- Relationship between Endothelial-dependent/-independent Vasodilation and Carotid Intimal- media Thickness in Newly-diagnosed Korean Type 2 Diabetic Patients.
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Jung Ho Choi, Kyung Wan Min, Hyo Jeong Kim, Bo kyung Koo, Chae Young Lim, Hyun Jin Kim, Gang Seo Pak, Kyung Ah Han, Eung Jin Kim
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Korean Diabetes J. 2007;31(6):498-506. Published online November 1, 2007
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DOI: https://doi.org/10.4093/jkda.2007.31.6.498
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- BACKGROUND
The relative effect of diabetes on the risk of cardiovascular disease in Asian population is much the same as that in Western populations. Although multiple atherosclerotic risk factors have been documented in Asia, precise estimates of vascular reactivity might provide more critical informations for the prevention and the control of diabetes-related cardiovascular mortality and morbidity. The aims of this study were to estimate the vascular reactivity directly and evaluate its relationship with other cardiovascular risk factors and carotid intimal-media thickness (IMT) in newly-diagnosed Korean type 2 diabetic patients. METHODS: We measured flow-mediated vasodilation (FMD) and endothelial-independent vasodilation (EID) of the brachial artery using high-resolution ultrasonography in total of 121 (M; N = 68, F; N = 53) diabetic patients. We assessed conventional cardiovascular risk factors such as age, smoking, obesity, hypertension, hyperlipidemia or family history of cardiovascular disease and analyzed the association among FMD/EID with cardiovascular risk factors, carotid IMT or the total number of risk factors. RESULTS: The mean values of age, smoking, BMI, waist, systolic blood pressure and diastolic blood pressure were 51.2 +/- 12.3 years, 11.0 +/- 15.8 pack years, 25.0 +/- 3.2 kg/m2, 86 +/- 9 cm, 123 +/- 16 mmHg and 79 +/- 12 mmHg. The mean values of HbA1c, fasting blood glucose, total cholesterol, triglyceride, LDL-cholesterol and HDL-cholesterol were 8.4 +/- 2.0%, 166 +/- 51 mg/dL, 187 +/- 37 mg/dL, 166 +/- 143 mg/dL, 114 +/- 30 mg/dL and 46 +/- 12 mg/dL. FMD and EID were estimated by 6.1 +/- 2.8% and 16.6 +/- 5.6% respectively. The mean/maximal carotid IMT were 0.63 +/- 0.12/0.76 +/- 0.16 mm and the number of risk factors besides diabetes mellitus were 2.3 +/- 1.3. After adjusting age, FMD was associated only with smoking, but EID was associated with smoking, systolic/diastolic blood pressure, mean/maximal carotid IMT and number of risk factors by partial correlations. Age, smoking and EID were independent risk variables for carotid IMT, analyzed by multiple regression test. CONCLUSION: These findings suggest that impaired vascular reactivity detected by EID is closely related to carotid IMT, an useful surrogate marker for atherosclerosis, in newly-diagnosed Korean type 2 diabetic patients.
- Therapeutic Efficacy of Combined Therapy with Once Daily Insulin Glargine and Once Daily Glimepiride in Korean Type 2 Diabetic Patients.
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Ji Young Park, Hyo Jeong Kim, Bo Kyung Koo, Hyun Jin Kim, Gang Seo Pak, Kyung Ah Han, Kyung Wan Min, Eung Jin Kim
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Korean Diabetes J. 2007;31(5):391-401. Published online September 1, 2007
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DOI: https://doi.org/10.4093/jkda.2007.31.5.391
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Once daily injection and 24 hour lasting glucose lowering effect of insulin glargine had recently changed a perception about the early insulin treatment of type 2 diabetic patients. This study was performed to investigate therapeutic efficacy of combined therapy with insulin glargine and glimepiride in Korean type 2 diabetic patients, who had received oral hypoglycemic agents (OHA) or conventional insulin therapy. METHODS: Total of 192 patients who needed to change the previous therapy because of uncontrolled diabetes or hypoglycemia were included and followed for about 6 months. Two groups of prior treatment modality were analyzed; OHA group (n = 54, 28.1%), conventional insulin therapy group in combination with or without OHA group (n = 138, 71.9%). The primary end point was changes in HbA1c according to baseline characteristics such as prior treatment modality, HbA1C, c-peptide, duration of diabetes mellitus, body mass index and prior used conventional insulin doses. Secondary end point was the dose conversion ratio of insulin glargine to prior used insulin in patients who had one or two insulin therapy. We also evaluated the level of the patients' satisfaction on the glucose lowering effects and the convenience for use of device. RESULTS: The differences of HbA1c according to prior treatment groups were -0.78 +/- 1.76 % in OHA group and 0.07 +/- 1.44 % in conventional insulin group with or without OHA group. The HbA1c improved better when baseline HbA1c was higher than 9%, c-peptide was higher than 0.6 ng/mL, duration of diabetes was shorter than 15 years, BMI was lower than 30 kg/m2 and prior conventional insulin dose was less than 30 IU. However, those effects were attenuated in subjects having duration of diabetes longer than 16 years, BMI higher than 30 kg/m2 and prior insulin dose more than 40 IU. Dose conversion ratio of the insulin glargine to prior insulin was 0.78 +/- 0.30 and showed a tendency to increase in patients who have prior insulin dose more than 40 IU. The scores of the patients' subjective satisfaction on insulin glargine were all high, irrespective of the changes of HbA1c. CONCLUSIONS: Once daily injection of insulin glargine and oral ingestion of glimepiride can be recommended as one of starting insulin regimen for patients who are not adequately controlled by OHA alone or as once daily regimen for whom treated with one or two conventional insulin therapy.
- Titration with an Initially Lower Dose Increased Compliance of Cilostazol (Pletaal(R)) in Diabetic Patients.
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Hyo Jeong Kim, Kyung Ah Han, Hyun Jin Kim, Kang Seo Park, Eung Jin Kim, Kyung Wan Min
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Korean Diabetes J. 2006;30(5):388-397. Published online September 1, 2006
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DOI: https://doi.org/10.4093/jkda.2006.30.5.388
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Headache is frequently reported by patients using cilostazol, which is a potent inhibitor of platelet aggregation with vasodilatory effects, for preventing atherosclerotic disease. The aims of this study were to think out a dosing schedule for improving compliance on headache and to investigate the possible mechanisms of headache associated with atherosclerosis measured as carotid intimal-media thickness (IMT) in Korean diabetic patients. METHODS: We therefore randomized patients into three groups according to the different dosing regimens for 6 weeks (1) group 1; 50 mg once daily, followed by 50 mg twice daily, and then 100 mg twice daily or (2) group 2; 50 mg twice daily, followed by 100 mg twice daily or (3) group 3; 100 mg twice daily without titration. We evaluated severity of the headache by visual analog scaled (VAS) symptom score from zero to ten and measured carotid IMT using high resolution ultrasound. RESULTS: A total of 122 diabetic patients were analyzed. The mean values of age, sex, duration of diabetes, BMI, HbA1c, lipid profiles, blood pressure, and smoking were not different among three groups. The proportion of headache was significantly lower in group 1 than group 2 and 3 (26% vs. 48% and 51%, P < 0.05). The proportion of severe headache was significantly lower in group 1 than group 2 and 3 (3% vs. 19% , 27%, P < 0.05). Among patients who had headache, the proportion of severe headache was significantly lower in group 1 than group 3. (10% vs. 52%, P < 0.05). The VAS symptom score of headache was significantly lower in group 1 than group 3 (4.9+/-2.1 vs. 7.0+/-2.4, P < 0.05). The proportion of the discontinuation of medication due to headache was significantly lower in group 1 than other two groups (8% vs. 24% and 29%, P < 0.05). The patients who had discontinued medication due to headache had lower carotid IMT than in whom were tolerable (Mean carotid IMT; 0.65+/-0.12 vs. 0.77+/-0.16 mm, P < 0.01, Maximal carotid IMT; 0.80+/-0.17 vs. 0.94+/-0.23 mm, P < 0.01). The proportion of patients who had discontinued medication due to headache was significantly lower in group 1 than other two groups (8% vs. 24%, 29%, P < 0.05] CONCLUSION: Titration with an initially lower dose of cilostazol could be considered to reduce the proportion and severity of headache and thereby increase compliance. Atherosclerosis estimated as carotid IMT may contribute to the tolerability of cilostazol.
- Eighteen-Year Trends in Korean Diabetic Patients(1981 through 1998).
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Hyejin Lee, Kyung Ah Han, Kyung Wan Min, Eung Jin Kim
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Korean Diabetes J. 2005;29(3):239-246. Published online May 1, 2005
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This study was conducted to determine trends in the age, gender, body mass index(BMI), and fasting blood glucose of the diagnosed Korean diabetic patients. METHODS: The medical records were obtained on 32,867 Korean diabetic patients who were treated at the Eulji Diabetes Center from 1981 to 1998. We investigated the age, gender, height, weight, BMI and fasting blood glucose. Regression analysis was used to analyze the time trends. RESULTS: BMI(from 23.2kg/m2 to 24.1kg/m2, P<0.001) and weight(from 59.6kg to 61.9kg, P<0.001) were gradually increased over the 18 years. and these factors were still significant after correction for age. The age of onset(from 45year to 51year, P<0.001) was also increased over the 18 years. The fasting blood glucose level was decreased from 10.2 mmol/L to 7.2mmol/L P<0.001). The portion of male patients was significantly decreased over the 18 years(from 52.1% to 47.4%). CONCLUSION: Over the 18years, the weight and BMI at the time of diagnosis were increased. And the onset age of diabetes was increased, according to an aging society. As it was easy to gain access the medical service, the fasting blood glucose level was decreased, and the prevalence of female patients was increased over 18 years in Korea
- Effects of the Glycemic Index of Dietary Carbohydrates on Insulin Requirement in Type 1 Diabetics on Continuous Subcutaneous Insulin Infusion.
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Hye Jin Lee, Kwon Beom Kim, Kyung Ah Han, Kyung Wan Min, Eung Jin Kim, Ki Nam Kim
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Korean Diabetes J. 2005;29(1):72-77. Published online January 1, 2005
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For ideal glycemic control, the pump user should have a meal planning approach that is as precise and flexible as the pump. Counting carbohydrate is simple and works, but is not a perfect system. Many researches indicate that not all carbohydrates create an equal response when it comes to their effect on blood glucose levels. For a better match between the glucose and insulin profiles, the glycemic index as along with counting carbohydrate might be considered. Therefore, we investigated whether the same amount of carbohydrates with different glycemic indices might require different insulin doses. METHODS: Five type 1 diabetics, using portable external pumps, whose basal rates were correctly set to maintain their blood glucose levels with in the target range under 12 hours fasting conditions, were enrolled. 50 grams of 4 carbohydrate containing foods, with different glycemic indices, were administered for 4 consecutive days to diabetic patients in an overnight fasting state. The test foods were rice, apple, milk and orange juice, for which the glycemic indices were 83, 54, 39 and 97, respectively. The insulin requirement for each food was determined so that the blood glucose level reached the target range four hours after eating. RESULTS: The glycemic indices for each food/rice ratio were significantly correlated with the insulin requirement (r = 0.586, P < 0.01). CONCLUSION: The meal-related insulin dose should be changed according to the glycemic index of the meal. Therefore both amount and source of carbohydrate determine the glucose and insulin responses of type 1 diabetic subjects
- Insulin Requirement for Korean Type 1 Diabetics using Continuous Insulin Infusion with Portable External Pumps.
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Hye Jin Lee, Kwon Beom Kim, Kyung Ah Han, Kyung Wan Min, Eung Jin Kim
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Korean Diabetes J. 2004;28(6):538-546. Published online December 1, 2004
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Insulin pumps can be extremely effective in achieving a normal or near-normal blood glucose level in type 1 diabetic patients. For designing a pump program in western countries, it has been recommended that approximately half of the daily insulin dose should given in the basal infusion, and the other half make up the meal-related bolus dose. However, peoples' diet composition is quite different among the many countries. The carbohydrate composition in the Korean diet is higher (60~65%) than that in the western diet (45~50%). Carbohydrate is much more glycemic than protein or fat. Therefore, we evaluated the basal and meal-related insulin requirements for Korean type 1 diabetics by using continuous insulin infusion with portable external pumps. METHODS: Twenty three type 1 diabetic patients were admitted for continuous subcutaneous insulin infusion (CSII), and they were given a calculated diet (60% carbohydrate, 20% protein, and 20% fat). The Basal rates were set for the blood glucose levels to remain in the target range during 12 hour fasting state. The meal related bolus dose was set to remain in the target range at the premeal state. RESULTS: The daily total insulin requirement was 99.7 +/-0.3% of prepump insulin dose, and 0.57 +/-0.21 unit per kilogram of body weight. The basal and mealrelated insulin dose among the daily total insulin requirements were 33.7 +/-8.6 and 66.3 +/-8.6%, respectively. The daily total, basal and meal-related insulin requirements were not significantly related with body weight, but the glucose disposal rate per 1unit of insulin was significantly related with body weight (r=-0.424, P <0.05). CONCLUSION: Although the daily total insulin requirement per kilogram of body weight in Korean type 1 diabetics was similar to that in western diabetics, the basal insulin requirements were less and the meal-related insulin requirements were more than that in western diabetics.
- Clinical Characteristics of Diabetic Patients Controlled by Diet and Exercise.
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Kil Sang Wang, Sung Bae Lee, Hyun Suk Lee, Jae Suk Jeon, Kyung Wan Min, Kyung Ah Han, Eung Jin Kim
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Korean Diabetes J. 1999;23(1):98-107. Published online January 1, 2001
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In order to rnaintain blood glucose in ao acceptable range, some patients with type 2 diabetes mellitus may be able to their level manage with diet and exercise alone, but others require oral agents or insulin. To assess which factors gave important influences on therapeutic methocls, we investigated clinical characteristics and life-style in the type 2 diabetic patients who could be managed with diet and exercise alone. METHODS: We recruited patients with type 2 diabetes mellitus from Eulji Medical College Diabetes Center, who had dieted and exercised for over 3 years (99; group 1) and compared them with patients who were managed with oral agents (130; group 2) or insulin (47; group 3). We conducted the retrospective evaluation of age, sex, duration of DM, initial and recent BM1 (body mass index), serial HbA 1c, skipped period ratio of hospital follow-up, self monitoring of blood glucose (SMBG) or urine sugar, diet and exercise and educational chance for diabetes with dependency of folk remedies. RESULTS: The duration of the DM was significantly shorter in group 1 than in group 2 or 3 (p<0,05). Initial BMI and HbA. were not different among these three groups, but HMI reduction was more decreased in group 1 (p<0.05). The mean HbA, during follow-up was lower in group 1 (p<0.05). The skipped period ratio of hospital follow-up was lower in group 1 (p<0.05). SMBG was less frequent, the meal-time was more regular, extra-snacks were less frequent and folk remedies were rarely tried in group 1. CONCLUSION: This study suggests that the duration of DM, BMI reduction and mean HbA 1c, were associated with the therapeutic method in patients with type 2 diabetes mellitus. We would like to a]so emphasize the importance of SMBG, meal-time regularity, extra-snacks and folk remedies in the education of patients with type 2 diabetes mellitus.
- Secretion of plasminogen activator by cultured bovine retinal endothelial cell:modulation by insulin-like growth factor-i.
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Dong Sun Kim, Eung Jin Kim, Woong Hwan Choi, Tae Wha Kim, Mok Hyun Kim
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Korean Diabetes J. 1993;17(4):359-366. Published online January 1, 2001
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- A clinical study on the microvascular complications of diabetes mellitus.
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Sung Mok Kim, Sang Ho Yoon, Dae Kwan Jeong, Ji Hee Han, Wun Young Yu, Chan Ju Lee, Hie Yeon Kim, Sean Jae Kang, Dong Sun Kim, Eung Jin Kim
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Korean Diabetes J. 1993;17(3):293-300. Published online January 1, 2001
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