| Byung Yeon Yu | 16 Articles |
Background
We assessed the frequency and severity of hypoglycemia in type 2 diabetes mellitus patients treated with sulfonylurea monotherapy or sulfonylurea+metformin. Methods We conducted a retrospective, observational, cross-sectional study in 2011 and 2012 including patients with type 2 diabetes mellitus aged ≥30 years who were treated with ≥6 months of sulfonylurea monotherapy or sulfonylurea+metformin at 20 university-affiliated hospitals in Korea. At enrollment, glycated hemoglobin (HbA1c) was assessed; participants completed self-reported questionnaires describing hypoglycemia incidents over the past 6 months. A review of medical records up to 12 months before enrollment provided data on demographics, disease history, comorbidities, laboratory results, and drug usage. Results Of 726 enrolled patients, 719 were included (55.6% male); 31.7% and 68.3% were on sulfonylurea monotherapy and sulfonylurea+metformin, respectively. Mean±standard deviation age was 65.9±10.0 years; mean HbA1c level was 7.0%±1.0%; 77.8% of patients had hypertension (89.4% used antihypertensive medication); 60.5% had lipid disorders (72.5% used lipid-lowering medication); and 52.0% had one or more micro- or macrovascular diseases. Among patients with A1c measurement (n=717), 56.4% achieved therapeutic goals (HbA1c <7.0%); 42.4% (305/719) experienced hypoglycemia within 6 months of enrollment; and 38.8%, 12.9%, 12.7%, and 3.9% of patients experienced mild, moderate, severe, and very severe hypoglycemia symptoms, respectively. Several reported hypoglycemia frequency as 1–2 times over the last 6 months. The mean number of very severe hypoglycemia episodes was 3.5±5.5. Conclusion Among type 2 diabetes mellitus patients treated with sulfonylurea-based regimens, glycemic levels were relatively well controlled but hypoglycemia remained a prevalent side effect. Citations Citations to this article as recorded by
Alcohol use disorder (AUD) affects not only an individual's health but also their family. This study was conducted to examine effects of a spouse's AUD on family functioning and family communication. We conducted a cross-sectional study using data from 890 participants (445 couples) in a Korean family cohort in primary care. Participants with Alcohol Use Disorders Identification Test in Korea scores of 8 or greater were classified into an AUD group. Family functioning was classified into three groups (balanced, midrange, and extreme) using the Family Adaptability and Cohesion Scale (FACES)-III questionnaire, and then reclassified into two groups (appropriate and extreme groups) for binominal analyses. Family communication was classified into three groups (high, moderate, and low) using the Family Communication Scale, FACES-IV, and also reclassified into two groups (good and poor). There was no significant difference in adaptability and cohesion between both male and female participants with a spouse with AUD and participants with a spouse without AUD. Using multivariate logistic regression to adjust for potential confounders, there was no significant difference in family type and communication between the two groups in males. However, there was a significant decrease in family communication (odds ratio, 2.14; 95% confidence interval, 1.29 to 3.58) in females with a spouse with AUD compared to females with a spouse without AUD, even after adjusting for the participant's own AUD. In females, family communication is significantly worse when spouses have AUD. This suggests that a husband's alcohol consumption has negative effects on his wife's family communication. Citations Citations to this article as recorded by
Backgroud: Body mass index (BMI) for gender and age and percentage-weight-for-height (PWH) for gender and height have been frequently used to diagnose childhood obesity. However, few studies have examined the optimal cutoff of percent body fat (%BF) to predict metabolic abnormalities in obese children. Methods: One thousand fi fteen obese children aged 10 to 15 years were enrolled in this study. The %BF cutoff values were calculated by ROC analysis for metabolic abnormalities. We also calculated %BF cutoff values corresponding to a BMI of > 85th or 95th percentile for gender and age and a PWH of > 120% for gender and height based on the 2007 Korean children and adolescents growth standard chart. To defi ne metabolic abnormalities in children, we used the criteria of metabolic syndrome recommended by International Diabetes Federation consensus for children and adolescents. Results: The %BF cutoff corresponding to the group having more than one metabolic abnormality in this study population were 38.4% (sensitivity 40.1%, specifi city 84.4%) in total, 38.4% (sensitivity 35.4%, specifi city 84.8%) in boys and 39.5% (sensitivity 38.9%, specifi city 90.9%) in girls. The %BF cutoff values corresponding to a BMI ≥ 95 percentile were 38.1% (sensitivity 50.5%, specifi city 72.7%), a BMI ≥ 85 percentile were 34.5% (sensitivity 69.3%, specifi city 74.2%), and a PWH ≥ 120% were 36.4% (sensitivity 72.3%, specifi city 64.4%) in total. Conclusion: The optimal cutoff value of percent body fat to predict metabolic abnormalities in obese children may be 38.4% (boys 38.4, girls 39.5%) and we suggest 34.5% as a cutoff value of %BF for screening childhood obesity.
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Background
Bioelectrical impedance analysis (BIA) is frequently used to diagnose obesity in clinical setting, but the usefulness of BIA in children is not become known accurately. We analyzed the usefulness of BIA and anthropometric measurement compared with Dual-energy X-ray absorptiometry (DXA) as a diagnostic tool of childhood obesity. Methods: 205 volunteer primary and middle school children were recruited. We measured weight and height, and analyzed the body composition by BIA and DXA. By paired t-test and Bland-Altman plots, mean difference and limit of agreement were calculated between DXA and BIA according to sex and age groups. Sensitivity and specificity were displayed with the gold standard of PBF above 35% by DXA. Results: There was significantly positive correlation between DXA and BIA in fat mass (FM) (r=0.982, P＜0.001), fat free mass (FFM) (r=0.990, P＜0.001), and percent body fat (PBF) (r=0.956, P＜0.001). Mean difference between DXA and BIA in FM, FFM, and PBF were 0.4⁑1.4 kg (P＜0.001), 0.6⁑1.3 kg (P＜0.001), and 0.5⁑2.8% (P=0.016), respectively. Limit of agreement in FM, FFM, and PBF were 0.4⁑2.7 kg, 0.6⁑2.5 kg, and 0.5⁑5.5%, respectively. The most sensitive method of diagnosis of obesity was Korean BMI standards for 85 percentile (94.7%) and IOTF BMI 25 kg/m2 (94.7%). The sensitivity and specificity by BIA were 90.7% and 97.7%. Conclusions: BIA was not interchangeable with DXA. However because of higher diagnostic accuracy and correlation, it could be used to measure body composition as simple field method. We recommend Korean BMI standards for 85 percentile or IOTF BMI 25 kg/m2 as the screening test for diagnosis of Korean childhood obesity. (J Korean Acad Fam Med 2007;28:523-531)
Background
: InBody 4.0, a bioelectrical impedance analyser (BIA) has an automatic function of printing out the measurement data of visceral fat area. The purpose of this study was to assess the usefulness of the visceral obesity measured by the InBody 4.0 and the waist circumference Methods : A total of 124 participants who visited an obesity clinic in a university hospital were measured their waist circumference, height, weight and the visceral fat area by the InBody 4.0 and CT scan. The mean difference and agreement between the two visceral fat areas by the two methods had been analyzed according to sex, age and BMI groups. The accuracy of the visceral obesity by the BIA and the waist circumference was respectively compared with the visceral obesity by the CT scan. Results : There was no significant difference between visceral fat area measured by the CT and the BIA in women participants under 46 years of age and below BMI 30. When comparing visceral fat area obtained from the CT with those obtained from the BIA, the 95% confidence interval for the limit agreement was higher in male subjects than in females. The waist circumference was the more sensitive method to diagnose visceral obesity than the BIA (91.80% vs. 77.94%), but the BIA method showed a higher specificity than the waist circumference (76.79% vs 52.38%). Conclusion : Waist circumference turned out to be more useful than the BIA as a screening tool for visceral obesity. In the group of males, BMI of over 30, or the age over 46 years, it is recommended that the CT rather than the BIA for measurement of visceral fat area be utiliged.
Background
: The aim of this study was to elucidate the relationship between nonalcoholic fatty liver disease diagnosed by ultrasonography and the metabolic syndrome defined by NCEP-ATP III criteria. Methods : Sixty-nine adult male subjects with negligible alcohol consumption underwent an anthropometric and laboratory investigation. The ultrasound scan of the liver was performed to determine the presence and the severity of nonalcoholic fatty liver disease. Results : Nonalcoholic fatty liver disease was diagnosed in 36 cases by ultrasound scan. According to the severity of nonalcoholic fatty liver, triglyceride, HDL- cholesterol, alanine aminotransferase, aspartate aminotrasnferase, fasting insulin level, HOMA-IR, and obesity related variables (body mass index, percent body fat, waist circumference) showed a significant difference. The independent variables which account for the severity of nonalcoholic fatty liver disease was waist circumference, and alanine aminotransferase which is a predictor of nonalcoholic steatohepatitis. The prevalence of metabolic syndrome was 41% vs 6.1% in nonalcoholic fatty liver group vs control group, respectively, and the odds ratio was 11.1 (95% CI 2.29∼53.6). The prevalence of nonalcoholic fatty liver was increased with increasing the number of features of metabolic syndrome. Conclusion : Nonalcoholic fatty liver disease was closely related to the metabolic syndrome and the severity classification of nonalcoholic fatty liver by ultrasound scan could be useful to predict of the severity of insulin resistance, and the risk of nonalcoholic steatohepatitis.
Background
: It is well known that heavy alcohol consumption may result in various lesions on multiple organs and tissue, especially liver. The aim of this study was to measure prevalence of raised liver-derived enzymes in healthy men and possible association with alcohol consumption, smoking and body mass index. Methods : All subjects were 450 men who received Adult Health Examination at Seoul Hospital of Konkuk medical center from May, 1998 to October, 1998. We carried out telephone survey and analyzed 360 men, excluding men with HBs Ag(+), hepatic problems within 6 months, medication drug that could change serum activity of hepatic enzyme or joints, muscles, cardiac problem and non-responder to telephone survey. We examined prevalence of raise liver enzymes and its possible association with alcohol consumption, smoking, and body mass index, applying logistic regression analysis. Results : In 20.3% of study subjects, we found raised levels of liver-derived enzymes. If the alcohol consumption was higher than 270 g/week, the odds ratio(OR) for raised liver enzymes, adjusted for body mass index and smoking, increased ; serum gamma glutamyltransferase(r GTP) (OR: 9.48), serum aspartate aminotransferase(AST) (OR: 13.09), and serum alanine aminotransferase(ALT) (OR: 7.40). Smoking was not associated with the risk of raised liver enzymes and obesity(body mass index 25 kg/㎡) showed a positive association with two enzymes ; rGTP(OR: 1.92) and ALT(OR: 2.08). Conclusion : If alcohol consumption was higher than 270 g/week, the risk of raised liver enzymes increased dramatically and rGTP, AST were shown more sensitive than ALT in alcoholic liver disease.
Background
: Cerebral infarction is one of the common cause of death in Korea. There are many studies about risk factors of cerebral infarction in the world and Korea. and there are some studies about risk factors of mortality and recurrence after first cerebral infarction in the world. but there are no reliable epidemiologic studies about risk factors of mortality and recurrence after first cerebral infarction in Korea. So this study was designed to investigate the risk factors of mortality and recurrence after first cerebral infarction in Korea. Methods : A cohort of 257 patients with diagnosing first cerebral infarction at our hospital were selected and followed for at least 5 years. 30 days, 1 year, 5 year cumulative mortality and recurrence was calculated. Risk Factors classified at the time of first cerebral infarction. and then entered into a Cox proportional harzards model for mortality and for recurrence. Results : The cumulative risk of mortality after first cerebral infarction was 13%, at 30days, 21%, at 1year, 49% at 5years. The cumulative risk of recurrence after first cerebral infarction was 4% at 30days, 11% at 1year, 24% 5years. The significant risk factors of mortality after first cerebral infarction were age(≥65), heavy alcohol drinking history, heart, failure, untreated diabetes mellitus history, untreated hypertension history, high admission Hct(≥50%), high admission glucose(≥200), atrial fibrillation at admission, under drowsy mental state at admission, embolic infarction type, high admission systolic bolld pressure(≥160), high admission diastolic blood pressure(≥100). The significant risk factors of recurrence were age(<65), men, heavy alcohol drink-ing history, ischemic heart disease, untreated DM history, high admission glucose(≥200). Conclusion : Diabetes mellitus, hypertension, heavy alcohol drinking, cardiovascular disease were important factor of cerebral infarction prognosis on our study. So primary care physicians focus on these factors when treating cerebral infarction patient.
Background
: Urinary tract infection is one of the most common diseases in primary practice. Although quantitative urine culture is the standard for diagnosis, a rapid screening test is needed for effective management. But numerous studies in the past were controversial. We evaluated the utility of dipstick urine analysis as a screening test for urinary tract infection. Methods : A retrospective analysis of 311 patients who were admitted between May 1997, and April 1998 were chosen as subject. Patients had a complete urine analysis, such as microscopic analysis, chemical analysis by dipstick and urine culture was performed as part of an evaluation for urinary tract infection or suspicious febrile illness. We compared dipstick analysis with microscopic examination and urine culture. The results of the dipstick urinalysis were compared with the results of the urine culture, sensitivity, specificity, positive predictive value and negative predictive value. Results : A total of 311 cases were included in the study among which 122 cases were true pos-itive in urine culture. For dipstick urine analysis 92 of 122 cases were leukocyte esterase positive and 39 of 122 were nitrite positive. On microscopic examination 44 of 122 cases were leukocyte positive and 40 of 122 were microorganism positive. Conclusion : The sensitivity of the dipstick urinalysis seems higher than the microscopic exami-nation in urinary tract infection. We conclude that the dipstick urinalysis is a useful screening test for urinary tract infection for those above 2 years old.
Background
: Recently in Korea, the rate of addictive drug abuse is rapidly increasing in men on salary, housewives, and even in adolescents, who have been considered to be free from drugs, which presents a serious problem to the society. Especially, the habituation to gateway drug, such as cigarettes and alcohol, before 15 years old, would lead to the increased possibility of other drug abuse, including illicit drugs. Thereupon in this study, we intended to review the effect of adolescents' smoking on the drug abuse and deviated behaviors. Methods : On September, 1997, randomly selected were 12 classes, on the basis of 2 classes per grade, from the two schools which was located each in Seoul and Bucheon. And survey was done on 610 students with non-nominal, self-reported questionnaire. Results : The rate of adolescent smoking was 28.1% in male students and had increasing tendency of "the higher the grades, the higher the smoking rate"(17.0% in the 1st grade, 31.5% in the 2nd grade, 35.9% in the 3rd grade). The smoking rate of female students was 12.3%. From the 2nd grade of middle school to the 2nd grade of high school was the critical period when the smoking habit was initiated in almost 90% of the students. The experiencing rates of drug abuse in studied subjects were as follows : drinking(79.0%), stimulants(4.8%), sedatives(4.1%), hypnotics(3.1%), glue sniffing(1.5%), butane gas(0.7%), marijuana/hemp(0.2%). They were higher in the smoking group than in the nonsmoking group, showing statistical significances in most items except hypnotics and marijuana/hemp. Also similar results were shown in deviated behaviors between the groups. Conclusion : With the concerted efforts of family, school, society and nation, we as family physicians should make efforts to delay and prevent adolescents' smoking, which is a gateway to drug abuse and deviated behaviors, and to increase people's recognition of health risks caused by smoking, and to provide proper program for adolescents to stop smoking.
Background
: Papanicolaou smear adequacy is directly related to endocervical edll discovery, and therefore can improve the value of the Papanicolaou smear as a cancer screening test. One of the pruposes of this study is to assess capture rate of endocervical element of the current Pap smear method in Korea which is performed by using only dry cotton swab. The other purpose is to compare effectiveness of cytobrush cell collector when performing Pap smear. Methods : This study was performed for 333 patients visiting Family medicine outpatient department at Konkuk University Medical College Hospital to take Pap smear test from March 3, 1994 to July 12, 1994. The both dry cotton swab and cytobrush cell collector were used to collect specimen for each of total 333 patients. Results : The endocervical cell capture rate was 37.2% for dry cotton swab, 73.0% for cytobrush. The difference of endocervical cell capture rates among two methods was significant statistically. A significant higher number of atypical epithelial changes was found in smears with endocervical cells than in smears without endocervical epithelial changes was found in smears with endocervical cells than in smears without endocervical columnar cells. Thus, the chance of missing an abnormal epithelial change is increased in smears without endocervical columnar cells irrespective of instruments. The use of the cytobrush incresased the number of smears that contained endocervical cells for reproductive age and postmenopausal women. Conclusion : The use of cytobrush is considered as a more effective method for collection of endocervical cells compared with dry cotton swab, and the chance of detecting an abnormal epithelial change is increased in smears with endocervical cells.
Background
: Glaucoma is one of the main causes of blindness throughout the world and the prevalence of glaucoma increases with the increasing numbers of elderly in our population. Typically, glaucoma occurs without any subjective symptoms until the late stage of the disease. Early detection of glaucoma by screening and therapeutic intervention are therfore of the highest importance for the prevention of blindness by glaucoma. The purpose of this study was to demonstrate the importance of glaucoma screening in family practice. Methods : We conducted glaucoma screenings by tonometry and direct opthalmoscopy in the health examination center of university hospital in Chungjoo. A total of 283 subjects were screened and patients with suspected abnormalities were referred to opthalmologist. Results : The mean intraocular pressure obtained with Shiotz tonometry was 14.73mmHg and there was no sexual or age-related differences. Of 17 patients referred to opthalmologist 9 patients (3.18%) were confirmed as having glaucoma. The most common type of glaucoma was low tension glaucoma. Conclusion : Glaucoma is the preventable cause of blindness and one of the objectvies of family medicine is early diagnosis and disease prevention. Therefore, we support the view that it is prerequisite to adopt glaucoma screening in health examination.
Background
: Health status is affected by various factors-dietary habits, life style, local difference etc. The prevalence of cardiovascular disorder is increasing in Korea. Serum cholesterol level, blood sugar level, body fatness are closely related to cardiovascular disorder. We performed comparative studies of the results of periodic health examinations in insured adults of different areas. Methods : Of the results of periodic health examination of insured adults, 3,305 subjects were gathered. 935 subjects were residents of Seoul and 2,370 subjects were residents of Chungjoo. All the subjects' serum cholesterol level, fasting blood sugar level, arterial blood pressure, and body mass index were analyzed statistically. Results : Serum cholesterol level(Seoul : 207.66mg/dL, Chungjoo : 202.60mg/dl ; P<0.01) and fasting blood sugar level(Seoul : 92.77mg/dL, Chungjoo : 90.16mg/dL ; P<0.01) were statistically different between two areas, but arterial blood pressure and body mass index had no statistical differences. The prevalence of abnormal findings was no statistically different between two areas. Conclusion : Geographic differences affected above mentioned index values were noted. We did not consider specific environmental factors, such as diet habit, physical activity and individual concern about health. But this study will be a supportive data for future studies of health maintenance factors in Korean.
To study the various factors related with hypertriglyceridemia, 2,011 persons who visited Yongdong Health Examination Center for general check-up during the period from May. 1990 to Sep. 1990 were examined by means of questionnaire on living environment and health behavior and laboratory findings.
Hypertriglyceridemia was defined as plasma triglyceride over 250mg%. We made the nongypertriglyceridemic control group by random matching each hypertriglyceridemic person by age and sex(1:1 matching). There were 128 persons for nonhypertriglyceridemic group and 128 persons for hypertriglyceridemic group. The results were as follows. 1. The incidence of hypertriglyceridemia was 128(6.3%) among 2,011 cases and sexual distribution was 102/1215(8.4%) in males and 26/796(3.3%) in females. 2. The incidence of hypertriglyceridemia was increasing while patient's age increased and which was statistically significant(p<0.05). 3. In hypertriglyceridemic group, smoking rate(p<0.01) and smoking amount(p<0.05), alcohol drinking rate(p<0.05), hypertension(p<0.05), diabetes mellitus(p<0.05), fatty liver(p<0,05), total cholesterol level, HDL cholesterol level and LDL cholesterol level were significantly different from nonhypertriglyceridemic group by statistics. 4. In respect of obesity, there was no significant difference between hypertriglyceridemic and nonhypertriglyceridemic groups.
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