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￭ S-415 ￭
The additive effect of NAFLD on the development of diabetes in individuals with metabolic syndrome
1Division of Endocrinology and Metabolism, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea, 2Division of Endocrinology and Metabolism, Department of Medicine, Gyeongsang National University School of Medicine,
Jinju, Korea, 3Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
*Jeong Gu Na1, Ji Cheol Bae2, Soo Kyoung Kim3, Eun Jung Rhee4
Background: Non-alcoholic fatty liver disease (NAFLD) is considered as the hepatic manifestation of the metabolic syndrome (MetS), with insulin re- sistance as the common pathophysiology. In a current longitudinal cohort study, we evaluated the separate and combined effects of MetS and NAFLD on incident diabetes risk. Methods: The data were obtained from the 10,950 subjects participated in comprehensive health check-ups annually for 5 years (between January 2005 and December 2009). Participants were categorized into four groups on the basis of the presence of NAFLD and MetS at baseline as follows: [1] having neither NAFLD nor MetS; (ii) having NAFLD without MetS; (iii) having MetS without NAFLD; and (iv) having both NAFLD and MS. Results: During the mean follow up of 4 years (47.3±5.0 months), 435 of the 7,849 participants (5.5%) developed diabetes. The in- cidence rate of diabetes per 1,000 person-years was 8.1, 13.1, 24.6, and 47.2 in subjects with neither, NAFLD without metabolic syndrome, metabolic syndrome without NAFLD, and both, respectively. The age, sex, and smoking-adjusted risk of incident diabetes was higher in the group of NAFLD without metabolic syndrome (HR 1.51, 95% CI 1.14-1.99), metabolic syndrome without NAFLD (HR 2.82, 95% CI 2.01-3.95), and both (HR 5.45, 95% CI 4.32-6.82) compared with the group of neither. When compared with the NAFLD only group, the age, sex, and smoking-adjusted HR for in- cident diabetes was 1.87 (95% CI 1.29-2.72) in the metabolic syndrome without NAFLD group and 1.93 (95% CI 1.38-2.71) in the both metabolic syn- drome and NAFLD group. Among individuals with metabolic syndrome, the presence of NAFLD showed a significant increase in risk of incident dia- betes (HR 1.93, 95% CI 1.38-2.71). Conclusions: The presence of MetS alone or NAFLD alone was associated with increased risk of diabetes. Also, the presence of NAFLD showed additive effects on risk of incident diabetes in individuals with MetS.
￭ S-416 ￭
Cause-of-Death Trends for Diabetes Mellitus over 20 Years
동아대학교병원, 내과
*양원열, 서성환, 박미경, 김덕규
Background: This study set to analyze changes in the cause of death in type 2 diabetes mellitus (T2DM) in the past 20 years. Methods: All subjects were T2DM patients over the age of 30 whose death certificates were issued at six hospitals in the Busan metropolitan area from 2010 to 2014. The pa- tients were excluded if they had been clinically diagnosed with significant tuberculosis, liver, thyroid, renal, connective tissue diseases and cancers, pri- or to T2DM diagnosis. The causes of death were retrospectively determined based on the information from attending physicians or death certificates.
We classified the cause of death into eight categories: (1) cardiovascular disease (CVD), (2) congestive heart failure (CHF), (3) infectious disease, (4) DM, (5) chronic liver disease, (6) malignancy, (7) renal disease, and (8) others.The results were compared with our published data on the period from 1990 to 1994 and 2000 to 2004. Results: The study comprised 680 patients of which 61.7% were male. The average age of death was 66.5 years. The most common cause of death was malignancy (47.7%), followed by renal disease (14.0%), infectious disease (10.6%), and CVD (8.5%). Among fatal cancers, hepatocellular carcinoma was the most frequent (21.4%). Among the fatal infections, sepsis was the most frequent (44%), followed by pneu- monia (32%). Compared with previous study, cancer became the most common cause of death in T2DM patients, while CVD and infectious disease sig- nificantly decreased in the rank. Conclusions: Over the 20 years, death by cancer in T2DM patients was is rising steeply. Preventive strategies to pro- mote primary prevention and early detection of malignancies are urgently needed to reduce this excess mortality.
