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Volume 36(1); February 2012
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Improving Patients' Adherence to Physical Activity in Diabetes Mellitus: A Review
Shan-hu Qiu, Zi-lin Sun, Xue Cai, Lili Liu, Bingquan Yang
Diabetes Metab J. 2012;36(1):1-5.   Published online February 17, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.1.1
  • 4,219 View
  • 51 Download
  • 44 Crossref
AbstractAbstract PDFPubReader   

Regular physical activity (PA) is a key element in the prevention and management of type 2 diabetes mellitus (T2DM). Participation in regular PA improves blood glucose control and can prevent or delay T2DM and its complications, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life. However, most people with T2DM are not active and show poor adherence. This paper reviews the possible barriers to PA and strategies to improve the adherence to PA. Based on the currently available literature, it is concluded that self-efficacy and social support from family, friends, and health care providers play the important role in adoption and maintenance of regular PA. Here we also highlight some new modern and innovative interventions that facilitate exercise participation and improve the adherence.

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Diabetic Peripheral Neuropathy in Type 2 Diabetes Mellitus in Korea
Seung-Hyun Ko, Bong-Yun Cha
Diabetes Metab J. 2012;36(1):6-12.   Published online February 17, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.1.6
  • 4,495 View
  • 80 Download
  • 30 Crossref
AbstractAbstract PDFPubReader   

Diabetic peripheral neuropathy (DPN), a common and troublesome complication in patients with type 2 diabetes mellitus (T2DM), contributes to a higher risk of diabetic foot ulcer and lower limb amputation. These situations can negatively impact the quality of life of affected individuals. Despite its high prevalence and clinical importance, most diabetes mellitus patients not only do not recognize the presence of diabetic neuropathy, but also do not report their symptoms to physicians or other health care providers. Therefore, DPN is usually under diagnosed and undertreated. For early detection and appropriate intervention for DPN, a careful history, physical with neurologic examination, and prompt treatment are needed in T2DM patients.

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Anti-Obesity Drugs: A Review about Their Effects and Safety
Jun Goo Kang, Cheol-Young Park
Diabetes Metab J. 2012;36(1):13-25.   Published online February 17, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.1.13
  • 15,137 View
  • 243 Download
  • 386 Crossref
AbstractAbstract PDFPubReader   

The current recommendations for the treatment of obese people include increased physical activity and reduced calories intake. When the behavioral approach is not sufficient, a pharmacologic treatment is recommended. In past years, numerous drugs have been approved for the treatment of obesity; however, most of them have been withdrawn from the market because of their adverse effects. In fact, amphetamine, rimonabant and sibutramine licenses have been withdrawn due to an increased risk of psychiatric disorders and non-fatal myocardial infarction or stroke. Even if orlistat is not as effective as other drugs in reducing body weight, orlistat is presently the only available choice for the treatment of obesity because of its safety for cardiovascular events and positive effects on diabetic control. Hopefully, more effective and better tolerated anti-obesity drugs will be developed through an improved understanding of the multiple mechanisms and complex physiological systems targeting appetite.

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Editorial
Fibroblast Growth Factor 21: A Novel Metabolic Regulator
Ji A Seo, Nan Hee Kim
Diabetes Metab J. 2012;36(1):26-28.   Published online February 17, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.1.26
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Original Articles
Various Oscillation Patterns of Serum Fibroblast Growth Factor 21 Concentrations in Healthy Volunteers
Sang Ah Lee, Eunheiu Jeong, Eun Hee Kim, Mi-Seon Shin, Jenie Yoonoo Hwang, Eun Hee Koh, Woo Je Lee, Joong-Yeol Park, Min-Seon Kim
Diabetes Metab J. 2012;36(1):29-36.   Published online February 17, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.1.29
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AbstractAbstract PDFPubReader   
Background

Fibroblast growth factor 21 (FGF21) was originally identified as a paroxysm proliferator activated receptor-α target gene product and is a hormone involved in metabolic regulation. The purpose of this study was to investigate the diurnal variation of serum FGF21 concentration in obese and non-obese healthy volunteers.

Methods

Blood samples were collected from five non-obese (body mass index [BMI] ≤23 kg/m2) and five obese (BMI ≥25 kg/m2) healthy young men every 30 to 60 minutes over 24 hours. Serum FGF21 concentrations were determined by radioimmunoassay. Anthropometric parameters, glucose, free fatty acid, insulin, leptin, and cortisol concentrations were also measured.

Results

The serum FGF21 concentrations displayed various individual oscillation patterns. The oscillation frequency ranged between 6 and 12 times per day. The average duration of oscillation was 2.52 hours (range, 1.9 to 3.0 hours). The peaks and troughs of FGF21 oscillation showed no circadian rhythm. However, the oscillation frequency had a diurnal variation and was lower during the light-off period than during the light-on period (2.4 vs. 7.3 times, P<0.001). There was no difference in the total frequency or duration of oscillations between non-obese and obese subjects, but obese individuals had increased numbers of larger oscillations (amplitude ≥0.19 ng/mL).

Conclusion

Various oscillation patterns in serum FGF21 concentration were observed, and reduced oscillation frequencies were seen during sleep. The oscillation patterns of serum FGF21 concentration suggest that FGF21 may be secreted into systemic circulation in a pulsatile manner. Obesity appeared to affect the amplitude of oscillations of serum FGF21.

Citations

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Role of HbA1c in the Screening of Diabetes Mellitus in a Korean Rural Community
Jae Hyun Kim, Gun Woo Kim, Mi Young Lee, Jang Yel Shin, Young Goo Shin, Sang Baek Koh, Choon Hee Chung
Diabetes Metab J. 2012;36(1):37-42.   Published online February 17, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.1.37
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AbstractAbstract PDFPubReader   
Background

Recently, the measurement of glycated hemoglobin (HbA1c) was recommended as an alternative to fasting plasma glucose or oral glucose tolerance tests for diagnosing diabetes mellitus (DM). In this study, we analyzed HbA1c levels for diabetes mellitus screening in a Korean rural population.

Methods

We analyzed data from 10,111 subjects from a Korean Rural Genomic Cohort study and generated a receiver operating characteristic curve to determine an appropriate HbA1c cutoff value for diabetes.

Results

The mean age of the subjects was 56.3±8.1 years. Fasting plasma glucose and 2-hour plasma glucose after 75 g oral glucose tolerance tests were 97.5±25.6 and 138.3±67.1 mg/dL, respectively. The mean HbA1c level of the subjects was 5.7±0.9%. There were 8,809 non-DM patients (87.1%) and 1,302 DM patients (12.9%). A positive relationship between HbA1c and plasma glucose levels and between HbA1c and 2-hour plasma glucose levels after oral glucose tolerance tests was found in a scatter plot of the data. Using Youden's index, the proper cutoff level of HbA1c for diabetes mellitus screening was 5.95% (sensitivity, 77%; specificity, 89.4%).

Conclusion

Our results suggest that the optimal HbA1c level for DM screening is 5.95%.

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Prevalence of Dyslipidemia among Korean Adults: Korea National Health and Nutrition Survey 1998-2005
Myung Ha Lee, Hyeon Chang Kim, Song Vogue Ahn, Nam Wook Hur, Dong Phil Choi, Chang Gyu Park, Il Suh
Diabetes Metab J. 2012;36(1):43-55.   Published online February 17, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.1.43
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AbstractAbstract PDFPubReader   
Background

Dyslipidemia is a disorder of lipid metabolism, including elevated total cholesterol, elevated triglyceride, elevated low density lipoprotein cholesterol (LDL-C), and decreased high density lipoprotein cholesterol (HDL-C). The objective of this study was to investigate recent changes in the prevalence of dyslipidemia and also the rates of awareness, treatment, and control of dyslipidemia among Korean adults.

Methods

Dyslipidemia is defined according to the National Cholesterol Education Program-Adult Treatment Panel III as total cholesterol ≥240 mg/dL, LDL-C ≥160 mg/dL, HDL-C <40 mg/dL, and triglyceride ≥200 mg/dL. The prevalence of dyslipidemia was estimated for adults aged ≥20 years using the Korea National Health and Nutrition Survey (KNHANES) in 1998 (n=6,923), 2001 (n=4,882), and 2005 (n=5,323). Rates of awareness, treatment and control of dyslipidemia were calculated for adults aged ≥30 years using the KNHANES in 2005 (n=4,654).

Results

The prevalence of dyslipidemia (aged ≥20 years) increased from 32.4% in 1998 to 42.6% in 2001 and 44.1% in 2005. Compared with the KNHANES in 1998, the prevalence of dyslipidemia was 47% (95% confidence interval [CI], 35% to 59%) higher in 2001 and 61% (95% CI, 49% to 75%) higher in 2005. In 2005, only 9.5% of people with dyslipidemia were aware of the disease, 5.2% used lipid-lowering medication, and 33.2% of patients with treatment reached treatment goals.

Conclusion

The prevalence of dyslipidemia in Korea gradually increased between 1998 and 2005. These findings suggest that more intense efforts for the prevention and treatment of dyslipidemia may lead to further improvement in the management of dyslipidemia.

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The Association between Apolipoprotein A-II and Metabolic Syndrome in Korean Adults: A Comparison Study of Apolipoprotein A-I and Apolipoprotein B
Dong Won Yi, Dong Wook Jeong, Sang Yeoup Lee, Seok Man Son, Yang Ho Kang
Diabetes Metab J. 2012;36(1):56-63.   Published online February 17, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.1.56
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AbstractAbstract PDFPubReader   
Background

Apolipoprotein A-II (apoA-II) is the second-most abundant apolipoprotein in human high-density lipoprotein and its role in cardio metabolic risk is not entirely clear. It has been suggested to have poor anti-atherogenic or even pro-atherogenic properties, but there are few studies on the possible role of apoA-II in Asian populations. The aim of this study is to evaluate the role of apoA-II in metabolic syndrome (MetS) compared with apolipoprotein A-I (apoA-I) and apolipoprotein B (apoB) in Korean adults.

Methods

We analyzed data from 244 adults who visited the Center for Health Promotion in Pusan National University Yangsan Hospital for routine health examinations.

Results

The mean apoB level was significantly higher, and the mean apoA-I level was significantly lower, in MetS; however, there was no significant difference in apoA-II levels (30.5±4.6 mg/dL vs. 31.2±4.6 mg/dL, P=0.261). ApoA-II levels were more positively correlated with apoA-I levels than apoB levels. ApoA-II levels were less negatively correlated with homocysteine and high sensitivity C-reactive protein levels than apoA-I levels. The differences in MetS prevalence from the lowest to highest quartile of apoA-II were not significant (9.0%, 5.7%, 4.9%, and 6.6%, P=0.279). The relative risk of the highest quartile of apoA-II compared with the lowest quartile also was not significantly different (odds ratio, 0.96; 95% confidence interval, 0.95 to 1.04; P=0.956).

Conclusion

Compared with apoA-I (negative association with MetS) and apoB (positive association with MetS) levels, apoA-II levels did not show any association with MetS in this study involving Korean adults. However, apoA-II may have both anti-atherogenic and pro-atherogenic properties.

Citations

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Clinical Significance of the Presence of Autonomic and Vestibular Dysfunction in Diabetic Patients with Peripheral Neuropathy
Soo Kyoung Kim, Kyeong Ju Lee, Jong Ryeal Hahm, Sang Min Lee, Tae Sik Jung, Jung Hwa Jung, Sungsu Kim, Deok Ryong Kim, Seong-Ki Ahn, Won-Hee Choi, Soon Il Chung
Diabetes Metab J. 2012;36(1):64-69.   Published online February 17, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.1.64
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AbstractAbstract PDFPubReader   
Background

We investigated the prevalence of diabetic autonomic neuropathy (DAN) and vestibular dysfunction (VD) in diabetic patients with peripheral neuropathy.

Methods

Thirty-five diabetic patients with peripheral neuropathy were enrolled from August 2008 to July 2009. All subjects underwent autonomic function tests. Nineteen of the patients (54.3%) underwent videonystagmography.

Results

Diabetic autonomic neuropathy was observed in 28 patients (80%). A mild degree of autonomic failure was observed in 18 patients (64.3%), and a moderate degree of autonomic failure was observed in ten patients (35.7%). Factors related to DAN included diabetic nephropathy (P=0.032), degree of chronic kidney disease (P=0.003), and duration of diabetes (P=0.044). Vestibular dysfunction was observed in 11 of 19 patients (57.9%). There was no significant association between DAN and VD.

Conclusion

Diabetic autonomic neuropathy was observed in 28 diabetic patients (80%) with peripheral neuropathy. Vestibular dysfunction was observed in nearly 60% of diabetic patients with peripheral neuropathy who complained of dizziness but showed no significant association with DAN. Diabetic patients who complained of dizziness need to examine both autonomic function and vestibular function.

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AbstractAbstract PDFPubReader   
Background

Sleep disturbances are common in individuals with diabetes. Patients with diabetes have higher rates of insomnia, excessive daytime sleepiness and increased incidence of restless leg syndrome. The purpose of our study was to investigate the prevalence and determine the predictors of sleep dysfunction in patients with type 2 diabetes in a southeast Asian Indian population.

Methods

We enrolled 120 patients with type 2 diabetes who attended an endocrinology clinic in a tertiary-care hospital. After we collected their demographic data, we recorded their anthropometric measurements. Fasting, postprandial blood glucose values and glycosylated hemoglobin (HbA1c) values were then obtained. Quality of sleep was evaluated in all the patients through the Pittsburgh Sleep Quality Index (PSQI), which is a questionnaire that assesses sleep quality and disturbances over a monthlong period. A Global Sleep Quality score ≥5 discriminates between good and poor sleepers.

Results

The mean global PSQI score was 7.08 (standard deviation, 3.89), which suggested poor sleep quality in this population. Sixty-nine percent of patients had a global PSQI score ≥5, indicating that they were "poor sleepers." The global PSQI score positively correlated with the duration of diabetes and was also independent of other variables such as age, gender, body mass index, HbA1c, or medications.

Conclusion

We found a high prevalence of sleep dysfunction in patients with type 2 diabetes. We also found a significant correlation between duration of diabetes and quality of sleep, independent of other variables. It is important for physicians to address the quality and duration of sleep in patients with type 2 diabetes.

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Response
Response: The Prevalence of Peripheral Arterial Disease in Korean Patients with Type 2 Diabetes Mellitus Attending a University Hospital (Diabetes Metab J 2011;35:543-50)
Ji Hee Yu, Ki-Up Lee
Diabetes Metab J. 2012;36(1):77-78.   Published online February 17, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.1.77
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Citations

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Letter
Letter: Higher Glycated Hemoglobin Level Is Associated with Increased Risk of Ischemic Stroke in Non-Diabetic Korean Male Adults (Diabetes Metab J 2011;35:551-7)
Seok Hong Lee, Jihyun Ahn, Jaetaek Kim
Diabetes Metab J. 2012;36(1):79-80.   Published online February 17, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.1.79
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Response
Response: Higher Glycated Hemoglobin Level Is Associated with Increased Risk for Ischemic Stroke in Non-Diabetic Korean Male Adults (Diabetes Metab J 2011;35:551-7)
Hyung Geun Oh, Eun-Jung Rhee, Tae-Woong Kim, Kyung Bok Lee, Jeong-Ho Park, Kwang-Ik Yang, Dushin Jeong, Hyung-Kook Park
Diabetes Metab J. 2012;36(1):81-82.   Published online February 17, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.1.81
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Diabetes Metab J : Diabetes & Metabolism Journal