－S 238 －
￭ ♣S-351 ￭
The changes of HbA1c values and relationship between HbA1c variability and diabetic nephropathy in newly diagnosed type 2 diabetic patients
1Department of Internal Medicine, Maryknoll Medical Center, 2Inje University, Busan, Korea
*A Ra Jo1, Ji hye Suk1, Mikyung Kim1, Jeonghyun Park2
Background and Objectives: Recently, a few studies reported HbA1c variability was related to the development of microvascular complications in type 1 diabetes. However, there are not many studies about relationship between HbA1c variability and diabetic complications in type 2 diabetic patients. We investigated the changes in HbA1c values and the relation between HbA1c variability and diabetic nephropathy in newly diagnosed type 2 diabetic patients. Methods: HbA1c was collected by serially from the time of diagnosis for over 5 years. Intrapersonal SD of measured HbA1c was considered as HbA1c variability. We divided patients into normal, microalbuminuria, macroalbuminuria and renal insufficiency group. We divided patients into low, middle, high group by percent changes of HbA1c within the first year of diagnosis. Result s：Of the eligible 192 patients, 109 patients were female (57%). The mean age was 53.1±11.6 years, and the mean BMI was 24.3±3.2 kg/m2 at diagnosis. Seventy seven percentage of patients attained HbA1c goal (<7%) within the first year of diagnosis. Patients who attained HbA1c goal showed lesser HbA1c variability than patients who did not (p=0.017). High percent change of HbA1c group showed higher HbA1c variability than the other groups (p<0.001). HbA1c variability in 4 groups of renal insufficiency was 1.11, 1.33, 1.12 and 1.60, respectively.
HbA1c variability in the renal insufficiency group was greater than the normal group (p=0.031). Conclusion: HbA1c variability was related with the attainment of HbA1c goal within the first year and diabetic nephropathy in newly diagnosed type 2 diabetic patients.
￭ ♣S-352 ￭
HLA DRB1*0406와 연관된 자가면역성 저혈당증 1예
경희대학교 의과대학 내분비-대사내과1, 내분비연구소2, 핵의학과3
김양균1, *박지윤1, 권미광1, 이상열1, 전 숙1,2, 정인경1,2, 오승준1,2, 안규정1,2, 김덕윤1,3, 정호연1,2, 우정택1,2, 김성운1,2, 김진우1,2, 김영설1,2
인슐린 항체에 의한 자가면역성 저혈당은 이전에 인슐린 치료를 받지 않은 사람에게서 유발되며 자가면역 질환을 동반하거나 설파기 (sulfhydryl group, S-H)을 가진 약물을 복용한 과거력이 있는 경우에 나타난다. 저자 등은 구불결장암으로 저위전방절제술과 항암치료 (FOLFOX -oxaloplatin, 5-FU)를 받은 과거력이 있는 환자에서 인슐린 자가항체에 의한 자가면역성 저혈당을 진단한 후 환자의 HLA typing 을 하여 인슐린 자가 면역성 저혈당증과 관련 깊은 HLA DRB1*0406을 확인하였다. 치료로서 혈장사혈(plasmapheresis)을 하였고 72시간 연속혈당검사(Continuous glucose monitoring system, CGMS)를 이용하여 치료 반응 관찰시 새벽 저혈당이 발생하여 alpha-glucosidase inhibitor 투여를 시작하였다. Alpha- glucosidase inhihitor를 투여하며 72시간 연속혈당검사(Continuous glucose monitoring system, CGMS)시에는 저혈 당이 발생하지 않았다. 환자는 2년 5개월간의 alpha-glucosidase inhibitor의 지속적인 투여 후 증상 호전되어 현재는 약물 치료 없이 7개월 째 외래에서 경과 관찰 중으로 이에 본 증례를 보고하는 바이다.
