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Volume 39(4); August 2015
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Reviews
Glycemic Variability: How Do We Measure It and Why Is It Important?
Sunghwan Suh, Jae Hyeon Kim
Diabetes Metab J. 2015;39(4):273-282.   Published online August 17, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.4.273
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AbstractAbstract PDFPubReader   

Chronic hyperglycemia is the primary risk factor for the development of complications in diabetes mellitus (DM); however, it is believed that frequent or large glucose fluctuations may independently contribute to diabetes-related complications. Postprandial spikes in blood glucose, as well as hypoglycemic events, are blamed for increased cardiovascular events in DM. Glycemic variability (GV) includes both of these events; hence, minimizing GV can prevent future cardiovascular events. Correcting GV emerges as a target to be pursued in clinical practice to safely reduce the mean blood glucose and to determine its direct effects on vascular complications in diabetes. Modern diabetes management modalities, including glucagon-related peptide-1-based therapy, newer insulins, modern insulin pumps and bariatric surgery, significantly reduce GV. However, defining GV remains a challenge primarily due to the difficulty of measuring it and the lack of consensus regarding the optimal approach for its management. The purpose of this manuscript was not only to review the most recent evidence on GV but also to help readers better understand the available measurement options and how the various definitions relate differently to the development of diabetic complications.

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Peripheral Arterial Disease in Patients with Type 2 Diabetes Mellitus
Sang Youl Rhee, Young Seol Kim
Diabetes Metab J. 2015;39(4):283-290.   Published online August 17, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.4.283
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AbstractAbstract PDFPubReader   

Peripheral arterial disease (PAD) in patients with type 2 diabetes mellitus (T2DM) exhibits broad clinical characteristics and various consequences and is known as one of the major macrovascular complications of T2DM. Atherosclerosis is recognized as the most direct and important cause of PAD, but acute or chronic limb ischemia may be the result of various risk factors. In light of the increasing number of patients who undergo peripheral vascular procedures, the number of subjects who are exposed to the risks for PAD and related complications is increasing. In this review, we will discuss the clinical and epidemiological characteristics of PAD, as well as the clinical significance of PAD in T2DM subjects.

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Probiotics as Complementary Treatment for Metabolic Disorders
Mélanie Le Barz, Fernando F. Anhê, Thibaut V. Varin, Yves Desjardins, Emile Levy, Denis Roy, Maria C. Urdaci, André Marette
Diabetes Metab J. 2015;39(4):291-303.   Published online August 17, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.4.291
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AbstractAbstract PDFPubReader   

Over the past decade, growing evidence has established the gut microbiota as one of the most important determinants of metabolic disorders such as obesity and type 2 diabetes. Indeed, obesogenic diet can drastically alter bacterial populations (i.e., dysbiosis) leading to activation of pro-inflammatory mechanisms and metabolic endotoxemia, therefore promoting insulin resistance and cardiometabolic disorders. To counteract these deleterious effects, probiotic strains have been developed with the aim of reshaping the microbiome to improve gut health. In this review, we focus on benefits of widely used probiotics describing their potential mechanisms of action, especially their ability to decrease metabolic endotoxemia by restoring the disrupted intestinal mucosal barrier. We also discuss the perspective of using new bacterial strains such as butyrate-producing bacteria and the mucolytic Akkermansia muciniphila, as well as the use of prebiotics to enhance the functionality of probiotics. Finally, this review introduces the notion of genetically engineered bacterial strains specifically developed to deliver anti-inflammatory molecules to the gut.

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Editorial
Effects of Sitagliptin on Insulin and Glucagon Levels in Type 2 Diabetes Mellitus
Ji Hyun Kim
Diabetes Metab J. 2015;39(4):304-306.   Published online August 17, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.4.304
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PDFPubReader   

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    Omar Hegazi, Samer Alalalmeh, Moyad Shahwan, Ammar Jairoun, Mansour Alourfi, Ghfran Bokhari, Abdullah Alkhattabi, Saeed Alsharif, Mohannad Aljehani, Abdulmalik Alsabban, Mohammad Almtrafi, Ysear Zakri, Abdullah AlMahmoud, Khalid Alghamdi, Ahmed Ashour, Na
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Original Articles
Current Status of Management in Type 2 Diabetes Mellitus at General Hospitals in South Korea
Jin-Hee Jung, Jung-Hwa Lee, Jin-Won Noh, Jeong-Eun Park, Hee-Sook Kim, Joo-Wha Yoo, Bok-Rye Song, Jeong-rim Lee, Myeong-Hee Hong, Hyang-Mi Jang, Young Na, Hyun-Joo Lee, Jeong-Mi Lee, Yang-Gyo Kang, Sun-Young Kim, Kang-Hee Sim
Diabetes Metab J. 2015;39(4):307-315.   Published online August 17, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.4.307
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AbstractAbstract PDFPubReader   
Background

In Korea, the prevalence, complications, and mortality rate of diabetes are rapidly increasing. However, investigations on the actual condition of diabetes management are very limited due to lack of nation-wide research or multicenter study. Hence, we have minutely inquired the current status of diabetes management and achievement of glucose target goal in general hospital offering education program. That way, we are able to furnish data for policy making of diabetes education and draw up guideline which may allow us to reduce the morbidity and mortality of diabetes.

Methods

The subjects consisted of 2,610 patients with type 2 diabetes who visited the 13 general hospital in Seoul or Gyeonggi region from March 19 to May 29, 2013. General characteristics, associated diseases, complications, and management status were investigated.

Results

The mean age was 61.0±11.6 years, body mass index was 25.0±3.3 kg/m2, and family history of diabetes was 50.5%. The mean duration of diabetes was 10.7±7.9 years and 53% received education about diabetes. The prevalence of hypertension and dyslipidemia were 59.2% and 65.5%, respectively, and 18.3% of the subjects were accompanied by liver disease. Diabetic retinopathy appeared in 31.6%, nephropathy in 28.1%, and neuropathy in 19.9% of the subjects. The mean glycosylated hemoglobin (HbA1c) level was 7.3%±1.3% and the achieving rate based on Korean Diabetes Association guideline (HbA1c <6.5%) was 24.8%, blood pressure (130/80 mm Hg or less) was 49.4%, and low density lipoprotein cholesterol (<100 mg/dL) was 63.6%. The reaching rate to the target level in four parameters (blood glucose, blood pressure, lipids, and body weight) was 7.8%.

Conclusion

The blood glucose control rate was lower than other parameters, and the implementation rate of diabetes education was only 53%. Thus more appropriate glucose control and systematic diabetes education are imperative.

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    Jin Hee Jung, Jung Hwa Lee, Hyang Mi Jang, Young Na, Hee Sun Choi, Yeon Hee Lee, Yang Gyo Kang, Na Rae Kim, Jeong Rim Lee, Bok Rye Song, Kang Hee Sim
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    Young-Hoon Lee
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    Soo Kyoung Kim, Jaehoon Jung, Jung Hwa Jung, Byong Won Lee, Sang Soo Kang, Gu Seob Roh, Jong Ryeal Hahm
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    Thilak Priyantha Weerarathna, Miyuru Kavinda Weerarathna, Vidarsha Senadheera, Herath Mudiyanselage Meththananda Herath, Gayani Liyanage
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    Sejeong Park, Sang Youl Rhee, Su Jin Jeong, Kiyoung Kim, Suk Chon, Seung-Young Yu, Jeong-Taek Woo
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    Zijian Li, Haimin Jin, Wei Chen, Zilin Sun, Lulu Jing, Xiaohui Zhao, Sainan Zhu, Xiaohui Guo, China NEEDs Study Group
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    Jung Min Kim, Jae Won Hong, Jung Hyun Noh, Dong-Jun Kim
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Maternal and Neonatal Outcomes in Korean Women with Type 1 and Type 2 Diabetes
Hee-Sook Kim, Hye-Jung Jang, Jeong-Eun Park, Moon-Young Kim, Sun-Young Ko, Sung-Hoon Kim
Diabetes Metab J. 2015;39(4):316-320.   Published online August 17, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.4.316
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AbstractAbstract PDFPubReader   
Background

The purpose of this study was to evaluate maternal and neonatal outcomes in Korean women with type 1 diabetes and type 2 diabetes.

Methods

We performed a retrospective survey of 163 pregnancies in women with type 1 diabetes (n=13) and type 2 diabetes (n=150) treated from 2003 to 2010 at Cheil General Hospital & Women's Healthcare Center, Korea. We compared maternal characteristics as well as maternal and neonatal outcomes between groups.

Results

Differences in glycosylated hemoglobin between type 1 and type 2 diabetes were not significant. Birth weight (3,501±689.6 g vs. 3,366±531.4 g) and rate of major congenital malformations (7.7% vs. 5.6%) were not significantly different. However, women with type 1 diabetes had higher rates of preeclampsia (38.5% vs. 8.2%, P=0.006), large for gestational age (LGA; 46.2% vs. 20.4%, P=0.004), macrosomia (38.5% vs. 13.4%, P=0.032), and admission for neonatal care (41.7% vs. 14.8%, P=0.03) than women with type 2 diabetes.

Conclusion

Maternal and neonatal outcomes for women with type 1 diabetes were poorer than for women with type 2 diabetes, especially preeclampsia, LGA, macrosomia and admission to the neonatal intensive care unit.

Citations

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    Aycan Celik, Rita Forde, Simona Racaru, Angus Forbes, Jackie Sturt
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Agreement between Framingham Risk Score and United Kingdom Prospective Diabetes Study Risk Engine in Identifying High Coronary Heart Disease Risk in North Indian Population
Dipika Bansal, Ramya S. R. Nayakallu, Kapil Gudala, Rajavikram Vyamasuni, Anil Bhansali
Diabetes Metab J. 2015;39(4):321-327.   Published online July 8, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.4.321
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AbstractAbstract PDFPubReader   
Background

The aim of the study is to evaluate the concurrence between Framingham Risk score (FRS) and United Kingdom Prospective Diabetes Study (UKPDS) risk engine in identifying coronary heart disease (CHD) risk in newly detected diabetes mellitus patients and to explore the characteristics associated with the discrepancy between them.

Methods

A cross-sectional study involving 489 subjects newly diagnosed with type 2 diabetes mellitus was conducted. Agreement between FRS and UKPDS in classifying patients as high risk was calculated using kappa statistic. Subjects with discrepant scores between two algorithms were identified and associated variables were determined.

Results

The FRS identified 20.9% subjects (range, 17.5 to 24.7) as high-risk while UKPDS identified 21.75% (range, 18.3 to 25.5) as high-risk. Discrepancy was observed in 17.9% (range, 14.7 to 21.7) subjects. About 9.4% had high risk by UKPDS but not FRS, and 8.6% had high risk by FRS but not UKPDS. The best agreement was observed at high-risk threshold of 20% for both (κ=0.463). Analysis showed that subjects having high risk on FRS but not UKPDS were elderly females having raised systolic and diastolic blood pressure. Patients with high risk on UKPDS but not FRS were males and have high glycosylated hemoglobin.

Conclusion

The FRS and UKPDS (threshold 20%) identified different populations as being at high risk, though the agreement between them was fairly good. The concurrence of a number of factors (e.g., male sex, low high density lipoprotein cholesterol, and smoking) in both algorithms should be regarded as increasing the CHD risk. However, longitudinal follow-up is required to form firm conclusions.

Citations

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Maximal Fat Oxidation Rate during Exercise in Korean Women with Type 2 Diabetes Mellitus
Min Hwa Suk, Yeo-Jin Moon, Sung Woo Park, Cheol-Young Park, Yun A Shin
Diabetes Metab J. 2015;39(4):328-334.   Published online July 8, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.4.328
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AbstractAbstract PDFPubReader   
Background

The purpose of this study was to determine the appropriate exercise intensity associated with maximum fat oxidation, improvement of body composition, and metabolic status in Korean women with type 2 diabetes mellitus (T2DM).

Methods

The study included a T2DM group (12 women) and a control group (12 women). The groups were matched in age and body mass index. The subjects performed a graded exercise test on a cycle ergometer to measure their maximal fat oxidation (Fatmax). We also measured their body composition, metabolic profiles, and mitochondrial DNA (mtDNA).

Results

The exercise intensity for Fatmax was significantly lower in the T2DM group (34.19% maximal oxygen uptake [VO2 max]) than the control group (51.80% VO2 max). Additionally, the rate of fat oxidation during exercise (P<0.05) and mtDNA (P<0.05) were significantly lower in the T2DM group than the control group. The VO2 max level (P<0.001) and the insulin level (P<0.05) were positively correlated with the rate of fat oxidation.

Conclusion

The results of this study suggest lower exercise intensity that achieves Fatmax is recommended for improving fat oxidation and enhancing fitness levels in Korean women with T2DM. Our data could be useful when considering an exercise regimen to improve health and fitness.

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Effects of 6-Month Sitagliptin Treatment on Insulin and Glucagon Responses in Korean Patients with Type 2 Diabetes Mellitus
Hae Kyung Yang, Borami Kang, Seung-Hwan Lee, Hun-Sung Kim, Kun-Ho Yoon, Bong-Yun Cha, Jae-Hyoung Cho
Diabetes Metab J. 2015;39(4):335-341.   Published online July 17, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.4.335
  • 3,658 View
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AbstractAbstract PDFPubReader   
Background

This study aimed to evaluate the effect of sitagliptin, an oral dipeptidyl peptidase-4 inhibitor, on insulin secretion and glucagon suppression in Korean subjects with type 2 diabetes mellitus.

Methods

Twenty-four subjects underwent a 75-g oral glucose tolerance test (OGTT) before and after 6 months of sitagliptin treatment. Sitagliptin, insulin, and sulfonylurea were withdrawn for 3 days before OGTT to eliminate any acute effects on β-cell insulin or α-cell glucagon secretion. Venous samples were drawn five times during each OGTT to measure plasma glucose, insulin, and glucagon. Indices on insulin secretion and resistance were calculated.

Results

Early phase insulin secretion, measured by the insulinogenic index significantly increased after 6 months of sitagliptin treatment, especially in the higher baseline body mass index group and higher baseline glycosylated hemoglobin (HbA1c) group. There were no significant differences in the insulin resistance indices before and after sitagliptin treatment. Although no significant differences were observed in the absolute levels of glucagon and the glucagon-to-insulin ratio, there was a significant reduction in the percentile change of glucagon-to-insulin ratio at 30- and 120-minute during the OGTT.

Conclusion

Although the HbA1c level did not decrease significantly after 6 months of sitagliptin treatment, an increase in insulin secretion and reduction in early phase postprandial plasma glucagon-to-insulin ratio excursion was confirmed in Korean subjects with type 2 diabetes.

Citations

Citations to this article as recorded by  
  • A genetic variant in GLP1R is associated with response to DPP-4 inhibitors in patients with type 2 diabetes
    Eugene Han, Hye Sun Park, Obin Kwon, Eun Yeong Choe, Hye Jin Wang, Yong-ho Lee, Sang-Hak Lee, Chul Hoon Kim, Lee-Kyung Kim, Soo Heon Kwak, Kyong Soo Park, Chul Sik Kim, Eun Seok Kang
    Medicine.2016; 95(44): e5155.     CrossRef
  • Effects of sitagliptin on circulating zinc-α2-glycoprotein levels in newly diagnosed type 2 diabetes patients: a randomized trial
    Mingyuan Tian, Zerong Liang, Rui Liu, Ke Li, Xinrong Tan, Yong Luo, Mengliu Yang, Harvest F Gu, Hua Liu, Ling Li, Gangyi Yang
    European Journal of Endocrinology.2016; 174(2): 147.     CrossRef
  • Effects of Sitagliptin on Insulin and Glucagon Levels in Type 2 Diabetes Mellitus
    Ji Hyun Kim
    Diabetes & Metabolism Journal.2015; 39(4): 304.     CrossRef
Predictive Factors for Efficacy of Dipeptidyl Peptidase-4 Inhibitors in Patients with Type 2 Diabetes Mellitus
Shusuke Yagi, Ken-ichi Aihara, Masashi Akaike, Daiju Fukuda, Hotimah Masdan Salim, Masayoshi Ishida, Tomomi Matsuura, Takayuki Ise, Koji Yamaguchi, Takashi Iwase, Hirotsugu Yamada, Takeshi Soeki, Tetsuzo Wakatsuki, Michio Shimabukuro, Toshio Matsumoto, Masataka Sata
Diabetes Metab J. 2015;39(4):342-347.   Published online July 21, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.4.342
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Background

Predictive factors for the efficacy of dipeptidyl peptidase-4 (DPP-4) inhibitors for lowering glycosylated hemoglobin (HbA1c) remain unclear in patients with type 2 diabetes mellitus. The aim of this study is therefore to clarify predictive factors of the efficacy of DPP-4 inhibitors for lowering HbA1c after 12 months of treatment.

Methods

A total of 191 consecutive type 2 diabetic patients (male sex 55%, mean age, 68.3±35.8 years), who had been treated with DPP-4 inhibitors for 12 months, were enrolled in this study and evaluated retrospectively.

Results

After 12 months of DPP-4 inhibitor treatment, random blood glucose level, and HbA1c level, decreased from 167±63 to 151±49 mg/dL (P<0.01), and from 7.5%±1.3% to 6.9%±0.9% (P<0.01) respectively, without severe side effects. Multiple regression analysis showed that predictors of DPP-4 inhibitor treatment efficacy in lowering HbA1c level after 12 months were a decrease in HbA1c level after 3 months of treatment, a high baseline HbA1c level, a low baseline body mass index, and the absence of coronary artery disease.

Conclusion

Most suitable candidates for treatment with DPP-4 inhibitors are diabetics who are not obese and do not have coronary artery disease. In addition, long-term efficacy of DPP-4 inhibitors can be predicted by decrement of HbA1c after 3 months of treatment.

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    Frontiers in Endocrinology.2022;[Epub]     CrossRef
  • Dipeptidyl peptidase‐4 inhibitor, anagliptin, alters hepatic insulin clearance in relation to the glycemic status in Japanese individuals with type 2 diabetes
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    Yuli Cai, Tianshu Zeng, Zhongyuan Wen, Lulu Chen
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    Anna A. Mosikian, Alina Y. Babenko, Yulia A. Sevastyanova, Roman V. Drai, Evgenij V. Shlyakhto
    Diabetes mellitus.2018; 21(5): 333.     CrossRef
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    Guang Ning, Tushar Bandgar, Uwe Hehnke, Jisoo Lee, Juliana C. N. Chan
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  • Potential regulatory mechanisms of lncRNA in diabetes and its complications
    Shui-Dong Feng, Ji-Hua Yang, Chao Hua Yao, Si-Si Yang, Ze-Mei Zhu, Di Wu, Hong-Yan Ling, Liang Zhang
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  • Letter: Predictive Factors for Efficacy of Dipeptidyl Peptidase-4 Inhibitors in Patients with Type 2 Diabetes Mellitus (Diabetes Metab J2015;39:342-7)
    Ye An Kim
    Diabetes & Metabolism Journal.2015; 39(5): 444.     CrossRef
  • Response: Predictive Factors for Efficacy of Dipeptidyl Peptidase-4 Inhibitors in Patients with Type 2 Diabetes Mellitus (Diabetes Metab J2015;39:342-7)
    Shusuke Yagi, Ken-ichi Aihara, Masataka Sata
    Diabetes & Metabolism Journal.2015; 39(5): 446.     CrossRef
Letter
Letter: Increased Risk of Hospitalization for Heart Failure with Newly Prescribed Dipeptidyl Peptidase-4 Inhibitors and Pioglitazone Using the Korean Health Insurance Claims Database (Diabetes Metab J 2015;39:247-52)
Dae Ho Lee
Diabetes Metab J. 2015;39(4):348-349.   Published online August 17, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.4.348
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Citations

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Response
Response: Increased Risk of Hospitalization for Heart Failure with Newly Prescribed Dipeptidyl Peptidase-4 Inhibitors and Pioglitazone Using the Korean Health Insurance Claims Database (Diabetes Metab J 2015;39:247-52)
Sunghwan Suh, Gi Hyeon Seo, Chang Hee Jung, Mee-Kyoung Kim, Sang-Man Jin, You-Cheol Hwang, Byung-Wan Lee, Jae Hyeon Kim
Diabetes Metab J. 2015;39(4):350-351.   Published online August 17, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.4.350
  • 3,220 View
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Diabetes Metab J : Diabetes & Metabolism Journal