2023 Clinical Practice Guidelines for Diabetes Mellitus of the Korean Diabetes Association

In May 2023, the Committee of Clinical Practice Guidelines of the Korean Diabetes Association published the revised clinical practice guidelines for Korean adults with diabetes and prediabetes. We incorporated the latest clinical research findings through a comprehensive systematic literature review and applied them in a manner suitable for the Korean population. These guidelines are designed for all healthcare providers nationwide, including physicians, diabetes experts, and certified diabetes educators who manage patients with diabetes or individuals at risk of developing diabetes. Based on recent changes in international guidelines and the results of a Korean epidemiological study, the recommended age for diabetes screening has been lowered. In collaboration with the relevant Korean medical societies, recently revised guidelines for managing hypertension and dyslipidemia in patients with diabetes have been incorporated into this guideline. An abridgment containing practical information on patient education and systematic management in the clinic was published separately.

Analysis of YouTube Content on Oral Disease Information about the Elderly / 치위생과학회지

Background@#The elderly have, a higher disease morbidity than other age groups due to a decrease in resistance to the diseaseand have complex diseases, so care should be taken. Accordingly, it is considered important to provide information for improving the health of the elderly. Health information plays an important role in individual health promotion and education, so the degree of exposure to information about oral health of the elderly is expected to have a significant impact on understanding and acquiring information on oral content videos on the importance, prevention, and management of oral health of the elderly in the future. @*Methods@#This study analyzed video content related to oral diseases of the elderly in a total of 150 videos uploaded on YouTubefrom January 1, 2012 to May 13, 2021, using a total of three books of dental hygiene for the elderly. @*Results@#Forty-nine broadcasters accounted for the most of this information. Among the information providers, there were twodental hygienists. They accounted for 1.3% of all the information providers. The highest number of dental hygienists who broadcasted information was 42 in 2019. The average number of views was 37,303 periodontal diseases, the highest. Among the videos, dry mouth was the most common with 34 oral diseases. @*Conclusion@#The number of images for each disease varies, so it seems that information should be provided in various ways. Dentalhygienists should widely improve oral health knowledge by providing various dental hygiene management images for each oral disease to improve the oral health of the general public. In addition, based on the information of the Health Insurance Review and Assessment Service, the development and provision of content should be actively carried out so that people can obtain the information they desire.

2018 Guidelines for the Management of Dyslipidemia in Korea

No abstract available.

Erratum: 2018 Guidelines for the management of dyslipidemia in Korea

The title and author names are incorrect.

Macronutrient Distributions in Nutrition Recommendation for Type 2 Diabetes Management / 임상당뇨병

Dietary intake is a major contributor to both the development and management of type 2 diabetes. Multiple studies have provided evidence that diabetes nutrition therapy is effective for improving glycemic control and other metabolic outcomes. However, there remains no conclusive evidence as to which diet, if any, is the most effective for optimizing glycemic control in patients with diabetes. The roles of differing macronutrient percentages, eating patterns and weight loss interventions are controversial topics concerning dietary intake. In particular, there are no ideal percentages of macronutrients or eating patterns that can simultaneously apply to all persons with diabetes. A reduced energy intake for persons with type 2 diabetes, referred to as nutrition therapy intervention, has been shown to be effective for achieving glycemic and other metabolic outcomes. For such a treatment option to be effective, diabetes nutrition therapy must be individualized. Thus, treatment goals, personal preference, individual ability and willingness to make lifestyle changes must all be considered when educating or counseling individuals with diabetes.

Determination of the Main Theme and Tasks for an Obesity Educator Training Program

After discussion about the need to develop an obesity educator training program and certification for obesity educators, the Education Committee of the Korean Society for the Study of Obesity has developed and determined the main theme for the Obesity Educator Training Program implemented as a workshop and public hearing. We reviewed the process of the determination of the main theme and discuss topics such as subjects, operation of the program, and certification processing to design a credible obesity educator training program.

A Prospective Observational Study Evaluating the Change of Nutritional Status and the Incidence of Dumping Syndrome after Gastrectomy

PURPOSE: The aim of this study was to investigate the change of nutritional status and the incidence of dumping syndrome after gastrectomy for gastric cancer. METHODS: From January 2013 to May 2014, 36 patients who underwent gastrectomy for gastric cancer were prospectively investigated in terms of nutritional status by body weight, anthropometric measurements, biochemical data, and Patient-Generated Subjective Global Assessment (PG-SGA). Dumping syndrome was assessed using a newly developed questionnaire based on the Japanese Society of Gastroenterological Surgery survey and Sigstad's scoring system. RESULTS: Body weight losses were 4.6%, 8.1%, and 6.9% at discharge, six months, and one year after discharge, respectively. Triceps skinfold thickness had no significance, however, mid-arm muscle circumference showed significant loss after gastrectomy. A part of the biochemical data showed significant change after gastrectomy, but almost indicated a restoring tendency within two months after discharge. In terms of PG-SGA, 33 patients (91.7%) were classified as A (well-nourished) before surgery, however, the number of well-nourished patients showed a sharp decrease to 1 (2.8%) at two weeks after discharge, and then gradually increased to 25 (69.4%) at one year. The main obstacles against diet intake were reported as 'early satiety' and 'anxiety'. The number of patients who had experience in at least one dumping syndrome related symptom was 21 (58.3%) at discharge, 26 (72.2%) at two months after discharge, and 11 (30.6%) at one year after discharge. CONCLUSION: Nutritional deficit as well as dumping syndrome is encountered in a large number of gastric cancer patients after gastrectomy. Postoperative nutritional support and personalized education seem to be very important during the postoperative period.

How much fruit should diabetic patients eat? / 임상당뇨병

High fruit intake has been shown to reduce the risk of cardiovascular disease and some forms of cancer; however, the association between fruit intake and glycemic control in diabetes has been reported inconsistently. Some health professionals often have concerns about the sugar content in fruit and advise individuals with diabetes to restrict their fruit intake. Recent nutrition recommendations for the management of diabetes have emphasized individualized nutrition therapy based on a varied diet including whole grains, vegetables, and fruits, however. Higher fruit intake may reduce the risk of diabetes. Fruit intake should not be restricted and we recommend 2 exchanges (100-300 g) of fruit intake for diabetic patients.

The effect of high-carbohydrate diet and low-fat diet for the risk factors of metabolic syndrome in Korean adolescents: Using the Korean National Health and Nutrition Examination Surveys (KNHANES) 1998-2009 / 한국영양학회지

PURPOSE: The prevalence of metabolic syndrome has increased in both the adult population and in adolescents. How-ever, few studies have been conducted for adolescents. The aim of this study was to examine the association of metabolic syndrome and its risk factors with high carbohydrate diet and high fat diet using data from the Korea National Health and Nutrition Examination Survey (1998-2009). METHODS: Using the Acceptable Macronutrient Distribution Range for Korean Dietary Reference Intakes, subjects whose energy intake from carbohydrate was greater than 70% and from fat was less than 15% were classified as the 'High-carbohydrate & low-fat diet (HCLF)' group and subjects whose energy intake from carbohydrate was less than 60% and from fat was 25% or more were classified as the 'Low-carbohydrate & high-fat Diet (LCHF)' group. Among 5,931 eligible subjects, HCLF included 853 subjects and LCHF included 1,084 subjects. RESULTS: The mean age in both groups was 14 years and significant difference in age, BMI, sex, physical activity, and household income was observed between the HCLF and LCHF groups. Regarding the energy intake compared to Estimated Energy Re-quirement, the HCLF group met 79.0% and the LCHF group met 100.3%. Regarding nutrient intake per 1,000 kcal, carbo-hydrate, iron, potassium, and vitamin C intake in the HCLF group were significantly higher, but protein, fat, calcium, phos-phorus, vitamin A, thiamin, riboflavin, and niacin intakes were significantly lower in the HCLF group compared to the LCHF group. After adjusting for age, sex, BMI, study year, household income, physical activity, and energy intake, the serum tri-glycerides level and systolic blood pressure were slightly higher, while the serum HDL-cholesterol level was significantly lower in HCLF than LCHF. The odds ratio of metabolic syndrome did not differ significantly between HCLF and LCHF. CONCLUSION: Our findings indicate an association of a high carbohydrate diet with increased risks for metabolic syndrome components. Conduct of future studies would be necessary in order to explore the underlying mechanism and to confirm our findings in a prospective study.

Early Postoperative 24-Hour Continuous Jejunostomy Feeding in Esophagectomy Patients

Esophagectomy can result in various postoperative nutrition-related complications that may impair the nutritional status of the patient. In our institution, we usually initiate 16-hour continuous jejunostomy feeding using an enteral feeding pump on postoperative day 2 as a routine protocol after esophagectomy. The target calorie intake was achieved in 6-7 days with this protocol, which is longer than that required with other recently reported feeding protocols. Accordingly, early jejunostomy feeding protocol, which starts on postoperative day 1 and continues for 24 hours was attempted. In the present report, we described 3 cases of early 24-hour continuous jejunostomy feeding after esophagectomy. The use of this new protocol reduced the duration required to achieve the target calorie intake as less than 5 days without any enteral feeding-related complications.

Evaluation of Nutrient Intake in Early Post Kidney Transplant Recipients

The purpose of our study was to evaluate the dietary intake of kidney transplant recipients (KTRs) and assess oral intake related nutrition problems. Fifty patients who had undergone kidney transplantation were included: 24 males, 26 females. The mean age was 46.8 +/- 11.2 years, height was 161.3 +/- 8.3 cm, and body weight was 60.5 +/- 8.7 kg. We conducted nutrition education based on the diet guideline for KTRs (energy 32 kcal/kg of ideal body weight [IBW], protein 1.3 g/kg of IBW) and neutropenic diet guideline before discharge. Dietary intake of the patients at 1 month after transplantation was investigated by 3-day food records. Body weight and laboratory values for nutritional status and graft function were also collected. Body weight was significantly decreased from admission to discharge. Body weight from discharge to 1 month and 3 months after transplantation was increased but was not significant. Biochemical measurements were generally improved but the number of patients with hypophosphatemia increased. The daily dietary intake of energy and protein was adequate (33.1 kcal/kg, 1.5 g/kg, respectively). However, the dietary intake of calcium, folate, and vitamin C did not meet the Korean Recommended Nutrient Intake of vitamins and minerals (86.8%, 62.4%, and 88.0%, respectively). Patients with low intake of calcium, folate, and vitamin C presented low intake in milk and dairy products, vegetables, and fruits, and these foods were related to restricted food items in neutropenic diet. More attention should be paid on improving quality of diet, and reconsideration of present neutropenic diet guideline is necessary. These results can be used to establish evidence-based medical nutrition therapy guideline for KTRs.

Salt Intake and Diabetes / 임상당뇨병

As in the general population, people with diabetes should be advised to reduce their sodium intake with a diet high in fruits, vegetable, whole grains, and low-fat dairy products. For patients with diabetes and hypertension, renal disease, or cardiovascular disease, dietary sodium intake should be restricted to less than 2,000 mg/day. Lifestyle interventions that incorporate balanced diets and increased physical activity can effectively reduce the risk of diabetes complications. Further studies are needed to develop evidence-based dietary recommendations for Korean patients with diabetes.

A Survey of Diabetic Educators and Patients for the Revision of Korean Food Exchange Lists

BACKGROUND: Food exchange lists are one of the main methods of nutritional education. However, Korean food exchange lists have not been revised since 1994. Therefore, we surveyed the opinions of diabetes educators and patients with diabetes regarding the need for revision of the current food exchange lists. METHODS: For two weeks beginning on 10 March 2008, a 12-item questionnaire regarding the opinion and need for revision of the current food exchange lists was e-mailed to diabetes educators nationwide. Another 15-question survey was administered to patients with diabetes in 13 hospitals located in the Seoul and Gyeonggi regions of Korea. RESULTS: We obtained survey responses from 101 diabetes educators and 209 patients; 65 (64.3%) of the educators answered that the current food exchange lists should be revised. The items that needed revision were the glycemic index, addition of new foods and reaffirmation of exchange standard amounts. The patients demanded specific education about choosing appropriate foods, a balanced meal plan, proper snacks, and dining intake. CONCLUSION: Our survey results demonstrate the need to revise the Korean food exchange lists. This process should focus on glycemic index, the addition of new foods and reconfirmation of one exchange reference unit.

Secular Trend in Dietary Patterns in a Korean Adult Population, Using the 1998, 2001, and 2005 Korean National Health and Nutrition Examination Survey

Koreans have undergone many changes in dietary patterns with economic growth. The purpose of this research was to examine changes in dietary patterns using data from the 1998, 2001, and 2005 Korean National Health and Nutrition Examination Survey. The study included 21,525 subjects (8,295 from 1998, 6,880 from 2001, and 6,350 from 2005) who were 20 years or older and who participated in a 24-h diet recall. The percentage energy intake from 22 food groups was calculated, and a cluster analysis was applied to identify dietary patterns. Two dietary patterns emerged; the first pattern was characterized by high intake of white rice, legumes, vegetables, kimchi, and seaweeds, the so-called "traditional" pattern (53%), whereas the other pattern was characterized by high intake of other grains, noodle dumplings, floured bread, pizza, hamburgers, cereals and snacks, potatoes, sugared sweets, nuts, fruits, meat.its products, eggs, fish, milk and dairy products, oils, beverages and seasoning, or the so-called "modified" pattern. The modified pattern comprised a higher proportion of younger aged, metropolitan residents with more education and higher incomes. However, the gender distribution was not significantly different. The modified pattern had a significantly higher intake of all nutrients except carbohydrates and had a higher proportion of energy from fat and protein. No association with a risk for metabolic syndrome was found for either dietary pattern. After age was standardized, the traditional pattern included 52% of the respondents in 1998, 54% in 2001, and 50% in 2005. However, the modified pattern was significantly more prevalent in the younger age group (20-29 yr), whereas the traditional pattern increased significantly in the older age group (> or = 65 yr). In conclusion, a secular trend was found for dietary pattern by age group, suggesting that it is necessary to monitor the changes in dietary pattern by age group and to develop appropriate dietary education and guidelines.

Association between Dietary Patterns and Blood Lipid Profiles in Korean Adults with Type 2 Diabetes

We aimed to explore the associations of dietary patterns with blood lipid profiles and obesity in adults with type 2 diabetes. The data were obtained from the Forth Korean National Health and Nutrition Examination Survey, 2007-2008. Adults 30 yr or older, from which had both biochemical and dietary data were obtained. Among them, 680 subjects were defined as having diabetes based on criteria of fasting glucose > or = 126 mg/dL, anti-diabetic treatment, or previously diagnosed diabetes. Dietary data from a 24-hr recall were used to derive dietary patterns by factor analysis. Four dietary patterns by factor analysis were identified: 'Bread & Meat & Alcohol', 'Noodles & Seafood', 'Rice & Vegetables', and 'Korean Healthy' patterns. Serum cholesterol levels in the highest quartile of the 'Bread & Meat & Alcohol' pattern were significantly higher compared with those in the lowest quartile. In addition, total cholesterol and triglyceride levels in the highest quartile of the 'Korean Healthy' pattern were significantly lower after adjusting for potential confounders. Dietary patterns of adults with diabetes were found to be associated with blood lipid profiles. 'Korean Healthy' pattern including whole grains, legumes, vegetables, and fruits could thus improve lipid profiles among those with type 2 diabetes.

The clinical and cost effectiveness of medical nutrition therapy in persons with hypercholesterolemia

Although medical nutrition therapy (MNT) is considered as a cornerstone of medical treatment for hypercholesterolemia, few studies have evaluated medical and economical outcome of MNT. This study was conducted to identify whether MNT administered by registered dieticians could lead to a beneficial clinical and cost outcome in persons with hypercholesterolemia. A prospective clinical trial was carried out at outpatient clinics, which involved an initial visit with a dietitian followed by another visit at first 4 weeks during the 6 weeks study periods. Thirty-nine subjects took part in a 6 weeks nutrition intervention program. Clinical and economical outcomes were compared before and after MNT. Medical nutrition therapy lowered total serum cholesterol level 6.1% (P<0.05), low-density lipoprotein cholesterol (LDL-C) 9.4% (P<0.05) and high-density lipoprotein cholesterol (HDL-C) 3.0% (P<0.05). The cost-effective ratio was 1,520 won/cholesterol mg/dl and 1,441 won/LDL-cholesterol mg/dl, respectively. After dietitian's intervention, lipid drug eligibility was obviated in 16 of 39(41%) subjects. The cost savings from the avoidance of lipid medications was 151,107 won per patient annually. In conclusion, it is suggested that provision of systemic intensive nutritional care for persons with hypercholesterolemia has significant effects on serum cholesterol reduction and clinical cost savings.

A Clinical Study of IgA Nephropathy with Serum Hepatitis B Surface Antigen / 대한신장학회잡지

There are some clinical evidences that hepatitis B virus(HBV) infection may cause IgA nephropathy. To evaluate clinical significances and pathogenetic roles of HBV infection in patients with IgA nephropathy, we studied that varius clinical and lab- oratory findings in 172 patients with IgA nephrop-athy as serum hepatitis B surface antigen (HBsAg) positive (19 cases) and negative group (153 cases). The result was as following: 1) The incidence of positive serum HRsAg was 11.0%(19/172 cases) in patients with IgA nephropathy and it was higher than that of the randomized age-sex matched general population(4.1%) but has no significance statistically. 2) There was no significant differences in incidence of hypertension, serum levels of IgA, C3, SGOT, SGFf between HBsAg postive and negative group. 3) The cases of nephrotic range proteinuria (3.5g/ day) was more prevalent in HBsAg positive group (31.6%) than that in negative group(7.2%). significantly (p<0.05). 4) The cases of impaired renal function (serum creatinine more than 1.4mg/dL) were more frequent in HBsAg positive group (42.19%) than that in neg-ative group (13.1%) significantly(p<0.05).

Aneurysm of Sinus of Valsalva Dissecting into Interventricular Septum: A Possible Cause of Complete Atrioventricular Block

Dissection of the interventricular septum by aneurysm of sinus of Valsalva is a rare lesion and has poor prognosis. However, it can be diagnosed noninvasively with echocardiography and managed well by surgical repair. A 55 year old female was readmitted due to aggravated exertional dyspnea. She was implanted with permanent pace-maker due to complete atrioventricular (AV) block of recent onset at a community hospital. Previous diastolic murmur near aortic area was changed to a new continuous murmur. The diagnosis of an aneurysm of sinus of Valsalva dissected into the interventricular septum was confirmed by routine two-dimensional echocardiography. The neck of the aneurysm was closed primarily with patch and aortic valve replacement was done. The pro-gnosis was good. The finding of AV block of recent onset and obscure origin in a young patient should alert the physician to the possibility of an aneurysm of sinus of Valsalva and warrants systematic echocardiography.

The effects of PDGF and LPS on the viabillty of human periodontal ligament cells / 대한치과교정학회지

Platelet-derived growth factor(PDGF) and lipopolysaccharide(LPS) may be the important regualtors of bone metabolism. Exogenous PDGF is recognized to have a stimulating effect on bone resorption in organ culture, but to stimulate the formation of new bone ultimately. LPS is known to be a stimulating agent on the osteoclastic activity. The purpose of this study was to evaluate the effects and the interaction of PDGF and LPS on periodontal ligament(PDL) cells which have important roles in bone remodeling. Cultured human periodontal ligament cells were treated with various concentration of PDGF and/or LPS. The cellular viability was measured by Microtitration(MTT) assay according to the lapse time of culture. The obtained results were as follows: 1. The viability of PDL cells was not different from the control in O.lng/ml of PDGF, but was significantly increased to be over the level of control in lng/ml of PDGF at the second day of culture, and in lOng/ml of PDGF at the second and the third day of culture. 2. The cellular viability was decreased in O.5microgram/ml or 5microgram/ml of LPS at the third day of culture. 3. Incubation with both 1ng/ml or 10ng/ml of PDGF and 0.5microgram/ml or 5microgram/ml of LPS resulted in the increased cellular viability at the third day, which. was greater than LPS only treated group. It was greater than even the control group in lOng/ml of PDGF. From the above findings, we could summarize that the admixture of PDGF and LPS could not less increase the viability of the human periodontal ligament cells than PDGF only.

Recurrent Cardiac Tamponade Complicated by Coronary Intervention

Coronary perforation is a rare, but potentially catastrophic complication of percutaneous coronary intervention. It rarely results in cardiac tamponade with the use of standard anticoagulant regimens. But spontaneous cardiac tamponade was reported recently during balloon angioplasty under the large dose of heparin infusion, and after stent implantation under powerful antiplatelet therapy including platelet IIb/IIIa receptor inhibitor administration. We report a case of delayed cardiac tamponade complicated by guidewire manipulation under powerful anticoagulant and antiplatelet therapy, which recurred early after the first pericardiocentesis.