Diabetes & Metabolism Journal

Volume 27(2); April 2003

Review

The Significance of Hyperglycemia Control in Acutely Ill or Hopitalized Patients.: Doo Man Kim; Korean Diabetes J. 2003;27(2):85-94. Published online April 1, 2003

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Abstract PDF: No abstract available.

Editorial

VEGF in the Pathogenesis of Diabetic Nephropathy.: Nan Hee Kim, Dong Seop Choi; Korean Diabetes J. 2003;27(2):95-105. Published online April 1, 2003

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Abstract PDF: No abstract available.

Original Articles

Effect of Angiotensin II Receptor Blockade on VEGF Expression in Diabetic Nephropathy.: Myoungsook Shim, Mijin Kim, Munkyu Kim, Hyunjin Chang, Younggoo Shin, Junam Kim, Jaeman Song, Hosuk Kang, Eunyoung Lee, Kihak Song, Choonhee Chung; Korean Diabetes J. 2003;27(2):106-114. Published online April 1, 2003

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Abstract PDF: BACKGROUND
Diabetic nephropathy is one of the most serious complications of diabetes, and is the leading cause of chronic renal failure. Vascular endothelial growth factor (VEGF) plays an important role in the pathophysiology of diabetic retinopathy, which can be blocked by ACE inhibitors, but its precise role in diabetic nephropathy is uncertain. METHODS: 32 eight week-old Sprague-Dawley male rats were prepared, of which 16 were chosen for injection with streptozotocin (60 mg/kg) into the peritoneal cavity, with the goal of inducing diabetes. One week later, the peripheral blood sugar, taken from the tail vein was checked. A glucose level exceeding 200 mg/dL was taken as evidence of diabetes. The rats were divided into 4 groups of 8. Group I served as a control. Group II was treated with angiotensin II receptor blockade (L-158,809, 5 mg/kg/day, in drinking water). Group III consisted of diabetic rats and group IV diabetic rats treated with the same angiotensin II receptor blockade (L-158,809). At the beginning of the experiment and on 8th and 12th weeks, 24-hour urine protein and body weight checks were performed. At the end of the study, I extracted kidney and the glomerular volumes and optical densities of the VEGF expression in the glomeruli compared. RESULTS: The basal characteristics were initially the same. However, on weeks 8 and 12 the amount of 24-hour urine protein had increased in groups III and IV (p<0.05). By week 12, it was noticeably greater in group III than in group IV (p<0.05). The glomerular volume was also greater in groups III and IV (p<0.05). Optical density of the VEGF in the glomeruli had increased more in group III than in groups I, II and IV (p<0.05). CONCLUSION: VEGF plays a precise role in diabetic nephropathy, and angiotensin II receptor blockade can reduce diabetic nephropathy by suppressing the expression of VEGF.

Fetal Protein Deficiency Causes Long Term Changes in Mitochondrial DNA Content of Liver and Muscle in Female Sprague-Dawley Rats.: Suk Kyeong Kim, Min Seon Kim, Youn Young Kim, Do Joon Park, Kyong Soo Park, Ki Up Lee, Hong Kyu Lee; Korean Diabetes J. 2003;27(2):115-122. Published online April 1, 2003

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Abstract PDF: BACKGROUND
Epidemiological data suggest a strong association between low birth weight and the increased risk of metabolic syndrome, including type 2 diabetes, hypertension and cardiovascular disease, in adult life. However, the underlying mechanisms are largely unknown. In our previous study, the mitochondrial DNA (mtDNA) copy number in peripheral blood leukocytes was decreased in patients with type 2 diabetes and insulin resistance. To test the hypothesis that mitochondrial changes may serve as a link between fetal under nutrition and insulin resistance in later life, the effects of fetal protein malnutrition on the mitochondria of the liver and skeletal muscle, the main sites of insulin action in adulthood, were investigated. METHODS: Eight-week old female rats were divided into 2 groups and fed on either a control diet (casein 180 g/kg diet) (n=5) or a low protein diet (casein 80 g/kg diet) (n=7) for 15 days prior to mating. They were mated with 10 week-old male Sprague Dawley rats that had been fed on the control diet. The female offspring, born to the mothers fed the low protein diet, were randomly divided into 2 groups 4 weeks after birth, and weaned on either the low protein (low protein group, n=48) or control diet (resuscitated group, n=48). As a control group, the offspring born to the mothers fed the control diet were weaned on the control diet (n=48). The animals in each group were again randomly divided into 4 groups, and sacrificed at 5, 10, 15 and 20 weeks of age, respectively (n=12 per group). The body weight, liver and muscle mtDNA content were measured at weeks 5, 10, 15 and 20. RESULTS: The mtDNA contents of the liver and skeletal muscle were reduced in fetal malnourished adult rats, and were not restored to normal levels even when proper nutrition was supplied after weaning. CONCLUSION: Our findings indicate that under nutrition in early life causes long lasting changes in the mitochondria DNA content of the liver and muscles, which may contribute to the development of insulin resistance in later life.

Polymorphism of Melanocortin-4 Receptor and Obesity.: Hye Soon Kim, In Kyu Lee, Young Sung Suh; Korean Diabetes J. 2003;27(2):123-131. Published online April 1, 2003

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Abstract PDF: BACKGROUND
The application of genetics to obesity has made remarkable progress in recent years. The melanocortin-4 receptor (MC4R) regulates food intake, and possibly that of energy expenditure. The MC4R gene is the most prevalent obesity gene found to date in humans. The prevalence of single nucleotide substitution, replacing valine with isoleucine, at codon 103 was studied, and the role of the MC4R gene polymorphism on the body weight, fat distribution and lipid profile were determined. METHODS: Anthropometry and biochemical studies were performed on 226 subjects (82 male and 144 female subjects). The MC4R genotype was determined by a polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) method. The body fat distributions were measured by computerized tomography. RESULTS: The frequencies of the homozygotes, Val103Val and Val103/Ile, were 88.9 and 11.1%, respectively. The frequencies of the heterozygotes were similar (11.8 vs. 10.6%) in the control and obese groups. However, the heterozygotes had lower waist-to-hip ratios (WHR) (p=0.033) and visceral fat masses (p=0.038) compared to the homozygotes. In the obese group, the heterozygotes had lower body mass indices (BMI) and visceral fat masses (p=0.043 and p=0.044, respectively). The heterozygote males had lower BMI and fasting plasma glucose levels (p=0.046 and p<0.001, respectively) than the homozygote males. The heterozygote females tended to have lower WHR (p=0.081) than the homozygote females. CONCLUSION: These results suggest that mutations in the MC4R gene are likely to be a cause of human obesity, and possibly of metabolic syndrome.

Analysis of the Body Mass Index of Newly Diagnosed Type 2 Diabetic Patients and Its Temporal Trends.: Ji Hye Suk, Jung Choi, Yong Wuk Kim, Jae Suk Park, Ji Sup Kim, Mi Kyung Kim, Sin Yeong Choi, Jeong Hyun Park, Byung Doo Rhee; Korean Diabetes J. 2003;27(2):132-140. Published online April 1, 2003

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Abstract PDF: BACKGROUND
Previous epidemiological studies have shown that Korean type 2 diabetic patients were mainly non-obese compared to their Western counterparts. This retrospective study was performed to find the percentage of obese type 2 diabetic patients, and its temporal changes, using the newly proposed Asian criteria for the diagnosis of obesity. In addition, our results were compared with Caucasian data. METHODS: The subjects of our study were all newly diagnosed type 2 diabetic patients; 157 for 1991, 176 for 1996 and 275 for 2001. The all the study subjects were aged over 30 years. They all had visited the Mary Knoll General Hospital for the first time, and were diagnosed with type 2 diabetes mellitus within 1 year. The maximum BMI (Body Mass Index) was calculated from the patients heaviest life-time body weight, and their current BMI from the values obtained at their first visit to our institution. The delta BMI (deltaBMI) was calculated by subtracting the current BMI from the maximum BMI the HbA1c value at the time of the first visit was also recorded. Obesity was defined as a body mass index greater than 25kg/m2. RESULTS: The mean values of maximum BMI were 25.7+/-4.5, 26.4+/-4.3 and 25.9+/-6.0 kg/m2 for the years of 1991, 1996 and 2001, respectively. The mean values of the current BMI were 24.0+/-3.0, 24.2+/-3.0 and 24.8+/-3.6 kg/m2 for the years of 1991, 1996 and 2001, respectively. None of these values showed statistically significant differences. The percentages of obese type 2 diabetic patients in 1991, 1996 and 2001 were 64.3, 69.0 and 66.9%, according to their maximum BMI, respectively. The percentages of obese type 2 diabetic patients, from their current BMI, were 31.8, 39.8 and 43.6% in 1991, 1996 and 2001, respectively, and these values showed statistically significant increases over time (p=0.016). The mean value of the delta BMI was significantly lower in 2001 compared with 1996, and it was positively correlated with the HbA1c at the time of the first visit (p< 0.01). CONCLUSION: The percentage of obese type 2 diabetic patients at the time of the maximum body weight was 60 to 70%, but the percentage at the time of diagnosis had decreased to 30 to 40%. The percentage of obese type 2 diabetic patients at the time of diagnosis significantly increased over time. The mean BMI value of the Korean type 2 diabetic patients was lower than that of Caucasians, but the percentage of obese type 2 diabetic patients and its temporal trends were similar to those of Caucasians. Our study shows that Korean type 2 diabetic patients are as obese as Caucasians when they meet their own diagnostic criteria for obesity.

The Effect of Growth Hormone on Insulin Resistance and Atherosclerotic Risk Factors in Obese Patients with Uncontrolled Type 2 Diabetes Mellitus.: Jae Hyun Nam, Soo Jee Yoon, Dol Mi Kim, Chul Sik Kim, Joo Young Nam, Jong Suk Park, Jina Park, Chul Woo Ahn, Suk Won Park, Bong Soo Cha, Young Duk Song, Sung Kil Lim, Kyung Rae Kim, Hyun Chul Lee, Kap Bum Huh; Korean Diabetes J. 2003;27(2):141-152. Published online April 1, 2003

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Abstract PDF: BACKGROUND
Insulin resistance in visceral obesity constitutes a risk factor for the development of atherosclerosis. The insulin resistance in obese type 2 diabetic patients can be improved by a decrease in the visceral fat and an increase in the skeletal muscle, which may influence the insulin sensitivity. Growth hormone (GH) accelerates lipolysis and promotes protein conservation. The effects of GH therapy, with diet restriction, on lipolysis and protein anabolism, were evaluated, which may change body composition, insulin resistance and atherosclerotic risk factors in obese type 2 diabetes mellitus. METHODS: Sixteen obese type 2 diabetic patients (31~56yrs), who had high glucose levels (glucose 12.8+/-1.7 mmol/L, HbA1c 10.2+/-2.1%), were treated with recombinant human GH (GH; 1 unit/d, 5 times/week), diet restriction (25 kcal/kg ideal body weight/day) and exercise (250 kcal/day) for 12 weeks. They underwent anthropometric measurement, bioelectrical impedance for total body fat and lean body mass, as well as computed tomography, for visceral and subcutaneous fat, at the umbilicus and muscle area at the mid-thigh levels. All subjects underwent the test for GH response to hypoglycemia. The insulin sensitivity index (ISI) was measured using insulin tolerance tests (ITT). RESULTS: 1. The visceral fat area (VFA)/thigh muscle area (TMA) ratio was more decreased in the GH-treated group than in the control group, but there was no change of body weight. 2. The ISI was significantly increased in only the GH-treated group, which was negatively correlated with the VFA/TMA ratio. The serum free fatty acid, fibrinogen and plasminogen activator inhibitor-1 were significantly decreased after the GH treatment. The serum glucose level and HbA1c remained unchanged during the GH therapy, but were significantly decreased after 3 months. 3. The total cholesterol and triglyceride levels were decreased in the GH treated group. 4. The insulin-like growth factor-I, fasting c-peptide and insulin level were all significantly increased after the GH treatment. CONCLUSION: This study suggested that in type 2 diabetic patients, with insulin resistance and uncontrolled blood sugar, GH treatment caused a decrease in the visceral fat and an increase in the muscle mass, which could result in the improvement of the ISI, atherosclerotic risk factors and dyslipidemia.

Analysis of Insulin Injection Focused Self-Care and Related Factors in Diabetics.: Joo Wha Yoo, Moon Ja Suh; Korean Diabetes J. 2003;27(2):153-164. Published online April 1, 2003

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Abstract PDF: BACKGROUND
The purposes of this study were to investigate the level of insulin injection focused self-care, in patients with diabetes mellitus, and to identify the relationship between the perceived sensitivity/severity, perceived benefits, perceived barriers, self-efficacy and situational barriers relating to the insulin injection focused self-care. METHODS: The data were collected from Type 2 diabetic patients (n=120), at an outpatients clinic of a University Hospital in Seoul, Korea, between March and May 2001. The reliability of the instrument ranged from 0.64 to 0.87 Cronbach's Alpha. The data were analyzed using the SPSS PC+, version 10.0 software: descriptive statistics were conducted for the characteristics of the sample. T-tests, Pearson correlation coefficients and multivariate multiple regression analyses were conducted to identify the associations between the cognitive-affective factors and the insulin injection focused self-care. RESULTS: 1) The average level of self-injection was 4.72+/-.45. The average of coping with hypoglycemia was 2.98 .57. The average self-monitored blood glucose was 2.83 1.15. Among these three insulin injection focused self-care activities, the average for both the coping with hypoglycemia and self-monitored blood glucose were lower than the average for self-injection. 2) The mean scores for perceived sensitivity/severity, perceived benefits, perceived barriers, self-efficacy and situational barriers were 3.32+/-.97 (range 1-5); 3.74+/-.65, 2.49+/-.76, 72.86+/-16.70 (range 10-100) and 1.10+/-.19 (range 1-4), respectively. 3) The education was significantly correlated with the insulin injection focused self-care (p=.012), but the age was not. The frequency of the self-monitoring was significantly correlated with the insulin injection-focused self-care (p=.000) and self- efficacy (p=.000). 4) The self-efficacy was significantly positively correlated with the insulin injection focused self-care (p<.01) and perceived benefits (p<.01), but negatively correlated with situational barriers (p<.05). The perceived benefits were significantly positive correlated with the insulin injection focused self-care (p<.01) and the perceived sensitivity/severity (p<.05). The perceived barriers was also significantly positively correlated with the perceived sensitivity/severity (p<.05). CONCLUSION: Our results suggest that improving the level of insulin injection focused self-care may be increased by increasing the self-efficacy, perceived benefits and perceived sensitivity/severity, and by improving the capabilities for problem solving with the situational barriers faced. Since the purposed of this study was investigate the level of insulin injection focused self-care, rather than the overall management of diabetics, there is the need to develop substantial data to support nursing interventions for the improvement of self-care in patients with diabetes mellitus.

Case Report

A Case of Primary Antiphospholipid Syndrome in a Patient with Diabetes Presenting as Foot Ulcer.: Chul Sik Kim, Dae Hoon Song, Jina Park, Jong Suk Park, Joo Young Nam, Young Kim, Hee Jung Yoon, Dol Mi Kim, Soo Jee Yoon, Chul Woo Ahn, Bong Soo Cha, Sung Kil Lim, Kyung Rae Kim, Hyun Chul Lee; Korean Diabetes J. 2003;27(2):165-171. Published online April 1, 2003

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Abstract PDF: Antiphospholipid syndrome is a disorder characterized by recurrent vascular thrombosis, pregnancy loss and thrombocytopenia, and the presence of the lupus anticoagulant or a positive anticardiolipin test. A link of antiphospholipid syndrome to diabetes mellitus has not been established. There have been no reports of large artery thrombosis associated with antiphospholipid syndrome or diabetes mellitus. We present a case of an adult with large artery thrombosis, elevated anticardiolipin antibodies and lupus anticoagulant associated with diabetes. The patient was managed by successful primary percutaneous transluminal angioplasty and stent implantation, with accompanying anticoagulation therapy. To our knowledge, this is the first case where the occluded large artery was treated with primary stent implantation in primary antiphospholipid syndrome with diabetes mellitus

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