- Can the Oral Glucose Tolerance Test (OGTT) done at Postpartum (PPT) 1 Wddk Substitute OGTT at PPT 6 Week OGTT at PPT 6 Week in Diagnosing Rersistent PPT Glucose Intolerance in the Patients with Gastrational Diagetes Melltus (GDM)?.
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Yoo Lee Kim, Yong Wook Cho, Seok Won Park, Yun Kyung Cho, Hwa Young Lee, In Hyun Kim, Jong Gun Won, Hye Sun Jun, Ho Taek Lee, Seog Ki Lee, Sang Jong Lee
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Korean Diabetes J. 2000;24(2):267-280. Published online January 1, 2001
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- BACKGROUND
Although 75 g-OGTT at PPT 6 week is necessary to diagnose persistent PPT glucose intolerance (PPGI) in GDM patients, it 1s difficult to perform this test because many patients drop-out during the follow-up period. Thus we tested whether OGTT done at PPT 1 week can substitute OGTT at PPT 6 week in diagnosing PPGI in GDM patients. METHOD: In 370 GDM patients, 75 g-OGTT was performed at PPT 1 week and repeat OGTT was done in 196 patients at PPT 6 week. Results of OGTT were classified as normal glucose tolerance(NGT), impaired glucose tolerance(IGT), and diabetes mellitus (DM) according to National Diabetes Data Group(NDDG) criteria. Changes in glucose tolerance state between PPT 1 and 6 week were assessed, and the predictability of clinical characteristics for these changes were investigated by logistic regression analysis. RESULTS: Among 370 GDM patients who performed OGTT at PPT 1 week, 79.4% had NGT, 12.2% had IGT, and 8.4% had DM. 53% (196/370) of subjects repeated OGTT at PPT 6 week. In OGTT at PPT 6 week, 77.6% (152/196, 140/149 in NGT, 4/26 in IGT and 8/21 in DM) were in the same glucose tolerance state as at PPT 1 week. The glucose tolerance improved in 14.8% (29/196, 16/26 in IGT and 13/21 in DM) and deteriorated in 7,6% (15/196, 9/149 in NGT and 6/26 in IGT). 94%(140/149) of patients who had NGT at PPT 1 week had NGT at PPT b week and 48.9/o (23/47) of patients who had abnormal glucose tolerance at PPT 1 week had abnormal glucose tolerance at PPT 6 week. Mean fasting plasma glucose level on OGTT became lower at PPT 1 week than during pregnancy (4.6+/-0,8 vs 5.1+/-1.2mmol/L, p<0.05) and became higher at PPT 6 week than at PPT 1 week (5.4+/-1.1 vs 4.6+/-0.8 mmol/L, p<0.05). Mean plasma glucose level at 2 hour after glucose load was significantly lower at PPT 6 week than at PPT 1 week (7.2+/-2.7 vs 8.3+/-2.5 mmol/L). When the subjects were grouped into NGT, IGT, and DM according to glucose tolerance state at PPT 6 week, the NGT group already showed normal glucose tolerance at PPT 1 week. The IGT and DM group showed slightly lower glucose levels at PPT 1 week than during pregnancy but became high to the level during pregnancy at PPT 6 week. In the patients group showing deterioration in glucose tolerance state between PPT 1 and 6 week, prevalence of insulin treatment was higher (63.4% vs 9.4, 20.7%), the gestational age at diagnosis of GDM were lower (25.0+/-6.2 week vs 29.8+/-3.3, 29.9+/-4,8 waek), and prepregnant weight was higher (113.4+/-21.2% vs 102.5+/-12.4, 102.4+/-14.6%) than those in the patients groups showing no change and improvement in glucose tolerance state, Weight gain until diagnosis of GDM during pregnancy(5.7+/-4.4kg vs 9.4+/-3.4kg) and weight change between prepregnancy and PPT 5 week(-1,3+/-3.5kg vs 1.5+/-29kg) was smaller in the deterioration group than those in the no change group. Logistic regression analysis performed using improvement and deterioration of glucose tolerance state between PPT 1 and 6 week as an outcome of interest revealed that an earlier diagnosis of GDM and a smaller weight at PPT 6 week than prepregnant weight were independent predictors for deterioration of glucose tolerance between PPT 1 and 6 week. In conclusion, OGTT done at PPT 1 week can substitute OGTT at PPT 6 week in a large subgroup of GDM patients who has NGT at PPT 1 week without any risk factors for deterioration in glucose tolerance.
- Relationship Among Urinary Glycosaminoglycan (GAG) Excretion Rates, Urinary Albumin Excretion and Macrovascular Disease in Patients with Type 2 Diabetes Mellitus.
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Yoon Sang Choi, Sang Hoon Kim, Hyang Kim, Yun Kyung Cho, Hyun Ju Um, Si Yong Kim, Byong Ik Kim, Yoo Lee Kim, Hwa Young Lee, Sang Jong Lee
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Korean Diabetes J. 2000;24(2):245-255. Published online January 1, 2001
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Increased loss of proteoglycan (PG) from glomerular basement membrane (GBM) has been postulated to alter glomerular charge selectivity which contributes to urinary loss of albumin. The glycosaminoglycan (GAG) is the degradation products of PG. Recently, one of the hypothesis suggested that urinary albumin execretion(UAE) reflects not only merely a glomerular manifes-tation but also a macrovascular disease (by Deckert et al), Wasty et al. reported a significant decrease in total GAG concentration and marked changes in their distribution in atherosclarotic plaques in human. Thus, the alterations in the metabolism of GAG might play a role in the pathogenesis of diabetic macroangiopathy. Therefore, we investigated the relationship among urinary GAG execretion rates, UAE and macrovascular disease in patients with type 2 diabetes mellitus. METHODS: We measured urinary excretion rates of GAS in type 2 diabetic patients with and without macrovascular disease ( cerebrovascular disease, ischemic heart disease and other peripheral vascular disease ) and investigated the relationships among urinary execretion of GAG, UAE and macrovascular disease in 103 patients with type 2 diabetes mellitus. RESULTS: 1) Among total 103 patients, 66 patients (64.0%) showed normoal-buminuria, 18 patients (17.5%) showed microabluminuria and 19 paitents (18.4%) showed macro albuminuria respectively. The duration of diabetes mellitus and the prevalence of hypertension, diabetic retinopathy and macrovascular disease were increased according to the degree of UAE. 2) The urinary excretion rates of GAG in type 2 diabetes mellitus with normo-, microand macro-albuminuria were 6.72+/-4.05, 9.17+/-3.26 and 14.20+/-6.13 microgram glucuronic acid/min respectively (p<0.05). The urinary GAG levels were significantly correlated with UAE (r=0.43, p<0.05). 3) The urinary excretion rates of GAG in type 2 diabetes mellitus with (n=26) and without (n=77) macrovascular disease were 6.21+/-2.75 and 9,31+/-5.59 ug glucuronic acid/min, respectively (p<0.05). CONCLUSION: 1) The urinary excretion rates of GAG were decreased in patients with macro vascular complications of type 2 diabetes mellitus. 2) The urinary excretion rates of GAG may be a possible marker of macrovascular disease in type 2 diabetes mellitus. Yet, further large prospective studies are necessary to confirm our findings.
- Antepartum Characteristics Predicting Persistent Postpartum Glucose lntolerance in the Patients with Gestational Diabetes Mellitus (GDM).
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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
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Korean Diabetes J. 2000;24(1):46-59. Published online January 1, 2001
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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.
- The Comparison between Doppler Ultrasonography and Digital Infrared Thermographic Imaging (DITI) in Detecting the Diabetic Peripheral Angiopathy.
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Yoon Sang Choi, Hyun Ju Um, Seung Oh Song, Si Yong Kim, Byong Ik Kim, Young Uk Lee, Seok Won Park, Yoo Lee Kim, Hwa Young Lee, Yong Wook Cho, Sang Jong Lee
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Korean Diabetes J. 1999;23(5):686-694. Published online January 1, 2001
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The frequency of nontraumatic lower extremities amputation has significantly increased in patients with type 2 diabetes (DM). Digital Infrared Thermographic (DITI) has been used to demonstrate the skin temperature and its change. mellitus Imaging regional Doppler ultrasonography was developed to show excellent images of superficial arteries. In this study, we observed the relationship between DITI and doppler ultrasonography for detection or evaluation of diabetic peripheral angiopathy. METHODS: 71 patients with type 2 DM were divided to groups with and without peripheral arterial obliteration (PAO) by ankle pressure index (API). For all patients, doppler ultrasonography of lower extremities was performed in measuring inner diameter, wall thickness and calcification of femoral, popliteal and dorsalis pedis artery. DITI was done also. We analized the result of doppler ultrasono-graphy and DITI findings. RESULT: 1) In clinical characteristics of patients between nonperipheral arterial obliteration (NPAO) and PAO : there was no significant differences between two groups with respect to age, sex, smoking, BMI (body mass index), FPG (fasting plasma glucose)/2HPG (2 hour plasma glucose), HbA(1C), serum lipid profile and/or the frequency of NPDR (nonproliferative diabetic retinopathy). However, the number of patients with hypertension and 24hr urine total protein amount were significantly increased in PAO group. 2) The results of doppler ultrasonographic imaging of lower extremities: In PAO group, inner diameters of common femoral artery and dorsalis pedis artery were significantly narrower than in those of NPAO group. However, no difference was detected in respect to vessel wall thickness. The numbers of calcified vessel wall have significantly increased in all vessels in PAO group 3) The results of DITI patterns of big toes after cold stimulus: (1) In 49 patients with NPAO: 11 showed as normal, 14 an increased, 15 a decreased, and 9 flat patterns, respectively. (2) All of 22 patients with PAO showed abnormal patterns. Among them, 2 showed a decreased, but 20 a flat pattern. 4) The comparison between the results of doppler ultrasonography and DITI: In all groups, inner diameter of common femoral artery, which was measured by doppler ultrasonography, were narrow in the flat pattern. Also, the number of calcified vessel walls in common femoral artery and dorsalis pedis artery increased more in the same patterns. No significant difference of vessel wall thickness was found between both groups. CONCLUSION : Vasoreaction of lower extremities after cold stimulus was mainly related to PAO of the common femoral artery and dorsalis pedis artery. DITI is a useful method used in detecting the early state of artherosclerosis. As a result, it can be employed in early prevention and treatment of diabetic angiopathy. If DITI is combined with doppler ultrasonography, we can practice more precise diagnosis and follow-up in diabetic peripheral angiopathy.
- Clinical Study on Cerebral Infarction Complicated with CIDDM pateints.
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Sang Jong Lee, Yoon Sang Choi, Seong Chun Shim, Hi Moo Lee, Kwon Choi, Hwa Young Lee
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Korean Diabetes J. 1999;23(4):585-591. Published online January 1, 2001
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Diabetes mellitus increases the risk of cardiovascular disease by two-fold and ischemic cerebrovascular disease by two to four-fold compared with the risk for non-diabetic patients. In patients with NIDDM, the risk of athero- thromboembolic cerebral infarction is known to be increased. We evaluated the significance of clinical variables with respect to the risk of cerebral infarction in NIDDM patients. METHODS: We assessed clinical variables retrospectively in 170 patients (90 men, 80 women) from April 1, 1991 through March 31, 1996, divided into 3 groups;100 NIDDM patients with cerebral infarction (58 men, 42 women), 40 NIDDM patients (17 men, 23 women) and 30 non-diabetic patients with cerebral infarction(15 men, 15 women). We evaluated 130 patients with cerebral infarction employing brain CT or MRI. RESULTS: 1) The mean values of age, serum total cholesterol, LDL, TG, HbA1C, systolic and diastolic BP were significantly higher in patients with NIDDM complicated by cerebral infarction than in those without cerebral infarction. 2) There were no statistically significant differences in body mass index (BMI), duration of DM and HDL between the two groups, respectively. 3) Diabetic retinopathy (especially, proliferative retinopathy) andmacroproteinuria(550 mg/day) were found significantly higher in diabetic patients with cerebral infarction than in those without cerebral infarction. 4) Multiple lacunar infarctions were more frequently observed in patients with NIDDM than non-diabetic patients with cerebral infarction. However, there were no statistically significant differences between the two groups. Conclusion: We suggest that increased age and HbAlC, hypertension, dyslipidemia, macroproteinuria and proliferative diabetic retinopathy could be associated with the risk of cerebral infarction in patients with NIDDM. The results showed that multiple lacunar infarctions were more frequent in patients with NIDDM than in non-diabetic patients. However, there were no statistical significances between the two groups.
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