- Clinical Characteristics and Direct Medical Costs of Type 2 Diabetic Patients.
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Eun Joon Moon, Young Eun Jo, Tae Chin Park, Yun Kyung Kim, Sun Hye Jung, Hae Jin Kim, Dae Jung Kim, Yoon Sok Chung, Kwan Woo Lee
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Korean Diabetes J. 2008;32(4):358-365. Published online August 1, 2008
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DOI: https://doi.org/10.4093/kdj.2008.32.4.358
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- BACKGROUND
Type 2 diabetes mellitus is an expensive chronic metabolic disorder and its prevalence has been increasing rapidly in South Korea, owing to a westernized lifestyle. We analyzed the annual direct medical costs attributable to type 2 diabetes and its chronic complications in Korea retrospectively. METHODS: We randomly selected 1,051 patients with type 2 diabetes who visited Ajou University Hospital as an outpatient in 2005. Clinical characteristics, duration of diabetes, and microvascular and macrovascular complications were assessed from a medical chart review. The annual direct medical costs included insurance covered and uncovered medical costs. RESULTS: Of the 1,051 patients with type 2 diabetes, 48.2% had at least one microvascular complication, 5.6% had at least one macrovascular complication, and 12.4% of the patients had both microvascular and macrovascular complications. The average annual direct medical cost was found to be 3,348,488won per patient. In patients with microvascular complications, the total cost of management was increased 1.4 times compared to those without complications. Direct medical costs for patients with macrovascular complications were 2.1-fold as high as patients with no complications. Those patients with both microvascular and macrovascular complications, increased costs by 3.1-fold over those without complications. CONCLUSION: Chronic complications have a substantial impact on the direct medical costs of type 2 diabetes. The prevention of chronic diabetic complications will not only influence the mortality and morbidity of patients with type 2 diabetes, but also potentially reduce medical costs.
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Citations
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- Chronic Diabetic Complications in the Insulin- Treated Animal Model of Type 2 Diabetes Mellitus.
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Jee Won Park, Sung Kyu Lee, Hyo Jung Kim, Hae Lim Noh, Chang Young Hah, Su Jin Lee, Yoon Sok Chung, Kwan Woo Lee, Hyun Man Kim, Eun Ju Paek
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Korean Diabetes J. 2001;25(3):200-210. Published online June 1, 2001
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- BACKGROUND
Non-Insulin Dependent Diabetes Mellitus (NIDDM) is a characterized by insulin resistance and impairment of beta cell function. OLETF male rat usually developed NIDDM and obesity at 20 weeks old spontaneously. It is a metabolically characterized by insulin resistance in onset of early disease. However, body weight and insulin secretory function was gradually reduced during the diabetes developed. These characteristics of disease is similar to Korean type 2 diabetic patients. NIDDM patients in Korea are thought to be different from traditional NIDDM in western countries. They are non obese type and also has reduced insulin secretory function compared to western countries. These patients are not easily managed on diet and/or oral hypoglycemic agent. Reduced C-peptide and insulin concentrations in these patients are similar to patients with IDDM. In these patients, insulin therapy is effective to control glucose level. Therefore, we investigated the effect of insulin and oral hypoglycemic therapy to glucose control and severity of chronic complications in OLETF male rats of 6weeks (42 weeks old) and 14 weeks (50 weeks old) treated groups. MATERIAL AND METHODS: The OLETF male rats which are 36 weeks old is diagnosed to NIDDM. A total of 20 rats were stratified into the three groups: control group (n=3), OHA's group; rats treated by OHA's (n=3) and insulin group; rats treated with insulin (n=4). We evaluated anthropometry, fasting glucose and 75 gram OGATT, nerve conduction studies, sclerotic degree of kidney and thickness of carotid arteries at 42 and 50 weeks old. RESULTS: In the 42 weeks old groups (6 weeks treated group), there was a significant difference in weight gain in group 3 but no differences were observed in kidney tissue pathology and thickness of carotid arteries. In the 50 weeks old groups (14 weeks treated group), there were also no changes in the kidneys and arteries, but weight gain and peak amplitude in NCV was significantly higher in insulin - treated group. CONCLUSIONS: OLETF male rats as NIDDM animal mocel, with late stage diabetic complications show weight loss and decreased insulin secretory capacity. Insulin treated group shows improved blood glucose control. Also it showed improved severity of diabetic neuropathy.
- Microvascular Complications and lts Relationship with Obesity in Outpatient Type 2 Diabetics.
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Seong Kyu Lee, Bong Nam Chae, Eun Gyoung Hong, Hye Lim Noh, Hyeon Kyoung Cho, Yoon Jung Kim, Mi Deok Lee, Yoon Sok Chung, Kwan Woo Lee, Nam Han Cho, Hyeon Man Kim
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Korean Diabetes J. 2000;24(1):60-70. Published online January 1, 2001
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Korean type 2 diabetic patients who are frequently non-obese, may be genetically different from Western type 2 diabetics who are frequently obese. Therefore, the diabetic complications of type 2 diabetes mellitus in Korea may be also different from those of Western countries. Until now, most studies reported in Korea did not analyse the microvascular complications of type 2 diabetes mellitus according to obesity, and also the criteria in the diagnosis of microvascular complications were different in each study. We investigated the microvascular complications and its relationship with obesity, in type 2 diabetic patients visiting an outpatient clinic. METHODS: The study subjects were type 2 diabetic patients visiting an outpatient clinic of Ajou University Hospital. We selected patients participating in a 75 g oral glucose tolerance test, retrospectively. Type 2 diabetes was diagnosed according to the WHO/NDDG classification of diabetes. Biochemical studies including lipid profile, plasma insulin and C-peptide levels were done. Anthropometric measurements were performed. Based on BMI (kg/m2), the patients were divided into the following groups: the lean group, whan the BMI was less than 20kg/m2; the ideal body weight (IBW) group, if the BMI was between 20 kg/m and 25 kg/m in women and 20kg/m and 27 kg/m in men; and the obese group, when the BMI was>25 kg/m in women and >27 kg/m2 in men. RESULTS: 1. Neuropathy (45.2%) was the most frequent among the microvascular complications, and the frequency of retinopathy was 15.1%, and that of nephropathy was 4.9k. Within 5 years of diabetes duration, the frequency of neuropathy, retinopathy, and nephropathy was 43.2%, 11.8%, and 2,9%, respectively. 2. Glycosylated hemoglobin (HbA1c) and fasting blood glucose levels were not different among the three groups. Beta cell function{delta(insulin 30min insulin Omin)/delta(glucose 30min - glucose Omin)} was the highest in the obese group, However, beta cell function(delta/delta G) divided by the basal insulin level, considered insulin resistance, was not different among the three groups. 3. Within 5 years of diabetes duration, retinopathy tended to be the most frequent in the lean group, whereas neuropathy tended to be the most frequent in the obese group, and body mass index influenced the retinopathy and neuropathy, statistically significantly. CONCLUSION: Diabetic neuropathy was the most frequent among microvascular complications of type 2 diabetes mellitus in our study subjects. At the time of presentation within 5 years of diabetes duration, the lean group of type 2 diabetics had a tendency of the more frequent retinopathy, the obese group had a tendency of the more frequent neuropathy. These results suggest that type 2 diabetes mellitus in Korea is also not a singie disease entity, as in Western countries and is a heterogenous group of disorders with a diversity of microvascular complications. However, the more studies about this will be required.
- Insulin Resistance and Related Factors in the Healthy Young Men.
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Seok Won Park, Yoon Sok Chung, Yong Seok Yun, Bong Soo Cha, Young Duk Song, Hyun Chul Lee, Kap Bum Huh
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Korean Diabetes J. 1998;22(4):504-512. Published online January 1, 2001
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Resistance to insulin-stimulated glucose uptake is present in the majority of patients with obesity, glucose intolerance, hypertension, dyslipidemia, and coronary artery disease. It is known that values for insulin-stimulated glucose uptake(insulin sensitivity) vary widely within individuals with normal glucose tolerance. We investigated the variations in insulin sensitivity and related factors in the nonobese healthy young men. METHODS: Insulin sensitivity was considered as whole body insulin-stimulated glucose uptake rate(M), determined by euglycemic hyperinsulinemic clamp technique in 44 non-obese healthy young men with normal glucose tolerance. Plasma glucose, insulin, and C-peptide concentrations after a standard oral glucose tolerance test and total cholesterol, triglyceride, and HDL-cholesterol levels were measured after 12-hours fasting. The subjects were divided into four quartiles based on the insulin sensitivity (M) and their clinical and biochemical characteristics were compared. RESULTS: Glucose disposal rates (M-values) were ranged from 4.14 to 11.06 mg/kg/min and distributed normally. The plasma glucose levels were not different between quartiles but plasma insulin levels of quartile 1 were significantly higher than the other three quartiles during oral glucose tolerance test. There was a curvilinear relationship between insulin sensitivity and acute insulin response (Ins[o-30]) to oral glucose challenge. There were negative cnrrelations between insulin sensitivity and BMI, percent ideal body weight, WHR, body fat content, fasting insulin level, insulin response area during OGTT, and fasting serum triglyceride level. HDL-cholesterol concentration was positively correlated with insulin sensitivity. In multiple linear regression analysis, body fat content, fasting insulin, and HDL-cholesterol were independent variables, which were related to the insulin sensitivity. CONCLUSION: There were considerable variations in insulin sensitivity in the nonobese healthy young men with normal glucose tolerance and the related independent factors were body fat content, fasting insulin, and HDL-cholesterol cancentrations.
- The Role of Insulin Secretion and Insulin Resistance in the Development of Korean Type 2 Diabetes Mellitus.
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Bong Nam Chae, Seong Kyu Lee, Eun Gyoung Hong, Yoon Sok Chung, Kwan Woo Lee, Hyeon Man Kim
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Korean Diabetes J. 1998;22(4):491-503. Published online January 1, 2001
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Impaired insulin secretinn, peripheral insulin resistance, a disproportionately elevated rate of hepatic glucose production and influence of inherited or enviromental factors contribute to the pathogenesis of type 2 diabetes mellitus(DM). But, which defect is primary is still controversial To determine whether insulin resistance or insulin deficiency is primary in the pathogenesis of type 2 DM, we studied normal glucose tolerant offsprings of type 2 diabetic patients. METHODS: 22 offsprings of type 2 diabetic patients with normal glucose tolerance, ranging in age from 20 to 40 years, and 17 control subjects in same age range who had no family history of diabetes, and 21 diabetic subjects were included. We performed 75 g oral glucose tolerance test, euglycemic hyper-insulinemic clamp test and hyperglycemic clamp test. RESULTS: With euglycemic clamp test, the values of peripheral insulin sensitivity, M, were 8.59+0.94 mg/kg/min in control group, 6.98+0.65 mg/kg/min in offspring group, and 5.19+0.89 mg/kg/min in diabetes group (P<0.05). Considering that lower limit of the normal range were 3.78 mg/kg/min in M and 3.10 mg/kg/min in M/I, the frequency of insulin resistance was 14.3% in the offspring group and 33.3 % in diabetes group. First and second phase insulin secretion during hyperglycemic clamp test were blunted in diabetes group. In the offspring group, first and second phase insulin secretion during hyperglycemic clamp test were increased greater than control group, though statistically insignificant. The mean first phase insulin secretion were 38.55+6.81 pU/mL in control group, 55.09+9.40 pU/mL in the offspring group and 6.02+0.98 pU/mL in diabetes group (P<0.05). The mean second phase insulin secretion were 65.11+15.5 pU/mL in control group, 90.25 + 11.9 pU/mL in the offspring group and 17.6 +2.71 pUmL in diabetes group(P<0,05). Considering that lower limit of the normal range were 19.5 pU/mL in the first phase insulin secretion and 26.1 pU/mL in the second phase insulin secretion, the frequency of impaired insulin secretion was 14.3 % in the offspring group and 100 % in diabetes group. There was an inverse relation between insulin resistance and insulin secretion in control subjects. But in the offspring group, this relation was absent. CONCLUSION: Our results show that both insulin resistance and impaired insulin secretion contribute to the development of type 2. DM in Koreans. In addifion, diabetic subjects had more severe impairment in insulin secretory capacity than insulin resistance.
- The Oxidative Stress and the Antioxidant System in Type 2 Diabetics with Complications.
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Ae Wha Ha, Hye Lim Noh, Yoon Sok Chung, Kawn Woo Lee, Hyeon Man Kim, Jung Soon Cho
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Korean Diabetes J. 1998;22(3):253-261. Published online January 1, 2001
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Diabetes mellitus represents a state of increased oxidative stress which is based on the evidence of increased peroxidation and glycosylation, and reduced antioxidant system. It has been suggested that increased oxidative stress may play an important role on the pathogenesis of diabetic complication in type 2 diabetes. However, limited informations regarding the oxidative stress and antioxidant system in diabetic complications are available. Therefore the purpose of this study is to determine the oxidative stress and antioxidant system in type 2 diabetes with diabetic complications. METHODS: The study population consisted of 94 type 2 diabetic patients and 44 normal subjects. The concentration of thiobarbituric acid reactive substance(TBA-RS) and the activities of antioxidants enzymes, catalase, superoxide dismutase(SOD), glutathione peroxidase(GSH-Px) in erythrocyte were detennined by using spectrophotometer. The plasma concantrations of b-carotene, lycopene, lutein, a-tocopherol and retinol were determined by using HPLC. RESULTS: The TBA-RS concentrations in type 2 diabetes(1.33+0.30nmol/mL) were significantly higher than those in normal subjects(1.10+0.17nmol/ mL). Also the TBA-RS concentrations between subjects with complications(1.37+0.27nmol/mL) and without complications(1.28+0.17nmol/mL) differed (p<0.05). The activities of SOD and GSH-Px in type 2 diabetes(2.99+0.80U/mgHb, 2.88+0.39U/ mgHb) were significantly lower than those in normal subjects(3.54+0.44U/mgHb, 3.14+0.39U/mgHb). GSH-Px between diabetics with(2.81+0.6U/mgHb) and without complications(3.17+0.4U/mgHb) differed significantly. The plasma concentrations of lycopene and b-carotene were significantly lower in type 2 diabetes(0.07+0.05umol/L, 0.54+0.27umol/L) than in control subjects(0.14+0.06umol/L, 0.67+0.32umol/L). Also, lycopene and b-carotene in subjects with complications(0.05+0.04umol/L, 0.45+0.23umol/L) were lower than in subjects without complications(0.08+0.05umol/L, 0.62+0.30umol/L). No significant differences in plasma a-tocopherol concentrations between subjects with and without complications(19.42+0.93umol/L vs 18.66+ 0.79umoll/L). CONCLUSION: This study showed that in diabetes with diabetic complications, the lipid peroxidation of erythrocytes are highly increased and the antioxidant reserves are significmtly depleted, compared with diabetes without diabetic complications, which suggests that diabetes with complications are under high oxidative stress and the supplementations of carotenoids could decrease the oxidative stress in diabetes with diabetic complications.
- Fibroblast PC-1 mRNA Content, Body mass index and Insulin Sensitivity in Korean NIDDM Patients.
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Deok Bae Park, Seong Kyu Lee, Young Goo Shin, Seong Keun Lee, Yoon Sok Chung, Kwan Woo Lee, Hyeon Man Kim
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Korean Diabetes J. 1997;21(4):388-396. Published online January 1, 2001
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- A clinical trial of celiprolol in type II diabetic patients with essential hypertension.
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Seung Woo Park, Yoon Sok Chung, June O Park, Seog Won Park, Sung Kil Lim, Hyun Chul Lee, Kap Bum Huh
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Korean Diabetes J. 1993;17(3):307-313. Published online January 1, 2001
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- The relationship between renin-aldosterone system and obesity in non-insulin dependent diabetes mellitus(NIDDM).
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Kwang Jin Ahn, Yoon Sok Chung, Choon Hee Chung, Eun Jig Lee, Sung Kil Lim, Kyung Rac Kim, Hyun Chul Lee, Kap Bum Huh
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Korean Diabetes J. 1993;17(3):283-291. Published online January 1, 2001
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- Effects of w3 fatty acid supplementation on serum lipids in patients with non-insulin dependent diabetes mellitus.
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Yoon Sok Chung, Seog Won Park, Jin Ahn Kim, Eun Jig Lee, Sung Kil Lim, Kyung Rac Kim, Hyun Chul Lee, Kap Bum Huh, In Kyoung Paik, Ji Young Yoon, Hee Son Kim, Hyun Jong Chang
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Korean Diabetes J. 1993;17(3):267-274. Published online January 1, 2001
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- Type V hyperlipopropteinemia during acute pancreatitis in diabetic and recurrent pancreatitic patient.
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Gil Jin Jang, Yoon Sok Chung, Dong Woon Jun, Seog Won Park, Sung Kil Lim, Hyun Chul Lee, Kap Bum Huh
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Korean Diabetes J. 1993;17(2):225-229. Published online January 1, 2001
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- Gastric emptying in diabetic patients and effect of cisapride.
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Hyun Seung Shin, Yoon Sok Chung, Jae Hee Chung, Young Sik Lee, Seog Won Park, Sung Kil Lim, Hyun Chul Lee, Kap Bum Huh
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Korean Diabetes J. 1993;17(2):207-216. Published online January 1, 2001
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- Clinical Effect of cliostazol in non-insulin deptendent diabetic patients with peripheral vascular disease.
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Yoon Sok Chung, Hyun Chul Lee, Kap Bum Huh
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Korean Diabetes J. 1993;17(1):111-117. Published online January 1, 2001
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- Effects of acipimox on lipid and glucose metabolism in NIDDM patients with concomitant hyperlipidemia.
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Seog Won Park, Yoon Sok Chung, Hyun Seung Shin, Choon Hee Chung, Kwang Jin Ahn, Sung Kim Lim, Hyun Chul Lee, Kap Bum Huh
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Korean Diabetes J. 1993;17(1):99-104. Published online January 1, 2001
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- Effect of nutritional support on underweight non-insulin dependent diabetics.
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Yoon Sok Chung, Hyun Chul Lee, Kap Bum Huh, Jong Ho Lee, In Kyung Paik, Mi Sook Choi, Soo Jae Moon, Seong Su Cheong
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Korean Diabetes J. 1992;16(1):55-62. Published online January 1, 2001
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- Influence of body fat distribution onglucose tolerance and serum lipids in patients with non-insulin dependent diabetes mellitus.
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Mi Sook Choi, Jong Ho Lee, In Kyoung Paik, Yoon Sok Chung, Hyun Chul Lee, Kap Bum Huh
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Korean Diabetes J. 1992;16(1):45-53. Published online January 1, 2001
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- No abstract available.
- Influence of duration of diabetes on nutritional status in non-insulin dependent diabetes mellitus.
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Mi Sook Choi, Jong Ho Lee, In Kyoung Paik, Kwang Jin Ahn, Yoon Sok Chung, Hyun Chul Lee, Kap Bum Huh
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Korean Diabetes J. 1992;16(1):35-44. Published online January 1, 2001
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- Is the pancreas of cytomegalovirus genome in type I diabetic Koreans significant?.
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Yoon Sok Chung, Hyun Chul Lee, Kwang Jin Ahn, Eun Jig Lee, Seung Kil Lim, Kap Bum Huh, Dong Soo Kim, Duk Hi Kim, Jeong Im Lee
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Korean Diabetes J. 1991;15(2):213-219. Published online January 1, 2001
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