Diabetes & Metabolism Journal

Volume 22(4); December 1998

Original Articles

Canditate Gene Approach for the Genetics of Type 2 Diabetes Mellitus.: Jeong Hyun Park; Korean Diabetes J. 1998;22(4):439-441. Published online January 1, 2001

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Abstract PDF: No abstract is available.

Insulin Gene Polymorphisms in non-insulin-dependent Diabetes Mellitus ( NIDDM ) in Korean.: Jin Suk Kwon, Seok Won Park, Bong Soo Cha, Young Duk Song, Churl Woo Ahn, Keun Soo Jang, Soo Jin Kim, Seung Kil Lim, Kyung Rae Kim, Hyun Chul Lee, Kap Bum Huh; Korean Diabetes J. 1998;22(4):442-449. Published online January 1, 2001

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Many epidemiologic and family studies indicated stronger influence of genetic factors in NiDDM compared to IDDM, and there has been investigations to identify the susceptibility genes but without definite results. Insulin gene with its regulator region has been considered as a possible candidate gene of NIDDM because of relative deficiency in insulin secretion. So, we investigated the possible relationship between insulin gene polymorphisms and NIDDM in Korean. METHODS: we investigated -23 Hph I and +1,127 Pst I restriction site on insulin gene region in 67 NIDDM patients and 33 healthy controls by polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP) method, and compared the allelic frequencies. We also compared the insulin secretory capacity, degree of blood glucose control, and family history of diabetes mellitus according to insulin gene polymorphism. RESULTS: l. Insulin gene polymorphism on -23 Hph I restriction site or +1,127 Pst I restrietion site does not confer susceptibility to NIDDM in Korea, 2. No differences were observed in onset age, family history of diabetes mellitus, insulin secretory capacity, and degree of blood glucose control, according to insulin gene polymorphism. CONCLUSION: Insulin gene polymorphism on Hph I site and Pst I site probably does not play an important role in the pathogenesis of NIDDM in Korean population.

The Significance of thebeta3 Adrenergic Receptor Gene Polymorphism in Obese Koreans.: Byoung Joon Kim, Sung Hoon Kim, Dong Jun Kim, Jong Ryeal Hahm, Jin Seok Kim, Kyu Jeung Ahn, Jae Hoon Chung, Yong Ki Min, Myung Shik Lee, Moon Kyu Lee, Kwang Won Kim; Korean Diabetes J. 1998;22(4):450-456. Published online January 1, 2001

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The b3 adrenergic receptor (b3-AR), expressed mainly in visceral fat of human, is involved in regulation of lipolysis and thermogenesis. The missense mutation of b3-AR gene, resulting in the replacement of tryptophan by arginine at position 64 (Trp64Arg), is associated with decreased resting metabolic rate, weight gain and development of obesity. The purpose of this study was to investigate the frequency of the b3-AR gene polymorphism in obese Koreans. Subjects and METHODS: b3-AR genotype was determined in 87 healthy Koreans who visited SMC for the purpose of health checking from Dec/1996 to Feb/1997. Oral glucose tolerance test was performed with 75 g glucose. Lipid profiles, insulin, C-peptide were measured. Anthropometric data was obtained from physical examination and medical records. The subjects with previously diagnosed diabetes mellitus, other endocrine diseases or chronic illness were excluded. To determine the polymorphism, genomic DNA was isolated and PCR and RFLP by MvaI were carried. RESULTS: 1. The difference in frequency of Trp64Arg mutation between two groups was highly significant. (12 subjects (63%) in obese group and 21 subjects (30%) in non obese group, p<0.02) 2. There was significantly high allele frequency in obese group. (obese group: 32 %; non obese group: 15 %, p<0.02). 3. According to BMI, there were significantly high WHR (0.88+0.04 vs 0.83+0.06,p=0.01), total body fat (29.8+7.4 vs 24.4+6.5%, p=0.01) and systolic blood pressure(132+19 vs 124+14mmHg, p=0.04) in obese group. 4. According to b3-AR genotype, there were significantly high WHR (0.830.056 vs. 0.860.05) and 120 min (260.5+171. 5 vs 355.9+234.6 pmol/L, p=0.04) insulin level during OGTT in heterozygote group. CONCLUSION: These results suggest that the frequency of the b3-AR gene mutation was significantly higher in obese Koreans and b3-AR gene polymorphism might play a role in the pathogenesis of obesity.

Association between FABP2 Gene Polymorphism and Energy Metabolism in Normal Korean.: Seog Ki Yun, Chul Hee Kim, Young Sun Kim, Dong Won Byun, Kyo Il Suh, Myung Hi Yoo, Guk Bae Kim; Korean Diabetes J. 1998;22(4):457-466. Published online January 1, 2001

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The human intestinal fatty acid binding protein (FABP2) locus has been proprosed to be a major candidate gene in determining insulin resistance. It has been hypothesized that alanine to threonine substitution at codon 54 (Ala54Thr) of the FABP2 gene may result in enhanced intestinal uptake of fatty acids, and thereby an impairment of insulin action. FABP2 polymorphism was recently shown to be associated with insulin resistance in several populations including Mexican-Americans, Pima Indians, and Japanese, but not associated in the English, Wales, and Finn. METHODS: We investigated the association ot the FABP2 gene polymorphism and insulin resistance, fat absorption, and body fuel metabolism in 96 normal Korean men aged between 21 and 36 years. RESULTS: In normal Koreans, the alanine-encoding allele frequency was 0.66 and threonine encoding allele frequency was 0.34. Subjects with threonine-encoding allele were found to have a higher mean fasting plasma insulin concentration, a higher insulin resistance index, and a higher basal fat oxidation rate compared with subjects who were homozygous for the alanine-encoding allele. CONCLUSION: These results show that the Ala54Thr substitution in the FABP2 gene is associated with increased fat oxidation and insulin resistance in normal Korean men.

Development of Proinsulin-secreting Non-endocrine Cell.: Do Jun Yoon, Seok Hyun Kim, Jae Woo Kim, Yu Kyong Kim, Young Duk Song, Yong Ho Ahn; Korean Diabetes J. 1998;22(4):467-474. Published online January 1, 2001

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Recently, the advent of genetic engineering technics enabled. us to transfer foreign genes of interests into various cells and establish an "artificial b-cells" capable of secreting insulin in response to plasma glucose level. In this study, we have designed a study to establish an "artificial b-cells" by transfecting liver/pancreatic b-cell type glucose transporter 2(GLUT2) cDNA and genomic DNA of proinsulin into non-endocrine cell. Because GLUT2 molecules on the plasma membranes act as a sensor of glucose outside the cell and promote the secretion of proinsulin from the cells, cotransfection of GLUT2 cDNA along with insulin gene will translate the GLUT2 molecules necessary for glucose transport into the cells and hence leading to insulin secretion. METHODS: We have subcloned GLUT2 cDNA and proinsulin gene into separate eukaryotic expression vectors and transfected them to Chinese hamster ovary cells. The stable cell lines harboring GLUT2 cDNA and proinsulin gene were selected by G418, neomycin analogue. The surviving clones were harvested and subjected to Southem blot analysis by digesting the chromosomal DNA either with BamHI for insulin gene detection or Xho I/Sma I double digestion for GLUT2 gene detection. The amount of proinsulin secretion into the medium was measured by the insulin radioimmunoassay(DPC, Coat-A-Count insulin, LA, USA) which detected proinsulin with 40% cross-reactivity. RESULTS: 1) We were able to find out 3 clones positive for both GLUT2 gene and insulin gene. 2) Of these clones, clone 5 cells secreted proinsulin 3 times as much as that of the control CHO cells. CONCLUSION: There was some increase of proinsulin secretion in artificial g-cells compared to control cells. But this increased proinsulin secretion was not enough to be used as therapeutics. We need more expriments to find out more efficient way of proinsulin secretion and to identify the glucose-regulated insulin secretion in these artificial b-cells.

The Effects of Metformin Given into the Brain on Food Intake and a Expressions of Hypothalamic Neurotransmitters in the Rats.: Eun Sook Kim, Jin Yub Kim, Sang Wook Kim, Joong Yeol Park, Ki Up Lee, Sung Kwan Hong; Korean Diabetes J. 1998;22(4):475-481. Published online January 1, 2001

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Metformin, a biguanide agent, is an oral hypoglycemic agent frequently prescribed to non-insulin-dependent diabetic patients. In adclition to the glucose lowering effect, it is known to suppress fol intake, but the action mechanism for food intake suppression is not known yet. Hypothalamic neuropeptide Y (NPY) is recently identified that strongly stimulates food intake and melanin concentrating hormone (MCH) is also known to be involved in the ingestion of foods. The effects of mettormin on these substances are not known yet. We tried to define the effect of metformin administered into the lateral ventricle on the amount of food intake and mRNA expressions of NPY and MCH. METHODS: Each rat was housed in a separate cage, and brain cannula was set into the lateral ventricle and proper position was checked by the response to angiotensin-II injection. Metformin l ug (1 ug/uL) or normal saline (1 uL) were injected daily into the lateral ventricle for 4 days in the Metformin group (n=7) and Control group (n=6) respectively, and the amount of food intake and weight change were recrded. Expressions of corticotropin releasing hormone mRNA in paraventricular nucleus, NPY mRNA in arcuate nucleus, and MCH mRNA in lateral hypothalamus were measured by the in situ hybridization technique. RESULTS: The amount of food intake was lower in metformin group than that in control group by 14~35% during the study period (p<0.05). Changes of body weight was -18+9 g (mean+SD) in metformin group and -2+11 g in control group. But mRNA expressions of NPY, MCH and CRH were not different between the groups (p>0.05). CONCLUSION: Metformin injected into the brain reduced the amount of food intake and body weight without the changes of NPY and MCH mRNAs. This study suggests that metformin suppress food intake by directly acting in the brain, but these effects are not through the changes of NPY and MCH mRNA expressions.

Combined Measurements of Anti-ICA512 and Anti-GAD Antibodies in Insulin-dependent Diabetes Mellitus and Slowly Progressive Insulin-dependent Diabetes Mellitus in Korea.: Kyoung Ah Kim, Kyu Jung Ahn, Jae Hoon Chung, Yong Ki Min, Moon Kyu Lee, Phil Soo Oh, Dong Kyu Jin, Byung Tae Kim, Hae Joon Park, Kwang Won Kim, Myung Shik Lee; Korean Diabetes J. 1998;22(4):482-490. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Type 1 diabetes mellitus is a chronic autoimmune disease in which circulating antibodies to various islet-specific antigens including autoantibodies to glutamic acid decarboxylase (GADAb), antibodies reacting with an islet tyrosine phosphatase-related molecule termed as ICA512 (ICA512Ab), and insulin autoantibodies are frequently detected. These autoantibodies could be useful for presymptomatic diagnosis of type 1 diabetes mellitus, and tbeir presence suggest some patients with atypical diabetes mellitus that appears to be more prevalent in Asian than in western countries have autoimmune characteristics. ICA512Ab was discovered in 1992 and, when combined with GADAb, may increase the diagnostic sensitivity in autoimmune diabetes. In an attempt to study the autoimmune feature of atypical diabetes mellitus, we studied the prevalence of ICA512Ab using an in vitro transcription and translation method in the patients with insulin-dependent diabetes mellitus (IDDM), slowly progressive insulin-dependent diabetes mellitus (SPIDDM) and non-msulin-dependent diabetes mellitus (NIDDM), and compared it with that of GADAb. METHODS: ICA512Ab were measured by a radioimmunoprecipitation method using in vitro transcribed and translated S-methionine-labeled ICA512. GADAb were measured using a commercial radioimmunoassay kit (RSR, United Kingdom). The subjects in this study consisted of 43 patients with IDDM, 32 with SPIDDM, and 40 witb NIDDM. Their mean age was 21.2+14.5 years, 50.1+17.1 years, 52.5+13.4 years, respectively. RESULTS: The prevalence of ICA512Ab and GADAb in IDDM was 29 % and 51 %, respectively. That in SPIDDM was 9 % and 29 %; in NIDDM, 0 % and 2.5 %, respectively. When two antibodies were combined, 60 % of IDDM and 50 % of SPIDDM had the autoantibodies. When we analyzed the prevalence of autoantibodies according to the duration of diabetes, the prevalence of ICA 512Ab in patients tested within 4 years after the rliagnosis and more than 4 years after the diagnosis was 35 % and 19 %, respectively in IDDM. And also that of GADAb was 59 % and 38 %, respectively. In SPlDDM, the prevalence of ICA512Ab was 13 % and 7 %, respectively, while that of GADAb was 67 % and 14 % (p<0.05), respectively. In IDDM, ICA512Ab were more frequently detected in patients younger than 15 years ot age (45 %) than in older ones (14%) (p<0.05) while the prevalence of GADAb was not different according to the age (55 % vs 44 %). CONCLUSION: ICA512Ab are detected in some patients with autoimmune diabetes, while their prevalence is lower than that of GADAb. However, ICA512Ab, in combination with GADAb, increases the sensitivity ot autoantibody tests in autoimmune diabetes. Some of SPIDDM have an autoimmune etiology.

The Role of Insulin Secretion and Insulin Resistance in the Development of Korean Type 2 Diabetes Mellitus.: Bong Nam Chae, Seong Kyu Lee, Eun Gyoung Hong, Yoon Sok Chung, Kwan Woo Lee, Hyeon Man Kim; Korean Diabetes J. 1998;22(4):491-503. Published online January 1, 2001

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Impaired insulin secretinn, peripheral insulin resistance, a disproportionately elevated rate of hepatic glucose production and influence of inherited or enviromental factors contribute to the pathogenesis of type 2 diabetes mellitus(DM). But, which defect is primary is still controversial To determine whether insulin resistance or insulin deficiency is primary in the pathogenesis of type 2 DM, we studied normal glucose tolerant offsprings of type 2 diabetic patients. METHODS: 22 offsprings of type 2 diabetic patients with normal glucose tolerance, ranging in age from 20 to 40 years, and 17 control subjects in same age range who had no family history of diabetes, and 21 diabetic subjects were included. We performed 75 g oral glucose tolerance test, euglycemic hyper-insulinemic clamp test and hyperglycemic clamp test. RESULTS: With euglycemic clamp test, the values of peripheral insulin sensitivity, M, were 8.59+0.94 mg/kg/min in control group, 6.98+0.65 mg/kg/min in offspring group, and 5.19+0.89 mg/kg/min in diabetes group (P<0.05). Considering that lower limit of the normal range were 3.78 mg/kg/min in M and 3.10 mg/kg/min in M/I, the frequency of insulin resistance was 14.3% in the offspring group and 33.3 % in diabetes group. First and second phase insulin secretion during hyperglycemic clamp test were blunted in diabetes group. In the offspring group, first and second phase insulin secretion during hyperglycemic clamp test were increased greater than control group, though statistically insignificant. The mean first phase insulin secretion were 38.55+6.81 pU/mL in control group, 55.09+9.40 pU/mL in the offspring group and 6.02+0.98 pU/mL in diabetes group (P<0.05). The mean second phase insulin secretion were 65.11+15.5 pU/mL in control group, 90.25 + 11.9 pU/mL in the offspring group and 17.6 +2.71 pUmL in diabetes group(P<0,05). Considering that lower limit of the normal range were 19.5 pU/mL in the first phase insulin secretion and 26.1 pU/mL in the second phase insulin secretion, the frequency of impaired insulin secretion was 14.3 % in the offspring group and 100 % in diabetes group. There was an inverse relation between insulin resistance and insulin secretion in control subjects. But in the offspring group, this relation was absent. CONCLUSION: Our results show that both insulin resistance and impaired insulin secretion contribute to the development of type 2. DM in Koreans. In addifion, diabetic subjects had more severe impairment in insulin secretory capacity than insulin resistance.

Insulin Resistance and Related Factors in the Healthy Young Men.: Seok Won Park, Yoon Sok Chung, Yong Seok Yun, Bong Soo Cha, Young Duk Song, Hyun Chul Lee, Kap Bum Huh; Korean Diabetes J. 1998;22(4):504-512. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Resistance to insulin-stimulated glucose uptake is present in the majority of patients with obesity, glucose intolerance, hypertension, dyslipidemia, and coronary artery disease. It is known that values for insulin-stimulated glucose uptake(insulin sensitivity) vary widely within individuals with normal glucose tolerance. We investigated the variations in insulin sensitivity and related factors in the nonobese healthy young men. METHODS: Insulin sensitivity was considered as whole body insulin-stimulated glucose uptake rate(M), determined by euglycemic hyperinsulinemic clamp technique in 44 non-obese healthy young men with normal glucose tolerance. Plasma glucose, insulin, and C-peptide concentrations after a standard oral glucose tolerance test and total cholesterol, triglyceride, and HDL-cholesterol levels were measured after 12-hours fasting. The subjects were divided into four quartiles based on the insulin sensitivity (M) and their clinical and biochemical characteristics were compared. RESULTS: Glucose disposal rates (M-values) were ranged from 4.14 to 11.06 mg/kg/min and distributed normally. The plasma glucose levels were not different between quartiles but plasma insulin levels of quartile 1 were significantly higher than the other three quartiles during oral glucose tolerance test. There was a curvilinear relationship between insulin sensitivity and acute insulin response (Ins[o-30]) to oral glucose challenge. There were negative cnrrelations between insulin sensitivity and BMI, percent ideal body weight, WHR, body fat content, fasting insulin level, insulin response area during OGTT, and fasting serum triglyceride level. HDL-cholesterol concentration was positively correlated with insulin sensitivity. In multiple linear regression analysis, body fat content, fasting insulin, and HDL-cholesterol were independent variables, which were related to the insulin sensitivity. CONCLUSION: There were considerable variations in insulin sensitivity in the nonobese healthy young men with normal glucose tolerance and the related independent factors were body fat content, fasting insulin, and HDL-cholesterol cancentrations.

Estimation of Cut-off Point of Fasting Blood Glucose Predicting Pancreaticbeta-cell Decompensation During Oral Glucose Tolerance Test.: Mi Deok Lee, Hong Seung Kim, Young Uk Kim, Young Goo Shin, Chang Ho Song, Young Jun Won, Choon Hee Chung; Korean Diabetes J. 1998;22(4):513-521. Published online January 1, 2001

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Abstract PDF: BACKGROUND
The secretory dysfunction of pancreatic B-cell is one of the important in the pathogenesis of NIDDM. And the conversion from IGT to DM is developed by the exhaustion and decompensation of 0-cell. So our purp was estimating the cut-off point of fasting blood sugar predicting B-cell decompensation during OGTT. METHOD: The clinical characteristics and anthropometric parameters were determined in all subjects. 75 g ora] glucose tolerance tests were performed with serial blood sampling to measure plasma glucose levels, insulin and C-peptide levels. And we calcolated insulin response areas and C-peptide response areas. RESULTS: l) The basal C-peptide levels were elevated in IG1' and DM group. however, post-load 30min C-peptide and 30min insulin levels were significantly decreased in DM group compared with normal and IGl. 2) IGT group showed the highest C-peptide response areas among three groups. 3) The relationships between fasting plasma glucose, C-peptide & insulin levels showed that basal C-peptide level had turning point at 6.7 mmol/L of fastiing glucose, basal insulin level at 6.5 mmol/L, 30 min C-peptide at 6.2 mmol/1, 30 min insulin at 5.8 mmol/L and C-peptide response area at 7.0 mmol/L. Conclusion : Above result suggest that the fasting plasma glucose of 7.0 mmol/L may be the cut-off point of pancreatic B-cell decompensation.

Serum Levels of Transforming Growth Factor ( TGF ) -beta1 in Type 2 Diabetic Patients.: Nan Hee Kim, Jung Heon Oh, Young Hyun Kim, Ie Byung Park, Sang Jin Kim, Sei Hyun Baik, Dong Seop Choi; Korean Diabetes J. 1998;22(4):522-530. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Transforming growth factor(TGF)-Bl is a potent inducer of extracellular matrix production and of fibrogenesis and has been associated wnh the occurrence of diabetic complications. Our aim was to determine whether circulating levels of TGF-gl are altered in type 2 DM and, if so, whether they are correlated with blorxi glucose levels and show an association with diabetic complications. METHOD: Serum levels of TGF-gl were measured by quantitative sandwitch enzyme immunoassay in 76 type 2 DM patients and were correlated with clinical and biochemical parameters and the presence of diabetic complications. Result: 1) Serum TGF-B1 levels were correlated with fasting blood glucose levels (r=0.30, p=0.007) and inversely correlated with duration of diabetes (r=-0.31, p=0.007), BUN (r=-0.31, p=0.034), and creatinine (r=-0.40, p=0.004). In linear logistic regression analysis, duration of diabetes and HbA 1C <- were independently related to serum TGF-B1 levels. 2) Serum levels of TGF-B1 were significantly decreased in proteinuria group (n=23) than in normoalbuminuria group (n=26) (69.5+27.5 vs 85.7 +23 ng/mL, p=0.022). TGF-B1 concentrations were inversely correlated with serum creatinine and age in normoalbuminuria group (r=-0.40, p

Plasma leptin Concentrations in Korean Type 2 Diabetic Patients.: Eun Young Oh, Yun Jae Chung, Yoon Ho Choi, Jae Hoon Chung, Yong Ki Min, Myung Shik Lee, Moon Kyu Lee, Kwang Won Kim; Korean Diabetes J. 1998;22(4):531-537. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Obesity is a well-established risk factor for a number of chronic diseases, including type 2 diabetes mellitus, hypertension, cardiovascular disease, and hyperlipidemia. Leptin, the protein procluct of the ob gene, is increased in obese individuals, suggesting resistance to its effect. We investigated whether the subjects with type 2 diabetes have an altered regulation of serum leptin levels METHODS: 205 Korean type 2 diabetic patients and 174 normal contro1 subjects participated in this study. We evaluated a difference between leptin level of diabetic patients and that of normal controls. In diabetic patients, correlations among plasma leptin concentration and other factors such as serum insulin concentration, percentage body fat, BMI, gender, total cholesterol, triglyceride, and fasting serum glucose level were evaluated. RESULTS: Fasting plasma leptin concentrations were correlated to BMI, percentage body fat, gender and serum insulin concentration. Plasma leptin concentrations are not significantly different in diabetic subjects compared to controls. CONCLUSIONS: We conclude that there was no significant difference in semm leptin level between type 2 diabetic and normal subjects and that body fat, sex, and the fasting insulin level are independently associated with plasma leptin level in type 2 diabetic patients.

Prevalence and Risk Factors of Erectile Dysfunction in Diabetic Men by Self-Reported Questionnaires.: Jin Hwa Lee, Jee Young Oh, Young Sun Hong, Yeon Ah Sung, Nan Ho Kyung, Woo Sik Chung, Eun Young Choi; Korean Diabetes J. 1998;22(4):538-545. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Erectile dysfunction is the consistent inability to achieve or sustain an erection of suffieient rigidity for sexual intercourse. Erectile dysfunction is an important cause of decreased quality of life in diabetic men. The prevalence of ereciile dysfunction has been reported to be three times higher in diabetic men than nondiabetics. Erectile dysfunction in diabetic men has been associated with increased age, poor glycemic control, smoling, alcohol intake, depression, and microvascular diabetic complication. Our purpose was to determine the prevalence of erectile dysfunction in diabetic men and to assess risk factors re]ated to erectile dysfunction in diabetes mellitus. METHODS: From l53 diabetic men visiting Ewha Womans University Hospital from March, 1997 to March, 1998, we analyzed the self-reported questionnaires. Three questions about erection and one question about overall sexual satisfaetion were given and the answer to each question was categorized into 5 degrees according to the severity of sexua] dysfunction. Erectile dysfunction was diagnosed when any answer for erection showed a degree lower than 4. We obtained the history of smoking, alcohol and hypertension, and measured the current weight and height. Fasting glucose, HBA 1c and lipid profile were me measured. We also evaluated for the presence of diabetic retinopathy, nephropathy and neuropathy. RESULTS: 1) The self-reported prevalence of erectile dysfunction in diabetic men was 75.5 % in this study. 2) In the patients with erectile dysfunction, age, duration of diabetes mellitus, HbAlc, and systolic blood pressure were significantly higher, and BMI and triglyceride significantly lower than in the patients without erectile dysfunction. 3) The prevalence of erectile dysfunction was increased with aging and increasing duration of diabetes mellitus, HBA. was significantly positively related and BMI was inversely related to erectile dysfunction. 4) Age and HbA 1c were independently and positively related to erectile dysfunction by multiple logistic regression. 5) The erectile dysfunction was significantly associated with diabetic autonomic neuropathy and retinopathy. CONCLUSION: The prevalence of self-reported erectile dysfunction in diabetic men was 75.5 % in this study, and it was significantly related to aging and the degree of the glycemic control.

HbA1c Concentration of Elderly Diabetic Patients with the Hypoglycemic Shock who were Admitted via Emergency Room.: Jin Cheol Park, Hyung Joon Yoo, Hae Seang Yim, Yong Tae Kim, Do Kyun Jin, Hyun Kyu Kim, Doo Man Kim, Jae Myung Yoo, Sung Hee Ihm, Moon Gi Choi, Sung Woo Park; Korean Diabetes J. 1998;22(4):546-551. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Mild degree of hypoglycemia is not unusual during drug therapy in elderly diabetic patients. However it is very difficult that the precise incidence of hypoglycemia is measured in elderly patients because the decreased cognitive function and autonomic dysfunction contribute to atypical hypoglycemic symptoms and signs. Therefore, most cases of elderly diabetic patients with hypoglycemia are discovered in comatose mental state. We did this study to evaluate the clinical charaeteristics of elderly diabetic patients with the hypoglycemic shock who were admitted via emergency room. METHODS: We analyzed the precipitating factors, mental status, and blood chemistries of the adult group(n=22, age 51+3.6 year, BMI-19 kg/m2) and elderly group(n=37, age=72+4.3 year, BMI=23 kg/m) that were classified by the point of 65 years old who were admitted via emergency room in state of the hypoglycemic shock. RESULTS: 1) In the precipitating factor of hypoglycemia, irregular oral intake was found in 64%(14/22) of the adult group and 64%(23/37) of the elderly group, and drug overdose was found in 27 %(1.6/22) of the adult group and 24%(9/37) of the elderly group. But there, was no significant difference between the adult and elderly group. 2) Those who arrived at the emerency room in comatose mental status were found in 45.5 % of adult group and 54.1 % of elderly group, that was no difference stastically. 3) HbA 1c was 5.8 +- 0.27% in elderly group and 8.0 +- 0.63% in the adult group who arrived at the emergency room, which was stastically significant difference between two groups. CONCLUSION: We concluded that lower HbA 1c in the elderly group than adult group who arrived at the emergency room suggest there was probability of unrecognized mild hypoglycemia before the onset of hypoglycemic shock.

Relationship between Circadian Mean Blood Pressure ( MBP ) Rhythm and Microvascular Complications in Normotensive NIDDM Patients.: Hyang Kim, Seong Chun Shim, Dae Jung Shim, Hi Moo Lee, Yoon Sang Choi, Jin Ho Kang, Byung Ik Kim, Sang Jong Lee, Yoo Lee Kim, Yoon Kyung Cho; Korean Diabetes J. 1998;22(4):552-560. Published online January 1, 2001

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Thanks to ambulatory 24-h blood pressure monitoring device, it became possible to investigate circadian pressure rhythm under variable physiologic and pathologic conditions. Moreover, ambulatory 24-h blood pressure has allowed us to detect in diabetic patients unsuspected abnormalities of the blood pressure circadian rhythm and to relate them to autonomic or renal dysfunction. This study was designed to evaluate the relationship between circadian rhythm of mean blood pressure (MBP) and microvascular complications in patients with noninsulin-dependent diabetes mellitus (NIDDM). METHODS: 24hr blood pressure monitoring was applied to 63 normotensive NIDDM patients(mean age 55.3+7.2 year, male: 35, female: 28) who have been hospitalized at our hospital from March 1993 to December 1994 to measure systolic, diastolic and hourly mean pressure of daytime, night time and 24hr. In addition, NIDDM patients were divided into 2 groups according to 24 hour circadian blood pressure rhythm by measuring hourly mean pressure. These 2 groups, group 1 who had a circadian MBP rhythm, with a peak value in the afternoon and group 2 who had an absent or reversed circadian rhythm with a peak value during the night time, were observed to evaluate the frequency of diabetic microvascular complication. RESULTS: The mean systolic and diastolic ambulatory BP values were significantly higher in the group 2 NIDDM during night-time compared with control group and group 1(systolic pressure: F=12.53 p<0.05 diastolic pressure: F:=15.159 p<0.05). Although there was no significant differences in day-time heart rate between three groups, 1 and 2 group showed significant higher level of night-time heart rate comparing with that of control group (F=3.444 p<0.05). Group 2 diabetes patients showed, both systolic and diastolic, higher night-time and day-time blood pressure ratio(systolic pressure: F=35.958 p<0.05> diastolic pressure F=40.126 p<0.05). Observing the night-time and day-time heart rate ratio, group 1 and 2 patients showed significantly higher level compared with that of cantrol group(F=12.144 p<0.05). Regarding the retmopathy, group 1 patient.; showed mild degree retinopathy or normal finding(X =3.65 p<0.05). However, many group 2 patients showed moderate 2 degree nonproliferative retinopathy(X =3.23 p<0.05). The prevalence of overt nepkuopathy (24-hour urine protein>500mg) and autonomic neuropathy (postural and abnormal E:I ratio during deep breathing test) was significantly higher in group 2 (overt nephropathy: X'=3.23 p

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