2023-07-15 21:00:00
At Seoul St. Mary’s Hospital in Seocho-gu, Seoul, Professor Yoon Gun-ho of the Department of Endocrinology at Catholic University of Korea explains diabetes./Reporter Kim Myung-ji
In ‘The Squid Game’, which topped Netflix in 2021, the main character Seong Ki-hoon (Lee Jung-jae) is a person who lives a lethargic life following losing his job and falling into gambling. He lives in a single room with his mother in Ssangmun-dong, Dobong-gu, Seoul, and his life is so low that he steals his mother’s check card and goes to the racetrack. However, it was because of his mother that he participated in the squid game where he risked his life. It was because her mother needed money to save her feet from diabetic foot disease, a complication of her diabetes.
Diabetes is a disease in which there is sugar in the urine. It originated from the symptom that glucose (blood sugar) in the body overflows into urine. I want to know what a big problem it is that glucose escapes into urine, but like the diabetic feet in ‘The Squid Game’, it is a very scary disease that I don’t notice even if my feet are festering and rotting. This is because glucose, the basic energy source of our body, overflows into urine, which means that our body is so damaged that it cannot carry out basic metabolism.
However, recent studies have shown that the lower the income level, the higher the number of diabetic patients. In 2017, Professor Yoon Gun-ho of the Department of Endocrinology at Seoul St. Mary’s Hospital at the Catholic University of Korea, who has studied Korean type diabetes, displayed a map showing the prevalence of obesity-type diabetes in each district in Seoul on a laptop monitor. It was explained that the more prevalent the population, the more red it was, but only the 3 districts of Gangnam were orange, and all the rest pointed to ‘red’, which is a risk level. The color of Dobong, Gangbuk, and Jungnang-gu is exceptionally bright red.
Professor Yoon said, “Right now, in terms of Seoul alone, the number of people with obesity-type diabetes is rapidly increasing in areas other than the 3rd district of Gangnam, where the income level is high,” and said that a health care policy is needed to prepare for this.
At Seoul St. Mary’s Hospital in Seocho-gu, Seoul, Professor Yoon Gun-ho of the Department of Endocrinology at Catholic University of Korea explains diabetes./Reporter Kim Myung-ji
It’s not just outbreaks that are the problem. According to a study published in an international academic journal in the field of public health in 2021, the lower the income of diabetic patients, the higher the risk of dying within 5 years when diabetic feet appear. Professor Yoon said, “As for diabetes, the gap between the rich and the poor is appearing as a health gap,” and “We must hurry to prepare for Western-type diabetes.”
Professor Yoon is known as a diabetic doctor who has treated and studied Korean diabetes for more than 20 years. He graduated from the Catholic University of Korea and received his master’s and doctoral degrees from the same university. He later served as the vice president of the Korean Diabetes Association and then the chairman of the Korean Diabetes Association. The following is a question and answer.
– What is diabetes? How to diagnose and define
“Diabetes is a disease in which the body cannot control blood sugar levels well. Diabetes is diagnosed when fasting blood sugar is 126 mg/dL or higher following fasting for 8 hours or more and 200 mg/dL or higher 2 hours following eating. Diabetes is diagnosed when the glycated hemoglobin test result is 6.5% or higher. Glycated hemoglobin is a value that reflects average blood sugar over the past two to three months, which means that not only fasting blood sugar but also normal blood sugar control following eating is a criterion for judgment.”
– Too professional. Please explain more simply.
“When we eat rice and bread, they are broken down into glucose. Insulin secreted by the pancreas causes the cells in our body to use glucose. Type 1 diabetes in which insulin is not secreted congenitally, and insulin secretion is possible, but type 2 diabetes in which the cells of the body do not recognize insulin secretion (resistance) and the function is reduced due to obesity or various social and genetic problems classified as What we often refer to as “managed diabetes” is type 2 diabetes. It often develops gradually following the age of 35. The key to diabetes treatment is to prolong life by managing blood sugar at an appropriate level to prevent complications.”
-Is diabetes that dangerous? Isn’t it enough to manage blood sugar well?
“That’s the problem because I can’t control my blood sugar. If the blood sugar rises too much and there is a problem with the blood vessels going to the head, it causes a stroke, and then, if the blood vessels going to the heart are blocked, myocardial infarction, heart failure, and death. If the blood sugar rises and the kidneys are damaged, kidney failure, and when it goes to the retina, the eyes are damaged by retinopathy. The overflowing sugar in the body also damages the sensory, motor, and autonomic nerves. this is diabetic Even if there is a wound on the body, you don’t notice it, and the wound doesn’t heal, so it rots. ”
– What are the early symptoms of diabetes?
“Diabetes can experience three main symptoms. These are many urination, Daum, and many meals. It is a symptom of urinating a lot, drinking a lot of water due to severe thirst, and trying to eat more and more because of hunger. Precursor symptoms include sudden weight gain, chronic fatigue, blurred vision, and other symptoms, which should be suspected of diabetes. These are all symptoms of high blood sugar.”
Seoul St. Mary’s Hospital YouTube capture
-I wonder if there are any characteristics of Korean type diabetes. Is there anything unique regarding it compared to the West?
“In the United States and Europe, many people die from cardiovascular disease, a complication of diabetes, but in Korea, kidney disease is the most common cause of death. In the West, there are many obesity-type diabetes that occurs in obese people over the age of 65, but in Korea, blood vessels are clean, but there are many so-called ‘skinny diabetes’ in which blood sugar is not managed well. Complications of dry diabetes include retinopathy (retinal damage) and nephropathy (kidney damage). “
– There are not many obesity-type diabetes in Korea, so it’s not a big problem.
“This does not mean that there is no obesity-type diabetes in Korea. According to recent statistics, regarding 55% of type 2 diabetes accounts for half of obesity-type diabetes. Of course, there are many more in the US and Europe. And in Korea, the proportion is gradually increasing. Especially in low-income regions, the number of obese diabetic patients is increasing rapidly. It is fortunate that many effective new drugs are being developed these days.”
-What kind of medicines are effective medicines? I heard that there are many drugs derived from diabetes treatments.
“There is a growing interest in a new class of treatments called weight loss diabetes drugs, such as SGLT-2 inhibitors or GLP-1 analogues, these days. Saxenda, which is more famous as an obesity treatment these days, is a GLP-1 inhibitor.”
– Then, can you explain the SGLT-2 inhibitor?
“SGLT-2 inhibitors are a diabetes treatment developed regarding 10 years ago, but these days, their use is expanding not only for blood sugar management, but also for heart failure treatment, chronic renal failure prevention, hypertension reduction, and weight loss effects.”
The medical community compares SGLT-2 inhibitors to 21st-century statins. Statins appeared in the late 1980s and are drugs that dramatically improved high cholesterol, the main cause of cardiovascular disease.
-Can you explain in more detail?
“In SGLT, S stands for sodium, GL stands for glucose, and T2 stands for Transporter. It is a drug that lowers blood sugar and blood pressure by inhibiting the absorption of salt (sodium) and sugar (glucose) in our body. In order to use energy efficiently, our body reabsorbs all of it in the metabolic process so that no sugar is lost in urine and uses it as energy. Diabetes is when this system is broken and glucose levels in the blood rise, ruining health. SGLT-2 inhibitors lower blood sugar and blood pressure by excreting excess salt and sugar in the body through urine. On average, regarding 70 g of glucose per day is excreted in the urine. 70g of glucose is 280㎉, which is a figure that can only be achieved by riding a fast bicycle for an hour.”
At Seoul St. Mary’s Hospital in Seocho-gu, Seoul, Professor Yoon Gun-ho of the Department of Endocrinology at Catholic University of Korea explains diabetes./Reporter Kim Myung-ji
-What is the difference from existing treatments?
“Existing treatments focused only on lowering blood sugar, so I didn’t see any other problems in the body. For example, metformin, used as a first-line treatment for diabetes, is a drug derived from lily extract. Since it has a long history of using medicine, its safety has been proven, so many prescriptions are being made. It is also an advantage that the drug is cheap because it is an old drug. However, other than lowering blood sugar, there are few other beneficial effects. Several side effects are also emerging. If metformin is prescribed to the elderly, weight loss is severe due to loss of appetite, and since it only lowers blood sugar, there is a risk that the patient will fall into hypoglycemic shock if the drug is used incorrectly.”
– Then, are there no risks of hypoglycemia with SGLT-2 and GLP-1?
“Since the two drugs are systems that release excess glucose, there is no risk of hypoglycemia. Both drugs are attracting attention as ‘weight loss diabetes drugs’, but their personalities are slightly different. If SGLT-2 is effective in preventing heart failure and kidney failure, GLP-1 is a much more effective drug in cardiovascular management and weight loss. Because of the good efficacy of SGLT-2 in terms of drug cost and management of renal complications of Korean diabetes, it is being re-examined.”
The Korean Diabetes Association revised the treatment guidelines in May this year. At that time, it is said that interest in SGLT-2 inhibitors was hot within the society. As a result, treatment including SGLT-2 inhibitors was recommended first for diabetic patients with renal failure (chronic kidney disease). It can be used as a first-line treatment.
– I understand that Enblo (ingredient name: Inavogliflozin) developed by Daewoong Pharmaceutical is an SGLT-2 inhibitor. I heard that it is a domestically produced new drug. What does this mean? A drug that came out 10 years ago is a new drug.
“It means that it is difficult to develop new drugs. As a doctor, I am deeply moved that a domestic drug was developed 10 years following SGLT-2 inhibitors began to be used in Korea. Enbloh produces the same effect with a much smaller dose (0.3mg) compared to existing SGLT-2 inhibitors. In clinical trials, blood glucose levels were also lowered, and the rate of achieving target blood sugar levels was as high as 70%. Personally, I am looking forward to it as a domestic blockbuster new drug.”
-Is there a big difference in efficacy and effectiveness of SGLT-2 developed by a global pharmaceutical company?
“Hasn’t the efficacy and side effects been proven through licensed clinical trials? Enblo’s clinical trial was published online in the journal ‘Diabetes, Obesity and Metabolism (DOM)’, an International Scientific Citation Index (SCIE) level paper. This journal is a journal in the field of endocrine metabolism and is a prestigious academic journal with a citation index (IF) of 6.408 in 2021. In the efficacy evaluation index ‘change in glycated hemoglobin (HbA1c) at 24 weeks following taking Enblo,’ the Enblo-treated group was -0.88%P and the placebo control group was 0.11%P, and the difference between the two groups was -0.99%P, a significant difference. seemed There were no adverse reactions, adverse drug reactions, or serious adverse reactions.”
Seoul St. Mary’s Hospital YouTube capture
– The Korean government is presenting several policies to foster the pharmaceutical bio industry. how do you see
“It’s a positive sign, but I wish they were more proactive. In order to foster the Korean pharmaceutical industry, I think it is necessary to consider domestically produced new drugs first. There is also a case where Japan blocks entry of foreign pharmaceutical companies when it develops a domestic new drug.”
-Looks like an Enblo missionary.
“That’s because there are so many advantages of SGLT-2 inhibitors. There is no need to hesitate in recommending a drug that can solve the problem of obesity, the root cause of all diseases by reducing weight, and treat kidney failure. Enblo is also affordable, so it can solve the problem of diabetes in the low-income class.”
Enblo’s drug costs regarding 611 won per tablet, which is cheaper than the existing SGLT-2 drugs Jardiance (660 won), Suglet (685 won), and Steglatro tablets (666 won).
– New drug development is important, but isn’t the medical system for patient management also important?
“The role of local hospitals is particularly important for chronic diseases such as diabetes. University hospitals see patients with type 1 diabetes or critically ill patients suffering from severe complications from diabetes. I worry that essential medical care is collapsing these days. These problems are ultimately due to medical expenses. However, more than 90% of medical expenses come from critically ill patients. Then, reducing the number of critically ill patients is the way to reduce the country’s medical expenses. If a patient with mild symptoms goes to a local hospital and is managed, the patient does not become critically ill. So, if you go to the local hospital well, wouldn’t it be helpful not only for the patient’s own health but also for the national finances?”
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