Diabetes & Metabolism Journal

Volume 21(4); December 1997

Original Articles

Serum Proinsulin Responses during Oral Glucose Tolerance Test in patients with Non-insulin Dependent Diabetes Mellitus.: Moon Suk Nam, Seong Bin Hong, Yeo Joo Kim, Mi Rim Kim, Yong Seong Kim, In Young Hyun, In Ho Kwak; Korean Diabetes J. 1997;21(4):356-364. Published online January 1, 2001

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Abstract PDF: BACKGROUND
When insulin is secreted from the pancreas, a small amount of proinsulin is also secreted at the same time. Pancreatic beta cell may release immature granules richer in proinsulin contents as well as mature granules in the over-stirnulated state. The significance of hyperproinsulinemia was recently reevaluated in the pathogenesis of non-insulin dependent diabetes mellitus(NIDDM). We studied proinsulin response at fasting and oral glucose tolerance test(OGTT) in NIDDM with a simple and sensitive human proinsulin radioimmunoassay system. METHODS: 22 new onset non-obese NIDDM patients and 11 matched healthy controls were selected for the study. The NIDDM group was divided into 3 groups(group 1; 7.8, group 2; 7.8~11, group 3; 11.0 mmol/L) according to the fasting plasma glucose level. After an overnight fast, a 75 g OGTT was performed and samples were analyzed with proinsulin and specific human insulin radioimmunoassay kits. RESULTS: The basal serum proinsulin level was reported as 9.29+/-4.19 pmol/L in normal control and as 18.09+/-9.32 pmol/L(p=0.04, compared with control) in diabetic group. The values in NIDDM group 1 and 2(18.07+/-9.D2; p=0.04, 21.60+/-6.98; p=0.03) were higher than in control. The molar ratia of the basal proinsulin to total insulin were also increased in NIDDM group 1 and 2(0.24, 0.28) than in control subjmts(0.13, p=0.03). The basal proinsulin and proineulin/total insulin ratio were highest in the group 2(p 0,05, than group 3). During oral glucose loading, the proinsulin response increased more slowly than total insulin response. The proinsulin and proinsulin/ total insulin ratio during oral glucose loading were higher in NIDDM group 1 and group 2 than cantrols. CONCLUSION: The basal proinsulin level in diabetic group was higher than in normal control. The proinsulin responses during oral glucose loading were higher in diabetic group 1 and 2 than controls. The proinlulin response increased more slowly than total insulin response during oral glucose loading. So we conclude that the proinsulin secretion frorn pancreatic beta cell is impaired in diabetic group. The mechanism about the metabolic pathway of the proinsulin secretion should be studied more.

Serum Fasting Proinsulin Level as a Predictor for Development of NIDDM in Korean Subjects.: Geon Sang Park, Chan Soo Shin, Kyong Soo park, Seong Yeon Kim, Hong Kyu Lee, Sun Ja Kwon, Yong Soo Park; Korean Diabetes J. 1997;21(4):365-371. Published online January 1, 2001

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Proinsulin is raised in people with NIDDM. Hyperproinsulinemia is thought to be a predictor for the subsequent development of NIDDM. We studied to investigate whether hyperproinsulinemia can predict the development of NIDDM in Korean subjects. METHOD: This study was performed as a nested case-control study. The case group was 67 newly developed diabetic patients out of 1193 initially non-diabetic cohott in Yonchon county. We have also selected 66 age-sex-B541-WHR matched control group who remain non-diabetic for 2 years. We compared baseline insulin, proinsulin and proinsulin/insulin ratio between two groups, RESULTS: There was no significant difference in baseline fasting insulin levels[46,77+/-17.3 vs 42.87+/- 11.6(pmol/L)] between converters to diabetes and non-converters. However, the baseline proinsulin levels in converters to diabetes were higher than those in non-converters.[16.07+/-14.3 vs 8.72+/-5.2(pmol/L)) The baseline proinsulin/imulin ratio in converters was also higher than those in non-converters. [0.30+/-0.17 vs 0.20+/-0.10] CONCLUSION: The results suggest that fasting hyper-proinsulinemia may be a predictor for subsequent development of NIDDM in Korean subjects.

Effect of Aminoguanidine on Lipid Peroxidation in Streptozotocin-induced Diabetic Rats.: Kwon Yeop Lee, Sung Hee Ihm, Hyung Joon Yoo, Sung Woo Park, Ja Hei Ihm; Korean Diabetes J. 1997;21(4):372-380. Published online January 1, 2001

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Diabetes mellitus is postulated to be associated with increased lipid peroxidation which may contribute to vascular complications. One potential mechanism of the increased lipid peroxidation in diabetes is lipid-linked advanced glycosylation and oxidation. Aminoguanidine(AMGN), the prototype inhibitor of advanced glycosylation end-product formation, has been recently shown to prevent oxidative moditication of LDL in vitro at moderate concentration. It is unknown whether AMGN might act as an anti-oxidant against lipid peroxidation under hyperglycemia in vivo. METHODS: To investigate the in vivo effect of AMGN on lipid peroxidation in diabetes, we administered AMGN(1 g/L in drinking water) or vitamin E (400mg/day, 5 days/week) to streptozotocin(STZ)-induced diabetic rats for 9 weeks and measured plasma lipid hydroperoxides by ferrous oxidation with xylenol orange II method and RBC membrane malon-dialdehyde(MDA) by thiobarbituric acid method. RESULTS: Plasma lipid hydroperoxide level was higher in STZ-induced diabetic rats than in control rats(7.53+/-2.03 vs.5.62+/-0.44*pmol/L). RBC membrane MDA was also higher in STZ-induced diabetic rats than in control rats(2.67+/-0.46 vs. 1.81+/-0.19* nmol/mL). Plasma lipid hydroperoxide level was lower in AMGN-treated(6.23+/-0.59*umol/L) and vitamin E-treated(5.29+/-0.27*umol/L) diabetic rats than in untreated diabetic rats. RBC membrane MDA was also lower in AMGN-treated(1.93+/-0.12""'nmol/ mL) diabetic rats than in untreated diabetic rats. There was no significant difference in plasma glucose, triglyceride levels among diabetic groups(Mean +/-S.D; *, P<0.05 vs. untreated STZ-induced diabetic rats; n=8-14/group). CONCLUSION: Although the mechanisms of action of AMGN on lipid peroxidation in vivo should be studied further, these results suggest that AMGN might have an additional beneficial effect as an antioxidant against lipid peroxidation in prevention trial for diabetic vascular complications.

Effects of Free Fatty Acid on Insulin Secretion in Cultured Rat Pancreatic Islets.: Hong Kyu Kim, Young Il Kim, Chul Hee Kim, Joong Yoel Park, Sung Kwan Hong, Jae Dam Lee, Ki Up Lee; Korean Diabetes J. 1997;21(4):381-387. Published online January 1, 2001

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It has been recently suggested that enhanced fat oxidation is responsible for the abnormal insulin secretory pattern in non-insulin-dependent diabetes mellitus. This study was undertaken to assess the effect of chronic exposure of pancreatic islets to free fatty acid on insulin secretion. METHODS: Rat pancreatic islets were cultured in various concentrations of glucose(5.5, 11, 27 mM) for 48 hrs with or without addition of free fatty acid(90 upM linoleic acid), and the basal and glucose-stimulated insulin secretion were measured. The effect of fatty acid oxidation inhibitor(2-bromopalmitate) was also tested. RESULTS: Islets cultured in high glucose concentrations showed a marked increase in basal insulin secretion. Free fatty acid stimulated the basal insulin secretion in islets cultured at 5.5 or 11 mM glucose, but no additional effect was seen in islets eultured at 27 mM glucose. In contrast, glucose-stimulated insulin secretion was decreased in islets cultured in high glucose media. Exposure to free fatty acid exerted an additive inhibitory effect on glucose-induced insulin secretion in islets cultured at 5.5 or 1 1 mM glucose, but not in islets cultured at 27M glucose, An inhibitor of fatty acid oxidation, 2-bromopalmitate, prevented the fatty acid-induced changes in both basal and glucosestimulated insulin secretion. CONCLUSION: These results showed that longterm exposure of pancreatic islets to free fatty acid altered the dynamics of insulin secretion, probably through a glucosefatty acid cycle.

Fibroblast PC-1 mRNA Content, Body mass index and Insulin Sensitivity in Korean NIDDM Patients.: Deok Bae Park, Seong Kyu Lee, Young Goo Shin, Seong Keun Lee, Yoon Sok Chung, Kwan Woo Lee, Hyeon Man Kim; Korean Diabetes J. 1997;21(4):388-396. Published online January 1, 2001

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Abstract PDF: No abstract available.

Angiotensin 1 Converting Enzyme ( ACE ) Gene Polymorphism According to Micro- and Mocro - angiopathy in non-insulin Dependent Diabetes Mellitus.: Moon Suk Nam, Hyun Chul Lee, Ji Hyun Lee, Bong Soo Cha, Su Youn Nam, Young Duk Song, Sung Kil Lim, Kyung Rae Kim, Kap Bum Huh; Korean Diabetes J. 1997;21(4):397-405. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Chronic micro- and macro-angiopathy in diabetes are clinically significant complications that affect both quality and length of life in diabetic patients. Angiotensin 1 converting enzyme (ACE) is of key importance in regulating systemic and renal circulation by converting angiotensin-1 into -2 and inactivating bradykinin, Recent reports suggest that the ACE gene polymorphism is associated with susceptibility to micro- and macro-angiopathy in diabetes. But the results are diffetent according to the type of diabetes and complication. METHODS: We investigated the alleles of the ACE gene and measured the ACE activity in the 169 cases of non-insulin dependent diabetic patients and in the 95 cases of controls matched with age and BMI. RESULTS: The measured ACE activity was well correlated with the count of D allele. We found no differences of ACE alleles between in diabetes and control. No association was found between ACE gene polymorphism and diabetic microangiopathy(retinopathy or nephropathy). But DD genotypes (homozy-gotes for the deletion polymorphism) and D allele were found more frequently in diabetic patients with coronary artery obstructive diseases than in patients without coronary artery obstructive diseases in coronary angiography. CONCLUSION: These data indicate that ACE gene polymorphism in non-insulin dependent diabetes is associated with coronary artery obstructive diseases, but not with chronic microangiopathy.

Hyperfibrinogenemia as an Important Risk Factor for Microvascular Complications in NIDDM Patients.: Suk Kyeong Kim, Hyeong Kyu Park, Sun Wook Kim, Do Joon Park, Chan Soo Shin, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee; Korean Diabetes J. 1997;21(4):406-413. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Abundant evidences have accumulated to suggest that atherosclerosis is accelerated in both type I and type Il diabetes but, traditional risk factors(hyperlipidemia, hypertension, smoking, age, obesity) do not account fully for the increased prevalence and severity of vascular diseases in diabetes. In this study, we examined the relationship of plasma fibrinogen to microvascular complications in NIDDM patients METHODS: In this cross-sectional study, 104 NIDDM patients were chosen from subjects who were attending the metabolic ward of Seoul National University Hospital. None of them were smokers, nor had any clinical evidences of acute infections, cancers or liver diseases. Arnong 104 patients, 55 patients (male 26, fernale 29) had no evidence of microvascular complications and 49(male 30, female 19) had one or moe microvascular complications. Their mean age(55.7+11.6 and 57.2+8.9 years old) and BMI (23.34+2.98 kg/m and 23.74+3.41 kg/m) were similar between two groups. This study defined microvascular complications as follows: 1) retinopathy classified based on fundoscopic and fluorescein angiographic assessmeot to background and proliferative, 2) nephropathy defined by 24 hour urine protein over 500mg, and 3) pheripheral neuropathy assessed by symptoms or NCV. RESULTS: 1) Clinically, there was no differences between two groups with respect to diastolic BP, C-peptide, HbA1c, and triglyceride level. However statistically significant differences were noted in systolic blood pressure, and total and LDL-cholesterol. Also mean fibrinogen level was more elevated significantly in diabetic patients with microvascular complications than those without microvascular complications. 2) Univariate analysis shows significant correlations between fibrinogen and the other variables such as duration of diabetes, total cholesterol level and systolic blood pressure. 3) However, fibrinogen concentration was higher in NIDDM patients with microvascuiar complications regardless of duration of diabetes, hypertension and HbA1c in multivariate logisric regression analysis (P=0.010). Conclusions: These results indicated that hyperfibrinogenemia were observed in NIDDM patient with microvascular complications regardless of duration of diabetes, systolic BP, and total cholesterol. Therefore our study suggests that hyperfibrogenemia may be one of the important missing links in the pathogenesis of diabetic microvascular diseases.

Changes of Glomerular Filtration Rate and Urinary Albumin Excretion Rate in NIDDM patients with Microalbuminuria.: Hyo Jung Kim, Jung Min Koh, Eun Sug Shin, Yun Ey Chung, Young Il Kim, Chul Hee Kim, Joong Yeol Park, Sung Kwan Hong, Ki Up Lee; Korean Diabetes J. 1997;21(4):414-424. Published online January 1, 2001

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Abstract PDF: BACKGROUND
We previously suggested that micro-albuminuria in the presence of retinopathy may represent a state of real incipient diabetic nephropathy with declining glomerular filtration rate(GFR), while the meaning of microalbuminuria in the absence of retinopathy may be more heterogeneous. This study was performed to further test this hypothesis. METHODS: We prospectively followed up the changes in GFR and urinary albumin excretinn rate (UAE) in microalbuminuric NIDDM patients with or without diabetic retinopathy for 3.1 years. RESULTS: 1) Among 45 patients who completed the followup, 27 had retinopathy from the baseline(group A), while 18 patients did not have retinopathy throughout the study(group B). 2) UAE at baseline was not statistically different between the group A and group B. During follow-up, VAE remained stable in the group B patients(40.0 [20.5 ~ 158.0) to 60.0[20.2 ~ 231.0] ug/min, NS). On the other hand, UAE significantly increased in the group A patients(47.9[20.0~186.0] to 140.0[24.5~2862.0] ug/min, P <0.001). 3) Thirty percent of the group A patients(8/27) progressed to overt proteinuria, while 11%(2/18) of the group B patients developed overt proteinuria(NS). 4) GFR significantly decreased both in the group A (113.0+21.2 to 89.1+24.0 mL/min/1.73 m, P < 0,001) and in the group B patients(134.1+27.2 to 121.5+27.3 mL/min/1.73 m, P<0.01). However, the magnitude of change in GFR was significantly higher in the group A than in the group B patients(7.7+7.6 vs 3.9+4.2 mL/min/1.73 m /year, P <0.05), 5) Multiple logistic regression analysis revealed that the presence of retinopathy was a independent risk factor for faster decline in GFR. CONCLUSION: It appears that clinical course is different in NIDDM patients with microalbuminuria, according to the presence or absence of diabetic retinopathy. Microalbuminuria in the presence of retinopathy predicts aggravation of albuminuria and decline in GFR. In contrast, the renal function in microalbuminuric NIDDM patients in the absence of retinopathy may remain stable for years.

Measurement of Insulin Sensitivity Index Estimated from LDIGIT ( Continuous Low Dose Insulin and Glucose Infusion Test.: Young Duk Song, Bong Soo Cha, Suk Won Park, Young Joon Won, Soo Yeon Nam, Sung Kil Lim, Kyung Rae Kim, H C Lee, K B Huh; Korean Diabetes J. 1997;21(4):425-431. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Measurement of insulin sensitivity index by continuous low dose insulin and glucose infusion test(LDIGIT) has been reported to be simple and reliable. METHODS: The method is a refinement of the modified Harano test and consisted of continuous low dose insulin(25mU/kghr) and glucose(4mg/kghr) infusion lasting 150 min. Insulin sensitivity was evaluated as the amount of glucose infusion divided by the steady state serum insulin and glucose levels achieved at the end of the test. Insulin secretion was expressed as the incremental area for C-peptide concentration during the first 15 min of the test. The indices of insulin sensitivity and insulin secretion yielded by LDIGIT were compared with those derived from the euglycemic clamp and oral glucose tolerance test (OGTT), respectively. Thirteen subjects underwent LDIGIT and euglycemic clamp. RESULTS: LDIGIT resulted in stable final glucose levels but 3 subjects showed hypoglycemia during the test. The index of insulin secretion provided by LBIGIT did not correlate well with that of OGTT. There was a significant correlation between the ISI (insulin sensitivity index) determined by LDIGIT and the ISI determined by clamp(r=0.60, p<0.05). CONCLUSION: LDIGIT is a simple and accurate methcd to assess insulin sensitivity. It can be used in population studies and in situations when more complex technique is not feasible. However, it is desirable to reduce the insulin infusion rate to avoid the occurrence of hypoglycemia in Koreans.

Fasting Serum Insulin Levels in Relation to Age and Body Mass Index and Serum Glucose Level in Healthy Subjects in Korea.: Sang Ah Chang, Ho Young Son, Bong Yun Cha, Sung Dae Moon, Ki Ho Song, Soon Jib Yoo, Kun Ho Yoon, Moo Il Kang, Kwang Woo Lee, Sung Ku Kang; Korean Diabetes J. 1997;21(4):433-443. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Ethnic variability in the relationship between glucose tolerance and insulin secretion has been reported. Clinical characteristics of Korean diabetic patients are different from that of diabetic patients in Western countries. It is generally assumed that typical IDDM or obese diabetic patients are relatively rare among Korean subjects. This study attempted to define the characteristics of fasting serum insulin levels of healthy Korean adult subjects. Futhermore, we tried to evaluate the relationship between fasting serum insulin level and age, body mass index, serum glucose. METHODS: We examined 1917 Korean subjects who had fasting blood glucose within normal range (3.6~6.4mmol/L). The fasting insulin levels, total choiesterol, triglyceride concentrations and anthropometric characteristics(body weight, height and body mass index(BMI)) of these subjects were measured. RESULTS: 1) Mean fasting insulin levels were 33.9+0.5pmol/ L, the fasting insulin levels in men and women were 34.9+0.6 and 31.8+0.6pmol/L, respectively. 2) The fasting insulin levels of obese(BMI>25) subjects were significantly higher than those of non-obese subjects(43.2+ 1.2 pmol/L vs. 30.6+0.6 pmol/L, p<0.001). 3) There were significant differences in the basal insulin levels among the age groups, and fasting blood glucose levels were increased with aging. 4) In a multiple stepwise regression analysis, insulin levels were positively correlated with serum triglycerides, fasting blood glucose, body mass index and negatively correlated with age. Conclusion : The fasting insulin levels of healthy subjects in Korea were relatively lower than the previously measured value of Caucasians. The insulin levels were decreased with aging and increased with the elevation of BMI, fasting blood glucose and triglyceride.

Visceral Fat Accumulation and the Fatty Acid Composition of Serum Phospholipids in Middle-Aged Women with Different Degrees of Glucose Tolerance.: Jee Young Yoon, Jong Ho Lee, Yang Cha Lee, Hyun Chul Lee, Kap Bum Huh; Korean Diabetes J. 1997;21(4):444-456. Published online January 1, 2001

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The aim of this study was to determine visceral fat accumulation and the fatty acid composition of serum phospholipids(PL) in middleaged female volunteers with different degrees of glucose tolerance and to analyze the factors that could be responsible for the observed differences between different degrees of glucose tolerance. METHODS: Anthropometric measurements and computed tomography measurements at umbilicus and thigh midway between the patella and pubis were performed in 125 subjects with normal glucose tolerance(NGT), 62 subjects with impaired glucose tolerance(IGT) and 50 subjects with non-insulin-dependent diabetes mellitus(NIDDM), Normal weight subjects were divided into 3 groups; NGT, IGT and long term NIDDM and overweight subjects into 4 groups; NGT, IGT, newly-onset NIDDM and long-term NIDDM. An oral glucose tolerance test(OGTT), the fatty acid composition of serum PL, fasting serum levels of IGF-1 were determined. RESULTS: Visceral fat area and visceral to subcutaneous fat ratio were higher in overweight control than normal weight control and higher in long-term NIDDM groups than controls. Thigh fat and muscle areas and serum levels of growth hormone and IGF-1 were lower in long-term NIDDM groups than controls. Insulin response area during OGTT was the highest in IGT groups and the lowest in NIDDM groups. The progression from the NGT group to the NGT and NlDDM groups was associated with an increase in glucose and free fatty acid areas during OGTT. Overweight long-term NIDDM group showed the lowest serum level of IGF-1 and the highest areas of glucose and FFA. The low ratio(about 0.64.~0.71) of polyunsaturated to saturated fatty acids in serum PL was found in diabetic groups. Long-term NIDDM groups showed an increase in proportions of palrnitic (C16:0), stearic(C18:0), dihomo-r-linolenic(C20:3w6) and docosapentaenoic(C22:3w6) and and a decrease in linoleic(C18:2w6), a-linolenic(C18;3w3), C20:4/20:3 (5-desaturase activity) and C18:1/18:0(9-desa-turase activity) in their serum PL compared with NGT groups. CONCLUSION: This study suggests that an increase in visceral fat and a decrease in thigh fat and muscle may be related to reduced secretion of growth hormone and insulin in long-term NIDDM subjects, These endocrine perturbations can be exacerbated by the prolonged exposure of hyperglycemia and high serum level of free fatty acid. In addition, lang term NIDDM may decrease 5-desaturase activity and 9-desaturase activity. Thus, the factors regulating fatty acid composition of serum PL in long-term NIDDM are affected by not only dietary fat but stored fat and serum concentrations of glucose and hormones, including insulin.

Effects of Smoking on Plasma Lipid Metabolism in Patients with non-insulin Dependent Diabetes Mellitus.: Seon Min Jeon, Yeun Kyung Lee, Hye Sung Lee, Bo Wan Kim, Young Bok Park, Myung Sook Choi; Korean Diabetes J. 1997;21(4):457-468. Published online January 1, 2001

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Diabetes mellitus has been identified as a risk factor in the development of coronary vascular disease. Smoking also has been known as an independent risk factor in the development of coronary artery disease, causing a dislipidemia. This study was carried out to examine the effects of smoking on plasma lipids and lipoproteins metabolism in patients with NIDDM and in normal healthy subjects among Korean population in Taegu. METHODS: The 80 patients with NIDDM and 60 normal subjects were suMivided into non-stnoker, ex-smoker, and smoker group. Antbropornetric assessments, mean intake of nutrients, and the levels of plasma lipids, Apo A-I, L,p(a), CETP activity, and antioxidant vitamins such as vitamin A, E were measured, RESULTS: WHR in non-smoker of patients with NIDDM was greater than that in non-smoker of normal control. There were no differences in the nutrient intakes among groups, but protein intake was even higher in smoker of NIDDM group than that of normal group. There were no smoking effect on total cholesterol, LDL-C, AI, Apo A-I, Lp(a) and lipid peroxide in plasma of two groups, but they were higher in NIDDM group than normal group. Plasma TG concentrations were higher in smoker group than other groups within normal group, HDL-C levels were lower in non-smoker group than other groups within NIDDM group. CETP activities were higher in smoker group than non-smoker within normal group. And CEPT activities in NIDDM group were mostly higher than those of normal group. Vit. A levels of non-smoker in normal group were higher than ex-smoker within same group, and were also higher than non-smoker in NIDDM group. Vit. E levels showed no difference within each group, but they were mostly lower in NIDDM group than normal group. CONCLUSION: It was concluded that smoking was not a major factor for changing lipid metabolism in NIDDM patients as well as normal subjects unlike others findings. Their abnormal lipid rnetabolism may be induced from other risk factors for NIDDM rather than smoking itself. However, present study was done only for a short period, thus more studies are needed for longer term to investigate the effects af smoking on lipid metabolism in NIDDM among Korean population.

Relationship between Carotid Artery Plaque Measured by Ultrasound and Cerebral infarction in Patients with Non-insulin Dependent Diabetes.: Kil Hong Rhee, Sang In Choi, Seung Ok Lee, Cheol Su Lim, Tae Sun Park, Hong Sun Baek; Korean Diabetes J. 1997;21(4):469-475. Published online January 1, 2001

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Abstract PDF: BACKGROUND
The frequency of cerebral infarction is significantly increased in diabetic patients. Early detection of artherosclerotic lesions will be a useful to predict and delay the occurence of cerebral infarction in diabetic patients. The purpose of this study was to investigate the relationship between extracranial carotid artery plaque and cerebral infarction in NIDDM patients, who have cerebral infarction or not, using non-invasive B-mode ultrasonography. METHODS: Ultrasound high resolution B-mode imaging of carotid arteries was conducted on cerebral infaretion patients with NIDDM and non cerebral infaretion patients with NIDDM to determine the presence of the carotid artery plaque. RESULTS: The incidence rate of cerebral infarction was increased in relation to extracranial carotid artery plaquie existence. The exeistence of carotid artery plaque was higher in NIDDM patients with cerebral infarction than without cerebral infarction(p<01050). Multiple logistic regression analysis showed that development of cerebral infarction in NIDDM patients, who had carotid plaque, was 2.8 fold higher than NIDDM patients who had not carotid plaque(p<0.05), Conclusions: Existence of carotid plaque was closely related to cerebral infarction. Therefore, early detection of extraeranial carotid plaque by B-mode ultrasonography is very useful in predicting cerebral mfarction in NIDDM patients.

Relationship between Peripheral Neuropathy and Cardiovascular Autonomic Neuropathy in Non-Insulin Dependent Diabetics.: Sung Woo Ha, Hyun Jeong Lee, Jeung Hun Han, Sang Won Jung, Jick Hwa Nam, Byoung Ho Sin, Seong Mo Koo, Jung Guk Kim, Sam Kwon, Bo Wan Kim; Korean Diabetes J. 1997;21(4):476-483. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Autonomic neuropathy was detected in some diabetics with symmetric peripheral neuropathy, a common complication of diabetes mellitus that may be associated with considerable morbidity. There has been known to be similarity of pathogenic mechanism in two neuropathies. Then we examined nerve conduction velocity and cardiovascular autonomic function tests. We studied relationship between peripheral and cardiovascular autonomic neuropathy in non-insulin dependent diabetics. METHODS: We studied 166 patients with or witbout peripheral neuropathy who had been diagnosed as non-insulin dependent diabetes mellitus. We examined nerve conduction tests to assess diabetic peripheral neuropathy and classified them into 4 groups aecording to neuropathic symptoms and results of nerve conduction tests. We examined five cardiovascular autonomic function tests by Ewing's methods. RESULTS: 1. The duration of diabetes mellitus was significantly longer in the group of cliabetics with neuropathic symptoms and abnormal findings in the nerve conduction velocity tests than the other groups. The level of blood glucose was significantly higher in the group of diabetics with neuropathic symptoms and findings than the other groups. 2. In the 5 cardiovascular autonomic function tests, heart rate response to deep breathing and Valsalva maneuver had significant differences between the diabetic group with peripheral neuropathy and the other groups. 3. The frequency and severity of autonomic neuropathy were higher in the group with peripheral neuro-pathic symptoms and findings than the other groups without neuropathic syrnptoms and findings. There was an overall significant relationship between sensorirnotor neural function and autonomic function. 4. There was no association between peripheral neuropathy and nephropathy although peripheral neuropathy was related with retinopathy. CONCLUSION: Diabetic peripheral neuropathy accompanies autonomic neuropathy. Then, this result suggests that there is the relationship between peripheral and cardiovascular autonomic neuropathy.

Randomized Controlled Trial

The Effect of Acarbose as an Adjuvant Therapy in Sulfonylurea-Treated NIDDM Patients.: Yun Yong Lee, Geon Sang Park, Jin Seong Kim, Byeong Sool Mun, Do Joon Park, Chan Soo Shin, Kyeong Soo Park, Seong Yeon Kim, Hong Kyu Lee; Korean Diabetes J. 1997;21(4):484-492. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Acarbose-an aglucosidase inhibitor-is known to have a glucose lowering effect by delaying the digestion of complex carbohydrates in the small intestine. Acarbose especially prevents the abnormally high increment of postprandial blood glucose, reduces postprandial hyperinsulinemia and probably, alleviates insulin resistance. The aim of this study is to evaluate the glucose lowering effect of acarbose as an adjunt with a sulfonylurea in the treatment of NIDDM patients who have been poorly controlled with the use of sulfonylurea alone. METHODS: Forty NIDDM patients, who were poorly controlled with sulfonylurea alone, were randomly selected frorn outpatient diabetic clinic for study. For 16 weeks, they recieved either acarbose or placebo in additian to sulfonylurea under double blind method. RESULTS: 1) The metabohc parameters measured before initiation of either treatment regimen were similiar. 2) The HbAlc in placebo group increased from 8.9% to 9.0%. In contrast, in the acarbose group, HbAlc value decreased from 9.3% to 8.1%(p<0.05). 3) Mean fasting plasma glucose and 1-h postprandial glucose levels were reduced significantly in the acarbose group(p<0.001), especially in I-h postpandial glucose level in comparison with placebo group(p <0.0001). 4) Mean fasting, 1-h postprandial insulin levels decreased with time in the acarbose group in comparison with placebo group, but the decrease was not statistically significant. 5) Lipid profiles did not change during 16weeks of treatment period. 6) Adverse effects were observed in 3 patients on acarbose and 2 patients on placebo. CONCLUSION: Acarbose can be used as an effective adjuvant therapy to sulfonylurea in NIDDM patients who are poorly controlled with sulfonylurea alone.

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