Diabetes & Metabolism Journal

Original Articles

Clinical Care/Education
Glycemic Effects of Rebaudioside A and Erythritol in People with Glucose Intolerance: Dong Hee Shin, Ji Hye Lee, Myung Shin Kang, Tae Hoon Kim, Su Jin Jeong, Chong Hwa Kim, Sang Soo Kim, In Joo Kim; Diabetes Metab J. 2016;40(4):283-289. Published online June 15, 2016; DOI: https://doi.org/10.4093/dmj.2016.40.4.283

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Background

Rebaudioside A and erythritol are nonnutritive sweeteners. There have been several studies of their glycemic effects, but the outcomes remain controversial. The purpose of this study was to evaluate the glycemic effects of rebaudioside A and erythritol as a sweetener in people with glucose intolerance.

Methods

This trial evaluated the glycemic effect after 2 weeks of consumption of rebaudioside A and erythritol as sweeteners in a pre-diabetic population. The patients were evaluated for fructosamine, fasting plasma glucose, C-peptide, insulin, and 2-hour plasma glucose before and after consumption of sweetener. The primary outcome was a change in fructosamine levels from the baseline to the end of treatment. Secondary outcomes were the changes in levels of fasting plasma glucose and 2-hour plasma glucose.

Results

From the baseline to the end of experiment, the changes in fructosamine levels after consumption of rebaudioside A and erythritol, did not differ significantly (244.00±19.57 vs. 241.68±23.39 µmol/L, P=0.366). The change in levels from the baseline to end of the study for rebaudioside A and erythritol were fasting plasma glucose (102.56±10.72 vs. 101.32±9.20 mg/dL), 2-hour plasma glucose (154.92±54.53 vs. 141.92±42.22 mg/dL), insulin (7.56±4.29 vs. 7.20±5.12 IU/mL), and C-peptide (2.92±1.61 vs. 2.73±1.31 ng/mL), respectively, and also did not differ significantly (P>0.05 for all).

Conclusion

Our study suggests that consumption of rebaudioside A and erythritol does not alter the glucose homeostasis in people with glucose intolerance.

Citations

Citations to this article as recorded by

The Cardiometabolic Impact of Rebaudioside A Exposure during the Reproductive Stage
Isabella Bracchi, Juliana Morais, João Coelho, Ana Ferreira, Inês Alves, Cláudia Mendes, Beatriz Correia, Alexandre Gonçalves, João Guimarães, Inês Falcão-Pires, Elisa Keating, Rita Negrão
Biology.2024; 13(3): 163. CrossRef
Re‐evaluation of erythritol (E 968) as a food additive
Maged Younes, Gabriele Aquilina, Laurence Castle, Gisela Degen, Karl‐Heinz Engel, Paul J. Fowler, Maria José Frutos Fernandez, Peter Fürst, Ursula Gundert‐Remy, Rainer Gürtler, Trine Husøy, Melania Manco, Wim Mennes, Peter Moldeus, Sabina Passamonti, Romi
EFSA Journal.2023;[Epub] CrossRef
Sugar-Free Dark Chocolate Consumption Results in Lower Blood Glucose in Adults With Diabetes
Barbara Oliveira, Kaja Falkenhain, Jonathan P Little
Nutrition and Metabolic Insights.2022; 15: 117863882210769. CrossRef
Acute responses of stevia and d-tagatose intake on metabolic parameters and appetite/satiety in insulin resistance
Verónica Sambra, Isabella A. Vicuña, Kathleen M. Priken, Selva L. Luna, Daniela A. Allendes, Paula M. Godoy, Victoria Novik, Claudia A. Vega
Clinical Nutrition ESPEN.2022; 49: 217. CrossRef
Modulating effects of steviol and steviol glycosides on adipogenesis, lipogenesis, glucose uptake and insulin resistance in 3T3-L1 adipocyte model
Jakub Michał Kurek, Joanna Zielińska-Wasielica, Katarzyna Kowalska, Zbigniew Krejpcio, Anna Olejnik
Journal of Functional Foods.2022; 94: 105141. CrossRef
Stevia, sucralose and sucrose added to a maqui-Citrus beverage and their effects on glycemic response in overweight subjects: A randomized clinical trial
Débora Villaño, Hedyeh Masoodi, Javier Marhuenda, Cristina García-Viguera, Pilar Zafrilla
LWT.2021; 144: 111173. CrossRef
Low-energy sweeteners and body weight: a citation network analysis
Mie Normand, Christian Ritz, David Mela, Anne Raben
BMJ Nutrition, Prevention & Health.2021; 4(1): 319. CrossRef
Diabetes and COVID-19, potentialities of Morus alba L. (mulberry) and Stevia rebaudiana Bertoni (stevia). Mini-review
Hernandez Claudia Chavez, Payrol Juan Abreu, Laime Sirley Gonzalez, Garcia Ariel Martinez, Michel Lazaro, Legarreta Morera, Perez Marisol Gonzalez
Global Journal of Rare Diseases.2021; : 006. CrossRef
Evaluation of minor steviol glycosides effect on insulin resistance, serum triglycerides, and antioxidant capacity of diabetised Wistar rats
Carolina Díaz Canul, Fibi Yenisie Coop Gamas, María Luisa Ávila Escalante, David Betancur-Ancona, Irma Aranda-González
International Food Research Journal.2021; 28(2): 342. CrossRef
Effects of the Daily Consumption of Stevia on Glucose Homeostasis, Body Weight, and Energy Intake: A Randomised Open-Label 12-Week Trial in Healthy Adults
Nikoleta S. Stamataki, Benjamin Crooks, Abubaker Ahmed, John T. McLaughlin
Nutrients.2020; 12(10): 3049. CrossRef
Safety of a proposed amendment of the specifications for steviol glycosides (E 960) as a food additive: to expand the list of steviol glycosides to all those identified in the leaves of Stevia Rebaudiana Bertoni
Maged Younes, Gabriele Aquilina, Karl‐Heinz Engel, Paul Fowler, Maria Jose Frutos Fernandez, Peter Fürst, Rainer Gürtler, Ursula Gundert‐Remy, Trine Husøy, Melania Manco, Wim Mennes, Peter Moldeus, Sabina Passamonti, Romina Shah, Ine Waalkens‐Berendsen, D
EFSA Journal.2020;[Epub] CrossRef
A comparison of the effects of Stevia extract and metformin on metabolic syndrome indices in rats fed with a high‐fat, high‐sucrose diet
Tahereh Ranjbar, Ali Akbar Nekooeian, Nader Tanideh, Omid Koohi‐Hosseinabadi, Seyed Jalil Masoumi, Sasan Amanat, Negar Azarpira, Ahmad Monabati
Journal of Food Biochemistry.2020;[Epub] CrossRef
The effect of a new mixture of sugar and sugar-alcohols compared to sucrose and glucose on blood glucose increase and the possible adverse reactions: A phase I double-blind, three-way randomized cross-over clinical trial
Mohammad Ali Mohsenpour, Fatemeh Kaseb, Reza Nazemian, Hassan Mozaffari-Khosravi, Hossein Fallahzadeh, Amin Salehi-Abargouei
Endocrinología, Diabetes y Nutrición.2019; 66(10): 647. CrossRef
Effect of Steviol Glycosides on Human Health with Emphasis on Type 2 Diabetic Biomarkers: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Bundgaard Anker, Rafiq, Jeppesen
Nutrients.2019; 11(9): 1965. CrossRef
The effect of a new mixture of sugar and sugar-alcohols compared to sucrose and glucose on blood glucose increase and the possible adverse reactions: A phase I double-blind, three-way randomized cross-over clinical trial
Mohammad Ali Mohsenpour, Fatemeh Kaseb, Reza Nazemian, Hassan Mozaffari-Khosravi, Hossein Fallahzadeh, Amin Salehi-Abargouei
Endocrinología, Diabetes y Nutrición (English ed.).2019; 66(10): 647. CrossRef
Non-nutritive Sweeteners and Glycaemic Control
Yoona Kim, Jennifer B. Keogh, Peter M. Clifton
Current Atherosclerosis Reports.2019;[Epub] CrossRef
FDA regulatory approach to steviol glycosides
Judith D. Perrier, Jeremy J. Mihalov, Susan J. Carlson
Food and Chemical Toxicology.2018; 122: 132. CrossRef
Health outcomes of non-nutritive sweeteners: analysis of the research landscape
Szimonetta Lohner, Ingrid Toews, Joerg J. Meerpohl
Nutrition Journal.2017;[Epub] CrossRef
Erythritol is a pentose-phosphate pathway metabolite and associated with adiposity gain in young adults
Katie C. Hootman, Jean-Pierre Trezzi, Lisa Kraemer, Lindsay S. Burwell, Xiangyi Dong, Kristin A. Guertin, Christian Jaeger, Patrick J. Stover, Karsten Hiller, Patricia A. Cassano
Proceedings of the National Academy of Sciences.2017;[Epub] CrossRef

Others
The Effect of Glycemic Status on Kidney Stone Disease in Patients with Prediabetes: Tzu-Hsien Lien, Jin-Shang Wu, Yi-Ching Yang, Zih-Jie Sun, Chih-Jen Chang; Diabetes Metab J. 2016;40(2):161-166. Published online April 25, 2016; DOI: https://doi.org/10.4093/dmj.2016.40.2.161

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Background

While the evidence supporting a positive association between diabetes mellitus and kidney stone disease (KSD) is solid, studies examining the association between impaired fasting glucose (IFG) and KSD show inconsistent results. Currently, there are no studies examining the relationship between impaired glucose tolerance (IGT) and KSD. The objective of this study is to investigate the effects of different glycemic statuses on KSD. The results may help to motivate patients with diabetes to conform to treatment regimens.

Methods

We conducted a cross sectional study of a population that underwent health check-ups between January 2000 and August 2009 at the Health Evaluation Center of National Cheng Kung University Hospital. A total of 14,186 subjects were enrolled. The following categories of glycemic status were used according to the criteria of the 2009 American Diabetes Association: normal glucose tolerance, isolated IGT, isolated IFG, combined IFG/IGT, and diabetes. The existence of KSD was evaluated using renal ultrasonography, and the presence of any hyperechoic structures causing acoustic shadowing was considered to be indicative of KSD.

Results

The prevalence of KSD was 7.4% (712/9,621), 9.3% (163/1,755), 10.8% (78/719), 12.0% (66/548), and 11.3% (174/1,543) in subjects with NGT, isolated IGT, isolated IFG, combined IFG/IGT, and diabetes, respectively. Isolated IFG, combined IFG/IGT, and diabetes were associated with KSD after adjusting for other clinical variables, but isolated IGT was not. Age (41 to 64 years vs. ≤40 years, ≥65 years vs. ≤40 years), male gender, hypertension, and hyperuricemia were also independently associated with KSD.

Conclusion

Isolated IFG, combined IFG/IGT, and diabetes, but not isolated IGT, were associated with a higher risk of KSD.

Citations

Citations to this article as recorded by

Related Risk Factor Analysis for Upper Urinary Tract Stones in Patients with Abnormal Glucose Metabolism
泽伟于
Advances in Clinical Medicine.2022; 12(02): 749. CrossRef
Nephrolithiasis: A Red Flag for Cardiovascular Risk
Alessia Gambaro, Gianmarco Lombardi, Chiara Caletti, Flavio Luciano Ribichini, Pietro Manuel Ferraro, Giovanni Gambaro
Journal of Clinical Medicine.2022; 11(19): 5512. CrossRef
Association between metabolic syndrome components and the risk of developing nephrolithiasis: A systematic review and bayesian meta-analysis
Ilham Akbar Rahman, Ilham Fauzan Nusaly, Syakri Syahrir, Harry Nusaly, Makbul Aman Mansyur
F1000Research.2021; 10: 104. CrossRef
Glycemic Status, Insulin Resistance, and the Risk of Nephrolithiasis: A Cohort Study
Seolhye Kim, Yoosoo Chang, Hyun-Suk Jung, Young Youl Hyun, Kyu-Beck Lee, Kwan Joong Joo, Heung Jae Park, Young-Sam Cho, Hyeonyoung Ko, Eunju Sung, Hocheol Shin, Seungho Ryu
American Journal of Kidney Diseases.2020; 76(5): 658. CrossRef
Associations between nephrolithiasis and diabetes mellitus, hypertension and gallstones: A meta‐analysis of cohort studies
Bing‐Biao Lin, Rong‐Hua Huang, Bing‐Liang Lin, Ying‐Kai Hong, Ming‐En Lin, Xue‐Jun He
Nephrology.2020; 25(9): 691. CrossRef
Risk Factors for Urolithiasis (Review)
В. А. Слободянюк
Health of Man.2020; (1): 75. CrossRef
Re: Evidence of Disordered Calcium Metabolism in Adolescent Girls with Type 1 Diabetes: An Observational Study Using a Dual-Stable Calcium Isotope Technique
Dean G. Assimos
Journal of Urology.2018; 199(2): 335. CrossRef
Metabolic syndrome and uric acid nephrolithiasis: insulin resistance in focus
Leonardo Spatola, Pietro Manuel Ferraro, Giovanni Gambaro, Salvatore Badalamenti, Marco Dauriz
Metabolism.2018; 83: 225. CrossRef
Kidney stones diseases and glycaemic statuses: focus on the latest clinical evidences
Leonardo Spatola, Claudio Angelini, Salvatore Badalamenti, Silvio Maringhini, Giovanni Gambaro
Urolithiasis.2017; 45(5): 457. CrossRef

Plasma Glucose Regulation and Mortality in Korea: A Pooled Analysis of Three Community-Based Cohort Studies: Nan Hee Kim, Dong-Jun Kim, Seok Won Park, Jee-Young Oh, Joong-Yeol Park, Chol Shin, Hong Kyu Lee, Yongsoo Park; Diabetes Metab J. 2014;38(1):44-50. Published online February 19, 2014; DOI: https://doi.org/10.4093/dmj.2014.38.1.44

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Background

Although diabetes is a well-known risk factor for death, its impact on cancer death is not clearly understood. Furthermore, it remains controversial whether impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) are associated with increased risk of mortality. We investigated the impact of diabetes or glucose tolerance categories on all cause and cause-specific mortality.

Methods

Mortality analysis was conducted in three population-based cohort studies of 3,801 participants, divided according to fasting plasma glucose (FPG) (normal; stage 1 IFG [5.6≤FPG<6.1 mmol/L]; stage 2 IFG [6.1≤FPG<7.0 mmol/L]; diabetes mellitus [DM]-FPG); or 2-hour glucose after 75 g glucose loading (2hPG) (normal; IGT; DM-2hPG), or a combination of FPG and 2hPG criteria.

Results

During a median follow-up of 11.0 years, 474 subjects died from all causes. Hazard ratios (HRs) for all cause death were higher in those with diabetes as defined by either FPG or 2hPG criteria than their normal counterparts (HR, 2.2, 95% confidence interval [CI], 1.6 to 2.9 for DM-FPG; HR, 2.0, 95% CI, 1.5 to 2.7 for DM-2hPG). Similarly, diabetes defined by either FPG or 2hPG was associated with cancer death (HR, 2.9, 95% CI, 1.7 to 5.0; and HR, 2.1, 95% CI, 1.2 to 3.9, respectively). Although neither IFG nor IGT conferred higher risk for death, when combining stage 2 IFG and/or IGT, the risk of all cause death was higher than in subjects with normal glucose regulation (HR, 1.3; 95% CI, 1.0 to 1.6).

Conclusion

Diabetes is associated with higher risk of death from all causes and cancer. In subjects without diabetes, stage 2 IFG and/or IGT confers increased risk for mortality.

Citations

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Abnormal Fasting Glucose Increases Risk of Unrecognized Myocardial Infarctions in an Elderly Cohort
Richard Brandon Stacey, Janice Zgibor, Paul E. Leaverton, Douglas D. Schocken, Jennifer A. Peregoy, Mary F. Lyles, Alain G. Bertoni, Gregory L. Burke
Journal of the American Geriatrics Society.2019; 67(1): 43. CrossRef
Increased Vascular Disease Mortality Risk in Prediabetic Korean Adults Is Mainly Attributable to Ischemic Stroke
Nam Hoon Kim, Tae Yeon Kwon, Sungwook Yu, Nan Hee Kim, Kyung Mook Choi, Sei Hyun Baik, Yousung Park, Sin Gon Kim
Stroke.2017; 48(4): 840. CrossRef
β-Cell Function and Insulin Sensitivity in Normal Glucose-Tolerant Subjects Stratified by 1-Hour Plasma Glucose Values
Miranda M. Priya, Anandakumar Amutha, T.A. Pramodkumar, Harish Ranjani, Saravanan Jebarani, Kuppan Gokulakrishnan, Rajendra Pradeepa, Ranjit Unnikrishnan, Ranjit Mohan Anjana, Viswanathan Mohan
Diabetes Technology & Therapeutics.2016; 18(1): 29. CrossRef
Effect of Socio-Economic Status on the Prevalence of Diabetes
Yu Jeong Kim, Ja Young Jeon, Seung Jin Han, Hae Jin Kim, Kwan Woo Lee, Dae Jung Kim
Yonsei Medical Journal.2015; 56(3): 641. CrossRef
The Population-Based Risk of Need for Coronary Revascularization According to the Presence of Type 2 Diabetes Mellitus and History of Coronary Heart Disease in the Korean Population
Chang Hee Jung, Gi Hyeon Seo, Sunghwan Suh, Ji Cheol Bae, Mee Kyoung Kim, You-Cheol Hwang, Jae Hyeon Kim, Byung-Wan Lee, Xian Wu Cheng
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Effect of Treadmill Exercise on Interleukin-15 Expression and Glucose Tolerance in Zucker Diabetic Fatty Rats: Hee-Jae Kim, Jae Young Park, Seung Lyul Oh, Yong-An Kim, Byunghun So, Je Kyung Seong, Wook Song; Diabetes Metab J. 2013;37(5):358-364. Published online October 17, 2013; DOI: https://doi.org/10.4093/dmj.2013.37.5.358

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Background

Interleukin-15 (IL-15), a well-known myokine, is highly expressed in skeletal muscle and is involved in muscle-fat crosstalk. Recently, a role of skeletal muscle-derived IL-15 in the improvement of glucose homeostasis and insulin sensitivity has been proposed. However, little is known regarding the influence of endurance training on IL-15 expression in type 2 diabetic skeletal muscles. We investigated the effect of endurance exercise training on glucose tolerance and IL-15 expression in skeletal muscles using type 2 diabetic animal models.

Methods

Male Zucker diabetic fatty (ZDF) and ZDF lean control (ZLC) rats were randomly divided into three groups: sedentary ZLC, sedentary ZDF (ZDF-Con), and exercised ZDF (ZDF-Ex). The ZDF-Ex rats were forced to run a motor-driven treadmill for 60 minutes once a day 5 times per week for 12 weeks. Intraperitoneal glucose tolerance test (IPGTT) was performed after 12 weeks. Expression of IL-15 was measured using ELISA in extracted soleus (SOL) and gastrocnemius medial muscles.

Results

After 12 weeks of treadmill training, reduction of body weight was observed in ZDF-Ex compared to ZDF-Con rats. Glucose tolerance using IPGTT in diabetic rats was significantly improved in ZDF-Ex rats. Furthermore, the expression of IL-15 was significantly increased (P<0.01) only in the SOL of ZDF-Ex rats compared to ZDF-Con. Additionally, IL-15 expression in SOL muscles was negatively correlated with change of body weight (R=-0.424, P=0.04).

Conclusion

The present study results suggest that 12 weeks of progressive endurance training significantly improved glucose tolerance with concomitant increase of IL-15 expression in SOL muscles of type 2 diabetic rats.

Citations

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Beyond muscles: Investigating immunoregulatory myokines in acute resistance exercise – A systematic review and meta‐analysis
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The FASEB Journal.2024;[Epub] CrossRef
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Linjing Yan, Liang Guo
Journal of Cellular Physiology.2023; 238(8): 1670. CrossRef
Effects of short-term physical training on the interleukin-15 signalling pathway and glucose tolerance in aged rats
Luciele Guerra Minuzzi, Luciana Renata da Conceição, Vitor Rosetto Muñoz, Renan Fudoli Lins Vieira, Rafael Calais Gaspar, Adelino S.R. da Silva, Dennys Esper Cintra, Leandro Pereira de Moura, Eduardo Rochete Ropelle, Ana Maria Teixeira, José Rodrigo Pauli
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Diabetology & Metabolic Syndrome.2021;[Epub] CrossRef
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Interval aerobic training combined with strength-endurance exercise improves metabolic markers beyond caloric restriction in Zucker rats
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Effect of Green Tea Extract/Poly-γ-Glutamic Acid Complex in Obese Type 2 Diabetic Mice: Ki-Cheor Bae, Jae-Hyung Park, Ann-Yae Na, Sun-Joo Kim, Shinbyoung Ahn, Sang-Pyo Kim, Byung-Chul Oh, Ho-Chan Cho, Yong Woon Kim, Dae-Kyu Song; Diabetes Metab J. 2013;37(3):196-206. Published online June 14, 2013; DOI: https://doi.org/10.4093/dmj.2013.37.3.196

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Background

The increasing prevalence of type 2 diabetes mellitus (T2DM) is associated with the rapid spread of obesity. Obesity induces insulin resistance, resulting in β-cell dysfunction and thus T2DM. Green tea extract (GTE) has been known to prevent obesity and T2DM, but this effect is still being debated. Our previous results suggested that circulating green tea gallated catechins (GCs) hinders postprandial blood glucose lowering, regardless of reducing glucose and cholesterol absorption when GCs are present in the intestinal lumen. This study aimed to compare the effect of GTE with that of GTE coadministered with poly-γ-glutamic acid (γ-PGA), which is likely to inhibit the intestinal absorption of GCs.

Methods

The db/db mice and age-matched nondiabetic mice were provided with normal chow diet containing GTE (1%), γ-PGA (0.1%), or GTE+γ-PGA (1%:0.1%) for 4 weeks.

Results

In nondiabetic mice, none of the drugs showed any effects after 4 weeks. In db/db mice, however, weight gain and body fat gain were significantly reduced in the GTE+γ-PGA group compared to nondrug-treated db/db control mice without the corresponding changes in food intake and appetite. Glucose intolerance was also ameliorated in the GTE+γ-PGA group. Histopathological analyses showed that GTE+γ-PGA-treated db/db mice had a significantly reduced incidence of fatty liver and decreased pancreatic islet size. Neither GTE nor γ-PGA treatment showed any significant results.

Conclusion

These results suggest that GTE+γ-PGA treatment than GTE or γ-PGA alone may be a useful tool for preventing both obesity and obesity-induced T2DM.

Citations

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Qiantu Hu, Huafeng Chen, Yanli Zuo, Qin He, Xuan He, Steve Simpson, Wei Huang, Hui Yang, Haiying Zhang, Rui Lin
Nutrition & Metabolism.2019;[Epub] CrossRef
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Review

Obstructive Sleep Apnea and Abnormal Glucose Metabolism: Nan Hee Kim; Diabetes Metab J. 2012;36(4):268-272. Published online August 20, 2012; DOI: https://doi.org/10.4093/dmj.2012.36.4.268

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Abstract PDF PubReader

Obstructive sleep apnea (OSA) is a chronic disorder that is prevalent, especially in subjects with obesity or diabetes. OSA is related to several metabolic abnormalities, including diabetes, insulin resistance, hypertension, and cardiovascular diseases. Although Koreans are less obese than Caucasians, the prevalence of OSA is comparable in both groups. Thus, the impact of OSA on metabolism may be similar. Many epidemiologic and experimental studies have demonstrated that OSA is associated with glucose intolerance and insulin resistance via intermittent hypoxia, sleep fragmentation, and sleep deprivation. The effect of continuous positive airway pressure treatment on glucose metabolism is still controversial. Randomized controlled trials are needed to evaluate the ability of OSA treatment to reduce the risk of diabetes and insulin resistance in subjects without diabetes and to ameliorate glucose control in patients with diabetes.

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Original Article

The Effect of Gamma-Glutamyltransferase on Impaired Fasting Glucose or Type 2 Diabetes in Korean Men.: Tae Yeon Kim, Do Hoon Kim, Chang Hae Park, Kyung Hwan Cho, Seung Hwan Lee, Hyuk Ga, Hwan cheol Kim; Korean Diabetes J. 2009;33(3):215-224. Published online June 1, 2009; DOI: https://doi.org/10.4093/kdj.2009.33.3.215

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Abstract PDF

BACKGROUND
We sought to determine the association between serum gamma-glutamyltransferase (GGT) levels within the normal range and the risk for development of impaired fasting glucose (IFG) or type 2 diabetes. METHODS: This retrospective cohort study spanned four years (2002~2006) with 1,717 Korean men who underwent periodic health examinations at a university hospital in Incheon, Korea and were not diagnosed with IFG or type 2 diabetes. Fasting plasma glucose levels were measured at the annual health examination. IFG and diabetes were defined as a serum fasting glucose concentration of 100~125 mg/dL and more than 126 mg/dL, respectively. Cox's proportional hazards model was used to evaluate the association between serum GGT levels and development of IFG or type 2 diabetes. RESULTS: There was a strong dose-response relationship between serum GGT levels and the incidence of IFG and diabetes. A total of 570 cases (33.2%) of incident IFG and 50 cases (2.9%) of diabetes were found. After controlling potential predictors, the relative risks for the incidence of IFG for GGT levels < or = 19, 20~25, 26~34, 35~50 and > or = 51 were 1.00, 0.99, 1.17, 1.23 and 1.38 respectively (P for trend 0.015), and for the incidence of diabetes were 1.00, 1.44, 1.80, 2.55 and 2.58 respectively (P for trend 0.050). CONCLUSION: The risk for development of IFG and type 2 diabetes increased in a dose-dependent manner as serum GGT increased within its normal range in Korean men.

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Case Report

A Case of Bartter's Syndrome occurring in Diabetes Mellitus.: Jang Yel Shin, Jeung Rae Cho, Do Young Kim, Joon Kye Lee, Chul Woo Ahn, Jae Hyun Nam, Soo Yon Nam, Young Duk Song, Kyu Hun Choi, Sung Kil Lim, Kyung Rae Kim, Hyun Chul Lee, Kap Bum Huh, Jai Ho Han, Heun Ju Jung; Korean Diabetes J. 2000;24(1):90-96. Published online January 1, 2001

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Abstract PDF: Bartter's syndrome is characterized by hypokalemia, metabolic alkalosis, hyperreninemia and secondary hyperaldosteronism without hypertension and edema, Histologically, existing hyperplasia of the juxtaglomerular cell occurs mostly in childhood or adolescence, and initial presentation in patients over 40 years old of age is very rare. It has been recorded that Bartter's syndrome is associated with glucose intolerance, but not with overt diabetes mellitus. Whether this association is coincidental or causal is uncertain, although hypokalemia can cause glucose intolerance. We experienced a case of Bartters syndrome in 44 years old non-insulin dependent diabetic woman. She improved with potassium supplements along with combination of prostaglandin synthetase inhibitor and aldosterona antagonist. We report present case with the review of literature.

Original Article

Antepartum Characteristics Predicting Persistent Postpartum Glucose lntolerance in the Patients with Gestational Diabetes Mellitus (GDM).: Yoo Lee Kim, Yong Wook Cho, Seok Won Park, Seog Ki Lee, In Sup Ahn, Byung Wook Na, Jun Lee, Yun Kyung Cho, Hwa Young Lee, Sang Jong Lee; Korean Diabetes J. 2000;24(1):46-59. Published online January 1, 2001

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Abstract PDF: BACKGROUND
The aim of this study is to investigate the prevalence of persistent postpartum glucose intolerance and to examine antepartum clinical characteri-stics for their predictability of persistent postpartum glucose intolerance in the patients with GDM. METHODS: In 211 GDM patients who showed more than two abnormal glucose values of O'Sullivan and Mahan's criteria on 100g-oral glucose tolerance test (OGTT), 75g-OGTT were performed at 6 weeks postpartum. The incidence of postpartum normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and diabetes mellitus (DM) were investigated and antepartum ciinical parameters were compared among the three groups, Predictability of antepartum clinical characteristics for postpartum IGT and DM were also investigated by logistic regression analysis. RESULTS: When we grouped the patients into postpartum NGT, IGT, DM according to the results of 75g-OGTT performed 6 weeks postpartum, The incidence were 81,5% of subjects had NGT, 9.0% had IGT, and 9.5% had DM. Plasma glucose levels and GAUC on antepartum 100 g-OGTT(NGT: 1660+/-159, IGT: 1948+/-730, DM: 2538+/-629mmol/L ' min), and proportion of patients receiving insulin therapy increased progressively and significantly in association with worsening postpartum glucose tolerance. Frequency of positive family history of DM in qroups with IGT and DM (63,2% & 80.0%) were significantly higher than that in group with NGT(37,2%). Weight gain before diagnosis of GDM in groups with IGT and DM(6.7+/-3.9kg & 6.8+/-4.1 kg) were significantly smaller than that of group with NGT(9.5+/-3,5kg), Gestational age at diagnosis of GDM in group with DM(25.8+/-5.4 weeks) was significantly shorter than that in group with NGT(30.0+/-3,3 weeks), Proportion of subjects diagnosed earlier than 24 weeks of gestation were significantly higher in groups with IGT (15.8%) and DM (25.0%) than in group with NGT (1.2%). Proportions of subjects delivered heavier infants, > or =4 kg,were significantly higher in the DM group (40.0%) than in the NGT group (9.3%). In the patients having fasting plasma glucose levels hlgher than 5.8 mmol/L on antepartum 100g-OGTT, the prevalence of persistent glucose intolerance was significantly higher than in the patients FPG level lower than 5.8 mmol/L (61.9% vs 7.7%), Logistic regression analysis were performed using IGT and DM as the outcome of interest. The GAUC on antepartum 100g-OGTT, family history of DM, and the gestational age at diagnosis of GDM were independent predictors for both postpartum DM and postpartum IGT. CONCLUSION: The prevalence of persistent postpartum glucose intolerance in GDM patients were 18.5% and the most important independent predictor for persistent postpartum glucose intolerance was the degree of severity in glucose intolerance during pregnancy.

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