMG-CoA reductase inhibitors prescribed in Korean patients. Pharmacoepidemiol Drug Saf 2017; 26:1156-1163. [PMID: 28556206 DOI: 10.1002/pds.4237] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 04/05/2017] [Accepted: 04/27/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Very few studies conducted in Korea have investigated the relationship between statins and the incidence of diabetes. Therefore, we analyzed the progression from normal blood glucose to prediabetes and then to diabetes mellitus (DM) according to the type, intensity, and dose of statin prescribed. METHODS Data of patients who were first prescribed statins between 2009 and 2011 were extracted from electronic medical records. Patients with normal blood glucose or prediabetes were observed for 4 years after initiation of statin therapy. RESULTS A total of 2890 patients were included in our study and analyzed on the basis of the first statin they were prescribed. The incidence rate of DM in patients with prediabetes was 1.72 times that of patients with normal glucose levels (odds ratio = 1.72, 95% confidence interval = 1.41-2.10, P < .001). Regarding progression from normal blood glucose to prediabetes, the incidence rate of prediabetes was significantly lower in patients prescribed pitavastatin (odds ratio = 0.62, 95% confidence interval = 0.40-0.96, P = .031) compared to that in patients prescribed atorvastatin. Regarding the progression from normal blood glucose or prediabetes to DM, there were no significant differences among all statins. CONCLUSIONS Lower DM incidence in patients prescribed pitavastatin appears to be primarily because of the lower rate of progression from normal blood glucose to prediabetes. These findings indicate that avoiding statins because of DM risk is unjustified and that clinicians should prescribe statins from the appropriate potency group.
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Affiliation(s)
- Tong Min Kim
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyunah Kim
- College of Pharmacy, Sookmyung Women's University, Seoul, Republic of Korea
| | - Yoo Jin Jeong
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sun Jung Baik
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - So Jung Yang
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung-Hwan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary''s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae-Hyoung Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary''s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyunyong Lee
- Clinical Research Coordinating Center, Catholic Medical Center, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyeon Woo Yim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Young Choi
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kun-Ho Yoon
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary''s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hun-Sung Kim
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary''s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Kim SG, Kim NH, Ku BJ, Shon HS, Kim DM, Park TS, Kim YS, Kim IJ, Choi DS. Delay of insulin initiation in patients with type 2 diabetes mellitus inadequately controlled with oral hypoglycemic agents (analysis of patient- and physician-related factors): A prospective observational DIPP-FACTOR study in Korea. J Diabetes Investig 2017; 8:346-353. [PMID: 27712034 PMCID: PMC5415458 DOI: 10.1111/jdi.12581] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 09/07/2016] [Accepted: 09/27/2016] [Indexed: 01/07/2023] Open
Abstract
Aims/Introduction 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). Materials and Methods 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. Results 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. Conclusions 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.
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Affiliation(s)
- Sin Gon Kim
- Division of Endocrinology, Korea University Anam Hospital, Seoul, Korea
| | - Nam Hoon Kim
- Division of Endocrinology, Korea University Anam Hospital, Seoul, Korea
| | - Bon Jeong Ku
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Ho Sang Shon
- Division of Endocrinology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Doo Man Kim
- Division of Endocrinology, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Tae Sun Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Yong-Seong Kim
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Inha University Incheon, Incheon, Korea
| | - In Joo Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Dong Seop Choi
- Division of Endocrinology, Korea University Anam Hospital, Seoul, Korea
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Jung CH, Chung JO, Han K, Ko SH, Ko KS, Park JY. Improved trends in cardiovascular complications among subjects with type 2 diabetes in Korea: a nationwide study (2006-2013). Cardiovasc Diabetol 2017; 16:1. [PMID: 28057001 PMCID: PMC5216535 DOI: 10.1186/s12933-016-0482-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 12/08/2016] [Indexed: 12/25/2022] Open
Abstract
Background Representative data on the secular trends in cardiovascular disease (CVD) are limited in Asian populations with diabetes. We aimed to estimate the temporal trends in cardiovascular complications using Korean nationwide whole population-based claims data in subjects with and without diabetes. Methods Type 2 diabetes was defined as a current medication history of anti-diabetic drugs and the presence of International Classification of Diseases (ICD)-10 codes (E11–E14) as diagnosis. We compared the 8-year rates of six cardiovascular complications [i.e., ischemic heart disease, acute myocardial infarction (AMI), ischemic stroke, hemorrhagic stroke, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG)] in Korean adults aged 30 years and older using data from four consecutive nationwide databases (2006–2007, 2008–2009, 2010–2011, and 2012–2013) of Korean national health insurance service. Results A total of 1,645,348, 1,971,559, 2,291,247, and 2,562,612 subjects with type 2 diabetes were found in the year of 2006–2007, 2008–2009, 2010–2011, and 2012–2013, respectively. Age and gender standardized rates of the six predefined cardiovascular complications decreased in Korean adults with type 2 diabetes during the study period. The greatest relative reductions were observed for hospitalization due to AMI (−37.28%), followed by hospitalizations due to ischemic stroke (−36.98%). In the overall population without type 2 diabetes, the greatest relative reductions were observed for hospitalization for hemorrhagic stroke (−29.47%), followed by hospitalization due to ischemic stroke (−28.92%). Relative decreases in all six predefined cardiovascular complications were generally more profound in adults with diabetes than in those without diabetes, which led to significant decrease in the relative risks of all six cardiovascular complications in subjects with diabetes over the past 8 years. However, people with diabetes still had a two- to sixfold higher risk of hospitalization for major CVD events and interventions than people without diabetes. Conclusions Our findings suggest a significant reduction in the rate of people affected by CVD within the diabetic population. However, as the number of people with diabetes rises, the absolute burden of CVD will still be high in Korea. Electronic supplementary material The online version of this article (doi:10.1186/s12933-016-0482-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chang Hee Jung
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Seoul, Songpa-gu, 05505, South Korea
| | - Jin Ook Chung
- Department of Internal Medicine, Chonnam National University Medical School, Kwangju, South Korea
| | - Kyungdo Han
- Department of Biostatics, The Catholic University of Korea, Seoul, South Korea
| | - Seung-Hyun Ko
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea
| | - Kyung Soo Ko
- Depatment of Internal Medicine, Cardiovascular and Metabolic Center, Inje University Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Seoul, Nowon-gu, 139-707, South Korea.
| | - Joong-Yeol Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Seoul, Songpa-gu, 05505, South Korea.
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Suh S, Song SO, Kim JH, Cho H, Lee WJ, Lee BW. Effectiveness of Vildagliptin in Clinical Practice: Pooled Analysis of Three Korean Observational Studies (the VICTORY Study). J Diabetes Res 2017; 2017:5282343. [PMID: 29057274 PMCID: PMC5613692 DOI: 10.1155/2017/5282343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/03/2017] [Accepted: 06/13/2017] [Indexed: 01/21/2023] Open
Abstract
The present observational study aimed to evaluate the clinical effectiveness of vildagliptin with metformin in Korean patients with type 2 diabetes mellitus (T2DM). Data were pooled from the vildagliptin postmarketing survey (PMS), the vildagliptin/metformin fixed drug combination (DC) PMS, and a retrospective observational study of vildagliptin/metformin (fixed DC or free DC). The effectiveness endpoint was the proportion of patients who achieved a glycemic target (HbA1c) of ≤7.0% at 24 weeks. In total, 4303 patients were included in the analysis; of these, 2087 patients were eligible. The mean patient age was 56.99 ± 11.25 years. Overall, 58.94% patients achieved an HbA1c target of ≤7.0% at 24 weeks. The glycemic target achievement rate was significantly greater in patients with baseline HbA1c < 7.5% versus ≥7.5% (84.64% versus 43.97%), receiving care at the hospital versus clinic (67.95% versus 52.33%), and receiving vildagliptin/metformin fixed DC versus free DC (70.69% versus 55.42%). Multivariate logistic regression analysis indicated that disease duration (P < 0.0001), baseline HbA1c (P < 0.0001), and DC type (P = 0.0103) had significant effects on drug effectiveness. Vildagliptin plus metformin appeared as an effective treatment option for patients with T2DM in clinical practice settings in Korea.
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Affiliation(s)
- Sunghwan Suh
- Division of Endocrinology, Dong-A University Medical Center, Dong-A University School of Medicine, Busan, Republic of Korea
| | - Sun Ok Song
- Division of Endocrinology, Department of Internal Medicine, National Health Insurance Service, Ilsan Hospital, Ilsan, Republic of Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | - Woo Je Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- *Woo Je Lee: and
| | - Byung-Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- *Byung-Wan Lee:
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Yang Y, Shin JA, Yang HK, Lee SH, Ko SH, Ahn YB, Yoon KH, Cho JH. Reduction of Sulfonylurea with the Initiation of Basal Insulin in Patients with Inadequately Controlled Type 2 Diabetes Mellitus Undergoing Long-Term Sulfonylurea-Based Treatment. Diabetes Metab J 2016; 40:454-462. [PMID: 27766795 PMCID: PMC5167710 DOI: 10.4093/dmj.2016.40.6.454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 08/08/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND There were a limited number of studies about β-cell function after insulin initiation in patients exposed to long durations of sulfonylurea treatment. In this study, we aimed to evaluate the recovery of β-cell function and the efficacy of concurrent sulfonylurea use after the start of long-acting insulin. METHODS In this randomized controlled study, patients with type 2 diabetes mellitus (T2DM), receiving sulfonylurea for at least 2 years with glycosylated hemoglobin (HbA1c) >7%, were randomly assigned to two groups: sulfonylurea maintenance (SM) and sulfonylurea reduction (SR). Following a 75-g oral glucose tolerance test (OGTT), we administered long-acting basal insulin to the two groups. After a 6-month follow-up, we repeated the OGTT. RESULTS Among 69 enrolled patients, 57 completed the study and were analyzed: 31 in the SM and 26 in the SR group. At baseline, there was no significant difference except for the longer duration of diabetes and lower triglycerides in the SR group. After 6 months, the HbA1c was similarly reduced in both groups, but there was little difference in the insulin dose. In addition, insulin secretion during OGTT was significantly increased by 20% to 30% in both groups. A significant weight gain was observed in the SM group only. The insulinogenic index was more significantly improved in the SR group. CONCLUSION Long-acting basal insulin replacement could improve the glycemic status and restore β-cell function in the T2DM patients undergoing sulfonylurea-based treatment, irrespective of the sulfonylurea dose reduction. The dose reduction of the concurrent sulfonylurea might be beneficial with regard to weight grain.
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Affiliation(s)
- Yeoree Yang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Ah Shin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Serim Hospital, Incheon, Korea
| | - Hae Kyung Yang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Hwan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Yu Bae Ahn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Kun Ho Yoon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Hyoung Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Pinchevsky Y, Shukla VJ, Butkow N, Chirwa T, Raal F. Multi-ethnic differences in HbA 1c, blood pressure, and low-density-lipid cholesterol control among South Africans living with type 2 diabetes, after a 4-year follow-up. Int J Gen Med 2016; 9:419-426. [PMID: 27895508 PMCID: PMC5117891 DOI: 10.2147/ijgm.s119965] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose Our study set out to examine if disparities in control of glycated hemoglobin (HbA1c), blood pressure (BP), and low-density-lipoprotein cholesterol (LDL-C) existed among an urban multi-ethnic cohort of South Africans, living with type 2 diabetes mellitus (T2DM). Patients and methods This longitudinal, retrospective study consisted of 261 men and women with previously diagnosed T2DM who attended Charlotte Maxeke Johannesburg Academic Hospital, South Africa across two time periods 2009 and 2013. Demographic and clinical data were extracted from consecutive medical records. The primary outcome was to determine achievements in HbA1c, BP, and LDL-C among ethnic groups using evidence-based goals. Results The mean age of the cohort was 64 (±10.6) years, females represented 55%, and the self-reported diabetes duration was 16 (±10.6) years as at 2013. Black Africans (42.9%, n=112 of 261) were more likely to reach the HbA1c target (<7%) and less likely to have had retinopathy, nephropathy, or cardiovascular disease. Over two-thirds of mixed-ancestry patients attained the BP target (<140/80 mmHg), while 90.2% of Caucasians achieved LDL-C goals (<2.5 mmol/L). Overall, across the ethnic groups studied, we found that HbA1c control deteriorated over time, although BP levels remained the same and LDL-C levels drastically improved. Conclusion There was poor control of HbA1c, BP, and LDL-C across all ethnic groups. Although a minority achieved recommended targets, some ethnic groups appeared to have worse control than others. Timely aggressive actions in particularly high-risk ethnic groups will prevent/delay the complications commonly associated with T2DM.
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Affiliation(s)
- Yacob Pinchevsky
- Department of Pharmacy and Pharmacology, School of Therapeutic Sciences
| | - Varada J Shukla
- Department of Pharmacy and Pharmacology, School of Therapeutic Sciences
| | - Neil Butkow
- Department of Pharmacy and Pharmacology, School of Therapeutic Sciences
| | - Tobias Chirwa
- Division of Epidemiology and Biostatistics, School of Public Health
| | - Frederick Raal
- Carbohydrate and Lipid Metabolism Research Unit, Division of Endocrinology and Metabolism, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Abstract
BACKGROUND Morbidly obese patients with type 2 diabetes have shown significant improvement in glycemic control after Roux-en-Y gastric bypass (RYGB). This study aimed to elucidate the predictors of diabetes remission. METHODS A retrospective review of a prospectively established database identified 134 type 2 diabetes patients who underwent laparoscopic RYGB between January 2011 and February 2014. Partial and complete remission of diabetes was defined as glycated hemoglobin (HbA1c) level <6.5 and <6.0%, respectively, without the use of antidiabetic medication. Pre- and postoperative clinical outcomes were compared between the remission and non-remission groups to identify the predictors of partial or complete remission of diabetes. RESULTS The mean duration of diabetes and preoperative HbA1c level were 4.6 years and 8.0%, respectively. The body mass index (BMI) of the enrolled patients decreased from 37.9 to 28.8 kg/m(2) during the mean follow-up of 12.3 months; 61.8% of the patients achieved partial or complete remission of diabetes. Multivariate analysis revealed that age at operation (odds ratio [OR] = 0.880; 95% confidence interval [CI] 0.807-0.960), HbA1c level (OR = 0.527; 95% CI 0.325-0.854), and C-peptide level (OR = 1.463; 95% CI 1.054-2.029) in the preoperative laboratory study, and the percentage of total weight loss (%TWL) (OR = 1.186; 95% CI 1.072-1.313) after RYGB were the independent predictors of partial or complete diabetes remission. CONCLUSION The predictive factors for diabetes remission after RYGB include age at operation, HbA1c and C-peptide levels, and the %TWL after surgery.
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Kim HS, Jeong YJ, Baik SJ, Yang SJ, Kim TM, Kim H, Lee H, Lee SH, Cho JH, Choi IY, Yoon KH. Social Networking Services-Based Communicative Care for Patients with Diabetes Mellitus in Korea. Appl Clin Inform 2016; 7:899-911. [PMID: 27679839 DOI: 10.4338/aci-2016-06-ra-0088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 08/22/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Social networking services (SNS)-based online communities are good examples of improving quality of care by incorporating information technology into medicine. Therefore, we created an SNS-based community care webpage for communication among patients with diabetes mellitus (DM). We aimed to identify what diabetic patients wanted to know and were interested in by analyzing their posts and classified content in which users were interested. METHODS As opposed to the existing physician-focused health information websites, we built a patient-focused experience exchange website, "I love insulin (http://www.iloveinsulin.co.kr)." The DM communication webpage was divided into "My Web-Chart," "My community-free board," and "Life & Health." The contents analysis targeted users' postings, and replies were classified by theme from May 2012 to June 2013. The data included number of questions asked, answers, and question-to-answer (QA) ratio in each category. RESULTS A total of 264 patients registered on the "I Love Insulin" website. The most frequent topic of posts classified as questions were about diabetes itself (23%), diet (22%), and glucose levels (19%). Conversely, most answers and information provided by users were about daily life with no relationship to diabetes mellitus (54%). While there were many questions about diet, there were very few answers (2%). Whereas there was much provision of knowledge about general DM, sharing diet information was rare. The ratios of answers to questions on diet (ratio=0.059, 1/17), glucose level (ratio=0.067, 1/15), insulin regulation (ratio=0.222, 2/9) and webpage (ratio=0.167, 1/6) were significantly low compared to DM itself (all p < 0.001). DISCUSSION Patients in Korea with DM tend to have insufficient knowledge about diet and insulin regulation; continuously providing diet and insulin regulation information are desirable. It is hoped that the patients would be motivated to participate actively by "knowledge sharing." Through this process, patients learn about their diseases not from the physicians but from among themselves.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Kun-Ho Yoon
- Kun-Ho Yoon, M.D., Ph.D., Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Republic of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea, Tel: +82-2-2258-8262, Fax: +82-2-2258-8297, E-mail:
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Jung AN, Park JH, Kim J, Kim SH, Jee BC, Cha BH, Sull JW, Jun JH. Detrimental Effects of Higher Body Mass Index and Smoking Habits on Menstrual Cycles in Korean Women. J Womens Health (Larchmt) 2016; 26:83-90. [PMID: 27603944 DOI: 10.1089/jwh.2015.5634] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Alteration of menstrual cycle by individual lifestyles and unfavorable habits may cause menstrual irregularity. We aimed to investigate the relationship between lifestyle factors and menstrual irregularity in Korean women using data from the Fifth Korea National Health and Nutrition Examination Survey (KNHANES) 2010-2012. MATERIALS AND METHODS This cross-sectional study included 3779 nondiabetic Korean women aged 19-49 years who did not take any oral contraceptives or sex hormonal compounds. We examined the association of menstrual irregularity with age, body mass index (BMI), drinking experience, and smoking habits. RESULTS Age, Asian BMI, marriage status, age at menarche, and smoking habits were significantly associated with menstrual cycle irregularity (p < 0.01). The prevalence of menstrual irregularity was significantly increased at younger ages: 18.4%, 10.3%, and 10.5% at 19-29, 30-39, and 40-49 years, respectively. Moreover, obesity groups, defined as per Asian BMI using modified WHO criteria, were strongly associated with menstrual irregularity. BMI 25.0-29.9 [obesity class I] (adjusted odds ratios [OR], 1.94; 95% confidence intervals [CI], 1.37-2.74) and ≥30.0 [obesity class II] (adjusted OR, 2.18; 95% CI, 1.22-3.91) presented significantly higher risk of menstrual irregularity compared with BMI 18.5-22.9 [normal weight]. Multivariable analysis revealed that high BMI in younger women aged 19-29 years (p < 0.001) and smoking habits in middle-aged women aged 30-39 years (p < 0.005) significantly predicted menstrual irregularity. CONCLUSION This study substantiated that menstrual irregularity was closely associated with higher BMI and smoking habits in nondiabetic Korean women. Weight loss and smoking cessation should be recommended to promote women's reproductive health.
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Affiliation(s)
- An Na Jung
- 1 Department of Biomedical Laboratory Science, Graduate School, Eulji University , Seongnam-si, Gyeonggi-do, Korea.,2 Samkwang Medical Laboratories , Seoul, Korea
| | - Ju Hwan Park
- 1 Department of Biomedical Laboratory Science, Graduate School, Eulji University , Seongnam-si, Gyeonggi-do, Korea.,3 Hankook Institute of Life Science , Seoul, Korea
| | - Jihyun Kim
- 4 Department of Senior Healthcare, BK21 Plus Program, Graduated School, Eulji University , Daejeon, Korea
| | - Seok Hyun Kim
- 5 Department of Obstetrics and Gynecology, Seoul National University College of Medicine , Seoul, Korea
| | - Byung Chul Jee
- 6 Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital , Seongnam-si, Gyeonggi-do, Korea
| | - Byung Heun Cha
- 1 Department of Biomedical Laboratory Science, Graduate School, Eulji University , Seongnam-si, Gyeonggi-do, Korea
| | - Jae Woong Sull
- 1 Department of Biomedical Laboratory Science, Graduate School, Eulji University , Seongnam-si, Gyeonggi-do, Korea.,4 Department of Senior Healthcare, BK21 Plus Program, Graduated School, Eulji University , Daejeon, Korea
| | - Jin Hyun Jun
- 1 Department of Biomedical Laboratory Science, Graduate School, Eulji University , Seongnam-si, Gyeonggi-do, Korea.,4 Department of Senior Healthcare, BK21 Plus Program, Graduated School, Eulji University , Daejeon, Korea.,7 Eulji Medi-Bio Research Institute (EMBRI), Eulji University , Seongnam-si, Gyeonggi-do, Korea
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Abstract
Diabetes mellitus is an increasing global health problem. Guidelines for diabetic care recommend management of lifestyle and risk factors (glucose, blood pressure, and cholesterol), as well as regular screening for complications associated with treatment of the conditions related to diabetes. The prevalence of diabetes increased from 8.6% to 11.0% from 2001 to 2013. According to the diabetes fact sheet 2015, the proportion of patients with diabetes treated with antihypertensive medications increased from 56.0% to 62.5% from 2006 to 2013, and 49.5% of those with diabetes were being treated with lipid-lowering medications in 2013, a 1.8-fold increase since 2006. According to the 2014 Korea National Health and Nutrition Examination Survey data, 45.6% of patients with diabetes achieved a hemoglobin A1c level of < 7.0%, 72.8% achieved a blood pressure of < 140/85 mmHg, and 58.0% achieved a low density lipoprotein cholesterol level of < 100 mg/dL. Only 19.7% of patients with diabetes had good control of all three of these parameters. Despite improvements in health promotion efforts, the rates of adherence to medication and risk-factor control are low. Therefore, a systematic approach to managing diabetes, including self-management education, is needed to prevent or delay complications. The government needs to establish a long-term policy to address the growing burden of diabetes.
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Affiliation(s)
- Kyoung Hwa Ha
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
- Cardiovascular and Metabolic Disease Etiology Research Center, Ajou University School of Medicine, Suwon, Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
- Cardiovascular and Metabolic Disease Etiology Research Center, Ajou University School of Medicine, Suwon, Korea
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Goh SY, Ang E, Bajpai S, Deerochanawong C, Hong EG, Hussein Z, Joshi S, Kamaruddin NA, Kho S, Kong APS, Pan CY, Perfetti R, Vichayanrat A, Vlajnic A, Chan JCN. A patient-centric approach to optimise insulin therapy in Asia. J Diabetes Complications 2016; 30:973-80. [PMID: 27288201 DOI: 10.1016/j.jdiacomp.2016.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/20/2016] [Accepted: 05/20/2016] [Indexed: 11/16/2022]
Affiliation(s)
| | - Ernesto Ang
- Cardinal Santos Medical Center, San Juan, Philippines; The Institute for Studies on Diabetes Foundation Inc., Metro Manila, Philippines
| | | | | | - Eun-Gyoung Hong
- Hallym University School of Medicine, Dongtan Sacred Heart Hospital, Gyeonggi-do, South Korea
| | | | | | | | - Sjoberg Kho
- University of Santo Tomas, Manila, Philippines
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Ko SH, Kim DJ, Park JH, Park CY, Jung CH, Kwon HS, Park JY, Song KH, Han K, Lee KU, Ko KS. Trends of antidiabetic drug use in adult type 2 diabetes in Korea in 2002-2013: Nationwide population-based cohort study. Medicine (Baltimore) 2016; 95:e4018. [PMID: 27399082 PMCID: PMC5058811 DOI: 10.1097/md.0000000000004018] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 05/26/2016] [Accepted: 06/01/2016] [Indexed: 02/03/2023] Open
Abstract
This study investigated trends in the prescription of antidiabetic medications for patients with type 2 diabetes, focusing on changing patterns of prescriptions and the cost of drugs during the last 10 years. Retrospective data on patients with type 2 diabetes aged 30 years or older were analyzed using information from the National Health Information Database collected by the National Health Insurance Service in Korea from January 2002 to December 2013. We identified patients with type 2 diabetes who had at least one service claim in each year during the study period. The prescribing information was collected and fixed-dose combination tablets were counted as each of their constituent classes. The total number of adults with type 2 diabetes who were treated using antidiabetic agents increased from 0.87 million in 2002 to 2.72 million in 2013 in Korea. Among antidiabetic medications in 2002, sulfonylurea (SU) was the most commonly used agent (87.2%), and metformin was the second (52.9%). However, in 2013, the use of metformin increased to 80.4% of the total antidiabetic prescriptions. The use of dipeptidyl peptidase-4 (DPP-4) inhibitor increased remarkably after release in late 2008 and composed one-third of the market share with 1 million prescriptions (38.4%) in 2013. Among the prescriptions for monotherapy, only 13.0% were metformin in 2002, but the amount increased to 53.2% by 2013. In contrast, the use of SU declined dramatically from 75.2% in 2002 to 30.6% in 2013. Dual and triple combinations steadily increased from 35.0% and 6.6% in 2002 to 44.9% and 15.5% in 2013, respectively. In 2013, SU with metformin (41.7%) and metformin with DPP-4 inhibitor (32.5%) combination were most frequently prescribed. The total antidiabetic medication cost increased explosively from U.S. $70 million (82.5 billion won) in 2002 to U.S. $4 billion (480 billion won) in 2013.The use of antidiabetic agents and their costs have been increasing steadily. Metformin is the most commonly used drug recently. The use of DPP-4 inhibitor increased significantly over the past decade, whereas the use of SU decreased. However, SUs still remain the most commonly prescribed second-line agents with metformin in 2013.
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Affiliation(s)
- Seung-Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul
| | - Dae-Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon
| | | | - Cheol-Young Park
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
| | - Chang Hee Jung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine
| | - Hyuk-Sang Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul
| | - Joong-Yeol Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine
| | - Kee-Ho Song
- Department of Internal Medicine, Konkuk University School of Medicine
| | - Kyungdo Han
- Department of Biostatistic, The Catholic University of Korea
| | - Ki-Up Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine
| | - Kyung-Soo Ko
- Department of Internal Medicine, Cardiovascular and Metabolic Disease Center, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
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Park J, Lim S, Yim E, Kim Y, Chung W. Factors Associated with Poor Glycemic Control among Patients with Type 2 Diabetes Mellitus: The Fifth Korea National Health and Nutrition Examination Survey (2010-2012). HEALTH POLICY AND MANAGEMENT 2016. [DOI: 10.4332/kjhpa.2016.26.2.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Jeon YJ, Kim CR, Park JS, Choi KH, Kang MJ, Park SG, Park YJ. Health inequalities in hypertension and diabetes management among the poor in urban areas: a population survey analysis in south Korea. BMC Public Health 2016; 16:492. [PMID: 27286953 PMCID: PMC4901480 DOI: 10.1186/s12889-016-3169-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 05/28/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND This study investigated whether the prevalence, awareness, treatment, and control of hypertension and diabetes differed by residential areas. In addition, the rate of good hypertension or diabetes control was examined separately in men and women, and in urban and rural areas. METHODS This study used Korea National Health and Nutrition Examination V (2010-2012) data, a nationwide cross-sectional survey of general South Korean population. Residential areas were categorized into urban and rural areas. To examine differences between the residential areas in terms of prevalence, awareness, treatment, and control of hypertension and diabetes we performed a multivariate logistic regression adjusting for age, body mass index, physical activity, alcohol use, smoking, marital status, monthly income, and educational level. To investigate control of hypertension or diabetes within each residential area, we performed a subgroup analysis in both urban and rural areas. RESULTS The prevalence of hypertension is higher among men in urban areas than among those in rural areas (OR = 0.80; 95 % CI = 0.67-0.96, reference group = urban areas). However, the subgroups did not differ in terms of diabetes prevalence, awareness, treatment, and control. Regardless of both sex and residential area, participants in good control of their hypertension and diabetes were younger. Inequality in good control of hypertension was observed in men who lived in urban (≤Elementary school, OR 0.74, 95 % CI 0.60-0.92) and rural areas (≤Elementary school, OR 0.67, 95 % CI 0.46-0.99). Inequality in health status was found in women who resided in urban areas (≤Elementary school, OR 0.53, 95 % CI 0.37-0.75). Good control of diabetes also showed inequalities in health status for both men (≤Elementary school, OR 0.61, 95 % CI 0.40-0.94; Middle/High school, OR 0.69, 95 % CI 0.49-0.96) and women in urban areas (≤1 million won, OR 0.56, 95 % CI 0.33-0.93) (Reference group = '≥College' for education and '>3 million' Korean won for income). CONCLUSIONS After correction for individual socioeconomic status, differences by residential area were not observed. However, when the participants with good disease control were divided by region, inequality was confirmed in urban residents. Therefore, differentiated health policies to resolve individual and regional health inequalities are necessary.
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Affiliation(s)
- Young-Jee Jeon
- Department of Family Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Chung Reen Kim
- Department of Rehabilitation Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Republic of Korea.
| | - Joo-Sung Park
- Department of Family Medicine, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Kyung-Hyun Choi
- Center for Health Promotion and Cancer Prevention, Dongnam Institute of Radiological and Medical Sciences, Busan, Republic of Korea
| | - Myoung Joo Kang
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Seung Guk Park
- Departments of Family Medicine, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Young-Jin Park
- Department of Family Medicine, Dong-A University College of Medicine, Busan, Republic of Korea
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Kim HJ, Kim YG, Park JS, Ahn YH, Ha KH, Kim DJ. Association between blood glucose level derived using the oral glucose tolerance test and glycated hemoglobin level. Korean J Intern Med 2016; 31:535-42. [PMID: 26898598 PMCID: PMC4855099 DOI: 10.3904/kjim.2015.075] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 06/15/2015] [Accepted: 06/15/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND/AIMS Glycated hemoglobin (HbA1c) is widely used as a marker of glycemic control. Translation of the HbA1c level to an average blood glucose level is useful because the latter figure is easily understood by patients. We studied the association between blood glucose levels revealed by the oral glucose tolerance test (OGTT) and HbA1c levels in a Korean population. METHODS A total of 1,000 subjects aged 30 to 64 years from the Cardiovascular and Metabolic Diseases Etiology Research Center cohort were included. Fasting glucose levels, post-load glucose levels at 30, 60, and 120 minutes into the OGTT, and HbA1c levels were measured. RESULTS Linear regression of HbA1c with mean blood glucose levels derived using the OGTT revealed a significant correlation between these measures (predicted mean glucose [mg/dL] = 49.4 × HbA1c [%] - 149.6; R (2) = 0.54, p < 0.001). Our linear regression equation was quite different from that of the Alc-Derived Average Glucose (ADAG) study and Diabetes Control and Complications Trial (DCCT) cohort. CONCLUSIONS Discrepancies between our results and those of the ADAG study and DCCT cohort may be attributable to differences in the test methods used and the extent of insulin secretion. More studies are needed to evaluate the association between HbA1c and self monitoring blood glucose levels.
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Affiliation(s)
- Hyoung Joo Kim
- Department of Internal Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Young Geon Kim
- Department of Internal Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Jin Soo Park
- Department of Internal Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Young Hwan Ahn
- Department of Internal Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Kyoung Hwa Ha
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
- Department of Cardiovascular and Metabolic Disease Etiology Research Center, Ajou University School of Medicine, Suwon, Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
- Department of Cardiovascular and Metabolic Disease Etiology Research Center, Ajou University School of Medicine, Suwon, Korea
- Correspondence to Dae Jung Kim, M.D. Department of Endocrinology and Metabolism, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon 16499, Korea Tel: +82-31-219-5128 Fax: +82-31-219-4497 E-mail:
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Kim SS, Kim IJ, Kim YK, Yoon KH, Son HY, Park SW, Sung YA, Baek HS. Insulin Initiation in Insulin-Naïve Korean Type 2 Diabetic Patients Inadequately Controlled on Oral Antidiabetic Drugs in Real-World Practice: The Modality of Insulin Treatment Evaluation Study. Diabetes Metab J 2015; 39:481-8. [PMID: 26616594 PMCID: PMC4696984 DOI: 10.4093/dmj.2015.39.6.481] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 03/27/2015] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The Modality of Insulin Treatment Evaluation (MOTIV) study was performed to provide real-world data concerning insulin initiation in Korean type 2 diabetes mellitus (T2DM) patients with inadequate glycemic control with oral hypoglycemic agents (OHAs). METHODS This multicenter, non-interventional, prospective, observational study enrolled T2DM patients with inadequate glycemic control (glycosylated hemoglobin [HbA1c] ≥7.0%) who had been on OHAs for ≥3 months and were already decided to introduce basal insulin by their physician prior to the start of the study. All treatment decisions were at the physician's discretion to reflect real-world practice. RESULTS A total of 9,196 patients were enrolled, and 8,636 patients were included in the analysis (mean duration of diabetes, 8.9 years; mean HbA1c, 9.2%). Basal insulin plus one OHA was the most frequently (51.0%) used regimen. After 6 months of basal insulin treatment, HbA1c decreased to 7.4% and 44.5% of patients reached HbA1c <7%. Body weight increased from 65.2 kg to 65.5 kg, which was not significant. Meanwhile, there was significant increase in the mean daily insulin dose from 16.9 IU at baseline to 24.5 IU at month 6 (P<0.001). Overall, 17.6% of patients experienced at least one hypoglycemic event. CONCLUSION In a real-world setting, the initiation of basal insulin is an effective and well-tolerated treatment option in Korean patients with T2DM who are failing to meet targets with OHA therapy.
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Affiliation(s)
- Sang Soo Kim
- Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan. Korea
| | - In Joo Kim
- Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan. Korea.
| | - Yong Ki Kim
- Kim Yong Ki Internal Medicine Clinic, Busan, Korea
| | - Kun Ho Yoon
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho Young Son
- Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sung Woo Park
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon Ah Sung
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hong Sun Baek
- Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
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Janghorbani M, Papi B, Amini M. Current status of glucose, blood pressure and lipid management in type 2 diabetes clinic attendees in Isfahan, Iran. J Diabetes Investig 2015; 6:716-25. [PMID: 26543547 PMCID: PMC4627550 DOI: 10.1111/jdi.12349] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 02/12/2015] [Accepted: 03/02/2015] [Indexed: 01/22/2023] Open
Abstract
AIMS/INTRODUCTION To estimate the prevalence of meeting American Diabetes Association clinical practice recommendations for hemoglobin A1c (HbA1c), blood pressure (BP) and low-density lipoprotein cholesterol (LDLC) among Iranian type 2 diabetes clinic attendees, and to identify the factors associated with therapeutic target achievement. MATERIALS AND METHODS A total of 2,640 patients with type 2 diabetes (944 men and 1,696 women) from Isfahan Endocrine and Metabolism Research Center outpatient clinics, Iran, were examined. The main outcome measures were HbA1c, BP and LDLC, in accordance with the American Diabetes Association recommendations. The mean (standard deviation) age of participants was 49.6 years (9.3 years) with a mean (standard deviation) duration of diabetes of 5.0 years (4.9 years) at initial registration. RESULTS The percentages of patients who had HbA1c <7%, BP <140/90 mmHg and LDLC <100 mg/dL was 37.4% (95% confidence interval [CI] 35.6-39.3), 35.3% (95% CI 33.5-37.3) and 48.9% (95% CI 47.0-50.8), respectively. The proportion of patients meeting all three goals was 7.7% (95% CI 6.7-8.8). Lower BP, cholesterol level and higher education at registration, and higher follow up but lower number of follow-up visits affected achievement of all three goals. CONCLUSIONS The present study highlights that a substantial proportion of Iranian type 2 diabetes clinic attendees did not meet the American Diabetes Association clinical practice recommendations, and shows the difficult challenges physicians face when treating patients with type 2 diabetes.
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Affiliation(s)
- Mohsen Janghorbani
- School of Public Health, Isfahan University of Medical SciencesIsfahan, Iran
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical SciencesIsfahan, Iran
| | - Bahman Papi
- School of Public Health, Isfahan University of Medical SciencesIsfahan, Iran
| | - Masoud Amini
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical SciencesIsfahan, Iran
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Abstract
The prevalence of diabetes is increasing globally, particularly in Asia. According to the 2013 Diabetes Atlas, an estimated 366 million people are affected by diabetes worldwide; 36% of those affected live in the Western Pacific region, with a significant proportion in East Asia. The reasons for this marked increase in the prevalence of diabetes can be extrapolated from several distinct features of the Asian region. First, the two most populated countries, China and India, are located in Asia. Second, Asians have experienced extremely rapid economic growth, including rapid changes in dietary patterns, during the past decades. As a result, Asians tend to have more visceral fat within the same body mass index range compared with Westerners. In addition, increased insulin resistance relative to reduced insulin secretory function is another important feature of Asian individuals with diabetes. Young age of disease onset is also a distinctive characteristic of these patients. Moreover, changing dietary patterns, such as increased consumption of white rice and processed red meat, contributes to the deteriorated lifestyle of this region. Recent studies suggest a distinctive responsiveness to novel anti-diabetic agents in Asia; however, further research and efforts to reverse the increasing prevalence of diabetes are needed worldwide.
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Affiliation(s)
- Eun Jung Rhee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Ha KH, Kim DJ. Trends in the Diabetes Epidemic in Korea. Endocrinol Metab (Seoul) 2015; 30:142-6. [PMID: 26194073 PMCID: PMC4508257 DOI: 10.3803/enm.2015.30.2.142] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 03/20/2015] [Accepted: 03/25/2015] [Indexed: 11/21/2022] Open
Abstract
Diabetes mellitus is a leading cause of mortality and increased disability-adjusted life years worldwide. In Korea, the prevalence of diabetes increased from 8.6% to 11.0% in 2001 to 2013 and the prevalence of adult obesity, which is the most important risk factor of diabetes, increased from 29.2% to 31.8% during the same period. There has been a dramatic increase in the number of obese Koreans with diabetes in recent decades and the prevalence of diabetes in people aged 40 years and older also increased in 2001 to 2013. Nevertheless, the mean age at the first diagnosis of diabetes was very similar for men in 2005 and 2013, while the mean age for women decreased slightly. There is an inverse linear relationship between body mass index and age at the diagnosis of diabetes among those who are newly diagnosed. Accordingly, the prevalence of diabetes is increasingly shifting to younger individuals and those who are obese. Therefore, public efforts should focus on healthy lifestyle changes, primary prevention measures, screening for the early detection of diabetes, and long-term management.
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Affiliation(s)
- Kyoung Hwa Ha
- Department of Endocrinology and Metabolism; Cardiovascular and Metabolic Disease Etiology Research Center, Ajou University School of Medicine, Suwon, Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism; Cardiovascular and Metabolic Disease Etiology Research Center, Ajou University School of Medicine, Suwon, Korea.
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Affiliation(s)
- Sang Yong Kim
- Department of Endocrinology and Metabolism, Chosun University Hospital, Chosun University School of Medicine, Gwangju, Korea
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