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Volume 44(4); August 2020
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Guideline/Fact Sheet
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Sodium-Glucose Cotransporter-2 Inhibitor for Renal Function Preservation in Patients with Type 2 Diabetes Mellitus: A Korean Diabetes Association and Korean Society of Nephrology Consensus Statement
Tae Jung Oh, Ju-Young Moon, Kyu Yeon Hur, Seung Hyun Ko, Hyun Jung Kim, Taehee Kim, Dong Won Lee, Min Kyong Moon, The Committee of Clinical Practice Guideline, Korean Diabetes Association and Committee of the Cooperative Studies, Korean Society of Nephrology
Diabetes Metab J. 2020;44(4):489-497.   Published online August 21, 2020
DOI: https://doi.org/10.4093/dmj.2020.0172
  • 8,746 View
  • 180 Download
  • 4 Web of Science
  • 4 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   

Diabetes is a leading cause of end-stage renal disease. Therefore, prevention of renal dysfunction is an important treatment goal in the management of diabetes. The data of landmark cardiovascular outcome trials of sodium-glucose cotransporter-2 (SGLT2) inhibitor showed profound reno-protective effects. The Korean Diabetes Association and the Korean Society of Nephrology reviewed clinical trials and performed meta-analysis to assess the effects of SGLT2 inhibitors on the preservation of estimated glomerular filtration rate (eGFR). We limited the data of SGLT2 inhibitors which can be prescribed in Korea. Both eGFR value and its change from the baseline were significantly more preserved in the SGLT2 inhibitor treatment group compared to the control group after 156 weeks. However, some known adverse events were increased in SGLT2 inhibitor treatment, such as genital infection, diabetic ketoacidosis, and volume depletion. We recommend the long-term use SGLT2 inhibitor in patients with type 2 diabetes mellitus (T2DM) for attenuation of renal function decline. However, we cannot generalize our recommendation due to lack of long-term clinical trials testing reno-protective effects of every SGLT2 inhibitor in a broad range of patients with T2DM. This recommendation can be revised and updated after publication of several large-scale renal outcome trials.

Citations

Citations to this article as recorded by  
  • Real-World Treatment Patterns according to Clinical Practice Guidelines in Patients with Type 2 Diabetes Mellitus and Established Cardiovascular Disease in Korea: Multicenter, Retrospective, Observational Study
    Ye Seul Yang, Nam Hoon Kim, Jong Ha Baek, Seung-Hyun Ko, Jang Won Son, Seung-Hwan Lee, Sang Youl Rhee, Soo-Kyung Kim, Tae Seo Sohn, Ji Eun Jun, In-Kyung Jeong, Chong Hwa Kim, Keeho Song, Eun-Jung Rhee, Junghyun Noh, Kyu Yeon Hur
    Diabetes & Metabolism Journal.2024; 48(2): 279.     CrossRef
  • 2023 Clinical Practice Guidelines for Diabetes Management in Korea: Full Version Recommendation of the Korean Diabetes Association
    Jun Sung Moon, Shinae Kang, Jong Han Choi, Kyung Ae Lee, Joon Ho Moon, Suk Chon, Dae Jung Kim, Hyun Jin Kim, Ji A Seo, Mee Kyoung Kim, Jeong Hyun Lim, Yoon Ju Song, Ye Seul Yang, Jae Hyeon Kim, You-Bin Lee, Junghyun Noh, Kyu Yeon Hur, Jong Suk Park, Sang
    Diabetes & Metabolism Journal.2024; 48(4): 546.     CrossRef
  • Renoprotective Mechanism of Sodium-Glucose Cotransporter 2 Inhibitors: Focusing on Renal Hemodynamics
    Nam Hoon Kim, Nan Hee Kim
    Diabetes & Metabolism Journal.2022; 46(4): 543.     CrossRef
  • Real-World Prescription Patterns and Barriers Related to the Use of Sodium-Glucose Cotransporter 2 Inhibitors among Korean Patients with Type 2 Diabetes Mellitus and Cardiovascular Disease
    Jong Ha Baek, Ye Seul Yang, Seung-Hyun Ko, Kyung Do Han, Jae Hyeon Kim, Min Kyong Moon, Jong Suk Park, Byung-Wan Lee, Tae Jung Oh, Suk Chon, Jong Han Choi, Kyu Yeon Hur
    Diabetes & Metabolism Journal.2022; 46(5): 701.     CrossRef
Basic Research
Article image
Role of CRTC2 in Metabolic Homeostasis: Key Regulator of Whole-Body Energy Metabolism?
Hye-Sook Han, Yongmin Kwon, Seung-Hoi Koo
Diabetes Metab J. 2020;44(4):498-508.   Published online March 5, 2020
DOI: https://doi.org/10.4093/dmj.2019.0200
  • 8,227 View
  • 185 Download
  • 16 Web of Science
  • 17 Crossref
AbstractAbstract PDFPubReader   ePub   

Cyclic adenosine monophosphate (cAMP) signaling is critical for regulating metabolic homeostasis in mammals. In particular, transcriptional regulation by cAMP response element-binding protein (CREB) and its coactivator, CREB-regulated transcription coactivator (CRTC), is essential for controlling the expression of critical enzymes in the metabolic process, leading to more chronic changes in metabolic flux. Among the CRTC isoforms, CRTC2 is predominantly expressed in peripheral tissues and has been shown to be associated with various metabolic pathways in tissue-specific manners. While initial reports showed the physiological role of CRTC2 in regulating gluconeogenesis in the liver, recent studies have further delineated the role of this transcriptional coactivator in the regulation of glucose and lipid metabolism in various tissues, including the liver, pancreatic islets, endocrine tissues of the small intestines, and adipose tissues. In this review, we discuss recent studies that have utilized knockout mouse models to delineate the role of CRTC2 in the regulation of metabolic homeostasis.

Citations

Citations to this article as recorded by  
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  • Biological functions of CRTC2 and its role in metabolism-related diseases
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  • Exploring the diagnostic value, prognostic value, and biological functions of NPC gene family members in hepatocellular carcinoma based on a multi-omics analysis
    Keheng Chen, Xin Zhang, Huixin Peng, Fengdie Huang, Guangyu Sun, Qijiang Xu, Lusheng Liao, Zhiyong Xing, Yanping Zhong, Zhichao Fang, Meihua Liao, Shihua Luo, Wencheng Chen, Mingyou Dong
    Functional & Integrative Genomics.2023;[Epub]     CrossRef
  • MicroRNA regulation of AMPK in nonalcoholic fatty liver disease
    Hao Sun, Jongsook Kim Kemper
    Experimental & Molecular Medicine.2023; 55(9): 1974.     CrossRef
  • Serine active site containing protein 1 depletion alters lipid metabolism and protects against high fat diet-induced obesity in mice
    Miaomiao Du, Xueyun Li, Fangyi Xiao, Yinxu Fu, Yu Shi, Sihan Guo, Lifang Chen, Lu Shen, Lan Wang, Huang Cheng, Hao Li, Anran Xie, Yaping Zhou, Kaiqiang Yang, Hezhi Fang, Jianxin Lyu, Qiongya Zhao
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  • cAMP Signaling in Cancer: A PKA-CREB and EPAC-Centric Approach
    Muhammad Bilal Ahmed, Abdullah A. A. Alghamdi, Salman Ul Islam, Joon-Seok Lee, Young-Sup Lee
    Cells.2022; 11(13): 2020.     CrossRef
  • Hepatic Sam68 Regulates Systemic Glucose Homeostasis and Insulin Sensitivity
    Aijun Qiao, Wenxia Ma, Ying Jiang, Chaoshan Han, Baolong Yan, Junlan Zhou, Gangjian Qin
    International Journal of Molecular Sciences.2022; 23(19): 11469.     CrossRef
  • The Role of Small Heterodimer Partner-Interacting Leucine Zipper (SMILE) as a Transcriptional Corepressor in Hepatic Glucose and Lipid Metabolism
    Woo-Ram Park, Byungyoon Choi, Nanthini Sadasivam, Don-Kyu Kim
    Trends in Agriculture & Life Sciences.2022; 60: 7.     CrossRef
  • AMPK Localization: A Key to Differential Energy Regulation
    Qonita Afinanisa, Min Kyung Cho, Hyun-A Seong
    International Journal of Molecular Sciences.2021; 22(20): 10921.     CrossRef
Basic Research
Article image
Consequences of Obesity on the Sense of Taste: Taste Buds as Treatment Targets?
Kerstin Rohde, Imke Schamarek, Matthias Blüher
Diabetes Metab J. 2020;44(4):509-528.   Published online May 11, 2020
DOI: https://doi.org/10.4093/dmj.2020.0058
  • 13,453 View
  • 345 Download
  • 39 Web of Science
  • 39 Crossref
AbstractAbstract PDFPubReader   ePub   

Premature obesity-related mortality is caused by cardiovascular and pulmonary diseases, type 2 diabetes mellitus, physical disabilities, osteoarthritis, and certain types of cancer. Obesity is caused by a positive energy balance due to hyper-caloric nutrition, low physical activity, and energy expenditure. Overeating is partially driven by impaired homeostatic feedback of the peripheral energy status in obesity. However, food with its different qualities is a key driver for the reward driven hedonic feeding with tremendous consequences on calorie consumption. In addition to visual and olfactory cues, taste buds of the oral cavity process the earliest signals which affect the regulation of food intake, appetite and satiety. Therefore, taste buds may play a crucial role how food related signals are transmitted to the brain, particularly in priming the body for digestion during the cephalic phase. Indeed, obesity development is associated with a significant reduction in taste buds. Impaired taste bud sensitivity may play a causal role in the pathophysiology of obesity in children and adolescents. In addition, genetic variation in taste receptors has been linked to body weight regulation. This review discusses the importance of taste buds as contributing factors in the development of obesity and how obesity may affect the sense of taste, alterations in food preferences and eating behavior.

Citations

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Editorial
Obesity Degree and Glycemic Status: Factors That Should Be Considered in Heart Failure
Hye Soon Kim
Diabetes Metab J. 2020;44(4):529-531.   Published online August 21, 2020
DOI: https://doi.org/10.4093/dmj.2020.0166
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PDFPubReader   ePub   

Citations

Citations to this article as recorded by  
  • Mechanisms and Perspectives of Sodium-Glucose Co-transporter 2 Inhibitors in Heart Failure
    Qingchun Zeng, Qing Zhou, Weitao Liu, Yutong Wang, Xingbo Xu, Dingli Xu
    Frontiers in Cardiovascular Medicine.2021;[Epub]     CrossRef
Original Articles
Drug/Regimen
Article image
Switching to Once-Daily Insulin Degludec/Insulin Aspart from Basal Insulin Improves Postprandial Glycemia in Patients with Type 2 Diabetes Mellitus: Randomized Controlled Trial
Kyu Yong Cho, Akinobu Nakamura, Chiho Oba-Yamamoto, Kazuhisa Tsuchida, Shingo Yanagiya, Naoki Manda, Yoshio Kurihara, Shin Aoki, Tatsuya Atsumi, Hideaki Miyoshi
Diabetes Metab J. 2020;44(4):532-541.   Published online November 22, 2019
DOI: https://doi.org/10.4093/dmj.2019.0093
  • 6,669 View
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  • 8 Web of Science
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background

To explore the efficacy and safety of switching from once-daily basal insulin therapy to once-daily pre-meal injection insulin degludec/insulin aspart (IDegAsp) with respect to the glycemic control of participants with type 2 diabetes mellitus (T2DM).

Methods

In this multicenter, open-label, prospective, randomized, parallel-group comparison trial, participants on basal insulin therapy were switched to IDegAsp (IDegAsp group; n=30) or continued basal insulin (Basal group; n=29). The primary endpoint was the superiority of IDegAsp in causing changes in the daily blood glucose profile, especially post-prandial blood glucose concentration after 12 weeks.

Results

Blood glucose concentrations after dinner and before bedtime were lower in the IDegAsp group, and the improvement in blood glucose before bedtime was significantly greater in the IDegAsp group than in the Basal group at 12 weeks (−1.7±3.0 mmol/L vs. 0.3±2.1 mmol/L, P<0.05). Intriguingly, glycemic control after breakfast was not improved by IDegAsp injection before breakfast, in contrast to the favorable effect of injection before dinner on blood glucose after dinner. Glycosylated hemoglobin significantly decreased only in the IDegAsp group (58 to 55 mmol/mol, P<0.05). Changes in daily insulin dose, body mass, and recorded adverse effects, including hypoglycemia, were comparable between groups.

Conclusion

IDegAsp was more effective than basal insulin at reducing blood glucose after dinner and before bedtime, but did not increase the incidence of hypoglycemia. Switching from basal insulin to IDegAsp does not increase the burden on the patient and positively impacts glycemic control in patients with T2DM.

Citations

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  • Glycaemic outcomes in hospital with IDegAsp versus BIAsp30 premixed insulins
    Joshua R. Walt, Julie Loughran, Spiros Fourlanos, Rahul D. Barmanray, Jasmine Zhu, Suresh Varadarajan, Mervyn Kyi
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Drug/Regimen
γ-Linolenic Acid versus α-Lipoic Acid for Treating Painful Diabetic Neuropathy in Adults: A 12-Week, Double-Placebo, Randomized, Noninferiority Trial
Jong Chul Won, Hyuk-Sang Kwon, Seong-Su Moon, Sung Wan Chun, Chong Hwa Kim, Ie Byung Park, In Joo Kim, Jihyun Lee, Bong Yun Cha, Tae Sun Park
Diabetes Metab J. 2020;44(4):542-554.   Published online November 4, 2019
DOI: https://doi.org/10.4093/dmj.2019.0099
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background

This study was a multicenter, parallel-group, double-blind, double-dummy, randomized, noninferiority trial to evaluate the efficacy and safety of γ-linolenic acid (GLA) relative to α-lipoic acid (ALA) over a 12-week treatment period in type 2 diabetes mellitus (T2DM) patients with painful diabetic peripheral neuropathy (DPN).

Methods

This study included 100 T2DM patients between 20 and 75 years of age who had painful DPN and received either GLA (320 mg/day) and placebo or ALA (600 mg/day) and placebo for 12 weeks. The primary outcome measures were mean changes in pain intensities as measured by the visual analogue scale (VAS) and the total symptom scores (TSS).

Results

Of the 100 subjects who initially participated in the study, 73 completed the 12-week treatment period. Per-protocol analyses revealed significant decreases in the mean VAS and TSS scores compared to baseline in both groups, but there were no significant differences between the groups. The treatment difference for the VAS (95% confidence interval [CI]) between the two groups was −0.65 (−1.526 to 0.213) and the upper bound of the 95% CI did not exceed the predefined noninferiority margin (δ1=0.51). For the TSS, the treatment difference was −0.05 (−1.211 to 1.101) but the upper bound of the 95% CI crossed the noninferiority margin (δ2=0.054). There were no serious adverse events associated with the treatments.

Conclusion

GLA treatment in patients with painful DPN was noninferior to ALA in terms of reducing pain intensity measured by the VAS over 12 weeks.

Citations

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Complications
Article image
Differences in Clinical Outcomes between Patients with and without Hypoglycemia during Hospitalization: A Retrospective Study Using Real-World Evidence
Jeongmin Lee, Tong Min Kim, Hyunah Kim, Seung-Hwan Lee, Jae Hyoung Cho, Hyunyong Lee, Hyeon Woo Yim, Kun-Ho Yoon, Hun-Sung Kim
Diabetes Metab J. 2020;44(4):555-565.   Published online May 8, 2020
DOI: https://doi.org/10.4093/dmj.2019.0064
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background

Some patients admitted to hospitals for glycemic control experience hypoglycemia despite regular meals and despite adhering to standard blood glucose control protocols. Different factors can have a negative impact on blood glucose control and prognosis after discharge. This study investigated risk factors for hypoglycemia and its effects on glycemic control during the hospitalization of patients in the general ward.

Methods

This retrospective study included patients who were admitted between 2009 and 2018. Patients were provided regular meals at fixed times according to ideal body weights during hospitalization. We categorized the patients into two groups: those with and those without hypoglycemia during hospitalization.

Results

Of the 3,031 patients, 379 experienced at least one episode of hypoglycemia during hospitalization (HYPO group). Hypoglycemia occurred more frequently particularly in cases of premixed insulin therapy. Compared with the control group, the HYPO group was older (61.0±16.8 years vs. 59.1±16.5 years, P=0.035), with more females (60.4% vs. 49.6%, P<0.001), lower body mass index (BMI) (23.5±4.2 kg/m2 vs. 25.1±4.4 kg/m2, P<0.001), and higher prevalence of type 1 diabetes mellitus (6.1% vs. 2.6%, P<0.001), They had longer hospital stay (11.1±13.5 days vs. 7.6±4.6 days, P<0.001). After discharge the HYPO group had lower glycosylated hemoglobin reduction rate (−2.0%±0.2% vs. −2.5%±0.1%, P=0.003) and tended to have more frequent cases of cardiovascular disease.

Conclusion

Hypoglycemia occurred more frequently in older female patients with lower BMI and was associated with longer hospital stay and poorer glycemic control after discharge. Therefore, clinicians must carefully ensure that patients do not experience hypoglycemia during hospitalization.

Citations

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    Swarna Deepak Kuragayala, Sumita Nayak, Khalid Khatib
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    Sung-Woo Kim
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    Jeongmin Lee, Hun-Sung Kim
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Complications
Article image
Therapeutic Effects of Fibroblast Growth Factor-21 on Diabetic Nephropathy and the Possible Mechanism in Type 1 Diabetes Mellitus Mice
Wenya Weng, Tingwen Ge, Yi Wang, Lulu He, Tinghao Liu, Wanning Wang, Zongyu Zheng, Lechu Yu, Chi Zhang, Xuemian Lu
Diabetes Metab J. 2020;44(4):566-580.   Published online May 15, 2020
DOI: https://doi.org/10.4093/dmj.2019.0089
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AbstractAbstract PDFPubReader   ePub   
Background

Fibroblast growth factor 21 (FGF21) has been only reported to prevent type 1 diabetic nephropathy (DN) in the streptozotocin-induced type 1 diabetes mellitus (T1DM) mouse model. However, the FVB (Cg)-Tg (Cryaa-Tag, Ins2-CALM1) 26OVE/PneJ (OVE26) transgenic mouse is a widely recommended mouse model to recapture the most important features of T1DM nephropathy that often occurs in diabetic patients. In addition, most previous studies focused on exploring the preventive effect of FGF21 on the development of DN. However, in clinic, development of therapeutic strategy has much more realistic value compared with preventive strategy since the onset time of DN is difficult to be accurately predicted. Therefore, in the present study OVE26 mice were used to investigate the potential therapeutic effects of FGF21 on DN.

Methods

Four-month-old female OVE26 mice were intraperitoneally treated with recombinant FGF21 at a dose of 100 µg/kg/day for 3 months. The diabetic and non-diabetic control mice were treated with phosphate-buffered saline at the same volume. Renal functions, pathological changes, inflammation, apoptosis, oxidative stress and fibrosis were examined in mice of all groups.

Results

The results showed that severe renal dysfunction, morphological changes, inflammation, apoptosis, and fibrosis were observed in OVE26 mice. However, all the renal abnormalities above in OVE26 mice were significantly attenuated by 3-month FGF21 treatment associated with improvement of renal adenosine 5′-monophosphate (AMP)-activated protein kinase (AMPK) activity and sirtuin 1 (SIRT1) expression.

Conclusion

Therefore, this study demonstrated that FGF21 might exert therapeutic effects on DN through AMPK-SIRT1 pathway.

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Basic Research
Article image
Inhibition of Ceramide Accumulation in Podocytes by Myriocin Prevents Diabetic Nephropathy
Chang-Yun Woo, Ji Yeon Baek, Ah-Ram Kim, Chung Hwan Hong, Ji Eun Yoon, Hyoun Sik Kim, Hyun Ju Yoo, Tae-Sik Park, Ranjan Kc, Ki-Up Lee, Eun Hee Koh
Diabetes Metab J. 2020;44(4):581-591.   Published online November 4, 2019
DOI: https://doi.org/10.4093/dmj.2019.0063
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AbstractAbstract PDFPubReader   ePub   
Background

Ceramides are associated with metabolic complications including diabetic nephropathy in patients with diabetes. Recent studies have reported that podocytes play a pivotal role in the progression of diabetic nephropathy. Also, mitochondrial dysfunction is known to be an early event in podocyte injury. Thus, we tested the hypothesis that ceramide accumulation in podocytes induces mitochondrial damage through reactive oxygen species (ROS) production in patients with diabetic nephropathy.

Methods

We used Otsuka Long Evans Tokushima Fatty (OLETF) rats and high-fat diet (HFD)-fed mice. We fed the animals either a control- or a myriocin-containing diet to evaluate the effects of the ceramide. Also, we assessed the effects of ceramide on intracellular ROS generation and on podocyte autophagy in cultured podocytes.

Results

OLETF rats and HFD-fed mice showed albuminuria, histologic features of diabetic nephropathy, and podocyte injury, whereas myriocin treatment effectively treated these abnormalities. Cultured podocytes exposed to agents predicted to be risk factors (high glucose, high free fatty acid, and angiotensin II in combination [GFA]) showed an increase in ceramide accumulation and ROS generation in podocyte mitochondria. Pretreatment with myriocin reversed GFA-induced mitochondrial ROS generation and prevented cell death. Myriocin-pretreated cells were protected from GFA-induced disruption of mitochondrial integrity.

Conclusion

We showed that mitochondrial ceramide accumulation may result in podocyte damage through ROS production. Therefore, this signaling pathway could become a pharmacological target to abate the development of diabetic kidney disease.

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Cardiovascular Risk/Epidemiology
Article image
Associations among Obesity Degree, Glycemic Status, and Risk of Heart Failure in 9,720,220 Korean Adults
Eun-Jung Rhee, Hyemi Kwon, Se Eun Park, Kyung-Do Han, Yong-Gyu Park, Yang-Hyun Kim, Won-Young Lee
Diabetes Metab J. 2020;44(4):592-601.   Published online April 20, 2020
DOI: https://doi.org/10.4093/dmj.2019.0104
Correction in: Diabetes Metab J 2020;44(5):783
  • 7,541 View
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  • 19 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background

Recent studies suggest an association between diabetes and increased risk of heart failure (HF). However, the associations among obesity status, glycemic status, and risk of HF are not known. In this study, we analyzed whether the risk of HF increases in participants according to baseline glycemic status and whether this increased risk is associated with obesity status.

Methods

We analyzed the risk of HF according to baseline glycemic status (normoglycemia, impaired fasting glucose [IFG], and diabetes) in 9,720,220 Koreans who underwent Korean National Health Screening in 2009 without HF at baseline with a median follow-up period of 6.3 years. The participants were divided into five and six groups according to baseline body mass index (BMI) and waist circumference, respectively.

Results

Participants with IFG and those with diabetes showed a 1.08- and 1.86-fold increased risk of HF, respectively, compared to normoglycemic participants. Compared to the normal weight group (BMI, 18.5 to 22.9 kg/m2), the underweight group (BMI <18.5 kg/m2) showed a 1.7-fold increased risk of HF, and those with BMI ≥30 kg/m2 showed a 1.1-fold increased risk of HF, suggesting a J-shaped association with BMI. When similar analyses were performed for different glycemic statuses, the J-shaped association between BMI and HF risk was consistently observed in both groups with and without diabetes.

Conclusion

Participants with IFG and diabetes showed a significantly increased HF risk compared to normoglycemic participants. This increased risk of HF was mostly prominent in underweight and class II obese participants than in participants with normal weight.

Citations

Citations to this article as recorded by  
  • Association between underweight and risk of heart failure in diabetes patients
    Tae Kyung Yoo, Kyung‐Do Han, Eun‐Jung Rhee, Won‐Young Lee
    Journal of Cachexia, Sarcopenia and Muscle.2024; 15(2): 671.     CrossRef
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    Tae Kyung Yoo, Kyung-Do Han, Yang-Hyun Kim, Ga Eun Nam, Sang Hyun Park, Eun-Jung Rhee, Won-Young Lee
    Diabetes & Metabolism Journal.2023; 47(6): 846.     CrossRef
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    Darae Kim
    Diabetes & Metabolism Journal.2020; 44(5): 777.     CrossRef
  • Response: Associations among Obesity Degree, Glycemic Status, and Risk of Heart Failure in 9,720,220 Korean Adults (Diabetes Metab J 2020;44:592-601)
    Eun-Jung Rhee, Won-Young Lee
    Diabetes & Metabolism Journal.2020; 44(5): 781.     CrossRef
Covid-19
Article image
The Clinical Characteristics and Outcomes of Patients with Moderate-to-Severe Coronavirus Disease 2019 Infection and Diabetes in Daegu, South Korea
Mi Kyung Kim, Jae-Han Jeon, Sung-Woo Kim, Jun Sung Moon, Nan Hee Cho, Eugene Han, Ji Hong You, Ji Yeon Lee, Miri Hyun, Jae Seok Park, Yong Shik Kwon, Yeon-Kyung Choi, Ki Tae Kwon, Shin Yup Lee, Eon Ju Jeon, Jin-Woo Kim, Hyo-Lim Hong, Hyun Hee Kwon, Chi Young Jung, Yin Young Lee, Eunyeoung Ha, Seung Min Chung, Jian Hur, June Hong Ahn, Na-young Kim, Shin-Woo Kim, Hyun Ha Chang, Yong Hoon Lee, Jaehee Lee, Keun-Gyu Park, Hyun Ah Kim, Ji-Hyun Lee
Diabetes Metab J. 2020;44(4):602-613.   Published online August 12, 2020
DOI: https://doi.org/10.4093/dmj.2020.0146
  • 14,709 View
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  • 71 Web of Science
  • 83 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background

Coronavirus disease 2019 (COVID-19) is a global pandemic that had affected more than eight million people worldwide by June 2020. Given the importance of the presence of diabetes mellitus (DM) for host immunity, we retrospectively evaluated the clinical characteristics and outcomes of moderate-to-severe COVID-19 in patients with diabetes.

Methods

We conducted a multi-center observational study of 1,082 adult inpatients (aged ≥18 years) who were admitted to one of five university hospitals in Daegu because of the severity of their COVID-19-related disease. The demographic, laboratory, and radiologic findings, and the mortality, prevalence of severe disease, and duration of quarantine were compared between patients with and without DM. In addition, 1:1 propensity score (PS)-matching was conducted with the DM group.

Results

Compared with the non-DM group (n=847), patients with DM (n=235) were older, exhibited higher mortality, and required more intensive care. Even after PS-matching, patients with DM exhibited more severe disease, and DM remained a prognostic factor for higher mortality (hazard ratio, 2.40; 95% confidence interval, 1.38 to 4.15). Subgroup analysis revealed that the presence of DM was associated with higher mortality, especially in older people (≥70 years old). Prior use of a dipeptidyl peptidase-4 inhibitor or a renin-angiotensin system inhibitor did not affect mortality or the clinical severity of the disease.

Conclusion

DM is a significant risk factor for COVID-19 severity and mortality. Our findings imply that COVID-19 patients with DM, especially if elderly, require special attention and prompt intensive care.

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Brief Report
Complications
Article image
Short-Term Walking Outcomes in Diabetic and Non-Diabetic Unilateral Transtibial Amputees
Dong Gyu Kwak, Jeong-Yong Hur, Jun Sung Moon, Min Cheol Chang
Diabetes Metab J. 2020;44(4):614-618.   Published online November 4, 2019
DOI: https://doi.org/10.4093/dmj.2019.0080
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This study compared short-term walking outcomes in diabetic amputees after prosthesis fitting compared to that in non-diabetic amputees. We retrospectively investigated walking outcomes at 3 months after starting gait training with a prosthesis. Forty-four unilateral transtibial amputees with (n=18) and without diabetes (n=26) were included. At 3 months after gait training with a prosthesis, only 2/18 (11.1%) and 3/18 (16.7%) diabetic amputees were capable of independent outdoor and indoor walking without cane, respectively. However, 21/26 (80.8%) and 24/26 (92.3%) non-diabetic amputees were capable of independent outdoor and indoor walking without cane, respectively. With assistance of cane, most of non-diabetic amputees (n=24, 92.3%) were capable of walking in both outdoor and indoor but only seven (38.9%) and nine (50.0%) diabetic amputees were capable, respectively. Thus, short-term walking outcome were poor in transtibial amputee with diabetes compare to those without diabetes, and these results suggest intensive rehabilitation would be needed to them.

Letters
Letter: The Risk of Diabetes on Clinical Outcomes in Patients with Coronavirus Disease 2019: A Retrospective Cohort Study (Diabetes Metab J 2020;44:405–13)
So-Yeon Kim, Kyung-Soo Kim
Diabetes Metab J. 2020;44(4):621-622.   Published online August 21, 2020
DOI: https://doi.org/10.4093/dmj.2020.0151
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  • 1 Crossref
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    Journal of Personalized Medicine.2021; 11(6): 459.     CrossRef
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