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Diabetic Muscle Infarction in a Young Patient with Prader-Willi Syndrome and Type 2 Diabetes Mellitus

Eun-Jeong KWON ; Eun-Ji LEE ; Hak Chul JANG ; Eun Ha KANG ; Yun Jong LEE ; You-Jung HA

Journal of Korean Diabetes.2020;21(4):227-234. doi:10.4093/jkd.2020.21.4.227

Diabetic muscle infarction (DMI), also known as diabetic myonecrosis, is a rare complication of diabetes mellitus (DM); hence, it is often underdiagnosed. Thus, timely diagnosis and treatment are essential for a better prognosis. We describe a 24-year-old woman with Prader-Willi syndrome and an 8-year history of uncontrolled type 2 DM, who presented with a sudden onset of fever and subacute painful swelling of her left thigh. She was finally diagnosed with DMI based on magnetic resonance imaging and muscle biopsy after excluding other infectious and inflammatory diseases of proximal muscles. The patient was treated with bed rest, strict glycemic control, and analgesics, and her symptoms gradually resolved. DMI should be considered in the differential diagnosis of patients with poorly controlled DM, who present with subacute pain and swelling of lower extremity muscles, without a history of trauma.

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Management of Obesity and Diabetes Mellitus in Children and Adolescents: Staged Intervention

Yu Jeong PARK

Journal of Korean Diabetes.2020;21(4):221-226. doi:10.4093/jkd.2020.21.4.221

Obesity is becoming a social issue as well as a medical problem, and childhood obesity, which affects healthy longevity, can lead to psychological, emotional, and social problems along with the transition to other diseases such as high blood pressure and diabetes. Active management at the social and government level is required. Nevertheless, there are few advanced general hospitals that systematically provide education for obese patients, and it is a reality that interventions for obese patients with diabetes, especially children and adolescents, are rare. As the number of children and adolescents with obesity and diabetes increases, attention should be paid to the approach, including individuals, families, and schools in the community that take into account characteristics and surrounding individuals. In addition, if education is being prepared in the field, changes in each system, including individual patients, take time, and a step-by-step approach is required. In this review, I would like to look at a step-by-step approach for educators on the juvenile obesity.

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Medical Nutrition Therapy Using Continuous Glucose Monitoring System

Mee Ra KWEON

Journal of Korean Diabetes.2020;21(4):216-220. doi:10.4093/jkd.2020.21.4.216

Medical nutrition therapy plays an integral role in diabetes management. There is no “one-size-fits-all” eating pattern for those with diabetes, and meal planning should be individualized. For many people with diabetes, glucose monitoring is key for glycemic control. Continuous glucose monitoring (CGM) metrics are suggested to provide a personalized diabetes management plan. Use of CGM continues to expand in clinical practice. Integrating CGM results into diabetes management can be useful for guiding medical nutrition therapy and physical activity, preventing hypoglycemia, and adjusting medications. Clinical dietitians should develop personalized nutrition management using CGM to help people with diabetes optimize dietary intake.

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Special Considerations in Diabetes Self-Management Education for Older Adults with Diabetes: A Study Focusing on Community Senior Welfare Centers

Sun Ju CHANG

Journal of Korean Diabetes.2020;21(4):211-215. doi:10.4093/jkd.2020.21.4.211

Optimal diabetes self-management can lead to positive outcomes such as blood glucose control, prevention of diabetes-related complications, and improvement in quality of life. Various strategies have been developed for delivering diabetes self-management education to older adults with diabetes. This paper describes factors that should be considered when planning diabetes self-management education in community senior welfare centers. Diabetes educators should be aware of cognitive changes, such as changes in executive function and cognitive impairment, and health literacy. In addition, physical changes such as vision and hearing impairment and psychosocial changes such as depression should be considered when implementing diabetes self-management education for older adults with diabetes.

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Clinical Effects of Remote Glucose Monitoring and Patient-Centered Education Platform for Patients with Diabetes

Yeoree YANG ; Jae-Hyoung CHO

Journal of Korean Diabetes.2020;21(4):204-210. doi:10.4093/jkd.2020.21.4.204

With development of the internet and smartphones, various systems have been introduced to monitor patient blood sugar remotely, and their clinical effect on diabetes management has been analyzed in different patient groups. However, these systems need to be available cost-effectively to many patients for the long term. Also, there is need for a communication platform that can easily identify a patient's blood sugar pattern and provide appropriate counseling and education. In addition, relevant educational contents must be provided so that patients maintain self-care for diabetes. With the rapid increase in diabetes patients, we must continuously develop the field of digital healthcare to efficiently monitor blood sugar and provide effective face-to-face management of these patients.

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New Insulin Pumps and Open Source Artificial Pancreas System in Korea

Jae Hyeon KIM

Journal of Korean Diabetes.2020;21(4):197-203. doi:10.4093/jkd.2020.21.4.197

Diabetes technology that includes artificial pancreas system (APS) has achieved remarkable progress in the past decades. The first APS, the Medtronic MiniMed 670G system introduced in 2017, and other subsequent commercial APSs have come as answers to patient and clinician prayers. However, these devices are not accessible by most persons with type 1 diabetes (T1D) in Korea. Therefore, highly motivated, and tech-savvy persons in the diabetes community have started developing open source APS (Open APS) that integrate continuous glucose monitoring (CGM), insulin pumps, and smartphone technology to run their own do-it-yourself APS (DIYAPS). Observational studies have revealed significant improvements in HbA1c levels, time in range, and quality of life after the initiation of Open APS use. However, the use of regularized CGM and an insulin pump with an unauthorized DIYAPS makes these devices off-label and this has been a matter of grave clinical concern. In addition, lack of randomized controlled trials, insurance coverage, and legal issues are barriers to the general acceptance of DIYAPS among persons with T1D. In this article, I will summarize existing DIYAPS studies including those in Korea and their concerns. In addition, I will introduce new insulin pumps available in Korea.

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Adjustment of Insulin Therapy: New Insights from Continuous Glucose Monitoring

Tae Jung OH

Journal of Korean Diabetes.2020;21(4):191-196. doi:10.4093/jkd.2020.21.4.191

Diabetes management technology has advanced dramatically in recent decades, particularly real time continuous glucose monitoring (rtCGM) systems. A recent meta-analysis showed that rtCGM can reduce HbA1c by around 0.3% compared to standard care, and prevent hypoglycemia. In the CGM era, new treatment targets such as time in range should be considered in conjunction with HbA1c. One study using rtCGM demonstrated an increase of time in range compared to conventional treatment. rtCGM presents current glucose concentration data, as well as the direction and rate of change in glucose level every 1 to 5 minutes. This information enables development of new insulin dosing algorithms. This fine-tuning of insulin therapy should be based on healthy eating behavior. Furthermore, as the patient is the center of diabetes management patient education is needed regarding how this new technology can improve glucose management. This manuscript summarizes the utility of rtCGM for insulin adjustment.

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Use of Flash Glucose Monitoring in Patients on Intensive Insulin Treatment

Jun Sung MOON

Journal of Korean Diabetes.2020;21(4):184-190. doi:10.4093/jkd.2020.21.4.184

Glucose monitoring is the key component for successful management of patients with diabetes. Though glycated hemoglobin (HbA1c) and self-monitoring of blood glucose by finger pricking are effective methods for assessing glucose exposure, they provide limited information about glycemic variability. Flash glucose monitoring (FGM) is a factory-calibrated, sensor-based technology worn on the body as a small-sized patch that has a lifetime up to 14 days. On-demand sensor scanning provides patients with comprehensive glucose data, including current glucose level, which is updated every minute, historical glucose readings from the last 8 hours, and trend arrows. Also, ambulatory glucose profiles can be shared with the physician and caregivers. Early clinical studies demonstrated relevant benefits of FGM in patients with type 1 and type 2 diabetes in terms of fewer hypoglycemic episodes but did not differ in metrics of glycemic control such as HbA1c or time-in-range. Another study highlighted the importance of intensive and structured patient education for maximizing the benefits of FGM use. These results suggest that proper FGM use improves the quality of life as well as glycemic control in patients on intensive insulin treatment.

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The Present and Future of Continuous Glucose Monitoring

Sang-Man JIN

Journal of Korean Diabetes.2020;21(4):179-183. doi:10.4093/jkd.2020.21.4.179

The accuracy and convenience of real-time continuous glucose monitoring (CGM) devices have been substantially improved in the past decade, with an accuracy comparable to finger-stick glucose meters. In addition, new advantageous features of CGM devices include a painless one button inserter, smaller (or integrated) transmitters, better connectivity with smartphones, an extended 14-day wear period, no acetaminophen interference, and no need for calibration with a finger-stick glucose meter. Real-time CGM is now the go-to diabetes technology for most people with type 1 diabetes, and acts as a gateway to more advanced diabetes technology. Real-time CGM has become a standard therapy for type 1 diabetes, and a well-proven therapy for type 2 diabetes with multiple daily injections. In the near future, advanced hybrid closed-loop devices with an automated correction bolus will be clinically available, which will be a major breakthrough toward fully automated insulin delivery.

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Current Status and Problems of National Diabetes Care

Seak Ki YUN

Journal of Korean Diabetes.2020;21(4):173-178. doi:10.4093/jkd.2020.21.4.173

South Korea is one of many countries that has implement national chronic disease management programs. These programs comprise “A pilot program for the registration and management of cardiocerebrovascular high-risk groups” in 2007, “A pilot program for community primary medical care” in 2014, “A pilot program for chronic care charges” in 2016, and “Primary medical chronic disease management pilot project” in 2019. For establishing and implementing policies to strengthen chronic care management in primary medical care, a virtuous cycle, in which experiences in various programs are monitored and achievements are accumulated in aid of policy development, is important. That is, objective evaluation indices and systems should be designed as programs are carried forward, and program quality should be improved through of evaluation results and feedback. This study highlight the problems with existing programs and the necessary steps to achieve the expected effects.

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