• Health Policy and Management
• /
• v.29 no.3
• /
• pp.262-276
• /
• 2019

Background: The most important thing to strengthen primary care is to prove that the continuity of primary care is an essential area for good health outcomes. The purpose of this study is to analyze the effect of outpatient continuity of primary care on the hospitalization experience of diabetes mellitus in new diabetic patients. Methods: Using the Korean National Health Insurance Service national sample cohort (NHIS-NSC 2011-2015) data, 3,391 new diabetic patients in 2012 were selected for the study. Multiple logistic regression was performed to investigate the effect of outpatient continuity of primary care on hospitalization in new diabetic patients. Results: The outpatient continuity of primary care in new diabetic patients was measured by the continuity of care index, which showed that 69.4% (n=2,352) were high level and 30.6% (n=1,039) were low level. Patients who had high continuity of primary care at the early stage of diabetes diagnosis showed 3.49 times more likely to maintain high continuity of primary care in the second year (95% confidence interval [CI], 2.72-4.49). Patients with low continuity of primary care for 2 years from the initial diagnosis of diabetes were 2.56 times more likely to be hospitalized due to diabetes than those who did not (95% CI, 1.55-4.25). Conclusion: This study identified the need for policies to increase the continuity of primary care for new diabetic patients and could contribute to lowering the admission rate of diabetic patients if the policy for this would work effectively.

• Journal of Yeungnam Medical Science
• /
• v.40 no.4
• /
• pp.343-351
• /
• 2023

Diabetic foot is one of the most devastating consequences of diabetes, resulting in amputation and possibly death. Therefore, early detection and vigorous treatment of infections in patients with diabetic foot are critical. This review seeks to provide guidelines for the therapy and rehabilitation of patients with moderate-to-severe diabetic foot. If a diabetic foot infection is suspected, bacterial cultures should be initially obtained. Numerous imaging studies can be used to identify diabetic foot, and recent research has shown that white blood cell single-photon emission computed tomography/computed tomography has comparable diagnostic specificity and sensitivity to magnetic resonance imaging. Surgery is performed when a diabetic foot ulcer is deep and is accompanied by bone and soft tissue infections. Patients should be taught preoperative rehabilitation before undergoing stressful surgery. During surgical procedures, it is critical to remove all necrotic tissue and drain the inflammatory area. It is critical to treat wounds with suitable dressings after surgery. Wet dressings promote the formation of granulation tissues and new blood vessels. Walking should begin as soon as the patient's general condition allows it, regardless of the wound status or prior walking capacity. Adequate treatment of comorbidities, including hypertension and dyslipidemia, and smoking cessation are necessary. Additionally, broad-spectrum antibiotics are required to treat diabetic foot infections.

• Journal of Korean Academy of Nursing
• /
• v.18 no.3
• /
• pp.281-288
• /
• 1988

This study examined the effect of patient teaching on Compliance with sick role behavior in diabetic patients. The purpose was to improve diabetic patients Compliance by D. M. patient teaching. The study objectives were to determine the effect of patient teaching on Compliance with sick role behavior, and factors influencing compliance with sick role behavior of diabetic patients. The Subjects, consisting of 52 diabtic patients diagnosed in the C. and Other hospitals in K. city were divided into experimental and Control groups. Data were gathered from July 25th to September 3rd, 1988 through interviews by questionnaires, measurment of blood sugar level by Reflolux. D. M. Patient teaching was defined as informational intervention of social support by the nurse. A booklet representing patient education and questionnairs were developed by the investigator, and were tested for Content validity, and reliability by Item Analysis: Cronbachs $\alpha$ for any instrument to measure variables was patient Compliance .83, perceived health belief .65, diabetic knowledge .70. Analysis of data were done by paired t-test, t-test, Anova, Pearson correlation and Stepwise multiple regression, The results of the study may be summarized as follows : 1. The effect of patient teaching on Compliance with sick role behavior, on diabetic Knowledge and health belief was Confirmed by significant differences between the experimental and the control group before and after the experiments. (P＝000 P＝006, P＝004). 2. Factors influencing compliance with sick role behavior of diabetic patient were diabetic patient teaching (P＜.005), perceived health belief(r＝.5597, P＜.005), blood sugar(r＝.3205, P＜.01), diabetic knowledge(r＝.2876, P＜.05).

• Journal of Korean Foot and Ankle Society
• /
• v.26 no.1
• /
• pp.30-39
• /
• 2022

Purpose: This study aimed to report the current trends in the management of diabetic foot over the last few decades through a survey of the Korean Foot and Ankle Society (KFAS) members. Materials and Methods: A web-based questionnaire containing 40 questions was sent to all KFAS members in September 2021. The questions were mainly related to the demographics of patients with diabetic foot, diagnostic tools, and multidisciplinary treatment. Answers with a prevalence of ≥50% of respondents were considered a tendency. Results: Seventy-eight of the 550 members (14.2%) responded to the survey. The most common demographic factors of diabetic foot patients were male dominance with a high percentage in the 60- to 70-year-old. Although the need for multidisciplinary treatment is highly recognized in the treatment of diabetic foot patients, the actual implementation rate is about 39%. The contrast-enhanced magnetic resonance imaging (88.5%) was reported to be the most used tool for the diagnosis of osteomyelitis of the diabetic foot. It was reported that the use of antibiotics was started empirically and then changed based on bacterial culture tests in 82.1% of patients. Simple wound dressing and antibiotic treatment were most frequently reported for mild ulcers. Conclusion: This study provides updated information on the current trends in the management of a diabetic foot in Korea. Both consensus and variations in the approach to patients with diabetic foot were identified by this survey study. Further efforts are required for better access to a multidisciplinary approach, such as appropriate insurance payment policies and patient education.

• Journal of Korean Foot and Ankle Society
• /
• v.8 no.1
• /
• pp.16-21
• /
• 2004

Purpose: To investigate the characteristics of the patients and therapeutic shoes for diabetic patients. Materials and Methods: Forty two diabetic patients who had their own therapeutic shoes which were prescribed somewhere else were studied from March 2003 to December 2003. There were 27 males and 15 females, and the mean age was 62.1 years (range, 49-72 years). Duration of diabetes was average 14 years (range, $6{\sim}30$ years), all had type 2 diabetes. Sensation was examined with 5.07 nylon monofilament. The route of purchasing the shoes, compliance to the prescribed shoes were investigated by interview. The shape of shoe, stiffness of upper, conformity of insole to the shape of the foot were recorded. In-shoe plantar pressure was measured in 15 patients. Results: Eighteen patients were insensate to the monofilament. Seven patients did not wear the therapeutic shoes, and only 18 of 35 patients were wearing the therapeutic shoes more than 6 hours a day. The shoes of 17 patients were prescribed by medical doctor and the rest were purchased by the recommendation of acquaintances or advertisement. Ulcer recurred in four of five patients to whom the shoe was prescribed by medical doctor and the cause of three recurrences were evident by just observing the foot and shoe. The therapeutic shoes were made from 11 different makers. Eight shoes were adequate for diabetic patients with respect to the material, shape of insole, type of shoe. In-shoe plantar pressure was examined in 15 patients and was less than 300 kPa in all patients. Conclusion: The therapeutic shoes for the diabetic patients need to be prescribed by medical doctor for selective patients with neuropathy or previous history of ulcer and follow-up examination is important to monitor the compliance of the patients and adequacy of the shoes.

• Journal of Korean Neurosurgical Society
• /
• v.37 no.1
• /
• pp.44-47
• /
• 2005

Objective: The purpose of this study is to investigate the elevated blood glucose levels in the postoperative period are associated with an increased risk of deep wound infection in diabetic individuals undergoing lumbar spine surgery. Methods: Of 2896 patients who underwent lumbar spine operations by one surgeon between 1993 and 2002, 329(11.4%) were diabetics. The rate of deep wound infections in diabetic patients was 6.4%, versus 3.2% for nondiabetics. 152 patients had their operation before implementation of the protocol and 177 after implementation. Charts of the diabetic patients were reviewed. Mean blood glucose levels were calculated from documented results of finger-stick glucometer testing. Results: Twenty-one diabetic patients suffered deep wound infection. Infected diabetic patients had a higher mean blood glucose level through the first 2 postoperative days than noninfected patients($230{\pm}6.9$ versus $175{\pm}3.8mg/dL$; p<0.003) and had a long operation time($216{\pm}57.9$ versus $167.5{\pm}42.2$ minute; p<0.05). Multivariable logistic regression showed that mean blood glucose level for the first 2 postoperative days, long operation time, and use of the instrumentation(p<0.02) were all related predictiors of deep wound infection. Institution of a protocol of postoperative continuous intravenous insulin to maintain blood glucose level less than 200mg/dL was began in september 1997. This protocol resulted in a decrease in blood glucose levels for the first 2 postoperative days and a concomitant decrease in the proportion of patients with deep wound infection, from 8.3%(11/132) to 5.1%(10/195) (p<0.02). Conclusion: The incidence of deep wound infection in diabetic patients is reduced after implementation of a protocol to maintain mean blood glucose level less than 200mg/dL in the immediate postoperative period.

• Annals of Laboratory Medicine
• /
• v.38 no.6
• /
• pp.524-529
• /
• 2018

Background: An increase in neutrophil gelatinase-associated lipocalin (NGAL) indicates tubular injury. Diabetic nephropathy causes typical changes in the kidney, characterized by glomerulosclerosis and eventual tubular damage. We validated the usefulness of plasma NGAL (pNGAL) as a biomarker of tubular damage in patients with diabetic nephropathy. Methods: We included 376 patients with diabetes mellitus (260 patients with chronic renal insufficiency who had not received hemodialysis and 116 hemodialyzed due to diabetic nephropathy) and 24 healthy controls. Patients with chronic renal insufficiency were divided into three groups according to urinary albumin excretion (UAE) levels. pNGAL levels were measured using the Triage NGAL test (Alere, San Diego, CA, USA) and were compared between groups. We also examined whether pNGAL level was related to the degree of albuminuria and cystatin C-based glomerular filtration rate (GFR). Results: Mean pNGAL levels of the healthy controls, chronic renal insufficiency patients with diabetes mellitus, and hemodialyzed patients were $61.9{\pm}5.3ng/mL$, $93.4{\pm}71.8ng/mL$, and $1,536.9{\pm}554.9ng/mL$, respectively. pNGAL level increased significantly in patients with severe albuminuria (P <0.001) and had a moderate correlation with the degree of albuminuria (r=0.467; P <0.001) and GFR (r=0.519; P <0.001). Multivariate regression analysis showed that the pNGAL level was associated with tubular damage independent of patient age, sex, and GFR. Conclusions: pNGAL level independently reflects the degree of tubular damage in patients with diabetic nephropathy. Measurement of pNGAL, combined with UAE, would enable simultaneous, highly reliable assessments of tubular damage for such patients.

• Journal of Haehwa Medicine
• /
• v.8 no.1
• /
• pp.853-863
• /
• 1999

This study was designed and undertaken to examine the sexual concern and sexual satisfaction in diabetic patients. The data were collected from September to November, 1997. The subjects in this study were 77 diabetic patients who visited to check their blood glucose level to the outpatient department of internal medicine in one of hospitals located in Taejon city. The questionnaires developed by Derogatis L. R. were used. Data were analysed using percentages, means, F-test, done with the SAS program. The results of this study were as follows ; 1) In the question that If the patients want to be counselled about sexual need or not, male and female diabetic patients answered "moderate"(37 patients(48.1%). 2) In the question that if the patients are worry for their sexual life or not because of present illness, male and female diabetic patients answered "moderate"(27 patients (35.1%). 3) In the question that If the patients worried about sexual life, they wish to counsell for who, the majority of patients answered that want to counsell the medical doctor(49 patients(64.5%). 4) In the question that if a medical team is concerned about patient's sexual need or not, the patients usually answered negatively. 5) In the question of attitude about masturbation, male and female answered that they think it doesn't matter if they maintain privacy. 6) In the question that if they use professional therapeutic method for sexual act or not, it is highly appeared not using(72 patients(93.5%). 7) In the relationships between the sexual satisfaction and the sex, age, the period of disease, want to counselling about sexual need, the concern of the medical team about sexual need of the Patients showed statistically significant differences.

• Korean Journal of Adult Nursing
• /
• v.18 no.1
• /
• pp.3-9
• /
• 2006

Purpose: The purpose of this study was to assess the difference between prevalence and risk factors of the metabolic syndrome(MS) by gender in type2 diabetic patients. Method: 108 participants(males 69, females 39) were recruited from the endocrinology outpatient department of a tertiary care hospital in an urban city. MS was defined by a third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults(Adult Treatment Panel III)(ATP III), and abdominal obesity was determined by Asia-Pacific criteria in waist circumference. Results: The prevalence of MS by definition of NCEP-ATP III and the Asia-Pacific criteria in waist circumference was 39.3% in males and 66.7% in females type2 diabetic patients. The abdominal obesity prevalence was seen in 44.9% of males and in 79.5% of females patients. The prevalence of low HDL-cholesterolemia in serum was 26.2% in male, 52.8% in female type2 diabetic patients. Conclusion: These results show that nurses should focus on female diabetic patients for preventing MS.

• Journal of Korean Biological Nursing Science
• /
• v.5 no.1
• /
• pp.5-12
• /
• 2003

The purpose of this study to compare of clinical profile between obese and nonobese type 2 diabetic patients. The subjects were consist of 111 obese (50 male, 61 female) and 159 non obese (79 male, 80 female) type 2 diabetic patients underwent fasting blood glucose, 2-hour postprandial blood glucose, $HbA_1c$, total cholesterol, triglyceride, high density lipoprotein, microalbuminuria, fasting C-peptide and 2-hour postprandial C-peptide were measured. Diabetes was diagnosed according to the American Diabetes Association (ADA) criteria. Obesity was defined as body mass index (BMI, kilograms per meters squared) ${\geq}23$. Data analyses were t-test, chisquare test in SAS program. The results were as follows : 1) Triglycerides and 2-hour postprandial C-peptide were significant higher in obese than non-obese patients. 2) Systolic blood pressure, Diastolic blood pressure, fasting blood sugar, 2-hour postprandial blood glucose, $HbA_1c$, total cholesterol, high-density lipoprotein, microalbuminuria and fasting C-peptide were no difference between obese and non-obese groups. These data indicate that obesity is a risk factor for the development of coronary heart disease (CHD) in diabetic patients. Therefore, weight reductions have beneficial effects on insulin action and glycemic control in obese type 2 diabetic patients.