Diabetes & Metabolism Journal

Original Article

Drug/Regimen
Efficacy and Safety of Alogliptin-Pioglitazone Combination for Type 2 Diabetes Mellitus Poorly Controlled with Metformin: A Multicenter, Double-Blind Randomized Trial: Ji-Yeon Park, Joonyub Lee, Yoon-Hee Choi, Kyung Wan Min, Kyung Ah Han, Kyu Jeung Ahn, Soo Lim, Young-Hyun Kim, Chul Woo Ahn, Kyung Mook Choi, Kun-Ho Yoon, the Practical Evidence of Antidiabetic Combination Therapy in Korea (PEAK) study investigators; Received August 7, 2023 Accepted November 30, 2023 Published online April 23, 2024; DOI: https://doi.org/10.4093/dmj.2023.0259 [Epub ahead of print]

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Abstract PDF: Background
Guidelines for switching to triple combination therapy directly after monotherapy failure are limited. This study investigated the efficacy, long-term sustainability, and safety of either mono or dual add-on therapy using alogliptin and pioglitazone for patients with type 2 diabetes mellitus (T2DM) who did not achieve their target glycemic range with metformin monotherapy.
Methods
The Practical Evidence of Antidiabetic Combination Therapy in Korea (PEAK) was a multicenter, placebo-controlled, double-blind, randomized trial. A total of 214 participants were randomized to receive alogliptin+pioglitazone (Alo+Pio group, n=70), alogliptin (Alo group, n=75), or pioglitazone (Pio group, n=69). The primary outcome was the difference in glycosylated hemoglobin (HbA1c) levels between the three groups at baseline to 24 weeks. For durability, the achievement of HbA1c levels <7% and <6.5% was compared in each group. The number of adverse events was investigated for safety.
Results
After 24 weeks of treatment, the change of HbA1c in the Alo+Pio, Alo, and Pio groups were –1.38%±0.08%, –1.03%±0.08%, and –0.84%±0.08%, respectively. The Alo+Pio group had significantly lower HbA1c levels than the other groups (P=0.0063, P<0.0001) and had a higher proportion of patients with target HbA1c achievement. In addition, insulin sensitivity and β-cell function, lipid profiles, and other metabolic indicators were also improved. There were no significant safety issues in patients treated with triple combination therapy.
Conclusion
Early combination triple therapy showed better efficacy and durability than the single add-on (dual) therapy. Therefore, combination therapy with metformin, alogliptin, and pioglitazone is a valuable early treatment option for T2DM poorly controlled with metformin monotherapy.

Brief Report

Drug/Regimen
A Multicentre, Multinational, Open-Label, 52-Week Extension Study of Gemigliptin (LC15-0444) Monotherapy in Patients with Type 2 Diabetes Mellitus: Sae Jeong Yang, Kyung Wan Min, Sandeep Kumar Gupta, Joong Yeol Park, Vyankatesh K.Shivane, Pankaj Kumar Agarwal, Doo Man Kim, Yong Seung Kim, Sei Hyun Baik; Diabetes Metab J. 2021;45(4):606-612. Published online September 9, 2020; DOI: https://doi.org/10.4093/dmj.2020.0047

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The purpose of this extension study was to assess the long-term efficacy and safety of gemigliptin 50 mg in patients with type 2 diabetes mellitus (T2DM). Patients with T2DM who had completed the initial 24-week study comparing gemigliptin monotherapy with placebo were eligible to enrol. In the open-label, 28-week extension study, all enrolled patients received gemigliptin, regardless of the treatment received during the initial 24-week study period. The mean reduction±standard deviation (SD) in glycosylated hemoglobin (HbA1c) observed after 24 weeks of treatment (–0.6%±1.1%) was further decreased for the gemi-gemi group and the mean change in HbA1c at week 52 from baseline was –0.9%±1.2% (P<0.0001). For the pbo-gemi group, HbA1c decreased after they were switched to gemigliptin, and the mean change in HbA1c at week 52 from baseline was –0.7%±1.2% (P<0.0001). Furthermore, the overall incidence of adverse events demonstrated that gemigliptin was safe and well tolerated up to 52 weeks.

Citations

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Efficacy and safety of enavogliflozin versus dapagliflozin added to metformin plus gemigliptin treatment in patients with type 2 diabetes: A double-blind, randomized, comparator-active study: ENHANCE-D study
Kyung-Soo Kim, Kyung Ah Han, Tae Nyun Kim, Cheol-Young Park, Jung Hwan Park, Sang Yong Kim, Yong Hyun Kim, Kee Ho Song, Eun Seok Kang, Chul Sik Kim, Gwanpyo Koh, Jun Goo Kang, Mi Kyung Kim, Ji Min Han, Nan Hee Kim, Ji Oh Mok, Jae Hyuk Lee, Soo Lim, Sang S
Diabetes & Metabolism.2023; 49(4): 101440. CrossRef

Original Articles

Lifestyle
Body Fat Is Related to Sedentary Behavior and Light Physical Activity but Not to Moderate-Vigorous Physical Activity in Type 2 Diabetes Mellitus: Keun Hee An, Kyung Ah Han, Tae Seo Sohn, Ie Byung Park, Hae Jin Kim, Sung Dae Moon, Kyung Wan Min; Diabetes Metab J. 2020;44(2):316-325. Published online November 12, 2019; DOI: https://doi.org/10.4093/dmj.2019.0029

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Abstract PDF PubReader

Background

Sedentary behavior (SB) has emerged as a new risk factor for cardiovascular accidents. We investigated whether physical activity levels or SB were related to percent body fat (%BF) in type 2 diabetes mellitus (T2DM).

Methods

In this cross sectional study, we measured the duration of SB, light physical activity (LPA), moderate to vigorous physical activity (MVPA), total energy expenditure, and step counts using a wireless activity tracker (Fitbit HR; FB) for 7 days in free-living conditions, along with %BF using a bio impedance analyzer (Inbody; Biospace) in 120 smartphone users with T2DM. Subjects were divided into exercise (Exe, n=68) and non-exercise (nonExe, n=52) groups based on self-reports of whether the recommended exercises (30 min/day, 3 days/week for 3 months) were performed. SBt, LPAt, MVPAt were transformed from SB, LPA, MVPA for normally distributed variables.

Results

Participants were: female, 59.2%; age, 59.3±8.4 years; body mass index, 25.5±3.4 kg/m²; glycosylated hemoglobin (HbA1c), 7.6%±1.2%; %BF, 30.4%±7.1%. They performed SB for 15.7±3.7 hr/day, LPA for 4.4±1.7 hr/day, and MVPA for 0.9±0.8 hr/day. The %BF was related to SBt and LPAt, but not to MVPA after adjustments for age, gender, and HbA1c. VPA was significantly higher in the Exe group than in the nonExe group, but SB, LPA, and moderate physical activity were not different. Predicted %BF was 89.494 to 0.105 (age), −13.047 (gender), −0.507 (HbA1c), −7.655 (LPAt) (F[4, 64]=62.929, P<0.001), with an R² of 0.785 in multiple linear regression analysis.

Conclusion

Reduced body fat in elderly diabetic patients might be associated with reduced inactivity and increased LPA.

Citations

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Explanatory variables of objectively measured 24-h movement behaviors in people with prediabetes and type 2 diabetes: A systematic review
Lotte Bogaert, Iris Willems, Patrick Calders, Eveline Dirinck, Manon Kinaupenne, Marga Decraene, Bruno Lapauw, Boyd Strumane, Margot Van Daele, Vera Verbestel, Marieke De Craemer
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Alex Ojeda-Aravena, Tomás Herrera-Valenzuela, Pablo Valdés-Badilla, Jorge Cancino-López, José Zapata-Bastias, José Manuel García-García
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Clinical Diabetes & Therapeutics
Acarbose Add-on Therapy in Patients with Type 2 Diabetes Mellitus with Metformin and Sitagliptin Failure: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Study: Hae Kyung Yang, Seung-Hwan Lee, Juyoung Shin, Yoon-Hee Choi, Yu-Bae Ahn, Byung-Wan Lee, Eun Jung Rhee, Kyung Wan Min, Kun-Ho Yoon; Diabetes Metab J. 2019;43(3):287-301. Published online December 20, 2018; DOI: https://doi.org/10.4093/dmj.2018.0054

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Abstract PDF Supplementary Material PubReader

Background

We evaluated the efficacy and safety of acarbose add-on therapy in Korean patients with type 2 diabetes mellitus (T2DM) who are inadequately controlled with metformin and sitagliptin.

Methods

A total of 165 subjects were randomized to metformin and sitagliptin (Met+Sita, n=65), metformin, sitagliptin, and acarbose (Met+Sita+Acarb, n=66) and sitagliptin and acarbose (Sita+Acarb, exploratory assessment, n=34) therapy in five institutions in Korea. After 16 weeks of acarbose add-on or metformin-switch therapy, a triple combination therapy was maintained from week 16 to 24.

Results

The add-on of acarbose (Met+Sita+Acarb group) demonstrated a 0.44%±0.08% (P<0.001 vs. baseline) decrease in glycosylated hemoglobin (HbA1c) at week 16, while changes in HbA1c were insignificant in the Met+Sita group (−0.09%±0.10%, P=0.113). After 8 weeks of triple combination therapy, HbA1c levels were comparable between Met+Sita and Met+Sita+Acarb group (7.66%±0.13% vs. 7.47%±0.12%, P=0.321). Acarbose add-on therapy demonstrated suppressed glucagon secretion (area under the curve of glucagon, 4,726.17±415.80 ng·min/L vs. 3,314.38±191.63 ng·min/L, P=0.004) in the absence of excess insulin secretion during the meal tolerance tests at week 16 versus baseline. The incidence of adverse or serious adverse events was similar between two groups.

Conclusion

In conclusion, a 16-week acarbose add-on therapy to metformin and sitagliptin, effectively lowered HbA1c without significant adverse events. Acarbose might be a good choice as a third-line therapy in addition to metformin and sitagliptin in Korean subjects with T2DM who have predominant postprandial hyperglycemia and a high carbohydrate intake.

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Mohammad Zamani, Mahlagha Nikbaf-Shandiz, Yasaman Aali, Niloufar Rasaei, Mahtab Zarei, Farideh Shiraseb, Omid Asbaghi
Frontiers in Nutrition.2023;[Epub] CrossRef
The effect of acarbose on lipid profiles in adults: a systematic review and meta-analysis of randomized clinical trials
Mohsen Yousefi, Sahand Tehrani Fateh, Mahlagha Nikbaf-Shandiz, Fatemeh Gholami, Samira Rastgoo, Reza Bagher, Alireza Khadem, Farideh Shiraseb, Omid Asbaghi
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Clinical Diabetes & Therapeutics
Efficacy and Safety of Voglibose Plus Metformin in Patients with Type 2 Diabetes Mellitus: A Randomized Controlled Trial: Tae Jung Oh, Jae Myung Yu, Kyung Wan Min, Hyun Shik Son, Moon Kyu Lee, Kun Ho Yoon, Young Duk Song, Joong Yeol Park, In Kyung Jeong, Bong Soo Cha, Yong Seong Kim, Sei Hyun Baik, In Joo Kim, Doo Man Kim, Sung Rae Kim, Kwan Woo Lee, Jeong Hyung Park, In Kyu Lee, Tae Sun Park, Sung Hee Choi, Sung Woo Park; Diabetes Metab J. 2019;43(3):276-286. Published online December 7, 2018; DOI: https://doi.org/10.4093/dmj.2018.0051

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Background

Combination of metformin to reduce the fasting plasma glucose level and an α-glucosidase inhibitor to decrease the postprandial glucose level is expected to generate a complementary effect. We compared the efficacy and safety of a fixed-dose combination of voglibose plus metformin (vogmet) with metformin monotherapy in drug-naïve newly-diagnosed type 2 diabetes mellitus.

Methods

A total of 187 eligible patients aged 20 to 70 years, with a glycosylated hemoglobin (HbA1c) level of 7.0% to 11.0%, were randomized into either vogmet or metformin treatments for 24 weeks. A change in the HbA1c level from baseline was measured at week 24.

Results

The reduction in the levels of HbA1c was −1.62%±0.07% in the vogmet group and −1.31%±0.07% in the metformin group (P=0.003), and significantly more vogmet-treated patients achieved the target HbA1c levels of <6.5% (P=0.002) or <7% (P=0.039). Glycemic variability was also significantly improved with vogmet treatment, estimated by M-values (P=0.004). Gastrointestinal adverse events and hypoglycemia (%) were numerically lower in the vogmet-treated group. Moreover, a significant weight loss was observed with vogmet treatment compared with metformin (−1.63 kg vs. −0.86 kg, P=0.039).

Conclusion

Vogmet is a safe antihyperglycemic agent that controls blood glucose level effectively, yields weight loss, and is superior to metformin in terms of various key glycemic parameters without increasing the risk of hypoglycemia.

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Mónica Aideé Díaz-Román, Juan José Acevedo-Fernández, Gabriela Ávila-Villarreal, Elizabeth Negrete-León, A. Berenice Aguilar-Guadarrama
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YAP/TAZ axis was involved in the effects of metformin on breast cancer
Yu Xu, Hongke Cai, Yuanfeng Xiong, Li Tang, Longjiang Li, Li Zhang, Yi Shen, Yongqiang Yang, Ling Lin, Jiayi Huang
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Jun Sung Moon, Sunghwan Suh, Sang Soo Kim, Heung Yong Jin, Jeong Mi Kim, Min Hee Jang, Kyung Ae Lee, Ju Hyung Lee, Seung Min Chung, Young Sang Lyu, Jin Hwa Kim, Sang Yong Kim, Jung Eun Jang, Tae Nyun Kim, Sung Woo Kim, Eonju Jeon, Nan Hee Cho, Mi-Kyung Ki
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Sanjay Kalra, Ganapathi Bantwal, Nitin Kapoor, Rakesh Sahay, Saptarshi Bhattacharya, Beatrice Anne, Raju A Gopal, Sunil Kota, Ashok Kumar, Ameya Joshi, Debmalya Sanyal, Mangesh Tiwaskar, Ashok Kumar Das
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Diabetes & Metabolism Journal.2020; 44(6): 908. CrossRef
Response: Efficacy and Safety of Voglibose Plus Metformin in Patients with Type 2 Diabetes Mellitus: A Randomized Controlled Trial (Diabetes metab J 2019;43;276-86)
Tae Jung Oh, Sung Hee Choi
Diabetes & Metabolism Journal.2019; 43(4): 547. CrossRef
Letter: Efficacy and Safety of Voglibose Plus Metformin in Patients with Type 2 Diabetes Mellitus: A Randomized Controlled Trial (Diabetes Metab J 2019;43;276-86)
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Clinical Diabetes & Therapeutics
Effects of High-Dose α-Lipoic Acid on Heart Rate Variability of Type 2 Diabetes Mellitus Patients with Cardiac Autonomic Neuropathy in Korea: Sol Jae Lee, Su Jin Jeong, Yu Chang Lee, Yong Hoon Lee, Jung Eun Lee, Chong Hwa Kim, Kyung Wan Min, Bong Yun Cha; Diabetes Metab J. 2017;41(4):275-283. Published online July 6, 2017; DOI: https://doi.org/10.4093/dmj.2017.41.4.275

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Background

Diabetic cardiac autonomic neuropathy (CAN) is one of the important complications of diabetes. It is characterized by reduced heart rate variability (HRV).

Methods

In this randomized, double-blind, placebo-controlled, multicenter trial, 75 patients were randomly assigned to one of two groups. One group (n=41) received α-lipoic acid (ALA) at an oral dose of 600 mg/day for the first 12 weeks and then 1,200 mg/day for the next 12 weeks. The other group (n=34) received placebo treatment for 24 weeks. CAN was assessed by measuring HRVs in people with diabetes.

Results

Most of the baseline measures for HRVs were similar between the ALA and placebo groups. Although there were no statistically significant HRV changes in the ALA group compared to the placebo group after 24 weeks of trial, we found a positive tendency in some of the HRV parameters of the ALA group. The standard deviations of normal-to-normal RR intervals in the standing position increased by 1.87 ms in the ALA group but decreased by −3.97 ms in the placebo group (P=0.06). The power spectrum of the low frequency (LF) band in the standing position increased by 15.77 ms² in the ALA group, whereas it declined by −15.04 ms² in the placebo group (P=0.08). The high frequency/LF ratio in the upright position increased by 0.35 in the ALA group, whereas it declined by −0.42 in the placebo group (P=0.06). There were no differences between the two groups regarding rates of adverse events.

Conclusion

Although a slight improvement tendency was seen in HRV in the ALA group, there were no statistically significant HRV changes in the ALA group compared to the placebo group after 24 weeks of trial. However, the high oral dose of ALA was well-tolerated.

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Arterial Stiffness by Aerobic Exercise Is Related with Aerobic Capacity, Physical Activity Energy Expenditure and Total Fat but not with Insulin Sensitivity in Obese Female Patients with Type 2 Diabetes: Ji Yeon Jung, Kyung Wan Min, Hee Jung Ahn, Hwi Ryun Kwon, Jae Hyuk Lee, Kang Seo Park, Kyung Ah Han; Diabetes Metab J. 2014;38(6):439-448. Published online December 15, 2014; DOI: https://doi.org/10.4093/dmj.2014.38.6.439

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Background

Arterial stiffness is an important factor in atherosclerosis. Thus we examined whether aerobic exercise could reduce arterial stiffness in obese women with type 2 diabetes without diabetic complication.

Methods

A total of 35 women with type 2 diabetes (body mass index, 26.6±2.8 kg/m²; age, 56.4±1.9 years; duration of diabetes, 4.7±4.8 years) were assigned to aerobic exercise group (AEG) or control group (CG). AEG completed a 12-week exercise program (3.6 to 5.2 metabolic equivalents, 3 day/week, 60 min/day), with their exercise activities monitored by accelerometers. We measured abdominal total fat area (TFA), visceral fat area (VFA), and subcutaneous fat area (SFA) by computed tomography, insulin sensitivity by insulin tolerance test (K_ITT), and augmentation index (AIx) by SphygmoCor at baseline and at the end of the 12-week program.

Results

The AIx was improved in the AEG compared with the CG (P<0.001). The percent change of AIx had significant correlation with the improvement of physical activity energy expenditure (PAEE), aerobic capacity, TFA, and SFA (r=-0.416, P=0.013; r=0.560, P<0.001; r=0.489, P=0.003; r=0.531, P=0.001, respectively), but not with insulin sensitivity, energy intake, or VFA.

Conclusion

Improvement in aortic stiffness by aerobic exercise is related with the improvement of aerobic capacity, PAEE, and total fat but not with insulin sensitivity or energy intake in obese women with type 2 diabetes.

Citations

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Min Li, Qidong Zheng, Joshua D. Miller, Panpan Zuo, Xiaodan Yuan, Jitao Feng, Chao Liu, Shan Bao, Qingqing Lou
Diabetes/Metabolism Research and Reviews.2022;[Epub] CrossRef
Effect of aerobic exercise on waist circumference in adults with overweight or obesity: A systematic review and meta‐analysis
Alex Armstrong, Klaus Jungbluth Rodriguez, Angelo Sabag, Yorgi Mavros, Helen M. Parker, Shelley E. Keating, Nathan A. Johnson
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Aortic waveform responses to insulin in late versus early chronotype with metabolic syndrome
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Exercise and ectopic fat in type 2 diabetes: A systematic review and meta-analysis
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Diabetes & Metabolism.2017; 43(3): 195. CrossRef
Arterial Stiffness Measured with the Cuff Oscillometric Method Is Predictive of Exercise Capacity in Patients with Cardiac Diseases
Yasushi Tazawa, Nobuyoshi Mori, Yoshiko Ogawa, Osamu Ito, Masahiro Kohzuki
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Review

Diabetes Epidemics in Korea: Reappraise Nationwide Survey of Diabetes "Diabetes in Korea 2007": Ie Byung Park, Jaiyong Kim, Dae Jung Kim, Choon Hee Chung, Jee-Young Oh, Seok Won Park, Juneyoung Lee, Kyung Mook Choi, Kyung Wan Min, Jeong Hyun Park, Hyun Shik Son, Chul Woo Ahn, Hwayoung Kim, Sunhee Lee, Im Bong Lee, Injeoung Choi, Sei Hyun Baik; Diabetes Metab J. 2013;37(4):233-239. Published online August 14, 2013; DOI: https://doi.org/10.4093/dmj.2013.37.4.233

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There are many studies on the prevalence, clinical characteristics, and economic burden of diabetes across the past four decades in Korea. Nonetheless, there is a dearth of nationwide study regarding diabetes encompassing all age group. Eight years ago, the Committee on the Epidemiology of Diabetes Mellitus of Korean Diabetes Association collaborated with Health Insurance Review & Assessment Service to evaluate the status of diabetes care and characteristics in diabetic patients in Korea. In 2007, the collaborative task force team published a comprehensive survey titled "Diabetes in Korea 2007." In this review, we reappraise the diabetic epidemics from the joint report and suggest further studies that are needed to be investigated in the future.

Citations

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Original Articles

Safety and Efficacy of Modern Insulin Analogues: Hye Jin Yoo, Keun Yong Park, Kang Seo Park, Kyu Jeung Ahn, Kyung Wan Min, Jeong Hyun Park, Sang Ah Chang, Bong Soo Cha, Dong-Jun Kim, Yong Seong Kim, Tae Keun Oh, Suk Chon, Il Seong Nam-Goong, Mi Jin Kim, Hye-Soon Kim, Young Sik Choi, You Hern Ahn, Sora Lee, Sei Hyun Baik; Diabetes Metab J. 2013;37(3):181-189. Published online June 14, 2013; DOI: https://doi.org/10.4093/dmj.2013.37.3.181

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Background

A1chieve® was a noninterventional study evaluating the clinical safety and efficacy of biphasic insulin aspart 30, insulin detemir, and insulin aspart.

Methods

Korean type 2 diabetes patients who have not been treated with the study insulin or have started it within 4 weeks before enrollment were eligible for the study. The patient selection and the choice of regimen were at the discretion of the physician. The safety and efficacy information was collected from the subjects at baseline, week 12, and week 24. The number of serious adverse drug reactions (SADRs) was the primary endpoint. The changes of clinical diabetic markers at week 12 and/or at week 24 compared to baseline were the secondary endpoints.

Results

Out of 4,058 exposed patients, 3,003 completed the study. During the study period, three SADRs were reported in three patients (0.1%). No major hypoglycemic episodes were observed and the rate of minor hypoglycemic episodes marginally decreased during 24 weeks (from 2.77 to 2.42 events per patient-year). The overall quality of life score improved (from 66.7±15.9 to 72.5±13.5) while the mean body weight was slightly increased (0.6±3.0 kg). The 24-week reductions in glycated hemoglobin, fasting plasma glucose and postprandial plasma glucose were 1.6%±2.2%, 2.5±4.7 mmol/L, and 4.0±6.4 mmol/L, respectively.

Conclusion

The studied regimens showed improvements in glycemic control with low incidence of SADRs, including no incidence of major hypoglycemic episodes in Korean patients with type 2 diabetes.

Citations

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Byung-Wan Lee
Diabetes & Metabolism Journal.2013; 37(3): 212. CrossRef

Relation of Absolute or Relative Adiposity to Insulin Resistance, Retinol Binding Protein-4, Leptin, and Adiponectin in Type 2 Diabetes: You Lim Kim, Tae Kyun Kim, Eun Sun Cheong, Dong Geum Shin, Gyu Sik Choi, Jihye Jung, Kyung-Ah Han, Kyung Wan Min; Diabetes Metab J. 2012;36(6):415-421. Published online December 12, 2012; DOI: https://doi.org/10.4093/dmj.2012.36.6.415

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Background

Central fat mass (CFM) correlates with insulin resistance and increases the risk of type 2 diabetes and cardiovascular complications; however, peripheral fat mass (PFM) is associated with insulin sensitivity. The aim of this study was to investigate the relation of absolute and relative regional adiposity to insulin resistance index and adipokines in type 2 diabetes.

Methods

Total of 83 overweighted-Korean women with type 2 diabetes were enrolled, and rate constants for plasma glucose disappearance (K_ITT) and serum adipokines, such as retinol binding protein-4 (RBP4), leptin, and adiponectin, were measured. Using dual X-ray absorptiometry, trunk fat mass (in kilograms) was defined as CFM, sum of fat mass on the lower extremities (in kilograms) as PFM, and sum of CFM and PFM as total fat mass (TFM). PFM/TFM ratio, CFM/TFM ratio, and PFM/CFM ratio were defined as relative adiposity.

Results

Median age was 55.9 years, mean body mass index 27.2 kg/m², and mean HbA1c level 7.12±0.84%. K_ITT was positively associated with PMF/TFM ratio, PMF/CFM ratio, and negatively with CFM/TFM ratio, but was not associated with TFM, PFM, or CFM. RBP4 levels also had a significant relationship with PMF/TFM ratio and PMF/CFM ratio. Adiponectin, leptin, and apolipoprotein A levels were related to absolute adiposity, while only adiponectin to relative adiposity. In correlation analysis, K_ITT in type 2 diabetes was positively related with HbA1c, fasting glucose, RBP4, and free fatty acid.

Conclusion

These results suggest that increased relative amount of peripheral fat mass may aggravate insulin resistance in type 2 diabetes.

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Qin Tang, Qinhui Liu, Jiahui Li, Jiamin Yan, Xiandan Jing, Jinhang Zhang, Yan Xia, Ying Xu, Yanping Li, Jinhan He
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Ilse M Schrover, Yolanda van der Graaf, Wilko Spiering, Frank LJ Visseren
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Regional Adiposity, Adipokines, and Insulin Resistance in Type 2 Diabetes
Jee-Young Oh
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Effects of Aerobic Exercise Intensity on Abdominal and Thigh Adipose Tissue and Skeletal Muscle Attenuation in Overweight Women with Type 2 Diabetes Mellitus: Ji Yeon Jung, Kyung Ah Han, Hee Jung Ahn, Hwi Ryun Kwon, Jae Hyuk Lee, Kang Seo Park, Kyung Wan Min; Diabetes Metab J. 2012;36(3):211-221. Published online June 14, 2012; DOI: https://doi.org/10.4093/dmj.2012.36.3.211

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Background

We investigated the effects of exercise intensity on abdominal and mid-thigh adipose tissue, attenuation of skeletal muscle, and insulin sensitivity in overweight women with type 2 diabetes mellitus (T2DM).

Methods

Twenty-eight patients were randomly assigned to control (CG, n=12), moderate intensity exercise (MEG, n=8), or vigorous intensity exercise (VEG, n=8) group. Subjects in both exercise groups completed a 12-week exercise program (MEG, 3.6 to 5.2 METs; VEG, ≥5.2 METs) that was monitored by accelerometers. We assessed body mass index (BMI), total fat area (TFA), visceral fat area (VFA), subcutaneous fat area (SFA), mid-thigh intramuscular adipose tissue (TIMAT), total skeletal muscle (TTM), low density skeletal muscle (TLDM), and normal density skeletal muscle (TNDM) using computed tomography, and measured insulin sensitivity with an insulin tolerance test (K_ITT), before and after the intervention.

Results

At baseline, the mean age was 53.8±7.9 years, duration of diabetes was 3.8±2.3 years, and BMI was 26.6±2.6 kg/m². After 12 weeks, the percent change (%C) in BMI, TIMAT, and TLDM were not different among three groups. However, %C in TFA and VFA were significantly reduced in MEG compared to CG (P=0.026 and P=0.008, respectively). %C SFA was significantly reduced in VEG compared to CG (P=0.038) and %C TTM, TNDM, and K_ITT were significantly increased in VEG compared to the CG (P=0.044, P=0.007, and P=0.016, respectively).

Conclusion

Although there was no difference in the change in BMI among groups, TFA and VFA were more reduced in MEG, and only VEG increased TTM, TNDM, and insulin sensitivity compared to CG.

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Cardiovascular Risk Assessment with Vascular Function, Carotid Atherosclerosis and the UKPDS Risk Engine in Korean Patients with Newly Diagnosed Type 2 Diabetes: Choon Sik Seon, Kyung Wan Min, Seung Yup Lee, Kyoung Woo Nho, Se Hwan Park, Bo Kyung Koo, Kyung Ah Han; Diabetes Metab J. 2011;35(6):619-627. Published online December 26, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.6.619

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Background

Patients with type 2 diabetes have an increased risk of cardiovascular disease. Few studies have evaluated the cardiovascular disease (CVD) risk simultaneously using the United Kingdom Prospective Diabetes Study (UKPDS) risk engine and non-invasive vascular tests in patients with newly diagnosed type 2 diabetes.

Methods

Participants (n=380; aged 20 to 81 years) with newly diagnosed type 2 diabetes were free of clinical evidence of CVD. The 10-year coronary heart disease (CHD) and stroke risks were calculated for each patient using the UKPDS risk engine. Carotid intima media thickness (CIMT), flow mediated dilation (FMD), pulse wave velocity (PWV) and augmentation index (AI) were measured. The correlations between the UKPDS risk engine and the non-invasive vascular tests were assessed using partial correlation analysis, after adjusting for age, and multiple regression analysis.

Results

The mean 10-year CHD and 10-year stroke risks were 14.92±11.53% and 4.03±3.95%, respectively. The 10-year CHD risk correlated with CIMT (P<0.001), FMD (P=0.017), and PWV (P=0.35) after adjusting for age. The 10-year stroke risk correlated only with the mean CIMT (P<0.001) after adjusting for age. FMD correlated with age (P<0.01) and systolic blood pressure (P=0.09). CIMT correlated with age (P<0.01), HbA1c (P=0.05), and gender (P<0.01).

Conclusion

The CVD risk is increased at the onset of type 2 diabetes. CIMT, FMD, and PWV along with the UKPDS risk engine should be considered to evaluate cardiovascular disease risk in patients with newly diagnosed type 2 diabetes.

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Carotid atherosclerosis and its relationship to coronary heart disease and stroke risk in patients with type 2 diabetes mellitus
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Response

Response: The Effect of an Angiotensin Receptor Blocker on Arterial Stiffness in Type 2 Diabetes Mellitus Patients with Hypertension (Diabetes Metab J 2011;35:236-42): Ji Hyun Kim, Su Jin Oh, Jung Min Lee, Eun Gyoung Hong, Jae Myung Yu, Kyung Ah Han, Kyung Wan Min, Hyun Shik Son, Sang Ah Chang; Diabetes Metab J. 2011;35(4):429-430. Published online August 31, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.4.429

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Original Articles

The Correlations between Extremity Circumferences with Total and Regional Amounts of Skeletal Muscle and Muscle Strength in Obese Women with Type 2 Diabetes: Hwi Ryun Kwon, Kyung Ah Han, Hee Jung Ahn, Jae Hyuk Lee, Gang Seo Park, Kyung Wan Min; Diabetes Metab J. 2011;35(4):374-383. Published online August 31, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.4.374

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Background

Insulin resistance is related to central obesity and the amount of skeletal muscle. A simple and practical anthropometric marker for muscle mass is not known, although waist circumference (WC) is used as an indicator of abdominal obesity. The aims of this study were to investigate whether arm (AC) and thigh circumferences (TC) can be used as an indicator of muscle mass and if they are related to muscle strength.

Methods

A total of 110 obese (body mass index [BMI]≥25 kg/m²) women with type 2 diabetes were enrolled, and WC, AC, and TC were measured. Abdominal visceral fat (AVF), subcutaneous fat (ASF), and total fat (ATF) were assessed by computed tomography, regional muscle (MM), and fat mass by dual-energy X-ray absorptiometry, muscle strength by one repetition maximum (1RM) of both extremities (chest and leg press) and insulin resistance by K_ITT.

Results

The mean age was 56.2±7.3 years, duration of diabetes was 4.2±4.4 years, and BMI was 27.2±2.8 kg/m². WC was correlated with ATF, AVF, and ASF (r=0.728, P<0.001; r=0.515, P<0.001; r=0.608, P<0.001, respectively). Arm MM was correlated with AC (r=0.500, P<0.001), and leg MM with TC (r=0.291, P=0.002). Upper 1RM was related to AC/WC ratio (r=0.359, P<0.001), and lower 1RM was to TC/WC ratio (r=0.286, P=0.003). Insulin resistance had significant relations with AVF, WC, and total MM (r=-0.262, P=0.008; r=-0.217, P=0.029; r=0.160, P=0.031, respectively).

Conclusion

The muscle mass was related to extremity circumferences, and muscle strength was to extremity/waist circumference ratio in obese women with type 2 diabetes.

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Thigh-hip ratio is significantly associated with all-cause mortality among Japanese community-dwelling men
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Effects of Aerobic Exercise vs. Resistance Training on Endothelial Function in Women with Type 2 Diabetes Mellitus: Hwi Ryun Kwon, Kyung Wan Min, Hee Jung Ahn, Hee Geum Seok, Jae Hyuk Lee, Gang Seo Park, Kyung Ah Han; Diabetes Metab J. 2011;35(4):364-373. Published online August 31, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.4.364

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Background

There is controversy over whether aerobic or resistance exercise is more effective for improving endothelial function in type 2 diabetes mellitus (T2DM). This study was aimed to investigate the effects of an aerobic and resistance training program on endothelial function, and the influences of glycemic control, body weight changes, and aerobic capacity in T2DM.

Methods

Total 40 overweight women with T2DM were assigned into 3 groups: an aerobic exercise group (AEG, n=13), resistance exercise group (REG, n=12), and control group (CG, n=15), and followed either brisk walking for the AEG or resistance band training for the REG, 60 minutes per day, 5 days per week for 12 weeks with monitoring daily activity using accelerometers. We assessed endothelial function by flow-mediated dilation (FMD), and aerobic capacity by oxygen uptake at anaerobic threshold (AT_VO₂) at baseline and following training program.

Results

The mean participants' age was 57.0±6.8 years, and body mass index (BMI) was 27.0±2.3 kg/m². After intervention, FMD increased by 2.2±1.9% in AEG, which differed from REG and CG (P=0.002), despite of decreased body weight (BW) in both AG and RG (2.8±2.5%, P=0.002; 1.6±2.0%, P=0.017, respectively). A significant increased AT_VO₂ and decreased HbA1c were found only in AEG. In all participants, FMD was changed with the significant relations to the AT_VO₂ (r=0.348, P=0.035), but not to HbA1c levels or BW.

Conclusion

Aerobic exercise appears to be more beneficial than resistance exercise for improving endothelial function in T2DM. In addition, aerobic capacity could be a better predictor of changes in FMD than BW and glycemic control.

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Original article – Effect of different resistance training intensities on endothelial function in people with type 2 diabetes mellitus: A systematic review
Thiago Borges Madureira Sabino, Denise Maria Martins Vancea, Manoel da Cunha Costa, Raphael José Perrier de Melo, Iago Vilela Dantas, Jonathan Nicolas dos Santos Ribeiro
Diabetes Research and Clinical Practice.2023; 200: 110676. CrossRef
장기간의 저항성 트레이닝이 전문 보디빌더의 중심 동맥 혈압 및 경직도에 미치는 영향
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The Korean Journal of Physical Education.2023; 62(4): 1. CrossRef
Dose-response relationships of resistance training in Type 2 diabetes mellitus: a meta-analysis of randomized controlled trials
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Frontiers in Endocrinology.2023;[Epub] CrossRef
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The Journal of Physiology.2022; 600(4): 707. CrossRef
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BMJ Open Diabetes Research & Care.2022; 10(2): e002595. CrossRef
Does Aerobic plus Machine-Assisted Resistance Training Improve Vascular Function in Type 2 Diabetes? A Systematic Review and Meta-Analysis of Randomized Controlled Trials with Trial Sequential Analysis
Xianshan Guo, Shizhe Guo, Hongmei Zhang, Zhen Li
Journal of Clinical Medicine.2022; 11(15): 4257. CrossRef
Endurance Training Depletes Antioxidant System but Does Not Affect Endothelial Functions in Women with Abdominal Obesity: A Randomized Trial with a Comparison to Endurance-Strength Training
Małgorzata Jamka, Paweł Bogdański, Patrycja Krzyżanowska-Jankowska, Anna Miśkiewicz-Chotnicka, Joanna Karolkiewicz, Monika Duś-Żuchowska, Radosław Mądry, Aleksandra Lisowska, Anna Gotz-Więckowska, Saule Iskakova, Jarosław Walkowiak, Edyta Mądry
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The Role of Physical Therapy in the Combined Treatment of Patients with Lower Extremities Diabetic Angiopathies
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Bulletin of Rehabilitation Medicine.2021; 20(2): 80. CrossRef
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International Journal of Environmental Research and Public Health.2021; 18(13): 6723. CrossRef
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Atherosclerosis.2021; 333: 91. CrossRef
Vascular Ageing and Aerobic Exercise
Michaela Kozakova, Carlo Palombo
International Journal of Environmental Research and Public Health.2021; 18(20): 10666. CrossRef
High-Intensity Endurance and Strength Training in Water Polo Olympic Team Players: Impact on Arterial Wall Properties
Evangelos Oikonomou, Gerasimos Siasos, Georgios Marinos, Marina Zaromitidou, Dimitris Athanasiou, Petros Fountoulakis, Sotiris Tsalamandris, Georgios Charalambous, Georgios Lazaros, Charalambos Vlachopoulos, Dimitris Tousoulis
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Beyond general resistance training. Hypertrophy versus muscular endurance training as therapeutic interventions in adults with type 2 diabetes mellitus: A systematic review and meta‐analysis
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Aerobic Exercise Increases Tear Secretion and Decreases Inflammatory Cytokines in Healthy Subjects
Hao Li, Fei Li, Rouxi Zhou, Kai Gao, Lingyi Liang, Xiulan Zhang
Asia-Pacific Journal of Ophthalmology.2020; 9(5): 404. CrossRef
The Role of Aerobic Training Variables Progression on Glycemic Control of Patients with Type 2 Diabetes: a Systematic Review with Meta-analysis
Rodrigo Sudatti Delevatti, Cláudia Gomes Bracht, Salime Donida Chedid Lisboa, Rochelle Rocha Costa, Elisa Corrêa Marson, Nathalie Netto, Luiz Fernando Martins Kruel
Sports Medicine - Open.2019;[Epub] CrossRef
Effect of Exercise on Risk Factors of Diabetic Foot Ulcers
Fuyuan Liao, Ruopeng An, Fang Pu, Stephanie Burns, Sa Shen, Yih-Kuen Jan
American Journal of Physical Medicine & Rehabilitation.2019; 98(2): 103. CrossRef
Therapeutic Options Targeting Oxidative Stress, Mitochondrial Dysfunction and Inflammation to Hinder the Progression of Vascular Complications of Diabetes
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Frontiers in Physiology.2019;[Epub] CrossRef
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Anderson Rech, Cíntia Ehlers Botton, Pedro Lopez, André Quincozes-Santos, Daniel Umpierre, Ronei Silveira Pinto
Experimental Gerontology.2019; 118: 19. CrossRef
Resistance Exercise Intensity is Correlated with Attenuation of HbA1c and Insulin in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis
Yubo Liu, Weibing Ye, Qian Chen, Yong Zhang, Chia-Hua Kuo, Mallikarjuna Korivi
International Journal of Environmental Research and Public Health.2019; 16(1): 140. CrossRef
Effects of Resistance Exercise on Glycated Hemoglobin and Functional Performance in Older Patients with Comorbid Diabetes Mellitus and Knee Osteoarthritis: A Randomized Trial
Shu-Mei Chen, Feng-Chih Shen, Jung-Fu Chen, Wen-Dien Chang, Nai-Jen Chang
International Journal of Environmental Research and Public Health.2019; 17(1): 224. CrossRef
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Physiological Reports.2019;[Epub] CrossRef
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Diabetology & Metabolic Syndrome.2018;[Epub] CrossRef
Exercise training and endothelial function in patients with type 2 diabetes: a meta-analysis
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Responses of healthy young males to fine-particle exposure are modified by exercise habits: a panel study
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Environmental Health.2018;[Epub] CrossRef
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Anti-inflammatory effects of active commuting and leisure time exercise in overweight and obese women and men: A randomized controlled trial
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Atherosclerosis.2017; 265: 318. CrossRef
The Effects of Exercise Training on Brachial Artery Flow-Mediated Dilation
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Sports Medicine.2017; 47(4): 717. CrossRef
Effects of Combination of Baduanjin and Elastic Band on Physical Fitness and Glycemic Control in Patients with Type 2 Diabetes Mellitus
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Advances in Physical Sciences.2017; 05(01): 5. CrossRef
Effects of progressive resistance training and weight loss versus weight loss alone on inflammatory and endothelial biomarkers in older adults with type 2 diabetes
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European Journal of Applied Physiology.2017; 117(8): 1669. CrossRef
Endurance exercise per se reduces the cardiovascular risk marker t-PA antigen in healthy, younger, overweight men
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Thrombosis Research.2017; 152: 69. CrossRef
Effect of Exercise Intervention on Flow-Mediated Dilation in Overweight and Obese Adults: Meta-Analysis
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International Journal of Vascular Medicine.2017; 2017: 1. CrossRef
Effects of Elastic Band Resistance Training on Glucose Control, Body Composition, and Physical Function in Women With Short- vs. Long-Duration Type-2 Diabetes
Bong-Sup Park, Andy V. Khamoui, Lee E. Brown, Do-Youn Kim, Kyung-Ah Han, Kyung-Wan Min, Geun-Hee An
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Glycemic reductions following water- and land-based exercise in patients with type 2 diabetes mellitus
Rodrigo Sudatti Delevatti, Carolina Dertzbocher Feil Pinho, Ana Carolina Kanitz, Cristine Lima Alberton, Elisa Corrêa Marson, Luciana Peruchena Bregagnol, Salime Chedid Lisboa, Beatriz D. Schaan, Luiz Fernando Martins Kruel
Complementary Therapies in Clinical Practice.2016; 24: 73. CrossRef
Short-term exercise training improves flow-mediated dilation and circulating angiogenic cell number in older sedentary adults
Rian Q. Landers-Ramos, Kelsey J. Corrigan, Lisa M. Guth, Christine N. Altom, Espen E. Spangenburg, Steven J. Prior, James M. Hagberg
Applied Physiology, Nutrition, and Metabolism.2016; 41(8): 832. CrossRef
Glucose control can be similarly improved after aquatic or dry-land aerobic training in patients with type 2 diabetes: A randomized clinical trial
Rodrigo S. Delevatti, Ana Carolina Kanitz, Cristine L. Alberton, Elisa Corrêa Marson, Salime Chedid Lisboa, Carolina Dertzbocher Feil Pinho, Gisele A. Lovatel, Arthiese Korb, Karine Bertoldi, Rodrigo C.O. Macedo, Ionara R. Siqueira, Beatriz D. Schaan, Lui
Journal of Science and Medicine in Sport.2016; 19(8): 688. CrossRef
Assessment of endothelial function by flow-mediated dilation in diabetic patients: Effects of physical exercise
Aline P Jarrete, Angelina Zanesco, Maria Andréia Delbin
Motriz: Revista de Educação Física.2016; 22(1): 3. CrossRef
Psychosocial Variables Related to Why Women are Less Active than Men and Related Health Implications
Elizabeth Skidmore Edwards, Sarah Carson Sackett
Clinical Medicine Insights: Women's Health.2016; 9s1: CMWH.S34668. CrossRef
In Search of the Ideal Resistance Training Program to Improve Glycemic Control and its Indication for Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis
Hajime Ishiguro, Satoru Kodama, Chika Horikawa, Kazuya Fujihara, Ayumi Sugawara Hirose, Reiko Hirasawa, Yoko Yachi, Nobumasa Ohara, Hitoshi Shimano, Osamu Hanyu, Hirohito Sone
Sports Medicine.2016; 46(1): 67. CrossRef
Effects of exercise training using resistance bands on glycaemic control and strength in type 2 diabetes mellitus: a meta-analysis of randomised controlled trials
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Acta Diabetologica.2015; 52(2): 221. CrossRef
Impact of combined exercise training on cardiovascular autonomic control and mortality in diabetic ovariectomized rats
Iris C. Sanches, Filipe F. Conti, Nathalia Bernardes, Janaina de O Brito, Elia G. Galdini, Cláudia R. Cavaglieri, Maria-Cláudia Irigoyen, Kátia De Angelis
Journal of Applied Physiology.2015; 119(6): 656. CrossRef
Three months of strictly controlled daily endurance exercise reduces thrombin generation and fibrinolytic risk markers in younger moderately overweight men
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European Journal of Applied Physiology.2015; 115(6): 1331. CrossRef
Exercise Modalities and Endothelial Function: A Systematic Review and Dose–Response Meta-Analysis of Randomized Controlled Trials
Ammar W. Ashor, Jose Lara, Mario Siervo, Carlos Celis-Morales, Clio Oggioni, Djordje G. Jakovljevic, John C. Mathers
Sports Medicine.2015; 45(2): 279. CrossRef
The Impact of High-Intensity Interval Training Versus Moderate-Intensity Continuous Training on Vascular Function: a Systematic Review and Meta-Analysis
Joyce S. Ramos, Lance C. Dalleck, Arnt Erik Tjonna, Kassia S. Beetham, Jeff S. Coombes
Sports Medicine.2015; 45(5): 679. CrossRef
Safety of Aerobic Exercise in People With Diabetic Peripheral Neuropathy: Single-Group Clinical Trial
Patricia M. Kluding, Mamatha Pasnoor, Rupali Singh, Linda J. D'Silva, Min Yoo, Sandra A. Billinger, Joseph W. LeMaster, Mazen M. Dimachkie, Laura Herbelin, Douglas E. Wright
Physical Therapy.2015; 95(2): 223. CrossRef
Sleep and exercise: A reciprocal issue?
Mounir Chennaoui, Pierrick J. Arnal, Fabien Sauvet, Damien Léger
Sleep Medicine Reviews.2015; 20: 59. CrossRef
Blood glucose response to aerobic exercise training program among patients with type 2 diabetes mellitus at the University of Nigeria Teaching Hospital, Enugu South-East, Nigeria
C. I. Ezema, S. Lamina, Amarachi A. Onwunali, U. A. Ezugwu, A. A. Amaeze, M. J. Nwankwo
International Journal of Diabetes in Developing Countries.2015; 35(S2): 88. CrossRef
Endothelial Function Increases after a 16-Week Diet and Exercise Intervention in Overweight and Obese Young Women
Lisa M. Cotie, Andrea R. Josse, Stuart M. Phillips, Maureen J. MacDonald
BioMed Research International.2014; 2014: 1. CrossRef
Impact of different training modalities on glycaemic control and blood lipids in patients with type 2 diabetes: a systematic review and network meta-analysis
Lukas Schwingshackl, Benjamin Missbach, Sofia Dias, Jürgen König, Georg Hoffmann
Diabetologia.2014; 57(9): 1789. CrossRef
Exercise as a Therapeutic Strategy for Primary Mitochondrial Cytopathies
Mark A. Tarnopolsky
Journal of Child Neurology.2014; 29(9): 1225. CrossRef
Effects of weight management by exercise modes on markers of subclinical atherosclerosis and cardiometabolic profile among women with abdominal obesity: a randomized controlled trial
Jina Choo, Juneyoung Lee, Jeong-Hyun Cho, Lora E Burke, Akira Sekikawa, Sae Young Jae
BMC Cardiovascular Disorders.2014;[Epub] CrossRef
Walking disability in patients with peripheral artery disease is associated with arterial endothelial function
S. Marlene Grenon, Karen Chong, Hugh Alley, Emily Nosova, Warren Gasper, Jade Hiramoto, W. John Boscardin, Christopher D. Owens
Journal of Vascular Surgery.2014; 59(4): 1025. CrossRef
Cardiovascular Function and Predictors of Exercise Capacity in Patients With Colorectal Cancer
Larissa Cramer, Bert Hildebrandt, Thomas Kung, Kristin Wichmann, Jochen Springer, Wolfram Doehner, Anja Sandek, Miroslava Valentova, Tatjana Stojakovic, Hubert Scharnagl, Hanno Riess, Stefan D. Anker, Stephan von Haehling
Journal of the American College of Cardiology.2014; 64(13): 1310. CrossRef
Effects of Exercise Training on Arterial Function in Type 2 Diabetes Mellitus
David Montero, Guillaume Walther, Eric Benamo, Antonia Perez-Martin, Agnès Vinet
Sports Medicine.2013; 43(11): 1191. CrossRef
A randomized trial of exercise for blood pressure reduction in type 2 diabetes: Effect on flow-mediated dilation and circulating biomarkers of endothelial function
Bethany Barone Gibbs, Devon A. Dobrosielski, Susanne Bonekamp, Kerry J. Stewart, Jeanne M. Clark
Atherosclerosis.2012; 224(2): 446. CrossRef

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