In May 2023, the Committee of Clinical Practice Guidelines of the Korean Diabetes Association published the revised clinical practice guidelines for Korean adults with diabetes and prediabetes. We incorporated the latest clinical research findings through a comprehensive systematic literature review and applied them in a manner suitable for the Korean population. These guidelines are designed for all healthcare providers nationwide, including physicians, diabetes experts, and certified diabetes educators who manage patients with diabetes or individuals at risk of developing diabetes. Based on recent changes in international guidelines and the results of a Korean epidemiological study, the recommended age for diabetes screening has been lowered. In collaboration with the relevant Korean medical societies, recently revised guidelines for managing hypertension and dyslipidemia in patients with diabetes have been incorporated into this guideline. An abridgment containing practical information on patient education and systematic management in the clinic was published separately.

The Committee of Clinical Practice Guidelines of the Korean Diabetes Association revised and updated the 6th Clinical Practice Guidelines in 2019. Targets of glycemic, blood pressure, and lipid control in type 2 diabetes mellitus (T2DM) were updated. The obese and overweight population is increasing steadily in Korea, and half of the Koreans with diabetes are obese. Evidence-based recommendations for weight-loss therapy for obesity management as treatment for hyperglycemia in T2DM were provided. In addition, evidence from large clinical studies assessing cardiovascular outcomes following the use of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide 1 receptor agonists in patients with T2DM were incorporated into the recommendations.
Blood Pressure ; Diabetes Mellitus, Type 2 ; Diagnosis ; Glucagon-Like Peptide 1 ; Humans ; Hyperglycemia ; Korea ; Obesity ; Overweight

BACKGROUND/AIMS: Repeat endoscopy with biopsy is often performed in patients with previously diagnosed gastric cancer to determine further treatment plans. However, biopsy results may differ from the original pathologic report. We reviewed patients who had a negative biopsy after referral for gastric cancer. METHODS: A total of 116 patients with negative biopsy results after referral for biopsy-proven gastric cancer were enrolled. Outside pathology slides were reviewed. Images of the first and second endoscopic examinations were reviewed. We reviewed the clinical history from referral to the final treatment. RESULTS: Eighty-eight patients (76%) arrived with information about the lesion from the referring physician. Among 96 patients with available outside slides, the rate of interobserver variation was 24%. Endoscopy was repeated at our institution; 85 patients (73%) were found to have definite lesions, whereas 31 patients (27%) had indeterminate lesions. In the group with definite lesions, 71% of the lesions were depressed in shape. The most common cause of a negative biopsy was mistargeting. In the group with indeterminate lesions, 94% had insufficient information. All patients with adequate follow-up were successfully treated based on the findings in the follow-up endoscopy. CONCLUSIONS: A negative biopsy after referral for biopsy-proven gastric cancer is mainly caused by mistargeting and insufficient information during the referral.
Adult ; Aged ; Aged, 80 and over ; Biopsy/statistics & numerical data ; Diagnostic Errors/*statistics & numerical data ; Female ; Gastroscopy/*statistics & numerical data ; Humans ; Male ; Middle Aged ; Observer Variation ; Referral and Consultation/statistics & numerical data ; Reoperation/statistics & numerical data ; Republic of Korea ; Retrospective Studies ; Stomach/*pathology ; Stomach Neoplasms/*pathology ; Young Adult

The role of duodenal reflux and the time required for the development of Barrett's esophagus has remained controversial. We report a case of Barrett's esophagus that developed 6 months after total gastrectomy. A 76-year-old man diagnosed with gastric adenocarcinoma underwent a total gastrectomy and a Rouxen-Y esophagojejunostomy. The gastroesophageal junction in the resected specimen was both grossly and microscopically normal at the time of the operation. A routine follow-up endoscopic examination performed 6 months later revealed a tongue-like projection of redcolored columnar tissue. No reflux symptoms (heartburn or acid regurgitation) had been present during the intervening 6 months. A biopsy specimen from the esophagus showed intestinal-type metaplasia of the columnar epithelium. This case supports the development of Barrett's esophagus solely from duodenal reflux and after a relatively short time in this clinical setting.
Adenocarcinoma ; Aged ; Barrett Esophagus ; Biopsy ; Duodenogastric Reflux ; Epithelium ; Esophagogastric Junction ; Esophagus ; Follow-Up Studies ; Gastrectomy ; Humans ; Metaplasia

PURPOSE: The purpose of this study was to identify the patterns of activities of daily living (ADL) functional status and to examine the relationships between sense of coherence (SOC), depression, and uncertainty in gynecologic cancer patients who were receiving chemotherapy. METHOD: A prospective, longitudinal design with repeated measures was utilized. Women reported depression, SOC, and uncertainty at the beginning of the first cycle of chemotherapy, and they recorded ADL functional status everyday for two consecutive treatment cycles. the The instruments used were the Karnofsky Performance Status Index, Orientation to Life Questionnaire, Beck Depression Inventory, and Mishel Uncertainty in Illness Scale-Adult Form. RESULT: Data from 42 women showed that the ADL functional status during the second cycle was better than that of the first cycle with significant improvement each week. However, it did not completely recover to the baseline level even three weeks after the treatment ended in both cycles. SOC was correlated with depression (r=-.64, p< .001) and uncertainty (r=-.62, p< .001). Uncertainty was related to depression (r=.66, p< .001) and to functional status during the second cycle (r=-.45, p< .05), while the scores of the functional status during the two cycles were not related. CONCLUSION: Changing patterns and level of functional status during the treatment phase would be useful information for cancer patients to prepare coping strategies for positive health outcomes.
Activities of Daily Living ; Depression ; Drug Therapy* ; Female ; Humans ; Karnofsky Performance Status ; Prospective Studies ; Surveys and Questionnaires ; Sense of Coherence ; Uncertainty

Familial adenomatous polyposis (FAP) is an autosomal dominant syndrome, typically characterized by multiple colorectal adenomas and increased incidence of colorectal carcinomas if left untreated. It is caused by germline mutations of the adenomatous polyposis coli (APC) gene, which has been mapped on chromosome 5q21, and is accompanied by various benign and malignant extracolonic manifestations. The prevalence of thyroid tumors developing in patients with FAP is about 1~2%, are associated with FAP and have certain characteristics; mean age of tumor diagnosis at less than 30 years of age, the pathology is the papillary histiotype in more than 90% of cases, including a so-called cribriform- morular pattern, and multifocality is a frequent feature. In a genetic analysis, thyroid cancer in FAP usually has a mutation in the 5-portion of exon 15 between 778 and 1309, on chromosome 5q21. Also, the ret/PTC (especially ret/PTC1 and ret/PTC3) and p53 genes are thought probably to be associated with thyroid cancer in FAP patients. A case of familial adenomatous polyposis, accompanied by thyroid papillary cancer, was experienced in a 29 year-old female. She had hundreds of adenomas throughout the entire colon and congenital hypertrophy of the retinal pigment epithelium (CHRPE). The pathological finding of thyroid cancer was revealed as a mixture of cribriform, trabecular and papillary patterns. In a genetic analysis, she and her brother had a germline mutation of the APC gene at codon 1309. In Korea, there has been no previous case of cribriform-morular pattern and familial genetic analysis in FAP associated with thyroid cancer. Therefore, this case is reported, with a review of the literature
Adenoma ; Adenomatous Polyposis Coli* ; Adult ; Codon ; Colon ; Colorectal Neoplasms ; Diagnosis ; Exons ; Female ; Genes, APC ; Genes, p53 ; Germ-Line Mutation ; Humans ; Hypertrophy ; Incidence ; Korea ; Pathology ; Prevalence ; Retinal Pigment Epithelium ; Siblings ; Thyroid Gland* ; Thyroid Neoplasms

A 48 year-old man was referred to our Department with a headache, and also presented with an elevated serum ACTH level, but without an elevated serum cortisol. Although there was no clinical evidence of Cushing's syndrome, a brain CT and MRI showed a 4x4.5 cm sized pituitary mass, which was successfully removed by a transsphenoidal approach (TSA). A histopathological examination revealed the mass to have an ACTH positive reaction. Therefore, through hormonal and pathological evaluation, a silent corticotroph-cell adenoma (SCCA), with an elevated serum ACTH level, was diagnosed. Although reports on SCCA have been recently increased, this case is reported because these kinds of tumor are still rare, and those SCCA with an elevated serum ACTH even more so
Adenoma* ; Adrenocorticotropic Hormone* ; Brain ; Cushing Syndrome ; Headache ; Humans ; Hydrocortisone ; Magnetic Resonance Imaging ; Middle Aged ; Pituitary Neoplasms

Pendred syndrome is an autosomal recessive genetic disorder, which is characterized by sensorineural hearing loss, goiter and a positive perchlorate discharge test. It is caused by mutations of the PDS gene, and its clinical characteristics vary widely. The thyroid function in most cases is normal, or shows only mild hypothyroidism. In Pendred syndrome, there is an organification defect that leads to defective thyroid hormone synthesis, followed by chronic TSH stimulation. Herein is reported a case of a follicular thyroid carcinoma associated with Pendred syndrome. To our knowledge, this is the first case reported in Korea. The patient presented with a huge anterior neck mass, sensorineural hearing loss and a positive perchlorate discharge test. Fine needle aspiration cytology suggested malignancy of the thyroid, and a total thyroidectomy, with central compartment node dissection, was performed. The pathology from the thyroid mass showed a poorly differentiated follicular thyroid carcinoma
Adenocarcinoma, Follicular* ; Biopsy, Fine-Needle ; Goiter ; Hearing Loss, Sensorineural ; Humans ; Hypothyroidism ; Korea ; Neck ; Pathology ; Thyroid Gland ; Thyroidectomy

Pendred syndrome is an autosomal recessive genetic disorder, which is characterized by sensorineural hearing loss, goiter and a positive perchlorate discharge test. It is caused by mutations of the PDS gene, and its clinical characteristics vary widely. The thyroid function in most cases is normal, or shows only mild hypothyroidism. In Pendred syndrome, there is an organification defect that leads to defective thyroid hormone synthesis, followed by chronic TSH stimulation. Herein is reported a case of a follicular thyroid carcinoma associated with Pendred syndrome. To our knowledge, this is the first case reported in Korea. The patient presented with a huge anterior neck mass, sensorineural hearing loss and a positive perchlorate discharge test. Fine needle aspiration cytology suggested malignancy of the thyroid, and a total thyroidectomy, with central compartment node dissection, was performed. The pathology from the thyroid mass showed a poorly differentiated follicular thyroid carcinoma
Adenocarcinoma, Follicular* ; Biopsy, Fine-Needle ; Goiter ; Hearing Loss, Sensorineural ; Humans ; Hypothyroidism ; Korea ; Neck ; Pathology ; Thyroid Gland ; Thyroidectomy