Journal of Yeungnam Medical Science

Focused Review articles

Management of diabetic foot ulcers: a narrative review: Jahyung Kim, Otgonsaikhan Nomkhondorj, Chi Young An, Ye Chan Choi, Jaeho Cho; J Yeungnam Med Sci. 2023;40(4):335-342. Published online September 22, 2023; DOI: https://doi.org/10.12701/jyms.2023.00682

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Diabetic foot ulcers (DFUs) are among the most serious complications of diabetes and are a source of reduced quality of life and financial burden for the people involved. For effective DFU management, an evidence-based treatment strategy that considers the patient's clinical context and wound condition is required. This treatment strategy should include conventional practices (surgical debridement, antibiotics, vascular assessment, offloading, and amputation) coordinated by interdisciplinary DFU experts. In addition, several adjuvant therapies can be considered for nonhealing wounds. In this narrative review, we aim to highlight the current trends in DFU management and review the up-to-date guidelines.

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Kick-Starting Wound Healing: A Review of Pro-Healing Drugs
Bethany L. Patenall, Kristyn A. Carter, Matthew R. Ramsey
International Journal of Molecular Sciences.2024; 25(2): 1304. CrossRef
Unveiling the challenges of diabetic foot infections: diagnosis, pathogenesis, treatment, and rehabilitation
Chul Hyun Park
Journal of Yeungnam Medical Science.2023; 40(4): 319. CrossRef

Management and rehabilitation of moderate-to-severe diabetic foot infection: a narrative review: Chi Young An, Seung Lim Baek, Dong-Il Chun; J Yeungnam Med Sci. 2023;40(4):343-351. Published online September 19, 2023; DOI: https://doi.org/10.12701/jyms.2023.00717

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Abstract PDF

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.

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Unveiling the challenges of diabetic foot infections: diagnosis, pathogenesis, treatment, and rehabilitation
Chul Hyun Park
Journal of Yeungnam Medical Science.2023; 40(4): 319. CrossRef

Original article

Analysis of single nucleotide polymorphisms associated with the vitamin D pathway in the placentas of women with gestational diabetes mellitus: a laboratory study: Mi Ju Kim, Hyun Mi Kim, Hyun-Hwa Cha, Won Joon Seong; J Yeungnam Med Sci. 2023;40(Suppl):S9-S16. Published online May 8, 2023; DOI: https://doi.org/10.12701/jyms.2023.00150

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Abstract PDF: Background
The aim of this study was to analyze the single nucleotide polymorphisms (SNPs) of genes known to be involved in vitamin D metabolism in the placenta using the placental tissue of mothers diagnosed with gestational diabetes mellitus (GDM) to determine whether the SNPs and occurrence of GDM are related.
Methods
We enrolled 80 women of the same gestational age, 40 with and 40 without GDM. The placenta was obtained from each woman after delivery and SNP genotyping was performed on seven SNPs in the CYP27B1 (rs10877012), CYP24A1 (rs2248359, rs6013897, and rs2209314), and GC (rs2282679, rs16847024, and rs3733359) genes. Maternal serum 25-hydroxyvitamin D levels were measured during the first trimester of pregnancy and before delivery.
Results
At the time of delivery, vitamin D levels were lower (21.05±12.05 mg/dL vs. 31.31±20.72 mg/dL, p=0.012) and the frequency of vitamin D deficiency was higher (60.7% vs. 32.5%, p=0.040) in the GDM group. In women with GDM, the G allele of rs10877012 was more common (86.3% vs. 65.0%, p=0.002). The rs10877012 GG genotype was more common in the GDM group (72.5% vs. 42.5%, p=0.007) and the rs10877012 TT genotype was more common in the control group (12.5% vs. 0%, p=0.007).
Conclusion
Mothers with GDM have lower serum concentrations of vitamin D before delivery than healthy controls and vitamin D deficiency is common. A polymorphism in CYP27B1 (rs10877012), is considered to be a cause of GDM pathogenesis.

Communication

The art of diabetes care: guidelines for a holistic approach to human and social factors: Muhammad Jawad Hashim; J Yeungnam Med Sci. 2023;40(2):218-222. Published online November 11, 2022; DOI: https://doi.org/10.12701/jyms.2022.00577

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Abstract PDF: A holistic approach to diabetes considers patient preferences, emotional health, living conditions, and other contextual factors, in addition to medication selection. Human and social factors influence treatment adherence and clinical outcomes. Social issues, cost of care, out-of-pocket expenses, pill burden (number and frequency), and injectable drugs such as insulin, can affect adherence. Clinicians can ask about these contextual factors when discussing treatment options with patients. Patients’ emotional health can also affect diabetes self-care. Social stressors such as family issues may impair self-care behaviors. Diabetes can also lead to emotional stress. Diabetes distress correlates with worse glycemic control and lower overall well-being. Patient-centered communication can build the foundation of a trusting relationship with the clinician. Respect for patient preferences and fears can build trust. Relevant communication skills include asking open-ended questions, expressing empathy, active listening, and exploring the patient’s perspective. Glycemic goals must be personalized based on frailty, the risk of hypoglycemia, and healthy life expectancy. Lifestyle counseling requires a nonjudgmental approach and tactfulness. The art of diabetes care rests on clinicians perceiving a patient’s emotional state. Tailoring the level of advice and diabetes targets based on a patient’s personal and contextual factors requires mindfulness by clinicians.

Original articles

Association of advanced chronic kidney disease with diabetic retinopathy severity in older patients with diabetes: a retrospective cross-sectional study: Geun Woo Lee, Chul Ho Lee, Seong Gyu Kim; J Yeungnam Med Sci. 2023;40(2):146-155. Published online May 26, 2022; DOI: https://doi.org/10.12701/jyms.2022.00206

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Abstract PDF

Background
Despite the recent increasing trend in the prevalence of type 2 diabetes among older individuals, the relationship between diabetic retinopathy (DR) and chronic kidney disease (CKD) in these patients remains unclear. This study investigated the severity of renal dysfunction according to the degree of DR in older patients with type 2 diabetes.
Methods
A total of 116 patients with diabetes and CKD stage ≥3 who visited both the nephrology and ophthalmology outpatient departments between July 2021 and January 2022 were screened. There were 53 patients in the no DR group, 20 in the nonproliferative DR (NPDR) group, and 43 in the proliferative DR (PDR) group.
Results
DR severity was related to the deterioration of renal function. The proportion of patients with advanced CKD significantly increased with DR severity (p for trend <0.001). In the multivariate regression model adjusted for age of ≥80 years, male sex, poorly controlled diabetes, macroalbuminuria, insulin use, diabetes duration of ≥10 years, cerebrovascular accident, hypertension, hyperlipidemia, and cardiovascular disease history, the odds ratio compared with the no DR group was approximately 4.6 for the NPDR group and approximately 11.8 for the PDR group, which were both statistically significant (p=0.025 and p<0.001, respectively).
Conclusion
DR severity in older patients with diabetes may be associated with deterioration of renal function and high prevalence of advanced CKD. Therefore, periodic examination for DR in older patients with diabetes is important for predicting renal function deterioration and CKD progression.

Citations

Citations to this article as recorded by

Diabetic Macular Edema Is Predictive of Renal Failure in Patients With Diabetes Mellitus and Chronic Kidney Disease
Shih-Hsiang Ou, Wei-Che Chang, Ling-Ying Wu, Shiow-Ing Wang, James Cheng-Chung Wei, Po-Tsang Lee
The Journal of Clinical Endocrinology & Metabolism.2024; 109(3): 761. CrossRef
Study on Correlation between Renal Function and Diabetic Retinopathy
卓越郑
Advances in Clinical Medicine.2024; 14(03): 513. CrossRef

Increase in blood glucose level and incidence of diabetic ketoacidosis in children with type 1 diabetes mellitus in the Daegu-Gyeongbuk area during the coronavirus disease 2019 (COVID-19) pandemic: a retrospective cross-sectional study: Mi Seon Lee, Rosie Lee, Cheol Woo Ko, Jung Eun Moon; J Yeungnam Med Sci. 2022;39(1):46-52. Published online August 26, 2021; DOI: https://doi.org/10.12701/yujm.2021.01221

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Abstract PDF

Background
The coronavirus disease 2019 (COVID-19) outbreak in the Daegu-Gyeongbuk area in 2020 has caused difficulties in the daily life and hospital care of children with type 1 diabetes mellitus (T1DM). We detected an increase in blood sugar levels in these children and the number of patients hospitalized with more severe diabetic ketoacidosis (DKA) compared to those before COVID-19.
Methods
This single-center study was conducted at Kyungpook National University Children’s Hospital. The following patient groups were included; 45 returning patients diagnosed with T1DM and undergoing insulin treatment for more than 2 years and 20 patients newly diagnosed with T1DM before and after COVID-19 were selected by age matching. Returning patients before and after the outbreak were selected, and changes in hemoglobin A1c (HbA1c) levels were retrospectively reviewed. The HbA1c levels and severity of symptoms in newly diagnosed patients during hospitalization were examined.
Results
HbA1c levels in returning patients with T1DM were significantly increased after COVID-19 (before, 7.70%±1.38% vs. after, 8.30%±2.05%; p=0.012). There were 10 and 10 newly diagnosed patients before and after COVID-19, respectively. The proportion of patients with drowsiness and dyspnea at the time of admission was higher after COVID-19 than before (before, 2 of 10 vs. after, 4 of 10). The HbA1c levels were higher in newly diagnosed patients hospitalized after COVID-19 than before (before, 11.15% vs. after, 13.60%; p=0.036).
Conclusion
Due to COVID-19 in the Daegu-Gyeongbuk area, there was an increase in blood glucose levels in children with T1DM and in the incidence of severe DKA in newly diagnosed diabetes mellitus patients.

Citations

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Incidence of diabetic ketoacidosis during COVID-19 pandemic: a meta-analysis of 124,597 children with diabetes
Anas Elgenidy, Ahmed K. Awad, Khaled Saad, Mostafa Atef, Hatem Helmy El-Leithy, Ahmed A. Obiedallah, Emad M. Hammad, Faisal-Alkhateeb Ahmad, Ahmad M. Ali, Hamad Ghaleb Dailah, Amira Elhoufey, Samaher Fathy Taha
Pediatric Research.2023; 93(5): 1149. CrossRef
Comments on Rahmati et al., The global impact of COVID‐19 pandemic on the incidence of pediatric new‐onset type 1 diabetes and ketoacidosis: A systematic review and meta‐analysis. J Med Virol. 2022; 1‐16 (doi: 10.1002/jmv.27996)
Joachim Rosenbauer, Anna Stahl‐Pehe, Sabrina Schlesinger, Oliver Kuß
Journal of Medical Virology.2023;[Epub] CrossRef
Impact of the COVID-19 Pandemic on Children and Adolescents with New-Onset Type 1 Diabetes
Clemens Kamrath, Alexander J. Eckert, Reinhard W. Holl, Joachim Rosenbauer, Andrea Scaramuzza
Pediatric Diabetes.2023; 2023: 1. CrossRef
Difficulties in differential diagnosis of carbohydrate metabolism disorders in patients with coronavirus infection in real clinical practice. Case report
Tatyana N. Markova, Mukhamed S. Stas, Valentina V. Chibisova, Anastasia A. Anchutina
Consilium Medicum.2023; 25(4): 241. CrossRef
Endocrinological Involvement in Children and Adolescents Affected by COVID-19: A Narrative Review
Valeria Calcaterra, Veronica Maria Tagi, Raffaella De Santis, Andrea Biuso, Silvia Taranto, Enza D’Auria, Gianvincenzo Zuccotti
Journal of Clinical Medicine.2023; 12(16): 5248. CrossRef
Glycemic control and complications of type 2 diabetes mellitus in children and adolescents during the COVID-19 outbreak
Kyeong Eun Oh, Yu Jin Kim, Ye Rim Oh, Eungu Kang, Hyo-Kyoung Nam, Young-Jun Rhie, Kee-Hyoung Lee
Annals of Pediatric Endocrinology & Metabolism.2023; 28(4): 275. CrossRef
Incidence of Diabetic Ketoacidosis Among Pediatrics With Type 1 Diabetes Prior to and During COVID-19 Pandemic: A Meta-Analysis of Observational Studies
Osamah M. Alfayez, Kholood S. Aldmasi, Nada H. Alruwais, Nouf M. Bin Awad, Majed S. Al Yami, Omar A. Almohammed, Abdulaali R. Almutairi
Frontiers in Endocrinology.2022;[Epub] CrossRef
Comparison of Initial Presentation of Pediatric Diabetes Before and During the Coronavirus Disease 2019 Pandemic Era
Yoonha Lee, Minseung Kim, Kyeongeun Oh, Eungu Kang, Young-Jun Rhie, Jieun Lee, Yong Hee Hong, Young-Lim Shin, Jae Hyun Kim
Journal of Korean Medical Science.2022;[Epub] CrossRef
The global impact of COVID‐19 pandemic on the incidence of pediatric new‐onset type 1 diabetes and ketoacidosis: A systematic review and meta‐analysis
Masoud Rahmati, Maryam Keshvari, Shahrzad Mirnasuri, Dong K. Yon, Seung W. Lee, Jae Il Shin, Lee Smith
Journal of Medical Virology.2022; 94(11): 5112. CrossRef
COVID-19 and diabetes: What do we know so far?
Prakash Gangadaran, Himabindu Padinjarathil, Shri Hari Subhashri Rajendran, Manasi P Jogalekar, Chae Moon Hong, Baladhandapani Aruchamy, Uma Maheswari Rajendran, Sridharan Gurunagarajan, Anand Krishnan, Prasanna Ramani, Kavimani Subramanian
Experimental Biology and Medicine.2022; 247(15): 1330. CrossRef
Stress hyperglycemia, Diabetes mellitus and COVID-19 infection: The impact on newly diagnosed type 1 diabetes
Ioanna Farakla, Theano Lagousi, Michael Miligkos, Nicolas C. Nicolaides, Ioannis-Anargyros Vasilakis, Maria Mpinou, Maria Dolianiti, Elina Katechaki, Anilia Taliou, Vasiliki Spoulou, Christina Kanaka-Gantenbein
Frontiers in Clinical Diabetes and Healthcare.2022;[Epub] CrossRef

Risk factors affecting amputation in diabetic foot: Jun Ho Lee, Ji Sung Yoon, Hyoung Woo Lee, Kyu Chang Won, Jun Sung Moon, Seung Min Chung, Yin Young Lee; Yeungnam Univ J Med. 2020;37(4):314-320. Published online May 6, 2020; DOI: https://doi.org/10.12701/yujm.2020.00129

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Abstract PDF

Background
A diabetic foot is the most common cause of non-traumatic lower extremity amputations (LEA). The study seeks to assess the risk factors of amputation in patients with diabetic foot ulcers (DFU).
Methods
The study was conducted on 351 patients with DFUs from January 2010 to December 2018. Their demographic characteristics, disease history, laboratory data, ankle-brachial index, Wagner classification, osteomyelitis, sarcopenia index, and ulcer sizes were considered as variables to predict outcome. A chi-square test and multivariate logistic regression analysis were performed to test the relationship of the data gathered. Additionally, the subjects were divided into two groups based on their amputation surgery.
Results
Out of the 351 subjects, 170 required LEA. The mean age of the subjects was 61 years and the mean duration of diabetes was 15 years; there was no significant difference between the two groups in terms of these averages. Osteomyelitis (hazard ratio [HR], 6.164; 95% confidence interval [CI], 3.561−10.671), lesion on percutaneous transluminal angioplasty (HR, 2.494; 95% CI, 1.087−5.721), estimated glomerular filtration rate (eGFR; HR, 0.99; 95% CI, 0.981−0.999), ulcer size (HR, 1.247; 95% CI, 1.107−1.405), and forefoot ulcer location (HR, 2.475; 95% CI, 0.224−0.73) were associated with risk of amputation.
Conclusion
Osteomyelitis, peripheral artery disease, chronic kidney disease, ulcer size, and forefoot ulcer location were risk factors for amputation in diabetic foot patients. Further investigation would contribute to the establishment of a diabetic foot risk stratification system for Koreans, allowing for optimal individualized treatment.

Citations

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Efficacy of Chinese and Western Medical Techniques in Treating Diabetic Foot Ulcers With Necrotizing Fasciitis of the Lower Leg
Yongchong Chen, Yunzhu Wang, TaiAn Zhang, Chao Meng, Qing Li, Bohui Zhang, Kai Zhang, Chunfang Qin
The International Journal of Lower Extremity Wounds.2024; 23(1): 70. CrossRef
Classification of foot ulcers in people with diabetes: A systematic review
Matilde Monteiro‐Soares, Emma J. Hamilton, David A. Russell, Gulapar Srisawasdi, Edward J. Boyko, Joseph L. Mills, William Jeffcoate, Fran Game
Diabetes/Metabolism Research and Reviews.2024;[Epub] CrossRef
Renal function is highly associated with podiatric risk in diabetic patients
Jean-Baptiste Bonnet, Ilan Szwarc, Antoine Avignon, Sébastien Jugant, Ariane Sultan
Clinical Kidney Journal.2023; 16(11): 2156. CrossRef
Risk factor analysis for diabetic foot ulcer‐related amputation including Controlling Nutritional Status score and neutrophil‐to‐lymphocyte ratio
Yandan Zhu, Hongtao Xu, Yuzhen Wang, Xia Feng, Xinyu Liang, Liying Xu, Zhiqiang Liang, Zhongjia Xu, Yawen Li, Yi Le, Manchen Zhao, Jianfei Yang, Ji Li, Yemin Cao
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The association between estimated glomerular filtration rate and prognosis in patients with diabetic foot osteomyelitis
Jinghang Zhang, Dong Chen, Xuemei Li, Min Ding, Jun Xu, Meijun Wang, Bai Chang
International Wound Journal.2022; 19(7): 1650. CrossRef
Renal Function Status in Patients with Diabetes Mellitus Having Diabetic Foot Infection and Role of Antibiotics
Shabab Hussain, . Arrham, Syeda Javeriya Saeed, Ahmad Murtaza Anwar, Asif Khan, Saifullah Brohi
Pakistan Journal of Health Sciences.2022; : 189. CrossRef
Re-understanding and focusing on normoalbuminuric diabetic kidney disease
Na An, Bi-tao Wu, Yu-wei Yang, Zheng-hong Huang, Jia-fu Feng
Frontiers in Endocrinology.2022;[Epub] CrossRef
The effects of curcumin intake on wound healing and metabolic status in patients with diabetic foot ulcer: A randomized, double‐blind, placebo‐controlled trial
Mehrdad Mokhtari, Reza Razzaghi, Mansooreh Momen‐Heravi
Phytotherapy Research.2021; 35(4): 2099. CrossRef
Prevalence of Sarcopenia and Its Association With Diabetes: A Meta-Analysis of Community-Dwelling Asian Population
Seung Min Chung, Jun Sung Moon, Min Cheol Chang
Frontiers in Medicine.2021;[Epub] CrossRef
Clinical outcomes among patients with chronic kidney disease hospitalized with diabetic foot disorders: A nationwide retrospective study
Michael Salim
Endocrinology, Diabetes & Metabolism.2021;[Epub] CrossRef

Review article

Maturity-onset diabetes of the young: update and perspectives on diagnosis and treatment: Kyung Mi Jang; Yeungnam Univ J Med. 2020;37(1):13-21. Published online January 9, 2020; DOI: https://doi.org/10.12701/yujm.2019.00409

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Abstract PDF

Maturity-onset diabetes of the young (MODY) is a clinically heterogeneous group of monogenic disorders characterized by ß-cell dysfunction. MODY accounts for between 2% and 5% of all diabetes cases, and distinguishing it from type 1 or type 2 diabetes is a diagnostic challenge. Recently, MODY-causing mutations have been identified in 14 different genes. Sanger DNA sequencing is the gold standard for identifying the mutations in MODY-related genes, and may facilitate the diagnosis. Despite the lower frequency among diabetes mellitus cases, a correct genetic diagnosis of MODY is important for optimizing treatment strategies. There is a discrepancy in the disease-causing locus between the Asian and Caucasian patients with MODY. Furthermore, the prevalence of the disease in Asian populations remains to be studied. In this review, the current understanding of MODY is summarized and the Asian studies of MODY are discussed in detail.

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Maturity-onset diabetes of the young type 7 (MODY7) and mutation in the Krüppel-like transcription factor 11 (KLF11) gene
Y Wang, X Ye, X Chen, H Zang, Q Shen, L Chen
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Cardio-cerebrovascular Outcomes in MODY, Type 1 Diabetes, and Type 2 Diabetes: A Prospective Cohort Study
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The Journal of Clinical Endocrinology & Metabolism.2023; 108(11): 2970. CrossRef
Genetic and Clinical Characterization of Patients with HNF1B-Related MODY in Croatia
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Quantitative profiling and diagnostic potential of one-carbon and central metabolism pools in MODY2 and T1DM
Jieying Liu, Ziyan Xie, Junling Fu, Miao Yu, Tong Wang, Cuijuan Qi, Peng Liu, Xiangyi Hui, Dongmei Wang, Lu Ding, Qian Zhang, Ting Xie, Xinhua Xiao
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When do we need to suspect maturity onset diabetes of the young in patients with type 2 diabetes mellitus?
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Diagnosis and Treatment of Monogenic Forms of Diabetes Mellitus: Focus on Mody-Diabetes
K. A. Aitbaev, I. T. Murkamilov, Zh. A. Murkamilova, V. V. Fomin, I. O Kudaibergenova, F. A. Yusupov
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Kyung Mi Jang
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Modeling Maturity Onset Diabetes of the Young in Pluripotent Stem Cells: Challenges and Achievements
Carmel Braverman-Gross, Nissim Benvenisty
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Gençlerin Erişkin Başlangıçlı Diyabeti (MODY) Sorumlu HNF4A, GCK ve HNF1 Gen Varyasyonlarının Dünya Genelinde Coğrafik Dağılımı
Deniz KANCA DEMİRCİ, Nurdan GÜL, İlhan SATMAN, Oguz OZTURK, Hülya YILMAZ AYDOĞAN
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Zsolt Gaál, Zsuzsanna Szűcs, Irén Kántor, Andrea Luczay, Péter Tóth-Heyn, Orsolya Benn, Enikő Felszeghy, Zsuzsanna Karádi, László Madar, István Balogh
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A Comprehensive Analysis of Hungarian MODY Patients—Part I: Gene Panel Sequencing Reveals Pathogenic Mutations in HNF1A, HNF1B, HNF4A, ABCC8 and INS Genes
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Original Article

Comparison of sevoflurane and propofol anesthesia on the incidence of hyperglycemia in patients with type 2 diabetes undergoing lung surgery: Hyuckgoo Kim, Jisoo Han, Sung Mee Jung, Sang-Jin Park, Nyeong Keon Kwon; Yeungnam Univ J Med. 2018;35(1):54-62. Published online June 30, 2018; DOI: https://doi.org/10.12701/yujm.2018.35.1.54

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Abstract PDF

Background
The type and regimen of anesthesia may affect perioperative hyperglycemia following major surgical stress. This study compared the effects of sevoflurane and propofol on the incidence of hyperglycemia and clinical outcomes in diabetic patients undergoing lung surgery.
Methods
This retrospective study included 176 patients with type 2 diabetes mellitus who had undergone lung surgery. Blood glucose levels and clinical outcomes from the preoperative period to the first 2 postoperative days (PODs) were retrospectively examined in patients who received sevoflurane (group S, n= 87) and propofol (group P, n=89) for maintenance of general anesthesia. The primary endpoint was the incidence of persistent hyperglycemia (2 consecutive blood glucose levels >180 mg/dL [10.0 mmol/L]) during the perioperative period. The secondary composite endpoint was the incidence of major postoperative complications and 30-day mortality rate after surgery.
Results
Blood glucose levels similarly increased from the preoperative period to the second POD in both groups (p=0.857). Although blood glucose levels at 2 hours after surgery were significantly lower in group P than in group S (p=0.022; 95% confidence interval for mean difference, -27.154 to -2.090), there was no difference in the incidence of persistent hyperglycemia during the perioperative period (group S, 70%; group P, 69%; p=0.816). The composite of major postoperative complications and all-cause in-hospital and 30-day mortality rates were also comparable between the two groups.
Conclusion
Sevoflurane and propofol were associated with a comparable incidence of perioperative hyperglycemia and clinical outcomes in diabetic patients undergoing lung surgery.

Citations

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Case Reports

Metformin induced acute pancreatitis and lactic acidosis in a patient on hemodialysis.: Yeon Kyung Lee, Kihyun Lim, Su Hyun Hwang, Young Hwan Ahn, Gyu Tae Shin, Heungsoo Kim, In Whee Park; Yeungnam Univ J Med. 2016;33(1):33-36. Published online June 30, 2016; DOI: https://doi.org/10.12701/yujm.2016.33.1.33

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Abstract PDF

Metformin, commonly prescribed for type 2 diabetes, is considered safe with minimal side-effect. Acute pancreatitis is rare but potentially fatal adverse side-effect of metformin. We report a patient on hemodialysis with metformin-related acute pancreatitis and lactic acidosis. A 62-year-old woman with diabetic nephropathy and hypertension presented with nausea and vomiting for a few weeks, followed by epigastric pain. At home, the therapy of 500 mg/day metformin and 50 mg/day sitagliptin was continued, despite symptoms. Laboratory investigations showed metabolic acidosis with high levels of lactate, amylase at 520 U/L (range, 30-110 U/L), and lipase at 1,250 U/L (range, 23-300 U/L). Acute pancreatitis was confirmed by computed tomography. No recognized cause of acute pancreatitis was identified. Metformin was discontinued. Treatment with insulin and intravenous fluids resulted in normalized amylase, lipase, and lactate. When she was re-exposed to sitagliptin, no symptoms were reported.

Citations

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Sex-differences in [68Ga]Ga-DOTANOC biodistribution
A. Leisser, K. Lukic, M. Nejabat, W. Wadsak, M. Mitterhauser, M. Mayerhöfer, G. Karnaikas, M. Raderer, M. Hacker, A.R. Haug
Nuclear Medicine and Biology.2019; 76-77: 15. CrossRef

A Case of Membranoproliferative Glomerulonephritis in a Patient with Type 2 Diabetes Mellitus.: Dong Hyun Kim, Jang Won Lee, Min Suk Jung, Seung Hyun Lee, Byung Cheol Min, Hyun Ju Kim; Yeungnam Univ J Med. 2013;30(2):136-140. Published online December 31, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.2.136

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Abstract PDF: Diabetic nephropathy (DN) is a common complication and the leading cause of end-stage renal disease (ESRD) in diabetic patients. The occurrence of non-diabetic renal disease (NDRD) in diabetic patients has been increasingly recognized in recent years. Generally, renal injuries in DN are deemed difficult to reverse, whereas some NDRDs are often treatable and even remittable. Thus, the diagnosis of NDRD in patients with diabetes mellitus (DM) via a kidney biopsy would be significant for its prognosis and therapeutic strategy. According to recent studies, the most common NDRD is IgA nephropathy in type 2 diabetic patients, and some cases of minimal change disease and membranous glomerulonephritis have been reported in Korea. However, membranoproliferative glomerulonephritis (MPGN) is an uncommon condition in diabetic patients. To our knowledge, there has been no case yet of MPGN, except in a child with type 1 DM. We present an unusual case of a 27-year-old woman who had type 2 DM with MPGN, as confirmed via a kidney biopsy.

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