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1.
Article in English | WPRIM | ID: wpr-924965

ABSTRACT

Evidence for involvement of the central nervous system (CNS) in the regulation of glucose metabolism dates back to the 19th century, although the majority of the research on glucose metabolism has focused on the peripheral metabolic organs. Due to recent advances in neuroscience, it has now become clear that the CNS is indeed vital for maintaining glucose homeostasis. To achieve normoglycemia, specific populations of neurons and glia in the hypothalamus sense changes in the blood concentrations of glucose and of glucoregulatory hormones such as insulin, leptin, glucagon-like peptide 1, and glucagon. This information is integrated and transmitted to other areas of the brain where it eventually modulates various processes in glucose metabolism (i.e., hepatic glucose production, glucose uptake in the brown adipose tissue and skeletal muscle, pancreatic insulin and glucagon secretion, renal glucose reabsorption, etc.). Errors in these processes lead to hyper- or hypoglycemia. We here review the current understanding of the brain regulation of glucose metabolism.

2.
Article in English | WPRIM | ID: wpr-924923

ABSTRACT

Carbohydrate-restricted diets and intermittent fasting (IF) have been rapidly gaining interest among the general population and patients with cardiometabolic disease, such as overweight or obesity, diabetes, and hypertension. However, there are limited expert recommendations for these dietary regimens. This study aimed to evaluate the level of scientific evidence on the benefits and harms of carbohydrate-restricted diets and IF to make responsible recommendations. A meta-analysis and systematic literature review of 66 articles on 50 randomized controlled trials (RCTs) of carbohydrate-restricted diets and 10 articles on eight RCTs of IF was performed. Based on the analysis, the following recommendations are suggested. In adults with overweight or obesity, a moderately-low carbohydrate or low carbohydrate diet (mLCD) can be considered as a dietary regimen for weight reduction. In adults with type 2 diabetes mellitus, mLCD can be considered as a dietary regimen for improving glycemic control and reducing body weight. In contrast, a very-low carbohydrate diet (VLCD) and IF are recommended against in patients with diabetes. Furthermore, no recommendations are suggested for VLCD and IF in adults with overweight or obesity, and carbohydrate-restricted diets and IF in patients with hypertension. Here, we describe the results of our analysis and the evidence for these recommendations.

3.
Article in English | WPRIM | ID: wpr-924922

ABSTRACT

The Joint Committee of the Korean Diabetes Association, the Korean Society for the Study of Obesity, and the Korean Society of Hypertension announced a consensus statement on carbohydrate-restricted diets and intermittent fasting, representing an emerging and popular dietary pattern. In this statement, we recommend moderately-low-carbohydrate or low-carbohydrate diets, not a very-low-carbohydrate diet, for patients with type 2 diabetes mellitus. These diets can be considered a dietary regimen to improve glycemic control and reduce body weight in adults with type 2 diabetes mellitus. This review provides the detailed results of a meta-analysis and systematic literature review on the potential harms and benefits of carbohydrate-restricted diets in patients with diabetes. We expect that this review will help experts and patients by fostering an in-depth understanding and appropriate application of carbohydrate-restricted diets in the comprehensive management of diabetes.

4.
Article in English | WPRIM | ID: wpr-924918

ABSTRACT

Background@#This study aimed to investigate the prevalence and management of diabetes mellitus, risk-factor control, and comorbidities among Korean adults. @*Methods@#We conducted a cross-sectional analysis of data from the Korea National Health and Nutrition Examination Survey to assess the prevalence, treatment, risk factors, comorbidities, and self-management behaviors of diabetes mellitus from 2019 to 2020. We also analyzed data from the Korean National Health Insurance Service to evaluate the use of antidiabetic medications in people with diabetes mellitus from 2002 through 2018. @*Results@#Among Korean adults aged 30 years or older, the estimated prevalence of diabetes mellitus was 16.7% in 2020. From 2019 through 2020, 65.8% of adults with diabetes mellitus were aware of the disease and treated with antidiabetic medications. The percentage of adults with diabetes mellitus who achieved glycosylated hemoglobin (HbA1c) <6.5% was 24.5% despite the increased use of new antidiabetic medications. We found that adults with diabetes mellitus who achieved all three goals of HbA1c <6.5%, blood pressure (BP) <140/85 mm Hg, and low-density lipoprotein cholesterol <100 mg/dL were 9.7%. The percentage of self-management behaviors was lower in men than women. Excess energy intake was observed in 16.7% of adults with diabetes mellitus. @*Conclusion@#The prevalence of diabetes mellitus among Korean adults remained high. Only 9.7% of adults with diabetes mellitus achieved all glycemic, BP, and lipid controls from 2019 to 2020. Continuous evaluation of national diabetes statistics and a national effort to increase awareness of diabetes mellitus and improve comprehensive diabetes care are needed.

5.
Article in English | WPRIM | ID: wpr-890348

ABSTRACT

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.

6.
Article in English | WPRIM | ID: wpr-898052

ABSTRACT

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.

7.
Article in Korean | WPRIM | ID: wpr-903516

ABSTRACT

Background@#Medical nutrition therapy is a fundamental part of diabetes management; however, it is very difficult for patients to maintain the recommended diet programs. We investigated whether providing home-delivered therapeutic meals designed by registered dietitians could be useful in lowering blood glucose levels in patients with type 2 diabetes. @*Methods@#During a 12-day study period, we monitored the blood glucose levels of 19 patients with type 2 diabetes by continuous glucose monitoring. For the first six days, the participants maintained their usual lifestyles and were allowed to eat freely (free meal period). During the last six days, two out of the three main meals per day were replaced with home-delivered therapeutic meals designed for diabetes management (therapeutic meal period), during which snacks and exercise were freely allowed. Blood glucose levels and estimated glycated hemoglobin (eHbA1c) were compared between the two periods. @*Results@#Between the free meal period and the therapeutic meal period, mean blood glucose level and eHbA1c dropped by 11.9 mg/dL (P < 0.001) and 0.4% (P = 0.002), respectively. These results were mainly due to the decrease in postprandial glucose levels rather than preprandial glucose levels. @*Conclusion@#Providing home-delivered therapeutic meals designed for diabetes management was effective in lowering the blood glucose levels in patients with type 2 diabetes.

8.
Article in Korean | WPRIM | ID: wpr-895812

ABSTRACT

Background@#Medical nutrition therapy is a fundamental part of diabetes management; however, it is very difficult for patients to maintain the recommended diet programs. We investigated whether providing home-delivered therapeutic meals designed by registered dietitians could be useful in lowering blood glucose levels in patients with type 2 diabetes. @*Methods@#During a 12-day study period, we monitored the blood glucose levels of 19 patients with type 2 diabetes by continuous glucose monitoring. For the first six days, the participants maintained their usual lifestyles and were allowed to eat freely (free meal period). During the last six days, two out of the three main meals per day were replaced with home-delivered therapeutic meals designed for diabetes management (therapeutic meal period), during which snacks and exercise were freely allowed. Blood glucose levels and estimated glycated hemoglobin (eHbA1c) were compared between the two periods. @*Results@#Between the free meal period and the therapeutic meal period, mean blood glucose level and eHbA1c dropped by 11.9 mg/dL (P < 0.001) and 0.4% (P = 0.002), respectively. These results were mainly due to the decrease in postprandial glucose levels rather than preprandial glucose levels. @*Conclusion@#Providing home-delivered therapeutic meals designed for diabetes management was effective in lowering the blood glucose levels in patients with type 2 diabetes.

9.
Article in English | WPRIM | ID: wpr-714107

ABSTRACT

Obesity has become a common healthcare problem worldwide. Cilia are tiny hair-like organelles on the cell surface that are generated and anchored by the basal body. Non-motile primary cilia have been considered to be evolutionary rudiments until a few decades, but they are now considered as important signaling organelles because many receptors, channels, and signaling molecules are highly expressed in primary cilia. A potential role of primary cilia in metabolic regulation and body weight maintenance has been suspected based on rare genetic disorders termed as ciliopathy, such as Bardet-Biedl syndrome and Alström syndrome, which manifest as obesity. Recent studies have demonstrated involvement of cilia-related cellular signaling pathways in transducing metabolic information in hypothalamic neurons and in determining cellular fate during adipose tissue development. In this review, we summarize the current knowledge about cilia and cilia-associated signaling pathways in the regulation of body metabolism.


Subject(s)
Adipose Tissue , Alstrom Syndrome , Bardet-Biedl Syndrome , Basal Bodies , Body Weight Maintenance , Cilia , Delivery of Health Care , Energy Metabolism , Hedgehogs , Metabolism , Neurons , Obesity , Organelles , Wnt Signaling Pathway
10.
Article in English | WPRIM | ID: wpr-715512

ABSTRACT

BACKGROUND: Blood levels of many hormones show rhythmic fluctuations with variable duration of cycles. Clusterin/apolipoprotein J is a glycoprotein which is highly expressed in the plasma and has modulatory roles in immune and inflammatory reactions, neurobiology, lipid metabolism, and leptin signaling. In this study, we examined the diurnal fluctuations of plasma clusterin concentrations in lean and obese young men. METHODS: For the study, 14 subjects (five lean and five obese men; two lean and two obese women) were admitted to the research ward and blood samples were drawn every 30 minutes during light-on period (6:00 AM to 10:00 PM) and every hour during light-off period. RESULTS: Notably, plasma clusterin concentrations displayed a unique ultradian rhythm with five cycles a day in both men and women. During the light-on period, circulating clusterin levels showed fluctuating curves with 4 hours regular intervals with sharp peaks and troughs. In contrast, single oscillation curve during light-off exhibited a smoothened/lower peak and longer (8-hour) duration. In obese men, these cycles were phase-advanced by approximately 1 hour, and had reduced amplitude of fluctuating curves and blunted diurnal pattern. Cyclic fluctuations of plasma clusterin were preserved under fasting and unexpected meal condition, suggesting that rhythmic oscillations in plasma clusterin levels are not generated by meal-related cues. CONCLUSION: These findings firstly demonstrate a novel pattern of plasma clusterin fluctuations with extremely regular cycles.


Subject(s)
Circadian Rhythm , Clusterin , Cues , Fasting , Female , Glycoproteins , Humans , Leptin , Lipid Metabolism , Male , Meals , Neurobiology , Obesity , Plasma
11.
Article in English | WPRIM | ID: wpr-150110

ABSTRACT

Acromegaly is a slowly progressing condition resulting from excess growth hormone (GH), generally caused by a GH-secreting pituitary adenoma. Cancer is the third most common cause of mortality in patients with acromegaly, and insulin-like growth factor 1 (IGF-1) is known to influence tumor formation by increasing cell proliferation and inhibiting apoptosis. Multiple myeloma (MM) is a plasma cell neoplasm, and previous studies have suggested the possible role of IGF-1 in its development of MM. However, no cases of acromegaly accompanied with MM have been reported in Asia to date. We here report the case of a 58-year-old woman with acromegaly accompanied with MM who presented with longstanding acromegalic manifestations resulting from a GH-secreting pituitary adenoma and also exhibited anemia, a reversed albumin/globulin ratio, and plasmacytosis on bone marrow examination. Because IGF-1 has been suggested to play an important role in the development and progression of MM, the patient promptly underwent surgical removal of the pituitary adenoma via a transsphenoidal approach. Since there is currently no consensus on therapeutic guidelines and suggested prognosis for MM with acromegaly, long-term follow-up of such cases is needed.


Subject(s)
Acromegaly , Anemia , Apoptosis , Asia , Bone Marrow Examination , Cell Proliferation , Consensus , Female , Growth Hormone , Growth Hormone-Secreting Pituitary Adenoma , Humans , Insulin-Like Growth Factor I , Middle Aged , Mortality , Multiple Myeloma , Neoplasms, Plasma Cell , Pituitary Neoplasms , Prognosis
12.
Article in English | WPRIM | ID: wpr-172594

ABSTRACT

Rheumatoid arthritis (RA) is a systemic autoimmune disorder which can affect all of the synovial joints including the cervical spine. Cervical involvement typically begins early in the disease process and shows relatively slow progression. Fractures of the odontoid process are mainly noted after a major trauma to the cervical spine. A case of a 77-year-old woman with paresthesia of the extremities caused by spontaneous atraumatic fracture of the odontoid process, which was revealed as a manifestation of RA, is presented in this report.


Subject(s)
Aged , Arthritis, Rheumatoid , Extremities , Female , Fractures, Spontaneous , Humans , Joints , Odontoid Process , Paresthesia , Spine
13.
Korean Journal of Medicine ; : 496-500, 2014.
Article in Korean | WPRIM | ID: wpr-176486

ABSTRACT

In randomized phase 3 clinical trials azacitidine has been shown to prolong survival in patients with higher-risk myelodysplastic syndrome (MDS). Therefore, azacitidine therapy should be considered for treating MDS patients with higher-risk disease. A 78-year-old male was administered the first cycle of azacitidine treatment for higher-risk MDS. On day three of chemotherapy he complained of fever and dyspnea, and radiographic findings revealed bilateral perihilar-peribronchial infiltration and a small amount of pleural effusion. Considering the possibility of pneumonia, intravenous broad-spectrum antibiotics were administered and azacitidine therapy was discontinued. Upon improvement of the patient's subjective symptoms and radiographic abnormalities, azacitidine therapy was resumed. However, fever and dyspnea developed again upon recommencement of azacitidine therapy. A diagnosis was made of azacitidine-induced lung injury and corticosteroid treatment was administered. Although lung injury is a rare complication induced by azacitidine, physicians should be aware of this life-threatening side effect.


Subject(s)
Aged , Anti-Bacterial Agents , Azacitidine , Diagnosis , Drug Therapy , Dyspnea , Fever , Humans , Lung Injury , Male , Myelodysplastic Syndromes , Pleural Effusion , Pneumonia
14.
Article in English | WPRIM | ID: wpr-59649

ABSTRACT

Mucormycosis is a rare fungal disease that holds a fatal opportunistic fungal infection in diabetes mellitus, hematological malignancy, and immunocompromised host. Isolated pulmonary mucormycosis is extremely rare. Optimal therapy is a combined medical-surgical approach and a management of the patient's underlying disease. Herein, we report a case-study of isolated pulmonary mucormycosis which was being presented as multiple lung nodules in a patient with no underlying risk factors. Considering that the patient had poor pulmonary functions, we treated him with only antifungal agent rather than a combined medical-surgical approach. After treatment with antifungal agent for six months, the nodules of pulmonary mucormycosis were improved with the prominent reductions of size on the computed tomography.


Subject(s)
Diabetes Mellitus , Hematologic Neoplasms , Humans , Immunocompetence , Immunocompromised Host , Lung , Mucormycosis , Risk Factors , Triazoles
16.
Korean Journal of Urology ; : 675-678, 1983.
Article in Korean | WPRIM | ID: wpr-203580

ABSTRACT

Authors experienced two cases of torsion of spermatic cord recently and reviewed the literatures. The patients were 12 and 20 years old with chief complaints of sudden onset on left scrotal swelling and testicular pain. Physical examination was not significant except positive Prehn's sign on the involving side of testicle. Under the diagnosis. of torsion of spermatic cord. One was performed of left orchiectomy and the opposite side orchiopexy. The other man was performed of both orchiopexy. We reported 2 cases with review of the literature.


Subject(s)
Diagnosis , Humans , Orchiectomy , Orchiopexy , Physical Examination , Spermatic Cord , Testis , Young Adult
17.
Korean Journal of Urology ; : 123-125, 1982.
Article in Korean | WPRIM | ID: wpr-168657

ABSTRACT

Primary tumors of the ureter are usually malignant and rare, a few are benign. Benign tumors arising from mesoderm are especially rare. But, recently the incidence rate was progressively increased due to developed methods of diagnostic procedures. We herein report a case of ureteral polyp in the left ureteropelvic junction with a brief review of literatures.


Subject(s)
Incidence , Mesoderm , Polyps , Ureter
18.
Korean Journal of Urology ; : 869-872, 1982.
Article in Korean | WPRIM | ID: wpr-168636

ABSTRACT

We presented one case of 13 years old girl with a single, unilateral ectopic ureter draining to the vaginal vestibule. She had complained of the urine leakage since her infancy without other urinary symptoms which she was treated with right ureteroneocystostomy. We reported the case with literature review.


Subject(s)
Adolescent , Female , Humans , Ureter , Urinary Bladder
19.
Korean Journal of Urology ; : 327-331, 1981.
Article in Korean | WPRIM | ID: wpr-120681

ABSTRACT

A statistical observation was made on 325 in-patients with age distribution, disease entities and operative procedures in the Department of Urology, Seoul Red Cross Hospital, during the period from January 1st 1977 to December 31st 1979.


Subject(s)
Age Distribution , Red Cross , Seoul , Surgical Procedures, Operative , Urology
20.
Korean Journal of Urology ; : 368-372, 1980.
Article in Korean | WPRIM | ID: wpr-197079

ABSTRACT

Tumor of the ureter is malignant and rare, but recently the incidence rate was progressively increased due to developed methods of diagnostic procedures. Here, we report two cases of ureteral cancer combined with urinary stones in the department of urology, Seoul Red Cross Hospital, with some literatures.


Subject(s)
Incidence , Red Cross , Seoul , Ureter , Ureteral Neoplasms , Urinary Calculi , Urology
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