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Volume 36(2); April 2012
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Reviews
Regulation of Muscle Microcirculation in Health and Diabetes
Zhenqi Liu, Seung-Hyun Ko, Weidong Chai, Wenhong Cao
Diabetes Metab J. 2012;36(2):83-89.   Published online April 17, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.2.83
  • 3,202 View
  • 28 Download
  • 7 Crossref
AbstractAbstract PDFPubReader   

Insulin increases microvascular perfusion and substrate exchange surface area in muscle, which is pivotal for hormone action and substrate exchange, by activating insulin signaling cascade in the endothelial cells to produce nitric oxide. This action of insulin is closely coupled with its metabolic action and type 2 diabetes is associated with both metabolic and microvascular insulin resistance. Muscle microvascular perfusion/volume can be assessed by 1-methylxanthine metabolism, contrast-enhanced ultrasound and positron emission tomography. In addition to insulin, several factors have been shown to recruit muscle microvasculature, including exercise or muscle contraction, mixed meals, glucagon-like peptide 1 and angiotensin II type 1 receptor (AT1R) blocker. On the other hand, factors that cause metabolic insulin resistance, such as inflammatory cytokines, free fatty acids, and selective activation of the AT1R, are capable of causing microvascular insulin resistance. Therapies targeting microvascular insulin resistance may help prevent or control diabetes and decrease the associated cardiovascular morbidity and mortality.

Citations

Citations to this article as recorded by  
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    Mark M. Smits, Marcel H.A. Muskiet, Lennart Tonneijck, Mark H.H. Kramer, Michaela Diamant, Daniël H. van Raalte, Erik H. Serné
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    Camila Manrique, Guido Lastra, James R. Sowers
    Annals of the New York Academy of Sciences.2014; 1311(1): 138.     CrossRef
  • Angiotensin-(1–7) Recruits Muscle Microvasculature and Enhances Insulin’s Metabolic Action via Mas Receptor
    Zhuo Fu, Lina Zhao, Kevin W. Aylor, Robert M. Carey, Eugene J. Barrett, Zhenqi Liu
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Challenges in Diagnosing Type 1 Diabetes in Different Populations
Marian Rewers
Diabetes Metab J. 2012;36(2):90-97.   Published online April 17, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.2.90
  • 4,041 View
  • 48 Download
  • 33 Crossref
AbstractAbstract PDFPubReader   

Diabetes affects today an estimated 366 million people world-wide, including 20 million to 40 million of patients with type 1 diabetes (T1D). While T1D accounts for 5% to 20% of those with diabetes, it is associated with higher morbidity, mortality and health care cost than the more prevalent type 2 diabetes. Patients with T1D require exogenous insulin for survival and should be identified as soon as possible after diagnosis to avoid high morbidity due to a delay in insulin treatment. It is also important to present to the patient correct prognosis that differs by the type of diabetes. From the research point of view, correct classification should help to identify the etiologies and to develop specific prevention for T1D. This review summarizes evidence that may be helpful in diagnosing T1D in various ethnic groups. Challenges in interpretation of results commonly used to determine the type of diabetes are highlighted.

Citations

Citations to this article as recorded by  
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The Roles of Glycated Albumin as Intermediate Glycation Index and Pathogenic Protein
Kwang Joon Kim, Byung-Wan Lee
Diabetes Metab J. 2012;36(2):98-107.   Published online April 17, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.2.98
  • 4,286 View
  • 62 Download
  • 72 Crossref
AbstractAbstract PDFPubReader   

The conventional glycemic indices used in management of diabetic patients includes A1c, fructosamine, 1,5-anhydroglucitol, and glycated albumin (GA). Among these indices, A1c is currently used as the gold standard. However, A1c cannot reflect the glycemic change over a relatively short period of time, and its accuracy is known to decrease when abnormalities in hemoglobin metabolism, such as anemia, coexist. When considering these weaknesses, there have been needs for finding a novel glycemic index for diagnosing and managing diabetes, as well as for predicting diabetic complications properly. Recently, several studies have suggested the potential of GA as an intermediate-term glycation index in covering the short-term effect of treatment. Furthermore, its role as a pathogenic protein affecting the worsening of diabetes and occurrence of diabetic complications is receiving attention as well. Therefore, in this article, we wanted to review the recent status of GA as a glycemic index and as a pathogenic protein.

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Alcoholism and Diabetes Mellitus
Soo-Jeong Kim, Dai-Jin Kim
Diabetes Metab J. 2012;36(2):108-115.   Published online April 17, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.2.108
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AbstractAbstract PDFPubReader   

Chronic use of alcohol is considered to be a potential risk factor for the incidence of type 2 diabetes mellitus (T2DM), which causes insulin resistance and pancreatic β-cell dysfunction that is a prerequisite for the development of diabetes. However, alcohol consumption in diabetes has been controversial and more detailed information on the diabetogenic impact of alcohol seems warranted. Diabetes, especially T2DM, causes dysregulation of various metabolic processes, which includes a defect in the insulin-mediated glucose function of adipocytes, and an impaired insulin action in the liver. In addition, neurobiological profiles of alcoholism are linked to the effects of a disruption of glucose homeostasis and of insulin resistance, which are affected by altered appetite that regulates the peptides and neurotrophic factors. Since conditions, which precede the onset of diabetes that are associated with alcoholism is one of the crucial public problems, researches in efforts to prevent and treat diabetes with alcohol dependence, receives special clinical interest. Therefore, the purpose of this mini-review is to provide the recent progress and current theories in the interplay between alcoholism and diabetes. Further, the purpose of this study also includes summarizing the pathophysiological mechanisms in the neurobiology of alcoholism.

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Editorial
Latent Autoimmune Diabetes in Adults: Autoimmune Diabetes in Adults with Slowly Progressive β-cell Failure
Hannah Seok, Byung Wan Lee
Diabetes Metab J. 2012;36(2):116-119.   Published online April 17, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.2.116
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Original Articles
Perception of Clinicians and Diabetic Patients on the Importance of Postprandial Glucose Control and Diabetes Education Status: A Cross Sectional Survey
Ji Hun Choi, Cheol Young Park, Bong Soo Cha, In Joo Kim, Tae Sun Park, Joong Yeol Park, Kyung Soo Park, Kun Ho Yoon, In Kyu Lee, Sung Woo Park
Diabetes Metab J. 2012;36(2):120-127.   Published online April 17, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.2.120
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AbstractAbstract PDFPubReader   
Background

Recent studies have shown the importance of postprandial glucose (PPG) in the development of diabetes complications. This study was conducted in order to survey the perceptions of clinicians and diabetic patients with respect to PPG management and the current status of diabetes education.

Methods

This was a cross-sectional study involving face-to-face interviews and an open questionnaire survey conducted in Korea. A total of 300 patients and 130 clinicians completed questionnaires, which included current education status, self monitoring of blood glucose (SMBG), criteria of diagnosis and management, and perceptions relating to PPG management.

Results

While there was a significantly higher perceived need for diabetes education, the sufficiency of the current education was considered to be severely lacking. Fasting plasma glucose (FPG), PPG, and glycosylated hemoglobin (HbA1c) were all important considerations for clinicians when making a diagnosis of diabetes, although PPG was considered less important than FPG or HbA1c in the treatment of diabetes. Most clinicians and patients were aware of the importance of PPG, but actual education on the importance of PPG was not actively being delivered.

Conclusion

Our study showed that the current status of diabetes education is insufficient to meet the needs of the Korean population. A considerable gap was found to exist between awareness and what was actually taught in the current education program in regard to the importance of PPG. These results suggest that clinicians need to be more active in patient education, especially in regard to the importance of PPG.

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    Kevin Cowart, Rachel Franks, Olivia Pane, Ellen Murphy, Kelly Oldziej
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    Soo Jin Kang, Soo Jung Chang
    Journal of Korean Public Health Nursing.2016; 30(2): 221.     CrossRef
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    Ariel Zisman, Francienid Morales, John Stewart, Andreas Stuhr, Aleksandra Vlajnic, Rong Zhou
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Effect of Eplerenone, a Selective Aldosterone Blocker, on the Development of Diabetic Nephropathy in Type 2 Diabetic Rats
Jae Hee Ahn, Ho Cheol Hong, Myong Jin Cho, Yoon Jung Kim, Hae Yoon Choi, Chai Ryoung Eun, Sae Jeong Yang, Hye Jin Yoo, Hee Young Kim, Ji A Seo, Sin Gon Kim, Kyung Mook Choi, Sei Hyun Baik, Dong Seop Choi, Nan Hee Kim
Diabetes Metab J. 2012;36(2):128-135.   Published online April 17, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.2.128
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AbstractAbstract PDFPubReader   
Background

Aldosterone antagonists are reported to have beneficial effects on diabetic nephropathy by effective blocking of the renin-angiotensin-aldosterone system. We investigated the renoprotective effect of the selective aldosterone receptor blocker eplerenone, the angiotensin converting enzyme inhibitor lisinopril, and combined eplerenone and lisinopril treatment in type 2 diabetic rats.

Methods

Animals were divided into six groups as follows: Otsuka Long-Evans Tokushima Fatty (OLETF) rat control, OLETF rats treated with a low dose of eplerenone (50 mg/kg/day), OLETF rats treated with a high dose of eplerenone (200 mg/kg/day), OLETF rats treated with lisinopril (10 mg/kg/day), OLETF rats treated with a combination of both drugs (eplerenone 200 mg/kg/day and lisinopril 10 mg/kg/day), and obese non-diabetic Long-Evans Tokushima Otsuka rats for 26 weeks.

Results

Urinary albumin excretion was significantly lower in the lisinopril group, but not in the eplerenone group. Urinary albumin excretion was decreased in the combination group than in the lisinopril group. Glomerulosclerosis and renal expression of type I and type IV collagen, plasminogen activator inhibitor-1, transforming growth factor-β1, connective tissue growth factor, and fibronectin mRNA were markedly decreased in the lisinopril, eplerenone, and combination groups.

Conclusion

Eplerenone and lisinopril combination showed additional benefits on type 2 diabetic nephropathy compared to monotherapy of each drug.

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    Maria Chiara Pelle, Michele Provenzano, Marco Busutti, Clara Valentina Porcu, Isabella Zaffina, Lucia Stanga, Franco Arturi
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Prevalence and Clinical Characteristics of Recently Diagnosed Type 2 Diabetes Patients with Positive Anti-Glutamic Acid Decarboxylase Antibody
Yul Hwangbo, Jin Taek Kim, Eun Ky Kim, Ah Reum Khang, Tae Jung Oh, Hak Chul Jang, Kyong Soo Park, Seong Yeon Kim, Hong Kyu Lee, Young Min Cho
Diabetes Metab J. 2012;36(2):136-143.   Published online April 17, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.2.136
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AbstractAbstract PDFPubReader   
Background

Latent autoimmune diabetes in adults (LADA) refers to a specific type of diabetes characterized by adult onset, presence of islet auto-antibodies, insulin independence at the time of diagnosis, and rapid decline in β-cell function. The prevalence of LADA among patients with type 2 diabetes varies from 2% to 20% according to the study population. Since most studies on the prevalence of LADA performed in Korea were conducted in patients who had been tested for anti-glutamic acid decarboxylase antibody (GADAb), a selection bias could not be excluded. In this study, we examined the prevalence and clinical characteristics of LADA among adult patients recently diagnosed with type 2 diabetes.

Methods

We included 462 patients who were diagnosed with type 2 diabetes within 5 years from the time this study was performed. We measured GADAb, fasting insulin level, fasting C-peptide level, fasting plasma glucose level, HbA1c, and serum lipid profiles and collected data on clinical characteristics.

Results

The prevalence of LADA was 4.3% (20/462) among adult patients with newly diagnosed type 2 diabetes. Compared with the GADAb-negative patients, the GADAb-positive patients had lower fasting C-peptide levels (1.2±0.8 ng/mL vs. 2.0±1.2 ng/mL, P=0.004). Other metabolic features were not significantly different between the two groups.

Conclusion

The prevalence of LADA is 4.3% among Korean adult patients with recently diagnosed type 2 diabetes. The Korean LADA patients exhibited decreased insulin secretory capacity as reflected by lower C-peptide levels.

Citations

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  • Utility of Fasting C-Peptide for the Diagnostic Differentiation of Patients with Type 1, Type 2 Diabetes, MODY, and LADA
    Ricardo Alemán-Contreras, Rita A. Gómez-Díaz, Maura E. Noyola-García, Rafael Mondragón-González, Niels Wacher, Aldo Ferreira-Hermosillo
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Fracture Incidence and Risk of Osteoporosis in Female Type 2 Diabetic Patients in Korea
Jong Kwan Jung, Hyo Jeong Kim, Hong Kyu Lee, Sang Soo Kim, Chan Soo Shin, Jin Taek Kim
Diabetes Metab J. 2012;36(2):144-150.   Published online April 17, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.2.144
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AbstractAbstract PDFPubReader   
Background

There are no published data regarding fracture risk in type 2 diabetic patients in Korea. In this study, we compared the fracture incidence and risk of osteoporosis of type 2 diabetic female patients with those in a non-diabetic hypertensive cohort.

Methods

The incidence of fracture in a type 2 diabetic cohort was compared with that in a non-diabetic hypertensive cohort over the course of 7 years. Female type 2 diabetic and non-diabetic hypertensive patients who visited Eulji General Hospital outpatient clinic from January 2004 to April 2004 were assigned to the diabetic cohort and the non-diabetic hypertensive cohort, respectively. Surveys on fracture event, use of anti-osteoporosis medications, and bone mineral density were performed.

Results

The number of fractures was 88 in the female diabetic cohort (n=1,268, 60.6±11.5 years) and 57 in the female non-diabetic hypertensive cohort (n=1,014, 61.4±11.7 years). The RR in the diabetic cohort was 1.38 (P=0.064; 95% confidence interval [CI], 0.98 to 1.94) when adjusted for age. Diabetic patients with microvascular complications (61.0%) showed a higher RR of 1.81 (P=0.014; 95% CI, 1.13 to 2.92) compared with those without these complications. The prevalence of osteoporosis was comparable between the groups, while use of anti-osteoporosis medication was more common in the diabetic cohort (12.8%) than in the hypertensive cohort (4.5%) (P<0.001).

Conclusion

In our study, a higher fracture risk was observed in female type 2 diabetics with microvascular complications. Special concern for this risk group is warranted.

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Impact of HbA1c Criterion on the Detection of Subjects with Increased Risk for Diabetes among Health Check-Up Recipients in Korea
Hong-Kyu Kim, Sung-Jin Bae, Jaeone Choe
Diabetes Metab J. 2012;36(2):151-156.   Published online April 17, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.2.151
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AbstractAbstract PDFPubReader   
Background

We performed the study to examine the impact of hemoglobin A1c (HbA1c) criterion on the screening of increased risk for diabetes among health check-up subjects in Korea.

Methods

We retrospectively analyzed clinical and laboratory data of 37,754 Korean adults (age, 20 to 89 years; 41% women) which were measured during regular health check-ups. After excluding subjects with previously diagnosed diabetes mellitus (n=1,812) and with overt anemia (n=318), 35,624 subjects (21,201 men and 14,423 women) were included in the analysis.

Results

Among the 35,624 subjects, 11,316 (31.8%) subjects were categorized as increased risk for diabetes (IRD) by fasting plasma glucose (FPG) criteria, 6,531 (18.1%) subjects by HbA1c criteria, and 13,556 (38.1%) subjects by combined criteria. Therefore, although HbA1c criteria alone identifies 42% [(11,316-6,531)/11,316] fewer subjects with IRD than does FPG criteria, about 20% [(13,556-11,316)/11,316] more subjects could be detected by including new HbA1c criteria in addition to FPG criteria. Among the 13,556 subjects with IRD, 7,025 (51.8%) met FPG criteria only, 2,240 (16.5%) met HbA1c criteria only, and 4,291 (31.7%) met both criteria. Among subjects with impaired fasting glucose, 65% were normal, 32% were IRD, and 3% were diabetes by HbA1c criterion. In receiver operating characteristic curve analysis, cutoff point of HbA1c with optimal sensitivity and specificity for identifying IRD was 5.4%.

Conclusion

Although HbA1c criteria alone identifies fewer subjects with IRD than does FPG criteria, about 20% more could be detected by addition of HbA1c criteria. Further studies are needed to define optimal cutoff point of HbA1c and to establish screening and management guidelines for IRD.

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    Mohsen Janghorbani, Masoud Amini
    Diabetes & Metabolic Syndrome: Clinical Research & Reviews.2012; 6(3): 136.     CrossRef
  • Usefulness of Glycated Hemoglobin as Diagnostic Criteria for Metabolic Syndrome
    Sang Hyun Park, Ji Sung Yoon, Kyu Chang Won, Hyoung Woo Lee
    Journal of Korean Medical Science.2012; 27(9): 1057.     CrossRef
  • Letter: Impact of HbA1c Criterion on the Detection of Subjects with Increased Risk for Diabetes among Health Check-Up Recipients in Korea (Diabetes Metab J 2012;36:151-6)
    Sung Hee Choi
    Diabetes & Metabolism Journal.2012; 36(3): 251.     CrossRef
Relationship between Opium Abuse and Severity of Depression in Type 2 Diabetic Patients
Sepehrmanesh Zahra, Sarmast Hossein, Kord Valeshabad Ali
Diabetes Metab J. 2012;36(2):157-162.   Published online April 17, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.2.157
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AbstractAbstract PDFPubReader   
Background

Opium use in diabetic populations is associated with major depressive disorder (MDD). This study was designed to investigate the relationship between opium use and severity of depression in Iranian diabetic patients.

Methods

In this case-control study, 642 type 2 diabetic patients were recruited from those presenting at two outpatient clinics at the Akhavan Hospital in Kashan, Iran; of them, 600 diabetic patients were included in the study and divided into two groups: opium-abusers (150 patients) and non-opium-abusers (450 patients). Clinical and demographic information was obtained through a detailed questionnaire. Depression symptomalogy and severity were assessed with the Beck Depression Inventory (BDI), and a corresponding diagnosis was made based on the Diagnostic and Statistical Manual of Mental Disorders-IV, Text Revision, 2000 (DSM-IV TR) criteria.

Results

The mean depression score was higher in the opium abuse group than in the non-abuser group (29.27±1.44 vs. 18.29±1.31, P<0.001). In general, a significant association was found between opium abuse and depression among patients (odds ratio [OR], 4.54; 95% confidence interval [CI], 2.87 to 7.44; P=0.001). No significant relationship was found between dysthymia and opium abuse (OR, 0.68; 95% CI, 0.18 to 1.192; P=0.155), while MDD was significantly higher in the opium abuser group (OR, 7.32; 95% CI, 5.20 to 12.01; P<0.001).

Conclusion

Depression is more frequent in opium-dependent diabetic patients, and its severity is also greater. Given these findings, opium-dependent diabetic patients should be advised about the increased risks of depression and related comorbidities.

Citations

Citations to this article as recorded by  
  • Prevalence of and factors associated with depression among hill tribe individuals aged 30 years and over in Thailand
    Chalitar Chomchoei, Tawatchai Apidechkul, Vivat Keawdounglek, Chanyanut Wongfu, Siriyaporn Khunthason, Niwed Kullawong, Ratipark Tamornpark, Panupong Upala, Fartima Yeemard
    Heliyon.2020; 6(6): e04273.     CrossRef
  • The prevalence of comorbid depression in patients with type 2 diabetes: an updated systematic review and meta-analysis on huge number of observational studies
    Mohammad Khaledi, Fahimeh Haghighatdoost, Awat Feizi, Ashraf Aminorroaya
    Acta Diabetologica.2019; 56(6): 631.     CrossRef
  • Psychometrics of the PHQ-9 as a measure of depressive symptoms in patients with heart failure
    Muna H Hammash, Lynne A Hall, Terry A Lennie, Seongkum Heo, Misook L Chung, Kyoung Suk Lee, Debra K Moser
    European Journal of Cardiovascular Nursing.2013; 12(5): 446.     CrossRef
Letter
Letter: Prevalence of Dyslipidemia among Korean Adults: Korea National Health and Nutrition Survey 1998-2005 (Diabetes Metab J 2012;36:43-55)
Bo Kyung Koo
Diabetes Metab J. 2012;36(2):163-164.   Published online April 17, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.2.163
  • 2,379 View
  • 28 Download
  • 1 Crossref
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Citations

Citations to this article as recorded by  
  • Prevalence of Dyslipidemia in Undiagnosed Palestinian Men: A Cross-Sectional Study
    Iyad Ali, Aya Kharma, Malak Samara, Samar Odeh, Nidal Jaradat, Abd Nasser Zaid, Mahdi Al Sayed Ahmad
    Journal of Lipids.2019; 2019: 1.     CrossRef
Response

Diabetes Metab J : Diabetes & Metabolism Journal