Showing papers in "Korean Diabetes Journal in 2008"

Current Status of Self-management and Barriers in Elderly Diabetic Patient

Abstract: Background: Diabetes has a critical effect on elderly diabetic patients’ quality of life. Elderly diabetic patients have many difficulties in diabetes self-management because their physical, psychological and social functions are decreased as a result of the aging process. Therefore, we evaluated the current status of self-management and barriers in elderly diabetic patients Methods: The sample was 124 elderly diabetic patients (over 61 years) who visited a hospital and two senior welfare centers in Seoul from July to August 2006. The results of the study were analyzed by descriptive statistics, ANOVA, T-test, and hierarchical regression. Results: 1) Diabetes self-management was composed of insulin injection, diet, exercise, foot management, smoking and drinking alcohol. An average score of self-management in the elderly diabetic patients was 4.5784. In demographic variables, only job status showed a significant effect on self-management. 2) Barriers such as 'forgetting taking diet and medication', 'being interru pted by others', and 'lack of family and social support' were significant factors in diabetes self-management. 3) These barriers for diabetes self-management were still significant in the case of controlling demographic and clinical variables. Conclusion: Diabetic educator should identify the significant factors that affect patient's self-management such as whether they have a full-time job, or the type of their job. In addition, diabetes education should focus on assertiveness training to deal with various interperso nal barriers and empowerment for enhancing patient's self-efficacy. These approaches would benefit patients who experience barriers of diabetes self-management (KOREAN DIABETES J 32:280-289, 2008)

Insulin Sensitivity and Insulin Secretion Determined by Homeostasis Model Assessment and Future Risk of Diabetes Mellitus in Korean Men

Abstract: Background: Insulin resistance and progressive pancreatic beta cell dysfun ction have been identified as the two fundamental features in the type 2 diabetes. Homeostasis model assessment (HOMA), based on plasma levels of fasting glucose and insulin, has been widely validated and applied for quantifying insulin resistance and secretion. This study was performed to assess the predictive value of HOMA indices for future diabetes risk. Methods: In 14,976 Korean men, in which medical check-up was performed both in 2002 and 2006 in a university hospital health promotion center in Seoul, Korea, prospective assessment for diabetes risk was assessed. At baseline, anthropometric measurements were done and fasting glucose, insulin, lipid profiles were measured. HOMA-insulin resistance (HOMA-IR) and beta cell function (HOMA β-cell) were calculated from fasting glucose and insulin levels. Results: After 4 years, 286 subjects (1.9%) were newly diagnosed as diabetes mellitus. These patients (mean age 40.3 years) were age-matched with 632 control subjects (mean age 39.8 years) and diabetes risk was assessed with HOMA indices. Among the parameters, body mass index, fasting glucose and HOMA β-cell were the significant determinants for future diabetes risk. When the subjects were divided into two groups according to the baseline median values of HOMA-IR and HOMA β -cell, and assessed jointly, those with the low HOMA β-cell and high HOMA-IR showed the highest risk for future diabetes (RR 39.065, 95% CI 11.736~130.035, P < 0.01). The subjects with low baseline HOMA β-cell showed higher RR for diabetes than those with high baseline HOMA-IR (4.413 vs. 3.379, P = 0.018, P = 0.051). Conclusion: High HOMA-IR and low HOMA β -cell were associated with the highest risk for future diabetes in this prospective study of Korean male subjects. These data s uggest the value of HOMA indices for diabetes risk in epidemiologic studies in Asian subjects. (KOREAN DIABETES J 32:498-505, 2008)

Clinical Characteristics and Direct Medical Costs of Type 2 Diabetic Patients

Abstract: Background: Type 2 diabetes mellitus is an expensive chronic metabolic disorder and its prevalence has been increasing rapidly in South Korea, owing to a westernized lifestyle. We analyzed the annual direct medical costs attributable to type 2 diabetes and its chronic complications in Korea retrospectively. Methods: We randomly selected 1,051 pati ents with type 2 diabetes who visited Ajou University Hospital as an outpatient in 2005. Clinical characteristics, duration of diabetes, and microvascular and macrovascular complications were assessed from a medical chart review. The annual direct medical costs included insurance covered and uncovered medical costs. Results: Of the 1,051 patients with type 2 diabetes, 48.2% had at least one microvascular complication, 5.6% had at least one macrovascular complication, and 12.4% of the patients had both microvascular and macrovascular complications. The average annual direct medical cost was found to be 3,348,488won per patient. In patients with microvascular complications, the total cost of management was increased 1.4 times compared to those without complications. Direct medical costs for patients with macrovascular complications were 2.1-fold as high as patients with no complications. Those patients with both microvascular and macrovascular complications, increased costs by 3.1-fold over those without complications. Conclusion: Chronic complications have a substantial impact on the direct medical costs of type 2 diabetes. The prevention of chronic diabetic complications will not only influence the mortality and morbidity of patients with type 2 diabetes, but also potentially reduce medical costs. (KOREAN DIABETES J 32:358-365, 2008)

Effects of Comprehensive Support on Glycemic Control Using Community Networks in Low- Income Elderly Patients with Diabetes.

Abstract: Background: Diabetes is common among elderly, and low-income is associated with poor adherence to treatment and increased mortality. We evaluated whether comprehensive support using community networks improves glycemic control among low-income elderly patients with diabetes. Methods: A total of 49 low-income elderly patients with type 2 diabetes, mean age 73 years, were enrolled. For 1 year, study subjects underwent various lifestyle modification programs provided by community networks. The biochemical data including glycemic markers and anthropometric data were obtained at the baseline and at the end of the study. Also, the patients were a sked to complete a questionnaire about their quality of life, self-confidence and self-care behavior. Results: After lifestyle modification program, overall changes of fasting plasma glucose, HbA1c, blood pressure, body weight, and other biochemical markers were not significantly different. In a subgroup analysis of 21 patients with poorly controlled diabetes (fasting glucose > 140 mg/dL or HbA1c > 7.5%), fasting plasma glucose was significantly reduced (P = 0.030). Among patients with baseline HbA1c level ≥ 8%, HbA1c levels after intervention decreased from 9.33 ± 1.07% to 8.27 ± 1.15% (P = 0.092). The results of the questionnaires revealed significant increases in the scores of quality of life, self-confidence and self-care behavior (P < 0.05). Conclusion: Among low-income, elderly patients with type 2 diabetes, lifestyle modification through community networks showed no significant changes in glycemic control markers. More intensive and precise interventions using community networks are needed for the glycemic control of low-income, elderly patients with type 2 diabetes. (KOREAN DIABETES J 32:453-461, 2008)

Oxidative Stress and Cell Dysfunction in Diabetes: Role of ROS Produced by Mitochondria and NAD(P)H Oxidase

Abstract: Oxidative stress has been considered to be a major contributor to the pathogenesis of the diabetic macrovascular and microvascular complications. In the absence of an appropriate antioxidant defense mechanism, increased oxidative stress leads to the activation of stress-sensitive intracellular signaling pathways and the formation of gene products that cause damage and contribute to the late complications of diabetes. The source of reactive oxygen species (ROS) in the pan creatic beta cells and insulin sensitive cells has postulated to be the mitochondrial electron transport chain. NAD(P)H oxidase-dependent ROS production is also important as the source both in pancreatic beta cells and other cells. NAD(P)H oxidase mediated ROS can alter parameters of signal transduction, insulin secretion, insulin action, cell proliferation and cell death. Additionally, oxidative stress as the pathogenic mechanism linking insulin resistance with dysfunction of both pancreatic beta cells and endothelial cells, eventually leads to diabetes and its complications. Further investiga tion of the mechanisms and its therapeutic interventions based on focusing NAD(P)H oxidase associated ROS production in the islet cells and other islet cells are needed. (KOREAN DIABETES J 32:389-398, 2008)

Direct Medical Costs of Type 2 Diabetic Patients in the Tertiary Hospital

Abstract: Background: Type 2 diabetes mellitus is a common, chronic and costly disease. Its prevalence is rapidly increasing worldwide. Diabetes has big economic burden mainly because of its chronic complications. We analyzed the annual direct medical costs of type 2 diabetic patients, including the costs associated with its complications in Korea retrospectively. Methods: We enrolled 531 type 2 diabetic patients who had been treated in the 3 Tertiary Hospital in 2005. Clinical characteristics, duration of diabetes, modality of glycemic control, and presence of microvascular and macrovascular complications were assessed by the review of medi cal records. The annual direct medical costs were assessed using the hospital electronic database and included insurance covered and uncovered medical costs. Results: The annual direct medical costs of type 2 diabetic patients wit hout any complications was 1,184,563 won (95% CI for mean: 973,006~1,396,121 won). Compared to diabetic patients without complications, annual total medical costs increased 4.7-fold, 10.7-fold, and 8.8-fold in patients with microvascular complications, macrovascular complications and both complications, respectively. Hospitalization costs largely increased by 78.7-fold and 61.0-fold in patients with macrovascular complications and both complications, respectively. Major complications to increase medical costs were kidney transplantation (23.1-fold), dialysis (21.0-fold), PTCA or CABG (12.4-fold), and leg amputation (11.8-fold). The tot al medical costs dramatically increased according to the stage of diabetic retinopathy and nephropathy. Conclusion: Diabetic complications have a substantial impact on the direct medical costs of type 2 diabetic patients. The prevention of diabetic complications will benefit the patients as well as the overall healthcare expenditures. (KOREAN DIABETES J 32:259-268, 2008)

Association of Hemoglobin A1c with Cardiovascular Disease Risk Factors and Metabolic Syndrome in Nondiabetic Adults

Abstract: Background: Glycosylated hemoglobin (HbA1c) is a useful index of mean blood glucose concentrations over the preceding 2 to 3 months. Elevated HbA1c levels (> 7%) are associated with a higher incidence of microvascular and macrovascular complications in patients with diabetes mellitus. However, the relationship between HbA1c and cardiovascualr disease risk in nondiabetic adults has been unclear. The aim of this study is to estimate the association of HbA1c with cardiovascular disease risk factors and metabolic syndrome in nondiabetic adults. Methods: The subjects of this study included 533 adults (180 males and 353 females) aged 20~70 years (mean age: 46.9 ± 10.12 years) without previously diagnosed diabetes who lived in Kangyang country. We examined baseline HbA1c levels and cardiovascular risk factors. Metabolic syndrome was defined based on International Diabetes Federation guidelines. Results: The prevalence of metabolic syndrome significantly increased as HbA1c increased. HbA1c revealed a significant correlation with age (r = 0.258, P < 0.001), BMI (r = 0.152, P < 0.001), waist circumference (r = 0.252, P < 0.001), fasting plasma glucose (r = 0.319, P < 0.001), systolic (r = 0.100, P = 0.021), diastolic (r = 0.115, P = 0.008) blood pressure, total cholesterol (r = 0.232, P < 0.001), triglyceride (r = 0.156, P < 0.001), LDL cholesterol (r = 0.216, P < 0.001), and HDL cholesterol (r = -0.167, P < 0.001). Multiple regression analysis showed that HbA1c had a association with age, fasting plasma gl ucose, and dyslipidemia. The receiver operating characterstics (ROC) curve analysis determined HbA1c of 5.35% to yield optimal sensitivity and specificity corresponding to the presence of metabolic syndrome. Conclusion: The HbA1c level is correlated with cardiovascular risk factors and prevalence of metabolic syndrome in nondiabetic adults. (KOREAN DIABETES J 32:435-444, 2008)

Clinical Implication of Adiponectin

Abstract: Adipose tissue is now considered as an active hormone-secreting organ, which secretes a number of biologically active adipokines such as free fatty acids, leptin, tumor necrosis factor alpha (TNFα), interleukin-6, plasminogen activator inhibitor-1, adiponectin and retinol binding protein 4 (RBP4). Among these, adiponectin has attracted considerable attention as an adipokin e that has important role in the development of type 2 diabetes, atherosclerosis and cardiovascular diseases. Adiponectin was discovered to be the most abundant adipose-specific transcript. Many epidemiological and clinical studies have demonstrated that serum levels of adiponectin are inversely associated with body weight, especially abdominal visceral fat accumulation. Studies among Japanese and Pima Indians have reported lower concentrations of adiponectin in patients with type 2 diabetes than in those with normal glucose tolerance. A low level of adiponectin was found to be a significant risk factor for the development of cardiovascular events in the Korean patients with type 2 diabetes. We recently published that exercise, having an insulin-sensitizing effect, could be a good therapy to prevent or delay diabetes and cardiovascular diseases in middle-aged women through the modification of adiponectin. These results suggest that the clinical implication of adiponectin. A number of studies have been conducted to clarify the biological role of adiponectin. Recent studies have showed that adiponectin has anti-inflammatory, anti-atherogenic, and glucos e-lowering properties. Taken together, it is conceivable that adiponectin plays as a backbone of metabolic syndrome. Finally, pleiotropic functions of adiponectin may possibly serve to prevent and treat atherosclerosis, type 2 diabetes and cardiovascular diseases. Furthermore, enhancement of adiponectin secretion or action may be a good therapeutic target for preventing type 2 diabetes or cardiovascular diseases. (KOREAN DIABETES J 32:85-97, 2008)

Effects of Walking and Physical Activity on Glucose Regulation among Type 2 Diabetics

Abstract: Background: Physical activity, especially walking is strongly recommended to control blood glucose among type 2 diabetic patients. Furthermore, physical activity is one of the most important tools to prevent secondary diabetes complications among type 2 diabetic patients such as retinopathy, nephropathy, neuropathy etc. The purpose of the study was to examine the association between the level of walking and physical activity and glucose control among Korean adults with type 2 diabetes. Methods: A total of 250 patients with type 2 diabetes (98 males and 152 females) were recruited (mean age = 62.1 ± 10.2 years) in the current study. The height, weight, waist and hip circumference were measured, and the level of physical activity and total walking hour were measured by physical activity scale for elderly (PASE). High density lipoprotein cholesterol (HDL-C), total cholesterol, triglyceride, fasting glucose and oral glucose tolerance test, creatinine, uric acid, total protein, albumin, hemoglobin A1c were measured. Results: After adjusting for potential covariates such as age, education, occupation income, smoking, and drinking, male patients who spent least time in walking were more likely to have 2 hour serum glucose level in oral glucose tolerance above 200 mg/dL than counterparts who spent most time in walking with age adjusted (Relative Risk (RR) = 11.75, 95% Confidence Interval (CI) = 1.94-71.00). Male patients who were in the least active group were 5.92 time (95% CI = 1.39-25.28) more likely to have 2 hour serum glucose level in oral glucose tolerance over 200 mg/dL than counterparts in the most active group. However, there was no significant finding in females. Conclusions: The current study showed that physical activity and walking are effective method to maintain glucose tolerance among type 2 diabetic male patients. (KOREAN DIABETES J 32:60~67, 2008)

Cystatin C is a Valuable Marker for Predicting Future Cardiovascular Diseases in Type 2 Diabetic Patients

Abstract: Background: Recent studies suggest that serum Cystatin C is both a sensitive marker for renal dysfunction and a predictive marker for cardiovascular diseases. We aimed to evaluate the association between Cystatin C and various biomarkers and to find out its utility in estimat ing risk for cardiovascular diseases in type 2 diabetic patients. Methods: From June 2006 to March 2008, anthropometric measurements and biochemical studies including biomarkers for risk factors of cardiovascular diseases were don e in 520 type 2 diabetic patients. A 10-year risk for coronary heart diseases and stroke was estimated using Framingham risk score and UKPDS risk engine. Results: The independent variables showing statistically significant as sociations with Cystatin C were age (β = 0.009, P < 0.0001), hemoglobin (β = -0.038, P = 0.0006), serum creatinine (β = 0.719, β < 0.0001), uric acid (β = 0.048, P = 0.0004), log hsCRP (β = 0.035, P = 0.0021) and homocysteine (β = 0.005, P = 0.0228). The levels of microalbuminuria, carotid intima-media thickness, fibrinogen and lipoprotein (a) also correlated with Cystatin C, although the significance was lost after multivariate adjustment. Calculated risk for coronary heart diseases increased in proportion to Cystatin C quartiles: 3.3 ± 0.4, 6.2 ± 0.6, 7.6 ± 0.7, 8.4 ± 0.7% from Framingham risk score (P < 0.0001); 13.1 ± 0.9, 21.2 ± 1.6, 26.1 ± 1.7, 35.4 ± 2.0% from UKPDS risk engine (P < 0.0001) (means ± SE). Conclusions: Cystatin C is significantly correlated with various emerging biomarkers for cardiovascular diseases. It was also in accordance with the calculated risk for cardiovascular diseases. These findings verify Cystatin C as a valuable and useful marker for predicting future cardiovascular diseases in type 2 diabetic patients. (KOREAN DIABETES J 32:488-497, 2008)

Comparison of the Predictability of Cardiovascular Disease Risk According to Different Metabolic Syndrome Criteria of American Heart Association/National Heart, Lung, and Blood Institute and International Diabetes Federation in Korean Men

Abstract: Background: We compared the prevalences of two criteria of metabolic syndrome, that is, American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) and International Diabetes Federation (IDF), in Korean male adults and compared the predictability of insulin resistance and future cardiovascular diseases using Framingham Risk Score. Methods: In total 23,467 male adults (mean age 43.3 years) who participated in medical check-up in 2005, the prevalences of metabolic syndrome according to AHA/NHLBI and ID F criteria and the presence of insulin resistance, defined by the highest quartile of Homeostasis Model Assessment of insulin resistance index (HOMA-IR), were compared. The relative risk (calculated risk/average risk) for 10-year risk for coronary artery disease (CHD) assessed by Framingham Risk Score were compared. Results: 5.8% of the subjects had diabetes mellitus. 20.7% and 13.2%of the subjects had metabolic syndrome defined by AHA/NHLBI and IDF criteria, and the two criteria sho wed high agreement with kappa value of 0.737 (P 1.0) for 10-year CHD were higher in AHA/NHLBI-defined subjects compared with IDF-defined subject (3.295 vs. 3.082). The Kappa values for the analysis of agreement between each criteria and prediction of insulin resistance or cardiovascular disease risk, were too low for comparison. Conclusion: In Korean males, the prevalence for metabolic syndrome defined by AHA/NHLBI criteria was higher than those defined by IDF criteria. IDF criteria detected more subjects with insulin resistance, but didn't have better predictability for CHD compared with AHA/NHLBI criteria. (KOREAN DIABETES J 32:317-327, 2008)

Analysis of Meal Habits from the Viewpoint of Regularity in Korean Type 2 Diabetic Patients

Abstract: Background: The regular meal pattern with consistent day-to-day calorie and carbohydrate intake is one of the most important determinants of good glycemic control in diabetes. This study was aimed to investigate the meal pattern and their relationships with total energy intake, nutrients intake and glycemic and lipid profile in type 2 diabetes. Methods: 1,084 subjects were divided according to glycemic status into three groups: the diabetes (DM), dysglycemia (DG) and normal (N). The meal frequency (MF), meal interval (MI) and daily intake of total energy, macronutrient and micronutrient were estimated with the 24 hours dietary recall from the Korean National Health and Nutrition Examination Survey (KNHANES) in 2001 and Eulji hospital. For analysis of meal pattern and it's relations with the nutrients intake, we regrouped into meal skipper (G1), non-meal skipper with unreasonable MI (G2), and non-meal skipper with reasonable MI (G3). Results: 17.5% of DM, 21.8% of DG, 23.3% of N skipped at least one meal a day without significant difference across the groups. 55.9% of non-meal skipper had unreasonable MI. Meal was more regular in older age, lower educated person, employee, and female. G1 took higher fat, and more calories form snack and less micronutrient density, compared with G3 (P < 0.05). HbA1c, total cholesterol and triglyceride values were higher in G1 compared with other two groups (P < 0.05). Conclusion: Many type 2 diabetics had the irregular meal patterns, which was associated with poor glycemic control, lipid profiles and less micronutrient density. This suggested that another treatment strategy might be required for those who had irregular lifestyle. (KOREAN DIABETES J 32:68~76, 2008)

Relationship between Menopausal Status and Metabolic Syndrome Components in Korean Women

Abstract: Background: Postmenopausal status is associated with a 60% increased risk for metabolic syndrome. It is thought to be associated with decreased estrogens and increased abdominal obesity in postmenopausal women with metabolic syndrome. The purpose of this study was to investigate the association between metabolic syndrome components and menopausal status. Methods: A total of 1,926 women were studied and divided into three groups according to their menstrual stage (premenopausal, perimenopausal or postmenopausal). The presence of metabolic syndrome was assessed using the National Cholesterol Education Program's (NCEP) Adult Treatment Panel Ⅲ criteria. Results: The prevalence of metabolic syndrome was 7.1% in premenopause, 9.8% in perimenopause, and 24.2% in postmenopause. The stro ng correlation was noted between the metabolic syndrome score and waist circumference in postmenopause (r = 0.56, P < 0.01) and perimenopause (r = 0.60, P < 0.01). Along the menopausal transition, the risk of metabolic syndrome increased with high triglyceride after the age-adjusted (odds ratio (OR) 1.517 (95% confidence interval (CI) 1.014~2.269) in perimenopausal women and OR 1.573 (95% CI 1.025~2.414) in postmenopausal women). In addition, the prevalence of metabolic syndrome increased in accordance with elevated alanine aminotransferase (ALT) and gamma-glutamyl transpeptidase (GGT) levels. Conclusion: Triglyceride and waist circumference were important metabolic syndrome components, though ALT and GGT may also be related for predicting metabolic syndrome during the transition to menopause. (KOREAN DIABETES J 32:243-251, 2008)

A Study on Resistance in Type 2 Diabetic Patient Against Commencement of Insulin Treatment

Abstract: Background: To achieve tight glycemic control in the poorly controlled type 2 diabetic patients with oral hypoglycemic agent, it maybe beneficial to initiate insulin treatment at the early stage. Many patients with type 2 diabetes are often reluctant to begin insulin therapy despite poor glycemic control with oral hypoglycemic agents, this little known phenomenon, often termed 'psychological insulin resistance (PIR)'. This study investigates psychological insulin resistance in Korean patients with type 2 diabetes. Method: This study examined a total of 76 type 2 diabetic patients with poor glycemic control during period of April to July 2006. Through questionnaire and telephone survey, total 24 questions were asked about various attitudes on insulin therapy including psychological ba rriers and patients' acceptance of this treatment. Subjects were asked to allocate points in 5-point sc ale (from 5 points for 'very true' to 1 point for 'very untrue'). Results: The means of psychological rejection, injection-related anxiety and fear of insulin side effects such as hypoglycemia and weight gain were 3.65 ± 0.92, 3.17 ± 0.98 and 2.8 ± 1.02, respectively. Unwillingness was common in insulin therapy, 67% of patient rejected or was unwilling to take insulin. Main reasons of patients most frequently endorsed beginning insulin indicate that disease is worsening, permanence (once you start insulin you can never quit) and sense of personal failure. Furthermore, study indicates that patients' reasons for avoiding insulin therapy were mainly psychological rejection, which extended far beyond a simple injection related anxiety. Conclusion: PIR was psychological reluctance rather than injection related anxiety. To overcome these psychological barriers to insulin treatment, it is necessary to address appropriate diabetes education including training and counseling with excellent interactive communications between patients and clinicians. (KOREAN DIABETES J 32:269-279, 2008)

Insulin Resistance in Polycystic Ovary Syndrome

Abstract: Polycystic ovary syndrome (PCOS) is the commonest endocrine dis order in women of reproductive age and now recognized as an important metabolic and reproductive disor der. The majority of women with PCOS have insulin resistance and this is regarded to have a central etiological role in PCOS. Insulin resistance and concomitant hyperinsulinemia modifies reproductive function by driving androgen production, suppression of sex hormone-binding globulin (SHBG) and disruption of insulin signaling pathways in the central nervous system. Insulin resistance, together with defects in insulin secretion, confers markedly increased risk for type 2 diabetes mellitus and metabolic syndrome. There are post-binding defects in insulin receptor signaling, with selective resistance to insulin's metabolic actions and preserved other actions. Genetic and environmental abnormalities interact to produce peripheral insulin resistance in PCOS. The numerous in vivo and in vitro data supporting the central role of insulin resistance in the pathogenesis of PCOS have led a new therapy for PCOS with insulin-sensitizing agents. (KOREAN DIABETES J 32:1~6, 2008)

The Correlation Between Visceral Fat Distance Measured by Ultrasonography and Visceral Fat Amount by Computed Tomography in Type 2 Diabetes

Abstract: Background: Visceral adipose tissue accumulation highly correlates with metabolic abnormalities and cardiovascular disease. Computed tomography (CT) is considered to be the standard method for visceral fat evaluation, but it is not used as a routine procedure. Ultrason ography (US) is a safe method, fairly inexpensive and widely available modality for measuring abdominal fat thickness. The aim of this study was to investigate the correlation between the intra-abdominal fat distance by US measurement and the visceral fat amount by CT and cardiovascular risk factors and to evaluate whether the intra-abdominal fat distance is better correlate with visceral fat amount by CT than other anthropometric paramete rs and to assess the cut-off value of intra-abdominal fat distance for visceral obesity in type 2 diabetic patients. Methods: We obtained abdominal subcutaneous and intra-abdominal fat dis tance by using a high-resolution US (HDI 5000, ATL, Phillps, USA) at 1 cm above umbilical level in one hundred twenty-eight type 2 diabetic patients. CT scan (Light Speed plus, GE, USA) for the measurement of subcutaneous and intra-abdominal visceral fat area was also performed in the supine position at the L4-5 level. Lean body mass and % body fat were measured in a bioimpedance using DSM (Direct Segmental Measurement by 8-point electrode) method (InBody 3.0, Biospace, Seoul, Korea). We measured patient's height, weight, BMI (Body mass index), waist circumference, WHR(Waist-hip ratio) and blood pressure and also measured fasting blood glucose, HbA1c and lipid profiles. Results: Abdominal subcutaneous and visceral fat distance measured by US is 2.05 ± 0.52 cm, 4.43 ± 1.54 cm, respectively. In pearson's correlations, visceral fat distance were correlated with BMI (r = 0.681, P < 0.001), waist circumference (r = 0.661, P < 0.001), WHR (r = 0.571, P < 0.001), triglyceride (r = 0.316, P < 0.001), HDL-cholesterol (r = -0.207, P < 0.004). US-determined visceral fat distance was also correlated with visceral fat amount by CT (r = 0.674, P < 0.001) and BMI (r = 0.610, P < 0.001), waist circumference (r = 0.626, P < 0.001), WHR (r = 0.557, P < 0.001). When we used waist circumference (men: 90 cm, women: 85 cm) as parameters for visceral obesity, the cutoff value of visceral f at distance, obtained by the receiver operating

Adiponectin Concentrations in Type 2 Diabetic Patients with or without Metabolic Syndrome

Abstract: Background: Adipocytes produce several adipokines that modulate insulin action as well as glucose and lipid metabolism. The aim of this study was to evaluate the relationship between serum adiponectin concentrations and metabolic syndrome (MS) in patients with type 2 diabetes mellitus. Methods: This study included 127 type 2 diabetic patients (males 63, females 64). The subjects were divided into two groups as with or without metabolic syndrome (MS(+) or MS(-)). The MS was diagnosed by International Diabetes Federation. Serum adiponectin, leptin, fasting plasma insulin, glucose, glycated hemoglobin, lipid profile, white blood corpuscle (WBC), aspartate aminotransferase (AST), alanine aminotransferase (ALT), uric acid and C-reactive protein (CRP) were examined. Results: Serum adiponectin concentrations were significantly lower in MS(+) than MS(-) (4.8 ± 2.4 μg/mL vs 7.6 ± 5.8 μg/mL, 7.6 ± 3.7 μg/mL vs 11.5 ± 7.2 μg/mL, P < 0.05 in males and females). After adjustment for age and body mass index (BMI), in MS (+), the serum levels of adiponectin correlated positively with high density lipoprotein - cholesterol (HDL-C) and negatively wi th height, body weight, ALT and CRP. In MS(-), the serum levels of adiponectin correlated positively with HDL-C and negatively with diastolic blood pressure (DBP), triglyceride and CRP. By multiple regression analysis, no parameters were independently correlated with serum adiponectin concentrations in MS(+), while DBP and HDL-C were independently related to serum adiponectin concentrations in MS(-). Conclusion: Serum adiponectin concentrations were lower in type 2 diabetic patients with MS than without MS. There were no significant parameters related to decrease serum adiponectin concentrations in MS. But further study is needed to confirm this result. (KOREAN DIABETES J 32:224-235, 2008)

Relationship Between Serum Bilirubin Levels and Coronary Atherosclerosis in Patients with Type 2 Diabetes

Abstract: Background: Lipid oxidation and formation of oxygen radicals have been identified to be the important factors of atherogenesis. Because bilirubin, a potent physiological antioxidant inhibits lipid oxidation, it is suggested that low serum concentrations of bilirubin is associated with atherosclerosis. The aim of this study was to evaluate the relationship between bilirubin levels and coronary atherosclerosis. Methods: The coronary calcium score (CCS) of 172 subjects (male 63, mean age 60.5 ± 1.0) with type 2 diabetes were evaluated in Yeungnam University Hospital between January 2005 and February 2007. The subjects were divided into two groups with CCS 10 as the cut off. Results: Higher CCS was significantly associated with lower bilirubin (P < 0.05), but after adjusted with age, no longer correlation were seen (P = 0.121). To determine the relationship between subclinical coronary atherosclerosis and bilirubin, the subjects with previous history of cardiovascular disease were excluded. In 138 subjects (male 54, mean age 58.4 ± 1.1), higher CCS was significantly associated with lower levels of bilirubin. After adjusted with age, duration of diabetes, and history of hypertension, CCS was also inversely related with bilirubin (P < 0.05). Conclusion: These results suggest that lower levels of bilirubin might be considered as a risk factor of coronary artery disease, especially in type 2 diabetics without cardiovascular disease. (KOREAN DIABETES J 32:338-345, 2008)

Determinants of 1-Year Changes of Brachial Ankle Pulse Wave Velocity (baPWV) in Patients with Type 2 Diabetes Mellitus

Abstract: Background: Cardiovascular disease is the leading cause of mortality in ty pe 2 diabetes. PWV correlates well with arterial distensibility and stiffness and a useful approach for evaluating the severity of systemic atherosclerosis in adults, and, in particular, the measurement of brachial-ankle PWV (baPWV) has been commonly reported as a simple, noninvasive and practicable method. baPWV was mainly affected by age, SBP and sex. And also, baPWV was affected by many different fac tors such as body weight, BMI, waist to hip ratio, HbA1c, microalbuminuria, triglyceride, ϒGTP, duration of DM. We evaluated determinants of 1-year changes of baPWV in patients with type 2 DM. Methods: The study group comprised 189 diabetic patients who measured ankle brachial pressure index (ABI), baPWV at base line and 1-year later. The anthropometric parameters, blood pressure, pulse pressure, fasting plasma glucose (FBS), fasting insulin, A1c, lipid profile, hsCRP, microalbuminuria, AST/ALT, ϒGTP were also checked concurrently. We also analyzed correlation be tween change of baPWV and subject's medications. We retrospectively analyzed the relationship betwe en the 1-year changes of baPWV and the other factors. All analyses were performed with the SPSS Version 14.0 and P values < 0.05 were considered significant. Results: baPWV change was affected by systolic blood pressure change, diastolic blood pressure change, pulse pressure change, body weight, BMI, triglyceride change, insulin treatment and total cholesterol. Multiple regression analysis of the relationship between change of baPWV and other associated variables shows that the 1-year change of baPWV was significantly associa ted with the changes of blood pressure and insulin treatment in patients with type 2 DM. Conclusion: 1-year change of baPWV was significantly associated with the changes of blood pressure in patients with type 2 DM. (KOREAN DIABETES J 32:346-357, 2008)

Evaluation of Fasting Plasma Glucose as a Screening for Diabetes Mellitus in Middle-aged Adults of Naju Country.

Abstract: Background: The criteria for the diagnosis of diabetes mellitus have been modified by the American Diabetes Association (ADA) in 1997. The ADA proposed that the diagnosis of diabetes be defined by a fasting plasma glucose (FPG) of 7.0 mmol/L. Disagreement has been reported betw een criteria based on FPG and postchallenge 2-h plasma glucose (2-h PG). The aim of the present study is to assess the FPG criteria as the diagnostic screening test for diabetes in Korean middle-aged adults in comparison to the 2-h PG criteria. Methods: Randomly selected 1,731 subjects (679 men and 1,052 women) aged 40~70 years (mean age: 58.4 ± 7.89 years) without previously diagnosed diabetes completed 75 g oral glucose tolerance test (OGTT). We assessed the prevalence of diabetes mellitus and the level of agreement (ĸ statistics) according to the different diagnostic glucose categories. Results: The frequency of newly diagnosed diabetes was 2.7% (n = 51) usi ng the FPG criteria only; 6.4% (n = 120) using the 2-h PG criteria only; and 6.9% (n = 130) using concentrations of ≥ 7.0 mmol/L for FPG or ≥ 11.1 mmol/L for 2-h PG. Of the 120 subjects with diabetes by the 2-h PG criteria, 65.8% (n = 79) were not diagnosed with diabetes according to FPG concentration. The level of agreement between two diagnostic criteria was low (ĸ = 0.268). The receiver operating characterstic (ROC) curve analysis determined FPG of 5.6 mmol/L to yield optimal sensitivity and specificity corresponding to 2-h PG 11.1 mmol/L. Conclusion: The findings in this study demonstrate that the discordance bet ween the FPG and 2-h PG criteria in the diagnosis of diabetes in Korean middle-aged adu lts is large. We suggest that IFG group (FPG 5.6~6.9 mmol/L) were performed 75 g OGTT for diagnosing diabetes mellitus in Korean middle-aged adults. (KOREAN DIABETES J 32:328-337, 2008)

Glucose Toxicity and Pancreatic Beta Cell Dysfunction in Type 2 Diabetes

Abstract: The adverse effects of prolonged exposure of pancreatic islets to supraphysiologic glucose concentrations(i.e. glucose toxicity) is mediated at least in part by glucose oxidation and the subsequent generation of reactive oxygen species(ROS) that can impair insulin gene expression and β cell function. Multiple biochemical pathways and mechanisms of action for glucose toxicity have been suggested. These include glucose autoxidation, protein kinase C activation, methylglyoxal formation and glycation, hexosamine metabolism, sorbitol formation, and oxidative phosphorylation. There are many potential mechanisms whereby excess glucose metabolites traveling along these pathways might cause β cell damage. However, all these pathways have in common the formation of reactive oxygen species that, in excess and over time, cause chronic oxidative stress, which in turn causes defective insulin gene expression and insulin secretion as well as increased apoptosis. The intracellular peroxide levels of the pancreatic islets(INS-1 cells, rat islets) by flow cytometry were increased in the high glucose media compared to 5.6 mM glucose media. The insulin, MafA, PDX-1 mRNA levels and glucose stimulated insulin secretion(GSIS) were decreased in high glucose media compared to 5.6 mM glucose media. The HO-1 seems to mediate the protective response of pancreatic islets against the oxidative stress that is due to high glucose conditions. Also, we observed decreased glutathione level, γ-GCS expression and increased oxidized LDL, malondialdehyde level at leukocytes and mesothelial cells from patients with Korean Type 2 Diabetes(esp, poorly controlled patients). In conclusion, this pathophysiologic sequence sets the scene for considering antioxidant therapy as an adjunct in the management of diabetes, especially type 2 Diabetes.(KOREAN DIABETES J 32:175-181, 2008)

The Biochemical Markers of Coronary Heart Disease Correlates Better to Metabolic Syndrome Defined by WHO than by NCEP-ATP III or IDF in Korean Type 2 Diabetic Patients

Abstract: Background: Metabolic syndrome (MetS) is constellation of cardiovascular risk factors. There are three typically used definitions of MetS proposed by WHO, IDF and NCEP-ATP III. We conducted this study to compare the associations of MetS by WHO, IDF and NCEP-ATP III definition to various metabolic markers of coronary heart diseases in Korean type 2 diabetes patients. Methods: We enrolled 151 Korean type 2 diabetes patients in one hospital. Anthropometric and biochemical parameters, including high-sensitivity C-reactive protein (hsCRP), homocysteine, uric acid were measured. And then, we divided MetS group from non-MetS group according to three other definitions. Results: Serum hsCRP level was higher in those with MetS group than non -MetS group by WHO definition (0.33 ± 0.36 mg/dL vs 0.18 ± 0.26 mg/dL, P < 0.001). But, there are no difference in MetS group and non-MetS group by IDF and NCEP-ATPIII definition. (By IDF, 0.28 ± 0.31 mg/dL vs 0.25 ± 0.34 mg/dL, P = 0.64; By NCEP-ATP III, 0.28 ± 0.33 mg/dL vs 0.22 ± 0.32 mg/dL, P = 0.41). Uric acid and homocysteine levels were higher in those with MetS by WHO definition (P < 0.05). Similarly, analyses according to IDF and NCEP ATP III definition showed no significant difference. Conclusion: In conclusion, WHO definition of MetS has a stronger relationship with the biochemical markers of coronary heart disease in Korean type 2 diabetes patients. (KOREAN DIABETES J 32:157~164, 2008)

The Classification of Diabetic Patients Presenting Diabetic Ketoacidosis: The Characteristics of Fulminant Type 1 Diabetes

Abstract: Background: The aim of the study was to classify newly diagnosed diabetic patients who initially presented with diabetic ketoacidosis (DKA) into specific types of diabetes and to describe the clinical and biochemical characteristics of patients with fulminant type 1 DM in Korea. Methods: Using data from 4 hospitals of CMC from 1 January 1999 to 1 March 2008, we identified all patients who manifested DKA when they were first diagnosed as d iabetes. Clinical and laboratory data were reviewed from medical records. Results: We identified 51 newly diagnosed diabetic patients manifested DKA. Among them, 14 (27.4%) patients were classified as autoimmune type 1 DM, 8 (15.7%) as antibody negative type 1 DM, 5 (9.8%) as fulminant type 1, 16 (31.4%) as type 2 DM and 8 (15.7%) as secondary DM. Five patients who fulfilled the criteria of fulminant type 1 DM were older (32.2 ± 10.7 vs. 15.7 ± 4.4 years, P = 0.010), had shorter duration of symptoms (4.2 ± 2.7 vs.16.7 ± 15.2 days, P = 0.014) and lower stimulated C-peptide levels (0.1 ± 0.0 vs. 0.7 ± 0.6 ng/mL, P = 0.050) compared with patients with autoimmune type 1 DM. Conclusion Newly diagnosed diabetic patients presenting with DKA composed of heterogenous types of diabetes. The prevalence of fulminant type 1 diabetes among them was 9.8% and the clinical and biochemical characteristics of these patients were different from those of autoimmune type 1 DM. (KOREAN DIABETES J 32:428-434, 2008)

The Association of Plasma HDL-Cholesterol Level with Cardiovascular Disease Related Factors in Korean Type 2 Diabetic Patients

Abstract: Background: Cardiovascular disease (CVD) is the major cause of death in type 2 diabetic patients. The purpose of this study was to investigate the characteristics of Korean type 2 diabetes mellitus (DM) patients according to plasma high density lipoprotein (HDL) cholesterol level and to document the effect of diet on HDL-cholesterol. Methods: The subjects were 252 (male: 134, female: 118) Korean type 2 DM patients recruited from a general hospital's DM clinic and divided into low HDL-cholesterol group (male < 40 mg/dL, female < 50 mg/dL) and control group (male ≥ 40 mg/dL, female ≥ 50 mg/dL). Anthropometric and hematological variables and dietary intake were assessed by the groups. Results: The subject's mean age was 60.2 ± 1.1 years and duration of diabetes was 9.5 ± 1.0 years. Anthropometric measurements (body fat mass, % body fat, WHR, fat free mass, and muscle mass) and BMI were not significantly different between two groups. The male subjects with low HDL-cholesterolemia showed higher Atherogenic Index (AI, P < 0.001) and higher % carbohydrate from energy than control group (P < 0.01). The female subjects with low HDL-cholesterolemia showed higher AI (P < 0.001) and a tendency of higher triglyceride level and lower intake of energy, protein, lipid, vitamin B1 and vitamin E (P < 0.05) than control group. Conclusion: The subject with low HDL-cholesterolemia showed significantly higher AI. Male subject with low HDL-cholesterolemia consumed higher carbohydrate and female subject with low HDL-cholesterolemia showed lower intakes of many nutrients. This result suggests the importance of an adequate and balanced diet to manage type 2 DM patients to prevent CVD complications.(KOREAN DIABETES J 32:215-223, 2008)

Factors Influencing Adherence to Preventive Behavior on Chronic Complications of Diabetes Mellitus

Abstract: Background: The prevalence of diabetes is steadily increasing in Korea. The increase of people with diabetes will ultimately result in taking a turn for the worse, not only affecting the health of the people, but there will be an increase of social finances. This study was aimed at investigating the factors influencing adherence to preventive behavior on chronic complications of Diabetes Mellitus. Methods: Data was collected by questionnaires from 332 diabetic patient s who were visited out-patient clinics, with 323 finally selected for the study. The data was analyzed by the SPSS program. Results: The level of knowledge on chronic complications of Diabetes Mellitus was 18.02 points space(maximum 24 points). The level of hardiness was 119.80 points(maximum 240 points). The level of adherence to preventive behavior on chronic complications of Diabetes Mellitus was 49.11 points(maximum 75 points). The score of knowledge and hardiness showed a significant correlation with adherence to preventive behavior on chronic complications of Diabetes Mellitus. The significant predictors influencing adherence to preventive behavior were treatment, knowledge of Diabetes Mellitus, and hardiness. Conclusion: This study suggests that treatment, knowledge, and hardiness a re significant influencing factors on adherence to preventive behavior on chronic complications of Diabetes Mellitus. The results of this study will contribute to developing a program for people with diabetes. (KOREAN DIABETES J 32:77~82, 2008)

Maintenance of Insulin Therapy by Desensitization in Insulin Allergy Patient.

Abstract: Allergic reaction to human insulin is uncommon. But they can cause mild to severe symptoms such as dyspnea, hypotensive shock, etc. Here we report the case of a patient with type 2 diabetes and insulin allergy successfully managed with desensitization. A 60-year-ol d man with insulin allergy was transferred. He had poorly controlled type 2 diabetes (fasting blood glucose 230 mg/dL). He developed itching sense and erythema at the injection sites of human insulin in a few minutes. And serum IgE level was elevated to 1618.0 IU/mL. The insulin was changed to other preparations, including short and long-acting insulin analogues, with similar responses. He was commenced on twice a day injection protocol in addition to his oral hypoglycemic agents, and achieved fair control (fasting blo od glucose 100 mg/dL) on 24 units of Novomix Flex Pen per day, with little or no skin or systemic reaction. This is the case report of insulin allergy in type 2 diabetes being successfully managed by desensitization. (KOREAN DIABETES J 32:529 -531, 2008)

Clinical Characteristics and Outcomes of Diabetic Ketoacidosis at a Single Institution

Abstract: Aims: The aim of this study was to describe the clinical characteris tics and outcomes of diabetic ketoacidosis (DKA) in Hospital for past 6 years Methods: We reviewed the retrospective medical records of all patients admitted with a diagnosis of DKA from 2000 to 2005 in Uijeongbu St Mary's Hospital Clinical characteristics including precipitating factors and hospital mortality were analyzed Results: Seventy-eight patients (78 episodes) fulfilled criteria for inc lusion in this study Their mean age was 4189 years 66 episodes had a prior history of diabetes but DKA was the initial presentation in 12 episodes 244% were on no treatment, 141% were using oral hypoglycemic agents and 538% were on insulin Poor glycemic control were the most common precipitating factor (564%) There were 3 deaths Conclusion: Our report is similar with past reports of DKA in Korea but it is different that poor glycemic control is most common precipitating factor and mortality rate are lower than past reports This observation suggests that many cases of DKA can be prevented by better access to medical care, proper education, and effective communication with a health care provider (KOREAN DIABETES J 32:165~170, 2008)

The Effect of Rosiglitazone and Metformin Therapy, as an Initial Therapy, in Patients with Type 2 Diabetes Mellitus.

Abstract: Background: Type 2 diabetes is usually preceded by a long and clinically silent period of increasing insulin resistance. The purpose of this study is to demonstrate that rosiglitazone and metformin fixed-dose combination therapy (RSG/MET) will safely and effectively control glycemia as a first line of oral therapy, better than rosiglitazone (RSG) or metformin (MET) monotherapy in Korean type 2 diabetes patients. Methods: This study was a 32-week, multicenter, randomized, double-blind study. Twenty-seven type 2 diabetes patients (males 14; females 13) were included and randomly divided into the rosiglitazone, metformin group, or rosiglitazone /metformin combination groups. The primary objective of this study was to determine the change in HbA1c from baseline (week 0) to week 32. The secondary end-points were to determine changes in fasting plasma glucose (FPG) and homeostasis model assessment insulin resistance (HOMA-IR), from baseline to week 3 2. Other cardiovascular risk markers were also assessed. Results: At week 32, there were significant reductions in HbA1c and FPG, in all three treatment groups. There was no statistical difference in HbA1c among the three groups, but the decrease in FPG in the RSG/MET group was statistically significant compared to the MET group (P < 0.05). RSG/MET significantly reduced HOMA-IR at week 32 compared to baseline, but there was no difference among the three groups. RSG/MET significantly decreased high-sensitive C-reactive protein (hs-CRP) value at week 32, compared to baseline. There were increases in adiponectin from baseline to week 32 in the RSG and RSG/MET groups, and the increase in the RSG/MET group was statistically signifi cant compared to that of the MET group (P < 0.05). At week 32, there was a significant decrease in plasminogen activator inhibitor-1 (PAI-1) in all three treatment groups, but no statistically significant difference among them. The RSG/MET group significantly decreased in terms of urinary albumin-creatinine ratio at week 32, compared to baseline. Conclusions: In this study, rosiglitazone and metformin combination therapy was effective in glycemic control as an initial therapy, and it improved cardiovascular risk markers in Korean type 2 diabetes patients. (KOREAN DIABETES J 32:445-452, 2008)

The Changes of Central Aortic Pulse Wave Analysis in Metabolic Syndrome

Abstract: The metabolic syndrome (MS) has been characterized as a cluster of risk factors that includes dyslipidemia, hypertension, glucose intolerance and central obesity This syndrome increases the risk of cardiovascular disease Augmentation index (AIx), a composite of wave reflection form medium-sized muscular arteries is related to the development of coronary artery disease The aim of this study is to examine the change on central aortic waveforms in subjects between patients with meta bolic syndrome and normal subjects Using the non-invasive technique of pulse wave analysis by applantation tonometry, we investigated central aortic waveforms in 45 patients with MS and 45 matched controls The MS was defined by NCEP-ATP III criteria Age did not differ between the two groups AIx was significantly elevated in patinets with MS compared with controls (2191 ± 1141% vs 1814 ± 1107%; P < 001) Subendocardial viability ratio (SEVR) (15809 ± 2869 vs 16709 ± 3006; P < 001) was significantly decreased in patients with MS compared with controls Only the fasting glucose (r = 0317, P = 003) among the components of MS and age (r = 0424, P = 0004) had a positive correlation with AIx AIx increased as the number of MS components increased These results show that the MS increased systemic arterial stiffness Age and fasting blood glucose are independent risk factors of arterial stiffness in MS The individual MS components, except for fasting blood glucose, do not affect arterial stiffness indepe ndently But the clustering of MS components might interact to synergistically affect arterial stiffness (KOREAN DIABETES J 32:522-528, 2008)