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Clinical Care/Education
Reduction of Sulfonylurea with the Initiation of Basal Insulin in Patients with Inadequately Controlled Type 2 Diabetes Mellitus Undergoing Long-Term Sulfonylurea-Based Treatment
Yeoree Yang, Jeong-Ah Shin, Hae Kyung Yang, Seung-Hwan Lee, Seung-Hyun Ko, Yu-Bae Ahn, Kun-Ho Yoon, Jae-Hyoung Cho
Diabetes Metab J. 2016;40(6):454-462.   Published online October 11, 2016
DOI: https://doi.org/10.4093/dmj.2016.40.6.454
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  • 4 Web of Science
  • 4 Crossref
AbstractAbstract PDFPubReader   
Background

There were a limited number of studies about β-cell function after insulin initiation in patients exposed to long durations of sulfonylurea treatment. In this study, we aimed to evaluate the recovery of β-cell function and the efficacy of concurrent sulfonylurea use after the start of long-acting insulin.

Methods

In this randomized controlled study, patients with type 2 diabetes mellitus (T2DM), receiving sulfonylurea for at least 2 years with glycosylated hemoglobin (HbA1c) >7%, were randomly assigned to two groups: sulfonylurea maintenance (SM) and sulfonylurea reduction (SR). Following a 75-g oral glucose tolerance test (OGTT), we administered long-acting basal insulin to the two groups. After a 6-month follow-up, we repeated the OGTT.

Results

Among 69 enrolled patients, 57 completed the study and were analyzed: 31 in the SM and 26 in the SR group. At baseline, there was no significant difference except for the longer duration of diabetes and lower triglycerides in the SR group. After 6 months, the HbA1c was similarly reduced in both groups, but there was little difference in the insulin dose. In addition, insulin secretion during OGTT was significantly increased by 20% to 30% in both groups. A significant weight gain was observed in the SM group only. The insulinogenic index was more significantly improved in the SR group.

Conclusion

Long-acting basal insulin replacement could improve the glycemic status and restore β-cell function in the T2DM patients undergoing sulfonylurea-based treatment, irrespective of the sulfonylurea dose reduction. The dose reduction of the concurrent sulfonylurea might be beneficial with regard to weight grain.

Citations

Citations to this article as recorded by  
  • Initiating or Switching to Insulin Degludec/Insulin Aspart in Adults with Type 2 Diabetes: A Real-World, Prospective, Non-interventional Study Across Six Countries
    Gregory R. Fulcher, Shahid Akhtar, Saleh J. Al-Jaser, Johan Medina, Mafauzy Mohamed, Nemencio A. Nicodemus, Anne Helene Olsen, Kiran P. Singh, Adri Kok
    Advances in Therapy.2022; 39(8): 3735.     CrossRef
  • Use of Insulin Glargine 100 U/mL for the Treatment of Type 2 Diabetes Mellitus in East Asians: A Review
    Takahisa Hirose, Ching-Chu Chen, Kyu Jeung Ahn, Jacek Kiljański
    Diabetes Therapy.2019; 10(3): 805.     CrossRef
  • Insulin Therapy for Adult Patients with Type 2 Diabetes Mellitus: A Position Statement of the Korean Diabetes Association, 2017
    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
    Diabetes & Metabolism Journal.2017; 41(5): 367.     CrossRef
  • Insulin therapy for adult patients with type 2 diabetes mellitus: a position statement of the Korean Diabetes Association, 2017
    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
Clinical Care/Education
Insulin Initiation in Insulin-Naïve Korean Type 2 Diabetic Patients Inadequately Controlled on Oral Antidiabetic Drugs in Real-World Practice: The Modality of Insulin Treatment Evaluation Study
Sang Soo Kim, In Joo Kim, Yong Ki Kim, Kun Ho Yoon, Ho Young Son, Sung Woo Park, Yeon Ah Sung, Hong Sun Baek
Diabetes Metab J. 2015;39(6):481-488.   Published online November 25, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.6.481
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  • 95 Download
  • 10 Web of Science
  • 11 Crossref
AbstractAbstract PDFPubReader   
Background

The Modality of Insulin Treatment Evaluation (MOTIV) study was performed to provide real-world data concerning insulin initiation in Korean type 2 diabetes mellitus (T2DM) patients with inadequate glycemic control with oral hypoglycemic agents (OHAs).

Methods

This multicenter, non-interventional, prospective, observational study enrolled T2DM patients with inadequate glycemic control (glycosylated hemoglobin [HbA1c] ≥7.0%) who had been on OHAs for ≥3 months and were already decided to introduce basal insulin by their physician prior to the start of the study. All treatment decisions were at the physician's discretion to reflect real-world practice.

Results

A total of 9,196 patients were enrolled, and 8,636 patients were included in the analysis (mean duration of diabetes, 8.9 years; mean HbA1c, 9.2%). Basal insulin plus one OHA was the most frequently (51.0%) used regimen. After 6 months of basal insulin treatment, HbA1c decreased to 7.4% and 44.5% of patients reached HbA1c <7%. Body weight increased from 65.2 kg to 65.5 kg, which was not significant. Meanwhile, there was significant increase in the mean daily insulin dose from 16.9 IU at baseline to 24.5 IU at month 6 (P<0.001). Overall, 17.6% of patients experienced at least one hypoglycemic event.

Conclusion

In a real-world setting, the initiation of basal insulin is an effective and well-tolerated treatment option in Korean patients with T2DM who are failing to meet targets with OHA therapy.

Citations

Citations to this article as recorded by  
  • Real-World Outcomes of Individualized Targeted Therapy with Insulin Glargine 300 Units/mL in Insulin-Naïve Korean People with Type 2 Diabetes: TOBE Study
    Eun-Gyoung Hong, Kyung-Wan Min, Jung Soo Lim, Kyu-Jeung Ahn, Chul Woo Ahn, Jae-Myung Yu, Hye Soon Kim, Hyun Jin Kim, Won Kim, Dong Han Kim, Hak Chul Jang
    Advances in Therapy.2024; 41(5): 1967.     CrossRef
  • Clinical Evidence and Practice-Based Guidelines on the Utility of Basal Insulin Combined Oral Therapy (Metformin and Glimepiride) in the Current Era
    Abhishek Shrivastava, Jothydev Kesavadev, Viswanathan Mohan, Banshi Saboo, Dina Shrestha, Anuj Maheshwari, Brij Mohan Makkar, Kirtikumar D. Modi, Ashok Kumar Das
    Current Diabetes Reviews.2023;[Epub]     CrossRef
  • Where to Initiate Basal Insulin Therapy: Inpatient or Outpatient Department? Real-World Observation in China
    Minyuan Chen, Puhong Zhang, Yang Zhao, Nadila Duolikun, Linong Ji
    Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy.2022; Volume 15: 3375.     CrossRef
  • Therapeutic Effect of Quadruple Oral Hypoglycemic Agents in Patients with Type 2 Diabetes Mellitus Who Have Insulin Limitations
    Won Sang Yoo, Do Hee Kim, Hee Jin Kim, Hyun Kyung Chung
    The Journal of Korean Diabetes.2019; 20(2): 117.     CrossRef
  • Use of Insulin Glargine 100 U/mL for the Treatment of Type 2 Diabetes Mellitus in East Asians: A Review
    Takahisa Hirose, Ching-Chu Chen, Kyu Jeung Ahn, Jacek Kiljański
    Diabetes Therapy.2019; 10(3): 805.     CrossRef
  • Nationwide Trends in Pancreatitis and Pancreatic Cancer Risk Among Patients With Newly Diagnosed Type 2 Diabetes Receiving Dipeptidyl Peptidase 4 Inhibitors
    Minyoung Lee, Jiyu Sun, Minkyung Han, Yongin Cho, Ji-Yeon Lee, Chung Mo Nam, Eun Seok Kang
    Diabetes Care.2019; 42(11): 2057.     CrossRef
  • Insulin therapy for adult patients with type 2 diabetes mellitus: a position statement of the Korean Diabetes Association, 2017
    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
  • Insulin Therapy for Adult Patients with Type 2 Diabetes Mellitus: A Position Statement of the Korean Diabetes Association, 2017
    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
    Diabetes & Metabolism Journal.2017; 41(5): 367.     CrossRef
  • Effectiveness of Vildagliptin in Clinical Practice: Pooled Analysis of Three Korean Observational Studies (the VICTORY Study)
    Sunghwan Suh, Sun Ok Song, Jae Hyeon Kim, Hyungjin Cho, Woo Je Lee, Byung-Wan Lee
    Journal of Diabetes Research.2017; 2017: 1.     CrossRef
  • 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 & Metabolism Journal.2017; 41(3): 170.     CrossRef
  • Instauration d’une insulinothérapie chez le patient diabétique de type 2 en médecine générale : Comparaison de l’étude belge InsuStar avec quelques études françaises et internationales
    A.-J. Scheen
    Médecine des Maladies Métaboliques.2016; 10(4): 334.     CrossRef
Correlations between Glucagon Stimulated C-peptide Levels and Microvascular Complications in Type 2 Diabetes Patients
Hye-Jin Yoon, Youn-Zoo Cho, Ji-young Kim, Byung-Joon Kim, Keun-Young Park, Gwan-Pyo Koh, Dae-Ho Lee, Dong-Mee Lim
Diabetes Metab J. 2012;36(5):379-387.   Published online October 18, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.5.379
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  • 23 Crossref
AbstractAbstract PDFPubReader   
Background

This study aimed to investigate whether stimulated C-peptide is associated with microvascular complications in type 2 diabetes mellitus (DM).

Methods

A cross-sectional study was conducted in 192 type 2 diabetic patients. Plasma basal C-peptide and stimulated C-peptide were measured before and 6 minutes after intravenous injection of 1 mg glucagon. The relationship between C-peptide and microvascular complications was statistically analyzed.

Results

In patients with retinopathy, basal C-peptide was 1.9±1.2 ng/mL, and stimulated C-peptide was 2.7±1.6 ng/mL; values were significantly lower compared with patients without retinopathy (P=0.031 and P=0.002, respectively). In patients with nephropathy, basal C-peptide was 1.6±0.9 ng/mL, and stimulated C-peptide was 2.8±1.6 ng/mL; values were significantly lower than those recorded in patients without nephropathy (P=0.020 and P=0.026, respectively). Stimulated C-peptide level was associated with increased prevalence of microvascular complications. Age-, DM duration-, and hemoglobin A1c-adjusted odds ratios for retinopathy in stimulated C-peptide value were 4.18 (95% confidence interval [CI], 1.40 to 12.51) and 3.35 (95% CI, 1.09 to 10.25), respectively. The multiple regression analysis between nephropathy and C-peptide showed that stimulated C-peptide was statistically correlated with nephropathy (P=0.03).

Conclusion

In patients with type 2 diabetes, the glucagon stimulation test was a relatively simple method of short duration for stimulating C-peptide response. Stimulated C-peptide values were associated with microvascular complications to a greater extent than basal C-peptides.

Citations

Citations to this article as recorded by  
  • A Nomogram for Predicting Vision-Threatening Diabetic Retinopathy Among Mild Diabetic Retinopathy Patients: A Case–Control and Prospective Study of Type 2 Diabetes
    Jing Ke, Kun Li, Bin Cao
    Diabetes, Metabolic Syndrome and Obesity.2023; Volume 16: 275.     CrossRef
  • The average 30-minute post-prandial C-peptide predicted diabetic retinopathy progress: a retro-prospective study
    Ting Pan, Jie Gao, Xinghua Cai, Huihui Zhang, Jun Lu, Tao Lei
    BMC Endocrine Disorders.2023;[Epub]     CrossRef
  • Dysregulation of miR-374a is involved in the progression of diabetic retinopathy and regulates the proliferation and migration of retinal microvascular endothelial cells
    Zhanhong Wang, Xiao Zhang, Yanjun Wang, Dailing Xiao
    Clinical and Experimental Optometry.2022; 105(3): 287.     CrossRef
  • The Relationship between the Lipid Accumulation Product and Beta-cell Function in Korean Adults with or without Type 2 Diabetes Mellitus: The 2015 Korea National Health and Nutrition Examination Survey
    Hye Eun Cho, Seung Bum Yang, Mi Young Gi, Ju Ae Cha, so Young Park, Hyun Yoon
    Endocrine Research.2022; 47(2): 80.     CrossRef
  • Effects of Serum C‐Peptide Level on Blood Lipid and Cardiovascular and Cerebrovascular Injury in Patients with Type 2 Diabetes Mellitus: A Meta‐Analysis
    Juan Qin, Rongli Sun, Ding Ding, Yuvaraja Teekaraman
    Contrast Media & Molecular Imaging.2022;[Epub]     CrossRef
  • Investigation of Diabetes Complication Risk Perception and Diabetes Self-Management Skills in Individuals with Diabetes
    Mehmet AYTEMUR, Bahar İNKAYA
    Turkish Journal of Diabetes and Obesity.2022; 6(2): 121.     CrossRef
  • Diabetic Retinopathy and Insulin Insufficiency: Beta Cell Replacement as a Strategy to Prevent Blindness
    Eli Ipp
    Frontiers in Endocrinology.2021;[Epub]     CrossRef
  • Association of C-peptide with diabetic vascular complications in type 2 diabetes
    Y. Wang, H. Wan, Y. Chen, F. Xia, W. Zhang, C. Wang, S. Fang, K. Zhang, Q. Li, N. Wang, Y. Lu
    Diabetes & Metabolism.2020; 46(1): 33.     CrossRef
  • Variations in glucose/C-peptide ratio in patients with type 2 diabetes associated with renal function
    John A. D'Elia, Christopher Mulla, Jiankang Liu, Larry A. Weinrauch
    Diabetes Research and Clinical Practice.2019; 150: 1.     CrossRef
  • The pharmacokinetics of porcine C‐peptide after intraperitoneal injection
    Naho Iizuka, Masuhiro Nishimura, Yasutaka Fujita, Osamu Sawamoto, Shinichi Matsumoto
    Xenotransplantation.2019;[Epub]     CrossRef
  • Association of KCNJ11(RS5219) gene polymorphism with biochemical markers of glycemic status and insulin resistance in gestational diabetes mellitus
    Lenin M, Ramesh Ramasamy, Sweta Kulkarani, Seetesh Ghose, Srinivasan A.R.S., Sathish Babu M
    Meta Gene.2018; 16: 134.     CrossRef
  • Glucagon secretion is increased in patients with Type 2 diabetic nephropathy
    Xiaoyu Wang, Juhong Yang, Baocheng Chang, Chunyan Shan, Yanguang Xu, Miaoyan Zheng, Ying Wang, Huizhu Ren, Liming Chen
    Journal of Diabetes and its Complications.2016; 30(3): 488.     CrossRef
  • Relationship between serum C-peptide level and diabetic retinopathy according to estimated glomerular filtration rate in patients with type 2 diabetes
    Jin Ook Chung, Dong Hyeok Cho, Dong Jin Chung, Min Young Chung
    Journal of Diabetes and its Complications.2015; 29(3): 350.     CrossRef
  • Independent association between serum C‐peptide levels and fat mass‐to‐lean mass ratio in the aging process
    Ying Li, Lian Shun Zheng, Yue Li, Duo Duo Zhao, Lu Meng
    Geriatrics & Gerontology International.2015; 15(7): 918.     CrossRef
  • Relationship Between β-Cell Function, Metabolic Control, and Microvascular Complications in Type 2 Diabetes Mellitus
    Lihua Zhao, Jing Ma, Shaoxin Wang, Yun Xie
    Diabetes Technology & Therapeutics.2015; 17(1): 29.     CrossRef
  • Association of fasting insulin and C peptide with diabetic retinopathy in Latinos with type 2 diabetes
    Jane Z Kuo, Xiuqing Guo, Ronald Klein, Barbara E Klein, Robert N Weinreb, Pauline Genter, Fone-Ching Hsiao, Mark O Goodarzi, Jerome I Rotter, Yii-Der Ida Chen, Eli Ipp
    BMJ Open Diabetes Research & Care.2014; 2(1): e000027.     CrossRef
  • Association between physical activity and serum C‐peptide levels among the elderly
    Ying Li, Lu Meng, QianQian Miao, Yasuto Sato
    Geriatrics & Gerontology International.2014; 14(3): 647.     CrossRef
  • Age at Diagnosis and C-Peptide Level Are Associated with Diabetic Retinopathy in Chinese
    Xiaoling Cai, Xueyao Han, Simin Zhang, Yingying Luo, Yingli Chen, Linong Ji, Alfred S. Lewin
    PLoS ONE.2014; 9(3): e91174.     CrossRef
  • Prevalence and risk factors for diabetic retinopathy in Asian Indians with young onset Type 1 and Type 2 Diabetes
    Ramachandran Rajalakshmi, Anandakumar Amutha, Harish Ranjani, Mohammed K. Ali, Ranjit Unnikrishnan, Ranjit Mohan Anjana, K.M. Venkat Narayan, Viswanathan Mohan
    Journal of Diabetes and its Complications.2014; 28(3): 291.     CrossRef
  • Prediction of response to GLP-1 receptor agonist therapy in Japanese patients with type 2 diabetes
    Kenjiro Imai, Tetsuro Tsujimoto, Atsushi Goto, Maki Goto, Miyako Kishimoto, Ritsuko Yamamoto-Honda, Hiroshi Noto, Hiroshi Kajio, Mitsuhiko Noda
    Diabetology & Metabolic Syndrome.2014;[Epub]     CrossRef
  • The Association between the Serum C-Peptide Level and Bone Mineral Density
    Ying Li, Hua Liu, Yasuto Sato, Bin He
    PLoS ONE.2013; 8(12): e83107.     CrossRef
  • C-Peptide and Its Career from Innocent Bystander to Active Player in Diabetic Atherogenesis
    Corinna Lebherz, Nikolaus Marx
    Current Atherosclerosis Reports.2013;[Epub]     CrossRef
  • C-Peptide and Vascular Complications in Type 2 Diabetic Subjects
    Seok Man Son
    Diabetes & Metabolism Journal.2012; 36(5): 345.     CrossRef
Glycemic Effects of Once-a-Day Rapid-Acting Insulin Analogue Addition on a Basal Insulin Analogue in Korean Subjects with Poorly Controlled Type 2 Diabetes Mellitus
Eun Yeong Choe, Yong-ho Lee, Byung-Wan Lee, Eun-Seok Kang, Bong Soo Cha, Hyun Chul Lee
Diabetes Metab J. 2012;36(3):230-236.   Published online June 14, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.3.230
  • 3,859 View
  • 33 Download
  • 6 Crossref
AbstractAbstract PDFPubReader   
Background

The present study investigates the efficacy in glycemic control by adding once-a-day glulisine to glargine as a basal plus regimen and factors influencing glycemic control with the basal plus regimen in Korean subjects with type 2 diabetes.

Methods

In the present retrospective study, subjects previously treated with the basal plus regimens for at least 6 months were reviewed. Changes in glycemic profiles and clinical parameters were evaluated.

Results

A total of 87 subjects were ultimately enrolled in this study. At baseline, mean glycated hemoglobin (A1c) and glycated albumin were 8.5% (8.0% to 9.6%) and 25.2±7.6%, respectively. After treatment with the basal plus regimen, patients had significant reductions of A1c at 6 months (0.8±0.1%, P<0.001) and their postprandial glucose levels were decreased by 48.7±10.3 mg/dL (P<0.001). Multiple logistic regression showed old age (odds ratio [OR], 1.25; 95% confidence interval [CI], 1.02 to 1.55), high initial A1c (OR, 22.21; 95% CI, 2.44 to 201.78), and lower amounts of glargine (OR, 0.85; 95% CI, 0.76 to 0.99), and glimepiride (OR, 0.23; 95% CI, 0.06 to 0.93) at baseline were independently associated with good responders whose A1c reduction was more than 0.5%.

Conclusion

The authors suggest a basal plus regimen may be effective in reducing glucose levels of subjects with old age, high initial A1c, and patients on low doses of glimepiride and glargine. Despite the use of high doses of hypoglycemic agents, elderly patients with poorly-controlled diabetes are preferred for early initiation of the basal plus regimen.

Citations

Citations to this article as recorded by  
  • Addition of a single short-acting insulin bolus to basal insulin-supported oral therapy: a systematic review of data on the basal-plus regimen
    Jochen Seufert, Anja Borck, Peter Bramlage
    BMJ Open Diabetes Research & Care.2019; 7(1): e000679.     CrossRef
  • Titration of basal insulin or immediate addition of rapid acting insulin in patients not at target using basal insulin supported oral antidiabetic treatment – A prospective observational study in 2202 patients
    Thorsten Siegmund, Martin Pfohl, Thomas Forst, Stefan Pscherer, Peter Bramlage, Johannes Foersch, Anja Borck, Jochen Seufert
    Diabetes & Metabolic Syndrome: Clinical Research & Reviews.2017; 11(1): 51.     CrossRef
  • Characteristics Predictive for a Successful Switch from Insulin Analogue Therapy to Oral Hypoglycemic Agents in Patients with Type 2 Diabetes
    Gyuri Kim, Yong-ho Lee, Eun Seok Kang, Bong-Soo Cha, Hyun Chul Lee, Byung-Wan Lee
    Yonsei Medical Journal.2016; 57(6): 1395.     CrossRef
  • Clinical Characteristics of Patients Responding to Once-Daily Basal Insulin Therapy in Korean Subjects with Type 2 Diabetes
    Sun Ok Song, You-Cheol Hwang, Kyu-Jeung Ahn, Bong Soo Cha, Young Duk Song, Dae Wook Lee, Byung-Wan Lee
    Diabetes Therapy.2015; 6(4): 547.     CrossRef
  • The optimal morning:evening ratio in total dose of twice‐daily biphasic insulin analogue in poorly controlled Type 2 diabetes: a 24‐week multi‐centre prospective, randomized controlled, open‐labelled clinical study
    C. H. Jung, J.‐Y. Park, J. H. Cho, K.‐H. Yoon, H. K. Yang, Y.‐H. Lee, B. S. Cha, B.‐W. Lee
    Diabetic Medicine.2014; 31(1): 68.     CrossRef
  • The glycemic efficacies of insulin analogue regimens according to baseline glycemic status in Korean patients with type 2 diabetes: sub‐analysis from the A 1 chieve ® study
    Y.‐C. Hwang, J. G. Kang, K. J. Ahn, B. S. Cha, S.‐H. Ihm, S. Lee, M. Kim, B.‐W. Lee
    International Journal of Clinical Practice.2014; 68(11): 1338.     CrossRef
Insulin Requirement for Korean Type 1 Diabetics using Continuous Insulin Infusion with Portable External Pumps.
Hye Jin Lee, Kwon Beom Kim, Kyung Ah Han, Kyung Wan Min, Eung Jin Kim
Korean Diabetes J. 2004;28(6):538-546.   Published online December 1, 2004
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AbstractAbstract PDF
BACKGROUND
Insulin pumps can be extremely effective in achieving a normal or near-normal blood glucose level in type 1 diabetic patients. For designing a pump program in western countries, it has been recommended that approximately half of the daily insulin dose should given in the basal infusion, and the other half make up the meal-related bolus dose. However, peoples' diet composition is quite different among the many countries. The carbohydrate composition in the Korean diet is higher (60~65%) than that in the western diet (45~50%). Carbohydrate is much more glycemic than protein or fat. Therefore, we evaluated the basal and meal-related insulin requirements for Korean type 1 diabetics by using continuous insulin infusion with portable external pumps. METHODS: Twenty three type 1 diabetic patients were admitted for continuous subcutaneous insulin infusion (CSII), and they were given a calculated diet (60% carbohydrate, 20% protein, and 20% fat). The Basal rates were set for the blood glucose levels to remain in the target range during 12 hour fasting state. The meal related bolus dose was set to remain in the target range at the premeal state. RESULTS: The daily total insulin requirement was 99.7 +/-0.3% of prepump insulin dose, and 0.57 +/-0.21 unit per kilogram of body weight. The basal and mealrelated insulin dose among the daily total insulin requirements were 33.7 +/-8.6 and 66.3 +/-8.6%, respectively. The daily total, basal and meal-related insulin requirements were not significantly related with body weight, but the glucose disposal rate per 1unit of insulin was significantly related with body weight (r=-0.424, P <0.05). CONCLUSION: Although the daily total insulin requirement per kilogram of body weight in Korean type 1 diabetics was similar to that in western diabetics, the basal insulin requirements were less and the meal-related insulin requirements were more than that in western diabetics.
Correlation between Basal Insulin Requirements and Daily Administered Insulin Dosage in Diabetes.
Min Kyong Moon, Jong Ho Ahn, Tae Yong Kim, Won Shik Shinn, Soo Lim, Young Min Cho, Kyong Soo Park, Seong Yeon Kim, Hong Kyu Lee
Korean Diabetes J. 2000;24(5):552-559.   Published online January 1, 2001
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AbstractAbstract
BACKGROUND
In patients who need insulin therapy, it is difficult to assess insulin requirements because of individual variability in insulin sensitivity and secretion. The aim of this study is to know that it is possible to achieve rapidly and efficiently normoglycemia based on insulin infusion algorithm and whether there is correlation between basal insulin requirements and daily administered total insulin dose. METHODS: Total 34 patients were enrolled. Insulin infusion was begun at 2:00 p.m., and bedside blood glucose concentration was measured at hourly intervals. The rate of insulin infusion was adjusted according to blood glucose levels. We compared insulin requirements to maintain normoglycemia (basal insulin requirements) with daily administered total insulin dose. RESULTS: At start, the mean blood glucose concentration was 14.9+/-4.7 mmol/L; by the first hour, it was 10.7+/-3.6 mmol/L; by the second hour, it was 7.4+/-3.1 mmol/L; when the infusion was discontinued, it was 5.7+/-1.0 mmol/L. This algorithm successfully inducted normoglycemia in all patients within 3.5+/-1.8 h. There was significant correlation between basal insulin requirements and daily administered total insulin dosage. And, daily administered insulin dose had significant correlation with first hour glucose concentration, first hour insulin infusion rate, second hour glucose concentration, second hour insulin infusion rate, and glucose concentration at the end. CONCLUSIONS: We concluded that normoglycemia can be achieved rapidly and efficiently based on insulin infusion algorithm. The present study suggested that we could predict daily insulin requirements through basal insulin requirements that we measured.
Association Between Uncoupling Protein-1 and 3-adrenergic Receptor Gene Polymorphisms and Energy Metabolism in normal Korean Adults.
Jae Han Kim, Seog Ki Yun, Chul Hee Kim, Dong Won Byun, Young Sun Kim, Kyo Il Suh, Myung Hi Yoo
Korean Diabetes J. 1999;23(6):803-813.   Published online January 1, 2001
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  • 22 Download
AbstractAbstract PDF
BACKGROUND
The beta3-adrenergic receptor (beta3-AR) and uncoupling protein 1 (UCP-1), expressed mainly in brown adipose tissue, are involved in the regulation of thermogenesis and lipolysis. Recent studies have shown that polymorphisms of the 3-AR (Trp64Arg) and UCP-1 (-3826, A to G) genes are associated with low basal metabolic rate (BMR) and obesity. METHODS: We investigated the effects of the beta3- AR and UCP-1 gene polymorphisms on body fat and energy metabolism in 65 normal Korean men aged from 21 to 36 years. The Trp64Arg mutation of the beta3-AR gene and A to G polymorphism (-3826) of UCP-1 gene were detected by polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) method. RESULT: In normal Koreans, Arg64 allele frequency of the beta3-AR was 0.15 and the allele frequency of the A to G substitution of the UCP-1 gene was 0.48. No significant difference was found in BMR, body fat and abdominal fat amount in relation to beta3-AR or UCP-1 genotypes. However, when the polymorphisms of the two genes were combined, the subjects with the polymorphisms of both UCP-1 and g-AR genes were found to have higher body mass index, higher total fat and abdominal fat amount, lower BMR, and lower fat oxidation rate when compared with the subjects without these polymorphisms. CONCLUSION: These results suggest that the polymorphisms of either beta3-AR or UCP-1 gene alone did not significantly affect BMR, fat oxidation and body fat amounts, but both UCP-1 and beta3-AR genes polymorphisms have synergistic effects on decreased basal metabolic rate, fat oxidation rate, and increased body fat in normal Korean adults.
Effect of Troglitazone on Glucose Transport in Human Skeletal Muscle Cell Cultures from Obese Non-diabetic and Obese Non-insulin Dependent Diabetes Mellitus.
Theodore Ciaraldi, Robert R Henry, Kyong Soo Park, Hong Kyu Lee
Korean Diabetes J. 1998;22(2):164-172.   Published online January 1, 2001
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AbstractAbstract PDF
BACKGROUND
Skeletal muscle is the principal tissue of insulin resistance in obese non-diabetic and non-insulin dependent diabetic(NIDDM) subjects. Troglitazone(Tgz), a member of thiazolidinedione class of compounds, has been shown to improve glucose tolerance in insulin resistant state. At the celluar level, troglitazone has been shown to improve insulin action in skeletal muscle, liver and adipose tissue. However, there has been little knowledge about the mechanism of this drug in human skeletal muscle from insulin resistant subjects. METHODS: To determine the effect of troglitzone on glucose transport(GT) in skeletal muscle of obese non-diabetic and obese NIDDM patients, muscle cultures from 7 obese nondiabetic and 8 obese NlDDM subjects were grown for 4 weeks and then fused for 4 days either with or without Tgz (05ug/mL). At the end of fusion, GT activity was measured and cells were harvested for the measurement of glucose transporter protein expression. RESULTS: Tgz treatment(4 days) increased GT activity dose-dependently in skeletal muscle cell culture of both obese non-diabetic and obese NIDDM subjects. 5ug/mL troglitazone increased basal GT by 2.3 +0.3 fold in obese non-diabetic and 5.7+1.3 fold in obese NIDDM subjects (p <0.05, respectively) Absolute rate of insulin-stimulated GT was significantly increased following Tgz treatment with no enhancement of the incremental response above basal value in either group. Total memhrane GLUTl protein increased 1.7+0.3 fold(p<0.05) following troglitazone treatment(5ug/mL) in NIDDM but were unchhanged in obese non-diabetic cells. GLUT4 protein levels were not affected by Tgz treatment in either group. CONCLUSION: Troglitazone increased both basal and insulin-stimulated GT activity without enhancing the incremental insulin response above basal value in muscle cultures from insulin resistant subjects. These results indicate that troglitazone is not an insulin sensitizer in muscle cultures but acts primarily by mimicking insulin's ability to stimulate basal glucose metabolism in the insulin resistant state of obesity and NlDDM

Diabetes Metab J : Diabetes & Metabolism Journal
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