Background: This study investigated the real-world efficacy and safety of insulin degludec/insulin aspart (IDegAsp) in Korean adults with type 2 diabetes mellitus (T2DM), whose insulin treatment was switched to IDegAsp. Methods: This was a multicenter, retrospective, observational study comprising two 26-week treatment periods, before and after switching to IDegAsp, respectively. Korean adults with uncontrolled T2DM treated with basal or premix insulin (±oral antidiabetic drugs) were enrolled. The primary objective was to compare the degree of glycosylated hemoglobin (HbA1c) change in each 26-week observation period. The analyses included changes in HbA1c, fasting plasma glucose (FPG), body weight, proportion of participants achieving HbA1c <7.0%, hypoglycemic events, and total daily insulin dose (ClinicalTrials.gov, number NCT04656106). Results: In total, 196 adults (mean age, 65.95 years; mean T2DM duration, 18.99 years) were analyzed. The change in both HbA1c and FPG were significantly different between the pre-switching and the post-switching period (0.28% vs. –0.51%, P<0.001; 5.21 mg/dL vs. –23.10 mg/dL, P=0.005), respectively. After switching, the rate of achieving HbA1c <7.0% was significantly improved (5.10% at baseline vs. 11.22% with IDegAsp, P=0.012). No significant differences (before vs. after switching) were observed in body weight change, and total daily insulin dose. The rates of overall and severe hypoglycemia were similar in the two periods. Conclusion In real-world clinical practice in Korea, the change of insulin regimen to IDegAsp was associated with an improvement in glycemic control without increase of hypoglycemia, supporting the use of IDegAsp for patients with T2DM uncontrolled with basal or premix insulin.

Purpose: This study examined outpatients’ experiences of patient participation, their level of patient satisfaction, and the factors that influence their patient satisfaction with outpatient care. Methods: This cross-sectional descriptive study utilized secondary data from the 2018 Survey on the Experience with Healthcare Service conducted in South Korea. Data from 6,684 outpatients over the age of 20 years who had visited hospitals were analyzed. Patient characteristics, health-related characteristics, and their experiences of patient participation were assessed as factors related to patient satisfaction. Factors that influenced patient satisfaction with outpatient care were identified using logistic regression analysis. Results: Overall, 84.9% of the participants were satisfied with the received outpatient care. Higher patient satisfaction with outpatient care was significantly associated with middle (40~59 years) and old age (≥60 years), good self-rated health status, and experience of patient participation in patient safety activities. Conclusion Multiple factors were related to patient satisfaction with outpatient care. These factors need to be considered when evaluating patients’ satisfaction levels. To improve satisfaction with health care use, it is essential to provide more experiences and expand their opportunities for patient participation during the care process and establish healthcare policies and strategies to enhance patient participation in patient safety.

Purpose: Little is known about the relationship between brain-derived neurotrophic factor (BDNF) gene polymorphisms and psychiatric symptoms in diabetes patients. We investigated the effects of BDNF Val/66/Met polymorphism, glucose status, psychological susceptibility, and resilience on anxiety and depression symptoms in patients newly diagnosed with type 2 diabetes mellitus (T2DM). Materials and Methods: We examined biochemical factors and BDNF polymorphism in 89 patients who were newly diagnosed with T2DM. Psychiatric symptoms were investigated with the Hospital Anxiety and Depression Scale (HADS), and the ConnorDavidson Resilience Scale (CD-RISC) and Impact of Event Scale (IES) were used to assess psychological resilience and susceptibility to psychological distress, respectively. Logistic regression analyses were conducted to investigate factors associated with psychiatric symptoms. Results: We determined that 62 patients (70%) were Met-carriers. No significant differences were found between the Val/Val homozygous and Met-carrier groups regarding age, sex, body mass index, and clinical factors related to glycemic control and lipid profiles. HADS-anxiety and HADS-depression scores and IES factor scores were higher in the Met-carrier than the Val/Val homozygous group. Hemoglobin A1c (HbA1c) level was significantly inversely correlated with the severity of depressive symptoms. Resilience factors showed significant inverse correlations, and IES factors showed positive correlations with depressive symptom severity. In the logistic regression analysis model, depressive symptoms were significantly associated with HbA1c and BDNF polymorphism, whereas only the hyperarousal factor of the IES scale was associated with anxiety. Conclusion Depressive symptoms are associated with the presence of the Met-carriers and lower HbA1c in patients newly diagnosed with T2DM.

Purpose: This study aimed to examine the factors influencing the degree of harm caused by fall incidents in hospitals. Methods: This cross-sectional descriptive study used secondary data from the “Korean Patient Safety Incident Report 2019” and was based on the International Classification for Patient Safety conceptual framework. We analyzed a total of 4,176 fall incidents between January 1 and December 31, 2019, in Korea. Multinomial logistic regression analyses were conducted to identify the factors that influence the degree of harm from these incidents. Results: Among the fall incidents, 443 (10.6%) were sentinel events, 2,514 (60.2%) were adverse events, and 1,219 (29.2%) were near misses. The factors associated with sentinel events were old age (≥60 years), gender, patient diagnosis, medical department, early detection after falls, long-term care hospital, and reporters. Adverse events were significantly associated with diagnosis, medical department, nurses’ night shift time, large bed size, location (i.e., operating room, recovery room, and intensive care unit), and reporters. Conclusion Both patient and incident characteristics are significantly associated with the degree of harm in hospitals. Therefore, multiple factors should be considered to establish healthcare policies and thus prevent fall risks and minimize damage following falls in hospitals.

Purpose: This study aimed to develop an educational informatics system for nursing faculty to improve their competencies in teaching patient safety and to evaluate the effectiveness of the system. Methods: We developed a system called, ‘Resource to Enhance Safety Competency and Utilize for Education’ (RESCUE) based on the World Health Organization Multi-professional Patient Safety Curriculum Guide, and it was implemented with full-time nursing faculty in 4-year nursing schools. A one-group pretest-posttest design was used for evaluation. A total of 46 nursing faculty members used the system during a 3-month period. The effects of the RESCUE were measured using a survey including patient safety teaching competency, system usability and user satisfaction. Data were analyzed using descriptive statistics and the Wilcoxon signed-rank test. Results: After using the RESCUE, participants showed a significant increase in self-confidence in teaching patient safety during lectures (Z=-3.61, p<.001) and practica (Z=-3.14, p=.002). Conclusion The developed informatics system was shown to be effective in improving the self-confidence of nursing faculty in teaching patient safety. To effectively integrate patient safety topics into the curriculum, it can be helpful to utilize the educational materials provided in this study with various clinical cases.

Purpose: This study aimed to examine the prevalence of unmet healthcare needs and the factors that influence unmet healthcare needs among older people with cognitive impairment. Methods: A cross-sectional, descriptive design with secondary data from the 2017 National Survey of Older Koreans was used in this study. Data from 1,382 people over the age of 65 years with cognitive impairments were analyzed. Logistic regression analysis was conducted based on Andersen’s Behavioral Model of Health Services Use. Results: Overall, 9.6% of the participants reported unmet healthcare needs during the previous 12 months. The main reasons for unmet healthcare needs were financial constraints (45.4%), mobility limitation (18.0%), and mildness of symptoms (14.9%). Higher unmet healthcare needs were significantly associated with fewer years of education, no family members providing caregiving or assistance with hospital visits, fewer close relatives, lower income, greater impairment in activities of daily living, and presence of depressive symptoms. Conclusion Our findings indicate that predisposing factors, enabling factors, and need factors were significantly associated with unmet healthcare needs among elderly individuals with cognitive impairment. Therefore, it is necessary to establish healthcare policies and strategies to improve the accessibility of healthcare services.

BACKGROUND/AIMS: The importance of α-cell dysfunction in the pathogenesis of type 2 diabetes has re-emerged recently. However, data on whether relative glucagon excess is present in clinical settings are scarce. We aimed to investigate associations between glucagon-to-insulin ratio and various metabolic parameters. METHODS: A total of 451 patients with type 2 diabetes naïve to insulin treatment were recruited. Using glucagon-to-insulin ratio, we divided subjects into quartiles according to both fasting and postprandial glucagon-to-insulin ratios. RESULTS: The mean age of the subjects was 58 years, with a mean body mass index of 25 kg/m² The patients in the highest quartile of glucagon-to-insulin ratio had higher glycated hemoglobin (HbA1c) levels. HbA1c levels were positively correlated with both fasting and postprandial glucagon-to-insulin ratios. Subjects in the highest quartile of postprandial glucagon-to-insulin ratio were more likely to exhibit uncontrolled hyperglycemia, even after adjusting for confounding factors (odds ratio, 2.730; 95% confidence interval, 1.236 to 6.028; p for trend < 0.01). CONCLUSIONS Hyperglucagonemia relative to insulin could contribute to uncontrolled hyperglycemia in type 2 diabetes patients.

BACKGROUND: Recently, the triglyceride glucose (TyG) index has been considered a surrogate marker of insulin resistance which is a well-known pathogenic factor in nonalcoholic fatty liver disease (NAFLD). However, few studies have investigated the relationship between the TyG index and NAFLD. Thus, we investigated the relationship between the TyG index and NAFLD and the effectiveness of the TyG index compared with the homeostasis model assessment of insulin resistance (HOMA-IR) in identifying NAFLD in Korean adults. METHODS: Participants of 4,986 who underwent ultrasonography in a health promotion center were enrolled. The TyG index was calculated as ln [fasting triglycerides (mg/dL)×fasting glucose (mg/dL)/2], and HOMA-IR was estimated. NAFLD was diagnosed by ultrasonography. RESULTS: Significant differences were observed in metabolic parameters among the quartiles of the TyG index. The prevalence of NAFLD significantly increased with increment in the TyG index. After adjusting for multiple risk factors, a logistic regression analysis was performed. When the highest and lowest quartiles of the TyG index and HOMA-IR were compared, the odds ratios for the prevalence of NAFLD were 2.94 and 1.93 (95% confidence interval, 2.32 to 3.72 and 1.43 to 2.61; both P for trend <0.01), respectively. According to the receiver operating characteristic analysis, the TyG index was superior to HOMA-IR in predicting NAFLD. CONCLUSION: The TyG index and prevalence of NAFLD were significantly related and the TyG index was superior to HOMA-IR in predicting NAFLD in Korean adults.
Adult ; Biomarkers ; Glucose ; Health Promotion ; Homeostasis ; Humans ; Insulin Resistance ; Insulin ; Logistic Models ; Non-alcoholic Fatty Liver Disease ; Odds Ratio ; Prevalence ; Risk Factors ; ROC Curve ; Triglycerides ; Ultrasonography

BACKGROUND: This study investigated the overall status of diabetes control and screening for diabetic microvascular complications in patients with type 2 diabetes mellitus attending primary care clinics in Korea. METHODS: In this cross-sectional observational study, 191 primary care clinics were randomly selected across Korea from 2015 to 2016. In total, 3,227 subjects were enrolled in the study. RESULTS: The patients followed at the primary care clinics were relatively young, with a mean age of 61.4±11.7 years, and had a relatively short duration of diabetes (mean duration, 7.6±6.5 years). Approximately 14% of subjects had diabetic microvascular complications. However, the patients treated at the primary care clinics had suboptimal control of hemoglobin A1c levels, blood pressure, and serum lipid levels, along with a metabolic target achievement rate of 5.9% according to the Korean Diabetes Association guidelines. The screening rates for diabetic nephropathy, retinopathy, and neuropathy within the past 12 months were 28.4%, 23.3%, and 13.3%, respectively. CONCLUSION: The overall status of diabetes management, including the frequency of screening for microvascular complications, was suboptimal in the primary care clinics. More efforts should be made and more resources need to be allocated for primary care physicians to promote adequate healthcare delivery, which would result in stricter diabetes control and improved management of diabetic complications.
Blood Pressure ; Delivery of Health Care ; Diabetes Complications ; Diabetes Mellitus, Type 2 ; Diabetic Nephropathies ; Humans ; Korea ; Mass Screening ; Observational Study ; Physicians, Primary Care ; Primary Health Care ; Tertiary Care Centers