Diabetes & Metabolism Journal

Original Articles

Clinical Care/Education
Physician-Directed Diabetes Education without a Medication Change and Associated Patient Outcomes: Hun-Sung Kim, Hyunah Kim, Hae-Kyung Yang, Eun Young Lee, Yoo Jin Jeong, Tong Min Kim, So Jung Yang, Seo Yeon Baik, Seung-Hwan Lee, Jae Hyoung Cho, In Young Choi, Hyeon Woo Yim, Bong-Yun Cha; Diabetes Metab J. 2017;41(3):187-194. Published online May 12, 2017; DOI: https://doi.org/10.4093/dmj.2017.41.3.187

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Background

When patients with diabetes mellitus (DM) are first referred to a hospital from primary health care clinics, physicians have to decide whether to administer an oral hypoglycemic agent (OHA) immediately or postpone a medication change in favor of diabetes education regarding diet or exercise. The aim of this study was to determine the effect of diabetes education alone (without alterations in diabetes medication) on blood glucose levels.

Methods

The study was conducted between January 2009 and December 2013 and included patients with DM. The glycosylated hemoglobin (HbA1c) levels were evaluated at the first visit and after 3 months. During the first medical examination, a designated doctor also conducted a diabetes education session that mainly covered dietary management.

Results

Patients were divided into those who received no diabetic medications (n=66) and those who received an OHA (n=124). Education resulted in a marked decrease in HbA1c levels in the OHA group among patients who had DM for <1 year (from 7.0%±1.3% to 6.6%±0.9%, P=0.0092) and for 1 to 5 years (from 7.5%±1.8% to 6.9%±1.1%, P=0.0091). Those with DM >10 years showed a slightly lower HbA1c target achievement rate of <6.5% (odds ratio, 0.089; P=0.0024).

Conclusion

For patients who had DM for more than 5 years, higher doses or changes in medication were more effective than intensive active education. Therefore, individualized and customized education are needed for these patients. For patients with a shorter duration of DM, it may be more effective to provide initial intensive education for diabetes before prescribing medicines, such as OHAs.

Citations

Citations to this article as recorded by

Management Status of Patients with Type 2 Diabetes Mellitus at General Hospitals in Korea: A 5-Year Follow-Up Study
Jin Hee Jung, Jung Hwa Lee, Hyang Mi Jang, Young Na, Hee Sun Choi, Yeon Hee Lee, Yang Gyo Kang, Na Rae Kim, Jeong Rim Lee, Bok Rye Song, Kang Hee Sim
The Journal of Korean Diabetes.2022; 23(1): 64. CrossRef
Effect of Voluntary Participation on Mobile Health Care in Diabetes Management: Randomized Controlled Open-Label Trial
Da Young Lee, Seung-Hyun Yoo, Kyong Pil Min, Cheol-Young Park
JMIR mHealth and uHealth.2020; 8(9): e19153. CrossRef
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Efficacy of the Smartphone-Based Glucose Management Application Stratified by User Satisfaction: Hun-Sung Kim, Wona Choi, Eun Kyoung Baek, Yun A Kim, So Jung Yang, In Young Choi, Kun-Ho Yoon, Jae-Hyoung Cho; Diabetes Metab J. 2014;38(3):204-210. Published online June 17, 2014; DOI: https://doi.org/10.4093/dmj.2014.38.3.204

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Abstract PDF PubReader

Background

We aimed to assess the efficacy of the smartphone-based health application for glucose control and patient satisfaction with the mobile network system used for glucose self-monitoring.

Methods

Thirty-five patients were provided with a smartphone device, and self-measured blood glucose data were automatically transferred to the medical staff through the smartphone application over the course of 12 weeks. The smartphone user group was divided into two subgroups (more satisfied group vs. less satisfied group) based on the results of questionnaire surveys regarding satisfaction, comfort, convenience, and functionality, as well as their willingness to use the smartphone application in the future. The control group was set up via a review of electronic medical records by group matching in terms of age, sex, doctor in charge, and glycated hemoglobin (HbA1c).

Results

Both the smartphone group and the control group showed a tendency towards a decrease in the HbA1c level after 3 months (7.7%±0.7% to 7.5%±0.7%, P=0.077). In the more satisfied group (n=27), the HbA1c level decreased from 7.7%±0.8% to 7.3%±0.6% (P=0.001), whereas in the less satisfied group (n=8), the HbA1c result increased from 7.7%±0.4% to 8.1%±0.5% (P=0.062), showing values much worse than that of the no-smartphone control group (from 7.7%±0.5% to 7.7%±0.7%, P=0.093).

Conclusion

In addition to medical feedback, device and network-related patient satisfaction play a crucial role in blood glucose management. Therefore, for the smartphone app-based blood glucose monitoring to be effective, it is essential to provide the patient with a well-functioning high quality tool capable of increasing patient satisfaction and willingness to use.

Citations

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Relationship between Plasminogen Activator Inhibitor-1 (PAI-1), Lipoprotein(a) and Diabetic Retinopathy in Type 2 Diabetes Mellitus.: Shin Young Choi, Eun Young Kim, Kyung Won Kim, yu Young Jung, Jung Ho, Young Hun Ku, Hyung Kul Lee, Mi Kyung Kim; Korean Diabetes J. 1999;23(4):552-561. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Diabetic retinopathy is a major cause of visual loss today, especially in diabetic patients having disturbances in hemostasis. Plasma plasminogen activator inhibitor-1 (PAI-1) and lipoprotein (a) may be involved in the pathogenesis of diabetic retinopathy of type 2 diabetes mellitus. This study was undertaken to determine whether plasma PAI-1 and Lp(a) levels are increased in type 2 diabetic patients with retinopathy, and to identify factors influencing PAI-1 and Lp(a) levels. METHODS: A total of 177 type 2 diabetic subjects were classified by the presence or absence of retinopathy, 92 and 85, respectively, and fasting blood samples were taken for assay of PAI-1, Lp(a), creatinine clearance, serum lipid profiles and C-peptide levels. RESULTS: Subjects with retinopathy showed higher levels of PAI-1 (p<0.05), Lp(a) (p<0.01), total cholesterol (p<0.01), triglyceride (p<0.01) and longer disease duration than those without retinopathy. In multiple regression analysis, PAI-1 levels were significantly correlated with high density lipoprotein (HDL) cholesterol, while Lp(a) levels were correlated with body mass index, total cholesterol and low density lipoprotein (LDL) cholesterol. CONCLUSION: These results suggest that elevated PAI-1and Lp(a) are associated with the presence of diabetic retinopathy.

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