Diabetes & Metabolism Journal

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Comparison of Operational Definition of Type 2 Diabetes Mellitus Based on Data from Korean National Health Insurance Service and Korea National Health and Nutrition Examination Survey: Jong Ha Baek, Yong-Moon Park, Kyung Do Han, Min Kyong Moon, Jong Han Choi, Seung-Hyun Ko; Diabetes Metab J. 2023;47(2):201-210. Published online February 8, 2023; DOI: https://doi.org/10.4093/dmj.2022.0375

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Background
We evaluated the validity and reliability of the operational definition of type 2 diabetes mellitus (T2DM) based on the Korean National Health Insurance Service (NHIS) database.
Methods
Adult subjects (≥40 years old) included in the Korea National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2017 were merged with those from the NHIS health check-up database, producing a cross-sectional dataset. We evaluated the sensitivity, specificity, accuracy, and agreement of the NHIS criteria for defining T2DM by comparing them with the KNHANES criteria as a standard reference.
Results
In the study population (n=13,006), two algorithms were devised to determine from the NHIS dataset whether the diagnostic claim codes for T2DM were accompanied by prescription codes for anti-diabetic drugs (algorithm 1) or not (algorithm 2). Using these algorithms, the prevalence of T2DM was 14.9% (n=1,942; algorithm 1) and 20.8% (n=2,707; algorithm 2). Good reliability in defining T2DM was observed for both algorithms (Kappa index, 0.73 [algorithm 1], 0.63 [algorithm 2]). However, the accuracy (0.93 vs. 0.89) and specificity (0.96 vs. 0.90) tended to be higher for algorithm 1 than for algorithm 2. The validity (accuracy, ranging from 0.91 to 0.95) and reliability (Kappa index, ranging from 0.68 to 0.78) of defining T2DM by NHIS criteria were independent of age, sex, socioeconomic status, and accompanied hypertension or dyslipidemia.
Conclusion
The operational definition of T2DM based on population-based NHIS claims data, including diagnostic codes and prescription codes, could be a valid tool to identify individuals with T2DM in the Korean population.

Citations

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Association Between Benzene and Other Volatile Organic Compounds Exposure and Diabetes Mellitus Among Korean Adults: Findings from the Nationwide Biomonitoring Data
Seong-Uk Baek, Minseo Choi, Yu-Min Lee, Jin-Ha Yoon
Exposure and Health.2025; 17(1): 153. CrossRef
New-Onset Type 1 and Type 2 Diabetes Among Korean Youths During the COVID-19 Pandemic
Da Hye Lee, Hwa Young Kim, Ji Young Park, Jaehyun Kim, Jae Hyeon Park
JAMA Pediatrics.2025; 179(2): 155. CrossRef
Big Data Research for Diabetes-Related Diseases Using the Korean National Health Information Database
Kyung-Soo Kim, Bongseong Kim, Kyungdo Han
Diabetes & Metabolism Journal.2025; 49(1): 13. CrossRef
The effect of sarpogrelate compared to aspirin in high- or very-high-risk diabetes for primary prevention
Soo Hyun Kang, Kilyoon Pack, Jung Ho Kim, Youngwoo Jang
Scientific Reports.2025;[Epub] CrossRef
Frequency and sequence of proteinuria positivity and clinical outcomes in patients with diabetes: A nationwide cohort study
Junseok Jeon, Kyungho Lee, Jung Eun Lee, Wooseong Huh, Kyungdo Han, Hye Ryoun Jang
Diabetes, Obesity and Metabolism.2025; 27(6): 3274. CrossRef
Association between mental disorders and suicide risk among people with type 2 diabetes
Han-Sang Baek, Kyu-Na Lee, Dong Woo Kang, Jae-Seung Yun, Hyuk-Sang Kwon, Kyungdo Han, Seung-Hwan Lee
Journal of Affective Disorders.2025;[Epub] CrossRef
Metabolic dysfunction-associated fatty liver disease increases the risk of type 2 diabetes mellitus in young Korean adults
Junchul Ha, Oak-Kee Hong, Kyungdo Han, Hyuk-Sang Kwon
Diabetes Research and Clinical Practice.2024; 212: 111584. CrossRef
Association between Age at Diagnosis of Type 2 Diabetes and Subsequent Risk of Dementia and Its Major Subtypes
Da Hea Seo, Mina Kim, Yongin Cho, Seong Hee Ahn, Seongbin Hong, So Hun Kim
Journal of Clinical Medicine.2024; 13(15): 4386. CrossRef
Gamma‐glutamyl transferase and the risk of all‐cause and disease‐specific mortality in patients with diabetes: A nationwide cohort study
Goh Eun Chung, Su‐Min Jeong, Su Jong Yu, Jeong‐Ju Yoo, Yuri Cho, Kyu‐na Lee, Dong Wook Shin, Yoon Jun Kim, Jung‐Hwan Yoon, Kyungdo Han, Eun Ju Cho
Journal of Diabetes.2024;[Epub] CrossRef
Association between exercise habits and incident type 2 diabetes mellitus in patients with thyroid cancer: nationwide population-based study
Jiyun Park, Jin-Hyung Jung, Hyunju Park, Young Shin Song, Soo-Kyung Kim, Yong-Wook Cho, Kyungdo Han, Kyung-Soo Kim
BMC Medicine.2024;[Epub] CrossRef
All-cause and cause-specific mortality risks in individuals with diabetes living alone: A large-scale population-based cohort study
Jae-Seung Yun, Kyungdo Han, Bongseong Kim, Seung-Hyun Ko, Hyuk-Sang Kwon, Yu-Bae Ahn, Yong-Moon Mark Park, Seung-Hwan Lee
Diabetes Research and Clinical Practice.2024; 217: 111876. CrossRef
Association between alcohol consumption and risk of developing tuberculosis in patients with diabetes: a nationwide retrospective cohort study
Chiwook Chung, Kyu Na Lee, Kyungdo Han, Junhee Park, Dong Wook Shin, Sei Won Lee
Respiratory Research.2024;[Epub] CrossRef
Validation of self-reported morbidities in the Korean Atomic Bomb Survivor Cohort
Ansun Jeong, Somin Jeon, Seong-geun Moon, Mi Kyung Kim, Inah Kim, Yu-Mi Kim, Boyoung Park
Epidemiology and Health.2024; 46: e2024058. CrossRef
Risk of Cause-Specific Mortality across Glucose Spectrum in Elderly People: A Nationwide Population-Based Cohort Study
Joonyub Lee, Hun-Sung Kim, Kee-Ho Song, Soon Jib Yoo, Kyungdo Han, Seung-Hwan Lee
Endocrinology and Metabolism.2023; 38(5): 525. CrossRef

Effect of Treadmill Exercise on Interleukin-15 Expression and Glucose Tolerance in Zucker Diabetic Fatty Rats: Hee-Jae Kim, Jae Young Park, Seung Lyul Oh, Yong-An Kim, Byunghun So, Je Kyung Seong, Wook Song; Diabetes Metab J. 2013;37(5):358-364. Published online October 17, 2013; DOI: https://doi.org/10.4093/dmj.2013.37.5.358

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Background

Interleukin-15 (IL-15), a well-known myokine, is highly expressed in skeletal muscle and is involved in muscle-fat crosstalk. Recently, a role of skeletal muscle-derived IL-15 in the improvement of glucose homeostasis and insulin sensitivity has been proposed. However, little is known regarding the influence of endurance training on IL-15 expression in type 2 diabetic skeletal muscles. We investigated the effect of endurance exercise training on glucose tolerance and IL-15 expression in skeletal muscles using type 2 diabetic animal models.

Methods

Male Zucker diabetic fatty (ZDF) and ZDF lean control (ZLC) rats were randomly divided into three groups: sedentary ZLC, sedentary ZDF (ZDF-Con), and exercised ZDF (ZDF-Ex). The ZDF-Ex rats were forced to run a motor-driven treadmill for 60 minutes once a day 5 times per week for 12 weeks. Intraperitoneal glucose tolerance test (IPGTT) was performed after 12 weeks. Expression of IL-15 was measured using ELISA in extracted soleus (SOL) and gastrocnemius medial muscles.

Results

After 12 weeks of treadmill training, reduction of body weight was observed in ZDF-Ex compared to ZDF-Con rats. Glucose tolerance using IPGTT in diabetic rats was significantly improved in ZDF-Ex rats. Furthermore, the expression of IL-15 was significantly increased (P<0.01) only in the SOL of ZDF-Ex rats compared to ZDF-Con. Additionally, IL-15 expression in SOL muscles was negatively correlated with change of body weight (R=-0.424, P=0.04).

Conclusion

The present study results suggest that 12 weeks of progressive endurance training significantly improved glucose tolerance with concomitant increase of IL-15 expression in SOL muscles of type 2 diabetic rats.

Citations

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Beyond muscles: Investigating immunoregulatory myokines in acute resistance exercise – A systematic review and meta‐analysis
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The effects of gut microbiome manipulation on glycemic indices in patients with non-alcoholic fatty liver disease: a comprehensive umbrella review
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Nutrition & Diabetes.2024;[Epub] CrossRef
Exercise‐regulated white adipocyte differentitation: An insight into its role and mechanism
Linjing Yan, Liang Guo
Journal of Cellular Physiology.2023; 238(8): 1670. CrossRef
Effects of short-term physical training on the interleukin-15 signalling pathway and glucose tolerance in aged rats
Luciele Guerra Minuzzi, Luciana Renata da Conceição, Vitor Rosetto Muñoz, Renan Fudoli Lins Vieira, Rafael Calais Gaspar, Adelino S.R. da Silva, Dennys Esper Cintra, Leandro Pereira de Moura, Eduardo Rochete Ropelle, Ana Maria Teixeira, José Rodrigo Pauli
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Swimming Program on Mildly Diabetic Rats in Pregnancy
Nathália C. D. Macedo, Isabela L. Iessi, Franciane Q. Gallego, Aline O. Netto, Yuri K. Sinzato, Gustavo T. Volpato, Elena Zambrano, Débora C. Damasceno
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Exercise training and de-training effects on serum leptin and TNF-α in high fat induced diabetic rats
Hamideh Dinari Ghozhdi, Ali Heidarianpour, Maryam Keshvari, Hassan Tavassoli
Diabetology & Metabolic Syndrome.2021;[Epub] CrossRef
Exercise-Induced Myokines can Explain the Importance of Physical Activity in the Elderly: An Overview
Jenny Hyosun Kwon, Kyoung Min Moon, Kyueng-Whan Min
Healthcare.2020; 8(4): 378. CrossRef
Myokine/Adipokine Response to “Aerobic” Exercise: Is It Just a Matter of Exercise Load?
Zihong He, Ye Tian, Pedro L. Valenzuela, Chuanye Huang, Jiexiu Zhao, Ping Hong, Zilin He, Shuhui Yin, Alejandro Lucia
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Overexpression of Interleukin-15 exhibits improved glucose tolerance and promotes GLUT4 translocation via AMP-Activated protein kinase pathway in skeletal muscle
Taku Fujimoto, Ken Sugimoto, Toshimasa Takahashi, Yukiko Yasunobe, Keyu Xie, Minoru Tanaka, Yuri Ohnishi, Shino Yoshida, Hitomi Kurinami, Hiroshi Akasaka, Yoichi Takami, Yasushi Takeya, Koichi Yamamoto, Hiromi Rakugi
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Hao Jiang, Beijian Zhang, Daile Jia, Wenlong Yang, Aijun Sun, Junbo Ge
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Myokine Response to High-Intensity Interval vs. Resistance Exercise: An Individual Approach
Zihong He, Ye Tian, Pedro L. Valenzuela, Chuanye Huang, Jiexiu Zhao, Ping Hong, Zilin He, Shuhui Yin, Alejandro Lucia
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Carmen Fiuza-Luces, Alejandro Santos-Lozano, Michael Joyner, Pedro Carrera-Bastos, Oscar Picazo, José L. Zugaza, Mikel Izquierdo, Luis M. Ruilope, Alejandro Lucia
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Effects of 8 Weeks Resistance Exercise on GSH, SOD, TBARS Activities and GLUT2 mRNA Expression of Pancreas in OLETF Rats
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IL15RA is required for osteoblast function and bone mineralization
Emanuele Loro, Girish Ramaswamy, Abhishek Chandra, Wei-Ju Tseng, Manoj K. Mishra, Eileen M. Shore, Tejvir S. Khurana
Bone.2017; 103: 20. CrossRef
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Obesity Reviews.2017; 18(10): 1147. CrossRef
Effects of interval aerobic training combined with strength exercise on body composition, glycaemic and lipid profile and aerobic capacity of obese rats
Irene Coll-Risco, Virginia A. Aparicio, Elena Nebot, Daniel Camiletti-Moirón, Rosario Martínez, Garyfallia Kapravelou, María López-Jurado, Jesús M. Porres, Pilar Aranda
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Interval aerobic training combined with strength-endurance exercise improves metabolic markers beyond caloric restriction in Zucker rats
V.A. Aparicio, I. Coll-Risco, D. Camiletti-Moirón, E. Nebot, R. Martínez, M. López-Jurado, P. Aranda
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IL-15 expression increased in response to treadmill running and inhibited endoplasmic reticulum stress in skeletal muscle in rats
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Time course of IL-15 expression after acute resistance exercise in trained rats: effect of diabetes and skeletal muscle phenotype
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Milène Catoire, Sander Kersten
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Grant O'Connell, Ge Guo, Janelle Stricker, LeBris S. Quinn, Averil Ma, Emidio E. Pistilli
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Exercise-induced myokines in health and metabolic diseases
Byunghun So, Hee-Jae Kim, Jinsoo Kim, Wook Song
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Exercise Treadmill Test in Detecting Asymptomatic Coronary Artery Disease in Type 2 Diabetes Mellitus: Mee Kyoung Kim, Ki Hyun Baek, Ki Ho Song, Hyuk Sang Kwon, Jung Min Lee, Moo Il Kang, Kun Ho Yoon, Bong Yun Cha, Ho Young Son, Kwang Woo Lee; Diabetes Metab J. 2011;35(1):34-40. Published online February 28, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.1.34

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Background

The present study was designed to develop criteria for screening patients with type 2 diabetes mellitus (T2DM) for asymptomatic coronary artery disease (CAD).

Methods

A total of 213 patients with T2DM without typical angina or chest pain were studied between 2002 and 2007. We also evaluated 53 patients with T2DM who had reported chest discomfort using an exercise treadmill test (ETT).

Results

Thirty-one of the 213 asymptomatic patients had positive ETT results. We performed coronary angiography on 23 of the 31 patients with a positive ETT and found that 11 of them had significant coronary stenosis. The main differences between the patients with significant stenosis and those with a negative ETT were age (63.1±9.4 vs. 53.7±10.1 years, P=0.008) and duration of diabetes (16.0±7.5 vs. 5.5±5.7 years, P<0.001). The positive predictive value (PPV) of the ETT was calculated to be 47.8%. The PPV of the ETT increased to 87.5% in elderly patients (≥60 years) with a long duration of diabetes (≥10 years). The latter value is similar to that of patients with T2DM who presented with chest discomfort or exertional dyspnea. The PPV of the ETT in symptomatic patients was 76.9%.

Conclusion

In the interest of cost-effectiveness, screening for asymptomatic CAD could be limited to elderly patients with a duration of diabetes ≥10 years.

Citations

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Duke Treadmill Score Predicts Coronary Artery Disease Severity in Diabetics and Non-Diabetics
Muhammad Khalil, Muhammad Shafique Arshad, Asma Zafar Khawaja, Iffat Aqeel, . Hidayatullah, Mahboob Ur Rehman, Sumeet Kumar, Shoaib Ahmed
Pakistan Journal of Health Sciences.2023; : 126. CrossRef
Prevalence of Coronary Artery Disease in Asymptomatic type 2 Diabetes Mellitus Patients with Invasive Correlation in North India
V Kumar, B Yadav, A Nachankar
Indian Journal of Endocrinology and Metabolism.2023; 27(2): 133. CrossRef
Anatomical and Neuromuscular Factors Associated to Non-Contact Anterior Cruciate Ligament Injury
Marc Dauty, Vincent Crenn, Bastien Louguet, Jérôme Grondin, Pierre Menu, Alban Fouasson-Chailloux
Journal of Clinical Medicine.2022; 11(5): 1402. CrossRef
Prevalence of Asymptomatic Silent Myocardial Ischemia among Type 2 Diabetes Mellitus Patients in Bangalore - A Hospital-Based Cross-Sectional Study
Nagappa H Handargal, Shristi J Shetty
Journal of the Practice of Cardiovascular Sciences.2021; 7(3): 207. CrossRef
Influence of sex on the incidence of potential coronary artery disease and long-term outcomes in asymptomatic patients with diabetes mellitus
Chisato Sato, Kohei Wakabayashi, Naoko Ikeda, Yuki Honda, Ken Sato, Toshiaki Suzuki, Keita Shibata, Kaoru Tanno
IJC Heart & Vasculature.2020; 27: 100504. CrossRef
Gauging the Positive Predictive Value of Exercise Tolerance Test Using Angiographic Evaluation: A Cross-Sectional Analysis From a Developing Country
Ismail Khan, Maria Hasan, Javeria Hasan, Ali Imran Dhillon, Moosa Khan, Mehwish Kaneez
Cureus.2020;[Epub] CrossRef
EVALUATION OF SILENT MYOCARDIAL ISCHEMIA IN ASYMPTOMATIC TYPE 2 DIABETES MELLITUS PATIENTS BY TREAD MILL TEST IN TERTIARY CARE CENTER IN SOUTH INDIA
Malepati Sai Sarath Reddy, Uma Mylandlahalli Anandkumar, Srinivasa Rao
Journal of Evolution of Medical and Dental Sciences.2019; 8(10): 740. CrossRef
Breathlessness and Restrictive Lung Disease: An Important Diabetes-Related Feature in Patients with Type 2 Diabetes
Stefan Kopf, Jan B. Groener, Zoltan Kender, Thomas Fleming, Maik Brune, Christin Riedinger, Nadine Volk, Esther Herpel, Dominik Pesta, Julia Szendrödi, Mark O. Wielpütz, Hans-Ulrich Kauczor, Hugo A. Katus, Michael Kreuter, Peter P. Nawroth
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Mehmet Eyuboglu, Ugur Kucuk, Omer Senarslan, Bahri Akdeniz
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Comparison of the presence of fragmented QRS complexes in the inferior versus the anterior leads for predicting coronary artery disease severity
Mehmet Eyuboglu, Ugur Kucuk, Omer Senarslan, Bahri Akdeniz
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High Serum Ykl-40 Level Positively Correlates With Coronary Artery Disease
Yan Jin, Jia-Ning Cao, Chun-Xia Wang, Qiu-Ting Feng, Xin-He Ye, Xin Xu, Cheng-Jian Yang
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Fragmented QRS Is Associated with Improved Predictive Value of Exercise Treadmill Testing in Patients with Intermediate Pretest Likelihood of Significant Coronary Artery Disease
Eyyup Tusun, Abdulselam Ilter, Feyzullah Besli, Emre Erkus, Ibrahim Halil Altiparmak, Mehmet Bozbay
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Use of imaging and clinical data to screen for cardiovascular disease in asymptomatic diabetics
Carlos Henrique Reis Esselin Rassi, Timothy W. Churchill, Carlos A. Fernandes Tavares, Mateus Guimaraes Fahel, Fabricia P. O. Rassi, Augusto H. Uchida, Bernardo L. Wajchenberg, Antonio C. Lerario, Edward Hulten, Khurram Nasir, Márcio S. Bittencourt, Carlo
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Potential association between coronary artery disease and the inflammatory biomarker YKL-40 in asymptomatic patients with type 2 diabetes mellitus
Hyun Min Kim, Byung-Wan Lee, Young-Mi Song, Won Jin Kim, Hyuk-Jae Chang, Dong-Hoon Choi, Hee Tae Yu, EunSeok Kang, Bong Soo Cha, Hyun Chul Lee
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Exercise Treadmill Test for Evaluation of Cardiovascular Disease in Diabetic Patients
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The Classification of Diabetic Patients Presenting Diabetic Ketoacidosis: The Characteristics of Fulminant Type 1 Diabetes.: Eun Hee Jang, Jeong Eun Yi, Seung Jae Lee, Sang Hoon Chun, Ki Hyun Baek, Ki Ho Song, Soon Jib Yoo, Jong Min Lee, Kun Ho Yoon, Moo Il Kang, Kwang Woo Lee, Mee Kyung Kim; Korean Diabetes J. 2008;32(5):428-434. Published online October 1, 2008; DOI: https://doi.org/10.4093/kdj.2008.32.5.428

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Abstract PDF

BACKGROUND
The aim of the study was to classify newly diagnosed diabetic patients who initially presented with diabetic ketoacidosis (DKA) into specific types of diabetes and to describe the clinical and biochemical characteristics of patients with fulminant type 1 DM in Korea. METHODS: Using data from 4 hospitals of CMC from 1 January 1999 to 1 March 2008, we identified all patients who manifested DKA when they were first diagnosed as diabetes. Clinical and laboratory data were reviewed from medical records. RESULTS: We identified 51 newly diagnosed diabetic patients manifested DKA. Among them, 14 (27.4%) patients were classified as autoimmune type 1 DM, 8 (15.7%) as antibody negative type 1 DM, 5 (9.8%) as fulminant type 1, 16 (31.4%) as type 2 DM and 8 (15.7%) as secondary DM. Five patients who fulfilled the criteria of fulminant type 1 DM were older (32.2 +/- 10.7 vs. 15.7 +/- 4.4 years, P = 0.010), had shorter duration of symptoms (4.2 +/- 2.7 vs.16.7 +/- 15.2 days, P = 0.014) and lower stimulated C-peptide levels (0.1 +/- 0.0 vs. 0.7 +/- 0.6 ng/mL, P = 0.050) compared with patients with autoimmune type 1 DM. CONCLUSION Newly diagnosed diabetic patients presenting with DKA composed of heterogenous types of diabetes. The prevalence of fulminant type 1 diabetes among them was 9.8% and the clinical and biochemical characteristics of these patients were different from those of autoimmune type 1 DM.

Citations

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A Case of Severe Diabetic Ketoacidosis in a Child with Type 2 Diabetes
Jaesung Yu, Hyunju Jin, Joontae Ko, Hoseok Kang
Journal of Korean Society of Pediatric Endocrinology.2011; 16(1): 46. CrossRef
A Case of Fulminant Type 1 Diabetes Mellitus Complicated with Ischemic Ileitis
Se-Won Oh, Ju-Ri Park, Yun-Jeong Lee, Hee-Yeong Kim, Ji-A Seo, Nan-Hee Kim, Kyung-Mook Choi, Sei-Hyun Baik, Dong-Seop Choi, Sin-Gon Kim
Journal of Korean Endocrine Society.2009; 24(2): 116. CrossRef

Case Report

A Case of Diabetic Ketoacidosis in Gestational Diabetes Mellitus.: Myung Hwan Kim, Eui Dal Jung, Seung Pyo Hong, Gyu Hwan Bae, Sun Young Ahn, Eon Ju Jeon, Seong Yeon Hong, Ji Hyun Lee, Ho Sang Son; Korean Diabetes J. 2007;31(4):368-371. Published online July 1, 2007; DOI: https://doi.org/10.4093/jkda.2007.31.4.368

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Abstract PDF: Gestational diabetes mellitus (GDM) is defined as glucose intolerance of variant severity with onset or first recognition during present pregnancy. Recently the prevalence of GDM in Korean has reported as 1.7~4.0%. Diabetic ketoacidosis is a serious metabolic complication of diabetes with high mortality if undetected. Its occurrence is very rare in gestational diabetes patients, but is harmful to fetal and maternal health. A 26 years-old pregnant woman was admitted at 37 weeks gestation because of progressive generalized weakness, anorexia and weight loss. Initial physical examination reveals that she had been dehydrated, and blood pressure 130/80 mmHg, pulse rate 100/min, respiratory rate 20/min, and body temperature was 36.9 degrees C. Serum glucose was 545 mg/dL, pH 7.282, HCO3- 10.5 mmol/L, urine ketone 3+, urine glucose 2+ when initial laboratory work was done. She was treated with intravenous fluid and insulin under the impression of diabetic ketoacidosis. Her delivery was performed after 24 hours from admission because of suggestive fetal distress. After recovery, she is being treated with insulin at outpatient department. We experienced a appropriately treated case of diabetic ketoacidosis in pregnant woman with GDM, and report it with a literature review.

Original Article

Prevalence of Metabolic Syndrome in Type 2 DM Patients with Non-alcoholic Fatty Liver.: Ji Min Kim, Ja Young Park, Hyn Kyung Nam, Ja Won Kim, Su Kyung Park, Kyung Jin Nam, Mi Kyoung Park, Hye Jeong Lee, Duk Kyu Kim; Korean Diabetes J. 2006;30(6):442-449. Published online November 1, 2006; DOI: https://doi.org/10.4093/jkda.2006.30.6.442

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Abstract PDF

BACKGROUND
Non-alcoholic fatty liver is rendered as one component of metabolic syndrome (MS). We evaluated the prevalence of MS as well as clinical and laboratory characteristics of Type 2 DM patients with non-alcoholic fatty liver. METHODS: Fatty liver group (n = 71) who showed significant fatty change by ultrasonography and age, sex matched control group (n = 40) were studied retrospectively. We compared demographic and laboratory findings and prevalence of MS by modified WHO criteria and new IDF criteria between both groups. RESULTS: There were no significant difference in age, DM duration, BMI, prevalence of hypertension, coronary artery disease, CVA, diabetic retinopathy, neuropathy, nephropathy between both groups. In fatty liver group, the plasma level of FBS, TG, ALT, total protein, albumin and GGT were significantly higher than those of control group (P = 0.033, P = 0.000, P = 0.002, P = 0.008, P = 0.003, P = 0.001). The plasma levels of HDL-C in fatty liver group were significantly lower than those of control group (P = 0.013). The plasma level of FBS, FFA, TG, total protein, albumin, ALT, HOMA(IR) and BMI were significantly related to the severity of fatty liver. The prevalence of MS in fatty liver group was significantly higher than that of control group by modified WHO criteria (P = 0.001) or new IDF criteria (P = 0.036). CONCLUSION: Type 2 DM patients with nonalcoholic fatty liver frequently accompanied the metabolic syndrome. They showed nonspecific changes in the liver function tests.

Citations

Citations to this article as recorded by

Cardio-Metabolic Features of Type 2 Diabetes Subjects Discordant in the Diagnosis of Metabolic Syndrome
Sa Rah Lee, Ying Han, Ja Won Kim, Ja Young Park, Ji Min Kim, Sunghwan Suh, Mi-Kyoung Park, Hye-Jeong Lee, Duk Kyu Kim
Diabetes & Metabolism Journal.2012; 36(5): 357. CrossRef
Metabolic Syndrome and Serum Alanine Aminotransferase Levels in Korean Adults : The Third Korea National Health and Nutrition Examination Survey (KNHANES III), 2005.
Mi Ah Han, So Yeon Ryu, Jong Park, Myung Geun Kang, Ki Soon Kim
Korean Journal of Epidemiology.2008; 30(1): 25. CrossRef

Case Report

A Case of Chronic Inflammatory Demyelinating Polyneuropathy in a Girl with Type 1 DM .: Yi Sun Jang, Hye Soo Kim, Jong Min Lee; Korean Diabetes J. 2006;30(2):130-135. Published online March 1, 2006; DOI: https://doi.org/10.4093/jkda.2006.30.2.130

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Abstract PDF: Chronic inflammatory demyelinating polyneuropathy (CIDP) is an immune-mediated disorder characterized by the symmetrical weakness in both proximal and distal muscles for at least 2 months, hyporeflexia or areflexia, nerve conduction abnormalities, and high CSF protein level. Diabetes mellitus, monoclonal gammopathy, hepatitis C infection, HIV infection, SLE, Sjogren syndrome and lymphoma have been associated with CIDP. The incidence of CIDP in diabetes is not known exactly, but occur more common among diabetic than nondiabetic patients. There is sometimes a difficulty in distinguishing between diabetic polyneuropathy and CIDP, but differential diagnosis is important because CIDP is treatable with immune-modulating therapy. We report a case of CIDP in 22-year-old girl with type 1 DM who presented with generalized motor weakness and walking disturbance which were treated with iv immunoglobulin

Original Articles

The Influence of Metabolic Syndrome on the Intima-Medial Thickness and Cardiovascular Risk Factors in Type 2 Diabetes.: Kwang Pyo Son, Young Je Chae, Tae Yu Lee, In Kyung Jeong, Mina Hur, Gu Young Jo, Young Lee, Seong Jin Lee, Chul Young Park, Ki Won Oh, Eon Kyung Hong, Hyun Kyu Kim, Jae Myoung Yu, Doo Man Kim, Sung Hee Lim, Moon Ki Choi, Hyung Jun Yoo, Sung Woo Park; Korean Diabetes J. 2004;28(5):392-406. Published online October 1, 2004

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Abstract PDF: BACKGROUND
Metabolic syndrome (MS) is usually present in type 2 DM (T2DM), and it is associated with atherosclerosis. The aim of this study is to exam the influence of MS on the intima-medial thickness(IMT) and the cardiovascular risk factors for type 2 diabetic patients. SUBJECTS AND METHODS: A cross sectional study was performed on 82 patients with Type 2 diabetes mellitus (DM) and 84 healthy controls. MS was defined according to the NCEP-ATP III criteria. Those subjects with any history of cerebro vascular accident, ischemic heart disease or acute inflammation were excluded. The cardiovascular risk factors (hsCRP, lipid profile, homocysteine, and uric acid), the status of glucose metabolism (HbA1c, fasting glucose, insulin, and HOMA-IR), the diabetic microvascular complications and the IMT at both common carotid arteries were measured. RESULTS: 1) For patients with T2DM, the levels of waist circumference, blood pressure, TG (1.7+/-1.4 vs 2.2+/-1.4 mmol/L), HDL-C (1.5+/-0.4 vs. 1.3+/-0.3 mmol/L), LDL-C (2.7+/-0.7 vs 3.1+/-0.9 mmol/L), TC/HDL-C (3.5 vs. 41), log of (hsCRP) (-0.11+/-0.4 vs 0.17+/-0.4), mean carotid IMT (0.63+/-0.12 vs. 0.74+/-0.12 mm) and max IMT (0.68+/-0.14 vs. 0.86+/-0.15 mm) were significantly different from the healthy control group. 2) The prevalence of MS in the T2DM groups was 64%. However, a decrease of the waist circumference, as measured by the modified Asian criteria, increased the crude prevalence of MS by up to 75%. 3) Diabetic patients with MS had a higher incidence of hypertension, a lower level of HDL-C, and higher levels of waist circumference, HOMA-IR, TG, and TC/HDL-C, a greater extent of microvasculopathy, an increased log (hsCRP), homocysteine, and carotid IMT than did diabetic patients without MS. 4) Among the component of MS, the presence of hypertriglyceridemia had an influence on the IMT mean and max. 5) The carotid IMT of patients with DM correlated with age, homocysteine, log (hsCRP), and uric acid on univariate analysis, and age and homocysteine we found to be independent risk factors of carotid IMT on multivariated analysis. CONCLUSION: Metabolic syndrome in subjects with glucose intolerance increases the risk of atherosclerosis.

Evaluation of Glycemic Control in Type 2 Diabetic Patients have been Treated in General Hospital.: Joung Ho Park, Kwan Woo Kim, Eun Jin Kang, Tak Young Kim, Sa Ra Lee, Su Chan Bae, Mi Kyung Kim, Sin Yeong Choi, Jeong Hyun Park; Korean Diabetes J. 2004;28(3):208-218. Published online June 1, 2004

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Abstract PDF: BACKGROUND
Good metabolic control is one of the most important parts of managing diabetes. Several studies in western countries have shown glycemic control in type 2 diabetic patients to be poorer than expected. Similar reports in Korea are very limited. Therefore, this study was performed to estimate the degree in glycemic control of type 2 diabetic patients that have been treated in general hospitals in Korea. METHODS: This was a cross-sectional retrospective study conducted on 1012 type 2 diabetic patients treated at the Maryknoll Hospital. Subjects with type 1 diabetes or a treatment duration of less than 6 month were excluded. The glycemic control was estimated by HbA1c and the clinical characteristics, including duration of diabetes, age, height and body weight, checked. The treatment methods were divided into four groups, namely diet, oral hypoglycemic agent, insulin alone, and insulin and oral hypoglycemic agent combination. Data were analyzedsed by SPSS version 11.0. RESULTS: The mean age, BMI, duration of diabetes and HbA1c of the subjects were 61.6+/-9.8 years, 24.6+/-3.2kg/m(2), 12.1+/-6.5 year and 7.6+/-1.3%, respectively, and the percentage of those achieving the goal of glycemic control(HbA1c<7%) was 35.7%. Those who achieved glycemic control were older than those who could not and also had a shorter duration of diabetes(p<0.001). There were no significant differences in the BMI, gender and HbA1c levels before treatment between the four groups. The subjects on diet treatment had a lower mean HbA1c level than those on insulin alone or combined therapy(p<0.05) CONCLUSION: The percentage of type 2 diabetic patients in good glycemic control in our general hospital was less than 40%, which was similar to previous western data. It is our suggestion that a large nationwide study is required to more accurately evaluate the state of glycemic control and find the reasons why certain patients could not reach this goal.

Plasma and urinary Vascular Endothelial Growth Factor and Diabetic Nephropathy in Type 2 Diabetes Mellitus.: Jeong Heon Oh, Hye Jin Yoo, Soo Yeon Park, Ohk Hyun Ryu, Sang Soo Park, Soon Beom Kwon, Hee Young Kim, Ji A Seo, Kye Won Lee, Sin Gon Kim, Nan Hee Kim, Kyung Mook Choi, Dae Ryong Cha, Sei Hyun Baik, Dong Seop Choi; Korean Diabetes J. 2004;28(2):111-121. Published online April 1, 2004

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Abstract PDF: BACKGROUND
VEGF(vascular endothelial growth factor) has been implicated in the pathogenesis of neovascularization and endothelial dysfunction in diabetes mellitus. However, its precise role in diabetic nephropathy is still unknown. Our aims were to determine whether alterations of plasma and urinary VEGF levels were related to diabetic microvascular complications, especially nephropathy in type 2 diabetic patients. METHODS: 107 type 2 diabetic patients, without non-diabetic kidney diseases, and 47 healthy control subjects were studied. The urinary albumin excretion was defined as the albumin-to-creatinine ratio(ACR) in 24 hour urine samples. The study subjects were divided into four groups: a nondiabetic healthy control group(n=47), a normoalbuminuric diabetic group(ACR <30mug/mg, n=37), a microalbuminuric diabetic group(ACR 30~299mug/mg, n=37) and an overt proteinuric diabetic group(ACR=300mug/mg, n=33). The plasma and urinary VEGF levels were measured in these subjects by enzyme-linked immunosorbent assays. RESULTS: 1) The urinary VEGF concentrations were significantly higher in the diabetic groups than in the controls, even in the normoalbuminuric stage(log VEGF/Cr, normoalbuminuria; 4.33+/-1.06 vs. control; 3.53+/-0.79, p=0.009). The levels of urinary VEGF excretions increased with advancing diabetic nephropathy stage. 2) The plasma and urinary VEGF levels were higher in the hypertensive diabetic than the normotensive diabetic patients. 3) In the diabetic patients, the level of plasma VEGF was positively correlated with the BUN(r=0.398, p=0.039) and urinary ACR (r=0.251, p=0.044). The level of urinary VEGF was positively correlated with the urinary ACR(r=0.645, p<0.001), and creatinine(r=0.336, p=0.009), but negatively correlated with the level of serum albumin(r=-0.557, p<0.001). Both the levels of urinary VEGF and serum creatinine were independently correlated with the urinary ACR. CONCLUSIONS: The excretion of urinary VEGF increased at a relatively earlier stage in diabetic nephropathy and was significantly correlated with the excretion of urinary albumin. These results suggested the possibility of urinary VEGF as a sensitive marker or the detection of diabetic nephropathy and in predicting disease progression.

Change of Cardiac Function and NT-proBNP According to Degree of Albuminuria in Type 2 Diabetic Patients.: Bon Jeong Ku, Jeong Hee Kim, Jin Ok Jeong, Eun Seok Jeon, Dong Hyun Seo, Jae Min Lee, Si Wan Choi, In Whan Seong, Young Kun Kim; Korean Diabetes J. 2004;28(1):28-35. Published online February 1, 2004

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Abstract PDF: BACKGROUND
The prevalence of diabetes mellitus has increased recently. The morbidity and mortality of diabetic patients are mainly caused by chronic complications, especially cardiovascular events. N-terminal proB-type natriuretic peptide(NT-proBNP) is a neurohormone that is secreted from ventricular myocardium due to myocardial dilatation or pressure overload. NT-proBNP has prognostic value, and reflects cardiac function in patients with myocardial infarction or heart failure. This study was performed to evaluate functional changes of the heart, according to the degree of albuminuria and the prognostic value of NT-proBNP in type 2 diabetic patients. METHODS: 57 patients with type 2 diabetes were divided into three groups according to their degree of albuminuria, these being normal(below 30mg/day), microalbuminuria(30 between 300mg/day) and overt proteinuria(over 300mg/ day). The clinical parameters in each of the patients were evaluated, echocardiography performed and the levels of NT-proBNP checked, and compared between the three groups. RESULTS: Of the 57 patients with type 2 diabetes the male:female ratio of 32:25, with mean age, duration of diabetes and BMI of 55.8+/-10.1 and 11.3+/-8.2 years, and 23.2+/-4.0kg/m2, respectively. Twenty-eight patients showed normal(49.1%), 15 microalbuminuria(26.3%) and 14 overt proteinuria(24.6%). The age, BMI, diastolic BP and glycosylated hemoglobin showed no significant difference between the three groups. The duration of diagnosed diabetes was significantly longer, the systolic blood pressure and serum creatinine levels significantly higher and the serum hemoglobin significantly lower (p<0.05) in the overt proteinuria compared to the normal group. The duration of diabetes was significantly longer and serum creatinine levels significantly higher in the overt proteinuria than the microalbuminuria group(p<0.05). The echocardiographic data showed no difference among the groups. The NT-proBNP levels also showed no significant difference, but tended to be elevated toward albuminuria. CONCLUSION: The cardiac function and NT-proBNP levels showed no significant difference between each of the albuminuric groups. This study suggests that the degree of albuminuria is not a predictive factor for changes of the cardiac function and NT-proBNP levels

The Effect of Alpha-lipoic Acid on Endothelial Dysfunction in Postmenopausal Uncomplicated Type 2 Diabetes.: Ho Chan Cho, Sang Jun Lee, Mi Jung Kim, Hye Sun Kim, Tae Sung Yun, Sung Jae Kim, Sang Hyon Kim, Seung Ho Hur, Kyo Chul Moon, Jae Hoon Bae, In Kyu Lee; Korean Diabetes J. 2002;26(4):242-252. Published online August 1, 2002

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Abstract PDF: BACKGROUND
Recently, increased oxidative stress has been proposed as a major cause of vascular complications of patients with diabetes mellitus. Increased generation of oxygen free radicals in patients with diabetes mellitus could deplete cellular antioxidants and inactivate endothelial dependent vasodilating factor (EDRF), such as nitric oxide (NO). The purpose of this study was to evaluate whether the antioxidant alpha-lipoic acid (ALA) is effective in endothelial dysfunction of brachial artery, which induced by increased oxidative stress in postmenopausal diabetic women using high resolution ultrasound technique and initial reaction time (IRT) measurement. METHODS: We enrolled 11 menopausal women (mean age, 56.5+/-5.1 years) with uncomplicated type 2 diabetes. All patients were taking 1200 mg of ALA (Thioctacid(R), Bukwang, Korea). We measured of superoxide anion (O2-) in neutrophils as a marker of oxidative stress. Flow-mediated dilation (FMD) was measured using a high-resolution ultrasound. RESULTS: After treatment of ALA, fasting blood glucose was decreased significantly, the endothelium-dependent vasodilation of the brachial artery was increased, and O2- production was also decreased significantly. CONCLUSION: These results show that short term ALA treatment could improve the endothelial dysfunction in patients with type 2 diabetes mellitus. This improvement might be related with the antioxidants effect of ALA.

Free Testosterone and Sex Hormone-Binding Globulin Level in Type 2 Diabetic Men.: Ki Deuk Nam, Young Seol Kim, Cheol Young Park, Seung Joon Oh, Deog Yoon Kim, Jeong Taek Woo, Sung Woon Kim, In Myung Yang, Jin Woo Kim, Young Kil Choi; Korean Diabetes J. 2000;24(6):699-707. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Insulin resistance is a risk factor for cardiovascular disease and type 2 diabetes mellitus. There are many previous studies indicating that insulin lowers serum sex hormone-binding globulin levels, and there is inverse correlation between insulin resistance and serum sex hormone-binding globulin levels in women. However, in men, a limited number of studies are available to explain the effect of sex hormone on age and insulin. Therefore, the present study was undertaken to investigate the relationship among free testosterone, hormone- binding globulin and age in type 2 diabetic men and control subjects. METHOD: Age, body mass index, total cholesterol, triglyceride, fasting blood sugar, and insulin concentrations were examined on 89 type 2 diabetic men and 47 control subjects. The free testosterone level was measured by commercially available double-antibody system (Radioimmunoassay). The sex hormone-binding globulin level was also measured by commercially available double-antibody system(Immunoradiometric assay). RESULTS: 1) Sex hormone-binding globulin level was significantly increased in patients with type 2 diabetes. However, there was no significant difference in free testosterone level between the two groups. 2) Sex hormone-binding globulin was positively correlated with age (r=0.4, p<0.001) in patients with type 2 diabetes. Sex hormone-binding globulin and free testos terone were not correlated with age in control sujects. 3) Free testosterone and sex hormone-binding globulin concentrations were not significantly related to serum insulin concentration after adjusting for age and body mass index. CONCLUSIONS: We observed increased sex hormone-binding globulin concentration in diabetes man, and was a positively related to age. Further studies are needed to understand the relationships between age, insulin resistance, testosterone, and sex hormone-binding globulin concentrations.

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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Abstract: 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.

Comparison of the Antiproteinuric Effect to ACE Inhibitors in NIDDM Patients with Nephropathy According to Genotypes of ACE Gene.: Yong Mo Yang, Jeong Chul Seo, Kyoung Soo Lee, Won Joong Jeon, Hyun Hee Lee, Ji Bong Jeong, Seong Su Koong, Tae Geun Oh; Korean Diabetes J. 2000;24(4):476-484. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Albuminuria is a risk factor for progression of diabetic nephropathy. Antihypertensive treatment, especially angiotensin converting enzyme (ACE) inhibition, has been shown to reduce albuminuria and to ameliorate progression of diabetic nephropathy in IDDM patients. Recently, an insertion (I)/deletion (D) polymorphism of the ACE gene (ACE/ID) has been shown to influence the antiproteinuric efficacy of ACE inhibition in non-diabetic renal disease and the deterioration in kidney function in both non-diabetic and diabetic kidney disease. We evaluated the potential role of the ACE/ID polymorphism on the antiproteinuric responsiveness to ACE inhibition in NIDDM patients with nephropathy. METHODS: 35 NIDDM patients with overt proteinuria were included in this study. DNA amplified by PCR techniques was used to detect the two alleles of the ID polymorphism. Subjects were classified as II+ID group and DD group according to the presence (I) or absence (D) of a 270 base pair insertion. Ramipril was used for ACE inhibition. At a baseline and an end of the study(6 months later from baseline), arterial blood pressure, HbA1c, serum creatinine, creatinine clearance, and 24 hour urine protein amount were measured. The significant response to ACE inhibition was defined as a decline in proteinuria > or =30% of baseline. RESULTS: The MABP was decreased significantly in each groups, but the degree of BP reduction was not different between the groups. Twenty-four hour urine protein amount and creatinine clearance was not different in each groups and between CONCLUSION: Antiproteinuric effect of ACE inhibition was not associated with ACE/ID polymorphism in diabetic patients with nephropathy.

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