The Committee of Clinical Practice Guidelines of the Korean Diabetes Association (KDA) updated the previous clinical practice guidelines for Korean adults with diabetes and prediabetes and published the seventh edition in May 2021. We performed a comprehensive systematic review of recent clinical trials and evidence that could be applicable in real-world practice and suitable for the Korean population. The guideline is provided for all healthcare providers including physicians, diabetes experts, and certified diabetes educators across the country who manage patients with diabetes or the individuals at the risk of developing diabetes mellitus. The recommendations for screening diabetes and glucose-lowering agents have been revised and updated. New sections for continuous glucose monitoring, insulin pump use, and non-alcoholic fatty liver disease in patients with diabetes mellitus have been added. The KDA recommends active vaccination for coronavirus disease 2019 in patients with diabetes during the pandemic. An abridgement that contains practical information for patient education and systematic management in the clinic was published separately.
목적: 클레부딘은 피리미딘 유사체로 실험실 및 동물실험에서 B형간염바이러스에 대해 강력한 억제 효과를 보여주었고, 만성 B형간염 환자를 대상으로 24주간 투여 효과를 평가한 3상 시험에서 강력하고 지속적인 항바이러스 효과를 나타내었다. 이번 연구에서는 48주 이상 클레부딘을 투여받은 만성 B형간염 환자 대상으로 클레부딘의 항바이러스 효과 및 바이러스 내성의 발생에 대해 알아보고자 하였다. 대상과 방법: 48주 이상 클레부딘을 투여받은 만성 B형간염 환자의 의무기록을 후향적으로 분석하였다. 3년 이내에 라미부딘 치료를 받은 적이 있는 환자는 제외하였다. 혈청 HBV DNA는 PCR hybridization 방법(검출 한계 316 copies/ mL)으로 측정하였다. 투여 24주와 48주째 혈청 HBV DNA, 혈청생화학검사 수치, 바이러스표지자 등을 분석하였다. 바이러스 돌파 현상 및 항바이러스 약제에 대한 내성의 발생 여부도 알아보았다. 결과: 총 74명의 만성 B형간염 환자가 포함되었으며(평균 연령 44세, 남:여=54:20, HBeAg 양성 환자 47명, HBeAg 음성 환자 27명), 이 중 10명은 라미부딘 치료를 받은 적이 있었다. 치료 전 혈청 HBV DNA 수치의 중앙값은 6.49 log10 copies/mL였다. 치료 48주째 혈청 HBV DNA 수치 감소폭의 중앙값은 전체 환자군에서 -4.34 log10 copies/mL, HBeAg 양성군에서 -4.84 log10 copies/mL, HBeAg 음성군에서 -3.74 log10 copies/mL였다. 치료 48주째 혈청 HBV DNA는 전체 환자 중 83.3%에서 검출되지 않았으며, 음전율은 HBeAg 양성군의 경우 76.6%, HBeAg 음성군의 경우 96.3%였다. 치료 48주째 84.7%의 환자에서 정상 혈청 ALT 수치를 보였다. 치료 48주째 두 명에서 바이러스 돌파 현상이 발생하였으며, 이전의 라미부딘 치료력과 간경변증의 존재가 내성 발생과 연관이 있었다. 결론: 만성 B형간염 환자를 대상으로 한 48주간의 클레부딘 치료는 효과적이었다. 그러나 이전 라미부딘 치료 경험자나 간경변이 동반된 경우 클레부딘에 대한 내성 발생의 위험이 증가한다.
BACKGROUND Effective health interventions for North Korean refugees vulnerable to metabolic disorders are currently unelucidated. OBJECTIVE This study aimed to evaluate the effects of digital health interventions in North Korean refugees using a wearable activity tracker (Fitbit device). METHODS We conducted a prospective, randomized, open-label study on North Korean refugees aged 19-59 years between June 2020 and October 2021 with a 12-week follow-up period. The participants were randomly assigned to either an intervention group or a control group in a 1:1 ratio. The intervention group received individualized health counseling based on Fitbit data every 4 weeks, whereas the control group wore the Fitbit device but did not receive individualized counseling. The primary and secondary outcomes were the change in the mean daily step count and changes in the metabolic parameters, respectively. RESULTS The trial was completed by 52 North Korean refugees, of whom 27 and 25 were in the intervention and control groups, respectively. The mean age was 43 (SD 10) years, and 41 (78.8%) participants were women. Most participants (44/52, 95.7%) had a low socioeconomic status. After the intervention, the daily step count in the intervention group increased, whereas that in the control group decreased. However, there were no significant differences between the 2 groups (+83 and –521 steps in the intervention and control groups, respectively; <i>P</i>=.500). The effects of the intervention were more prominent in the participants with a lower-than-average daily step count at baseline (<11,667 steps/day). After the 12-week study period, 85.7% (12/14) and 46.7% (7/15) of the participants in the intervention and control groups, respectively, had an increased daily step count (<i>P</i>=.05). The intervention prevented the worsening of the metabolic parameters, including BMI, waist circumference, fasting blood glucose level, and glycated hemoglobin level, during the study period. CONCLUSIONS The wearable device–based physical activity intervention did not significantly increase the average daily step count in the North Korean refugees in this study. However, the intervention was effective among the North Korean refugees with a lower-than-average daily step count; therefore, a large-scale, long-term study of this intervention type in an underserved population is warranted. CLINICALTRIAL Clinical Research Information Service KCT0007999; https://cris.nih.go.kr/cris/search/detailSearch.do/23622
Background: We investigated whether fasting glucose (FG) variability could predict the risk of dementia.Methods: This cohort study analyzed data from Koreans with diabetes after at least three health examinations by the Korean National Health Insurance Corporation between 2005 and 2010, which included at least one examination between 2009 and 2010. A total of 769,554 individuals were included, excluding those aged <40 years and those with dementia. FG variability was measured using the variability independent of the mean (FG-VIM). The incidence of dementia was defined by the International Classification of Diseases 10th Revision codes and prescription of anti-dementia medication and was subdivided into Alzheimer’s disease (AD) and vascular dementia (VD).Results: During the 6.9-year follow-up, 54,837, 41,032, and 6,892 cases of all-cause dementia, AD, and VD, respectively, were identified. Cox proportional regression analyses showed that as the FG-VIM quartile increased, the risk of dementia serially increased after adjustment for metabolic factors, income status, and diabetes-related characteristics, including the mean FG. Participants in FG-VIM quartile 4 showed a 18%, 19%, and 17% higher risk for all-cause dementia, AD, and VD, respectively, than those in quartile 1; this particularly included non-obese patients with a longer duration of diabetes, high FG levels, dyslipidemia, and those taking glucose-lowering medications. Conversely, the baseline FG status and dementia showed a U-shaped association.Conclusion: Increased FG variability over 5 years can predict the risk of dementia in individuals with diabetes in Korea. This finding was more pronounced in patients with less favorable metabolic profiles.
Today is an age of consilience. Moholy-Nagy is an artist to try consilience approach in various genre in the early 20th century. The purpose of this study is to find out the meaning of Typophoto in the point of view which Moholy-Nagy is a theorist rather than an artist who opened a new horizon of photographic art. Explanation of Typophoto exists in Bauhaus book "Painting, Photography, Film' written by Moholy-Nagy. 'Dynamic of the metropolis' which is introduced in the same book is only one existing Typophoto. So far Typophoto is considered as a collage of typography and photography. However, it is only determined by the formal logic. This study will analyse texts and works by Moholy-Nagy and reveal to intention of Typophoto as a true art of consilience.
Primary extranodal B cell lymphoma of mucosa- associated lymphoid tissue (MALT) can develop in diverse anatomic locations such as the stomach, salivary gland, thyroid, lung, and breast. Its distribution in the GI tract is as follows: 50∼60% in the stomach, 20∼30% in the small intestine and ileocecal area and 10% in the colorectal area. Although autoimmune and infectious diseases are known as the main etiologies, H. pylori infection has been clearly shown to play a causative role in lymphomagenesis, especially in the stomach. H. pylori eradication therapy only can induce disease remission nearly in 80% of the cases of gastric MALT lymphoma. However, there is lack of evidence for the extragastric area. In this case, a 71-year-old woman with low abdominal pain was diagnosed as having a rectal MALT lymphoma that was noted as a solitary rectal mass in a colonoscopic examination. Remission induction was commenced by H. pylori eradication and radiation therapy. (Korean J Gastrointest Endosc 2008;36:102-106)
X-linked inhibitor of apoptosis (XIAP) is the most potent member of the IAP family that exerts antiapoptotic effects. Recently, XIAP-associated factor 1 (XAF1) and two mitochondrial proteins, Smac/ DIABLO and HtrA2, have been identified to negatively regulate the caspase-inhibiting activity of XIAP. We explored the candidacy of XAF1, Smac/DIABLO and HtrA2 as a tumor suppressor in colonic carcinogenesis.Expression and mutation status of the genes in 10 colorectal carcinoma cell lines and 40 primary tumors were examined by quantitative PCR analysis.XAF1 transcript was not expressed or present at extremely low levels in 60% (6/10) of cancer cell lines whereas Smac/DIABLO and HtrA2 are normally expressed in all cell lines examined. Tumor-specific loss or reduction of XAF1 was also found in 35% (14/40) of matched tissue sets obtained from the same patients. XAF1 transcript was reactivated in all the low expressor cell lines by treatment with the demethylating agent 5-aza-2'-deoxycytidine. Moreover, bisulfite DNA sequencing analysis for 34 CpG sites in the promoter region revealed a strong association between hypermethylation and gene silencing. Restoration of XAF1 expression resulted in enhanced apoptotic response to etoposide and 5-flurouracil, whereas knockdown of XAF1 expression by siRNA transfection significantly inhibited chemotherapeutic drug-induced apoptosis.XAF1 undergoes epigenetic gene silencing in a considerable proportion of human colon cancers by aberrant promoter hypermethylation, suggesting that XAF1 inactivation might be implicated in colonic tumorigenesis.
Abstract Background — Athough an association exists between type 2 diabetes and Parkinson’s disease (PD), the implications of glycemic variability on PD are unknown. We assessed the future risk of incident PD according to visit-to-visit fasting plasma glucose (FPG) variability; this was calculated using standard deviation (FPG-SD), coefficient variance (FPG-CV), and variability independent of the mean (FPG-VIM). Methods — Using the Korean National Health Insurance Service–Health Screening Cohort, we followed 131,625 Korean adults without diabetes. This study population was divided into a midlife group (<65 years) and an elderly group (≥65 years), during a median follow-up of 8.4 years. Results — The adjusted hazard ratios (HRs) were calculated using a multivariable Cox proportional hazard analysis. In the midlife group, the HRs for incident PD in the highest quartile of FPG variability, as measured using SD, CV, and VIM, were 1.35 (95% confidence interval (CI), 1.07–1.70), 1.31 (95% CI, 1.04–1.65), and 1.33 (95% CI, 1.06–1.67), respectively, when compared to the lowest quartile group. However, the incident PD was not different depending on FPG variability in the elderly group. Kaplan–Meier curves of PD probability showed a progressively increasing risk of PD according to the higher FPG variability in the midlife group. According to a multivariable adjusted model, a 1-SD unit increment in glycemic variability was associated with a 9% higher risk for incident PD in the midlife group. Conclusions — Increased long-term glycemic variability is a preceding risk factor for developing PD in the midlife population without diabetes.
Lifestyle is a critical aspect of diabetes management. We aimed to define a healthy lifestyle using objectively measured parameters obtained from a wearable activity tracker (Fitbit) in patients with type 2 diabetes. This prospective observational study included 24 patients (mean age, 46.8 years) with type 2 diabetes. Expectation–maximization clustering analysis produced two groups: A (<i>n</i>=9) and B (<i>n</i>=15). Group A had a higher daily step count, lower resting heart rate, longer sleep duration, and lower mean time differences in going to sleep and waking up than group B. A Shapley additive explanation summary analysis indicated that sleep-related factors were key elements for clustering. The mean hemoglobin A1c level was 0.3 percentage points lower at the end of follow-up in group A than in group B. Factors related to regular sleep patterns could be possible determinants of lifestyle clustering in patients with type 2 diabetes.
Patients with type 2 diabetes are at risk of microvascular and macrovascular complications. Intensive glycaemic control, especially in patients with short duration of diabetes, is the mainstay of management of type 2 diabetes to lower the risk of complications. However, despite the improvement in the understanding of the pathophysiology of type 2 diabetes and development of novel glucose-lowering agents, long-term durable glycaemic control remains a difficult goal to achieve. Several challenging clinical trials proved that an early combination therapy with a variety of glucose-lowering agents had a more favourable effect than conventional stepwise therapy in terms of glycaemic control. We aim to evaluate the efficacy and tolerability of a novel, initial triple combination therapy with metformin, sodium glucose cotransporter 2 inhibitor (dapagliflozin) and dipeptidyl peptidase-4 inhibitor (saxagliptin) compared with conventional stepwise add-on therapy in drug-naïve patients with recent-onset type 2 diabetes.
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