Diabetes & Metabolism Journal

Original Articles

Pathophysiology
Enavogliflozin, an SGLT2 Inhibitor, Improves Nonalcoholic Steatohepatitis Induced by High-Fat, High-Cholesterol Diet: Phuc Thi Minh Pham, Giang Nguyen, So Young Park, Thuy Linh Lai, Dae-Hee Choi, Jeana Hong, Seon Mee Kang, Eun-Hee Cho; Diabetes Metab J. 2026;50(1):165-177. Published online June 16, 2025; DOI: https://doi.org/10.4093/dmj.2024.0259

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Background
Nonalcoholic fatty liver disease, a progressive condition caused by the accumulation of fat in the liver, begins with simple steatosis and can potentially progress to metabolic dysfunction-associated steatohepatitis (MASH) in the presence of inflammation and fibrosis, ultimately leading to cirrhosis or hepatocellular carcinoma. Increasing evidence indicates that sodiumglucose cotransporter 2 (SGLT2) inhibitors effectively alleviate MASH in mouse models. However, there is a lack of research on the effects of enavogliflozin on liver disease. In the present study, we investigated the effects of SGLT2 inhibitors on MASH induced by a high-fat, high-cholesterol (HFHC) diet in mice.
Methods
Male C57BL/6 mice were fed a normal chow diet, HFHC diet, or HFHC diet with enavogliflozin for 12 weeks. LX-2 and HepG2 cells were treated with enavogliflozin in the presence of various pathological stimuli.
Results
The HFHC diet induced excessive hepatic lipid accumulation, inflammation, and severe fibrosis. Administration of enavogliflozin not only ameliorated hepatic steatosis and fibrotic conditions but also suppressed the production of inflammatory cytokines. Positive outcomes were also observed in in vitro experiments, where enavogliflozin demonstrated the ability to impede the activation of hepatic stellate cells and alleviate lipid accumulation in hepatocytes. The potential pathway through which enavogliflozin attenuated liver fibrosis development may be associated with the transforming growth factor β1/Smad signaling pathway.
Conclusion
Our results suggest that enavogliflozin is effective in a mouse model of MASH by attenuating hepatic steatosis, suppressing inflammation, and improving liver fibrosis.

Citations

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Signaling Pathway Remodeling and Molecular Regulation in the HCC TME: Dynamic Evolution and Clinical Therapeutic Advances
Lin Xu, Xuanhao Zhang, Hengzhou Zhu, Dong Niu, Xiaodan Zhu, Chunhui Jin
Frontiers in Bioscience-Landmark.2026;[Epub] CrossRef
Dissecting out the unexpected effects of SGLT2 inhibitors on human aging
Goro Katsuumi, Tohru Minamino
The Journal of Clinical Endocrinology & Metabolism.2026; 111(8): 2154. CrossRef
SGLT2 Inhibitors as Systemic Metabolic Modulators: Linking Glucose Excretion to Liver Function Restoration
Seung Wan Noh, Han Sol Ryu, Yong-Ho Kim, Byung-Chul Oh
Endocrinology and Metabolism.2025; 40(6): 851. CrossRef

Lifestyle and Behavioral Interventions
Assessing Nutritional Factors for Metabolic Dysfunction-Associated Steatotic Liver Disease via Diverse Statistical Tools: Yea-Chan Lee, Hye Sun Lee, Soyoung Jeon, Yae-Ji Lee, Yu-Jin Kwon, Ji-Won Lee; Diabetes Metab J. 2026;50(1):178-189. Published online June 9, 2025; DOI: https://doi.org/10.4093/dmj.2025.0026

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Background
Lifestyle modifications are critical in addressing metabolic dysfunction-associated steatotic liver disease (MASLD); however, the specific macronutrients that most significantly influence the disease’s progression are uncertain. In this study, we aimed to explore the role of carbohydrate, fat, and protein intake in MASLD development using decision trees, random forest models, and cluster analysis.
Methods
Participants (n=3,951) from the Korean Genome and Epidemiology Study were included. We used the classification and regression tree analysis to classify participants into subgroups based on variables associated with the incidence of new-onset MASLD. Random forest analyses were used to assess the relative importance of each variable. Participants were grouped into homogeneous clusters based on carbohydrate, protein, fat, and total caloric intake using hierarchical cluster analysis. Subsequently, we used the Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for MASLD risk across the clusters.
Results
Carbohydrate intake was identified as the most significant predictor of new-onset MASLD, followed by fat, protein, and total caloric intake. Participants in cluster 3, who consumed a lower proportion of carbohydrate but had higher total caloric, protein, and fat intake, had a lower risk of new-onset MASLD than those in cluster 1 after adjusting for confounders (cluster 1 as a reference; cluster 3: HR, 0.90; 95% CI, 0.82 to 0.99).
Conclusion
The study’s results highlight the critical role of macronutrient composition, particularly carbohydrate intake, in MASLD development. The findings suggest that dietary strategies focusing on optimizing macronutrients, rather than simply reducing caloric intake, may be more effective in preventing MASLD.

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A Descriptive Analysis of Mediterranean Diet Meal Plans Using the Dietary Inflammatory Index, Dietary Antioxidant Index, and Dietary Lipid Indices: Implications for Dietary Intervention for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)
Melvin Bernardino, Claudio Tiribelli, Natalia Rosso
Nutrients.2026; 18(8): 1281. CrossRef
Human-Mouse Convergence in Metabolic Dysfunction-Associated Steatotic Liver Disease: Mouse Model Selection and Non-Invasive Diagnostic Strategies
Denise Bonente, Sara Gargiulo, Ludovica Livi, Matteo Gramanzini, Tiziana Tamborrino, Lisa Gherardini, Giovanni Inzalaco, Lorenzo Franci, Mario Chiariello, Virginia Barone
Livers.2026; 6(3): 46. CrossRef
Acceptability of Brazzein-Sweetened Ice Cream as a Sugar-Reduction Strategy in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Double-Blind Randomized Crossover Sensory Study
Vasily Isakov, Alexei Goncharov, Vladimir Pilipenko, Armida Sasunova, Alla Kochetkova, Vladimir Bessonov
Dairy.2026; 7(3): 44. CrossRef

Metabolic Risk/Epidemiology
Ultra-Processed Food Intake and Risk of Type 2 Diabetes Mellitus: A Dose-Response Meta-Analysis of Prospective Studies: Yujin Kim, Yoonkyoung Cho, Jin Eui Kim, Dong Hoon Lee, Hannah Oh; Diabetes Metab J. 2025;49(5):1064-1074. Published online June 9, 2025; DOI: https://doi.org/10.4093/dmj.2024.0706; Correction in: Diabetes Metab J 2026;50(1):211

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Background
Although some studies suggest a positive association between ultra-processed food (UPF) intake and type 2 diabetes mellitus (T2DM), little is known about the exact shape and risks associated with different units (percentage of g/day, absolute g/day, serving/day) of UPF intake and whether the association is independent of diet quality, total energy intake, and body mass index (BMI).
Methods
Prospective studies published through January 2024 were identified by searching PubMed, Embase, and Web of Science. Summary relative risks (RRs) and 95% confidence intervals (CIs) were estimated using random-effects models. A nonlinear dose-response meta-analysis was conducted using restricted cubic spline analysis.
Results
After screening 569 publications, a total of 12 prospective cohort studies were included. Comparing the highest vs. lowest categories of intake, summary RR for T2DM risk was 1.48 (95% CI, 1.36 to 1.61). Higher summary RRs were observed among studies from Europe and North America. Among individual UPF subgroups, processed meats (summary RR, 1.34; 95% CI, 1.16 to 1.54) were positively associated, whereas ultra-processed cereals and breads (0.98; 95% CI, 0.97 to 0.99) and packaged savory snacks (0.92; 95% CI, 0.88 to 0.95) were inversely associated. The summary RRs associated with every 10% (of g/day), 100-g/day, and 1-serving/day increase in UPF intake were 1.14 (95% CI, 1.11 to 1.17), 1.05 (95% CI, 1.03 to 1.06), and 1.04 (95% CI, 1.03 to 1.05), respectively. The dose-response curve for absolute g/d intake suggested nonlinearity, showing a steeper risk increase approximately at >300 g/day. The associations persisted after adjustment for diet quality, energy intake, or BMI.
Conclusion
Our data suggest that UPF intake increases diabetes risk, with a potential threshold effect at 300 g/day.

Citations

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Ultra-Processed Food Intake and Risk of Type 2 Diabetes Mellitus: A Dose-Response Meta-Analysis of Prospective Studies (Diabetes Metab J 2025;49:1064-74)
Lirong Hu, Aiji Chen, Gang Tian
Diabetes & Metabolism Journal.2026; 50(1): 194. CrossRef
Ultra-Processed Food Intake and Risk of Type 2 Diabetes Mellitus: A Dose-Response Meta-Analysis of Prospective Studies (Diabetes Metab J 2025;49:1064-74)
Yujin Kim, Hannah Oh
Diabetes & Metabolism Journal.2026; 50(1): 208. CrossRef
Dietary Patterns, Cooking Methods, and Their Association with Prediabetes Risk Markers in Romanian University Students: A Cross-Sectional Analysis
Teodora Piroș, Raluca Lupusoru, Lavinia Cristina Moleriu, Călin Muntean, Radu Dumitru Moleriu, Dora Mihalea Cîmpian, Mădălina Gabriela Cincu, Elena Gabriela Strete, Amalia Gabriela Timofte, Ruxandra-Cristina Marin
Nutrients.2026; 18(6): 977. CrossRef
Commentary on the Dietary Guidelines for Americans 2026–2030
Douglas Taren, Robert Bandsma, Alejandra Cantoral, Chi Chen, Brian Finck, Corrine Hanson, Gang Hu, Nicole Kellow, Kathleen Holton, Hanqi Luo, Joshua Miller, Maurizio Muscaritoli, Muzi Na, Rachel Novotny, Omar Ramos-Lopez, Manuel Ruz, Krista Varady, Saroja
Nutrition Reviews.2026;[Epub] CrossRef
Associations between dietary food categories, epigenetic age acceleration and low-grade inflammation in the Lifelines-DEEP cohort
Laura Bordoni, Fatemeh Mansouri, Chiara Rucci, João Agostinho de Sousa, Ferdinand von Meyenn
Clinical Nutrition.2026; 63: 106703. CrossRef
Ultra-processed food consumption and the trajectory of cardio-renal-metabolic multimorbidity: insights from multi-state modelling
Shuzhen Zhao, Chengnan Guo, Xin Zhang, Yi Li, Jingkun Hu, Jiayi Huang, Luojia Dai, Zhenqiu Liu, Tiejun Zhang
Food & Function.2026; 17(14): 6478. CrossRef
The association between ultra-processed food consumption and incidence of cardio-renal-metabolic multimorbidity: Tehran Lipid and Glucose Study
Emad Alem, Somayeh Hosseinpour-Niazi, Parvin Mirmiran, Fereidoun Azizi
Nutrition, Metabolism and Cardiovascular Diseases.2026; : 104855. CrossRef
Nutrition and cardiometabolic health in cystic fibrosis: Emerging evidence and research gaps
Veronica Lynch, Joanne Barrett, Sarah Collins, Paige Elliott, Darren Sills, Joanna Snowball, Pauline Douglas, Alan R Smyth, Audrey Tierney, Damian G. Downey, Claire McEvoy
Journal of Cystic Fibrosis.2026;[Epub] CrossRef
When ultra-processed food is clinically indicated: Oral nutritional supplements and the limits of the nova paradigm in clinical nutrition
Jimmy Chun Yu Louie
Clinical Nutrition.2026; 65: 106769. CrossRef
Trends in sales of sugar-sweetened beverages and associated type 2 diabetes burden in nine African countries: an ecological time-series analysis
Caroline H. Karugu, Gershim Asiki, Senzo Mthembu, Samuel Iddi, Peter M. Kaberia, Shukri F. Mohamed, Richard E. Sanya, Sylvia Kiwuwa-Muyingo, Stefanie Vandevijvere, Charles Agyemang
Global Health Action.2025;[Epub] CrossRef

Reviews

Lifestyle
Ultra-Processed Foods and the Impact on Cardiometabolic Health: The Role of Diet Quality: Xiaowen Wang, Qi Sun; Diabetes Metab J. 2024;48(6):1047-1055. Published online November 1, 2024; DOI: https://doi.org/10.4093/dmj.2024.0659

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The consumption of ultra-processed foods (UPFs) has surged globally, raising significant public health concerns due to their associations with a range of adverse health outcomes. This review aims to elucidate potential health impacts of UPF intake and underscore the importance of considering diet quality when interpreting study findings. UPF group, as classified by the Nova system based on the extent of industrial processing, contains numerous individual food items with a wide spectrum of nutrient profiles, as well as differential quality as reflected by their potential health effects. The quality of a given food may well misalign with the processing levels so that a UPF food can be nutritious and healthful whereas a non-UPF food can be of low quality and excess intake of which may lead to adverse health consequences. The current review argues that it is critical to focus on the nutritional content and quality of foods and their role within the overall dietary pattern rather than only the level of processing. Further research should dissect health effects of diet quality and food processing, investigate the health impacts of ingredients that render the UPF categorization, understand roles of metabolomics and the gut microbiome in mediating and modulating the health effects of food processing, and consider environmental sustainability in UPF studies. Emphasizing nutrient-dense healthful foods and dietary patterns shall remain the pivotal strategy for promoting overall health and preventing chronic diseases.

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Nutrients.2026; 18(4): 559. CrossRef
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Sui Ye, Jianchao Xi, Ziqiang Li
International Journal of Health Geographics.2026;[Epub] CrossRef
The Effect of Ultra-Processed Food Consumption and Physical Activity on Fatty Acid Profiles in Young Muslims in Melilla
Miriam Mohatar-Barba, María López-Olivares, Emilio González-Jiménez, Ana Rodríguez-Rodríguez, Mario Román-Cabezas, Javier S. Perona, Carmen Enrique-Mirón
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Dietary advanced glycation end products and risk of cardiometabolic disorders in older adults: cross-sectional data from the 2007–2021 Korea National Health and Nutrition Examination Survey (KNHANES)
Arti Sharma, Jimi Kim
BMC Nutrition.2026;[Epub] CrossRef
Ultra-Processed Food Consumption Is Independently Associated with Higher HbA1c and Poor Glycemic Control in Adults with Type 2 Diabetes
Nezihe Otay Lule, Serpil Şahin, Kemal Ozan Lule, Hamit Yildiz
Nutrients.2026; 18(12): 1951. CrossRef
Ultra-Processed Foods, MASLD, and Cognitive Aging: A Processing-Centered Gut–Liver–Brain Axis Perspective
Yirui Chen, Hongxin Gui, Tieniu Zhao, Chang Liu, Ye Zhang, Mengyang Wang, Rongrong Yang
Nutrients.2026; 18(13): 2041. CrossRef
Ultra-processed food consumption and the trajectory of cardio-renal-metabolic multimorbidity: insights from multi-state modelling
Shuzhen Zhao, Chengnan Guo, Xin Zhang, Yi Li, Jingkun Hu, Jiayi Huang, Luojia Dai, Zhenqiu Liu, Tiejun Zhang
Food & Function.2026; 17(14): 6478. CrossRef
Short-term ketogenic diet induces systemic lipidomic remodeling associated with metabolic adaptation in humans
Minkuk Park, Jae Sik Yu, Justin Y. Jeon, Hyun-A Oh, Yong-ho Lee, Sang-Guk Lee, Gakyung Lee
Frontiers in Nutrition.2026;[Epub] CrossRef
A systematic review to critically appraise methodological rigor in research on ultra-processed food and cardiovascular disease and hypertension
Tefera Chane Mekonnen, Zegeye Abebe, Anteneh Mengist Dessie, Teketo Tegegne, Tolassa Ushula, Kacie Dickinson, Catherine Brady, Zumin Shi, Robert Adams, Jason HY Wu, Mario Siervo, Yohannes Adama Melaku
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Kyunghun Sung, Seung‐Hwan Lee
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Are all ultra-processed foods bad? A critical review of the NOVA classification system
Jimmy Chun Yu Louie
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Cardiovascular Risk/Epidemiology
Artificial Light at Night and Type 2 Diabetes Mellitus: Jong-Ha Baek, Yong Zhu, Chandra L. Jackson, Yong-Moon Mark Park; Diabetes Metab J. 2024;48(5):847-863. Published online September 1, 2024; DOI: https://doi.org/10.4093/dmj.2024.0237

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The widespread and pervasive use of artificial light at night (ALAN) in our modern 24-hour society has emerged as a substantial disruptor of natural circadian rhythms, potentially leading to a rise in unhealthy lifestyle-related behaviors (e.g., poor sleep; shift work). This phenomenon has been associated with an increased risk of type 2 diabetes mellitus (T2DM), which is a pressing global public health concern. However, to date, reviews summarizing associations between ALAN and T2DM have primarily focused on the limited characteristics of exposure (e.g., intensity) to ALAN. This literature review extends beyond prior reviews by consolidating recent studies from 2000 to 2024 regarding associations between both indoor and outdoor ALAN exposure and the incidence or prevalence of T2DM. We also described potential biological mechanisms through which ALAN modulates glucose metabolism. Furthermore, we outlined knowledge gaps and investigated how various ALAN characteristics beyond only light intensity (including light type, timing, duration, wavelength, and individual sensitivity) influence T2DM risk. Recognizing the detrimental impact of ALAN on sleep health and the behavioral correlates of physical activity and dietary patterns, we additionally summarized studies investigating the potential mediating role of each component in the relationship between ALAN and glucose metabolism. Lastly, we proposed implications of chronotherapies and chrononutrition for diabetes management in the context of ALAN exposure.

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Obesity mediates the association of outdoor artificial light at night with type 2 diabetes mellitus
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Original Article

Technology/Device
Clinical and Lifestyle Determinants of Continuous Glucose Monitoring Metrics in Insulin-Treated Patients with Type 2 Diabetes Mellitus: Da Young Lee, Namho Kim, Inha Jung, So Young Park, Ji Hee Yu, Ji A Seo, Jihee Kim, Kyeong Jin Kim, Nam Hoon Kim, Hye Jin Yoo, Sin Gon Kim, Kyung Mook Choi, Sei Hyun Baik, Sung-Min Park, Nan Hee Kim; Diabetes Metab J. 2023;47(6):826-836. Published online August 24, 2023; DOI: https://doi.org/10.4093/dmj.2022.0273

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Background
There was limited evidence to evaluate the association between lifestyle habits and continuous glucose monitoring (CGM) metrics. Thus, we aimed to depict the behavioral and metabolic determinants of CGM metrics in insulin-treated patients with type 2 diabetes mellitus (T2DM).
Methods
This is a prospective observational study. We analyzed data from 122 insulin-treated patients with T2DM. Participants wore Dexcom G6 and Fitbit, and diet information was identified for 10 days. Multivariate-adjusted logistic regression analysis was performed for the simultaneous achievement of CGM-based targets, defined by the percentage of time in terms of hyper, hypoglycemia and glycemic variability (GV). Intake of macronutrients and fiber, step counts, sleep, postprandial C-peptide-to-glucose ratio (PCGR), information about glucose lowering medications and metabolic factors were added to the analyses. Additionally, we evaluated the impact of the distribution of energy and macronutrient during a day, and snack consumption on CGM metrics.
Results
Logistic regression analysis revealed that female, participants with high PCGR, low glycosylated hemoglobin (HbA1c) and daytime step count had a higher probability of achieving all targets based on CGM (odds ratios [95% confidence intervals] which were 0.24 [0.09 to 0.65], 1.34 [1.03 to 1.25], 0.95 [0.9 to 0.99], and 1.15 [1.03 to 1.29], respectively). And participants who ate snacks showed a shorter period of hyperglycemia and less GV compared to those without.
Conclusion
We confirmed that residual insulin secretion, daytime step count, HbA1c, and women were the most relevant determinants of adequate glycemic control in insulin-treated patients with T2DM. In addition, individuals with snack consumption were exposed to lower times of hyperglycemia and GV.

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Reviews

Guideline/Fact Sheet
Comprehensive Understanding for Application in Korean Patients with Type 2 Diabetes Mellitus of the Consensus Statement on Carbohydrate-Restricted Diets by Korean Diabetes Association, Korean Society for the Study of Obesity, and Korean Society of Hypertension: Jong Han Choi, Jee-Hyun Kang, Suk Chon; Diabetes Metab J. 2022;46(3):377-390. Published online May 25, 2022; DOI: https://doi.org/10.4093/dmj.2022.0051

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The Joint Committee of the Korean Diabetes Association, the Korean Society for the Study of Obesity, and the Korean Society of Hypertension announced a consensus statement on carbohydrate-restricted diets and intermittent fasting, representing an emerging and popular dietary pattern. In this statement, we recommend moderately-low-carbohydrate or low-carbohydrate diets, not a very-low-carbohydrate diet, for patients with type 2 diabetes mellitus. These diets can be considered a dietary regimen to improve glycemic control and reduce body weight in adults with type 2 diabetes mellitus. This review provides the detailed results of a meta-analysis and systematic literature review on the potential harms and benefits of carbohydrate-restricted diets in patients with diabetes. We expect that this review will help experts and patients by fostering an in-depth understanding and appropriate application of carbohydrate-restricted diets in the comprehensive management of diabetes.

Citations

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The effects of low-carbohydrate diet on glucose and lipid metabolism in overweight or obese patients with T2DM: a meta-analysis of randomized controlled trials
Wende Tian, Shuyu Cao, Yongxin Guan, Zihao Zhang, Qiyu Liu, Jianqing Ju, Ruixi Xi, Ruina Bai
Frontiers in Nutrition.2025;[Epub] CrossRef
Efficacy of convenience meal-type foods designed for diabetes in the management of metabolic syndrome based on a 3-week trial
Do Gyeong Lee, In Gyeong Kang, Tae Seok Kim, Yun Ahn, Sang Yun Lee, Hye Jin Ahn, Yoo Kyoung Park
Nutrition.2024; 118: 112287. CrossRef
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Ashley Berthoumieux, Sarah Linke, Melinda Merry, Alison Megliola, Jessie Juusola, Jenna Napoleone
The Science of Diabetes Self-Management and Care.2024; 50(1): 19. CrossRef
Medical nutrition therapy for diabetes mellitus
Suk Chon
Journal of the Korean Medical Association.2023; 66(7): 421. CrossRef

Guideline/Fact Sheet
Effect of Carbohydrate-Restricted Diets and Intermittent Fasting on Obesity, Type 2 Diabetes Mellitus, and Hypertension Management: Consensus Statement of the Korean Society for the Study of Obesity, Korean Diabetes Association, and Korean Society of Hypertension: Jong Han Choi, Yoon Jeong Cho, Hyun-Jin Kim, Seung-Hyun Ko, Suk Chon, Jee-Hyun Kang, Kyoung-Kon Kim, Eun Mi Kim, Hyun Jung Kim, Kee-Ho Song, Ga Eun Nam, Kwang Il Kim, Committee of Clinical Practice Guidelines, Korean Society for the Study of Obesity (KSSO), Committee of Clinical Practice Guidelines and Committee of Food and Nutrition, Korean Diabetes Association (KDA), Policy Committee of Korean Society of Hypertension (KSH), Policy Development Committee of National Academy of Medicine of Korea (NAMOK); Diabetes Metab J. 2022;46(3):355-376. Published online May 25, 2022; DOI: https://doi.org/10.4093/dmj.2022.0038

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818 Download
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Abstract PDF Supplementary Material PubReader ePub

Carbohydrate-restricted diets and intermittent fasting (IF) have been rapidly gaining interest among the general population and patients with cardiometabolic disease, such as overweight or obesity, diabetes, and hypertension. However, there are limited expert recommendations for these dietary regimens. This study aimed to evaluate the level of scientific evidence on the benefits and harms of carbohydrate-restricted diets and IF to make responsible recommendations. A meta-analysis and systematic literature review of 66 articles on 50 randomized controlled trials (RCTs) of carbohydrate-restricted diets and 10 articles on eight RCTs of IF was performed. Based on the analysis, the following recommendations are suggested. In adults with overweight or obesity, a moderately-low carbohydrate or low carbohydrate diet (mLCD) can be considered as a dietary regimen for weight reduction. In adults with type 2 diabetes mellitus, mLCD can be considered as a dietary regimen for improving glycemic control and reducing body weight. In contrast, a very-low carbohydrate diet (VLCD) and IF are recommended against in patients with diabetes. Furthermore, no recommendations are suggested for VLCD and IF in adults with overweight or obesity, and carbohydrate-restricted diets and IF in patients with hypertension. Here, we describe the results of our analysis and the evidence for these recommendations.

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Jong Han Choi, Jee-Hyun Kang, Suk Chon
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Complications
Peripheral Neuropathy Phenotyping in Rat Models of Type 2 Diabetes Mellitus: Evaluating Uptake of the Neurodiab Guidelines and Identifying Future Directions: Md Jakir Hossain, Michael D. Kendig, Meg E. Letton, Margaret J. Morris, Ria Arnold; Diabetes Metab J. 2022;46(2):198-221. Published online March 24, 2022; DOI: https://doi.org/10.4093/dmj.2021.0347

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Diabetic peripheral neuropathy (DPN) affects over half of type 2 diabetes mellitus (T2DM) patients, with an urgent need for effective pharmacotherapies. While many rat and mouse models of T2DM exist, the phenotyping of DPN has been challenging with inconsistencies across laboratories. To better characterize DPN in rodents, a consensus guideline was published in 2014 to accelerate the translation of preclinical findings. Here we review DPN phenotyping in rat models of T2DM against the ‘Neurodiab’ criteria to identify uptake of the guidelines and discuss how DPN phenotypes differ between models and according to diabetes duration and sex. A search of PubMed, Scopus and Web of Science databases identified 125 studies, categorised as either diet and/or chemically induced models or transgenic/spontaneous models of T2DM. The use of diet and chemically induced T2DM models has exceeded that of transgenic models in recent years, and the introduction of the Neurodiab guidelines has not appreciably increased the number of studies assessing all key DPN endpoints. Combined high-fat diet and low dose streptozotocin rat models are the most frequently used and well characterised. Overall, we recommend adherence to Neurodiab guidelines for creating better animal models of DPN to accelerate translation and drug development.

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Sulwon Lecture 2020

Pathophysiology
Rho-Kinase as a Therapeutic Target for Nonalcoholic Fatty Liver Diseases: Inês Sousa-Lima, Hyun Jeong Kim, John Jones, Young-Bum Kim; Diabetes Metab J. 2021;45(5):655-674. Published online September 30, 2021; DOI: https://doi.org/10.4093/dmj.2021.0197

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Nonalcoholic fatty liver disease (NAFLD) is a major public health problem and the most common form of chronic liver disease, affecting 25% of the global population. Although NAFLD is closely linked with obesity, insulin resistance, and type 2 diabetes mellitus, knowledge on its pathogenesis remains incomplete. Emerging data have underscored the importance of Rho-kinase (Rho-associated coiled-coil-containing kinase [ROCK]) action in the maintenance of normal hepatic lipid homeostasis. In particular, pharmacological blockade of ROCK in hepatocytes or hepatic stellate cells prevents the progression of liver diseases such as NAFLD and fibrosis. Moreover, mice lacking hepatic ROCK1 are protected against obesity-induced fatty liver diseases by suppressing hepatic de novo lipogenesis. Here we review the roles of ROCK as an indispensable regulator of obesity-induced fatty liver disease and highlight the key cellular pathway governing hepatic lipid accumulation, with focus on de novo lipogenesis and its impact on therapeutic potential. Consequently, a comprehensive understanding of the metabolic milieu linking to liver dysfunction triggered by ROCK activation may help identify new targets for treating fatty liver diseases such as NAFLD.

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Original Articles

Basic Research
Carnitine Orotate Complex Ameliorates Insulin Resistance and Hepatic Steatosis Through Carnitine Acetyltransferase Pathway: Jung-Hee Hong, Moon-Kyu Lee; Diabetes Metab J. 2021;45(6):933-947. Published online August 19, 2021; DOI: https://doi.org/10.4093/dmj.2020.0223

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Background
Carnitine orotate complex (Godex) has been shown to decrease glycated hemoglobin levels and improve steatosis in patients with type 2 diabetes mellitus with non-alcoholic fatty liver disease. However, the mechanisms of Godex in glucose metabolism remain unclear.
Methods
Male C57BL/6J mice were divided into four groups: normal-fat diet, high-fat diet, a high-fat diet supplemented with intraperitoneal injection of (500 mg or 2,000 mg/kg/day) Godex for 8 weeks. Computed tomography, indirect calorimetry, and histological analyses including electron microscopy of the liver were performed, and biochemical profiles and oral glucose tolerance test and insulin tolerance test were undertaken. Expressions of genes in the lipid and glucose metabolism, activities of oxidative phosphorylation enzymes, carnitine acetyltransferase, pyruvate dehydrogenase, and acetyl-coenzyme A (CoA)/CoA ratio were evaluated.
Results
Godex improved insulin sensitivity and significantly decreased fasting plasma glucose, homeostatic model assessment for insulin resistance, steatosis, and gluconeogenesis, with a marked increase in fatty acid oxidation as well as better use of glucose in high-fat diet-fed mice. It preserved mitochondrial function and ultrastructure, restored oxidative phosphorylation enzyme activities, decreased acetyl-CoA/CoA ratio, and increased carnitine acetyltransferase content and pyruvate dehydrogenase activity. Carnitine acetyltransferase knockdown partially reversed the effects of Godex in liver and in vitro.
Conclusion
Godex improved insulin resistance and steatosis by regulating carnitine acetyltransferase in liver in high-fat diet-fed mice.

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Metabolic Risk/Epidemiology
Trends and Risk Factors of Metabolic Syndrome among Korean Adolescents, 2007 to 2018: Jiun Chae, Moon Young Seo, Shin-Hye Kim, Mi Jung Park; Diabetes Metab J. 2021;45(6):880-889. Published online July 6, 2021; DOI: https://doi.org/10.4093/dmj.2020.0185

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Background
There is a lack of recent research on the changes in risk factors for metabolic syndrome (MetS) in the Asian pediatric population. We aimed to determine the 12-year trends in the prevalence of MetS and relevant lifestyle factors such as smoking, exercise, and calorie intake among Korean adolescents.
Methods
We investigated trends in MetS and lifestyle factors among 6,308 adolescents aged 12 to 18 years from the Korea National Health and Nutrition Examination Survey, 2007 to 2018.
Results
The prevalence of MetS was stable from 2007 to 2018 (1.7% to 2.2%). There were significant increases in the prevalence of central obesity (from 8.1% to 11.2%, P=0.012) and hyperglycemia (from 5.3% to 10.4%, P<0.001) and decreases in hypo-high-density lipoprotein (HDL)-cholesterolemia (from 22.4% to 14.8%, P<0.001). Total calorie intake and calorie intake from fat significantly increased (P<0.001), whereas calorie intake from carbohydrates significantly decreased (P<0.001) during the study period. The proportions of tobacco smokers and regular walkers significantly decreased from 2007 to 2018. After controlling for all covariates, total calorie intake was positively correlated with waist circumference (P<0.05). HDL-cholesterol was negatively associated with carbohydrate consumption (P<0.01) and positively associated with fat consumption (P<0.001). Regular walking and regular strength training were associated with lower waist circumference (P<0.05). Smoking was associated with lower fasting glucose levels (P<0.01).
Conclusion
Although the prevalence rate of MetS is stable among Korean adolescents, the prevalence of central obesity and hyperglycemia has increased greatly in the recent decade. Public education on proper dietary intake and lifestyle modification is required.

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Basic Research
The Effects of Exercise and Restriction of Sugar-Sweetened Beverages on Muscle Function and Autophagy Regulation in High-Fat High-Sucrose-Fed Obesity Mice: Didi Zhang, Ji Hyun Lee, Hyung Eun Shin, Seong Eun Kwak, Jun Hyun Bae, Liang Tang, Wook Song; Diabetes Metab J. 2021;45(5):773-786. Published online March 25, 2021; DOI: https://doi.org/10.4093/dmj.2020.0157

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Background
Autophagy maintains muscle mass and healthy skeletal muscles. Several recent studies have associated sugar-sweetened beverage (SSB) consumption with diseases. We investigated whether muscle dysfunction due to obesity could be restored by SSB restriction (SR) alone or in combination with exercise (EX) training.
Methods
Obese mice were subjected to SR combined with treadmill EX. Intraperitoneal glucose tolerance test, grip strength test, hanging time test, and body composition analysis were performed. Triglyceride (TG) and total cholesterol (TC) serum concentrations and TG concentrations in quadriceps muscles were analyzed. Western blot and reverse transcription-quantitative polymerase chain reaction helped analyze autophagy-related protein and mRNA expression, respectively.
Results
SR alone had no significant effect on fasting blood glucose levels, glucose tolerance, and muscle function. However, it had effect on serum TC, serum TG, and BCL2 interacting protein 3 expression. SR+EX improved glucose tolerance and muscle function and increased serum TC utilization than SR alone. SR+EX reduced P62 levels, increased glucose transporter type 4 and peroxisome proliferator-activated receptor γ coactivator-1α protein expression, and improved grip strength relative to the high-fat and high-sucrose liquid (HFHS) group, and this was not observed in the HFHS+EX group.
Conclusion
SR induced mitophagy-related protein expression in quadriceps, without affecting muscle function. And, the combination of SR and EX activated mitophagy-related proteins and improved muscle function.

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Metabolic Risk/Epidemiology
A Vegetable Dietary Pattern Is Associated with Lowered Risk of Gestational Diabetes Mellitus in Chinese Women: Qiong Chen, Weiwei Wu, Hailan Yang, Ping Zhang, Yongliang Feng, Keke Wang, Ying Wang, Suping Wang, Yawei Zhang; Diabetes Metab J. 2020;44(6):887-896. Published online September 11, 2020; DOI: https://doi.org/10.4093/dmj.2019.0138

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Background
Identification of modifiable dietary factors, which are involved in the development of gestational diabetes mellitus (GDM), could inform strategies to prevent GDM.
Methods
We examined the dietary patterns in a Chinese population and evaluated their relationship with GDM risk using a case-control study including 1,464 cases and 8,092 control subjects. Propensity score matching was used to reduce the imbalance of covariates between cases and controls. Dietary patterns were identified using factor analysis while their associations with GDM risk were evaluated using logistic regression models.
Results
A “vegetable” dietary pattern was characterized as the consumption of green leafy vegetables (Chinese little greens and bean seedling), other vegetables (cabbages, carrots, tomatoes, eggplants, potatoes, mushrooms, peppers, bamboo shoots, agarics, and garlic), and bean products (soybean milk, tofu, kidney beans, and cowpea). For every quartile increase in the vegetables factor score during 1 year prior to conception, the first trimester, and the second trimester of pregnancy, the GDM risk lowered by 6% (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.89 to 0.99), 7% (OR, 0.94; 95% CI, 0.88 to 0.99), and 9% (OR, 0.91; 95% CI, 0.86 to 0.96).
Conclusion
In conclusion, our study suggests that the vegetable dietary pattern is associated with lower GDM risk; however, the interpretation of the result should with caution due to the limitations in our study, and additional studies are necessary to explore the underlying mechanism of this relationship.

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Lifestyle
Reducing Carbohydrate from Individual Sources Has Differential Effects on Glycosylated Hemoglobin in Type 2 Diabetes Mellitus Patients on Moderate Low-Carbohydrate Diets: Hajime Haimoto, Shiho Watanabe, Keiko Maeda, Takashi Murase, Kenji Wakai; Diabetes Metab J. 2021;45(3):390-403. Published online July 21, 2020; DOI: https://doi.org/10.4093/dmj.2020.0033

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Background

We evaluated decreases in glycosylated hemoglobin (HbA1c) achieved by reducing carbohydrate from various sources in type 2 diabetes mellitus patients.

Methods

We followed up 138 male and 107 female outpatients on a moderate low-carbohydrate diet without diabetic medication for 6 months. Changes in carbohydrate sources (Δcarbohydrate) were assessed from 3-day dietary records at baseline and 6 months, and associations with changes in HbA1c (ΔHbA1c) were examined with Spearman's correlation coefficients (r_s) and multiple regression analysis.

Results

ΔHbA1c was −1.5%±1.6% in men and −0.9%±1.3% in women, while Δtotal carbohydrate was −115.3±103.7 g/day in men and −63.6±71.1 g/day in women. Positive associations with ΔHbA1c were found for Δtotal carbohydrate (r_s=0.584), Δcarbohydrate from soft drinks (0.368), confectionery (0.361), rice (0.325), bread (0.221), Chinese soup noodles (0.199) in men, and Δtotal carbohydrate (0.547) and Δcarbohydrate from rice (0.376) and confectionery (0.195) in women. Reducing carbohydrate sources by 50 g achieved decreases in HbA1c of 0.43% for total carbohydrate, 1.33% for soft drinks, 0.88% for confectionery, 0.63% for bread, 0.82% for Chinese soup noodles and 0.34% for rice in men and 0.45% for total carbohydrate, 0.67% for confectionery and 0.34% for rice in women, although mean reductions in carbohydrate from these sources were much smaller than that from rice.

Conclusion

Decreases in HbA1c achieved by reducing carbohydrate from soft drinks, confectionery, bread and Chinese soup noodles were 2- to 4-fold greater than that for rice. Our results will enable patients to decrease HbA1c efficiently (UMIN000009866).

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Obesity and Metabolic Syndrome
Premeal Consumption of a Protein-Enriched, Dietary Fiber-Fortified Bar Decreases Total Energy Intake in Healthy Individuals: Chang Ho Ahn, Jae Hyun Bae, Young Min Cho; Diabetes Metab J. 2019;43(6):879-892. Published online June 25, 2019; DOI: https://doi.org/10.4093/dmj.2018.0202

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Background

A premeal load of protein can increase satiety and reduce energy intake. Dietary fiber also conveys metabolic benefits by modulating energy intake. We made a protein-enriched, dietary fiber-fortified bar (PFB) and aimed to investigate its effects on food intake and gut hormone secretion in healthy individuals.

Methods

Twenty subjects with normal glucose tolerance were enrolled. On three separate visits, the subjects received, in a randomized order, one of the following: a PFB containing 73 kcal with 10.7 g of protein and 12.7 g of dietary fiber; a usual bar (UB) containing the same calories as the PFB but only 0.9 g of protein and no dietary fiber; or water (control). After 15 minutes, the subjects had ad libitum intake of a test meal. Food consumption, appetite, and plasma gut hormone levels were measured.

Results

Total energy intake, including the bar and the test meal, was significantly reduced with the PFB preload compared to the water (904.4±534.9 kcal vs. 1,075.0±508.0 kcal, P=0.016). With the UB preload, only the intake of the test meal was reduced (P=0.044) but not the total energy intake (P=0.471) than the water. Fullness was also significantly increased after the PFB. In addition, postprandial glucose levels decreased and glucagon-like peptide-1 levels increased with the PFB compared with both the UB and water.

Conclusion

In healthy individuals, a premeal supplementation of PFB reduced total energy intake and decreased postprandial glucose excursion. This finding necessitates long-term studies regarding clinical use in obesity.

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Frontiers in Nutrition.2021;[Epub] CrossRef
Response: Premeal Consumption of a Protein-Enriched, Dietary Fiber-Fortified Bar Decreases Total Energy Intake in Healthy Individuals (Diabetes Metab J 2019;43:879–92)
Chang Ho Ahn, Jae Hyun Bae, Young Min Cho
Diabetes & Metabolism Journal.2020; 44(1): 207. CrossRef
Letter: Premeal Consumption of a Protein-Enriched, Dietary Fiber-Fortified Bar Decreases Total Energy Intake in Healthy Individuals (Diabetes Metab J 2019;43:879–92)
Mi-kyung Kim
Diabetes & Metabolism Journal.2020; 44(1): 203. CrossRef
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Rocio Campos‐Vega, Andrea Arreguín‐Campos, Miguel A. Cruz‐Medrano, María Dolores Castillo Bilbao
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Clinical Diabetes & Therapeutics
Additional Effect of Dietary Fiber in Patients with Type 2 Diabetes Mellitus Using Metformin and Sulfonylurea: An Open-Label, Pilot Trial: Seung-Eun Lee, Yongbin Choi, Ji Eun Jun, You-Bin Lee, Sang-Man Jin, Kyu Yeon Hur, Gwang Pyo Ko, Moon-Kyu Lee; Diabetes Metab J. 2019;43(4):422-431. Published online April 23, 2019; DOI: https://doi.org/10.4093/dmj.2018.0090

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Background

Metformin, sulfonylurea, and dietary fiber are known to affect gut microbiota in patients with type 2 diabetes mellitus (T2DM). This open and single-arm pilot trial investigated the effects of the additional use of fiber on glycemic parameters, insulin, incretins, and microbiota in patients with T2DM who had been treated with metformin and sulfonylurea.

Methods

Participants took fiber for 4 weeks and stopped for the next 4 weeks. Glycemic parameters, insulin, incretins during mixed-meal tolerance test (MMTT), lipopolysaccharide (LPS) level, and fecal microbiota were analyzed at weeks 0, 4, and 8. The first tertile of difference in glucose area under the curve during MMTT between weeks 0 and 4 was defined as ‘responders’ and the third as ‘nonresponders,’ respectively.

Results

In all 10 participants, the peak incretin levels during MMTT were higher and LPS were lower at week 4 as compared with at baseline. While the insulin sensitivity of the ‘responders’ increased at week 4, that of the ‘nonresponders’ showed opposite results. However, the results were not statistically significant. In all participants, metabolically unfavorable microbiota decreased at week 4 and were restored at week 8. At baseline, metabolically hostile bacteria were more abundant in the ‘nonresponders.’ In ‘responders,’ Roseburia intestinalis increased at week 4.

Conclusion

While dietary fiber did not induce additional changes in glycemic parameters, it showed a trend of improvement in insulin sensitivity in ‘responders.’ Even if patients are already receiving diabetes treatment, the additional administration of fiber can lead to additional benefits in the treatment of diabetes.

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Review

Obesity and Metabolic Syndrome
Diabetes Prevention in Australia: 10 Years Results and Experience: James A. Dunbar; Diabetes Metab J. 2017;41(3):160-167. Published online February 2, 2017; DOI: https://doi.org/10.4093/dmj.2017.41.3.160

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Clinical trials have demonstrated the efficacy of lifestyle modification for the prevention of type 2 diabetes mellitus but it was achieved at higher cost than can be sustained in routine health services. The first clinical trial to report was the Finnish Diabetes Prevention Study. This paper describes how Australia worked with Finnish colleagues to adapt the findings of that study to achieve a statewide diabetes prevention program. Small evaluative, effectiveness trials have been conducted in a number of countries to see if the results of the clinical trials can be replicated in routine health services. The Australian evaluative trial, Greater Green Triangle Diabetes Prevention Program is described in detail to demonstrate the ingredients for success in moving a program from one country to another. Few countries have managed to scale up from evaluative trials to statewide or national programs. The Australian experience is described in detail including lessons learned about what reduced the effectiveness, particularly the need for policy makers in government, people from the implementing organisation and researchers to work together from the start of the evaluative trial and throughout the first 5 years of a national program.

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Original Articles

Obesity and Metabolic Syndrome
Regulating Hypothalamus Gene Expression in Food Intake: Dietary Composition or Calorie Density?: Mi Jang, So-Young Park, Yong-Woon Kim, Seung-Pil Jung, Jong-Yeon Kim; Diabetes Metab J. 2017;41(2):121-127. Published online December 16, 2016; DOI: https://doi.org/10.4093/dmj.2017.41.2.121

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Background

The proportion of saturated fatty acids/unsaturated fatty acids in the diet seems to act as a physiological regulation on obesity, cardiovascular diseases, and diabetes. Differently composed fatty acid diets may induce satiety of the hypothalamus in different ways. However, the direct effect of the different fatty acid diets on satiety in the hypothalamus is not clear.

Methods

Three experiments in mice were conducted to determine whether: different compositions of fatty acids affects gene mRNA expression of the hypothalamus over time; different types of fatty acids administered into the stomach directly affect gene mRNA expression of the hypothalamus; and fat composition changes in the diet affects gene mRNA expression of the hypothalamus.

Results

The type of fat in cases of purified fatty acid administration directly into the stomach may cause changes of gene expressions in the hypothalamus. Gene expression by dietary fat may be regulated by calorie amount ingested rather than weight amount or type of fat.

Conclusion

Therefore, the calorie density factor of the diet in regulating hypothalamic gene in food intake may be detrimental, although the possibility of type of fat cannot be ruled out.

Citations

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γ-aminobutyric acid improves gut-brain axis function and behavioral adaptation in broilers under low-protein diet
Randi Randi, Anisa Aulia, Muhtadin Muhtadin, Chusnul Hanim, Michael T. Kidd, Muhsin Al Anas
Poultry Science.2026; 105(1): 106085. CrossRef
Prepartum fatty acid supplementation in sheep. III. Effect of eicosapentaenoic acid and docosahexaenoic acid during finishing on performance, hypothalamus gene expression, and muscle fatty acids composition in lambs1
Ana Cristina Carranza Martin, Danielle Nicole Coleman, Lyda Guadalupe Garcia, Cecilia C Furnus, Alejandro E Relling
Journal of Animal Science.2018; 96(12): 5300. CrossRef
Acute anti‐obesity effects of intracerebroventricular 11β‐HSD1 inhibitor administration in diet‐induced obese mice
M. Seo, S. A. Islam, S.‐S. Moon
Journal of Neuroendocrinology.2018;[Epub] CrossRef
Letter: Regulating Hypothalamus Gene Expression in Food Intake: Dietary Composition or Calorie Density? (Diabetes Metab J 2017;41:121-7)
Bo Kyung Koo
Diabetes & Metabolism Journal.2017; 41(3): 223. CrossRef
Response: Regulating Hypothalamus Gene Expression in Food Intake: Dietary Composition or Calorie Density? (Diabetes Metab J2017;41:121-7)
Mi Jang, So-Young Park, Yong-Woon Kim, Seung-Pil Jung, Jong-Yeon Kim
Diabetes & Metabolism Journal.2017; 41(3): 225. CrossRef

Epidemiology
Dietary Sodium Intake in People with Diabetes in Korea: The Korean National Health and Nutrition Examination Survey for 2008 to 2010: Myung Shin Kang, Chong Hwa Kim, Su Jin Jeong, Tae Sun Park; Diabetes Metab J. 2016;40(4):290-296. Published online June 23, 2016; DOI: https://doi.org/10.4093/dmj.2016.40.4.290

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Background

Diabetics are likely to receive advice from their physicians concerning lifestyle changes. To understand how much sodium is consumed by diabetics in Korea, we compared the average daily sodium intake between diabetics and non-diabetics after controlling for confounding factors.

Methods

We obtained the sodium intake data for 13,957 individuals who participated in the Korean National Health and Nutrition Examination Survey (KNHANES), 2008 to 2010, which consisted of a health interview and behavioral and nutritional surveys. The KNHANES uses a stratified, multistage, probability-sampling design, and weighting adjustments were conducted to represent the entire population.

Results

Our analysis revealed that, overall, diabetics tended to have lower sodium intake (4,910.2 mg) than healthy individuals (5,188.2 mg). However, both diabetic and healthy individuals reported higher sodium intake than is recommended by the World Health Organization (WHO). Stratified subgroup analyses revealed that the sodium intake (4,314.2 mg) among newly diagnosed diabetics was higher among women when compared to patients with known diabetes (3,812.5 mg, P=0.035). Female diabetics with cardiovascular disease had lower average sodium intake compared to those without cardiovascular disease after adjusting for sex, age, body mass index, and total energy intake (P=0.058). Sodium intake among male diabetics with hypercholesterolemia (P=0.011) and female diabetics with hypertriglyceridemia (P=0.067) tended to be higher than that among those who without dyslipidemia.

Conclusion

The average sodium intake of diabetics in Korea was higher than the WHO recommends. Sodium intake in newly diagnosed diabetics was significantly higher than that in non-diabetics and previously diagnosed diabetics among females. Prospective studies are needed to identify the exact sodium intake.

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Reviews

Molecular Links between Caloric Restriction and Sir2/SIRT1 Activation: Yu Wang; Diabetes Metab J. 2014;38(5):321-329. Published online October 17, 2014; DOI: https://doi.org/10.4093/dmj.2014.38.5.321

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Ageing is the most significant risk factor for a range of prevalent diseases, including cancer, cardiovascular disease, and diabetes. Accordingly, interventions are needed for delaying or preventing disorders associated with the ageing process, i.e., promotion of healthy ageing. Calorie restriction is the only nongenetic and the most robust approach to slow the process of ageing in evolutionarily divergent species, ranging from yeasts, worms, and flies to mammals. Although it has been known for more than 80 years that calorie restriction increases lifespan, a mechanistic understanding of this phenomenon remains elusive. Yeast silent information regulator 2 (Sir2), the founding member of the sirtuin family of protein deacetylases, and its mammalian homologue Sir2-like protein 1 (SIRT1), have been suggested to promote survival and longevity of organisms. SIRT1 exerts protective effects against a number of age-associated disorders. Caloric restriction increases both Sir2 and SIRT1 activity. This review focuses on the mechanistic insights between caloric restriction and Sir2/SIRT1 activation. A number of molecular links, including nicotinamide adenine dinucleotide, nicotinamide, biotin, and related metabolites, are suggested to be the most important conduits mediating caloric restriction-induced Sir2/SIRT1 activation and lifespan extension.

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Regulation of Muscle Pyruvate Dehydrogenase Complex in Insulin Resistance: Effects of Exercise and Dichloroacetate: Dumitru Constantin-Teodosiu; Diabetes Metab J. 2013;37(5):301-314. Published online October 17, 2013; DOI: https://doi.org/10.4093/dmj.2013.37.5.301

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Abstract PDF PubReader ePub

Since the mitochondrial pyruvate dehydrogenase complex (PDC) controls the rate of carbohydrate oxidation, impairment of PDC activity mediated by high-fat intake has been advocated as a causative factor for the skeletal muscle insulin resistance, metabolic syndrome, and the onset of type 2 diabetes (T2D). There are also situations where muscle insulin resistance can occur independently from high-fat dietary intake such as sepsis, inflammation, or drug administration though they all may share the same underlying mechanism, i.e., via activation of forkhead box family of transcription factors, and to a lower extent via peroxisome proliferator-activated receptors. The main feature of T2D is a chronic elevation in blood glucose levels. Chronic systemic hyperglycaemia is toxic and can lead to cellular dysfunction that may become irreversible over time due to deterioration of the pericyte cell's ability to provide vascular stability and control to endothelial proliferation. Therefore, it may not be surprising that T2D's complications are mainly macrovascular and microvascular related, i.e., neuropathy, retinopathy, nephropathy, coronary artery, and peripheral vascular diseases. However, life style intervention such as exercise, which is the most potent physiological activator of muscle PDC, along with pharmacological intervention such as administration of dichloroacetate or L-carnitine can prove to be viable strategies for treating muscle insulin resistance in obesity and T2D as they can potentially restore whole body glucose disposal.

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Original Articles

Balsamic Vinegar Improves High Fat-Induced Beta Cell Dysfunction via Beta Cell ABCA1: Hannah Seok, Ji Young Lee, Eun Mi Park, Se Eun Park, Jae Hyuk Lee, Seungtaek Lim, Byung-Wan Lee, Eun Seok Kang, Hyun Chul Lee, Bong Soo Cha; Diabetes Metab J. 2012;36(4):275-279. Published online August 20, 2012; DOI: https://doi.org/10.4093/dmj.2012.36.4.275

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Background

The aim of this study was to investigate the effects of balsamic vinegar on β-cell dysfunction.

Methods

In this study, 28-week-old Otsuka Long-Evans Tokushima Fatty (OLETF) rats were fed a normal chow diet or a high-fat diet (HFD) and were provided with tap water or dilute balsamic vinegar for 4 weeks. Oral glucose tolerance tests and histopathological analyses were performed thereafter.

Results

In rats fed both the both chow diet and the HFD, the rats given balsamic vinegar showed increased insulin staining in islets compared with tap water administered rats. Balsamic vinegar administration also increased β-cell ATP-binding cassette transporter subfamily A member 1 (ABCA1) expression in islets and decreased cholesterol levels.

Conclusion

These findings provide the first evidence for an anti-diabetic effect of balsamic vinegar through improvement of β-cell function via increasing β-cell ABCA1 expression.

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Alberto Castagna, Yvelise Ferro, Francesca Rita Noto, Rossella Bruno, Analucia Aragao Guimaraes, Carmelo Pujia, Elisa Mazza, Samantha Maurotti, Tiziana Montalcini, Arturo Pujia
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The herbal extract ALS-L1023 from Melissa officinalis reduces weight gain, elevated glucose levels and β-cell loss in Otsuka Long-Evans Tokushima fatty rats
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Postprandial Triglyceride Is Associated with Fasting Triglyceride and HOMA-IR in Korean Subjects with Type 2 Diabetes: Seo Hee Lee, Byung-Wan Lee, Hee Kwan Won, Jae Hoon Moon, Kwang Joon Kim, Eun Seok Kang, Bong Soo Cha, Hyun Chul Lee; Diabetes Metab J. 2011;35(4):404-410. Published online August 31, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.4.404

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Background

Recent studies indicate postprandial triglyceride (TG) had a better association with cardiovascular events and metabolic syndrome than fasting TG. The authors of the present study investigated the metabolic and clinical relevance of postprandial TG.

Methods

In a cross-sectional retrospective study, the authors of the present study compared fasting and postprandial TG and analyzed the relationship between postprandial TG and various demographic and metabolic parameters in 639 Korean subjects with type 2 diabetes (T2D, group I, n=539) and impaired fasting glucose (IFG, group II, n=100) after ingestion of a standardized liquid meal (total 500 kcal, 17.5 g fat, 68.5 g carbohydrate, and 17.5 g protein).

Results

Fasting and postprandial TG were significantly correlated (r=0.973, r=0.937, P<0.001) in group I and II, respectively. Of the variables, total cholesterol, waist circumference and body mass index were significantly correlated with fasting and postprandial TG in both groups. Only postprandial TG showed a significant correlation with glucose metabolic parameters (e.g., postprandial glucose, homeostatic model assessment of insulin resistance [HOMA-IR], and fasting C-peptide) in subjects with T2D. Multiple regression analysis showed fasting TG and HOMA-IR could be predictable variables for postprandial TG in subjects with T2D.

Conclusion

Postprandial TG was very strongly correlated with fasting TG. The authors of the present study suggest insulin resistance may be more associated with postprandial TG than fasting TG in Korean T2D patients on a low-fat diet.

Citations

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Small Rice Bowl-Based Meal Plan for Energy and Marcronutrient Intake in Korean Men with Type 2 Diabetes: A Pilot Study: Hee Jung Ahn, Kyung Ah Han, Jin Young Jang, Jae Hyuk Lee, Kang Seo Park, Kyung Wan Min; Diabetes Metab J. 2011;35(3):273-281. Published online June 30, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.3.273

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Background

Koreans eat rice, which is usually served in a rice bowl. We investigated the effect of a meal plan using small rice bowls on the total energy intake (TEI) and the marcronutrient intake in Korean men with type 2 diabetes.

Methods

A total of 62 men with type 2 diabetes were divided by body mass index (BMI) (normal weight [NW], BMI<23 kg/m²; overweight [OW], 23≤BMI<25 kg/m²; obese [OB], BMI≥25 kg/m²) and proportions of carbohydrate intake to TEI (PCI) (low carbohydrate intake [LC], <55%; recommended carbohydrate intake [RC], ≥55% and ≤60%; high carbohydrate intake [HC], >60%). The 3-day dietary records were analyzed for TEI and proportions of macronutrients, before and 2 weeks after a small-sized (300 mL) rice bowl based education was given.

Results

There were no significant differences in the age and BMI within the sub-groups by BMI and PCI groups. In baseline, the ratio of TEI to recommended total energy intake (RTR) of OW and OB were higher than that of NW. The PCI of HC was higher than that of LC and alcohol intake of HC was lower than that of LC. After education, the reduction of RTREI in OB was higher than that in OW and NW. The reduction of PCI in HC was higher than that of LC.

Conclusion

A small rice bowl based meal plan was effective for the reduction of energy intake and control of marcronutrient intake in Korean obese men with type 2 diabetes consuming a high carbohydrate diet.

Citations

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Comprehensive Understanding for Application in Korean Patients with Type 2 Diabetes Mellitus of the Consensus Statement on Carbohydrate-Restricted Diets by Korean Diabetes Association, Korean Society for the Study of Obesity, and Korean Society of Hyperte
Jong Han Choi, Jee-Hyun Kang, Suk Chon
Diabetes & Metabolism Journal.2022; 46(3): 377. CrossRef
The association between measurement sites of visceral adipose tissue and cardiovascular risk factors after caloric restriction in obese Korean women
Hye-Ok Lee, Jung-Eun Yim, Jeong-Sook Lee, Young-Seol Kim, Ryowon Choue
Nutrition Research and Practice.2013; 7(1): 43. CrossRef
Daily Rice Intake Strongly Influences the Incidence of Metabolic Syndrome in Japanese Men Aged 40-59 Years
Yoko Watanabe, Isao Saito, Yasuhiko Asada, Taro Kishida, Tatsuhiro Matsuo, Masamitsu Yamaizumi, Tadahiro Kato
Journal of Rural Medicine.2013; 8(1): 161. CrossRef

The Small Rice Bowl-Based Meal Plan was Effective at Reducing Dietary Energy Intake, Body Weight, and Blood Glucose Levels in Korean Women with Type 2 Diabetes Mellitus: Hee Jung Ahn, Kyung Ah Han, Hwi Ryun Kwon, Kyung Wan Min; Korean Diabetes J. 2010;34(6):340-349. Published online December 31, 2010; DOI: https://doi.org/10.4093/kdj.2010.34.6.340

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Background

The typical Korean diet includes rice, which is usually served in a rice bowl. We investigated the effects of a meal plan using rice bowls of varying sizes on dietary energy intake (EI), body weight (BW), and blood glucose levels.

Methods

Forty-two obese women with type 2 diabetes mellitus were randomly assigned to use either a 200 mL small rice bowl (SB), a 380 mL regular rice bowl (RB), or to a control group (C). Both intervention groups were asked to reduce their EI by 500 kcal/day for 12 weeks and simple instructions for using the assigned bowl were provided. Dietary EI and proportion of macronutrients (PMN) were estimated from 3-day dietary records.

Results

Reduction of EI was more prominent in the SB group compared to the RB and C group, although EI decreased significantly from baseline in all groups. Carbohydrate and fat intakes of the SB group were decreased greater than those of the RB and C group. However, changes in PMN were not significant across the 3 groups. Reduction of BW and HbA1c levels in the SB group was more prominent compared to the C group. Although, BW and HbA1c were decreased significantly from baseline in both bowl groups. There was no statistical difference between the two groups.

Conclusion

The small rice bowl-based meal plan was effective at reducing EI, BW, and blood glucose levels, and the observed reductions in EI, carbohydrate, and fat intake were greater than those of the regular rice bowl-based meal plan.

Citations

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Enhanced glycemic control and cardiovascular risk reduction in type 2 diabetes patients using quantified tableware: A randomized controlled study
Ching-Hsiang Leung, Min-Su Tzeng, Chia-Ying Tsai, Wan-Rong Tsai, Sung-Chen Liu, Pi-Hui Hsu, Shih-Ming Chuang
Primary Care Diabetes.2025; 19(2): 149. CrossRef
Impact of Portion Control Tools on Portion Size Awareness, Choice and Intake: Systematic Review and Meta-Analysis
M. Angeles Vargas-Alvarez, Santiago Navas-Carretero, Luigi Palla, J. Alfredo Martínez, Eva Almiron-Roig
Nutrients.2021; 13(6): 1978. CrossRef
Do adults draw differently-sized meals on larger or smaller plates? Examining plate size in a community sample
David Sharp, Jeffery Sobal, Elaine Wethington
Food Quality and Preference.2019; 74: 72. CrossRef
Use and effectiveness of behavioural economics in interventions for lifestyle risk factors of non-communicable diseases: a systematic review with policy implications
Oana M Blaga, Livia Vasilescu, Razvan M Chereches
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Whether Smaller Plates Reduce Consumption Depends on Who's Serving and Who's Looking: A Meta-Analysis
Stephen S. Holden, Natalina Zlatevska, Chris Dubelaar
SSRN Electronic Journal .2015;[Epub] CrossRef
Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco
Gareth J Hollands, Ian Shemilt, Theresa M Marteau, Susan A Jebb, Hannah B Lewis, Yinghui Wei, Julian P T Higgins, David Ogilvie
Cochrane Database of Systematic Reviews.2015;[Epub] CrossRef

Effects of Endurance Exercise and High-Fat Diet on Insulin Resistance and Ceramide Contents of Skeletal Muscle in Sprague-Dawley Rats: Hyun Lyung Jung, Ho Youl Kang; Korean Diabetes J. 2010;34(4):244-252. Published online August 31, 2010; DOI: https://doi.org/10.4093/kdj.2010.34.4.244

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Background

We evaluated the effects of endurance exercise and a high-fat diet on insulin resistance and ceramide contents of skeletal muscle in Sprague-Dawley rats.

Methods

We randomly divided 32 rats into four groups: control (CON, n = 8), high fat diet (HF, n = 8), exercise (Ex, 24 m/min for 2 hours, 5 days/wk, n = 8), HF/Ex (n = 8). After 4-week treatments, plasma lipid profiles, glucose and insulin concentrations were measured. The triglycerides (TG), ceramide, and glucose transporter 4 (GLUT-4) contents were measured in the skeletal muscle. The rate of glucose transport was determined under submaximal insulin concentration during the muscle incubation.

Results

Free fatty acid levels were significantly higher in CON and HF than Ex (P = 0.032). Plasma glucose levels in HF were significantly higher than the two Ex groups (P = 0.002), and insulin levels were significantly higher in HF than in other three groups (P = 0.021). Muscular TG concentrations were significantly higher in HF than CON and Ex and also in HF/Ex than Ex, respectively (P = 0.005). Hepatic TG concentrations were significantly higher in HF than other three groups but Ex was significantly lower than HF/Ex (P = 0.000). Muscular ceramide content in HF was significantly greater than that in either Ex or HF/Ex (P = 0.031). GLUT-4 levels in CON and HF were significantly lower than those in Ex and HF/Ex (P = 0.009, P = 0.003). The glucose transport rate in submaximal insulin concentration was lower in CON than in either Ex or HF/Ex (P = 0.043), but not different from HF.

Conclusion

This study suggests that high fat diet for 4 weeks selectively impairs insulin resistance, but not glucose transport rate, GLUT-4 and ceramide content in skeletal muscle per se. However, endurance exercise markedly affects the content of ceramide and insulin resistance in muscle.

Citations

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Barbara Choromańska, Piotr Myśliwiec, Hady Razak Hady, Jacek Dadan, Hanna Myśliwiec, Adrian Chabowski, Agnieszka Mikłosz
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The Effects of Small Sized Rice Bowl on Carbohydrate Intake and Dietary Patterns in Women with Type 2 Diabetes: Hee-Jung Ahn, Yu-Kyung Eom, Kyung-Ah Han, Hwi-Ryun Kwon, Hyun Jin Kim, Kang Seo Park, Kyung-Wan Min; Korean Diabetes J. 2010;34(3):166-173. Published online June 30, 2010; DOI: https://doi.org/10.4093/kdj.2010.34.3.166

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Background

The main source of carbohydrate in the Korean diet is rice, which is usually served in a rice bowl. This study investigated the impact of a meal plan using smaller rice bowls on dietary energy intake and macronutrient composition in overweight or obese patients with type 2 diabetes mellitus.

Methods

A total of 67 women with type 2 diabetes were enrolled in our study. We divided these participants into three groups: a normal-weight group (NW; body mass index [BMI] < 23 kg/m²; n = 17), an overweight group (OW; 23 ≤ BMI < 25 kg/m²; n = 24) and an obese group (OB; BMI ≥ 25 kg/m²; n = 26). Three-day dietary records were analyzed for total energy intake (TEI) and macronutrient composition both before enrollment and two weeks after patients received instruction in a dietary plan based on using a small (200 mL) rice bowl.

Results

After the intervention, TEI decreased in the OW and OB groups. Decreased carbohydrate (NW, -4 ± 5%; OW, -4 ± 5%; OB, -3 ± 6%) and increased fat intakes were found in all three groups, which complies with Korean Diabetes Association recommendations. The protein proportion of TEI significantly increased only in the OW group. Body weight decreased both in the OW and OB groups.

Conclusion

A short-term, small-rice-bowl-based meal plan was effective for body weight control and macronutrient balance in overweight or obese women in Korea with type 2 diabetes.

Citations

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Diet Therapy Using a Small Rice Bowl among Japanese Men with Diabetes: A Randomized Controlled Trial
Misa Shimpo, Shiori Toga-Sato, Takahiro Tosaki
Journal of Obesity & Metabolic Syndrome.2022; 31(4): 345. CrossRef
A traditional Asian diet modified to meet nutritional requirements of diabetes, has anything changed? A cross-sectional dietary survey
Arjuna Medagama, Heshan Widanapathirana
BMC Nutrition.2015;[Epub] CrossRef
Relationship between Milk and Calcium Intake and Lipid Metabolism in Female Patients with Type 2 Diabetes
JaeHee Kim, Ji-Yun Hwang, Ki Nam Kim, Young-Ju Choi, Namsoo Chang, Kap-Bum Huh
Yonsei Medical Journal.2013; 54(3): 626. CrossRef
The Small Rice Bowl-Based Meal Plan was Effective at Reducing Dietary Energy Intake, Body Weight, and Blood Glucose Levels in Korean Women with Type 2 Diabetes Mellitus
Hee Jung Ahn, Kyung Ah Han, Hwi Ryun Kwon, Kyung Wan Min
Korean Diabetes Journal.2010; 34(6): 340. CrossRef

Small Rice Bowl-Based Meal Plan versus Food Exchange-Based Meal Plan for Weight, Glucose and Lipid Control in Obese Type 2 Diabetic Patients: Hee-Jung Ahn, Kyung-Ah Han, Hwi-Ryun Kwon, Bo-Kyung Koo, Hyun-Jin Kim, Kang-Seo Park, Kyung-Wan Min; Korean Diabetes J. 2010;34(2):86-94. Published online April 30, 2010; DOI: https://doi.org/10.4093/kdj.2010.34.2.86

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Background

The Korean National Health and Nutrition Examination Surveys reported 65% of daily energy intake (EI) as carbohydrate (CHO) in the Korean population and main source of CHO was cooked rice. We used a standardized-small sized rice bowl for diet education and investigated its effectiveness on body weight, glucose and lipid, compared to the conventional food exchange system in type 2 diabetes obese women.

Methods

Type 2 diabetic women with body mass index ≥ 23 kg/m² were randomly assigned to small rice bowl-based meal plan (BM) and food exchange-based meal plan (ExM) group. Both groups were asked to reduce their EI by 500 kcal/day for 12 weeks. The macronutrient composition was instructed: 55 to 60% of EI as CHO, 15 to 20% as protein, and 20 to 25% as fat. BM group received only a simple instruction for application of the rice bowl. Nutrient intake was estimated with the 3-day dietary records.

Results

Finally, 44 subjects finished the study. The percent reduction of body weight was significant both BM group (-5.1 ± 2.6%) and ExM group (-4.8 ± 2.8%) after 12 weeks (P < 0.001) but there was no difference between the groups. There was no difference in the proportional change of CHO, protein and fat in EI between the groups. Additionally, the change of HbA1c and low density lipoprotein-cholesterol were not significantly different between the two groups.

Conclusion

The BM group was as effective as ExM for body weight and glucose control in type 2 diabetes obese women.

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Small Rice Bowl-Based Meal Plan for Energy and Marcronutrient Intake in Korean Men with Type 2 Diabetes: A Pilot Study
Hee Jung Ahn, Kyung Ah Han, Jin Young Jang, Jae Hyuk Lee, Kang Seo Park, Kyung Wan Min
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The Small Rice Bowl-Based Meal Plan was Effective at Reducing Dietary Energy Intake, Body Weight, and Blood Glucose Levels in Korean Women with Type 2 Diabetes Mellitus
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Korean Diabetes Journal.2010; 34(6): 340. CrossRef

Development and Validation of a Semi-Quantitative Food Frequency Questionnaire to Assess Diets of Korean Type 2 Diabetic Patients: Seongbin Hong, Yunjin Choi, Hun-Jae Lee, So Hun Kim, Younju Oe, Seung Youn Lee, Moonsuk Nam, Yong Seong Kim; Korean Diabetes J. 2010;34(1):32-39. Published online February 28, 2010; DOI: https://doi.org/10.4093/kdj.2010.34.1.32

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Background

Our aim was to assess the validity of a semi-quantitative food frequency questionnaire (FFQ) by comparison with the 3-day diet record (DR) in patients with type 2 diabetes.

Methods

Eighty five type 2 diabetic patients (aged 33 to 70 years) from the Korean National Diabetes Program (KNDP) completed 3-day DR and FFQ. The FFQ was designed to reflect the eating pattern of Korean type 2 diabetic patients, and was based on the 2003 Korean National Health and Nutrition Examination Survey. The FFQ consists of 85 food items and 12 food groups. The validity of FFQ was assessed by comparison with the 3-day DR.

Results

The mean age was 49 ± 10 years. Clinical characteristic including body weight, diabetic duration, and HbA1c were not different from the total cohort subjects (n = 1,478). There were no significant differences in the mean intake of protein, fat and calcium estimated by the FFQ and the 3-day DR. Energy and carbohydrate estimated by the FFQ were higher than those estimated by the 3-day DR. The correlation coefficient was highest for energy (r = 0.740; P < 0.00) and lowest for iron (r = 0.269; P < 0.05). The Kappa values for energy, carbohydrate, protein, fat and calcium were 0.54, 0.37, 0.36, 0.46, and 0.19, respectively.

Conclusion

The FFQ is a reasonable instrument for assessing the intake of most macronutrients in Korean type 2 diabetes, although careful consideration is required for the food groups and nutrients for which the FFQ had low validity.

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Association Between Volume of Bowls and the Dietary Intakes in Subjects with Type 2 Diabetes.: Hee Jung Ahn, Bo Kyung Koo, Ji Yeon Jung, Hwi Ryun Kwon, Mi Yeon Chung, Yun Hyi Ku, Jin Taek Kim, Kyung Ah Han, Kyung Wan Min; Korean Diabetes J. 2009;33(4):335-343. Published online August 1, 2009; DOI: https://doi.org/10.4093/kdj.2009.33.4.335

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Abstract PDF

BACKGROUND
The results of previous studies suggest that portion size is a major factor dictating dietary energy intake. We investigated the relationship between frequencies of rice meals, bowl volumes, and dietary energy intake in a sample of patients with type 2 diabetes. METHODS: A total of 203 type 2 diabetes patients were enrolled in the study. A one-week food diary was collected from each patient and used to assess the types of meal consumed as well as the context of consumption. The volumes of the eating vessels (rice, soup and side dish bowls) used by each patient were obtained by comparisons to measuring cylinders, and dietary energy and macronutrient intake were estimated for each patient by consulting three-day dietary records. RESULTS: The mean age of the 203 subjects (male: 76, female: 127) was 53.9 +/- 9.1 years and the average body mass index (BMI) was 25.6 +/- 4.2 kg/m2. Among the subjects who ate three times per day, 96.4% consumed rice more than twice out of three meals. The median volume of rice bowls used by patients was 350 cc, of soup bowls was 530 cc and of side dish bowls was 260 cc. Portion size, as estimated by rice bowl volume, was not associated with BMI. Male subjects tended to eat out of larger rice and soup bowls (P < 0.001). Portion size was correlated with energy intake from rice (P = 0.021), but not with total energy intake (kcal/kg/day), especially in male subjects. CONCLUSION: Portion size of rice bowl was correlated with energy intake from rice, but not with total energy intake in male subjects with type 2 diabetes. To design effective meal planning methods for patients with type 2 diabetes, further prospective studies are warranted to investigate causative relationships between portion size andmetabolic conditions as well as variation by gender.

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Trends in adherence to dietary recommendations among Korean type 2 diabetes mellitus patients
Kyong Park
Nutrition Research and Practice.2015; 9(6): 658. CrossRef
Small Rice Bowl-Based Meal Plan for Energy and Marcronutrient Intake in Korean Men with Type 2 Diabetes: A Pilot Study
Hee Jung Ahn, Kyung Ah Han, Jin Young Jang, Jae Hyuk Lee, Kang Seo Park, Kyung Wan Min
Diabetes & Metabolism Journal.2011; 35(3): 273. CrossRef
Nutrients and Dish Intake by Fasting Blood Glucose Level
Jihyun Choi, Hyun-Kyung Moon
The Korean Journal of Nutrition.2010; 43(5): 463. CrossRef
Small Rice Bowl-Based Meal Plan versus Food Exchange-Based Meal Plan for Weight, Glucose and Lipid Control in Obese Type 2 Diabetic Patients
Hee-Jung Ahn, Kyung-Ah Han, Hwi-Ryun Kwon, Bo-Kyung Koo, Hyun-Jin Kim, Kang-Seo Park, Kyung-Wan Min
Korean Diabetes Journal.2010; 34(2): 86. CrossRef
The Effects of Small Sized Rice Bowl on Carbohydrate Intake and Dietary Patterns in Women with Type 2 Diabetes
Hee-Jung Ahn, Yu-Kyung Eom, Kyung-Ah Han, Hwi-Ryun Kwon, Hyun Jin Kim, Kang Seo Park, Kyung-Wan Min
Korean Diabetes Journal.2010; 34(3): 166. CrossRef
The Small Rice Bowl-Based Meal Plan was Effective at Reducing Dietary Energy Intake, Body Weight, and Blood Glucose Levels in Korean Women with Type 2 Diabetes Mellitus
Hee Jung Ahn, Kyung Ah Han, Hwi Ryun Kwon, Kyung Wan Min
Korean Diabetes Journal.2010; 34(6): 340. CrossRef

Bowl-Based Meal Plan versus Food Exchange-Based Meal Plan for Dietary Intake Control in Korean Type 2 Diabetic Patients.: Hee Jung Ahn, Boo Kyung Koo, Ji Yeon Jung, Hwi Ryun Kwon, Hyun Jin Kim, Kang Seo Park, Kyung Ah Han, Kyung Wan Min; Korean Diabetes J. 2009;33(2):155-163. Published online April 1, 2009; DOI: https://doi.org/10.4093/kdj.2009.33.2.155

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Abstract PDF

BACKGROUND
The food exchange-based meal plan is effective in controlling dietary energy intake with a macronutrient balance. However, it is difficult to practice for relatively low-literacy patients. As an alternative, we developed a system employing a standardized-sized bowl and investigated its effectiveness on achieving proper energy intake and macronutrient composition and patient compliance, compared to the conventional food exchange system in Korean type 2 diabetes patients. METHODS: Eighty subjects with type 2 diabetes were assigned to both the novel bowl-based meal plan group (BG) and the food exchange-based meal plan group (ExG). BG received limited simple instructions for the plan. Time spent for plan instruction was 10 min for BG and 40 min for ExG. Dietary energy and macronutrient intake were estimated with 3-day dietary records and patient comprehension of the plan was estimated with a 5-point Likert scale. RESULTS: After 12 weeks, dietary energy compliance showed no difference between the groups (BG: 103 +/- 10%, ExG: 101 +/- 17%). Both groups showed significant reduction in carbohydrate and protein intake and there was no difference in the proportion of carbohydrate, protein and fat in energy intake between the groups despite the shorter instruction time for BG. Following the instruction period, there was no difference in the understanding score between the groups. CONCLUSION: This bowl-based plan was equally effective as the food exchange-based plan in controlling dietary energy intake and macronutrient composition, as well as patient comprehension and compliance. Our novel plan may allow for more cost-effective methods in terms of time needed for plan instruction.

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Small Rice Bowl-Based Meal Plan versus Food Exchange-Based Meal Plan for Weight, Glucose and Lipid Control in Obese Type 2 Diabetic Patients
Hee-Jung Ahn, Kyung-Ah Han, Hwi-Ryun Kwon, Bo-Kyung Koo, Hyun-Jin Kim, Kang-Seo Park, Kyung-Wan Min
Korean Diabetes Journal.2010; 34(2): 86. CrossRef
Nutrients and Dish Intake by Fasting Blood Glucose Level
Jihyun Choi, Hyun-Kyung Moon
The Korean Journal of Nutrition.2010; 43(5): 463. CrossRef
The Effects of Small Sized Rice Bowl on Carbohydrate Intake and Dietary Patterns in Women with Type 2 Diabetes
Hee-Jung Ahn, Yu-Kyung Eom, Kyung-Ah Han, Hwi-Ryun Kwon, Hyun Jin Kim, Kang Seo Park, Kyung-Wan Min
Korean Diabetes Journal.2010; 34(3): 166. CrossRef

Review

Non-drug Intervention in Lipid Management: Dietary Portfolio.: In Ju Kim; Korean Diabetes J. 2007;31(5):377-382. Published online September 1, 2007; DOI: https://doi.org/10.4093/jkda.2007.31.5.377

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Abstract PDF: Non-Pharmaceutical interventions are essential in lipid management. The NCEP recommends the following three tiered approach to lipid management: 1. Institution of therapeutic lifestyle changes (TLC); 2. Use of non-drug adjuncts, including viscous fibers and plant sterol/stanol products; and 3. Drug therapy when required to reach treatment goals. Even though non-drug approaches often receive minimal attention in clinical practice, the efficacy of non-drug therapies is not so small. Non-drug adjuncts are known to reduce LDL cholesterol as follows: 12.5% for 45 g of soy protein/d; 6% to 7% for 9 to 10 g of psyllium/d, with smaller reductions for other viscous fibers; 10% for 1 to 2 g of plant sterols/d and 1% for 10 g almonds/d. Recently, combining these foods in a single dietary portfolio decreased LDL cholesterol and CRP similarly to the extent which achieved by a usual dose of a statin. This dietary portfolio can be regarded as an effective non-drug approach to reduce the risk of cardiovascular disease.

Original Articles

Prevalence of Diabetes Mellitus(Fasting Plasma Glucose by the ADA Criteria) and Impaired Fasting Glucose according to Anthropometric Characteristics and Dietary Habits: 1998 National Health and Nutrition Survey.: Chul Sik Kim, Eun Kyong Jeong, Jina Park, Min Ho Cho, Ji Sun Nam, Hai Jin Kim, Jee Hyun Kong, Jong Suk Park, Joo Young Nam, Dol Mi Kim, Chul Woo Ahn, Bong Soo Cha, Sung Kil Lim, Kyung Rae Kim, Hyun Chul Lee, Chung Mo Nam; Korean Diabetes J. 2005;29(2):151-166. Published online March 1, 2005

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Abstract PDF: BACKGROUND
The study is based on the National Health and Nutrition Examination Survey in Korea(1998). With these data, we want to predict the prevalence of diabetes mellitus(DM) and impaired fasting glucose(IFG), By investigating anthropometric characteristics and dietary intake habits, we also wanted to analyze any significant correlation between those factors and the prevalences of DM and IFG. METHODS: The study group was comprised of 8,166 people, a representative group of Koreans, who had undergone a health check-up and food intake survey among the total 39,331 members of 12,189 families who were surveyed. RESULTS: The final results are as the follows. 1) The peak prevalence of DM was 15.92% among women in their sixties and 18.21% among men in their fifties, and that of IFG was found to be 16.27% of women in their seventies and 14.09% of men in their sixties. 2) When analyzing the eating habits and the prevalences of DM and IFG, we found that women with more glucose intake had a lesser risk of DM, but this was of no statistical significance. 3) In men, age, total cholesterol, triglyceride(TG), and hypertension(HTN) were revealed as meaningful factors and in women, age, TG, and HTN were revealed as meaningful factors. As to the IFG, in females, age and TG were meaningful factors, and in males, age, TG, the waist/hip ratio (WHR), and body mass index (BMI) were meaningful factors. CONCLUSION: Although this study could not demonstrate meaningful correlation between diet habits and DM, the prevalence of IFG and the recent increase in the prevalence of DM in Koreans, owing to alterations in their diet habits, demands further organized group study for a better understanding of their relationship

High Carbohydrate Diet Effects on the Development of Diabetes Mellitus and Modification of Pancreatic Islets in OLETF Rats.: Sung Ki Kim, Seong Bin Hong, Hwi Ra Park, Eun A Kim, Kyung Wook Lee, Moon Suk Nam, Yong Seong Kim; Korean Diabetes J. 2004;28(3):187-198. Published online June 1, 2004

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Abstract PDF: BACKGROUND
Diet has long been believed to be an important risk factor for type 2 diabetes. The composition of carbohydrates in the diet was higher in the past, where as now it is considerably reduced in the diet of Korean peoples, which is probably associated with the risk of developing type 2 diabetes. The aim of the present study was to investigate the long-term effect of high carbohydrate/low protein diets on the glucose and lipid metabolism and the pancreatic islet in OLETF(Otsuka Long-Evans Tokushima Fatty) rats, the animal model of type 2 diabetes. METHODS: Seven week old male OLETF rat were fed a high carbohydrate/low protein diet(carbohydrate 71.0%, fat 14.5%, protein 14.5%) as the experimental group, with an ordinary chow diet(carbohydrate 63.5%, fat 14.5%, protein 22%) fed to the controls. The plasma insulin, lipid profiles, free fatty acid and oral glucose tolerance were analyzed at 16 and 32 weeks. After the glucose tolerance test, the pancreas was excised, and immunohistochemical staining was conducted for the islet morphology and insulin mRNA to quantify the insulin secretory capacity. RESULTS: The basal glucose levels tended to be higher in the control group, but with no significant statistical difference. There were no differences in the serum insulin, total cholesterol, triglyceride, HDL-cholesterol and plasma free fatty acid levels between the two groups. The pancreatic islets of the control group showed multilobulation, with fibrotic changes; where as those of the experimental group were maintained normal profiles. A higher expression of insulin mRNA was observed in the experimental than in the control group. CONCLUSION: A high carbohydrate diet induced lower body weight increases, and protected against beta cell injury and decreased the development of abnormal glucose tolerance in OLETF rats. This may explain the growing incidence of diabetes with respect to the change in carbohydrate composition in the diet of Korean peoples. However, whether the protective effect of a high carbohydrate diet, against the development of diabetes in OLETF rats, can be attributed to small weight increases or if the change in food composition itself, or both needs to be determined.

Clinical Characteristics of Diabetic Patients Controlled by Diet and Exercise.: Kil Sang Wang, Sung Bae Lee, Hyun Suk Lee, Jae Suk Jeon, Kyung Wan Min, Kyung Ah Han, Eung Jin Kim; Korean Diabetes J. 1999;23(1):98-107. Published online January 1, 2001

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Abstract PDF: BACKGROUND
In order to rnaintain blood glucose in ao acceptable range, some patients with type 2 diabetes mellitus may be able to their level manage with diet and exercise alone, but others require oral agents or insulin. To assess which factors gave important influences on therapeutic methocls, we investigated clinical characteristics and life-style in the type 2 diabetic patients who could be managed with diet and exercise alone. METHODS: We recruited patients with type 2 diabetes mellitus from Eulji Medical College Diabetes Center, who had dieted and exercised for over 3 years (99; group 1) and compared them with patients who were managed with oral agents (130; group 2) or insulin (47; group 3). We conducted the retrospective evaluation of age, sex, duration of DM, initial and recent BM1 (body mass index), serial HbA 1c, skipped period ratio of hospital follow-up, self monitoring of blood glucose (SMBG) or urine sugar, diet and exercise and educational chance for diabetes with dependency of folk remedies. RESULTS: The duration of the DM was significantly shorter in group 1 than in group 2 or 3 (p<0,05). Initial BMI and HbA. were not different among these three groups, but HMI reduction was more decreased in group 1 (p<0.05). The mean HbA, during follow-up was lower in group 1 (p<0.05). The skipped period ratio of hospital follow-up was lower in group 1 (p<0.05). SMBG was less frequent, the meal-time was more regular, extra-snacks were less frequent and folk remedies were rarely tried in group 1. CONCLUSION: This study suggests that the duration of DM, BMI reduction and mean HbA 1c, were associated with the therapeutic method in patients with type 2 diabetes mellitus. We would like to a]so emphasize the importance of SMBG, meal-time regularity, extra-snacks and folk remedies in the education of patients with type 2 diabetes mellitus.

Perceived barriers to Dietary Practice Adherence Among Persons with Diabetes.: O Keum Song, Hong Woo Nam, Do Ho Moon, Kyung Ho Lim, Hyun Kyung Moon, Eul Sang Kim; Korean Diabetes J. 1998;22(3):381-391. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Diet therapy is viewed as a cornerstone of diabetes care and emphasized to all the type of diabetes. The diet has been identified by many patients as one of the most difficult part of managing their diabetes. They may have several factors to influence adherence to a dict. The purpose of this study was to identify dietary practice adherence and perceived barriers(intrinsic and extrinsic factors) among the persons with diabetes at Diabetes Clinic in Nationwide.. METHODS: The survey questionnaire was mailed to 852 persons with diabetes member via diabetes educators of 156 hospitals, clinics and 24 health centers. Questionnaire divided into 3 part;(1)background information (2)meal regularity and food intake as a dietary practice adherence (3)40 items with motive/ attitude as a intrinsic factor and knowledge, resources/authority as a extrinsic factor was rated by the thoughts and feelings associated with barriers to dietary practice adherence. 432 questionnaires were returned. The response rate was 51%. RESULTS: Meal regularty was more satisfactory than food intake. Deficit of meal regularity was reasonable spacing between meal and snack' due to "grazing", "weak will", "hunger feeling". Deficit of food Intake was protein food in 3 meal a day' 43% less recommendation due to I wouldnt disturb anyone so I used to eat something available", fear of hyperglycemia, bother to prepare food. Conclusions: The respondents to this questionnaire were members of Diabetes Clinics. They perceived that motive/attitude(intrinsic factors) was as the major barriers while authority/resources(extrinsic factors) was as a minor barriers to the dietary practice adherence. Tliese results suggest that dietary strategies may need to be developed cognitive-behavioral aspect and problem-solving skills for alteration in 'Real-life' diabetic situation to dietary practice adherence.

Effect of Exercise Training on Insulin Sensitivity and Intracellular Glucose Metabolism in Skeletal Muscle of High Fat-fed Rats.: Chul Hee Kim, Joong Yeol Park, Sung Kwan Hong, Kyong Soo Park, Hong Kyu Lee, Ki Up Lee; Korean Diabetes J. 1998;22(2):231-242. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Insulin resistance is a major characteristic of non-insulin-dependent diabetes mellitus and obesity. Many studies have indicated that increased intake of fat are associated with obesity and insulin resistance. On the other hand, chronic exercise is known to improve insulin sensitivity. However, the mechanisms by which high fat diet induces insulin resistance and exercise trainmg improves insulin sensitivity are not established. This study was undertaken to examine the mechanisms by which high fat diet and exercise training affect the insulin sensitivity in the whole body and in skeletal muscles. METHODS: Male Sprague-Dawley rats were divided into three groups: high fat sedentary group, high fat exercise group, and control(low fat sedentary) group. High fat diet consists of 66.5% fat and 12.5% carbohydrate, and control(low fat) diet consists of 12 5% fat and 66.5% carbohydrate. Exercise training was performed by swimming three hours per day. After 3 weeks, animals underwent hyperinsulinemic euglycemic clamp study to measure whole body glucose metabolic fluxes. Glycogen synthase activity and glucose-6-phosphate (G-6-P) levels were measured in skeletal muscle at the end of the clamp study. RESULTS: In the high fat diet group, whole body glycolysis and glycogen synthesis were decreased. Exercise training reversed the insulin resistance induced by high fat diet by increasing both glycolysis and glycogen synthesis. Glycogen synthase activity in skeletal muscle was reduced in high fat diet group, and it was partially reversed by exercise training. G-6-P level in skeletal muscle was increased in high fat diet group, and it was further increased by exercise training. CONCLUSION: These results suggested that the insulin resistance in high fat diet-fed rats is due to the impairment in glucose metabolism at sites distal to G-6-P, i.e. glycolysis and glycogen synthesis. In contrast, the improvement in insulin sensitivity by exercise training in high fat-fed rats is primarily due to the increased glucose metabolic flux proximal to G-6-P, i.e. glucose transport and phosphorylation.

Effect of Dietary Polyunsaturated / Saturated Fatty Acid on Membrane Lipid Peroxidation of Red Blood Cells and Hepatic Intracellular Organelles in Streptozotocin Induced Diabetec Rats.: Hyung Joon Yoo; Korean Diabetes J. 1997;21(3):271-279. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Lipid peroxidation in tissues and in tissue fractions is a degradative free-radical process that primarily involves polyunsaturated fatty acids; it has been implicated as a major contribution to many types of tissue damage, especially in diabetes mellitus. This study was designed to investigate the effect of P/S dietary composition on the lipid peroxidation of biomembranes in streptozotocin-induced diabetic rats. METHODS: Diabetic Sprague Dawley rats weighing about 200g were randomly divided into 3 groups: Group L(n=8) fed with P/S ratio 0.4, Group M(n=8) fed with P/S ratio 1.2, and Group H(n=8) fed with P/S ratio 2.0. Diabetes was induced by daily intraperitoneal injection of streptozotocin(20mg/kg) for 5 days. After feeding for 6 weeks, plasma cholesterol, HDL-cholesterol, RBC membrane peroxidation and hepatic mitochondrial lipid peroxidation were measured. RESULTS: Total cholesterol(mmol/L) was decreased and HDL-cholesterol/total cholesterol % ratio was increased by increment of P/S ratio in a doseindependent manner(L 3.4+/-0.32 and 8.7; M 2.5+/- 0.29 and 12.6; H 2.5+/-0.29 and 12.3). RBC membrane lipid peroxidation(nmol/mI. packed RBC) was higher in H(3.21+/-0.20) than that in L(2.02+/-0.19) or M(2.40+/-0.21) (p<0.05). Hepatic mitoehondrial lipid peroxidation (nmol/g protein) was lower in L(7.5+/- 1.25) than that in M(11.7+1.57) or H(14.0+2.04) (p<0,05). CONCLUSION: P/S dietary increment increased the lipid peroxidation of biomembranes(RBC membrane an4 hepatic mitochondrial membrane) in streptozotocin-induced diabetic rats.

Mechanism of Insulin Resistance : Time Dependence of the Development of Insulin Resistance in High Fat Fed Rats.: Kyong Soo Park, Ki Up Lee, Sung Woo Park, Hong Kyu Lee, Hun Ki Min; Korean Diabetes J. 1997;21(2):168-175. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Increased FFA availability is known to induce insulin resistance by decrease in peripheral glucose utilization and increase in hepatic glucose procluction. However, there are conflicting results about the time dependence of the developrnent of insulin resistance with increased availability of FFA. METHODS: To elucidate the time dependence of the development of insulin resistance associated with increased availability of FFA, peripheral glucose utilization rate and hepatic glucose production rate were measured by euglycemic hyperinsulinemic clamp with 3-3H glucose infusion in rats fed high fat diet (1 week or 3 weeks) or control diet(ordinary chow diet). RESULTS: Basal plasrna FFA levels and steady state plasma insulin levels increased after high fat diet. After 1 week of high fat diet, suppressibility of hepatic glucose production rate by insulin was impaired(p<0.05 vs control). Insulin sensitivity index(glucose utilization rates/steady state plasma insulin concentrmtions X100) was decreased only after 3 weeks of high fat diet(p<0.05 vs control) which was accompanied by decreased glycogen synthase activity. CONCLUSION: High fat diet induces hepatic insulin resistance before peripheral insulin resistance and decreased glycogen synthase activity may contribute to the development of peripheral insulin resistance in rats fed high fat diet.

Effects of High Fat Diet on Lipolysis in Skeletal Muscle and Adipose Tissue in Rats.: Chul Hee Kim, Yun Ey Chung, Seong Jin Lee, Joong Yeol Park, Sung Kwan Hong, Hong Kyu Kim, Kyo Il Suh, Ki Up Lee; Korean Diabetes J. 2000;24(6):641-651. Published online January 1, 2001

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Abstract PDF: BACKGROUND
It has been hypothesized that increased fat oxidation reduces glucose utilization in skeletal muscle, and is responsible for the insulin resistance associated with obesity or high-fat feeding. In contrast, there have been reports that fat oxidation capacity was decreased in skeletal muscles from insulin resistant subjects. This study was undertaken to examine whether insulin resistance in high- fat fed rats is associated with increased lipolysis in skeletal muscle and adipose tissue. METHODS: Two groups of Sprague-Dawley rats were fed either high-fat or low-fat diets for 4 weeks. Lipolysis in skeletal muscle and adipose tissue was determined by measurement of interstitial glycerol concentrations by a microdialysis method in basal and hyperinsulinemic-euglycemic clamp conditions. RESULTS: In basal state, plasma glycerol levels and interstitial glycerol concen trations of skeletal muscle, and adipose tissue were lower in high-fat fed than in low-fat fed rats. The degree of suppression of glycerol release by the hyperinsulinemia was smaller in the high-fat diet than in the low-fat diet group. However, plasma and interstitial glycerol concentrations during the hyperinsul inemic euglycemic clamps were also lower in the high-fat diet group. CONCLUSION: Lipolysis was decreased in skeletal muscle and adipose tissue of insulin resistant, high-fat fed rats. These results support the idea that limited fat oxidation capacity resulting in lipid accumulation in tissues, rather than increased fat oxida tion per se, is responsible for the insulin resistance associated with high-fat feeding.

The Effect of Increased Beta Cell Mass on Glucose Tolerance in Rat.: Eun Sook Oh, Kun Ho Yoon, Sun Hee Seo, Sook Young Lee, Seung Hyun Ko, Won Young Lee, Sung Rae Kim, Moo Il Kang, Bong Yon Cha, Kwang Woo Lee, Ho Young Son, Sung Goo Kang; Korean Diabetes J. 2000;24(6):629-640. Published online January 1, 2001

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Abstract PDF: BACKGROUND
The aim of the present study is to evaluate the effect of increased beta cell mass by continuous 96-hour 50% glucose infusion on glucose tolerance in insulin resistance state induced by high fat diet in normal Sprague-Dawley rats. METHODS: The adult Sprague-Dawley rats weighing 200-250 gm were infused with 50% glucose or 0.45% saline via external jugular vein catheter for 96 hours. The both groups of rats were then randomly stratified into the two subgroups, and fed either high fat diet (54% of energy from fat) or normal rat chow (8.6% of energy from fat) for 4 weeks. On day 28, blood was collected for measuring the serum concentration of insulin, and oral glucose tolerance test (2 gm/kg body weight) was performed after overnight fasting. The beta cell mass was counted with the morphometric point-counting technique of Weibel. RESULTS: After the 96 hour infusion, the percentage of beta cell mass was significantly increased in glucose-infused rats when compared to the saline-infused group (p=0.03) and maintained up to day 28. Body weight gains were significantly greater in glucose infused rats than those of saline infused group (Increased value of weight : 142.9+/-15.2 g in glucose infused rats vs 125.3+/-21.1 g in saline infused rats, p=0.01). In the saline infusion-high fat diet group, the number of rats with impaired glucose tolerance was higher than those of other group (p<0.005). The glucose values at 90 minute and 120 minute were higher in saline infusion-high fat diet group than in glucose infusion-high fat diet group (p< 0.05). CONCLUSION: Our findings suggest that the increased beta cell mass has a favorable effect on glucose tolerance in insulin resistance state which were evoked by high fat diet.

Randomized Controlled Trial

The Effects of Teaching Methods on the Dietary Compliance and Hemoglobin A1c Level in Patients with Diabetes Mellitus.: Sung Oh Chung, O Keum Song, Jae Min Ko, Jun Hwan Wi, Tae Hoon Lee, Ju Hyup Yum, Dae Kyoung Cho, Jin Hee Son, Hong Woo Nam, Hyung Joon Yoo, Young Nam Lee, Sung Gon Kim, Hyun Kyung Moon, Eul Sang Kim; Korean Diabetes J. 2000;24(5):560-573. Published online January 1, 2001

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Abstract: BACKGROUND
Diet control plays an important role in diabetic management, but it is often hard for diabetic patients to follow the dietary control program. Poor dietary compliance leads to metabolic derangements in patients with diabetes and it may derive mainly from defects in dietary education program rather than from patients themselves. Therefore, we performed a randomized prospective study to compare the effects of three different teaching methods for diet control. METHODS: Forty eight diabetic patients with poor glycemic control (mean HbA1c 11.4+/-1.5%) were enrolled during hospitalization and allocated at random to three different teaching methods i.e. Conventional diet sheet instruction (Group 1), Food recording on every meal (Group 2), and Meal time demonstration (Group 3). For evaluation, knowledge about DM diet and barriers to diet control were assessed by a questionnaire. Consistency in carbohydrate intake (Coefficient of variation) and serial HbA1C measurements were used for the estimation of dietary compliance and glycemic control respectively. RESULTS: During five months' follow-up period, there was no remarkable improvement in knowledge about diabetic diet control, dietary compliance and glycemic control in Group 1 patients. But both dietary compliance and glycemic control improved in Group 2 and 3 patients during follow-up period. In Group 2 CV (Coefficient of Variation ) fell from 36.4+/-15.2% to 27.7+/-17.3% and in Group 3 from 32.1+/-9.6% to 23.2+/-10.5% (p<0.05). In Group 2 HbA1c fell from 12+/-2.2% to 8.3 +/-2.0% and in Group 3 from 11.5+/-2.0% to 7.5+/-1.9% (p<0.01). The change of HbA1c level showed an appreciable correlation with dietary compliance (r= 0.75). Among the perceived barriers to dietary practice in patients of Group 2 and Group 3, extrinsic factors related to knowledge lowered during the intervention (p<0.05). Even though Group 3 patients had good dietary compliance, they still felt that intrinsic factors related to motive and attitude were the major barriers at the end of the study (p<0.05). CONCLUSION: We found that meal time demonstration teaching method may improve dietary compliance and glycemic control compared with the conven tional diet sheet instruction method.

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