Ten-Year Mortality Trends for Adults with and without Diabetes Mellitus in South Korea, 2003 to 2013

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.

Effects of Lobeglitazone, a Novel Thiazolidinedione, on Bone Mineral Density in Patients with Type 2 Diabetes Mellitus over 52 Weeks

BACKGROUND: The aim of this multicenter, randomized, double-blind study was to examine the effect of lobeglitazone, a novel thiazolidinedione, on the changes in bone mineral density (BMD) in patients with type 2 diabetes mellitus. METHODS: A 24-week, double-blinded phase was followed by a 28-week, open-label phase, in which the placebo group also started to receive lobeglitazone. A total of 170 patients aged 34 to 76 years were randomly assigned in a 2:1 ratio to receive lobeglitazone 0.5 mg or a matching placebo orally, once daily. BMD was assessed using dual-energy X-ray absorptiometry at week 24 and at the end of the study (week 52). RESULTS: During the double-blinded phase, the femur neck BMD showed decreasing patterns in both groups, without statistical significance (−0.85%±0.36% and −0.78%±0.46% in the lobeglitazone and placebo groups, respectively). The treatment difference between the groups was 0.07%, which was also not statistically significant. Further, minimal, nonsignificant decreases were observed in both groups in the total hip BMD compared to values at baseline, and these differences also did not significantly differ between the groups. During the open-label phase, the BMD was further decreased, but not significantly, by −0.32% at the femur neck and by −0.60% at the total hip in the lobeglitazone group, and these changes did not significantly differ compared with the original placebo group switched to lobeglitazone. CONCLUSION: Our results indicate that treatment with lobeglitazone 0.5 mg over 52 weeks showed no detrimental effect on the BMD compared to the placebo.

Self-Care and Related Factors in Young and Middle Adulthood Patients with Type 2 Diabetes / 임상당뇨병

BACKGROUND: This study was designed to investigate the level of self-care and related factors such as perceived health status, family support, stress related to diabetes mellitus, self-efficacy, depression, situational influence and glycemic control level in young and middle adulthood patients with type 2 diabetes. METHODS: For this study, data were collected and individual interviews were conducted from June 1 to July 16, 2012, with 149 young and middle adulthood patients with type 2 diabetes at Korea University Anam Hospital. RESULTS: The mean score of self-care evaluated in terms of dietary control, medication administration, physical exercise, self-monitoring of blood glucose and general healthcare was 63.68 points (20 to 100). The mean scores of various factors related to self-care were as follows: The mean score of perceived health status was 8.90 points (3 to 15), family support was 37.75 points (12 to 48), stress related to diabetes mellitus was 44.61 points (17 to 85), self-efficacy was 26.06 points (10 to 40),depression was 10.19 points (0 to 63) and situational influence was 10.89 points (6 to 24). The most important factors related to self-care were predicted as 45% by self-efficacy and 48% added situational influence. According to age, the most important factors related to self-care were predicted as 77% by self-efficacy in the 20 to 29 age group, 52% by stress related to diabetes mellitus in the 30~39 age group, and 43% by self-efficacy in the 40 to 49 age group. CONCLUSION: To improve self-care of young and middle adulthood patients with type 2 diabetes, it is necessary to develop nursing intervention that is useful in strengthening self-efficacy, situational influence and stress related to diabetes.

Metastatic papillary thyroid cancers with malignant pleural effusion aggravated during thyroid hormone withdrawal for radioiodine therapy / 영남의대학술지

L-thyroxine (LT4) withdrawal prior to radioactive iodine (RAI) ablation therapy is a commonly used method for successful treatment of patients with papillary thyroid cancer (PTC). However, a prolonged period of hypothyroidism induced by LT4 withdrawal is sometimes associated with impaired quality of life and cardiopulmonary dysfunction in PTC patients. Furthermore, LT4 withdrawal may have a trophic effect on residual cancer by means of increased thyrotropin. We report on 2 cases of metastatic PTC patients with malignant pleural effusion (MPE) whose disease showed rapid worsening after LT4 withdrawal and RAI therapy. The first case is a 65-year-old woman who had PTC with multiple distant metastases and MPE. During LT4 withdrawal for RAI therapy, MPE showed rapid worsening, and the patient required repetitive therapeutic thoracentesis. The second case is a 49-year-old woman with PTC who underwent 3 additional operations for cancer recurrence in the neck lymph nodes and 6 times of RAI treatments. While preparing for the 7th RAI treatment by withdrawing LT4, she developed MPE which became progressively aggravated after RAI therapy. Both patients experienced increased pleural effusion during the LT4 withdrawal period and a rise in the thyroglobulin level was observed after RAI therapy. MPE was not controlled with therapeutic thoracentesis and pleurodesis. Eventually, both patients died of rapid disease progression after RAI therapy. In summary, LT4 withdrawal may have an adverse effect on metastatic PTC patients, particularly those with MPE.

Primary Hyperparathyroidism with Extensive Brown Tumors and Multiple Fractures in a 20-Year-Old Woman

A brown tumor is a benign fibrotic, erosive bony lesion caused by localized, rapid osteoclastic turnover, resulting from hyperparathyroidism. Although brown tumors are one of the most pathognomonic signs of primary hyperparathyroidism, they are rarely seen in clinical practice. In this report, we present a case of 20-year-old woman with recurrent fractures and bone pain. Plain digital radiographs of the affected bones revealed multiple erosive bone tumors, which were finally diagnosed as brown tumors associated with primary hyperparathyroidism due to a parathyroid adenoma. This case shows that multiple, and clinically severe form of brown tumors can even occur in young patients.

A Rare Manifestation of Hypothyroid Myopathy: Hoffmann's Syndrome

Hypothyroid myopathy is observed frequently and the resolution of the clinical manifestations of myopathy following thyroid hormone replacement is well known. However, a specific subtype of hypothyroid myopathy, Hoffmann's syndrome, characterized by increased muscular mass (pseudohypertrophy), proximal muscle weakness, muscle stiffness and cramps, is rarely reported. Herein, we describe a 34-year-old male who presented with proximal muscle weakness and non-pitting edema of the lower extremities. He initially visited the neurology department where he was suspected of having polymyositis. Additional laboratory evaluation revealed profound autoimmune hypothyroidism and elevated muscle enzymes including creatine kinase. The patient was started on levothyroxine treatment and, subsequently, clinical symptoms and biochemical parameters resolved with the treatment. The present case highlights that hypothyroidism should be considered in the differential diagnosis of musculoskeletal symptoms even in the absence of overt manifestations of hypothyroidism. To our knowledge, this is the first case reported in Korea.

Obstructive sleep apnea with excessive daytime sleepiness is associated with non-alcoholic fatty liver disease regardless of visceral fat

BACKGROUND/AIMS: Obstructive sleep apnea (OSA) is associated with an increased risk of obesity and non-alcoholic fatty liver disease (NAFLD), but it remains unclear whether the risk of NAFLD is independently related to OSA regardless of visceral obesity. Thus, the aim of the present study was to examine whether OSA alone or in combination with excessive daytime sleepiness (EDS) or short sleep duration was associated with NAFLD independent of visceral fat in Korean adults. METHODS: A total of 621 participants were selected from the Korean Genome and Epidemiology Study (KoGES). The abdominal visceral fat area (VFA) and hepatic fat components of the participants were assessed using computed tomography scans and they were then categorized into four groups depending on the presence of OSA and EDS. RESULTS: The proportions of NAFLD were 21.1%, 18.5%, 32.4%, and 46.7% in participants without OSA/EDS, with only EDS, with only OSA, and with both OSA and EDS, respectively. A combination of OSA and EDS increased the odds ratio (OR) for developing NAFLD (OR, 2.75; 95% confidence interval [CI], 1.21 to 6.28) compared to those without OSA/EDS, and this association remained significant (OR, 2.38; 95% CI, 1.01 to 5.59) even after adjusting for VFA. In short sleepers (< 5 hours) with OSA, the adjusted OR for NAFLD was 2.50 (95% CI, 1.08 to 5.75) compared to those sleeping longer than 5 hours without OSA. CONCLUSIONS: In the present study, OSA was closely associated with NAFLD in Korean adults. This association was particularly strong in those with EDS or short sleep duration regardless of VFA.

Changes in the clinical manifestations of primary aldosteronism

BACKGROUND/AIMS: Primary aldosteronism (PA) is now widely recognized to have a higher prevalence than was once thought. In view of its increasing prevalence, we compared chronological changes in clinical manifestations of PA according to different times of diagnosis. METHODS: In total, 85 patients diagnosed with PA from January 1986 through March 2012 were reviewed retrospectively, based on their medical records. During two periods-1986 to 2005 and 2006 to 2012-41 and 44 patients, respectively, were diagnosed with PA. We compared the clinical and biological characteristics of PA between these periods. RESULTS: The results demonstrate an increasing trend in the prevalence of idiopathic hyperaldosteronism (IHA; p = 0.19). In the 2006 to 2012 period, patients with PA presented with higher serum potassium levels at the time of diagnosis than in the 1986 to 2005 period (p < 0.0002). Adrenal vein sampling (AVS) was performed mostly in the latter period (82.3%) and the diagnostic accuracy of adrenal computed tomography, compared with AVS, was only 56.2%. About 78.0% versus 86.3% of patients had at least one target organ damage (TOD) in the 1986 to 2005 and 2006 to 2012 periods, respectively (p = 0.39). However, patients with TOD were older and had longer durations of hypertension than patients without, in both periods. CONCLUSIONS: PA is becoming more prevalent. There was an increasing tendency for IHA, and more PA patients presented with normokalemia than in the earlier period. Early and accurate diagnosis of PA with AVS and proper treatment should have substantial prognostic value.

Comparison of Acarbose and Voglibose in Diabetes Patients Who Are Inadequately Controlled with Basal Insulin Treatment: Randomized, Parallel, Open-Label, Active-Controlled Study

We studied the efficacy and safety of acarbose in comparison with voglibose in type 2 diabetes patients whose blood glucose levels were inadequately controlled with basal insulin alone or in combination with metformin (or a sulfonylurea). This study was a 24-week prospective, open-label, randomized, active-controlled multi-center study. Participants were randomized to receive either acarbose (n=59, 300 mg/day) or voglibose (n=62, 0.9 mg/day). The mean HbA1c at week 24 was significantly decreased approximately 0.7% from baseline in both acarbose (from 8.43% +/- 0.71% to 7.71% +/- 0.93%) and voglibose groups (from 8.38% +/- 0.73% to 7.68% +/- 0.94%). The mean fasting plasma glucose level and self-monitoring of blood glucose data from 1 hr before and after each meal were significantly decreased at week 24 in comparison to baseline in both groups. The levels 1 hr after dinner at week 24 were significantly decreased in the acarbose group (from 233.54 +/- 69.38 to 176.80 +/- 46.63 mg/dL) compared with the voglibose group (from 224.18 +/- 70.07 to 193.01 +/- 55.39 mg/dL). In conclusion, both acarbose and voglibose are efficacious and safe in patients with type 2 diabetes who are inadequately controlled with basal insulin. (ClinicalTrials.gov number, NCT00970528)

Increased Selenoprotein P Levels in Subjects with Visceral Obesity and Nonalcoholic Fatty Liver Disease

BACKGROUND: Selenoprotein P (SeP) has recently been reported as a novel hepatokine that regulates insulin resistance and systemic energy metabolism in rodents and humans. We explored the associations among SeP, visceral obesity, and nonalcoholic fatty liver disease (NAFLD). METHODS: We examined serum SeP concentrations in subjects with increased visceral fat area (VFA) or liver fat accumulation measured with computed tomography. Our study subjects included 120 nondiabetic individuals selected from participants of the Korean Sarcopenic Obesity Study. In addition, we evaluated the relationship between SeP and cardiometabolic risk factors, including homeostasis model of insulin resistance (HOMA-IR), high sensitivity C-reactive protein (hsCRP), adiponectin values, and brachial-ankle pulse wave velocity (baPWV). RESULTS: Subjects with NAFLD showed increased levels of HOMA-IR, hsCRP, VFA, and several components of metabolic syndrome and decreased levels of adiponectin and high density lipoprotein cholesterol than those of controls. Serum SeP levels were positively correlated with VFA, hsCRP, and baPWV and negatively correlated with the liver attenuation index. Not only subjects with visceral obesity but also those with NAFLD exhibited significantly increased SeP levels (P<0.001). In multiple logistic regression analysis, the subjects in the highest SeP tertile showed a higher risk for NAFLD than those in the lowest SeP tertile, even after adjusting for potential confounding factors (odds ratio, 7.48; 95% confidence interval, 1.72 to 32.60; P=0.007). CONCLUSION: Circulating SeP levels were increased in subjects with NAFLD as well as in those with visceral obesity and may be a novel biomarker for NAFLD.

Anaplastic Thyroid Carcinoma Following Radioactive Iodine Therapy for Graves' Disease

Radioactive iodine (RAI) therapy has been used as a treatment option for Graves' disease, and it has been widely accepted to be safe. On the other hand, some evidence suggests that RAI therapy is possibly associated with a small increased risk of thyroid cancer. Herein, we report a rare case of anaplastic thyroid carcinoma (ATC) associated with Graves' disease, following RAI treatment. A 42-year-old woman had been diagnosed with Graves' disease and although she was treated with an antithyroid drug, she remained in a hyperthyroid state, which led to two RAI treatments. More than 10 years later, the patient revisited our clinic due to hoarseness, dysphagia, and dyspnea, which had lasted for 2 months. Neck computed tomography suggested thyroid carcinoma and a lymph node biopsy showed metastatic papillary carcinoma. The patient underwent total thyroidectomy and was finally diagnosed as having an ATC. It is not clear if the occurrence of ATC reported here was influenced by the RAI therapy or alternatively, it may only represent the delayed recognition of a rare change in the natural history of Graves' disease. Nevertheless, this report is worthwhile since it presents a very rare case of ATC that occurred eleven years after the RAI therapy for Graves' disease.

Thyroid Dysfunction of North Korean Women Living in South Korea, Focusing on Subclinical Hypothyroidism

BACKGROUND: Thyroid function depends on ethnic and environmental factors. North Korean refugees have the same genetic background as South Koreans, but they have been exposed to different environments. This study examines the prevalence and pattern of thyroid disorders in North Korean women living in South Korea, focusing on subclinical hypothyroidism (SCH). METHODS: The intended sample was a total of 327 North Korean women residing in Seoul. Health questionnaires and medical examinations, including serum thyrotropin (thyroid stimulating hormone, TSH), free thyroxine, and thyroid autoantibodies, were conducted. RESULTS: The prevalence of SCH was 9.4%. In logistic regression analysis, smoking, menopause, length of stay in South Korea, body mass index, history of thyroid disease, and metabolic syndrome were not associated with the risk of SCH. Whereas, the positivity of autoantibodies were associated with a high risk for SCH (odds ratio [OR], 4.840; 95% confidence interval [CI], 1.80-13.017; P = 0.002), and age was associated with a low risk for SCH (OR, 0.94; 95% CI, 0.888-0.994; P = 0.031). The serum TSH levels also decreased with increasing age, and in particular, there was significant difference between 30-39 years, and over 60 years (2.33 +/- 1.51 microIU/mL vs. 1.54 +/- 0.73 microIU/mL, P = 0.028). CONCLUSION: In North Korean women, the positivity of autoantibodies was associated with a high risk for SCH. But interestingly, a younger age was associated with a high risk for SCH. Considering that they suffered from severe famine at the period of growth, and this led to malnutrition, their thyroid dysfunction might be associated with the peculiar environment that they experienced.

A Case of Multiple Osteoporotic Compression Fractures in Young Man with Budd-Chiari Syndrome

Osteoporosis in young men is extremely rare. In this report, we demonstrate a rare case of multiple vertebral fractures discovered in a young man with Budd-Chiari syndrome without prior history of trauma. A 29-year-old man was diagnosed as Budd-Chiari syndrome 12 years ago and underwent a mesocaval shunt to relieve the hepatic vein obstruction and was on warfarin therapy. He suffered from low back pain and it was not relieved by analgesics. A T-L spine X-ray revealed multiple compression fractures and the z-score at lumbar spine was -3.7 which is below the expected range for that age. The patient was treated with calcium, vitamin D and bisphosphonate, and showed clinical improvement. This case highlights the importance of the investigation for secondary osteoporosis in young adults with an underlying disease that alters bone metabolism.

Effect of Eplerenone, a Selective Aldosterone Blocker, on the Development of Diabetic Nephropathy in Type 2 Diabetic Rats

BACKGROUND: Aldosterone antagonists are reported to have beneficial effects on diabetic nephropathy by effective blocking of the renin-angiotensin-aldosterone system. We investigated the renoprotective effect of the selective aldosterone receptor blocker eplerenone, the angiotensin converting enzyme inhibitor lisinopril, and combined eplerenone and lisinopril treatment in type 2 diabetic rats. METHODS: Animals were divided into six groups as follows: Otsuka Long-Evans Tokushima Fatty (OLETF) rat control, OLETF rats treated with a low dose of eplerenone (50 mg/kg/day), OLETF rats treated with a high dose of eplerenone (200 mg/kg/day), OLETF rats treated with lisinopril (10 mg/kg/day), OLETF rats treated with a combination of both drugs (eplerenone 200 mg/kg/day and lisinopril 10 mg/kg/day), and obese non-diabetic Long-Evans Tokushima Otsuka rats for 26 weeks. RESULTS: Urinary albumin excretion was significantly lower in the lisinopril group, but not in the eplerenone group. Urinary albumin excretion was decreased in the combination group than in the lisinopril group. Glomerulosclerosis and renal expression of type I and type IV collagen, plasminogen activator inhibitor-1, transforming growth factor-beta1, connective tissue growth factor, and fibronectin mRNA were markedly decreased in the lisinopril, eplerenone, and combination groups. CONCLUSION: Eplerenone and lisinopril combination showed additional benefits on type 2 diabetic nephropathy compared to monotherapy of each drug.

Successful Localization of Distant Metastasis in Parathyroid Carcinoma Using Intraoperative Parathyroid Hormone Assay

Intra-operative parathyroid hormone (IOPTH) assay is a useful tool to confirm complete excision of all hyper-functioning parathyroid gland tissue. In this report, we describe a case with successful localization of distant metastasis in a patient with parathyroid carcinoma using the IOPTH assay. A 53-year-old man presented to our clinic with a serum calcium level of 11.8 mg/dL and an intact PTH level of 233.3 pg/mL. He had been treated for parathyroid carcinoma eleven years ago. Two suspected metastatic lesions were detected on the chest computed tomography. Due to the vastly different surgical field necessary to excise each lesion, we preferentially removed only one lesion and we monitored the other remaining suspected lesion without resection via IOPTH assay. Six months later, the patient's serum calcium and intact PTH levels remained within their normal ranges. To the best of our knowledge, this is the first case to effectively utilize IOPTH assay for the management of metastatic parathyroid carcinoma.

Hyperprolactinemia-Associated Breast Uptake of Radioiodine Following 131I Postablation Scan in Differentiated Thyroid Cancer

Scanning with whole-body 131I scintigraphy after surgery has been a valuable diagnostic modality in the surveillance of patients with differentiated thyroid cancer. Radioiodine uptake is rarely observed in non-lactating breast tissue, which mimics thyroid cancer metastasis. We now report a case of a 45-year-old female thyroid cancer patient who underwent radioiodine therapy, and in whom breast uptake of radioiodine was observed on a post-therapy whole body scan. Her serum prolactin level was elevated to 328 ng/mL at the time of the radioiodine uptake, and the hyperprolactinemia was induced by her antipsychotic medications. Six months after she discontinued that medication, her serum prolactin level was normalized to 12.6 ng/mL and breast uptake of iodine was no longer present in a follow-up whole body scan.

Klebsiella pneumoniae Orbital Cellulitis with Extensive Vascular Occlusions in a Patient with Type 2 Diabetes

A 39-year-old woman visited the emergency room complaining of right eye pain and swelling over the preceding three days. The ophthalmologist's examination revealed orbital cellulitis and diabetic retinopathy in the right eye, although the patient had no prior diagnosis of diabetes. It was therefore suspected that she had diabetes and orbital cellulitis, and she was started on multiple antibiotic therapies initially. She then underwent computed tomography scans of the orbit and neck and magnetic resonance imaging of the brain. These studies showed an aggravated orbital cellulitis with abscess formation, associated with venous thrombophlebitis, thrombosis of the internal carotid artery, and mucosal thickening of maxillary sinus with multiple paranasal abscesses. Three days later, initial blood culture grew Klebsiella pneumoniae. She recovered after incision and drainage and antibiotic therapy for 37 days.

Relationship Between Metabolic Syndrome and Risk of Chronic Complications in Koreans with Type 2 Diabetes / 당뇨병

BACKGROUND: We examined the relationships between components of metabolic syndrome at the time of diagnosis of type 2 diabetes, and the development of chronic complications in Korean patients with type 2 diabetes. METHODS: The medical records of patients with type 2 diabetes who had undergone treatment for at least five years prior were collected from 10 general hospitals in Korea. Among a total of 1,418 patients reviewed for possible inclusion in this study, 603 patients were selected, and the occurrence of complications among these patients was evaluated. RESULTS: Among the 603 patients (male, 253; female, 350), 154 males (60.8%) and 266 females (76.0%) were diagnosed with metabolic syndrome at the time of initial diagnosis of type 2 diabetes. The incidence of chronic complications (average follow-up 15.2 +/- 4.9 years) included 60 cases of coronary artery disease (CAD), 57 cases of cerebrovascular accident (CVA), 268 cases of diabetic retinopathy (DR), 254 cases of diabetic nephropathy (DN), and 238 cases of diabetic peripheral neuropathy (DPN). As compared to patients without metabolic syndrome, the adjusted relative risks (95% CI) of incidental diabetic complications in patients with metabolic syndrome were 3.28 (1.40~7.71) for CAD, 2.04 (0.86~4.82) for CVA, 1.53 (1.10~2.14) for DR, 1.90 (1.29~2.80) for DN, and 1.51, (1.06~2.14) for DPN. With the addition of just one constituent of metabolic syndrome, the relative risk of developing CAD, CVD, DR, DN, and DPN increased by 2.08 (95% CI, 1.27~3.40), 1.16 (0.80~1.66), 1.09 (0.93~1.26), 1.29 (1.06~1.57) and 1.06 (0.87~1.26), respectively. CONCLUSION: Metabolic syndrome in Korean patients with type 2 diabetes increases the risk of developing both macrovascular and microvascular complications.

Epidemiology and Current Status of Diabetes in Korea / 한양의대학술지

Diabetes mellitus is an epidemic worldwide. The worldwide prevalence of diabetes has risen rapidly over the past two decades, from an estimated 30 million cases in 1985 to 177 million in 2000. Especially, the prevalence of diabetes in Korea has explosively increased six to sevenfold from 1.5% to almost 10% during the past 30 years. Furthermore, diabetic patients in Korea suffered from various diabetic complications and diabetes-related mortality has rapidly increased over the last decades. However, the current status of diabetes management was not good. According to an analysis of Korean National Health Insurance Database on Diabetes (2003), only 53% of diabetic patients visited clinics for diabetes management. The proportion of diabetic patients with optimally controlled glycemia (HbA1c<7%), blood pressure (<130/80 mmHg) and dyslipidema (LDL cholesterol <100 mg/dL) were only 40%, 19% and 38%, respectively. If the current trend continues, diabetes would be a disaster in Korea, leading to a greater loss of human and financial resources. To reduce this harmful epidemic, comprehensive and improved public health strategies should be implemented

The Effect of Cellular Phone-Based Telemedicine on Glycemic Control in Type 2 Diabetes Patients Using Insulin Therapy / 당뇨병

BACKGROUND: Cellular phones are extremely prevalent in modern society and they enable appropriate feedback mechanisms through real time monitoring and short message services regarding blood glucose levels. We investigated whether cellular phone-based telemedicine support system could improve blood glucose control in type 2 diabetes patients who were in inadequate glycemic control regardless of insulin therapy. METHODS: A randomized, controlled clinical trial was conducted involving 74 type 2 diabetic patients with suboptimal glycemic control (HbA1c levels > 7%) regardless of insulin therapy. The intervention (cellular phone-based telemedicine) group managed their blood glucose using a cellular phone for 3 months, while the control (self monitoring of blood glucose) group managed their blood glucose with a standard glucometer for the same period. RESULTS: Three months later, HbA1c levels were decreased in both groups. However, the decrease in the control group from 8.37% to 8.20% was only 0.20% (P = 0.152) which was not significant. In contrast, the intervention group had a significant reduction of 0.61% from 8.77% to 8.16% (P or = 8%, the patients in the intervention group showed a significant reduction of 0.81% from 9.16% to 8.34% (P < 0.001). CONCLUSION: HbA1c levels were significantly decreased in the cellular phone-based telemedicine group compared with the control group after 3 months. This study suggests that cellular phone-based telemedicine is helpful for better glucose control in type 2 diabetes patients who previously were unable to control glucose levels adequately with insulin therapy.