• Diabetes and Metabolism Journal
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• 제42권6호
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• pp.496-512
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• 2018

Background: This study aimed to investigate the association between the presence and severity of cardiovascular autonomic neuropathy (CAN) and development of long-term glucose fluctuation in subjects with type 2 diabetes mellitus. Methods: In this retrospective cohort study, subjects with type 2 diabetes mellitus who received cardiovascular autonomic reflex tests (CARTs) at baseline and at least 4-year of follow-up with ${\geq}6$ measures of glycosylated hemoglobin (HbA1c) were included. The severity of CAN was categorized as normal, early, or severe CAN according to the CARTs score. HbA1c variability was measured as the standard deviation (SD), coefficient of variation, and adjusted SD of serial HbA1c measurements. Results: A total of 681 subjects were analyzed (294 normal, 318 early, and 69 severe CAN). The HbA1c variability index values showed a positive relationship with the severity of CAN. Multivariable logistic regression analysis showed that CAN was significantly associated with the risk of developing higher HbA1c variability (SD) after adjusting for age, sex, body mass index, diabetes duration, mean HbA1c, heart rate, glomerular filtration rate, diabetic retinopathy, coronary artery disease, insulin use, and anti-hypertensive medication (early CAN: odds ratio [OR], 1.65; 95% confidence interval [CI], 1.12 to 2.43) (severe CAN: OR, 2.86; 95% CI, 1.47 to 5.56). This association was more prominent in subjects who had a longer duration of diabetes (>10 years) and lower mean HbA1c (<7%). Conclusion: CAN is an independent risk factor for future higher HbA1c variability in subjects with type 2 diabetes mellitus. Tailored therapy for stabilizing glucose fluctuation should be emphasized in subjects with CAN.

• The Journal of Korean Physical Therapy
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• 제24권5호
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• pp.362-369
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• 2012

Purpose: This study examined the effects of an elastic band resistance exercise program on the body functions and Glycosylated hemoglobin (HbA1c) of elderly people with type 2 diabetes. Methods: Twenty-seven elderly patients with type 2 diabetes were enrolled in this study (exercise group 14, control group 13). The subjects in the exercise group participated in the program for 60 minutes a day, three times a week, for 12 weeks. All the subject's body functions, HbA1c were measured to compare the following: before the intervention, at the completion of the 12 weeks intervention, and eight weeks after the intervention. Results: Compared to the control group, the exercise group showed significant improvements in the 12 week and follow-up measurement after the intervention in body function, such as the strength of the upper and lower limbs, agility and limit of stability. The body functions of the exercise group improved as the period of intervention progressed. On the other hand, the HbA1c level at each follow-up measurement was similar in the two groups. Conclusion: The 12 week elastic band exercise program is recommended as an effective intervention for improving the body functions of elderly people with type 2 diabetes. Nevertheless, a combined intervention of steady exercise, diet therapy and drug therapy will be needed for further active prevention and management of type 2 diabetes.

• Advances in Traditional Medicine
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• 제8권2호
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• pp.146-153
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• 2008

The present study is aimed at finding the influence of silymarin (a flavonoid) (25 mg/kg & 50 mg/kg) in streptozotocin (STZ)-induced diabetic rats. Type 2 diabetes was induced by single intraperitoneal injection of STZ (100 mg/kg) to 3 days old rat pups. Silymarin was administered for 15 days after the animals were confirmed diabetic (75 days after STZ injection). Blood glucose, glycosylated hemoglobin ($HbA_{1c}$), lipid peroxides (LPO) levels and reduced glutathione (GSH) contents in pancreas and liver were estimated following the established procedures. Biochemical observations were further substantiated with histological examination of pancreas. Blood glucose and $HbA_{1c}$ levels, which were elevated by STZ, were lowered to physiological levels by the administration of silymarin. The levels of LPO were significantly increased in STZ-induced diabetic rats. Silymarin reduced the LPO levels in both pancreas and liver. GSH contents which were reduced significantly in pancreas and liver of STZ-induced diabetic rats were brought back to near normal levels by silymarin treatment. Multifocal necrotic and degenerative changes of pancreas in STZ-diabetic rats were minimized to near normal morphology by administration of silymarin as evident by histopathological examination. Silymarin showed a dose dependent protective effect on STZ-induced $\beta$-cell damage. It could be attributed to the antioxidative and free radicals scavenging properties of the flavonoid. Thus, it may be considered as a natural antioxidant with potential therapeutic application in the treatment of type 2 diabetes.

• Annals of Clinical Neurophysiology
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• 제21권1호
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• pp.36-43
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• 2019

Background: Diabetic peripheral polyneuropathy (DPN) is associated with a variety of symptoms. Nerve conduction studies (NCSs) are considered to be the gold standard of nerve damage assessments, but these studies are often dissociated from the subjective symptoms observed in DPN patients. Thus, the aim of the present study was to investigate the correlations between NCS parameters and neuropathic symptoms quantified using the Michigan Neuropathy Screening Instrument (MNSI). Methods: Patients with type 2 diabetes mellitus (T2DM) with or without symptoms of neuropathy were retrospectively enrolled. Demographic data, clinical laboratory data, MNSI score, and NCS results were collected for analysis; DPN was diagnosed based on the MNSI score (${\geq}3.0$) and abnormal NCS results. Pearson's correlation coefficients were used to evaluate the relationships between MNSI score and NCS variables. Results: The final analyses included 198 patients (115 men and 83 women) with a mean age of $62.6{\pm}12.7$ years and a mean duration of diabetes of $12.7{\pm}8.4$ years. The mean MNSI score was 2.8 (range, 0.0-9.0), and 69 patients (34.8%) were diagnosed with DPN. The MNSI score was positively correlated with the median motor nerve latency and negatively correlated with the median motor, ulnar sensory, peroneal, tibial, and sural nerve conduction velocities (NCVs). When the patients were categorized into quartiles according to MNSI score, peroneal nerve conduction velocity was significantly lower in the second MNSI quartile than in the first MNSI quartile (p = 0.001). A multivariate analysis revealed that the peroneal NCV was independently associated with MNSI score after adjusting for age, sex, and glycosylated hemoglobin A1c (HbA1c) levels. Conclusions: The present results indicate that a decrease in peroneal NCV was responsible for early sensory deficits in T2DM patients.

• 임상간호연구
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• 제28권3호
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• pp.277-288
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• 2022

Purpose: This study was conducted to evaluate the effects of the insulin therapy adherence program (INSTA GRAM) for patients with type 2 diabetes mellitus. Methods: This study examined a total of 63 patients with type 2 diabetes for whom the initiation of insulin therapy is being considered or within 6 months of undergoing insulin therapy. INSTAGRAM is a stage-specific intervention consisting of strategies for motivating patients to initiate and maintain insulin therapy using the transtheoretical model on the stages of change, the process of change, and self-efficacy. The participants were randomly assigned to either the INSTAGRAM group (experimental group, n=32) or the standard diabetes education group (control group, n=31). The INSTAGRAM group received 6 sessions over 8 weeks(face-to-face education was conducted in the first and last sessions, and telephone coaching was conducted from the second to fifth sessions). The outcomes were measured by psychological insulin resistance, self-efficacy, and glycosylated hemoglobin (HbA1c). Results: Psychological insulin resistance (p<.001), self-efficacy (p<.001), and HbA1c (p=.024) of the participants in the INSTAGRAM group significantly improved compared to those in the control group. Conclusion: INSTAGRAM is effective in overcoming psychological insulin resistance and improving self-efficacy and HbA1c. Therefore, the INSTAGRAM can be recommended as a nursing intervention for type 2 diabetic patients who delay the initiation of insulin therapy.

• 기본간호학회지
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• 제21권3호
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• pp.243-252
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• 2014

Purpose: The purpose of this study was to investigate diabetic knowledge, self-care behaviors, and HbA1c of patients with diabetic mellitus in public hospitals. Methods: Participants were 287 adult patients who had been diagnosed with diabetes in two public hospitals in Seoul. Collected data were analyzed using t-test, ANOVA, Pearson's correlation with the SPSS (PASW) 21.0 program. Results: For general characteristics of the participants, there were significant differences in the level of diabetic knowledge according to age (F=11.28, p<.001), educational level (F=11.07, p<.001), type of health insurance (F=9.38, p<.001), and monthly income (t=-4.58, p<.001) and in the self-care behaviors according to age (F=8.61, p<.001) and in HbA1c according to age (F=6.72, p=.001). As for disease related characteristics of the participants, significant differences were found for self-care behaviors according to education about diabetes (t=3.90, p<.001) and in HbA1c according to education about diabetes (t=3.26, p=.001) and current diabetic therapy methods (F=13.51, p<.001). The study results showed that there was no correlation between diabetic knowledge and self-care behavior, or between self-care behavior and HbA1c. Conclusion: Results indicate that when developing preliminary data on nursing intervention education programs on diabetes, increasing diabetic knowledge and self-care behaviors would help to improve blood glucose levels.

• Diabetes and Metabolism Journal
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• 제42권6호
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• pp.480-487
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• 2018

Background: This study aimed to evaluate the relationship between the frequency of self-monitoring of blood glucose (SMBG) and glycosylated hemoglobin (HbA1c) levels among Korean adolescents with type 1 diabetes mellitus (T1DM). Factors affecting the SMBG frequency were analyzed in order to improve their glycemic control. Methods: Sixty-one adolescents aged 13 to 18 years with T1DM were included from one tertiary center. Clinical and biochemical variables were recorded. Factors associated with SMBG frequency were assessed using structured self-reported questionnaires. Results: Average total daily SMBG frequency was $3.8{\pm}2.1$ and frequency during the school day was $1.3{\pm}1.2$. The mean HbA1c level was $8.6%{\pm}1.4%$. As the daily SMBG frequency increased, HbA1c levels declined (P=0.001). The adjusted odds of achieving the target HbA1c in participants who performed daily SMBG ${\geq}5$ significantly increased 9.87 folds (95% confidence interval [CI], 1.58 to 61.70) compared with those performed SMBG four times a day. In the subjects whose SMBG frequency <1/day during the school day, an 80% reduction in the adjusted odds ratio 0.2 (95% CI, 0.05 to 0.86) showed compared to the group with performing two SMBG measurements in the school setting. The number of SMBG testing performed at school was significantly high for individuals assisted by their friends (P=0.031) and for those who did SMBG in the classrooms (P=0.039). Conclusion: Higher SMBG frequency was significantly associated with lower HbA1c in Korean adolescents with T1DM. It would be necessary to establish the school environments that can facilitate adequate glycemic control, including frequent SMBG.

• 대한정형도수물리치료학회지
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• 제29권3호
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• pp.63-72
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• 2023

Background: This study investigated the effects of face-to-face and non-face-to-face McKenzie exercises and elastic band strengthening exercises on falls and fitness in older adults. Methods: A total of 44 subjects were divided into a face-to-face group (FG; n=22) and a non-face-to-face group (NFG; n=22) who met older adults. Both groups used McKenzie exercises and strength training with elastic bands The fall efficacy scale (K-FES) and glycosylated hemoglobin (HbA1c) Pro were used to compare the senior fitness test (SFT). Results: No significant differences were detected between the two groups before the intervention; however, a significant difference was noted in the K-FES scores after the intervention. The change in HbA1c after the intervention was not statistically significant in the FG or the NFG, and no significant difference was detected between the two groups. The change in lower limb muscle strength in the elderly physical fitness test showed no significant difference between the two groups before or after the intervention. The change in upper limb flexibility after the intervention was not significantly different in the FG or NFG, indicating no significant difference between the two groups. The change in the 3-meter round-trip test after the intervention was significantly different in both the FG and NFG groups, but the difference between the groups was not statistically significant. The change in the grip strength test of the dominant hand showed no significant difference after the intervention in the FG or the NFG, and the difference between the FG and NFG groups was not statistically significant. The dominant foot external standing after the intervention was significantly improved in the FG, but no significant difference was detected in the NFG, and the difference between the two groups was not statistically significant. Conclusion: The study findings revealed that FG and NFG McKenzie exercises and elastic band strengthen exercises were equally effective at preventing falls and improving fitness in older adults.

• Journal of Acupuncture Research
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• 제38권3호
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• pp.192-199
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• 2021

Background: In this retrospective study, we aimed to determine which diagnostic tests were associated with an improvement in Bell's palsy symptoms. Methods: There were 30 patients who visited Kyung Hee University Korean Medicine Hospital from April 1, 2017 to February 29, 2020, and who received East-West collaboration treatment for Bell's palsy. The tests included electroneurography (ENoG), electromyography (EMG), hematology, and heart rate variability (HRV) results which were used to determine if any test correlated with improvement of Bell's palsy symptoms. Results: The initial severity of symptoms did not correlate with the tests performed, with the exception of mean corpuscular hemoglobin concentration (p = 0.013). For both ENoG for oculi degeneration and mean EMG tests, the rate of nerve degeneration showed a significant negative correlation with the improvement of Bell's palsy symptoms. Amongst the HRV test indicators, the square root of the mean of the sum of the squares of differences between the adjacent normal R-R wave interval, the standard deviation of intervals, total power, very low frequency, and high frequency of the wave was negatively correlated with improvement of Bell's palsy symptoms. Similarly, glycosylated hemoglobin Type A1c (HbA1c) and erythrocyte sedimentation rate (ESR) showed a negative correlation with improvement of symptoms of Bell's palsy. With the exception of HbA1c and ESR, the remaining hematology test results showed no significant difference when comparing before and after treatment. Conclusion: ENoG, EMG, HRV test, HbA1c, and ESR negatively correlated with improvements in Bell's palsy symptoms and may determine the prognosis of Bell's palsy.

• Journal of Nutrition and Health
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• 제39권7호
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• pp.641-648
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• 2006

This study was designed to evaluate the effect of the individual nutrition education for type 2 diabetes who participate the diabetes buffet. The subjects were 66 patients and divided into education (n=34) and control groups (n=32). The mean age of education and control groups were 59.8 and 56.6 years old, respectively. There were no differences in age and body mass index (BMI) between two groups. Initial glycosylated hemoglobin (HbA1c), post prandial plasma glucose (PP2), total plasma cholesterol, and blood pressure were not different between two groups. But fasting blood sugar (FBS) was higher in education group than in control group. On completion of the study, the education group showed significant decreases in body weight, BMI, FBS and PP2, however, the control group showed no changes in body weight, BMI and PP2, and showed a significant increase in FBS. Initial calorie and protein intakes of the education group did not meet the prescribed amount, however, mineral and vitamin intakes were higher than estimated average requirement (EAR). By the end of study, calorie and protein intakes were significantly increased to meet the prescription. In order to evaluate the effect of diet education, awareness of calorie requirement was used as an index of understanding diet prescription. The degree of awareness of calorie requirement was dependent on age: younger patients showed higher awareness than older subjects. The subject who showed better understanding of diet prescription showed lower levels of HbA1c, FBS, and PP2 at the end of the experiment period. The results of this study clearly show that individual diabetes diet education is effective to make the patient understand their diet prescription, and is effective to control body weight and blood sugar level. Awareness of calorie requirement could be used as an index of understanding of prescribed diet. Since age is an important variable to determine the awareness of calorie requirement, different strategies of nutrition education should be developed for different age groups, especially patients over 70 years old.