Diabetes & Metabolism Journal

Volume 29(6); November 2005

Review

Insulin Resistance and Metabolic Syndrome.: Kyung Soo Ko, Byoung Doo Rhee; Korean Diabetes J. 2005;29(6):501-506. Published online November 1, 2005

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Abstract PDF: No abstract available.

Original Articles

Characterization of Preadipocyte factor-1 (Pref-1) Expressing Pancreatic Cells.: Marie Rhee, Sun Hee Suh, Youn Joo Yang, Ji Won Kim, Sung Yoon Jeon, Oak Kee Hong, Seung Hyun Ko, Yoon Hee Choi, Bong Yun Cha, Ho Yong Son, Kun Ho Yoon; Korean Diabetes J. 2005;29(6):507-516. Published online November 1, 2005

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Abstract PDF: BACKGROUND
Preadipocyte factor-1/Delta-like 1(Pref-1/Dlk1) is a type I membrane protein that has six epidermal growth factor (EGF)-like repeats in its extracellular and a short cytoplasmic domain. It is widely expressed in embryonic tissues, whereas its expressions were limited in adult and postnatal stage. To characterize the Pref-1 expressing cells during pancreas development and regeneration after birth, we analyzed Pref-1 expression in embryonic and adult partial pancreatectomized rat pancreas, and primary cultured neonatal pig pancreatic cells. METHODS: Whole fetuses or pieces of rat pancreas were obtained at E20. 90% partial pancreatectomy (Px) and sham operation were done using 5 week-old Sprague-Dawley rats. Experimental animals were divided into 11 groups by time of killing after surgery; 0, 1, 3, 6 and 12 hours, 1, 2, 3, 5, 7, and 14 days. All tissues were immunostained with Pref-1 and analysed by reverse transcriptase (RT)-PCR. Porcine neonatal pancreas cell clusters (NPCCs) were prepared from neonatal pigs aged 1-2 days. Cells were harvested on day 0, 3, 4, 5, 6, and 7 after dispersion. All cells were immunostained with Pref-1 and other specific cell markers such as Pan-cytokeratin (Pan-CK), vimentin (VT) and islet hormones, and confirmed by Western blot, RT-PCR and fluorescence activated cell sorting (FACS) analysis. RESULTS: In the rat embryonic pancreas at E20, Pref-1 expression was restricted only in the small branching ductules. In adult rat pancreas, Pref-1 was not expressed at all. Whereas, Pref-1 transiently expressed in the small regenerating duct cells located in foci of regeneration in Px model, then completely disappeared at day 7. The Pref-1 mRNA measured by RT-PCR was peaked at day 3 after Px and then gradually disappeared. Pref-1 expression pattern was also reproduced in monolayer cultured NPCCs. In NPCCs, protein levels of Pref-1 were peaked at day 0 to day 4 then gradually disappeared until day 7 by western blot. Most of Pref-1 expressing cells were co-stained with cytokeratin. The proportion of Pref-1 expressing cells in dispersed NPCCs were counted and isolated by FACS at 3 days after culture were 25% and then decreased over time during 7 days culture period. CONCLUSIONS: Pref-1 expression was regained in adult pancreatic cells during regeneration in vivo and in vitro and Pref-1 might be a useful marker for the pancreatic protodifferentiated cells.

The Study of Physical Activity in the Korean with Type 2 Diabetes.: Kyung Wan Min, Keun Hee An, Tae Seo Sohn, Yong Moon Park, Yeong Sun Hong, Yeon Su Kim, Yi Byeong Park, Kang Seo Park, Gwan Woo Lee, In Ju Kim, Kyung Ah Han, Jae Myoung Yu, Hyun Shik Son, Sei Hyun Baik, Won Cheol Lee, Chung Gu Cho, Hyoung Woo Lee, Sung Woo Park; Korean Diabetes J. 2005;29(6):517-525. Published online November 1, 2005

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Abstract PDF: BACKGROUND
Despite the importance of exercise, little is known about the epidemiology of exercise among persons with diabetes in the Korea. We do not have any standard method to evaluate physical activity of diabetics. So exercise committee of Korean diabetic association decided to survey the physical activities of Korean type 2 diabetic patients. METHODS: Cross-sectional study including 1073 type 2 diabetics (509 males, 564 females) over 18 age. 34 general hospitals collected data about physical activity from Dec. 2004 to Feb.2005. Data were randomly collected by interviewers using numeration table. Respondents were asked about the physical activities or exercise during recent 7 days and frequency, duration of each activity. To compare with normal population, we use 2001 KNHANES (Korean National Health and Nutrition Examination Survey) results. RESULTS: People with type 2 diabetes were more likely to report exercising regularly than people without this disease (52.5% vs. 27.5%) (p<0.0001), but 47.5% of type 2 diabetics didn't take exercise. Walking time of type 2 diabetics wasmore than that of people without this disease (p<0.0001). Type 2 diabetics exerting <700kcal/week of energy expenditure with physical activity were 45.5% in the exercising type 2 diabetics (males:44.2%, females:55.8%). Energy expenditure was positively correlated with frequency of physical exercise and exercise period (p<0.001). CONCLUSION: 47.5% of Korean type 2 diabetics and 72.5% of normal population did not take exercise. 45.5% of exercising type 2 diabetics exerted energy expenditure under 700kcal/week with physical activity. Therefore, various programs for initiating physical activity and increasing energy expenditure are required.

Long Term Effects of Exercise on Waist-Hip Ratio, BMI, HbA1c.: Keun Hee An, Kyung Ah Han, Kyung Wan Min; Korean Diabetes J. 2005;29(6):526-532. Published online November 1, 2005

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Abstract PDF: BACKGROUND
Korean Diabetes Association recommends exercise over than 3 times per week. But the compliance is poor and researches about physical activity of Korean type 2 diabetics are limited. The purpose of this study were to investigate the effectiveness of self report methods on the adherence to physical training and the long term effects of exercise on waist hip ratio, BMI and HbA1c. METHODS: The subjects were trained to exercise over 3 times per week with the load of anaerobic threshold(AT). During 1 year 7 times follow up education were carried out with self -report exercise diary by exercise physiologist bimonthly. The subjects were divided into 3 groups according to duration of exercise : Exercise group(> or =12 months), new exercise group(> or =6 months) control group(<6 months). RESULTS: The subjects were total 27 patients (male 13, female 14). Mean age was 52.4 +/- 7.4 and the duration of DM was 4.0 +/- 3.7 yea rand mean BMI was 25.5 +/- 3.9 year. There were no differences in ratio of BMI after exercise training among groups. Waist hip ratio increased in all groups but the ratio of change in waist hip ratio was significantly lower in exercise group than in control group. The ratio of change in BMI was positively correlated with the ratio of change in muscle mass and percent fat. But the ratio of change in percent fat(r=0.835) was more prominent than in muscle mass(r=0.686). The Mets of peak exercise was significantly increased in all groups. CONCLUSION: The physical training using the self-report method was effective in promoting physical activity. The effects of physical training were detected earlier in the change of waist hip ratio than in BMI change. Exercise capacity was increased not only by exercise training but also metabolic control .

Effect of 12-week Oral Treatment with alpha-lipoic acid on the Nerve Conduction in Symptomatic Diabetic Neuropathy.: Tae Seo Sohn, Jung Min Lee, Sang Ah Chang, Hyun Shik Son, Bong Youn Cha, Ho Young Son, Kwang Woo Lee, Sung Ku Kang; Korean Diabetes J. 2005;29(6):533-539. Published online November 1, 2005

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Abstract PDF: BACKGROUND
Diabetic peripheral neuropathy is multifactorial disorder arising from hyperglycemia and insulin deficiency. It has been suggested that oxidative stress resulting from enhanced free-radical formation and defects in antioxidant defence plays a major role among the putative pathogenic mechanisms of diabetic neuropathy. As alpha-lipoic acid, a natural antioxidant, has been suggested to improve symptoms of diabetic neuropathy, we assessed the efficacy of alpha-lipoic acid on neuropathic symptoms and peripheral nerve conduction in patients with type 2 diabetes mellitus with symptomatic polyneuropathy. METHODS: A cohort of 30 type 2 diabetic patients with symptomatic polyneuropathy received a daily dose of 600 mg alpha-lipoic acid, and was followed for 3 months. Neuropathic symptoms (pain, burning, paraesthesiae, and numbness) of the feet were scored at monthly interval and summarized as a Total Symptom Score (TSS). Nerve conduction study was done before and after 3 month treatment of alpha-lipoic acid. RESULTS: Treatment of alpha-lipoic acid given 600 mg per oral for 12 weeks improved the symptoms of diabetic polyneuropathy. Effects of alpha-lipoic acid on nerve conduction study were that in the motor nerve, the amplitudes of median nerve and tibial nerve and the conduction velocity of tibial nerve improved after 12 weeks treatment. In the sensory nerve, the conduction velocities of median nerve, ulnar nerve, and sural nerve improved after 12 weeks. CONCLUSION: alpha-Lipoic acid was effective in the treatment of diabetic peripheral polyneuropathy improving both clinical manifestations and nerve conduction. The improvement of clinical manifestations may be due to improved conduction velocity of sensory fibers.

The Association of Family History of Diabetes and Obesity in the Development of Type 2 Diabetes.: Wan Sub Shim, Hae Jin Kim, Soo Kyung Kim, Seung Jin Han, Eun Seok Kang, Yu Mie Rhee, Chul Woo Ahn, Sung Kil Lim, Kyung Rae Kim, Hyun Chul Lee, Bong Soo Cha; Korean Diabetes J. 2005;29(6):540-547. Published online November 1, 2005

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Abstract PDF: BACKGROUND
Type 2 diabetes is characterized by defects in both insulin secretion and insulin action. Type 2 diabetes has a strong genetic basis, and obesity is also known as a important risk factor for development of diabetes. The relative effects of obesity and family history of diabetes (FHx) to develop diabetes have not been well characterized. The aim of this study was to analyze the relative role of insulin resistance and insulin secretion in the newly diagnosed type 2 diabetic patients according to the presence of FHx and obesity. METHOD: We evaluated the presence of FHx, fasting and postprandial glucose, C-peptide and insulin in 219 newly diagnosed type 2 diabetic patients without the history of drug therapy from Jan. 2003 to Oct. 2004. RESULT: The mean age of patients was 54.7+/-10.2(yr) and the mean BMI was 25.5+/-3.0 kg/m2. The patients with FHx develop diabetes earlier than them without FHx. BMI, fasting glucose, postprandial glucose, fasting C-peptide and HOMAIR value were not different between groups. But postprandial C-peptide, fasting insulin, postprandial insulin and HOMAbeta-cell value were significantly lower in patient with FHx than in them without FHx. Interestingly, obese (BMI > or = 25kg/m2) patients with FHx developed diabetes earlier than nonobese (BMI <25kg/m2) patients with FHx. CONCLUSION: Obesity plays an important role in the determination of the earlier onset of diabetes in patients with FHx. Intentional prevention of obesity may be an important means to prevent, at least delay, the onset of diabetes in the subjects with FHx.

The Relationship between Metabolic Syndrome and Small Dense Low Density Lipoprotein-Cholesterol.: Wan Sub Shim, Hae Jin Kim, Eun Seok Kang, Yu Mie Rhee, Chul Woo Ahn, Sung Kil Lim, Hyun Chul Lee, Bong Soo Cha; Korean Diabetes J. 2005;29(6):548-556. Published online November 1, 2005

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Abstract PDF: BACKGROUND
Type 2 diabetes mellitus and metabolic syndrome (MS) are associated with the increased risk of cardiovascular disease and with characteristic dyslipidemia which is composed of high level of triglyceride, low level of HDL-C and increased small dense LDL (sd-LDL). Recently a simple method was established for the quantification of sd-LDL-C using heparin-magnesium precipitation. The aim of this study was to evaluate the relationship between the sd-LDL-C and the number of components of MS in type 2 diabetic patients. METHODS: 287 type 2 diabetic patients, who did not use the medication which can affect the concentration of lipid such as statin, fibrate, thiazolidinediones and corticosteroid, were enrolled. The NCEP-ATP III criteria of MS were used except obesity. RESULTS: Although LDL-C concentrations were not changed according to the number of components of MS, absolute level and percentage of sd-LDL-C were increased. Although LDL-C concentrations were not different between presence and absence of MS, in the case of MS, absolute level and percentage of sd-LDL-C were higher than not in the case of MS. Sd-LDL-C concentration was positively correlated with fasting plasma glucose, HbA1c, total cholesterol, triglyceride, LDL-C and percentage of sd-LDL-C, and negatively with HDL-C. The percentage of sd-LDL-C was positively correlated with total cholesterol, triglyceride and sd-LDL-C, and negatively with HDL-C. CONCLUSION: The sd-LDL-C may a factor that explains the higher risk of CVD in diabetic patients with the MS.

Clinical Characteristics of Non-obese, Adult-onset Diabetes Requiring Insulin Treatment.: Se Eun Park, Wan Sub Shim, Mi Young Do, Eun Seok Kang, Yumie Rhee, Chul Woo Ahn, Sung Kil Lim, Kyung Rae Kim, Hyun Chul Lee, Bong Soo Cha; Korean Diabetes J. 2005;29(6):557-565. Published online November 1, 2005

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Abstract PDF: BACKGROUND
The aim of this study is to clarify the clinical characteristics of non-obese, adult-onset diabetes requiring insulin treatment and to compare the different characteristics of the three groups categorized according to diabetes classification. METHODS: Total 128 diabetic patients who were non-obese (BMI < 25kg/m2) and had been diagnosed with diabetes after 20 years old, requiring insulin treatment were enrolled in the study. We divided the patients into three groups : 56 patients with type 1, 37 with unclassifiable, and 35 with type 2 diabetes. The type of diabetes was assigned by comparing serum C-peptide concentration and clinical phenotypes. RESULTS: Type 2 and unclassifiable diabetes had no differences in BMI, the interval to use insulin, daily insulin dose, the level of HDL cholesterol and the positive rate for GAD Ab, but type 1 diabetes didn't. However, type 1 diabetes and unclassifiable group was lower prevalence of microvascular complications than type 2 diabetes (retinopathy 38.2, 52.8, 84.8 % ; nephropathy 37.7, 36.7, 74.2 % ; neuropathy 36.7, 36.7, 72.7 %, P<0.05). The prevalence of macrovascular complications was higher in the order of type 1, unclassifiable, and type 2 diabetes (11.1, 29.4, 72.7 %, respectively, all P<0.05). CONCLUSION: The clinical characteristics were similar between unclassifiable and type 2 diabetes, but the prevalence of microvascular complication in unclassifiable group had no significant difference compared with type 1 diabetes. The prevalence of macrovascular complications was significantly higher in the order of type 1, unclassifiable, and type 2 diabetes.

Case Reports

Two Cases of Diabetic Ketoacidosis Associated with Atypical Antipsychotics.: Seung Hee Lee, Kum Ho Yi, Eun A Kim, Seong Bin Hong, Moon Suk Nam, Yong Seong Kim; Korean Diabetes J. 2005;29(6):566-570. Published online November 1, 2005

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Abstract PDF: Atypical antipsychotics have been widely used for the management of patients with schizophrenia and other psychotic disorders. However, they may be associated with a greater risk of metabolic abnormalities than others, including weight gain, hyperlipidemia, and new-onset type 2 diabetes mellitus or diabetic ketoacidosis (DKA). We report two cases of reversible DKA and new-onset DM that developed in patients treated with atypical antipsychotics. A 42-year-old male patient with schizophrenia who was on olanzapine admitted to the hospital because of DKA. He had been taking olanzapine for 5 months. Five months before the admission, his fasting serum glucose levels were 109 m/dL. Another 34-year-old male with no previous history of diabetes mellitus was admitted to the hospital and subsequently diagnosed with DKA. The patient had been taking risperidone. Clinicians should monitor blood glucose concentrations periodically in patients taking atypical antipsychotics.

A Case of Hyperglycemic Hyperosmolar Syndrome Induced by Steroid Treatment for Idiopathic Thrombocytopenic Purpura.: Soo Yeon Park, Se Yune Kim, Dong IL Kim, Hye Suk Kim, Sae Jeong Yang, Ju Ri Park, Dong Jin Kim, Hye Jin Yoo, Soon Beom Kwon, Sei Hyun Baik; Korean Diabetes J. 2005;29(6):571-573. Published online November 1, 2005

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Abstract PDF: Steroid induced diabetes mellitus, a complication due to corticosteroids, is commonly regarded as a form of type 2 diabetes mellitus. Hyperglycemic hyperosmolar syndrome, which requires relative insulin deficiency and concomitant elevation of counterregulatory hormones, such as glucagon, catecholamine, cortisol, and growth hormone, is acute a complication of type 2 diabetes mellitus. Here we report a case of hyperglycemic hyperosmolar syndrome induced by short-term steroid treatment in idiopathic thromobocytopenic purpura.

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