- The Effect of Intensive Education on Glycemic Control in Type 2 Diabetic Patients.
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Youn Wook Lee, Won Sun Hwang, Sun Jung Choe, Dong Hun Lee, Doh Hyun Kim, Eun Hee Lee, Eun Gyoung Hong, Hye Lim Noh, Yoon Sok Chung, Kwan Woo Lee, Hyeon Man Kim
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J Korean Endocr Soc. 2003;18(1):63-72. Published online February 1, 2003
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- BACKGROUND
To this date, efforts to develop effective methods for the education of diabetic patients have been limited. The important goal of self-management and weight control for diabetic treatment can not be attained without long and intensive period of education. This study was undertaken to assess the effectiveness of an intensive educational program, of behavior and diet control, which was carried out on subjects with type 2 diabetes, on an out-patient basis. We compared the effectiveness of an intensive education programme with that of a conventional education programme for the self-management of type 2 diabetic patients. METHODS: Subjects with type 2 diabetes were randomly selected, and allocated to one of two groups. One group received a conventional education programme of self-management(the CE group), and the second group received an intensive education programmes for three months, after which the effectiveness of the programmes were evaluated. RESULTS: 1) The levels of fasting blood sugar(FBS), postprandial 2 hour blood sugar(PP2h) and HbA1c were significantly lowered in both groups following the intervention(p<0.05). In the IE group, the FBS declined from 12.4nmol/L to 7.7nmol/L, PP2h declined from 20.3nmol/L to 10.9nmol/L, and the HbA1c showed a similar decline from 9.4 to 7.0% after intervention(p<0.05). In the CE group, the FBS declined from 10.9 to 9.4nmol/l, the PP2h decreased from 17.1 to 14.6 nmol/l, and the HbA1c also decreased from 8.5 to 7.3% after intervention(p<0.05). The decrease in the FBS and HbA1c following the educational intervention was more pronounced in the IE group than the CE group (p<0.05). 2) The effectiveness of the education programmes in promoting appropriate dietary behavior in the diabetic subjects was assessed by a scoring system in three parts: a regularity score, a balance score and an attitude score. From a comparative study of the three scores, the patients attitudes were observed to be much improved in both the groups following the intervention compared to before the programmes, but the balance and total scores were significantly higher in the IE group than the CE group(p<0.05). CONCLUSION: We can conclude that the intensive diabetic education programme is more effective than a conventional programme, not only in improving the patients' levels of glucose, HbAlc, and dietary score, but also the diabetic patients self-control abilities, promoting behavioral change, and prompting problem solving capabilities in respect to the everyday problems that they have to face throughout their lives.
- Adequate Duration of Medical Therapy for Koreans with Graves' Disease.
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Hyoung Suk Lee, Dong Hun Lee, Hee Sun Chung, Jong Woo Lee, Jung Eun Kim, Seung Soo Shin, Yoon Sok Chung, Kwan Woo Lee, Hyeon Man Kim
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J Korean Endocr Soc. 2003;18(1):24-31. Published online February 1, 2003
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- BACKGROUND
Graves' disease is an organ specific autoimmune disease. Three kinds of therapeutic modalities(antithyroid drugs, ablation with radioactive iodine and subtotal thyroidectomy) are frequently performed for the management of this disease. The most popular therapeutic policy for the disease in Korea is antithyroid treatment. We analysed and compared the remission rates of all three modalities for Graves' disease, and evaluated the antithyroid modality to determine the correct duration of treatment. SUBJECTS AND METHODS: The medical records of 205 patients with Graves' disease were reviewed. For the evaluation of the antithyroid modality medical treatment, antithyroid drugs were administered for more than 1 year. The prognostic factors associated with remission were analysed by means of an ROC curve. RESULTS: 1) Of the 205 patients, proportions that received medical therapy, subtotal thyroidectomy and radioiodine therapy were 83.0, 14.1 and 2.9%, respectively. 2) The remission rates of the medical therapy, surgery and radioiodine therapy were 60.0, 96.5 and 83.0%, respectively. 3) The remission rate of the medical therapy was associated with the duration of medication and TBII activity. The determined proper duration for the antithyroid treatment was 26 months from the ROC curve analysis. CONCLUSION: The above results suggest that the proper duration of antithyroid treatment for Graves' disease is 26 months, after which time the subtotal thyroidectomy or radioiodine therapy should be considered if the disease has not remitted.
- Impaired Metabolic Signal Transduction Networks in Isolated Skeletal Muscle in Korean type 2 Diabetic Patients.
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Joon Hyuck Choi, Kwan Woo Lee, Hyo Jeong Kim, Dong Hun Lee, Jong Woo Lee, Jung Eun Kim, Hyun Chae Yim, Kyung Mi Kim, Sung Yi Choi, Yoon Sok Chung, Hyeon Man Kim
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J Korean Endocr Soc. 2002;17(5):685-697. Published online October 1, 2002
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- BACKGROUND
The glucose uptake rate is the limiting step in glucose utilization and storage. The failure of insulin to stimulate glucose uptake in muscle appears to be a primary defect of insulin resistance. This study was undertaken to examine the effect of physiological hyperinsulinemia on the phosphorylation of the insulin receptor (IR-beta), insulin receptor substrate (IRS), Akt kinase and GSK-3 in isolated skeletal muscle, in people with type 2 diabetes (n=9) and control subjects (n=11). METHODS: 75g OGTT and euglycemic hyperinsulinemic clamp test were done. And vastus lateralis muscle was obtained before and 30 min into the euglycemic clamp. Western blots were performed for tyrosine phosphorylation of insulin receptor substrate (IRS) and phosphorylation of the insulin receptor(IR-beta), Akt and GSK-3. RESULT: There were no statistical differences in the mean age, BMI and body fat between the control subjects and diabetic patients. The fasting blood sugar and HbA1c in controls and diabetic patients were 98.+/-1.3 and 208.1+/-16.5 ng/dl, and 5.4+/-0.5 and 9.2+/-0.6%, and 1.4+/-0.2 in the control subjects, and 72.2+/-52.3% (p<0.01) and 10.2+/-6.3 (p<0.01) in the diabetic patients, respectively. The insulin resistance from the euglycemic hyperinsulinemic clamp tests were 8.2+/-0.6 mg/kg/min and 3.7+/-1.1 ng/kg/min in the control subjects and in the diabetic patients, respectively (p<0.01). Compared with the normal controls, insulin-stimulated IR phosphorylation was no different to that in the diabetic patients. However, insulin-stimulated IRS phosphorylation, insulin-stimulated Akt phosphorylation and insulin-stimulated GSK-3 phosphorylation were reduced in the diabetic patients compared with the normal controls by 24, 43 and 25%, respectively (p<0.05). CONCLUSION: In korean type 2 diabetic patients, the insulin resistance may be due to the impairment of the upstream insulin signal molecular network. Further studies will focus on determining whether these signaling defects are the cause of the development of insulin resistance, or secondary to the altered metabolic state, associated with type 2 diabetes mellitus
- A Case with Thyroid Tuberculosis Diagnosed by Non-operative Method.
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Dong Hun Lee, Hee Sun Chung, Hyoung Suk Lee, Mee Jung Kim, Jung Eun Kim, Yoon Sok Chung, Kwan Woo Lee, Hyeon Man Kim
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J Korean Endocr Soc. 2002;17(4):572-575. Published online August 1, 2002
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- Tuberculosis of the thyroid gland is extremely rare, with a few surgically removed cases having been reported. The differential diagnosis, from malignancies and other non tuberculous granulomatous lesions, is impossible clinical grounds. We experienced a case of tuberculosis of the thyroid gland with palpable thyroid nodules, in a 23 year-old female patient. She was clinical and biochemically euthyroid. US and CT scans demonstrated a low density mass in the left low lobe of the thyroid gland. An FNAB showed caseous necrosis, and AFB stains demonstrated tuberculosis bacilli. We report a case of tuberculosis of the thyroid gland, diagnosed by a non-operative method.
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