Diabetes & Metabolism Journal

Original Articles

Obesity and Metabolic Syndrome
Relationship between Regional Body Fat Distribution and Diabetes Mellitus: 2008 to 2010 Korean National Health and Nutrition Examination Surveys: Soo In Choi, Dawn Chung, Jung Soo Lim, Mi Young Lee, Jang Yel Shin, Choon Hee Chung, Ji Hye Huh; Diabetes Metab J. 2017;41(1):51-59. Published online December 21, 2016; DOI: https://doi.org/10.4093/dmj.2017.41.1.51

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Background

The aim of this study was to investigate the association between regional body fat distribution, especially leg fat mass, and the prevalence of diabetes mellitus (DM) in adult populations.

Methods

A total of 3,181 men and 3,827 postmenopausal women aged 50 years or older were analyzed based on Korea National Health and Nutrition Examination Surveys (2008 to 2010). Body compositions including muscle mass and regional fat mass were measured using dual-energy X-ray absorptiometry.

Results

The odds ratios (ORs) for DM was higher with increasing truncal fat mass and arm fat mass, while it was lower with increasing leg fat mass. In a partial correlation analysis adjusted for age, leg fat mass was negatively associated with glycosylated hemoglobin in both sexes and fasting glucose in women. Leg fat mass was positively correlated with appendicular skeletal muscle mass and homeostasis model assessment of β cell. In addition, after adjusting for confounding factors, the OR for DM decreased gradually with increasing leg fat mass quartiles in both genders. When we subdivided the participants into four groups based on the median values of leg fat mass and leg muscle mass, higher leg fat mass significantly lowered the risk of DM even though they have smaller leg muscle mass in both genders (P<0.001).

Conclusion

The relationship between fat mass and the prevalence of DM is different according to regional body fat distribution. Higher leg fat mass was associated with a lower risk of DM in Korean populations. Maintaining leg fat mass may be important in preventing impaired glucose tolerance.

Citations

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

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Abstract PDF PubReader

Background

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

Methods

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

Results

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

Conclusion

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

Citations

Citations to this article as recorded by

Hyperinsulinemia: an early biomarker of metabolic dysfunction
Rama A. Vaidya, Sharvari Desai, Panchali Moitra, Sheryl Salis, Shubhada Agashe, Rekha Battalwar, Anushree Mehta, Jagmeet Madan, Soumik Kalita, Shobha A. Udipi, Ashok B. Vaidya
Frontiers in Clinical Diabetes and Healthcare.2023;[Epub] CrossRef
A Novel Earwax Method to Measure Acute and Chronic Glucose Levels
Andrés Herane-Vives, Susana Espinoza, Rodrigo Sandoval, Lorena Ortega, Luis Alameda, Allan H. Young, Danilo Arnone, Alexander Hayes, Jan Benöhr
Diagnostics.2020; 10(12): 1069. CrossRef
Risk Factors for Underdiagnosis of Diabetes Based on the Korean National Health and Nutrition Examination Survey 2013-2015
Deulle Min, Eunhee Cho
Asia Pacific Journal of Public Health.2019; 31(5): 404. CrossRef
Recent advances of medical journals in Korea and and further development strategies: Is it possible for them to publish Nobel Prize-winning research?
Sun Huh
Journal of the Korean Medical Association.2018; 61(9): 524. CrossRef
The clinical value of HbA1c in combination with FPG in the early screening of the elderly with type 2 diabetes
Lihua Liu, Wenqing Chen, Minghua Dong, Lixia Jiang, Wei Qiu, Jian Li, Xiaoting Luo, Zhengchun Huang, Qin Wu, Qinfeng Wu, Shuiqin Chen, Lu Ou-Yang, Shumei Li, J.Q. Cheng, H.L. Moffitt, I. Kim, Z.T. Chi, J. Zhang
BIO Web of Conferences.2017; 8: 01030. CrossRef
The Cutoff Value of HbA1c in Predicting Diabetes and Impaired Fasting Glucose
Seyoung Kwon, Youngak Na
The Korean Journal of Clinical Laboratory Science.2017; 49(2): 114. CrossRef
Performance of HbA1c for the prediction of diabetes in a rural community in Korea
B. M. Song, H. C. Kim, J. Y. Lee, J.‐M. Lee, D. J. Kim, Y.‐H. Lee, I. Suh
Diabetic Medicine.2015; 32(12): 1602. CrossRef
The Relationship between BMI and Glycated Albumin to Glycated Hemoglobin (GA/A1c) Ratio According to Glucose Tolerance Status
Ji Hye Huh, Kwang Joon Kim, Byung-Wan Lee, Dong Wook Kim, Eun Seok Kang, Bong Soo Cha, Hyun Chul Lee, Marta Letizia Hribal
PLoS ONE.2014; 9(2): e89478. CrossRef
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Jennifer Hoponick Redmon, Myles F Elledge, Donna S Womack, Rajitha Wickremashinghe, Kamani P Wanigasuriya, Roshini J Peiris-John, Joseph Lunyera, Kristin Smith, James H Raymer, Keith E Levine
BMC Nephrology.2014;[Epub] CrossRef
Diagnostic Efficiency of Hemoglobin A1c for Newly Diagnosed Diabetes and Prediabetes in Community-Based Chinese Adults Aged 40 Years or Older
Kai Liang, Yu Sun, Wen-juan Li, Xiu-ping Zhang, Cheng-qiao Li, Wei-fang Yang, Ze-qiang Ma, Ai-xia Ma, Hui-zhen Zheng, Jun Song, Peng Lin, Xin-guo Hou, Li Chen
Diabetes Technology & Therapeutics.2014; 16(12): 853. CrossRef
Diagnostic accuracy of HbA1c in diabetes between Eastern and Western
Shuang Yan, Siying Liu, Yashuang Zhao, Wencui Zhang, Xiaohui Sun, Jianing Li, Fuli Jiang, Jiaming Ju, Ning Lang, Yingqi Zhang, Weiyu Zhou, Qiang Li
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Effects of Spironolactone and Losartan on Diabetic Nephropathy in a Type 2 Diabetic Rat Model: Mi Young Lee, Myoung Sook Shim, Bo Hwan Kim, Soon Won Hong, Ran Choi, Eun Young Lee, Soo Min Nam, Gun Woo Kim, Jang Yel Shin, Young Goo Shin, Choon Hee Chung; Diabetes Metab J. 2011;35(2):130-137. Published online April 30, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.2.130

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Abstract PDF PubReader

Background

While there is an evidence that the anti-inflammatory properties of spironolactone can attenuate proteinuria in type 2 diabetes, its effects on vascular endothelial growth factor (VEGF) expression in diabetic nephropathy have not been clearly defined. In this study, we examined the effects of spironolactone, losartan, and a combination of these two drugs on albuminuria, renal VEGF expression, and inflammatory and oxidative stress markers in a type 2 diabetic rat model.

Methods

Thirty-three Otsuka-Long-Evans-Tokushima-Fatty (OLETF) rats were divided into four groups and treated with different medication regimens from weeks 25 to 50; OLETF diabetic controls (n=5), spironolactone-treated (n=10), losartan-treated (n=9), and combination of spironolactone- and losartan-treated (n=9).

Results

At week 50, the albumin-to-creatinine ratio was significantly decreased in the losartan and combination groups compared to the control OLETF group. No decrease was detected in the spironolactone group. There was a significant reduction in renal VEGF, transforming growth factor (TGF)-β, and type IV collagen mRNA levels in the spironolactone- and combination regimen-treated groups. Twenty-four hour urine monocyte chemotactic protein-1 levels were comparable in all four groups but did show a decreasing trend in the losartan and combination regimen groups. Twenty-four hour urine malondialdehyde levels were significantly decreased in the spironolactone- and combination regimen-treated groups.

Conclusion

These results suggest that losartan alone and a combined regimen of spironolactone and losartan could ameliorate albuninuria by reducing renal VEGF expression. Also, simultaneous treatment with spironolactone and losartan may have protective effects against diabetic nephropathy by decreasing TGF-β and type IV collagen expression and by reducing oxidative stress in a type 2 diabetic rat model.

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Mahyar Khazaeli, Ane C. F. Nunes, Yitong Zhao, Mahziar Khazaali, John Prudente, Nosratola D. Vaziri, Bhupinder Singh, Wei Ling Lau
Pharmacology Research & Perspectives.2023;[Epub] CrossRef
Type 2 Diabetes Mellitus: Pathogenic Features and Experimental Models in Rodents
Inessa G. Gvazava, M. V. Karimova, A. V. Vasiliev, E. A. Vorotelyak
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Relationship between Menopausal Status and Metabolic Syndrome Components in Korean Women.: Jang Hyun Koh, Mi Young Lee, Soo Min Nam, Joong Kyung Sung, Pil Moon Jung, Jin Kyu Noh, Jang Yel Shin, Young Goo Shin, Choon Hee Chung; Korean Diabetes J. 2008;32(3):243-251. Published online June 1, 2008; DOI: https://doi.org/10.4093/kdj.2008.32.3.243

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Abstract PDF

BACKGROUND
Postmenopausal status is associated with a 60% increased risk for metabolic syndrome. It is thought to be associated with decreased estrogens and increased abdominal obesity in postmenopausal women with metabolic syndrome. The purpose of this study was to investigate the association between metabolic syndrome components and menopausal status. METHODS: A total of 1,926 women were studied and divided into three groups according to their menstrual stage (premenopausal, perimenopausal or postmenopausal). The presence of metabolic syndrome was assessed using the National Cholesterol Education Program's (NCEP) Adult Treatment Panel III criteria. RESULTS: The prevalence of metabolic syndrome was 7.1% in premenopause, 9.8% in perimenopause, and 24.2% in postmenopause. The strong correlation was noted between the metabolic syndrome score and waist circumference in postmenopause (r = 0.56, P < 0.01) and perimenopause (r = 0.60, P < 0.01). Along the menopausal transition, the risk of metabolic syndrome increased with high triglyceride after the age-adjusted (odds ratio (OR) 1.517 [95% confidence interval (CI) 1.014~2.269] in perimenopausal women and OR 1.573 [95% CI 1.025~2.414] in postmenopausal women). In addition, the prevalence of metabolic syndromeincreased in accordance with elevated alanine aminotransferase (ALT) and gamma-glutamyl transpeptidase (GGT) levels. CONCLUSION: Triglyceride and waist circumference were important metabolic syndrome components, though ALT and GGT may also be related for predicting metabolic syndrome during the transition to menopause.

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Alcohol Consumption, Liver Enzymes, and Prevalence of Metabolic Syndrome in Korean Adult Men.: Soo Min Nam, Ho Yeol Yu, Mi Young Lee, Jang Hyun Koh, Jang Yel Shin, Young Goo Shin, Choon Hee Chung; Korean Diabetes J. 2007;31(3):253-260. Published online May 1, 2007; DOI: https://doi.org/10.4093/jkda.2007.31.3.253

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Abstract PDF

BACKGROUND
Metabolic syndrome is associated with an increasing incidence of diabetes and cardiovascular disease. The relationship between the amount of alcohol consumption and the prevalence of metabolic syndrome is controversial. Our study was performed to evaluate the relationship between alcohol consumption and the prevalence of metabolic syndrome in Korean men. Also we examined the correlation of liver markers, including alanine transaminase (ALT) and gamma-glutamyl transferase (GGT) with the development of metabolic syndrome. METHODS: We enrolled 1,775 Korean men (mean age 40.0 +/- 5.8 years) who were undergone health check-ups in our hospital. Each component of metabolic syndrome was measured by using the American Association of Clinical Endocrinologists (AACE) criteria. The subjects were divided into 4 subgroups according to the amount of alcohol consumption; Group 1: no consumption, 2 (mild): those consumed less than 200 g/week, 3 (moderate): those consumed 200~399 g/week, 4 (heavy): those consumed more than 400 g/week. RESULTS: The prevalence of metabolic syndrome was 24.6%. There were significant positive correlations between the amount of alcohol consumption blood pressure, triglyceride, fasting blood glucose, GGT levels and HDL cholesterol levels. But the odds ratios for metabolic syndrome were not significantly increased in subjects with moderate alcohol consumption. The odds ratios for the metabolic syndrome significantly increased in proportion to the increasing levels of ALT and GGT. CONCLUSION: Although alcohol consumption didn't increase the prevalence of metabolic syndrome, the amount of alcohol consumption had significant positive correlation with components of metabolic syndrome in Korean men, and elevated ALT and GGT levels could strongly associate with the prevalence of metabolic syndrome.

Citations

Citations to this article as recorded by

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Association Between Impaired Vascular Endothelial Function and High Sensitivity C-reactive Protein, a Chronic Inflammatory Marker, in Patients with Type 2 Diabetes Mellitus.: Jang Yel Shin, Mi Young Lee, Jang Hyun Koh, Jang Young Kim, Young Goo Shin, Choon Hee Chung; Korean Diabetes J. 2005;29(5):469-478. Published online September 1, 2005

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Abstract PDF: BACKGOUND: Eighty percents of diabetes-related mortalities are due to atherosclerotic vascular complications. The accelerated atherosclerosis in type 2 diabetic patients is partly due to the increased incidences of cardiovascular risk factors, such as hypertension, obesity, dyslipidemia, insulin resistance and oxidative stress. Endothelial dysfunction is known as an early marker of cardiovascular disease and a predictor of cardiovascular events. The flow mediated dilation (FMD) of the brachial artery has been documented as being reduced in type 2 diabetic patients. Inflammatory markers, such as C-reactive protein(CRP) and interleukin-6(IL-6), are associated with the risk of cardiovascular disease. Endothelial dysfunction has a direct correlation with the levels of CRP, which are elevated in patients with diabetes compared with non-diabetic subjects. In this study, the FMD in diabetic and non-diabetic subjects were compared, and the association of cardiovascular risk factors and endothelial function examined in type 2 diabetic patients. METHODS: 57 consecutive diabetic subjects and 29 non-diabetic subjects, aged 35 to 69(54.0+/-1.0 years), without proven macrovascular complications, were enrolled in this study. Cardiovascular risk factors, such as body weight, height, waist and hip circumference, fasting plasma glucose and insulin levels, lipid profiles, inflammatory and coagulation markers were measured. The FMD of the brachial artery and the intima-media thickness(IMT) of the carotid artery were determined using high-resolution B-mode ultrasound. RESULTS: The FMD values were significantly lower in the diabetic compared with the non-diabetic subjects(7.6+/-0.2% vs. 8.9+/-0.4%, P=0.004). The homocysteine levels were significantly higher in the diabetic than non-diabetic subjects(12.4+/-0.4micromol/L vs. 9.5+/-0.6micromol/L, P<0.0001). In diabetic subjects, the FMD was shown to be significantly negatively correlated with high sensitivity C-reactive protein(hsCRP)(P=0.006), fibrinogen(P=0.024) and homocysteine (P=0.038). A multiple regression analysis, after adjusted for age, sex, body mass index(BMI), hypertension, and smoking, showed that hsCRP(beta=-0.424, P=0.002) and fibrinogen(beta=-0.324, P=0.025) had significant inverse association with the FMD in diabetic subjects. CONCLUSION: Diabetic subjects have an impaired endothelial function compared with the non-diabetic subjects, and the vascular endothelial function has a significant negative correlation with hsCRP and fibrinogen. These findings suggest that hsCRP might be an independent predictor of endothelial dysfunction and atherosclerosis, and chronic inflammation might play a pivotal role in the impairment of the endothelial function in diabetic patients.

Case Report

A Case of Bartter's Syndrome occurring in Diabetes Mellitus.: Jang Yel Shin, Jeung Rae Cho, Do Young Kim, Joon Kye Lee, Chul Woo Ahn, Jae Hyun Nam, Soo Yon Nam, Young Duk Song, Kyu Hun Choi, Sung Kil Lim, Kyung Rae Kim, Hyun Chul Lee, Kap Bum Huh, Jai Ho Han, Heun Ju Jung; Korean Diabetes J. 2000;24(1):90-96. Published online January 1, 2001

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Abstract PDF: Bartter's syndrome is characterized by hypokalemia, metabolic alkalosis, hyperreninemia and secondary hyperaldosteronism without hypertension and edema, Histologically, existing hyperplasia of the juxtaglomerular cell occurs mostly in childhood or adolescence, and initial presentation in patients over 40 years old of age is very rare. It has been recorded that Bartter's syndrome is associated with glucose intolerance, but not with overt diabetes mellitus. Whether this association is coincidental or causal is uncertain, although hypokalemia can cause glucose intolerance. We experienced a case of Bartters syndrome in 44 years old non-insulin dependent diabetic woman. She improved with potassium supplements along with combination of prostaglandin synthetase inhibitor and aldosterona antagonist. We report present case with the review of literature.

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