Diabetes & Metabolism Journal

Original Articles

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Glycemic Benefit of Insulin Degludec/Insulin Aspart Compared to Basal Insulin in Type 2 Diabetes Mellitus Associated with Impaired Glucagon-Like Peptide-1 Response: A Randomized Crossover Trial: Han Na Jang, Eun Shil Hong, Ye Seul Yang, Seong Ok Lee, Myoung-jin Jang, Andrea Mari, Soo Heon Kwak, Kyong Soo Park, Hak Chul Jang, Hye Seung Jung; Received November 21, 2024 Accepted April 28, 2025 Published online August 14, 2025; DOI: https://doi.org/10.4093/dmj.2024.0741 [Epub ahead of print]

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Abstract PDF Supplementary Material PubReader ePub: Background
We aimed to confirm that once-daily insulin degludec/insulin aspart (IDegAsp) is superior to basal insulin therapy in participants with type 2 diabetes mellitus (T2DM) exhibiting signs of overbasalization. Additionally, we analyzed incretin profiles in relation to the benefits of IDegAsp, providing insights into the underlying mechanisms.
Methods
A prospective study was conducted in participants receiving basal insulin therapy, with a fasting plasma glucose (FPG) level lower than predicted from their glycosylated hemoglobin (HbA1c). Participants were randomly assigned to either IDegAsp or insulin glargine (IGlar) in a 1:1 ratio. After 20 weeks of treatment, the insulins were switched in a crossover design. The primary endpoint was the change in HbA1c from baseline. Incretin profiles, hypoglycemic events, and continuous glucose monitoring (CGM) were also analyzed (Trial registration: www.cris.nih.go.kr; KCT0004597).
Results
The study included 55 participants (male 40%, mean age 65 years, FPG 103 mg/dL, and HbA1c 8.3%). HbA1c significantly decreased to 7.8%±0.8% with IDegAsp, compared to 8.0%±0.7% with IGlar. The mean estimated treatment difference of changes was –0.21% points (95% confidence interval, –0.39 to –0.02; P=0.031), favoring IDegAsp. Hypoglycemic events were comparable. CGM demonstrated significantly lower glucose measures during the daytime with IDegAsp compared to IGlar, and vice versa at dawn. The HbA1c benefit of IDegAsp over IGlar was associated with a low glucagon-like peptide-1 (GLP-1) ratio at 30 minutes relative to baseline (r=0.301, P=0.040), while not with glucose-dependent insulinotropic polypeptide.
Conclusion
The greater reduction in HbA1c achieved with IDegAsp compared to IGlar in individuals with T2DM was associated with an impaired GLP-1 response, facilitating personalized insulin therapy.

Drug/Regimen
Efficacy and Safety of IDegAsp in a Real-World Korean Population with Type 2 Diabetes Mellitus: Shinae Kang, Yu-Bae Ahn, Tae Keun Oh, Won-Young Lee, Sung Wan Chun, Boram Bae, Amine Dahaoui, Jin Sook Jeong, Sungeun Jung, Hak Chul Jang; Diabetes Metab J. 2024;48(5):929-936. Published online February 27, 2024; DOI: https://doi.org/10.4093/dmj.2023.0297

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Background
This study investigated the real-world efficacy and safety of insulin degludec/insulin aspart (IDegAsp) in Korean adults with type 2 diabetes mellitus (T2DM), whose insulin treatment was switched to IDegAsp.
Methods
This was a multicenter, retrospective, observational study comprising two 26-week treatment periods, before and after switching to IDegAsp, respectively. Korean adults with uncontrolled T2DM treated with basal or premix insulin (±oral antidiabetic drugs) were enrolled. The primary objective was to compare the degree of glycosylated hemoglobin (HbA1c) change in each 26-week observation period. The analyses included changes in HbA1c, fasting plasma glucose (FPG), body weight, proportion of participants achieving HbA1c <7.0%, hypoglycemic events, and total daily insulin dose (ClinicalTrials.gov, number NCT04656106).
Results
In total, 196 adults (mean age, 65.95 years; mean T2DM duration, 18.99 years) were analyzed. The change in both HbA1c and FPG were significantly different between the pre-switching and the post-switching period (0.28% vs. –0.51%, P<0.001; 5.21 mg/dL vs. –23.10 mg/dL, P=0.005), respectively. After switching, the rate of achieving HbA1c <7.0% was significantly improved (5.10% at baseline vs. 11.22% with IDegAsp, P=0.012). No significant differences (before vs. after switching) were observed in body weight change, and total daily insulin dose. The rates of overall and severe hypoglycemia were similar in the two periods.
Conclusion
In real-world clinical practice in Korea, the change of insulin regimen to IDegAsp was associated with an improvement in glycemic control without increase of hypoglycemia, supporting the use of IDegAsp for patients with T2DM uncontrolled with basal or premix insulin.

Citations

Citations to this article as recorded by

Switching to insulin degludec/aspart penfill reusable cartridges in patients with type 2 diabetes mellitus: real-life outcomes
Sezin Dogan Çakır, Hatice Deniz Yücel, Zeynep Akgül Kızılçay, Mine Adaş
Diabetology & Metabolic Syndrome.2025;[Epub] CrossRef
Efficacy and safety of insulin degludec/aspart in patients with type 2 and type 1 diabetes mellitus: real-world evidence from Indonesia
Hendra Zufry, Krishna Wardhana Sucipto, Agustia Sukri Ekadamayanti, Qanita Iqbal
Frontiers in Endocrinology.2025;[Epub] CrossRef
Switching from Premixed Insulin to Insulin Degludec/Insulin Aspart for the Management of Type 2 Diabetes Mellitus: Implications of a Real-World Study on Insulin Degludec Dosing
Yiming Wu, Junqing Zhang, Ang Li
Diabetes Therapy.2024; 15(12): 2515. CrossRef

Metabolic Risk/Epidemiology
Higher Muscle Mass Protects Women with Gestational Diabetes Mellitus from Progression to Type 2 Diabetes Mellitus: Yujin Shin, Joon Ho Moon, Tae Jung Oh, Chang Ho Ahn, Jae Hoon Moon, Sung Hee Choi, Hak Chul Jang; Diabetes Metab J. 2022;46(6):890-900. Published online April 28, 2022; DOI: https://doi.org/10.4093/dmj.2021.0334

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Background
We evaluated whether postpartum muscle mass affects the risk of type 2 diabetes mellitus (T2DM) in Korean women with gestational diabetes mellitus (GDM).
Methods
A total of 305 women with GDM (mean age, 34.9 years) was prospectively evaluated for incident prediabetes and T2DM from 2 months after delivery and annually thereafter. Appendicular skeletal muscle mass (ASM) was assessed with bioelectrical impedance analysis at the initial postpartum visit, and ASM, either divided by body mass index (BMI) or squared height, and the absolute ASM were used as muscle mass indices. The risk of incident prediabetes and T2DM was assessed according to tertiles of these indices using a logistic regression model.
Results
After a mean follow-up duration of 3.3 years, the highest ASM/BMI tertile group had a 61% lower risk of incident prediabetes and T2DM compared to the lowest tertile group, and this remained significant after we adjusted for covariates (adjusted odds ratio, 0.37; 95% confidence interval [CI], 0.15 to 0.92; P=0.032). Equivalent findings were observed in normal weight women (BMI <23 kg/m²), but this association was not significant for overweight women (BMI ≥23 kg/m²). Absolute ASM or ASM/height² was not associated with the risk of postpartum T2DM.
Conclusion
A higher muscle mass, as defined by the ASM/BMI index, was associated with a lower risk of postpartum prediabetes and T2DM in Korean women with GDM.

Citations

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Fang Wang, Yuan-Yuan Bao, Kang Yu
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Correlation of body composition in early pregnancy on gestational diabetes mellitus under different body weights before pregnancy
Li Xintong, Xu Dongmei, Zhang Li, Cao Ruimin, Hao Yide, Cui Lingling, Chen Tingting, Guo Yingying, Li Jiaxin
Frontiers in Endocrinology.2022;[Epub] CrossRef

Review

Metabolic Risk/Epidemiology
Gestational Diabetes Mellitus: Diagnostic Approaches and Maternal-Offspring Complications: Joon Ho Moon, Hak Chul Jang; Diabetes Metab J. 2022;46(1):3-14. Published online January 27, 2022; DOI: https://doi.org/10.4093/dmj.2021.0335

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Graphical Abstract Abstract PDF PubReader ePub

Gestational diabetes mellitus (GDM) is the most common complication during pregnancy and is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. GDM is associated with adverse pregnancy outcomes and long-term offspring and maternal complications. For GDM screening and diagnosis, a two-step approach (1-hour 50 g glucose challenge test followed by 3-hour 100 g oral glucose tolerance test) has been widely used. After the Hyperglycemia and Adverse Pregnancy Outcome study implemented a 75 g oral glucose tolerance test in all pregnant women, a one-step approach was recommended as an option for the diagnosis of GDM after 2010. The one-step approach has more than doubled the incidence of GDM, but its clinical benefit in reducing adverse pregnancy outcomes remains controversial. Long-term complications of mothers with GDM include type 2 diabetes mellitus and cardiovascular disease, and complications of their offspring include childhood obesity and glucose intolerance. The diagnostic criteria of GDM should properly classify women at risk for adverse pregnancy outcomes and long-term complications. The present review summarizes the strengths and weaknesses of the one-step and two-step approaches for the diagnosis of GDM based on recent randomized controlled trials and observational studies. We also describe the long-term maternal and offspring complications of GDM.

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Original Articles

Technology/Device
Glucose Profiles Assessed by Intermittently Scanned Continuous Glucose Monitoring System during the Perioperative Period of Metabolic Surgery: Kyuho Kim, Sung Hee Choi, Hak Chul Jang, Young Suk Park, Tae Jung Oh; Diabetes Metab J. 2022;46(5):713-721. Published online January 24, 2022; DOI: https://doi.org/10.4093/dmj.2021.0164

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Background
Continuous glucose monitoring (CGM) has been widely used in the management of diabetes. However, the usefulness and detailed data during perioperative status were not well studied. In this study, we described the immediate changes of glucose profiles after metabolic surgery using intermittently scanned CGM (isCGM) in individuals with type 2 diabetes mellitus (T2DM).
Methods
This was a prospective, single-center, single-arm study including 20 participants with T2DM. The isCGM (FreeStyle Libre CGM) implantation was performed within 2 weeks before surgery. We compared CGM metrics of 3 days before surgery and 3 days after surgery, and performed the correlation analyses with clinical variables.
Results
The mean glucose significantly decreased after surgery (147.0±40.4 to 95.5±17.1 mg/dL, P<0.001). Time in range (TIR; 70 to 180 mg/dL) did not significantly change after surgery in total. However, it was significantly increased in a subgroup of individuals with glycosylated hemoglobin (HbA1c) ≥8.0%. Time above range (>250 or 180 mg/dL) was significantly decreased in total. In contrast, time below range (<70 or 54 mg/dL) was significantly increased in total and especially in a subgroup of individuals with HbA1c <8.0% after surgery. The coefficient of variation significantly decreased after surgery. Higher baseline HbA1c was correlated with greater improvement in TIR (rho=0.607, P=0.005).
Conclusion
The isCGM identified improvement of mean glucose and glycemic variability, and increase of hypoglycemia after metabolic surgery, but TIR was not significantly changed after surgery. We detected an increase of TIR only in individuals with HbA1c ≥8.0%.

Citations

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Sang-Man Jin
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Complications
SUDOSCAN in Combination with the Michigan Neuropathy Screening Instrument Is an Effective Tool for Screening Diabetic Peripheral Neuropathy: Tae Jung Oh, Yoojung Song, Hak Chul Jang, Sung Hee Choi; Diabetes Metab J. 2022;46(2):319-326. Published online September 16, 2021; DOI: https://doi.org/10.4093/dmj.2021.0014

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Background
Screening for diabetic peripheral neuropathy (DPN) is important to prevent severe foot complication, but the detection rate of DPN is unsatisfactory. We investigated whether SUDOSCAN combined with Michigan Neuropathy Screening Instrument (MNSI) could be an effective tool for screening for DPN in people with type 2 diabetes mellitus (T2DM) in clinical practice.
Methods
We analysed the data for 144 people with T2DM without other cause of neuropathy. The presence of DPN was confirmed according to the Toronto Consensus criteria. Electrochemical skin conductance (ESC) of the feet was assessed using SUDOSCAN. We compared the discrimination power of following methods, MNSI only vs. SUDOSCAN only vs. MNSI plus SUDOSCAN vs. MNSI plus 10-g monofilament test.
Results
Confirmed DPN was detected in 27.8% of the participants. The optimal cut-off value of feet ESC to distinguish DPN was 56 μS. We made the DPN screening scores using the corresponding odds ratios for MNSI-Questionnaire, MNSI-Physical Examination, SUDOSCAN, and 10-g monofilament test. For distinguishing the presence of DPN, the MNSI plus SUDOSCAN model showed higher areas under the receiver operating characteristic curve (AUC) than MNSI only model (0.717 vs. 0.638, P=0.011), and SUDOSCAN only model or MNSI plus 10-g monofilament test showed comparable AUC with MNSI only model.
Conclusion
The screening model for DPN that includes both MNSI and SUDOSCAN can detect DPN with acceptable discrimination power and it may be useful in Korean patients with T2DM.

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Andra-Elena Nica, Emilia Rusu, Carmen Dobjanschi, Florin Rusu, Claudia Sivu, Oana Andreea Parliteanu, Ioana Verde, Andreea Andrita, Gabriela Radulian
Diabetology.2026; 7(4): 63. CrossRef
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Cristina Mocanu (Chitan), Teodor Salmen, Anca Pantea Stoian, Cristian Serafinceanu
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Sijia Fei, Jingwen Fan, Jiaming Cao, Huan Chen, Xiaoxia Wang, Qi Pan
Diabetes Research and Clinical Practice.2024; 209: 111585. CrossRef
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Okti Sri Purwanti, Nursalam Nursalam, Moses Glorino Rumambo Pandin
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Raffaele Galiero, Alfredo Caturano, Erica Vetrano, Domenico Beccia, Chiara Brin, Maria Alfano, Jessica Di Salvo, Raffaella Epifani, Alessia Piacevole, Giuseppina Tagliaferri, Maria Rocco, Ilaria Iadicicco, Giovanni Docimo, Luca Rinaldi, Celestino Sardu, T
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Electrochemical skin conductances values and clinical factors affecting sudomotor dysfunction in patients with prediabetes, type 1 diabetes, and type 2 diabetes: A single center experience
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The Journal of Korean Diabetes.2023; 24(2): 71. CrossRef
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Jean-Pierre Riveline, Roberto Mallone, Clarisse Tiercelin, Fetta Yaker, Laure Alexandre-Heymann, Lysa Khelifaoui, Florence Travert, Claire Fertichon, Jean-Baptiste Julla, Tiphaine Vidal-Trecan, Louis Potier, Jean-Francois Gautier, Etienne Larger, Jean-Pas
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COVID-19
Effects of Social Distancing on Diabetes Management in Older Adults during COVID-19 Pandemic: Soo Myoung Shin, Tae Jung Oh, Sung Hee Choi, Hak Chul Jang; Diabetes Metab J. 2021;45(5):765-772. Published online August 30, 2021; DOI: https://doi.org/10.4093/dmj.2021.0096

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Background
On March 22, 2020, intense social distancing (SD) was implemented in Korea to prevent the spread of coronavirus disease 19 (COVID-19). This study examined the impact of SD on diabetes control in older adults with diabetes.
Methods
Adults aged 60 to 90 years with type 2 diabetes mellitus who were physically and mentally independent were recruited. Participants who had complete blood chemistry data from April to July 2019 (pre-SD era) and April to July 2020 (SD era) were enrolled. Data were obtained about physical activity, nutrition, sarcopenia, and psychological and mental health from questionnaires in April to July 2020. Calf circumference was measured.
Results
In total, 246 people (100 men, 146 women; mean age, 73.8±5.7 years) participated in this study. The levels of glycated hemoglobin (HbA1c, 7.4%±1.0% vs. 7.1%±0.8%, P<0.001), fasting glucose (142.2±16.7 mg/dL vs. 132.0±27.7 mg/dL, P<0.001), and body weight (62.6±9.4 kg vs. 61.8±10.1 kg, P<0.01) were higher in the SD era than in the pre-SD era. Total physical activity was lower in the SD era (2,584.6±2,624.1 MET-min/week^–1 vs. 1,987.3±2,295.0 MET-min/week^–1, P<0.001). A larger increase in HbA1c level was associated with increased body weight and decreased physical activity.
Conclusion
SD had negative effects on diabetes management in older adults with diabetes. Fasting glucose and HbA1c levels and body weight increased during the SD era. Participants with reduced physical activity gained more weight and had higher blood glucose levels. Given that the COVID-19 pandemic is ongoing, health professionals and diabetes educators should monitor changes in lifestyle factors in older adults with diabetes.

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Metabolic Risk/Epidemiology
Maternal Hyperglycemia during Pregnancy Increases Adiposity of Offspring: Hye Rim Chung, Joon Ho Moon, Jung Sub Lim, Young Ah Lee, Choong Ho Shin, Joon-Seok Hong, Soo Heon Kwak, Sung Hee Choi, Hak Chul Jang; Diabetes Metab J. 2021;45(5):730-738. Published online February 22, 2021; DOI: https://doi.org/10.4093/dmj.2020.0154

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Background
The effect of intrauterine hyperglycemia on fat mass and regional fat proportion of the offspring of mothers with gestational diabetes mellitus (OGDM) remains to be determined.
Methods
The body composition of OGDM (n=25) and offspring of normoglycemic mothers (n=49) was compared using dualenergy X-ray absorptiometry at age 5 years. The relationship between maternal glucose concentration during a 100 g oral glucose tolerance test (OGTT) and regional fat mass or proportion was analyzed after adjusting for maternal prepregnancy body mass index (BMI).
Results
BMI was comparable between OGDM and control (median, 16.0 kg/m² vs. 16.1 kg/m² ). Total, truncal, and leg fat mass were higher in OGDM compared with control (3,769 g vs. 2,245 g, P=0.004; 1,289 g vs. 870 g, P=0.017; 1,638 g vs. 961 g, P=0.002, respectively), whereas total lean mass was lower in OGDM (15,688 g vs. 16,941 g, P=0.001). Among OGDM, total and truncal fat mass were correlated with fasting and 3-hour glucose concentrations of maternal 100 g OGTT during pregnancy (total fat mass, r=0.49, P=0.018 [fasting], r=0.473, P=0.023 [3-hour]; truncal fat mass, r=0.571, P=0.004 [fasting], r=0.558, P=0.006 [3-hour]), but there was no correlation between OGDM leg fat mass and maternal OGTT during pregnancy. Regional fat indices were not correlated with concurrent maternal 75 g OGTT values.
Conclusion
Intrauterine hyperglycemia is associated with increased fat mass, especially truncal fat, in OGDM aged 5 years.

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Clinical Diabetes & Therapeutics
Effects of Lobeglitazone, a Novel Thiazolidinedione, on Bone Mineral Density in Patients with Type 2 Diabetes Mellitus over 52 Weeks: Soo Lim, Kyoung Min Kim, Sin Gon Kim, Doo Man Kim, Jeong-Taek Woo, Choon Hee Chung, Kyung Soo Ko, Jeong Hyun Park, Yongsoo Park, Sang Jin Kim, Hak Chul Jang, Dong Seop Choi; Diabetes Metab J. 2017;41(5):377-385. Published online October 24, 2017; DOI: https://doi.org/10.4093/dmj.2017.41.5.377

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Background

The aim of this multicenter, randomized, double-blind study was to examine the effect of lobeglitazone, a novel thiazolidinedione, on the changes in bone mineral density (BMD) in patients with type 2 diabetes mellitus.

Methods

A 24-week, double-blinded phase was followed by a 28-week, open-label phase, in which the placebo group also started to receive lobeglitazone. A total of 170 patients aged 34 to 76 years were randomly assigned in a 2:1 ratio to receive lobeglitazone 0.5 mg or a matching placebo orally, once daily. BMD was assessed using dual-energy X-ray absorptiometry at week 24 and at the end of the study (week 52).

Results

During the double-blinded phase, the femur neck BMD showed decreasing patterns in both groups, without statistical significance (−0.85%±0.36% and −0.78%±0.46% in the lobeglitazone and placebo groups, respectively). The treatment difference between the groups was 0.07%, which was also not statistically significant. Further, minimal, nonsignificant decreases were observed in both groups in the total hip BMD compared to values at baseline, and these differences also did not significantly differ between the groups. During the open-label phase, the BMD was further decreased, but not significantly, by −0.32% at the femur neck and by −0.60% at the total hip in the lobeglitazone group, and these changes did not significantly differ compared with the original placebo group switched to lobeglitazone.

Conclusion

Our results indicate that treatment with lobeglitazone 0.5 mg over 52 weeks showed no detrimental effect on the BMD compared to the placebo.

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Clinical Care/Education
Comparison of Antidiabetic Regimens in Patients with Type 2 Diabetes Uncontrolled by Combination Therapy of Sulfonylurea and Metformin: Results of the MOHAS Disease Registry in Korea: Sung Hee Choi, Tae Jung Oh, Hak Chul Jang; Diabetes Metab J. 2017;41(3):170-178. Published online May 11, 2017; DOI: https://doi.org/10.4093/dmj.2017.41.3.170

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Background

The aim of this study was to investigate the glucose-lowering efficacy of antidiabetic treatments in patients with type 2 diabetes mellitus (T2DM) uncontrolled by sulfonylurea plus metformin.

Methods

This open-label, multicenter, prospective, observational study was conducted in 144 centers in Korea, from June 2008 to July 2010, and included patients with T2DM who had received sulfonylurea and metformin for at least 3 months and had levels of glycosylated hemoglobin (HbA1c) >7.0% in the last month. Data of clinical and biochemical characteristics were collected at baseline and 6 months after treatment. The treatment option was decided at the physician's discretion. Subjects were classified into the following three groups: intensifying oral hypoglycemic agents (group A), adding basal insulin (group B), or starting intensified insulin therapy (group C).

Results

Of 2,995 patients enrolled, 2,901 patients were evaluated, and 504 (17.4%), 2,316 (79.8%), and 81 patients (2.8%) were classified into groups A, B, and C, respectively. Subjects in group C showed relatively higher baseline levels of HbA1c and longer duration of diabetes. The mean decrease in HbA1c level was higher in the insulin treated groups (−0.9%±1.3%, −1.6%±1.3%, and −2.4%±2.3% in groups A, B, and C, respectively, P=0.042). The proportion of patients who achieved target HbA1c <7.0% was comparable among the groups; however, intensified insulin therapy seemed to be the most effective in achieving the target HbA1c of 6.5%.

Conclusion

These findings suggest that insulin-based therapy will be an important option in the improved management of Korean patients with T2DM whose glycemic control is not sufficient with sulfonylurea and metformin.

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The Korean Journal of Internal Medicine.2017; 32(6): 947. CrossRef
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Byung-Wan Lee, Jin Hwa Kim, Seung-Hyun Ko, Kyu Yeon Hur, Nan-Hee Kim, Sang Youl Rhee, Hyun Jin Kim, Min Kyong Moon, Seok-O Park, Kyung Mook Choi
The Korean Journal of Internal Medicine.2017; 32(6): 967. CrossRef
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Insulin

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Epidemiology
Application of the 2013 American College of Cardiology/American Heart Association Cholesterol Guideline to the Korean National Health and Nutrition Examination Surveys from 1998 to 2012: Young Shin Song, Tae Jung Oh, Kyoung Min Kim, Jae Hoon Moon, Sung Hee Choi, Hak Chul Jang, Kyong Soo Park, Soo Lim; Diabetes Metab J. 2017;41(1):38-50. Published online December 16, 2016; DOI: https://doi.org/10.4093/dmj.2017.41.1.38

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Background

The 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline for the treatment of blood cholesterol recommends statin therapy for individuals at high risk of atherosclerotic cardiovascular disease (ASCVD). The aim of this study was to investigate serial trends in the percentages of Korean adults considered eligible for statin therapy according to the new ACC/AHA cholesterol guideline.

Methods

Data from the Korean National Health and Nutrition Examination Survey (KNHANES) I (1998, n=7,698), II (2001, n=5,654), III (2005, n=5,269), IV (2007 to 2009, n=15,727), and V (2010 to 2012, n=16,304), which used a stratified, multistage, probability sampling design, were used as representative of the entire Korean population.

Results

The percentage of adults eligible for statin therapy according to the ACC/AHA cholesterol guideline increased with time: 17.0%, 19.0%, 20.8%, 20.2%, and 22.0% in KNHANES I, II, III, IV, and V, respectively (P=0.022). The prevalence of ASCVD was 1.4% in KNHANES I and increased to 3.3% in KNHANES V. The percentage of diabetic patients aged 40 to 75 years with a low density lipoprotein cholesterol levels of 70 to 189 mg/dL increased from 4.8% in KNHANES I to 6.1% in KNHANES V. People with an estimated 10-year ASCVD risk ≥7.5% and aged 40 to 75 years accounted for the largest percentage among the four statin benefit groups: 9.1% in KNHANES I and 11.0% in KNHANES V.

Conclusion

Application of the 2013 ACC/AHA guideline has found that the percentage of Korean adults in the statin benefit groups has increased over the past 15 years.

Citations

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Jeonghoon Ha, Jeongmin Lee, Kwanhoon Jo, Dong-Jun Lim, Moo Il Kang, Bong Yun Cha, Min-Hee Kim
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Response

Response: Hyperglycemia Is Associated with Impaired Muscle Quality in Older Men with Diabetes: The Korean Longitudinal Study on Health and Aging (Diabetes Metab J 2016;40:140-6): Ji Won Yoon, Hak Chul Jang; Diabetes Metab J. 2016;40(3):250-251. Published online June 20, 2016; DOI: https://doi.org/10.4093/dmj.2016.40.3.250

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Sulwon Lecture 2015

Clinical Care/Education
Sarcopenia, Frailty, and Diabetes in Older Adults: Hak Chul Jang; Diabetes Metab J. 2016;40(3):182-189. Published online April 20, 2016; DOI: https://doi.org/10.4093/dmj.2016.40.3.182

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Populations are aging and the prevalence of diabetes mellitus is increasing tremendously. The number of older people with diabetes is increasing unexpectedly. Aging and diabetes are both risk factors for functional disability. Thus, increasing numbers of frail or disabled older patients with diabetes will increase both direct and indirect health-related costs. Diabetes has been reported as an important risk factor of developing physical disability in older adults. Older people with diabetes have lower muscle mass and weaker muscle strength. In addition, muscle quality is poorer in diabetic patients. Sarcopenia and frailty have a common soil and may share a similar pathway for multiple pathologic processes in older people. Sarcopenia is thought to be an intermediate step in the development of frailty in patients with diabetes. Thus, early detection of sarcopenia and frailty in older adults with diabetes should be routine clinical practice to prevent frailty or to intervene earlier in frail patients.

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Original Articles

Clinical Care/Education
Feasibility of a Patient-Centered, Smartphone-Based, Diabetes Care System: A Pilot Study: Eun Ky Kim, Soo Heon Kwak, Seungsu Baek, Seung Lyeol Lee, Hak Chul Jang, Kyong Soo Park, Young Min Cho; Diabetes Metab J. 2016;40(3):192-201. Published online April 8, 2016; DOI: https://doi.org/10.4093/dmj.2016.40.3.192

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Abstract PDF PubReader ePub

Background

We developed a patient-centered, smartphone-based, diabetes care system (PSDCS). This study aims to test the feasibility of glycosylated hemoglobin (HbA1c) reduction with the PSDCS.

Methods

This study was a single-arm pilot study. The participants with type 2 diabetes mellitus were instructed to use the PSDCS, which integrates a Bluetooth-connected glucometer, digital food diary, and wearable physical activity monitoring device. The primary end point was the change in HbA1c from baseline after a 12-week intervention.

Results

Twenty-nine patients aged 53.9±9.1 years completed the study. HbA1c and fasting plasma glucose levels decreased significantly from baseline (7.7%±0.7% to 7.1%±0.6%, P<0.0001; 140.9±39.1 to 120.1±31.0 mg/dL, P=0.0088, respectively). The frequency of glucose monitoring correlated with the magnitude of HbA1c reduction (r=–0.57, P=0.0013). The components of the diabetes self-care activities, including diet, exercise, and glucose monitoring, were significantly improved, particularly in the upper tertile of HbA1c reduction. There were no severe adverse events during the intervention.

Conclusion

A 12-week application of the PSDCS to patients with inadequately controlled type 2 diabetes resulted in a significant HbA1c reduction with tolerable safety profiles; these findings require confirmation in a future randomized controlled trial.

Citations

Citations to this article as recorded by

Effect of Multimodal App-Based Interventions on Glycemic Control in Patients With Type 2 Diabetes: Systematic Review and Meta-Analysis
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Clinical Care/Education
Hyperglycemia Is Associated with Impaired Muscle Quality in Older Men with Diabetes: The Korean Longitudinal Study on Health and Aging: Ji Won Yoon, Yong-Chan Ha, Kyoung Min Kim, Jae Hoon Moon, Sung Hee Choi, Soo Lim, Young Joo Park, Jae Young Lim, Ki Woong Kim, Kyong Soo Park, Hak Chul Jang; Diabetes Metab J. 2016;40(2):140-146. Published online March 31, 2016; DOI: https://doi.org/10.4093/dmj.2016.40.2.140

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118 Download
116 Web of Science
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Abstract PDF PubReader ePub

Background

The study aimed to investigate the influence of hyperglycemia on muscle quality in older men with type 2 diabetes.

Methods

This was a subsidiary study of the Korean Longitudinal Study of Health and Aging. Among 326 older men consenting to tests of body composition and muscle strength, 269 men were ultimately analyzed after the exclusion because of stroke (n=30) and uncertainty about the diagnosis of diabetes (n=27). Body composition was measured using dual-energy X-ray absorptiometry and computed tomography. Muscle strength for knee extension was measured using an isokinetic dynamometer. Muscle quality was assessed from the ratio of leg strength to the entire corresponding leg muscle mass.

Results

The muscle mass, strength, and quality in patients with type 2 diabetes did not differ significantly from controls. However, when patients with diabetes were subdivided according to their glycemic control status, patients with a glycosylated hemoglobin (HbA1c) level of ≥8.5% showed significantly decreased leg muscle quality by multivariate analysis (odds ratio, 4.510; P=0.045) after adjustment for age, body mass index, smoking amount, alcohol consumption, physical activity, and duration of diabetes. Physical performance status was also impaired in subjects with an HbA1c of ≥8.5%.

Conclusion

Poor glycemic control in these older patients with diabetes was associated with significant risk of decreased muscle quality and performance status. Glycemic control with an HbA1c of <8.5% might be needed to reduce the risk of adverse skeletal and functional outcomes in this population.

Citations

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Clinical Care/Education
Clinical Characteristics and Metabolic Predictors of Rapid Responders to Dipeptidyl Peptidase-4 Inhibitor as an Add-on Therapy to Sulfonylurea and Metformin: Ye An Kim, Won Sang Yoo, Eun Shil Hong, Eu Jeong Ku, Kyeong Seon Park, Soo Lim, Young Min Cho, Kyong Soo Park, Hak Chul Jang, Sung Hee Choi; Diabetes Metab J. 2015;39(6):489-497. Published online November 27, 2015; DOI: https://doi.org/10.4093/dmj.2015.39.6.489

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Background

Dipeptidyl peptidase-4 (DPP-4) inhibitor add-on therapy is a new option for patients with inadequately controlled type 2 diabetes who are taking combined metformin and sulfonylurea (SU). We evaluated the efficacy and safety of this triple therapy and the characteristics of rapid responders and hypoglycemia-prone patients.

Methods

We included 807 patients with type 2 diabetes who were prescribed a newly added DPP-4 inhibitor to ongoing metformin and SU in 2009 to 2011. Glycemia and other metabolic parameters at baseline, 12, 24, and 52 weeks, as well as episodes of hypoglycemia were analyzed. Rapid responders were defined as patients with ≥25% reduction in glycosylated hemoglobin (HbA1c) within 12 weeks.

Results

At baseline, while on the submaximal metformin and SU combination, the mean HbA1c level was 8.4%. Twelve weeks after initiation of DPP-4 inhibitor add-on, 269 patients (34.4%) achieved an HbA1c level ≤7%. Sixty-six patients (8.2%, 47 men) were rapid responders. The duration of diabetes was shorter in rapid responders, and their baseline fasting plasma glucose (FPG), HbA1c, C-peptide, and homeostasis model assessment of insulin resistance were significantly higher. Patients who experienced hypoglycemia after taking DPP-4 inhibitor add-on were more likely to be female, to have a lower body weight and lower triglyceride and FPG levels, and to have higher homeostasis model assessment of β-cells.

Conclusion

An oral hypoglycemic triple agent combination including a DPP-4 inhibitor was effective in patients with uncontrolled diabetes. Proactive dose reduction of SU should be considered when a DPP-4 inhibitor is added for rapid responders and hypoglycemia-prone patients.

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

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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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

Citations to this article as recorded by

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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Prevalence of latent autoimmune diabetes in adults and insulin resistance: a systematic review and meta-analysis
Malihe Mohammadi
European Journal of Translational Myology.2024;[Epub] CrossRef
A Predictive Level of C-peptide for Glutamic Acid Decarboxylase Antibody Positivity in Autoimmune Diabetes
Dilek Geneş, Zeki Akkuş, Zafer Pekkolay, Alparslan Kemal Tuzcu
Dicle Tıp Dergisi.2024; 51(4): 523. CrossRef
The worldwide prevalence of latent autoimmune diabetes of adults among adult-onset diabetic individuals: a systematic review and meta-analysis
Deepika Ramu, Selvaraj Ramaswamy, Suresh Rao, Solomon F. D. Paul
Endocrine.2023; 82(1): 28. CrossRef
Investigation of serum level relationship anti-glutamic acid decarboxylase antibody and inflammatory cytokines (IL1-β, IL-6) with vitamins D in type 2 diabetes
Vahid Pouresmaeil, Sarmad Mashayekhi, Mohammad Sarafraz Yazdi
Journal of Diabetes & Metabolic Disorders.2022; 21(1): 181. CrossRef
Recent information on test utilization and intraindividual change in anti-glutamic acid decarboxylase antibody in Korea: a retrospective study
Rihwa Choi, Wonseo Park, Gayoung Chun, Jiwon Lee, Sang Gon Lee, Eun Hee Lee
BMJ Open Diabetes Research & Care.2022; 10(3): e002739. CrossRef
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Anselmo M. Manisha, Aminiel R. Shangali, Sayoki G. Mfinanga, Erasto V. Mbugi
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Dhekra Al-Zubairi, Molham AL-Habori, Riyadh Saif-Ali
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Rajashree Mishra, Kenyaita M. Hodge, Diana L. Cousminer, Richard D. Leslie, Struan F.A. Grant
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The prevalence of latent autoimmune diabetes in adults and its correlates in patients with type 2 diabetes in Kerman, Iran [2011]
Gozashti Mohammad Hossein, Shafiei Maryam, Esmaeilian Saeed, Najafipour Hamid, Mashrouteh Mahdieh
Diabetes & Metabolic Syndrome: Clinical Research & Reviews.2015; 9(2): 104. CrossRef
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Ashok Kumar Datusalia, Shyam Sunder Sharma
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Successful treatment of latent autoimmune diabetes in adults with Traditional Chinese Medicine: a case report
Jiaxing Tian, Wenke Liu, Zhong Zhen, Xiaolin Tong
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Clinical characteristics and insulin independence of Koreans with new‐onset type 2 diabetes presenting with diabetic ketoacidosis
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A Case of Latent Autoimmune Diabetes in Adults Developed after Surgical Cure of Growth Hormone Secreting Pituitary Tumor
Wonjin Kim, Jung Ho Kim, Youngsook Kim, Ji Hye Huh, Su Jin Lee, Mi Sung Park, Eun Yeong Choe, Jeong Kyung Park, Myung Won Lee, Jae Won Hong, Byung Wan Lee, Eun Seok Kang, Bong Soo Cha, Eun Jig Lee, Hyun Chul Lee
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Latent Autoimmune Diabetes in Adults: Autoimmune Diabetes in Adults with Slowly Progressive β-cell Failure
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Review

Epidemiology of Micro- and Macrovascular Complications of Type 2 Diabetes in Korea: Jung Hee Kim, Dae Jung Kim, Hak Chul Jang, Sung Hee Choi; Diabetes Metab J. 2011;35(6):571-577. Published online December 26, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.6.571

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The prevalence of diabetes in Korea has increased six- to sevenfold over the past 40 years with its complications becoming major causes of morbidity and mortality. The rate of death among patients with diabetes is about twice as high as that among persons without diabetes and the most common cause of death is cardiovascular disease (30.6%). Despite the seriousness of diabetic complications, 30 to 70% of patients receive inadequate care, and only 40% of treated diabetic patients achieve the optimal control with HbA1c level <7% in Korea. In 2006, over 30 to 40% of patients with diabetes have microvascular complications and around 10% of them have macrovascular complications from our national data. Despite there are some debates about intensive glycemic control resulting in the deterioration of macrovascular complication, multifactorial treatment approaches including proper glycemic control are important to prevent diabetic complications. There have been needs for finding proper biomarkers for predicting diabetic complications properly but we still need more longitudinal studies to find this correlation with causal relationship. In this article, we wanted to review the recent status of micro- and macrovascular complications of type 2 diabetes in Korea from integration of many epidemiologic studies.

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Original Articles

Carotid Intimal-Medial Thickness Is Not Increased in Women with Previous Gestational Diabetes Mellitus: Yun Hyi Ku, Sung Hee Choi, Soo Lim, Young Min Cho, Young Joo Park, Kyong Soo Park, Seong Yeon Kim, Hak Chul Jang; Diabetes Metab J. 2011;35(5):497-503. Published online October 31, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.5.497

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Background

Gestational diabetes mellitus (GDM) is known to increase the risk of cardiovascular diseases. Measuring the carotid artery intimal-medial thickness (CIMT) is a non-invasive technique used to evaluate early atherosclerosis and to predict future cardiovascular diseases. We examined the association between CIMT and cardiovascular risk factors in young Korean women with previous GDM.

Methods

One hundred one women with previous GDM and 19 women who had normal pregnancies (NP) were recruited between 1999 and 2002. At one year postpartum, CIMT was measured using high-resolution B-mode ultrasonography, and oral glucose tolerance tests were performed. Fasting glucose, glycated hemoglobin A1c (HbA1c), insulin levels and lipid profiles were also measured. CIMTs in the GDM and NP groups were compared, and the associations between CIMT and cardiovascular risk factors were analyzed in the GDM group.

Results

CIMT results of the GDM group were not significantly different from those of the NP group (GDM, 0.435±0.054 mm; NP, 0.460±0.046 mm; P=0.069). In the GDM group, a higher HbA1c was associated with an increase in CIMT after age adjustment (P=0.011). CIMT results in the group with HbA1c >6.0% were higher than those of the normal HbA1c (HbA1c ≤6.0%) (P=0.010). Nine of the patients who are type 2 diabetes mellitus converters within one year postpartum but showed no significant difference in CIMT results compared to NP group.

Conclusion

Higher HbA1c is associated with an increase in CIMT in women with previous GDM. However, CIMT at one year postpartum was not increased in these women compared to that in NP women.

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Women with a history of gestational diabetes mellitus present an accumulation of cardiovascular risk factors at age 46—A birth cohort study
Evi Bakiris, Kaisu Luiro, Jari Jokelainen, Laure Morin‐Papunen, Sirkka Keinänen‐Kiukaanniemi, Kari Kaikkonen, Terhi Piltonen, Juha S. Tapanainen, Juha Auvinen
Acta Obstetricia et Gynecologica Scandinavica.2024; 103(7): 1318. CrossRef
The effect of gestational diabetes mellitus on carotid artery intima-media thickness in and after pregnancy: a systematic review and meta-analysis
Andrea Sonaglioni, Elisabetta Piergallini, Angelo Naselli, Gian Luigi Nicolosi, Anna Ferrulli, Stefano Bianchi, Michele Lombardo, Giuseppe Ambrosio
Acta Diabetologica.2023; 61(2): 139. CrossRef
Prognostic indicators of persistent carotid intima-media thickness increase in postpartum period in a population of normotensive women with gestational diabetes mellitus
Andrea Sonaglioni, Gian Luigi Nicolosi, Valentina Esposito, Stefano Bianchi, Michele Lombardo
European Journal of Obstetrics & Gynecology and Reproductive Biology.2022; 269: 47. CrossRef
Pharmacotherapy for gestational diabetes
Angelo Maria Patti, Rosaria Vincenza Giglio, Kalliopi Pafili, Manfredi Rizzo, Nikolaos Papanas
Expert Opinion on Pharmacotherapy.2018; 19(13): 1407. CrossRef
Women with a history of gestational diabetes on long-term follow up have normal vascular function despite more dysglycemia, dyslipidemia and adiposity
Olubukola Ajala, Louise A. Jensen, Edmond Ryan, Constance Chik
Diabetes Research and Clinical Practice.2015; 110(3): 309. CrossRef
Gestational Diabetes Mellitus in Korean Women: Similarities and Differences from Other Racial/Ethnic Groups
Catherine Kim
Diabetes & Metabolism Journal.2014; 38(1): 1. CrossRef
History of Gestational Diabetes Mellitus and Future Risk of Atherosclerosis in Mid‐life: The Coronary Artery Risk Development in Young Adults Study
Erica P. Gunderson, Vicky Chiang, Mark J. Pletcher, David R. Jacobs, Charles P. Quesenberry, Stephen Sidney, Cora E. Lewis
Journal of the American Heart Association.2014;[Epub] CrossRef
Association of Gestational Diabetes Mellitus (GDM) with subclinical atherosclerosis: a systemic review and meta-analysis
Jing-Wei Li, Si-Yi He, Peng Liu, Lin Luo, Liang Zhao, Ying-Bin Xiao
BMC Cardiovascular Disorders.2014;[Epub] CrossRef
Cardiovascular Disease Risk in the Offspring of Diabetic Women: The Impact of the Intrauterine Environment
Laura J. Marco, Kate McCloskey, Peter J. Vuillermin, David Burgner, Joanne Said, Anne-Louise Ponsonby
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A Survey of Diabetic Educators and Patients for the Revision of Korean Food Exchange Lists: Jae Won Cho, Mee Ra Kweon, Young Mi Park, Mi Hye Woo, Hye Sook Yoo, Jeong Hyun Lim, Bo Kyung Koo, Chong Hwa Kim, Hae Jin Kim, Tae Sun Park, Choong Ho Shin, Kyu Chang Won, Soo Lim, Hak Chul Jang; Diabetes Metab J. 2011;35(2):173-181. Published online April 30, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.2.173

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Background

Food exchange lists are one of the main methods of nutritional education. However, Korean food exchange lists have not been revised since 1994. Therefore, we surveyed the opinions of diabetes educators and patients with diabetes regarding the need for revision of the current food exchange lists.

Methods

For two weeks beginning on 10 March 2008, a 12-item questionnaire regarding the opinion and need for revision of the current food exchange lists was e-mailed to diabetes educators nationwide. Another 15-question survey was administered to patients with diabetes in 13 hospitals located in the Seoul and Gyeonggi regions of Korea.

Results

We obtained survey responses from 101 diabetes educators and 209 patients; 65 (64.3%) of the educators answered that the current food exchange lists should be revised. The items that needed revision were the glycemic index, addition of new foods and reaffirmation of exchange standard amounts. The patients demanded specific education about choosing appropriate foods, a balanced meal plan, proper snacks, and dining intake.

Conclusion

Our survey results demonstrate the need to revise the Korean food exchange lists. This process should focus on glycemic index, the addition of new foods and reconfirmation of one exchange reference unit.

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Iva Marques-Lopes, Susana Menal-Puey, J. Alfredo Martínez, Giuseppe Russolillo
Journal of the Academy of Nutrition and Dietetics.2018; 118(7): 1161. CrossRef
A Practical Approach to the Management of Micronutrients and Other Nutrients of Concern in Food Exchange Lists for Meal Planning
Giuseppe Russolillo-Femenías, Susana Menal-Puey, J. Alfredo Martínez, Iva Marques-Lopes
Journal of the Academy of Nutrition and Dietetics.2018; 118(11): 2029. CrossRef
How much fruit should diabetic patients eat?
Jeong Hyun Lim
The Journal of Korean Diabetes.2014; 15(4): 185. CrossRef
Korean Food Exchange Lists for Diabetes: Revised 2010
Dal Lae Ju, Hak Chul Jang, Young Yun Cho, Jae Won Cho, Hye Sook Yoo, Kyung Suk Choi, Mi Hye Woo, Cheong Min Sohn, Yoo Kyoung Park, Ryo Won Choue
Journal of Korean Diabetes.2011; 12(4): 228. CrossRef
Korean Food Exchange Lists for Diabetes: Revised 2010
Dal Lae Ju, Hak Chul Jang, Young Yun Cho, Jae Won Cho, Hye Sook Yoo, Kyung Suk Choi, Mi Hye Woo, Cheong Min Sohn, Yoo Kyoung Park, Ryowon Choue
The Korean Journal of Nutrition.2011; 44(6): 577. CrossRef

Increasing Trend in the Number of Severe Hypoglycemia Patients in Korea: Jin Taek Kim, Tae Jung Oh, Ye An Lee, Jun Ho Bae, Hyo Jeong Kim, Hye Seung Jung, Young Min Cho, Kyong Soo Park, Soo Lim, Hak Chul Jang, Hong Kyu Lee; Diabetes Metab J. 2011;35(2):166-172. Published online April 30, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.2.166

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Background

To investigate whether the number of subjects with severe hypoglycemia who are brought to a hospital emergency department is increasing and to identify whether there have been changes in the demographic and clinical characteristics of those subjects.

Methods

We analyzed data from the Emergency Departments of two general hospitals in Seoul, Korea. We included data from all adult subjects with type 2 diabetes who presented to an emergency department with severe hypoglycemia between January 1, 2004 and December 30, 2009.

Results

A total of 740 cases of severe hypoglycemia were identified. The mean subject age was 69±12 years, mean duration of diabetes was 13.8±9.3 years, and 53.2% of subjects were receiving insulin therapy. We observed a sharp rise in the number of cases between 2006 and 2007. Stages 3-5 chronic kidney disease was diagnosed in 31.5% of subjects, and low C-peptide levels (<0.6 ng/mL) were found in 25.5%. The mean subject age, duration of diabetes, HbA1c level, and renal and insulin secretory function values did not change significantly during the study period. The proportion of glimepiride use increased, while use of gliclazide decreased among sulfonylurea users. Use of insulin analogues increased, while use of NPH/RI decreased among insulin users.

Conclusion

We identified a sharp increase in the number of subjects with severe hypoglycemia presenting to an emergency room since 2006. The clinical characteristics of these subjects did not change markedly during the study period. Nationwide studies are warranted to further clarify this epidemic of severe hypoglycemia.

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Insulin Secretion and Incretin Hormone Concentration in Women with Previous Gestational Diabetes Mellitus: Sung Hoon Yu, Bongjun Cho, Yejin Lee, Eunhye Kim, Sung Hee Choi, Soo Lim, Ka Hee Yi, Young Joo Park, Kyong Soo Park, Hak Chul Jang; Diabetes Metab J. 2011;35(1):58-64. Published online February 28, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.1.58

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Background

We examined the change in the levels of incretin hormone and effects of glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) on insulin secretion in women with previous gestational diabetes (pGDM).

Methods

A 75-g oral glucose tolerance test (OGTT) was conducted on 34 women with pGDM. In addition, 11 women with normal glucose tolerance, matched for age, height and weight, were also tested. The insulin, GIP, GLP-1, and glucagon concentrations were measured, and their anthropometric and biochemical markers were also measured.

Results

Among 34 women with pGDM, 18 had normal glucose tolerance, 13 had impaired glucose tolerance (IGT) and 1 had diabetes. No significant differences were found in GLP-1 concentration between the pGDM and control group. However, a significantly high level of glucagon was present in the pGDM group at 30 minutes into the OGTT. The GIP concentration was elevated at 30 minutes and 60 minutes in the pGDM group. With the exception of the 30-minute timepoint, women with IGT had significantly high blood glucose from 0 to 120 minutes. However, there was no significant difference in insulin or GLP-1 concentration. The GIP level was significantly high from 0 to 90 minutes in patients diagnosed with IGT.

Conclusion

GLP-1 secretion does not differ between pGDM patients and normal women. GIP was elevated, but that does not seem to induce in increase in insulin secretion. Therefore, we conclude that other factors such as heredity and environment play important roles in the development of type 2 diabetes.

Citations

Citations to this article as recorded by

Association of GLP-1 secretion with parameters of glycemic control in women after gestational diabetes mellitus
Eleni Pappa, Kristina Busygina, Saori Harada, Hana Hermann, Cornelia Then, Andreas Lechner, Uta Ferrari, Jochen Seissler
BMJ Open Diabetes Research & Care.2024; 12(1): e003706. CrossRef
Inadequate Glucagon Suppression During OGTT in Prediabetes: A Systematic Review and Meta-analysis
Lina Chang, Ying Liu, Yian Gu, Siyu Yan, Li Ding, Ming Liu, Qing He
The Journal of Clinical Endocrinology & Metabolism.2024; 109(10): 2673. CrossRef
Increased Pro-Inflammatory T Cells, Senescent T Cells, and Immune-Check Point Molecules in the Placentas of Patients With Gestational Diabetes Mellitus
Yea Eun Kang, Hyon-Seung Yi, Min-Kyung Yeo, Jung Tae Kim, Danbit Park, Yewon Jung, Ok Soon Kim, Seong Eun Lee, Ji Min Kim, Kyong Hye Joung, Ju Hee Lee, Bon Jeong Ku, Mina Lee, Hyun Jin Kim
Journal of Korean Medical Science.2022;[Epub] CrossRef
Simulation of Oral Glucose Tolerance Tests and the Corresponding Isoglycemic Intravenous Glucose Infusion Studies for Calculation of the Incretin Effect
Myeungseon Kim, Tae Jung Oh, Jung Chan Lee, Karam Choi, Min Young Kim, Hee Chan Kim, Young Min Cho, Sungwan Kim
Journal of Korean Medical Science.2014; 29(3): 378. CrossRef
Metabolic, hormonal characteristics and genetic variants of TCF7L2 associated with development of gestational diabetes mellitus in Mexican women
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Reduced postprandial GLP‐1 responses in women with gestational diabetes mellitus
L. Bonde, T. Vilsbøll, T. Nielsen, J. I. Bagger, J. A. Svare, J. J. Holst, S. Larsen, F. K. Knop
Diabetes, Obesity and Metabolism.2013; 15(8): 713. CrossRef
Women with normal glucose tolerance and a history of gestational diabetes show significant impairment of β-cell function at normal insulin sensitivity
P. Molęda, K. Homa, K. Safranow, Z. Celewicz, A. Fronczyk, L. Majkowska
Diabetes & Metabolism.2013; 39(2): 155. CrossRef

A Survey on Ubiquitous Healthcare Service Demand among Diabetic Patients: Soo Lim, So-Youn Kim, Jung Im Kim, Min Kyung Kwon, Sei Jin Min, Soo Young Yoo, Seon Mee Kang, Hong Il Kim, Hye Seung Jung, Kyong Soo Park, Jun Oh Ryu, Hayley Shin, Hak Chul Jang; Diabetes Metab J. 2011;35(1):50-57. Published online February 28, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.1.50

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Background

Advanced information technology can be used when developing diagnostic and treatment strategies to provide better care for diabetic patients. However, the levels of need and demand for the use of technological advances have not been investigated in diabetic patients. We proposed and developed an individualized, ubiquitous (U)-healthcare service using advanced information technology for more effective glucose control. Prior to our service initiation, we surveyed patient needs and other pertinent information.

Methods

During August 2009, we conducted a 34-item questionnaire survey among patients with diabetes who were older than 40 years in two certain hospitals in Korea.

Results

The mean age of the 228 participants was 61.2±9 years, and males made up 49.1% of the sample. Seventy-one percent replied that they wanted individualized healthcare service, and they also wanted their health information to be delivered through mobile devices such as a cellular phone or a personal digital assistant (40.4%). Most patients had never heard of U-healthcare services (81.1%); however, after explaining the concept, 71.1% of participants responded that they would use the service if it was provided. Despite their willingness, participants were concerned about technical difficulty in using the service (26.3%) as well as the cost of the service (29.8%).

Conclusion

The current study suggests that more than 70% of diabetic patients are interested in using U-healthcare services. To encourage widespread use, the application program or device of U-healthcare services should be simple, easy to use and affordable while also including a policy for the protection of private information.

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Review

Gestational Diabetes in Korea: Incidence and Risk Factors of Diabetes in Women with Previous Gestational Diabetes: Hak Chul Jang; Diabetes Metab J. 2011;35(1):1-7. Published online February 28, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.1.1

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Korean women with a history of gestational diabetes mellitus (GDM) have a 3.5 times greater risk of developing postpartum diabetes than the general population. The incidence of type 2 diabetes mellitus in early postpartum is reported as 10-15% in Korean women. A prospective follow-up study on Korean women with GDM showed that approximately 40% of women with previous GDM were expected to develop diabetes within 5 years postpartum. Independent risk factors for the development of diabetes in Korean women with previous GDM are pre-pregnancy body weight, gestational age at diagnosis, antepartum hyperglycemia on oral glucose tolerance test, low insulin response to oral glucose load, and family history of diabetes. Women with postpartum diabetes have greater body mass indexes, body weight, and waist circumferences than women with normal glucose tolerance. Multiple logistic regression analysis has revealed that waist circumference is the strongest obesity index along with systolic blood pressure and that triglyceride levels are a major independent risk factor for developing diabetes. These results in Korean women with previous GDM underline the importance of postpartum testing in Korean women diagnosed with GDM, and demonstrate that impaired B-cell function, obesity, and especially visceral obesity, are associated with the development of diabetes.

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Original Articles

Effects of 'Ubiquitous Healthcare' on the Ability of Self-Management in Elderly Diabetic Patients.: Sung Hoon Yu, Sun Hee Kim, So Yeon Kim, Sung Hee Choi, Soo Lim, Yoon Seok Chang, Hak Jong Lee, Young Joo Park, Hak Chul Jang; Korean Diabetes J. 2009;33(1):58-64. Published online February 1, 2009; DOI: https://doi.org/10.4093/kdj.2009.33.1.58

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Abstract PDF

BACKGROUND
The need for a new healthcare system is growing due to the paradigm shift from health supervision to health maintenance. Previously, we performed a pilot study that examined the effectiveness of a ubiquitous healthcare (U-healthcare) diabetes management program which consists of self-monitoring of blood glucose (SMBG) and mobile phone services for elderly patients with type 2 diabetes mellitus. In this study, we investigated the effect of a diabetes management program using U-healthcare based on the self-care skills of elderly patients with diabetes mellitus. METHODS: From July to October 2005, 17 patients were recruited and provided with a blood glucometer with the ZigBee module and a mobile phone. In addition, the patients' understanding of diabetes self-care skills was examined at the beginning and end of the study. At the end of the study, we determined the level of patient satisfaction regarding U-healthcare services. RESULTS: The patients' test scores on their understanding of diabetes mellitus improved from 57.2 +/- 20.7 to 72.7 +/- 13.4%. Specifically, patient knowledge of the basic principles for a proper diabetic diet (52.9% vs. 82.4%, P = 0.046), foods that influence blood sugar level (41.2% vs. 76.5%, P = 0.007) and the influence of beverage choice (41.2% vs. 64.7%, P = 0.007), all increased. In addition, a significant increase in knowledge of living standards regarding diabetes mellitus was observed (64.7% vs. 88.2%, P = 0.0032). CONCLUSION: We conclude that the U-healthcare incorporating SMBG could be promising, as it improves self-management skills of diabetes mellitus patients, as well as their understanding of the disease.

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Self-management of Chronic Conditions Using mHealth Interventions in Korea: A Systematic Review
Jae Yoon Yi, Yujin Kim, Yoon-Min Cho, Hongsoo Kim
Healthcare Informatics Research.2018; 24(3): 187. CrossRef
Effectiveness of the Smart Care Service for Diabetes Management
Young-Soon Chung, Yongsuk Kim, Chang Hee Lee
Healthcare Informatics Research.2014; 20(4): 288. CrossRef
Ubiquitous Healthcare Service Has the Persistent Benefit on Glycemic Control and Body Weight in Older Adults With Diabetes
Seon Mee Kang, Min Joo Kim, Hwa Young Ahn, Ji Won Yoon, Min Kyong Moon, Hye Seung Jung, Sung Hee Choi, Soo Lim, Kyong Soo Park, Hak C. Jang
Diabetes Care.2012; 35(3): e19. CrossRef
Improved Glycemic Control Without Hypoglycemia in Elderly Diabetic Patients Using the Ubiquitous Healthcare Service, a New Medical Information System
Soo Lim, Seon Mee Kang, Hayley Shin, Hak Jong Lee, Ji Won Yoon, Sung Hoon Yu, So-Youn Kim, Soo Young Yoo, Hye Seung Jung, Kyong Soo Park, Jun Oh Ryu, Hak C. Jang
Diabetes Care.2011; 34(2): 308. CrossRef
A Survey on Ubiquitous Healthcare Service Demand among Diabetic Patients
Soo Lim, So-Youn Kim, Jung Im Kim, Min Kyung Kwon, Sei Jin Min, Soo Young Yoo, Seon Mee Kang, Hong Il Kim, Hye Seung Jung, Kyong Soo Park, Jun Oh Ryu, Hayley Shin, Hak Chul Jang
Diabetes & Metabolism Journal.2011; 35(1): 50. CrossRef

Effect of Valsartan on Blood Pressure and Urinary Albumin Excretion in Hypertensive Type 2 Diabetic Patients: An Open-Label, Multicenter Study.: Se Jun Park, Dae Jung Kim, Hae Jin Kim, Soo Yeon Park, Ji A Seo, Nan Hee Kim, Sung Hee Choi, Soo Lim, Hak Chul Jang, Seung Hyun Ko, Ki Ho Song, Yu Bae Ahn, Soo Kyoung Kim, Yong Wook Cho, Jun Goo Kang, Sung Hee Ihm, Cheol Young Park, Sung Woo Park, Dong Hyun Shin, Yong Hyun Kim, Kwan Woo Lee; Korean Diabetes J. 2008;32(6):513-521. Published online December 1, 2008; DOI: https://doi.org/10.4093/kdj.2008.32.6.513

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Abstract PDF: BACKGROUND
Activation of renin-angiotensin system (RAS) has been an important mechanism of microvascular and macrovascular complications in diabetic patients. It has been reported that RAS blockades reduce the development and progression of diabetic nephropathy. The aim of this study was to evaluate whether valsartan, an angiotensin II receptor blocker (ARB), reduced blood pressure and urinary albumin excretion rate (UAER) in hypertensive type 2 diabetic patients. METHOD: Three hundred forty-seven hypertensive type 2 diabetic patients who had not taken angiotensin converting enzyme inhibitors or ARB for 6 months prior to this study were enrolled. We measured blood pressure and UAER before and after 24 weeks of valsartan treatment. RESULT: Baseline mean systolic and diastolic blood pressure was 143 +/- 15 and 87 +/- 11 mmHg, respectively and the median albumin excretion rate was 27 ug/mg. Reduction in systolic and diastolic blood pressure was 16 mmHg/10 mmHg and the median UAER was 19.3 ug/mg after 24 weeks (P < 0.01, respectively). When we divided the subjects into three groups according to the UAER (normoalbuminuria, microalbuminuria and macroalbuminuria), significant changes were reported in the microalbuminuria and the macroalbuminuria groups. Thirty-eight (42%) patients with microalbuminuria improved to normoalbuminuria and twelve (41%) patients with macroalbuminuria improved to microalbuminuria. We found an association between the improvement of blood pressure and UAER (R = 0.165, P = 0.015). CONCLUSION: We concluded that valsartan reduces urinary albumin excretion and blood pressure in hypertensive type 2 diabetic patients.

Review

Clinical Implication of Adiponectin.: Soo Lim, Hak Chul Jang; Korean Diabetes J. 2008;32(2):85-97. Published online April 1, 2008; DOI: https://doi.org/10.4093/kdj.2008.32.2.85

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Abstract PDF

Adipose tissue is now considered as an active hormone-secreting organ, which secretes a number of biologically active adipokines such as free fatty acids, leptin, tumor necrosis factor alpha (TNFalpha), interleukin-6, plasminogen activator inhibitor-1, adiponectin and retinol binding protein 4 (RBP4). Among these, adiponectin has attracted considerable attention as an adipokine that has important role in the development of type 2 diabetes, atherosclerosis and cardiovascular diseases. Adiponectin was discovered to be the most abundant adipose-specific transcript. Many epidemiological and clinical studies have demonstrated that serum levels of adiponectin are inversely associated with body weight, especially abdominal visceral fat accumulation. Studies among Japanese and Pima Indians have reported lower concentrations of adiponectin in patients with type 2 diabetes than in those with normal glucose tolerance. A low level of adiponectin was found to be a significant risk factor for the development of cardiovascular events in the Korean patients with type 2 diabetes. We recently published that exercise, having an insulin-sensitizing effect, could be a good therapy to prevent or delay diabetes and cardiovascular diseases in middle-aged women through the modification of adiponectin. These results suggest that the clinical implication of adiponectin. A number of studies have been conducted to clarify the biological role of adiponectin. Recent studies have showed that adiponectin has anti-inflammatory, anti-atherogenic, and glucose-lowering properties. Taken together, it is conceivable that adiponectin plays as a backbone of metabolic syndrome. Finally, pleiotropic functions of adiponectin may possibly serve to prevent and treat atherosclerosis, type 2 diabetes and cardiovascular diseases. Furthermore, enhancement of adiponectin secretion or action may be a good therapeutic target for preventing type 2 diabetes or cardiovascular diseases.

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Original Article

Association between Apolipoprotein E Polymorphism and Type 2 Diabetes in Subjects Aged 65 or Over.: You Jin Lee, Hak Chul Jang, Eun Hye Kim, Hye Jin Kim, Seok Bum Lee, Sung Hee Choi, Soo Lim, Kyoung Un Park, Young Joo Park, Ki Woong Kim; Korean Diabetes J. 2008;32(1):30-37. Published online February 1, 2008; DOI: https://doi.org/10.4093/kdj.2008.32.1.30

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Abstract PDF

BACKGROUND
Increased prevalence of diabetes in recent years is linked with increased cardiovascular morbidity and mortality. Apolipoprotein E (apo E) polymorphism is well known to be related to hyperlipidemia and coronary heart disease, but only a few studies investigated the association between apo E polymorphism and diabetes or insulin resistance. In Korea, two studies with relatively small subjects reported controversial results. Therefore, we investigated the association between apo E polymorphism and diabetes in elderly community population. METHODS: 982 elderly people aged 65 or over in Seongnam city were enrolled. We measured anthropometric variables and blood pressure and performed biochemical tests including fasting glucose, fasting insulin, HbA1c, and lipid profiles. Apo E polymorphism was determined by PCR-RFLP method. RESULTS: Frequencies of apo E isoforms and alleles were similar to those of other reports. Subjects with e4 allele had significantly higher total and LDL-cholesterol levels. However, there were no differences in cholesterol levels between normal subjects and diabetes. Diabetes was not related to apo E polymorphism. CONCLUSION: In Korean aged 65 or over, subjects with diabetes didn't have increased total or LDL-cholesterol, triglyceride, and decreased HDL-cholesterol levels. Diabetes and apo E polymorphism were not related.

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Association of APOE genotype with lipid profiles and type 2 diabetes mellitus in a Korean population
Jung Yeon Seo, Byeong Ju Youn, Hyun Sub Cheong, Hyoung Doo Shin
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Retraction of Publication

Retraction: Polymorphisms of Kir6.2 Gene are Associated with Type 2 Diabetes and Blood Pressure in the Korean Population.: Bo Kyeong Koo, Hong Il Kim, Eu Jin Lee, Young Min Cho, Hyoung Doo Shin, Hak Chul Jang, Hong Kyu Lee, Kyong Soo Park; Korean Diabetes J. 2007;31(2):185-185. Published online March 1, 2007; DOI: https://doi.org/10.4093/jkda.2007.31.2.185

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Original Articles

Association between Genetic Polymorphisms in Hepatocyte Nuclear Factor 4alpha and Type 2 Diabetes in Koreans.: Eun Jung Lee, Soo Heon Kwak, Sun Wook Jo, Hyung Jin Choi, Hyoung Doo Shin, Min Kyong Moon, Young Min Cho, Hak Chul Jang, Kyong Soo Park, Houng Kyu Lee; Korean Diabetes J. 2006;30(1):10-16. Published online January 1, 2006; DOI: https://doi.org/10.4093/jkda.2006.30.1.10

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Abstract PDF: BACKGROUND
Hepatocyte nuclear factor-4alpha (HNF-4alpha) is a member of transcription factor network which is essential for the development and function of the beta cell. Furthermore mutations in the HNF-4alpha gene have been known to cause maturity-onset diabetes of the young. Therefore we aimed to examine the association between polymorphisms in the HNF-4alpha gene and the risk of type 2 diabetes (T2DM) and its related phenotypes in the Korean population. METHODS: Two single nucleotide polymorphisms (SNPs) in the HNF-4alpha gene, g.4681C>T and HNF-4alpha g.12352C>T (Thr139Ile), were genotyped in unrelated T2DM (n=760) and non-diabetic subjects (n=303). The genetic associations between these SNPs and the risk of T2DM and metabolic phenotypes were analyzed. RESULTS: There was no significant association between genetic polymorphisms in the HNF-4alpha and the risk of T2DM. However HNF-4alpha g.4681C>T increased total cholesterol in the recessive model (P = 0.02) and showed marginal association with fasting plasma glucose (P = 0.049) in the additive model. CONCLUSION: There was no significant association between genetic polymorphisms and the risk of T2DM in the Korean populations. But HNF-4alpha g.4681C>T was associated with higher level of total cholesterol and fasting plasma glucose.

Polymorphisms of Kir6.2 Gene are Associated with Type 2 Diabetes and Blood Pressure in the Korean Population.: Bo Kyeong Koo, Hong Il Kim, Eu Jin Lee, Young Min Cho, Hyoung Doo Shin, Hak Chul Jang, Hong Kyu Lee, Kyong Soo Park; Korean Diabetes J. 2005;29(5):440-450. Published online September 1, 2005

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Abstract PDF: BACKGOUND: ATP-sensitive potassium channels are a heterooctamer of SUR1 and Kir6.2, which are key components in the insulin secretory mechanism. Whether common variants in the Kir6.2 gene are associated with type 2 diabetes and/or its associated phenotypes was investigated. METHODS: The Kir6.2 gene was sequenced in 24Korean DNA samples to identify common polymorphisms (frequency > 0.05). The common variants found among these samples were genotyped in a larger population including type 2 diabetic patients and nondiabetic subjects. RESULTS: Thirteen single nucleotide polymorphisms and one insertion/deletion polymorphism were identified in the Kir6.2 gene, with six common variants(g.-1709A>T, g.-1525T>C, g.67G >A [E23K], g.570C>T [A190A], g.1009A>G [1337V], and g.1388C>T) genotyped in 761 type 2 diabetic patients and 675 nondiabetic subjects. Four individual polymorphisms(g.-1525T > C, g.67G>A, g.1009A>G and g.1388C>T) appeared to be associated with type 2 diabetes (age, sex and BMI-adjusted odds ratio[OR]=0.751[0.584-0.967] in the recessive model on g-1525T>C, 1.193 [1.020-1.394] in the additive model in g.67G>A, 1.195 [1.022-1.399] in the additive model on g.1009A>G, 0.835 [0.717-0.973] in the additive model in g.1388C >T). The haplotype "ATACGC" in the Kir6.2 gene, composed of rare allele in the g.67 and g.1009, was also associated with a higher prevalence of type 2 diabetes (age, sex, and BMI- adjusted OR = 1.256 [1.067-1.479], P for logistic regression = 0.006). In addition g.67G>A and g.1009A >G in the KCNJ11 were strongly associated with a high systolic blood pressure. CONCLUSION: Polymorphisms in the Kir6.2 gene are associated with type 2 diabetes and blood pressure in the Korean population.

Increasing Trends of Metabolic Syndrome in Korea -Based on Korean National Health and Nutrition Examination Surveys-.: Soo Lim, Eun Jung Lee, Bo Kyeong Koo, Sung Il Cho, Kyong Soo Park, Hak Chul Jang, Seong Yeon Kim, Hong Kyu Lee; Korean Diabetes J. 2005;29(5):432-439. Published online September 1, 2005

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Abstract PDF: BACKGOUND: The number of individuals with metabolic syndrome is increasing in Asian as well as in Western countries. The aim of this study was to compare the prevalence and patterns of metabolic syndrome as determined by the 1998 and 2001 Korean National Health and Nutrition Examination Surveys(KNHANES). METHODS: A total of 6,907 and 4,536 Koreans aged over 20 years participated in the KNHANES in 1998 and 2001, respectively. A stratified multistage probability sampling design and weighting adjustments were made to obtain a representative Korean population. The working definition of the National Cholesterol Education Program-Adult Treatment Panel III was used to define metabolic syndrome. The International Obesity Task Force criteria for the Asian-Pacific population were used to determine waist circumference criteria. RESULTS: The age-adjusted prevalence of metabolic syndrome significantly increased from 22.5 to 24.1% between 1998 and 2001(P<0.01). Of the five components composing metabolic syndrome, low HDL-cholesterolemia showed the highest increase(32.6%) over this period, followed by hypertriglyceridemia and abdominal obesity, with 15.9% and 4.3% increases, respectively. In contrast, the number of subjects with high blood pressure or elevated fasting glucose levels were reduced(37.1-->33.1% and 18.9-->15.4%, respectively, both P<0.01). CONCLUSION: Dyslipidemia and abdominal obesity were primarily responsible for the increase in metabolic syndrome in Korea over the period 1998 to 2001. Changes to diet patterns and a reduction in physical activity are likely to have contributed to the rapid increase in metabolic syndrome in Korea; therefore, national strategies will be needed to counteract this increase.

Pregnancy Outcome in Korean Women with Gestational Diabetes Mellitus Diagnosed by the Carpenter-Coustan Criteria.: Hak Chul Jang, Young Min Cho, Kyong Soo Park, Seong Yeon Kim, Hong Kyu Lee, Moon Young Kim, Jae Hyug Yang, Son Moon Shin; Korean Diabetes J. 2004;28(2):122-130. Published online April 1, 2004

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Abstract PDF: BACKGROUND
The American Diabetes Association recently proposed the Carpenter-Coustan criteria for the diagnosis of gestational diabetes mellitus(GDM) based on the results of the Toronto Tri-Hospital Study. The prevalence of GDM in Korean women increased, on average, by 60% when the Carpenter-Coustan criteria were applied. However, the pregnancy outcome of Korean women with GDM with regard to the Carpenter-Coustan criteria tremains to be reported. The pregnancy outcomes of those Korean women with GDM by the Carpenter- Coustan criteria, but not by the NDDG criteria were assessed. METHODS: In this study, a total of 2776 pregnant women underwent universal screening for GDM, between January 1993 and December 1994, as recommended by the Third International Workshop-Conference on Gestational Diabetes Mellitus with minor modifications. The primary pregnancy outcomes were preeclampsia, premature delivery, delivery by C-section, birth weight and LGA infants. RESULTS: Of the 2776 women, 656 screened-positive for GDM. Of these, 37 and 74 had GDM by the Carpenter-Coustan and NDDG criteria, respectively. With increasing glucose intolerance, there was a stepwise increase in premature deliveries, deliveries by C-section and preeclampsia from those screening negative to GDM by the NDDG criteria, with a similar trend for the frequency of LGA infants. The LGA infant screening-negative and positive were 13.5 and 16.1%, but those with a normal glucose tolerance were 27.0 and 33.8% in those screening positive to GDM by the Carpenter-Coustan and NDDG criteria, respectively(P<0.001). CONCLUSION: Our study demonstrated that increasing glucose tolerance was associated with increasing frequencies of adverse pregnancy outcomes in Korean women. The maternally complicated and LGA infants were significantly higher in women with GDM by the Carpenter-Coustan criteria. Thus the Carpenter- Coustan criteria are recommended for the diagnosis of GDM in Korean Women.

Common Genetic Polymorphisms in the Promoter of Resistin Gene are Major Determinants of Plasma Resistin Concentrations in Humans.: Young Min Cho, Byung Soo Youn, Sung Soo Chung, Ki Woo Kim, Bo Kyeong Koo, Kang Yeol Yu, Hong Je Park, Hyoung Doo Shin, Hak Chul Jang, Kyong Soo Park, Seong Yeon Kim, Hong Kyu Lee; Korean Diabetes J. 2004;28(1):9-19. Published online February 1, 2004

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Abstract PDF: BACKGROUND
Resistin has been postulated to be an important link between obesity and insulin resistance. Genetic polymorphisms in the resistin gene promotor have been suggested as a determinant of the expression of resistin mRNA, which is possibly associated with obesity and insulin resistance. In this study, the association between the genotype of the resistin promoter, and its plasma concentrations, were investigated. METHODS: The g.-537A>C and g.-420C>G polymorphisms in the resistin promoter were examined, and the levels of plasma resistin measured in the Korean subjects, both with and without type 2 diabetes. Haplotype-based promoter activity and the gel electrophoretic mobility-shift assays(EMSA) were also performed. RESULTS: The -420G and the -537A alleles, which were in linkage disequilibrium, were associated with higher plasma resistin concentrations. Individuals with the A-G(-537 A and -420G) haplotypes showed significantly higher plasma resistin levels than those that did not. The haplotypes A-G had modestly increased promoter activities compared to the other haplotypes. The EMSA revealed the -420 G allele to be specific for binding of the nuclear proteins from adipocytes and monocytes. However, neither polymorphism was associated with type 2 diabetes or obesity in our study subjects. CONCLUSION: Polymorphisms in the promoter of the resistin gene are major determinants of plasma resistin concentrations in humans

Editorial

Insulin Secretion and Insulin Sensitivity in Women with a Previous Gestational Diabetes: Understanding of Pathogenesis of Type 2 Diabetes.: Hak Chul Jang; Korean Diabetes J. 2002;26(5):314-318. Published online October 1, 2002

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Abstract PDF: No abstract available.

Review

Diagnostic Criteria for Gestational Diabetes in Korean Women: Is New ADA Criteria Appropriate?.: Hak Chul Jang; Korean Diabetes J. 2002;26(4):221-228. Published online August 1, 2002

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Abstract PDF: No abstract available.

Editorial

Intrauterine Environment and Adult Disease.: Hak Chul Jang; Korean Diabetes J. 2001;25(3):184-189. Published online June 1, 2001

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18 Download

Abstract PDF: No abstract available.

Original Articles

Effect of Self-monitoring of Blood Glucose on Pregnancy Outcome in Women with Mild Gestational Diabetes.: Hak Chul Jang, Jeong Eun Park, Chang Hoon Yim, Ho Yeun Chung, Ki Ok Han, Hyun Koo Yoon, In Kwon Han, Moon Young Kim, Jae Hyug Yang, Mi Jung Kim, Sun Young Ko, Yeon Kyung Lee; Korean Diabetes J. 2001;25(1):93-102. Published online February 1, 2001

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Abstract PDF: BACKGROUND
Self-monitoring of blood glucose (SMBG) and intensive therapy with insulin demonstrated to have a positive effects in the reduction of the neonatal complications in women with gestational diabetes (GDM). However the utility of SMBG in the mild GDM who does not requiring insulin has not been formally reported. Therefore, to evaluate the effectiveness of SMBG in the management of mild GDM, we compared the pregnancy outcome and the postpartum glucose tolerance of women who monitored their glycemic control by SMBG to those of women who monitored by laboratory glucose test at each office visit during pregnancy. METHODS: We studied 185 women diagnosed as a GDM by NDDG criteria and their fasting glucose concentration < 5.8 mM. All subjects had singleton pregnancy,and no medical diseases that may affect fetal growth, and were certain of gestational age by early ultrasonography. They were treated with an identical GDM management protocol except glucose monitoring. One hundred five women were monitored by laboratory glucose test at each office visit (office group) and 80 women were monitored by SMBG (SMBG group). Pregnancy outcome including rates of cesarian section, obstetric complication, LGA infant and glucose tolerance status at postpartum were compared between two groups. RESULTS: The age, height, prepregnancy weight, weight at delivery and parity were not significantly different between the two groups. Fasting, 1-h, 2-h glucose concentration during the diagnostic test of GDM in SMBG group were similar to those of office group. However, 3-h glucose concentration of office group was 0.3 mM higher than that of SMBG group. The rate of primary cesarian section, preterm labor and pregnancy-induced hypertension of SMBG group were similar to those of office group. The mean postprandial 2-h glucose concentration of office group measured at each office was 0.5 mM higher than that of SMBG group. Although 5% of office group were treated with insulin, 24% of SMBG group were requiring insulin therapy. The birth weight and LGA infant rate of office group were 3403 432 g and 28%, those were heavier and higher than those of SMBG group (3169 447 g, 13.8%). The 90% of office group and 84% of SMBG group were performed 75 g oral glucose tolerance test at postpartum 6-8 weeks. There was no significant difference in rates of diabetes and IGT between office and SMBG group (9.5%, 11.6%; 7.5%, 9.0% respectively). CONCLUSIONS: This study demonstrated that SMBG is very seful in early detection of maternal hyperglycemia and lowing the postprandial glucose, as well as reducing the rate of LGA infants in women with mild GDM.

Chronary Heart Disease and Homecysteine metabolism.: Hak Chul Jang; Korean Diabetes J. 1999;23(5):621-624. Published online January 1, 2001

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Clinical Characteristics and Pregnancy Outcome in Korean Women with Type I & Type II Diabetes Mellitus.: Yoon Huh, Dong Won Suh, Hak Chul Jang, Chang Hoon Yim, Ki Ok Han, Hyun Ku Yoon, In Kwon Han, Hun Ki Min, Eun Sung Kim, Moon Young Kim, Hyun Mi Ryu, Sung Won Yang, Hae Kyoung Han; Korean Diabetes J. 1998;22(3):353-362. Published online January 1, 2001

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Abstract PDF: BACKGROUND
The prevalence of diabetes is gradually increasing iin Korean. Moreover, the prevalence of pregnancy complicated by established diabetes seems to be increasing. During the past decades, advances in the diabetes care as well as advances in fetal surveillance and neonatal care, have continued to improve pregnancy outcome of women with diabetes. However, the incidence of congenital anomalies and spontaneous abortion as well as the perinatal morbidity in the women with diabetes are still higher compared to those of the general population. In this study, we estimated the prevalence of prepmncy complicated by both type 1 and type 2 diabetes and described the clinical characteristics and outcome of diabetic pregnancies. METHODS: We analyzed data from four sources: 1) the mother(type and duration of diabetes, diabetic complication, preconceptional care), 2) obstetric outcome(method of delivery, obstetric complication), 3) neonatal outcome(birth weight, perinatal complication, congenital anomaly), 4) glycemic control during pregnancy, of women with pregestational diabetes delivered newborns at Samsung Cheil Hospital from 1992 to 1995. RESULTS: During the study period, 34 singleton infants were delivered by the 28 women with diabetes. The diabetic pregnancy was present in 0.14% of total deliveries in Samsung Cheil Hospital. Patients with IDDM comprised 18%(6/34) of total diabetic pregnancies, 82%(28/34) had NIDDM. The duration of diabetes was 6.3 and 2.1 years in patients with IDDM and NIDDM, respectively. Two IDDM patients presented with proliferative retinopathy, and 3 background retinopathy, one in IDDM and 2 in NIDDM. Three patients with IDDM and 2 patients with NIDDM had diabetic nephropathy. Insulin requirement during pregnancy was increased about 2 times at the time of delivery when compared to the initial in women with IDDM and NIDDM. Preeclampsia was the most common obstetric compliications, which were more frequently observed in women with diabetic complications. LGA was present in 43% of women with NIDDM. One infant of mother with NIDDM, delivered at 28 weeks gestation, was died because of respiratory distress and one infant of mother with IDDM had a congenital heart disease(TOF). Only 3 patients scught for the preconceptional care before pregnancy. CONCLUSION: Pregnancies complicated by diabetes was more frequent than was expected, even though it was much less than the rates in North America. Only 9% of women with diabetes had preconceptional care before pregnancy. The importance of planned pregnancy and prepregnancy counseling should be addressed in women with diabetes of child bearing age.

Increased membrane lipid peroxidation of erythrocytes in NIDDM.: Hak Chul Jang, Young Ki Min, In Kwon Han, Hong Kyu Lee, Hun Ki Min; Korean Diabetes J. 1992;16(4):309-316. Published online January 1, 2001

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Abstract PDF: No abstract available.

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