The rising incidence and prevalence of diabetes along with its complications have become a global concern. The necessity for a comprehensive model-targeting primary, secondary and tertiary prevention as well as all levels of care has become apparent. Staged Diabetes Management (SDM) was developed over a decade ago by the International Diabetes Centers, Minneapolis, Minnesota, U.S.A.. SDM was founded on the principle that a detailed understanding of the natural history of diabetes and the underlying defects responsible for the development of hyperglycemia and its associated complications should be the basis of sound clinical decision-making. It relies on clinical pathways to guide the clinicians though the detection, treatment and follow up of each type. Unique to SMD is that each pathway is customized for utilization in collaboration with local physicians and allied heath professionals. Thus far clinicians from 22 countries, using 11 translated versions of SDM, have participated in this process. In Korea, SDM was introduced in 1999 with the foundation of the committee in Korean Diabetes Association (KDA). Taking into account the regional difference in medical practice, resource allocation, availability of pharmacological agents and access to care, this Korean version of SDM was developed to reduce variation in practice, improve screening and detection, tighten glycemic control and to increase surveillance of complications. It has been noted that diabetes contributes to the cost of medical services. One way of reducing the financial burden is to find cost-effective approaches to prevention, detection and treatment of diabetes and its complications. The SDM model directly addresses this issue by seeking ways to optimize the limited resources available for diabetes care, prioritizing treatment, reducing medical error and expanding the role of allied health professionals. As SDM moves into the 21st century, its mission has expanded to encompass the principles of primary and secondary prevention.
Cooperative Behavior ; Critical Pathways ; Diabetes Mellitus ; Follow-Up Studies ; Health Occupations ; Humans ; Hyperglycemia ; Incidence ; Korea ; Mass Screening ; Medical Errors ; Minnesota ; Missions and Missionaries ; Natural History ; Prevalence ; Primary Health Care ; Resource Allocation ; Secondary Prevention ; Tertiary Prevention

Type 2 diabetes is rapidly increasing worldwide, and there have been many advances in the care of diabetic patients. Nevertheless, less than half of the patients are achieving the glycemic goal of HbA1c < 7%. This shows that current therapeutic modalities have limitations, and the need for continued development of new antidiabetic drugs is clear. In 2007, a meta-analysis focusing on the thiazolidinedione drug rosiglitazone suggested an unacceptably high cardiovascular risk for this newly approved drug, prompting changes in regulations for antidiabetic drug development. The FDA guidance for Diabetes Mellitus-Evaluation of Cardiovascular Risk in New Antidiabetic Therapies to Treat Type 2 Diabetes was released as a draft in Feb 2008, and the final form was published in December 2008. The guidance, though not a regulation, requires developers to demonstrate that all new antidiabetic agents have an acceptable cardiovascular risk. The European Medicine Agency (EMA) also published a draft guideline in January 2010 on the clinical investigation of medicinal products for the treatment of diabetes mellitus which included a cardiovascular safety assessment component. Considering the increased CV risk in type 2 diabetic patients, antidiabetic drugs should not result in an unacceptable increase in cardiovascular risk. The FDA has offered guidelines for the assessment of cardiovascular safety for antidiabetic drugs. Careful prospective planning of clinical trials (choice of study type, subject selection, and meta-analysis) and thorough preclinical safety assessment (choice of cardiovascular endpoints: MACE, endpoint adjudication) are needed to assess possible cardiovascular risk.
Diabetes Mellitus ; Humans ; Hypoglycemic Agents ; Social Control, Formal ; Thiazolidinediones

Soft tissue infections are common, generally of mild to moderate severity. The most common causative organisms of soft tissue infections are group A beta-hemolytic streptococci and Staphylococcus aureus. As the antimicrobial resistance pattern of these causative organisms has not been changed recently, the present recommendations for the treatment of soft tissue infections remain the same. In this review, we have presented extensive information on the clinical characteristics, diagnosis, and treatment of skin and soft tissue infections. We focused on two issues concerning antibiotic resistance; macrolide resistance of group A beta-hemolytic streptococci and the emergence of community-acquired methicillin-resistant Staphylococcus aureus.
Anti-Bacterial Agents ; Methicillin-Resistant Staphylococcus aureus ; Skin ; Soft Tissue Infections ; Staphylococcus aureus

Soft tissue infections are common, generally of mild to moderate severity. The most common causative organisms of soft tissue infections are group A beta-hemolytic streptococci and Staphylococcus aureus. As the antimicrobial resistance pattern of these causative organisms has not been changed recently, the present recommendations for the treatment of soft tissue infections remain the same. In this review, we have presented extensive information on the clinical characteristics, diagnosis, and treatment of skin and soft tissue infections. We focused on two issues concerning antibiotic resistance; macrolide resistance of group A beta-hemolytic streptococci and the emergence of community-acquired methicillin-resistant Staphylococcus aureus.
Anti-Bacterial Agents ; Methicillin-Resistant Staphylococcus aureus ; Skin ; Soft Tissue Infections ; Staphylococcus aureus

Background: Recent studies have demonstrated that the levels of adipocyte fatty acid-binding protein (A-FABP) are closely associated with diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM). This study aimed to examine the association between serum A-FABP level and rapid renal function decline in patients with T2DM and preserved renal function. Methods: This was a prospective observational study of 452 patients with T2DM and preserved renal function who had serial measurements of estimated glomerular filtration rate (eGFR). Rapid renal function decline was defined as an eGFR decline of >4% per year. The association between baseline serum A-FABP level and rapid renal function decline was investigated. Results: Over a median follow-up of 7 years, 82 participants (18.1%) experienced rapid renal function decline. Median A-FABP levels were significantly higher in patients with rapid renal function decline, compared to non-decliners (20.2 ng/mL vs. 17.2 ng/ mL, P=0.005). A higher baseline level of A-FABP was associated with a greater risk of developing rapid renal function decline, independent of age, sex, duration of diabetes, body mass index, systolic blood pressure, history of cardiovascular disease, baseline eGFR, urine albumin creatinine ratio, total cholesterol, glycosylated hemoglobin, high-sensitivity C-reactive protein and use of thiazolidinedione, insulin, angiotensin-converting-enzyme inhibitors and angiotensin II-receptor blockers and statin (odds ratio, 3.10; 95% confidence interval, 1.53 to 6.29; P=0.002). Conclusion A high level of serum A-FABP is associated with an increased risk of rapid renal function decline in patients with T2DM and preserved renal function. This suggests that A-FABP could play a role in the progression of DKD in the early stages.

Recent studies have demonstrated that the levels of adipocyte fatty acid-binding protein (A-FABP) are closely associated with diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM). This study aimed to examine the association between serum A-FABP level and rapid renal function decline in patients with T2DM and preserved renal function.

Untreated hyperthyroidism and high-dose thyroid hormone are associated with osteoporosis, and increased bone mineral density (BMD) has been demonstrated in postmenopausal females with hypoparathyroidism. Studies on the effect of suppressive levothyroxine (LT4) therapy on BMD and bone metabolism after total thyroidectomy in patients with differentiated thyroid carcinoma have presented conflicting results, and few studies in relation to the status of hypoparathyroidism have been studied. One hundred postmenopausal women and 24 premenopausal women on LT4 suppression therapy were included in this study. BMD of lumbar spine and femur and bone turnover markers were measured at the baseline and during the follow-up period up to 18 months using dual energy X-ray absorptiometry. Biochemical marker of bone resorption was measured by urine deoxypyridinoline and bone formation by serum osteocalcin. The age ranged from 36 to 64 years old. Thyroid stimulating hormone (TSH) was suppressed during the study. The results showed that BMD of femur and lumbar spine were not significantly changed in both pre- and postmenopausal women except femur neck in postmenopausal women without hypoparathyroidism. Patients with hypoparathyroidism had higher BMD gain than those without hypoparathyroidism in total hip (1.25 vs. -1.18%, P=0.015). Biochemical markers of bone turnover, serum osteocalcin, and urine deoxypyridinoline did not show significant change. In conclusion, patients with well differentiated thyroid carcinoma are not at a great risk of bone loss after LT4 suppressive therapy. The state of hypoparathyroidism is associated with increased BMD, particularly in postmenopausal women.
Absorptiometry, Photon ; Biomarkers* ; Bone Density* ; Bone Resorption ; Female ; Femur ; Femur Neck ; Follow-Up Studies ; Hip ; Humans ; Hyperthyroidism ; Hypoparathyroidism ; Metabolism ; Osteocalcin ; Osteogenesis ; Osteoporosis ; Postmenopause ; Spine ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Thyrotropin ; Thyroxine*

BACKGROUND: Regular aerobic exercise is essential for the prevention and management of type 2 diabetes mellitus and may be particularly beneficial for those treated with thiazolidinediones, since it may prevent associated weight gain. This study aimed to evaluate the effect of combined exercise and rosiglitazone treatment on body composition and glucose metabolism in obese diabetes-prone animals. METHODS: We analyzed metabolic parameters, body composition, and islet profiles in Otsuka Long Evans Tokushima Fatty rats after 28 weeks of aerobic exercise, rosiglitazone treatment, and combined exercise and rosiglitazone treatment. RESULTS: Combined exercise with rosiglitazone showed significantly less increase in weight and epididymal fat compared to rosiglitazone treatment. Aerobic exercise alone and combined rosiglitazone and exercise treatment led to similar retention of lean body mass. All experimental groups showed a decrease in fasting glucose. However, the combined exercise and rosiglitazone therapy group showed prominent improvement in glucose tolerance compared to the other groups. Rescue of islet destruction was observed in all experimental groups, but was most prominent in the combined therapy group. CONCLUSION: Regular aerobic exercise combined with rosiglitazone treatment can compensate for the adverse effect of rosiglitazone treatment and has benefit for islet preservation.
Animals ; Body Composition ; Diabetes Mellitus, Type 2 ; Exercise* ; Fasting ; Glucose* ; Metabolism* ; Rats, Inbred OLETF* ; Thiazolidinediones ; Weight Gain

Acute esophageal necrosis is a rare clinical entity characterized by the endoscopic finding of extensive black discoloration of the esophageal mucosa. Acute esophageal necrosis in a patient with diabetic ketoacidosis has rarely been reported. We report a case of acute esophageal necrosis in a patient with diabetic ketoacidosis. The patient had coffee ground emesis and, after an esophagogastroduodenoscopy with mucosal biopsy, acute esophageal necrosis was diagnosed. The patient was treated conservatively with an intravenous proton pump inhibitor and oral sucralfate without any complications.
Biopsy ; Coffee ; Diabetes Mellitus ; Diabetic Ketoacidosis ; Endoscopy, Digestive System ; Esophagus ; Humans ; Mucous Membrane ; Necrosis ; Proton Pumps ; Sucralfate ; Vomiting