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Volume 37(1); February 2013
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Reviews
AMPK and Exercise: Glucose Uptake and Insulin Sensitivity
Hayley M. O'Neill
Diabetes Metab J. 2013;37(1):1-21.   Published online February 15, 2013
DOI: https://doi.org/10.4093/dmj.2013.37.1.1
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AbstractAbstract PDFPubReader   

AMPK is an evolutionary conserved sensor of cellular energy status that is activated during exercise. Pharmacological activation of AMPK promotes glucose uptake, fatty acid oxidation, mitochondrial biogenesis, and insulin sensitivity; processes that are reduced in obesity and contribute to the development of insulin resistance. AMPK deficient mouse models have been used to provide direct genetic evidence either supporting or refuting a role for AMPK in regulating these processes. Exercise promotes glucose uptake by an insulin dependent mechanism involving AMPK. Exercise is important for improving insulin sensitivity; however, it is not known if AMPK is required for these improvements. Understanding how these metabolic processes are regulated is important for the development of new strategies that target obesity-induced insulin resistance. This review will discuss the involvement of AMPK in regulating skeletal muscle metabolism (glucose uptake, glycogen synthesis, and insulin sensitivity).

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Brown Adipose Tissue as a Regulator of Energy Expenditure and Body Fat in Humans
Masayuki Saito
Diabetes Metab J. 2013;37(1):22-29.   Published online February 15, 2013
DOI: https://doi.org/10.4093/dmj.2013.37.1.22
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AbstractAbstract PDFPubReader   

Brown adipose tissue (BAT) is recognized as the major site of sympathetically activated nonshivering thermogenesis during cold exposure and after spontaneous hyperphagia, thereby controling whole-body energy expenditure and body fat. In adult humans, BAT has long been believed to be absent or negligible, but recent studies using fluorodeoxyglucose-positron emission tomography, in combination with computed tomography, demonstrated the existence of metabolically active BAT in healthy adult humans. Human BAT is activated by acute cold exposure, being positively correlated to cold-induced increases in energy expenditure. The metabolic activity of BAT differs among individuals, being lower in older and obese individuals. Thus, BAT is recognized as a regulator of whole-body energy expenditure and body fat in humans as in small rodents, and a hopeful target combating obesity and related disorders. In fact, there are some food ingredients such as capsaicin and capsinoids, which have potential to activate and recruit BAT via activity on the specific receptor, transient receptor potential channels, thereby increasing energy expenditure and decreasing body fat modestly and consistently.

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Nutritional Status and Cardiac Autophagy
Jihyun Ahn, Jaetaek Kim
Diabetes Metab J. 2013;37(1):30-35.   Published online February 15, 2013
DOI: https://doi.org/10.4093/dmj.2013.37.1.30
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AbstractAbstract PDFPubReader   

Autophagy is necessary for the degradation of long-lasting proteins and nonfunctional organelles, and is activated to promote cellular survival. However, overactivation of autophagy may deplete essential molecules and organelles responsible for cellular survival. Lifelong calorie restriction by 40% has been shown to increase the cardiac expression of autophagic markers, which suggests that it may have a cardioprotective effect by decreasing oxidative damage brought on by aging and cardiovascular diseases. Although cardiac autophagy is critical to regulating protein quality and maintaining cellular function and survival, increased or excessive autophagy may have deleterious effects on the heart under some circumstances, including pressure overload-induced heart failure. The importance of autophagy has been shown in nutrient supply and preservation of energy in times of limitation, such as ischemia. Some studies have suggested that a transition from obesity to metabolic syndrome may involve progressive changes in myocardial inflammation, mitochondrial dysfunction, fibrosis, apoptosis, and myocardial autophagy.

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Editorial
The Efficacy of Vildagliptin in Korean Patients with Type 2 Diabetes
Jun Sung Moon, Kyu Chang Won
Diabetes Metab J. 2013;37(1):36-39.   Published online February 15, 2013
DOI: https://doi.org/10.4093/dmj.2013.37.1.36
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PDFPubReader   

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Original Articles
Factor Structure of Indices of the Second Derivative of the Finger Photoplethysmogram with Metabolic Components and Other Cardiovascular Risk Indicators
Tomoyuki Kawada, Toshiaki Otsuka
Diabetes Metab J. 2013;37(1):40-45.   Published online February 15, 2013
DOI: https://doi.org/10.4093/dmj.2013.37.1.40
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AbstractAbstract PDFPubReader   
Background

The second derivative of the finger photoplethysmogram (SDPTG) is an indicator of arterial stiffness. The present study was conducted to clarify the factor structure of indices of the SDPTG in combination with components of the metabolic syndrome (MetS), to elucidate the significance of the SDPTG among various cardiovascular risk factors.

Methods

The SDPTG was determined in the second forefinger of the left hand in 1,055 male workers (mean age, 44.2±6.4 years). Among 4 waves of SDPTG components, the ratios of the height of the "a" wave to that of the "b" and "d" waves were expressed as b/a and d/a, and used as SDPTG indices for the analysis.

Results

Principal axis factoring analysis was conducted using age, SDPTG indices, components of MetS, and the serum levels of C-reactive protein (CRP) and uric acid. Three factors were extracted, and the SDPTG indices were categorized in combination with age as the third factor. Metabolic components and the SDPTG indices were independently categorized. These three factors explained 44.4% of the total variation. Multiple logistic regression analysis revealed age, d/a, serum uric acid, serum CRP, and regular exercise as independent determinants of the risk of MetS. The odds ratios (95% confidence intervals) were 1.08 (1.04 to 1.11), 0.10 (0.01 to 0.73), 1.24 (1.06 to 1.44), 3.59 (2.37 to 5.42), and 0.48 (0.28 to 0.82), respectively.

Conclusion

The SDPTG indices were categorized in combination with age, and they differed in characteristics from components of MetS or inflammatory markers. In addition, this cross-sectional study also revealed decrease of the d/a as a risk factor for the development of MetS.

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Increasing Prevalence of Type 2 Diabetes in a Rural Bangladeshi Population: A Population Based Study for 10 Years
Bishwajit Bhowmik, Faria Afsana, Lien My Diep, Sanjida Binte Munir, Erica Wright, Sharif Mahmood, A. K. Azad Khan, Akhtar Hussain
Diabetes Metab J. 2013;37(1):46-53.   Published online February 15, 2013
DOI: https://doi.org/10.4093/dmj.2013.37.1.46
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AbstractAbstract PDFPubReader   
Background

To observe changes in the prevalence of type 2 diabetes mellitus (DM) and impaired fasting glucose (IFG) and its associated risk factors in a rural Bangladeshi population over a 10-year period.

Methods

Three cross-sectional studies were undertaken in a rural community (aged ≥20 years) in 1999, 2004, and 2009. Structured questionnaires including sociodemographic parameters, anthropometric measurements, blood pressure, and blood glucose values were recorded. DM and IFG were diagnosed using 1999 World Health Organization criteria.

Results

Age standardized prevalence of DM increased significantly (P<0.001) from 1999 to 2009 (2.3%, 6.8%, and 7.9% in 1999, 2004, and 2009, respectively). The prevalence of IFG increased significantly (P=0.011) from 4.6% to 5.8% between 1999 and 2004 but then decreased from 5.8% to 5.3% during 2004 to 2009. Significant linear trends were shown in both sexes for general and central obesity as indicated by body mass index, waist circumference, and waist hip ratio (WHR). Increasing age and systolic blood pressure were significant risk factors for DM in all three studies. WHR for males was also significantly associated with the risk of DM in all three studies. WHR for females was only significantly associated with DM in 2009.

Conclusion

A significant rise in the prevalence of DM was observed in this population over 10 years. This increase was seen in both sexes, and in all age groups. A significant increase in the prevalence of the associated risk factors of general and central obesity was observed in both sexes.

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Diagnostic Accuracy of 64-Slice MDCT Coronary Angiography for the Assessment of Coronary Artery Disease in Korean Patients with Type 2 Diabetes
Jun Sung Moon, Ji Sung Yoon, Kyu Chang Won, Ihn-Ho Cho, Hyoung Woo Lee
Diabetes Metab J. 2013;37(1):54-62.   Published online February 15, 2013
DOI: https://doi.org/10.4093/dmj.2013.37.1.54
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AbstractAbstract PDFPubReader   
Background

A 64-slice multidetector computed tomography (MDCT) is well known to be a useful noninvasive form of angiography for the general population, but not for certain patients with diabetes. The aim of this study was to investigate the diagnostic accuracy and usefulness of 64-slice MDCT coronary angiography for detecting coronary artery disease in Korean patients with type 2 diabetes mellitus (T2DM).

Methods

A total of 240 patients were included, 74 of whom had type 2 diabetes (M:F=40:33; 41.8±9.5 years). We compared significant coronary stenosis (>50% luminal narrowing) in MDCT with invasive coronary angiography (ICA) by segment, artery, and patient. We also evaluated the influence of obesity and coronary calcium score on MDCT accuracy.

Results

Of the 4,064 coronary segments studied, 4,062 segments (T2DM=1,109) were assessed quantitatively by both MDCT and ICA, and 706 segments (T2DM=226) were detected as a significant lesion by ICA in all patients. Sensitivity, specificity, as well as positive and negative predictive values for the presence of significant stenosis in T2DM were: by segment, 89.4%, 96.4%, 85.8%, and 97.4%, respectively; by artery (n=222), 95.1%, 92.9%, 94.4%, and 93.8%, respectively; by patients (n=74), 98.4%, 100.0%, 98.4%, and 90.0%, respectively. Regardless of presence of diabetes, there was no significant difference in diagnostic accuracy. Obesity (≥25 kg/m2) and coronary calcium score did not also affect the diagnostic accuracy of MDCT.

Conclusion

The 64-slice MDCT coronary angiography was found to have similar diagnostic accuracy with ICA, regardless of diabetes. These results suggest MDCT may be helpful to reduce unnecessary invasive studies for patients with diabetes.

Citations

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  • Retraction: Diagnostic Accuracy of 64-Slice MDCT Coronary Angiography for the Assessment of Coronary Artery Disease in Korean Patients with Type 2 Diabetes
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Increased Selenoprotein P Levels in Subjects with Visceral Obesity and Nonalcoholic Fatty Liver Disease
Hae Yoon Choi, Soon Young Hwang, Chang Hee Lee, Ho Cheol Hong, Sae Jeong Yang, Hye Jin Yoo, Ji A Seo, Sin Gon Kim, Nan Hee Kim, Sei Hyun Baik, Dong Seop Choi, Kyung Mook Choi
Diabetes Metab J. 2013;37(1):63-71.   Published online February 15, 2013
DOI: https://doi.org/10.4093/dmj.2013.37.1.63
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AbstractAbstract PDFPubReader   
Background

Selenoprotein P (SeP) has recently been reported as a novel hepatokine that regulates insulin resistance and systemic energy metabolism in rodents and humans. We explored the associations among SeP, visceral obesity, and nonalcoholic fatty liver disease (NAFLD).

Methods

We examined serum SeP concentrations in subjects with increased visceral fat area (VFA) or liver fat accumulation measured with computed tomography. Our study subjects included 120 nondiabetic individuals selected from participants of the Korean Sarcopenic Obesity Study. In addition, we evaluated the relationship between SeP and cardiometabolic risk factors, including homeostasis model of insulin resistance (HOMA-IR), high sensitivity C-reactive protein (hsCRP), adiponectin values, and brachial-ankle pulse wave velocity (baPWV).

Results

Subjects with NAFLD showed increased levels of HOMA-IR, hsCRP, VFA, and several components of metabolic syndrome and decreased levels of adiponectin and high density lipoprotein cholesterol than those of controls. Serum SeP levels were positively correlated with VFA, hsCRP, and baPWV and negatively correlated with the liver attenuation index. Not only subjects with visceral obesity but also those with NAFLD exhibited significantly increased SeP levels (P<0.001). In multiple logistic regression analysis, the subjects in the highest SeP tertile showed a higher risk for NAFLD than those in the lowest SeP tertile, even after adjusting for potential confounding factors (odds ratio, 7.48; 95% confidence interval, 1.72 to 32.60; P=0.007).

Conclusion

Circulating SeP levels were increased in subjects with NAFLD as well as in those with visceral obesity and may be a novel biomarker for NAFLD.

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Predictive Clinical Parameters and Glycemic Efficacy of Vildagliptin Treatment in Korean Subjects with Type 2 Diabetes
Jin-Sun Chang, Juyoung Shin, Hun-Sung Kim, Kyung-Hee Kim, Jeong-Ah Shin, Kun-Ho Yoon, Bong-Yun Cha, Ho-Young Son, Jae-Hyoung Cho
Diabetes Metab J. 2013;37(1):72-80.   Published online February 15, 2013
DOI: https://doi.org/10.4093/dmj.2013.37.1.72
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AbstractAbstract PDFPubReader   
Background

The aims of this study are to investigate the glycemic efficacy and predictive parameters of vildagliptin therapy in Korean subjects with type 2 diabetes.

Methods

In this retrospective study, we retrieved data for subjects who were on twice-daily 50 mg vildagliptin for at least 6 months, and classified the subjects into five treatment groups. In three of the groups, we added vildagliptin to their existing medication regimen; in the other two groups, we replaced one of their existing medications with vildagliptin. We then analyzed the changes in glucose parameters and clinical characteristics.

Results

Ultimately, 327 subjects were analyzed in this study. Vildagliptin significantly improved hemoglobin A1c (HbA1c) levels over 6 months. The changes in HbA1c levels (ΔHbA1c) at month 6 were -2.24% (P=0.000), -0.77% (P=0.000), -0.80% (P=0.001), -0.61% (P=0.000), and -0.34% (P=0.025) for groups 1, 2, 3, 4, and 5, respectively, with significance. We also found significant decrements in fasting plasma glucose levels in groups 1, 2, 3, and 4 (P<0.05). Of the variables, initial HbA1c levels (P=0.032) and history of sulfonylurea use (P=0.026) were independently associated with responsiveness to vildagliptin treatment.

Conclusion

Vildagliptin was effective when it was used in subjects with poor glycemic control. It controlled fasting plasma glucose levels as well as sulfonylurea treatment in Korean type 2 diabetic subjects.

Citations

Citations to this article as recorded by  
  • Predictive clinical parameters for the hemoglobin A1c-lowering effect of vildagliptin in Japanese patients with type 2 diabetes
    Yukihiro Bando, Masayuki Yamada, Keiko Aoki, Hideo Kanehara, Azusa Hisada, Kazuhiro Okafuji, Daisyu Toya, Nobuyoshi Tanaka
    Diabetology International.2014; 5(4): 229.     CrossRef
  • The Efficacy of Vildagliptin in Korean Patients with Type 2 Diabetes
    Jun Sung Moon, Kyu Chang Won
    Diabetes & Metabolism Journal.2013; 37(1): 36.     CrossRef
Letter
Letter: The Risk of Bladder Cancer in Korean Diabetic Subjects Treated with Pioglitazone (Diabetes Metab J 2012;36:371-8)
Sheyu Li, Haoming Tian
Diabetes Metab J. 2013;37(1):81-82.   Published online February 15, 2013
DOI: https://doi.org/10.4093/dmj.2013.37.1.81
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  • 31 Download
  • 2 Crossref
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Citations

Citations to this article as recorded by  
  • Thiazolidinedione drugs in the treatment of type 2 diabetes mellitus: past, present and future
    Melissa A. Davidson, Donald R. Mattison, Laurent Azoulay, Daniel Krewski
    Critical Reviews in Toxicology.2018; 48(1): 52.     CrossRef
  • Pioglitazone: Hype and hope
    SS Jadhav, TR Bandgar, VK Shivane, AR Lila, NS Shah
    Journal of Postgraduate Medicine.2014; 60(3): 293.     CrossRef
Response
Response: The Risk of Bladder Cancer in Korean Diabetic Subjects Treated with Pioglitazone (Diabetes Metab J 2012;36:371-8)
Kwang Joon Kim, Sun Ok Song, Byung-Wan Lee
Diabetes Metab J. 2013;37(1):83-84.   Published online February 15, 2013
DOI: https://doi.org/10.4093/dmj.2013.37.1.83
  • 3,311 View
  • 30 Download
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