- Poor Prognosis Factors and Risk Factors of Amputation in Foot ulcers in Diabetes.
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Mi Jung Eun, Jung Hoon Lee, Jin Ho Kim, Ji Eun Lee, Jae Hong Kim, Kyu Chang Won, In Ho Jo, Hyoung Woo Lee
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Korean Diabetes J. 2004;28(4):304-314. Published online August 1, 2004
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- BACKGROUND
Foot ulcers are a common complication of diabetes mellitus, and their prevalence is increased relative to those without diabetes. Foot ulcers and related complications represent an important cause of morbidity among patients with diabetes mellitus. Most of the poor prognosis factors and amputation risk factors of diabetic foot ulcers have been found to be largely affected by male sex, inadequate blood glucose control, vascular disease, neuropathy, end organ defects, and the depth and size of ulcers, prior ulcer history, infection and ischemia. Currently, the poor prognosis factors and amputation risk factors of diabetic foot ulcers in the Korean diabetic population are unknown. The purpose of this study was to identify and quantify the poor prognosis factors of diabetic foot ulcers and the risk factors of lower extremity amputation. METHODS: This study comprised of involved 37 male and 14 female diabetics with foot ulcers aged 23 to 83 years. According to the results of treatment, the patients were divided into 4 groups; complete healing (CH), partial healing (PH), unhealing (UH), and amputation (AM) groups. The baseline characteristics of the study subjects (gender, age, duration of diabetes, BMI, drinking, smoking, insulin therapy, blood pressure, whole blood count, renal function test and the size and depth of ulcer, prior ulcer history, osteomyelitis, infection, ischemia, neuropathy and retinopathy) were examined. RESULTS: The following characteristics were not significantly related to the poor prognosis factors and amputation risk factors of diabetic foot ulcers: age, duration of diabetes, BMI; drinking, smoking, insulin therapy, blood pressure, whole blood count and renal function test. The following characteristics were significantly related to the poor prognosis factors and amputation risk factors of diabetic foot ulcers: male (p=0.021), ischemia (p<0.05), infection (p<0.01), osteomyelitis (p<0.01), prior ulcer history (p<0.05), retinopathy (p<0.05), size of ulcer (p<0.001) and depth of ulcer (p<0.001). The size and depth of an ulcer, prior ulcer history, ischemia and infection were found to be associated with poor prognosis factors of treatment and risk factors of amputation in diabetic foot ulcer patients by a multiple regression test (P<0.05). CONCLUSION: This study shows that the size and depth of an ulcer, prior ulcer history, ischemia and infection are poor prognosis factors of diabetic foot ulcer and amputation risk factors However, further studies will be required due to the smaill size of our study population.
- Five Year Follow-up of ICA and GADA in Childhood onset Type 1 DM.
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Si Hyung Lee, Ji Sung Yoon, Mi Jung Eun, Jin Ho Kim, Yong Ho Park, Kyu Chang Won, Ihn Ho Jo, Hyoung Woo Lee
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Korean Diabetes J. 2003;27(5):395-404. Published online October 1, 2003
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Type 1 diabetes develops due to the destruction of insulin-secreting beta-cells by an autoimmune process, in which both genetic and environmental factors are involved. In children with newly diagnosed type 1 DM, the prevalence of ICA (Islet cell cytoplasmic antibody) is 60~86% and is highest at the time of onset after which it decreases. But, GADA (glutamic acid decarboxylase anti- bodies) are characterized by substantial fluctuations in the humoral immune response over a long period after clinical manifestation. This study was performed to evaluate the persistence of type 1 DM associated autoantibodies, including ICA and GADA, and their relation to clinical characteristics of the disease after clinical manifestation. METHODS: Eighteen childhood onset type 1 diabetes patients (mean age 13.7 years; duration 3.9 years) were included in this study. ICA was measured by indirect immunofluorescence using conventional ICA-IgG and positive samples were titered by serial dilutions. Also the sera were screened for GADA by radioimmuno-assay. RESULTS: The positivities of ICA and GADA at the time of study were 55.6% and 61%, falling to 44.4% and 41.2% 5 years later, respectively. There was no case of an ICA negative patient becoming positive or whose ICA titer was increased later. One case of a GADA negative patient became positive later. Initial c-peptide levels didn't have any correlation with initial ICA titers or ICA prevalence, but did with initial GADA titer. There were significant correlations between initial GADA titer and ICA prevalence (p<0.001), and between initial GADA titer or ICA titer and later ICA persistence (p<0.05). CONCLUSION: ICA and GADA persisted long after the clinical diagnosis of type 1 diabetes. And the persistence of autoantibody positivity showed a weak relation with endogenous insulin secretion and clinical characteristics, both at and after diagnosis of overt type 1 diabetes.
- Factors Determining Circadian Blood Pressure Rhythm in Normotensive Patients with Type 2 Diabetes.
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Jae Hong Kim, Jin Ho Kim, Mi Jung Eun, Si Hyung Lee, Kyeong Cheol Shin, Kyu Chang Won, Ihn Ho Cho, Hyoung Woo Lee
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Korean Diabetes J. 2002;26(5):416-430. Published online October 1, 2002
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Within healthy subjects, there exists the so-called 'dipper phenomenon', where the circadian blood pressure rhythm, that is the systolic and diastolic blood pressures values, are lower at night than during the day. The loss of nocturnal dipping in BP has prognostic value with regard to end-organ damage and vascular events in both hypertension and diabetic patients. A blunted nocturnal decrease in BP has been described in diabetic patients, and has been associated with autonomic neuropathy or nephropathy, but much controversy relating to this still exists. This study was designed to evaluate the factors that influence abnormal circadian blood pressure rhythm. METHODS: 24hr blood pressure monitoring was applied to 99 normotensive type 2 diabetes patients,comprising of 55 males and 44 females, with a mean age: 56 3 years, who visited our hospital between March 2000 and February 2002 for measurement of 24hr systolic and diastolic blood pressures. The control groups was 21 white coat hypertension type 2 diabetic patients, comprising of 15 males and 6 females, with a mean age of 53 4 years. The controls were subgrouped according to their standard cardiovascular autonomic function test(CAN) or nephropathy stage. All patients divided dipper, mean(day time night time) systolic BP/mean(day time-night time) diastolic BP above 10mmHg/5mmHg, and non-dipper groups. RESULTS: The prevalence of non-dipper phenomenon was much greater in the type 2 diabetes patients than in the control groups(p<0.05). There was a significant difference between the dipper and non-dipper groups in the 24hr total urine protein and CAN(p<0.05). In the type 2 diabetes patients, sub-grouped according to their nephropathy stage, there was a significant difference between the microalbuminuric and proteinuric groups relating to the prevalence of the non-dipper phenomenon (p<0.05). The circadian blood pressure, according to the nephropathy stage, the CAN in the normoalbuminuria group, the albumin excretion in the microalbuminuria group, CAN and 24hr total urine protein in the proteinuric group, may useful in determining abnormal circadian rhythm (p<0.05). There was no significant difference between the dipper and non-dipper groups with regard to neuropathy and retinopathy (p<0.05). CONCLUSION: In the early stage of diabetic nephropathy, autonomic dysfunction may have a relatively dominant influence on abnormal circadian blood pressure rhythm. Nephropathy was progressed in diabetic patients: therefore diabetic nephropathy may itself have an influence on abnormal circadian blood pressure rhythm.
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