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Latent Autoimmune Diabetes in Adults: A Review on Clinical Implications and Management

  • Pieralice, Silvia;Pozzilli, Paolo
    • Diabetes and Metabolism Journal
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    • v.42 no.6
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    • pp.451-464
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    • 2018
  • Latent autoimmune diabetes in adults (LADA) is a heterogeneous disease characterized by a less intensive autoimmune process and a broad clinical phenotype compared to classical type 1 diabetes mellitus (T1DM), sharing features with both type 2 diabetes mellitus (T2DM) and T1DM. Since patients affected by LADA are initially insulin independent and recognizable only by testing for islet-cell autoantibodies, it could be difficult to identify LADA in clinical setting and a high misdiagnosis rate still remains among patients with T2DM. Ideally, islet-cell autoantibodies screening should be performed in subjects with newly diagnosed T2DM, ensuring a closer monitoring of those resulted positive and avoiding treatment of hyperglycaemia which might increase the rate of ${\beta}-cells$ loss. Thus, since the autoimmune process in LADA seems to be slower than in classical T1DM, there is a wider window for new therapeutic interventions that may slow down ${\beta}-cell$ failure. This review summarizes the current understanding of LADA, by evaluating data from most recent studies, the actual gaps in diagnosis and management. Finally, we critically highlight and discuss novel findings and future perspectives on the therapeutic approach in LADA.

Clinical Characteristics of Coronary Artery Disease Patients by Comorbidity of Diabetes Mellitus (당뇨병을 동반한 관상동맥질환자의 임상적 특성)

  • Choi, Eun-Ha;Song, Mi-Soon
    • Journal of Korean Critical Care Nursing
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    • v.4 no.1
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    • pp.1-10
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    • 2011
  • Purpose: The study was conducted to find out clinical characteristics for coronary artery disease patients with diabetes mellitus. Methods: We retrospectively reviewed the electronic medical records which included the data of 6,792 patients, who had been diagnosed coronary artery disease (CAD) such as angina or acute myocardial infarction and admitted to a university hospital in Seoul from January, 2005 to November, 2010. Results: Of the 6,792 patients, 43% had been diagnosed diabetes as comorbidity. The CAD patients with diabetes had lower left ventricular ejection fraction, stayed longer at hospital, and spent on more time from the first symptom to hospital visit than those without diabetes. In addition, they were more likely to have multi vessel coronary artery disease. Conclusion: The CAD patients with diabetes lay on the various factors which can make more worsen condition. Hence, we need to pay attention to specialized nursing care and patient education for the CAD patients with diabetes.

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A Case Report of Paralytic Patient Associated with Diabetes Mellitus (당뇨를 동반한 뇌경색 환자의 천화산가미방 치험 1례)

  • Kim, Byoung-Woo
    • Journal of Pharmacopuncture
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    • v.12 no.3
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    • pp.97-102
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    • 2009
  • Objectives : This report aimed to study of paralytic patient associated with Diabetes Mellitus. Methods : Diabetes Mellitus has one of the highest death rate, because of it induces various complications. Especially paralytic patients who associated with diabetes mellitus are slow in recovery and easy to induce many complications. So control of the diabetes mellitus is the most important thing to treatment. We observed and treated with Cheunhwasangamibang and acupunture. Results : The paralytic patient with Diabetes Mellitus was treatment with Cheunhwasangamibang and improvement was seen. Conclusions : Results in this case support a role for Cheunhwasangamibang in controlling Diabetes Mellitus.

Contributing Factors to Diabetic Brain Injury and Cognitive Decline

  • Verma, Nirmal;Despa, Florin
    • Diabetes and Metabolism Journal
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    • v.43 no.5
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    • pp.560-567
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    • 2019
  • The link of diabetes with co-occurring disorders in the brain involves complex and multifactorial pathways. Genetically engineered rodents that express familial Alzheimer's disease-associated mutant forms of amyloid precursor protein presenilin 1 (PSEN1) genes provided invaluable insights into the mechanisms and consequences of amyloid deposition in the brain. Adding diabetes factors (obesity, insulin impairment) to these animal models to predict success in translation to clinic have proven useful at some extent only. Here, we focus on contributing factors to diabetic brain injury with the aim of identifying appropriate animal models that can be used to mechanistically dissect the pathophysiology of diabetes-associated cognitive dysfunction and how diabetes medications may influence the development and progression of cognitive decline in humans with diabetes.

The Anti-diabetes and Vasoelasticity Effects of Mori Folium and Aurantii Fructus in Streptozotocin Induced Type II Diabetes Mellitus Model (Streptozotocin 유발 당뇨 백서에 상엽 지각(桑葉 枳殼) 혼합물의 항당뇨 및 혈관탄성개선 효과)

  • Park, Jung-Sup;Park, Chong-Hyeong;Jun, Chan-Yong;Choi, You-Kyung;Hwang, Gwi-Seo;Kim, Dong-Woo
    • The Journal of Internal Korean Medicine
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    • v.28 no.3
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    • pp.544-559
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    • 2007
  • Objectives : This study was designed to evaluate the anti-diabetes and vasoelasticity effects of Mori Folium and Aurantii Fructus in streptozotocin-induced type II diabetes mellitus model. Methods : The anti-diabetic effect of Mori Folium and Aurantii Fructus on rats induced with diabetes by streptozotocin was investigated through analyses of changes in body weight, blood glucose, urine volume of rats, viability of human umbilical vein endothelial cells(HUVECs), and elasticity of descending thoracic aorta in rats. The subjects in this study were divided into four groups(n=15): a normal group without any treatment (Con), a normal group with Mori Folium and Aurantii Fructus treatment(Con+P), a diabetes group induced by streptozotocin(STZ), and a Mori Folium and Aurantii Fructus treatment group under diabetes induced by streptozotocin(STZ+P). Rats were administered streptozotocin to induce diabetes. Results : The study showed that Mori Folium and Aurantii Fructus significantly reduced highly increased blood glucose levels(p<0.01) and prevented the diabetic rats from weight loss(p<0.01) and polyurea(p<0.05), Mori Folium and Aurantii Fructus also recovered decreased viability of HUVECs(p<0.01) and damaged elasticity of aorta induced by the streptozotocin (p<0.01). Conclusions: It was concluded from the results that Mori Folium and Aurantii Fructus have a distinct anti-diabetes effect and they also prevent damage of blood vessel induced by diabetes. resulting in prevention of cardiovascular diseases ascribed to diabetes.

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Ratio of fat to energy intake independently associated with the duration of diabetes and total cholesterol levels in type 2 diabetes

  • Yim, Jung-Eun;Kim, Young-Seol;Cho, Mi-Ran;Choue, Ryo-Won
    • Nutrition Research and Practice
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    • v.5 no.2
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    • pp.157-162
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    • 2011
  • The importance of dietary intake in the treatment of type 2 diabetes was emphasized. This study was performed to investigate the dietary intakes of Korean type 2 diabetes patients according to the treatment and duration of diabetes and to examine the relationships between their diet and serum lipid profiles. The subjects were 111 type 2 diabetic patients who were treated by medical nutrition therapy only, oral hypoglycemic agents (OHA), or insulin with medical nutrition therapy. Dietary intake was assessed by a registered dietitian using semi-quantitative food frequency questionnaires Comparisons according to treatment type were made using covariance analyses. General linear models identified the independent effects of the different treatments after covarying for age, duration of diabetes, and 2-way interactions. There were no significant differences in age and BMI but was in duration of diabetes according to treatment type in these subjects. Carbohydrate to energy ratio was higher in the OHA group (P < 0.05), whereas the fat to energy ratio was higher in the insulin group for males (P < 0.05). Carbohydrate ($R^2$ = 0.24, P = 0.005) and fat ($R^2$ = 0.26, P = 0.02) to energy ratios were independently associated with the duration of diabetes after covarying for age, sex, treatment, and 2-way interactions. The levels of triglyceride (TG; $R^2$ = 0.32, P = 0.02) and total cholesterol (TC) were associated independently with energy intake and the carbohydrate ($R^2$ = 0.15, P = 0.02) and fat ($R^2$ = 0.15, P = 0.01) to energy ratios, respectively. The concern that the independent association of dietary intake with either duration of diabetes or dietary factors affects blood lipid levels could suggest that specific dietary recommendations may work better for identifiable groups of diabetes patients.

A Study of the Epidemiological Characteristics and Related Factors in School personnel with Diabetes Mellitus (서울시 교직원 당뇨병의 역학적 특성 및 관련위험요인분석)

  • Lee, Hee-Woo;Kim, Jong-Hee;Jang, Chul-Hwan;Shin, Sun-Mi
    • Journal of the Korean Society of School Health
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    • v.17 no.1
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    • pp.71-83
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    • 2004
  • Purpose: To describe the prevalence, epidemiological characteristics, and related factors of diabetes mellitus in school personnel. Method:5,384 school personnel (2,638 males 2,746 females) received physical examinations at the Seoul School Health Center in 2002. Using the American Diabetes Association criteria, and fasting blood sugar(FBS) was classified as normal at 110>=FBS, borderline 111-125, and the diabetes group 126<=FBS. Related factors of each group were evaluated by gender. Results: In the diabetes group, there were 4.74% males and 0.8% females, and the borderline group was 6.37% males and 2.22% females. The older age group gad a higher distribution in both males and females in the diabetes group. In the diabetes group, the mean and abnormal rate of BMI, systolic hypertension, diastolic hypertension, total cholesterol, GOT, GPT, and GTP were higher than in the normal group. In life style factor, the diabetes group gad a higher distribution of meat eating and smoking more than 20 years than the normal group. The effect of FBS on BMI, BP(blood pressure), total cholesterol, GOT, GPT, and GTP were investigated after controlling for confounding variables. In the borderline and diabetes group, the mean of BMI, BP, total cholesterol, GOT, GPT, and GTP was higher in dose-response effect. In the logistic multiple regression, the related factors of the diabetes group were hypertension and abnormal GTP in males, and abnormal total cholesterol and GTP in females. In the borderline group, the related factors were meat eating, hypertension, and high GOT in males and the older age group, and hypertension, total cholesterol, and abnormal GTP in females. Conclusions: It is possible to manage all related factors of diabetes mellitus except for age. An appropriate program for health promotion is necessary.

Convergence Study on Diabetes Self-Management Knowledge, Social Support, Educational Needs of the diabetes in rural elderly (농촌 지역 노인 당뇨병 환자의 자기관리 지식, 사회적 지지, 교육요구도에 관한 융합연구)

  • Kim, Nam Hee;Lim, Sun Young
    • Journal of the Korea Convergence Society
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    • v.8 no.3
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    • pp.79-89
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    • 2017
  • The purpose of this study was to identify convergence factors related to DSMK, social support, and educational needs on the diabetes in rural elderly. The subjects were 115 elderly patients who were registered in diabetes control center, taking medication more than 6 months in U city. The survey period was from August 24 to October 31, 2016. The results showed that DSMK showed significant differences in gender, education level, duration of diabetes, experience of diabetes education, experience of family participation in diabetes education, and perceived health status(p<.05). The degree of social support was found to be significant differences in marital status, diabetes education experience, diabetes education needs, gender, duration of diabetes, and perception of diabetes self-management difficulty(p<.05). There were significant positive correlations between DSMK and social support, social support and educational needs(p<.05). Based on these results, we hope to develop a convergent self - management program based on the needs of the elderly patients.

Diabetes and the Risk of Infection: A National Cohort Study

  • Kim, Eun Jin;Ha, Kyoung Hwa;Kim, Dae Jung;Choi, Young Hwa
    • Diabetes and Metabolism Journal
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    • v.43 no.6
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    • pp.804-814
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    • 2019
  • Background: Several studies have shown that people with diabetes are vulnerable to infection. This study compared the risk of infection-related hospitalizations, intensive care unit (ICU) admission, and deaths between the person with diabetes and the general population in South Korea. Methods: We conducted a cohort study of 66,426 diabetes and 132,852 age-sex-region-matched non-diabetes controls from the general population using a sample of data from the National Health Insurance Service-National Sample Cohort. The cohort was followed up for 9 years. Infections were classified into 17 separate categories. We used Poisson regression, with adjustment for household income and other comorbidities, to estimate incidence rate ratios (IRRs) in order to compare of infection-related hospitalizations, ICU admissions, and deaths. Results: Compared to non-diabetes controls, diabetes group had a greater risk of almost all the types of infections considered, with the adjusted IRRs (aIRRs) for infection-related hospitalizations being the highest for hepatic abscess (aIRR, 10.17; 95% confidence interval [CI], 7.04 to 14.67), central nervous system (CNS) infections (aIRR, 8.72; 95% CI, 6.64 to 11.45), and skin and soft tissue infections other than cellulitis (SSTIs) (aIRR, 3.52; 95% CI, 3.20 to 3.88). Diabetes group also had a greater risk of ICU admission and death due to SSTIs (aIRR, 11.75; 95% CI, 7.32 to 18.86), CNS infections (aIRR, 5.25; 95% CI, 3.53 to 7.79), and bone and joint infections (aIRR, 4.78; 95% CI, 3.09 to 7.39). Conclusion: In South Korea, people with diabetes has a considerably higher incidence of infection-related hospitalizations and deaths than the general population.