Diabetes & Metabolism Journal

Original Articles

Cardiovascular Risk/Epidemiology
Prognostic Value of Plasma Endothelin-1 in Predicting Worse Outcomes in Patients with Prediabetes and Diabetes and Stable Coronary Artery Diseases: Cheng Yang, Cheng-Gang Zhu, Yuan-Lin Guo, Na-Qiong Wu, Qian Dong, Rui-Xia Xu, Yong-Jian Wu, Jie Qian, Jian-Jun Li; Received November 12, 2023 Accepted April 24, 2024 Published online August 21, 2024; DOI: https://doi.org/10.4093/dmj.2023.0410 [Epub ahead of print]

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Abstract PDF Supplementary Material PubReader ePub: Background
Endothelin-1 (ET-1) is an endogenous vasoconstrictor implicated in coronary artery disease (CAD) and diabetes. This study aimed to determine the prognostic value of ET-1 in the patients with stable CAD under different glucose metabolism states.
Methods
In this prospective, large-cohort study, we consecutively enrolled 7,947 participants with angiography-diagnosed stable CAD from April 2011 to April 2017. Patients were categorized by baseline glycemic status into three groups (normoglycemia, prediabetes, and diabetes) and further divided into nine groups by circulating ET-1 levels. Patients were followed for the occurrence of cardiovascular events (CVEs), including nonfatal myocardial infarction, stroke, and cardiovascular mortality.
Results
Of the 7,947 subjects, 3,352, 1,653, and 2,942 had normoglycemia, prediabetes, and diabetes, respectively. Over a median follow-up of 37.5 months, 381 (5.1%) CVEs occurred. The risk for CVEs was significantly higher in patients with elevated ET-1 levels after adjustment for potential confounders. When patients were categorized by both status of glucose metabolism and plasma ET-1 levels, the high ET-1 levels were associated with higher risk of CVEs in prediabetes (adjusted hazard ratio [HR], 2.089; 95% confidence interval [CI], 1.151 to 3.793) and diabetes (adjusted HR, 2.729; 95% CI, 1.623 to 4.588; both P<0.05).
Conclusion
The present study indicated that baseline plasma ET-1 levels were associated with the prognosis in prediabetic and diabetic patients with stable CAD, suggesting that ET-1 may be a valuable predictor in CAD patients with impaired glucose metabolism.

A Study on the Patterns of Clinical Characteristics according to Body Weight and Weight Changes in Korean NIDDM Patients.: Young Sun Hong, Hee Jin Kim, Yeon Ah Sung, Nan Ho Kyung; Korean Diabetes J. 1997;21(1):65-73. Published online January 1, 2001

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Abstract PDF: BACKGROUND
It is known that Korean NIDDM patients are mainly non-obese and have experienced weight loss frequently during the course of the disease. However, there have been few studies about the patterns of treatment and complications according to the weight changes, Our purpose was to determine the characreristics of diabetes in Korea by examining the differences in the clinical features according to the current weight and the weight changes. METHODS: From 308 Korean NIDDM patients. We obtained the data about the weight at the time of maximal obesity and diagnosis of diabetes and measured the current weight and height. We also evaluared the presence of diabetic retinopathy, nephropathy and neuropathy, We designated the patients with BMI 21kg/m and less as the lean group, the patients with BMI 21 to <26kg/m as the middle-range group and the patients with 26kg/m and over as the obese group. RESULTS: At the time of maximal weight, 61.4% of the patients were obese, but 40.3% were obese at diagnosis and only 33.8% were obese at recruitment. In the lean group, C-peptide was low and the frequency of insulin therapy was high. Although there was no statistical significance, diabetic complications were more frequent in the lean group. The percentage of the patients who lost weight (loss of 10% trom the maximal weight) was 65.9% in the lean group, 42.3% in the middle-range group and 32.7% in the obese group. The prevalence of retinopathy and neuropathy were higher in the group with weight loss, although not significantly. CONCLUSION: Of 308 NIDDM patients, 42.2% experienced weight loss before and after the diagnosis and only 33.8% were obese at recruitment. In the lean group, insulin secretory capacity was low and the frequency of insulin therapy was high. Our study showed that the lean group and the patients who have lost weight tended to have higher prevalence of the complications. The mass prospective study about the clinical characteristics according to weight changes in Korean NIDDM patients would be needed.

Plasma Endothelin in Patients with Non-Insulin Dependent Diabetes Mellitus: Plasma Endothelin according to Insulin.: Jae Ook Lee, Sung Ook Choo, Jang Gyu Lee, Mu Ryen Jun, Gyeng Hyen Park, Jun Tack Joo, Jin Kwan Lee; Korean Diabetes J. 1997;21(1):49-55. Published online January 1, 2001

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Abstract PDF: BACKGROUND
As a potent vasoconstrictor isolated from human and porcine vessels, endothelin(Et) is involved in the pathophysiology of various cardiovascular disease. Although the pathophysiological roles of Et in the patient of diabetes needs further investigation, many reports have shown the increased level of Et in the patient of diabetes. Insulin has also been found to play a role in the elevation of Et in vivo and expenmental study. The aim of our study v as not only to estimate the level of Et-1 in the patient of NIDDM and normal subjects but also compare it to the level of plasma insulin, C-peptide and complications of NIDDM. METHODS: Plasma Et-1 levels were measured in 49 patients of NIDDM and 26 normal subjects. All patients of diabetes were divided into 3 groups: group I(patients with no previous treatment), group II (patients with oral hypoglycemic agent), and group lII(patients with insulin therapy). Nerve conduction velocity and ophtha]moscopic examination was done in all pertinent patients, Plasma Et was determined by RIA after extraction with an Prep Sep-Pac C-18 cartilidge. RESULTS: Plasma Et-1 level of the patient of each group and control subject was shown in Table 1. Plasma Et-1 level of the patient of NIDDM was 3.65 +2.05pmol/mL, which was not statistically different from that of control group(2.80+2.07, p=0.105). No significant correlation of plasma Et level with HbAlc, duration of diabetes, triglyceride and cholesterol in the patient of NIDDM was observed(p>0.05). There was not any significant correlation between plasma Et level and complications of diabetes. Such as angiopathy, microalbuminuria and neuropathy. Even through the insulin and Et level seems to he elevated in group III but it is statistically not significant(p>0.05). CONCLUSIONS: Our study suggests that the patient of NIDDM and normal subject statistically show no difference in the level ot Et although there appear slightly high value in the patient group. Any positive correlation is not found between the Et level and those factors such as angiopathy, microalbuminuria and neuropathy. In conclusion futher investigation is needed to clarify the role of Et in the patient of NIDDM.

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