OBJECTIVE -To investigate the long-term effectiveness of the Internet-based glucose monitoring system (IBGMS) on glucose control in patients with type 2 diabetes.RESEARCH DESIGN AND METHODS -We conducted a prospective, randomized, controlled trial in 80 patients with type 2 diabetes for 30 months. The intervention group was treated with the IBGMS, while the control group made conventional office visits only. HbA 1c (A1C) was performed at 3-month intervals. For measuring of the stability of glucose control, the SD value of A1C levels for each subject was used as the A1C fluctuation index (HFI).RESULTS -The mean A1C and HFI were significantly lower in the intervention group (n ϭ 40) than in the control group (n ϭ 40). (A1C [mean Ϯ SD] 6.9 Ϯ 0.9 vs. 7.5 Ϯ 1.0%, P ϭ 0.009; HFI 0.47 Ϯ 0.23 vs. 0.78 Ϯ 0.51, P ϭ 0.001; intervention versus control groups, respectively). Patients in the intervention group with a basal A1C Ն7% (n ϭ 27) had markedly lower A1C levels than corresponding patients in the control group during the first 3 months and maintained more stable levels throughout the study (P ϭ 0.022). Control patients with a basal A1C Ͻ7% (n ϭ 15) showed the characteristic bimodal distribution of A1C levels, whereas the A1C levels in the intervention group remained stable throughout the study with low HFI.CONCLUSIONS -Long-term use of the IBGMS has proven to be superior to conventional diabetes care systems based on office visits for controlling blood glucose and achieving glucose stability. Diabetes Care 29:2625-2631, 2006M any controlled clinical trials have shown that prolonged maintenance of the appropriate HbA 1c (A1C) level reduces the risk of developing diabetes complications in individuals with type 1 and type 2 diabetes (1-3). However, data from the National Health and Nutrition Examination Surveys in the U.S. showed that overall glycemic control did not improve between the assessment periods of 1988 -1994 and 1999 -2000 (4,5). Similar findings have been reported in other countries (6,7).Therefore, to achieve and maintain the target level of A1C, new approaches for a medical delivery system are necessary. For this purpose, different strategies using electronic technologies or educational programs have been proposed to improve the quality and efficiency of care for people with diabetes (8 -15). In our previous study (16), we introduced a new bidirectional communication tool for diabetes management referred to as the Internet-based glucose monitoring system (IBGMS) and demonstrated its short-term effects over 3 months. The IBGMS comprises an electronically organized circuit for diabetes management that includes both online and offline systems. This management system provides a close doctor-patient relationship, offers more educational opportunities, and enhances patient feedback.In this study, we demonstrated the long-term effectiveness of the IBGMS on glucose stability and A1C reduction.RESEARCH DESIGN AND METHODS -Initially, 120 individuals with type 2 diabetes were screened by a review of their medical reco...

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The hip was the most frequent site of nontraumatic fracture, and diabetic peripheral neuropathy was significantly associated with an increased risk of nontraumatic fractures in patients with type 2 diabetes.

OBJECTIVE -The effect of lipoprotein(a) [Lp(a)] on the progression of diabetic nephropathy has not been evaluated yet. The aim of this study was to determine whether Lp(a) is an independent risk factor for deteriorating renal function in type 2 diabetic patients with nephropathy.RESEARCH DESIGN AND METHODS -We conducted this prospective study in type 2 diabetic patients with overt proteinuria. Patients were divided into two groups according to their baseline serum Lp(a) level. Group 1 had Lp(a) levels Յ30 mg/dl (n ϭ 40) and group 2 had Lp(a) levels Ͼ30 mg/dl (n ϭ 41). Patients were followed for 2 years. Progression of diabetic nephropathy was defined as a greater than twofold increase of follow-up serum creatinine concentration from the baseline value.RESULTS -At baseline and during the follow-up, there was no difference in HbA 1c and lipid profile between groups 1 and 2. However, serum creatinine was significantly higher in group 2 than in group 1 after 1 year (148.3 Ϯ 78.0 vs. 108.1 Ϯ 34.9 mol/l, P ϭ 0.004) and after 2 years (216.9 Ϯ 144.5 vs. 131.3 Ϯ 47.3 mol/l, P ϭ 0.001), although baseline serum creatinine did not differ significantly between groups. In all, 13 of 14 patients with progression of diabetic nephropathy (progressors) were from group 2. Baseline Lp(a) levels were higher in the progressors than in the nonprogressors (62.9 Ϯ 26.7 vs. 33.5 Ϯ 27.5 mg/dl, P Ͻ 0.001). Multiple logistic regression showed that baseline Lp(a) level was a significant and independent predictor of the progression of diabetic nephropathy.CONCLUSIONS -Our study demonstrated that Lp(a) is an independent risk factor for the progression of diabetic nephropathy in type 2 diabetic patients with overt proteinuria. Diabetes Care 28:1718 -1723, 2005D iabetic nephropathy is characterized by proteinuria, hypertension, progressive loss of renal function, and a high incidence of cardiovascular morbidity and mortality (1). Of patients with type 2 diabetes, 20 -40% develop diabetic nephropathy over a period of 15-20 years after the onset of diabetes (2). It is noteworthy that the prevalence of diabetic nephropathy in type 2 diabetes appears to be higher in the Asian population than in the white population, although the underlying mechanisms for this difference are not clear (3,4). Because diabetic nephropathy is the leading cause of end-stage renal disease in many countries including Korea (5,6), it is critical to slow the loss of renal function in diabetic patients at the stage of overt proteinuria or macroalbuminuria (established diabetic nephropathy).Hyperglycemia, hypertension, hypercholesterolemia, and proteinuria are the most significant risk factors or markers for the development and progression of diabetic nephropathy in type 2 diabetic patients (1,2,7-9). Nevertheless, in type 2 diabetic patients with overt proteinuria, postponing end-stage renal disease remains an elusive goal in the clinical setting. Therefore, it is still important to explore other risk factors with possible therapeutic applications in these patients.Lipoprotei...

Summary:Autoimmune diseases can be transmitted and eliminated by bone marrow transplantation (BMT). There have been several cases of autoimmune thyroid disease (AITD) occurring after BMT, but AITD remission has been rarely reported. We present four cases in which the remission or transfer of AITD occurred after an allogeneic BMT. Two patients with severe aplastic anemia (SAA) showed evidence of remission of Hashimoto's thyroiditis which they had before allogeneic BMT. One patient with SAA, which developed during treatment with propylthiouracil for Graves' disease, underwent allogeneic BMT and showed evidence of Graves' disease remission following BMT. In one patient, new AITD occurred after an allogeneic BMT from an HLAmatched sibling who already had AITD. These cases support the evidence that the immune system is newly reconstituted after BMT, and severe autoimmune disease can be an indication for BMT. To fully understand the real changes in autoimmune status after BMT, longterm prospective studies are necessary. Bone Marrow Transplantation (2001) 28, 63-66.