Diabetes & Metabolism Journal

Original Articles

Complications
Color Doppler Ultrasonography Is a Useful Tool for Diagnosis of Peripheral Artery Disease in Type 2 Diabetes Mellitus Patients with Ankle-Brachial Index 0.91 to 1.40: Kyu Yeon Hur, Ji Eun Jun, Young Ju Choi, Yong-ho Lee, Dae Jung Kim, Seok Won Park, Byung Wook Huh, Eun Jig Lee, Sun-Ha Jee, Kap Bum Huh, Sung Hee Choi; Diabetes Metab J. 2018;42(1):63-73. Published online February 23, 2018; DOI: https://doi.org/10.4093/dmj.2018.42.1.63

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Background

The clinical utility of ankle-brachial index (ABI) is not clear in subjects with less severe or calcified vessel. Therefore, we investigated the usefulness of color Doppler ultrasonography for diagnosing peripheral artery disease (PAD) in type 2 diabetes mellitus (T2DM) subjects.

Methods

We analyzed 324 T2DM patients who concurrently underwent ABI and carotid intima-media thickness (CIMT) measurements and color Doppler ultrasonography from 2003 to 2006. The degree of stenosis in patients with PAD was determined according to Jager's criteria, and PAD was defined as grade III (50% to 99% stenosis) or IV stenosis (100% stenosis) by color Doppler ultrasonography. Logistic regression analysis and receiver operating characteristic curve analysis were performed to evaluate the risk factors for PAD in patients with ABI 0.91 to 1.40.

Results

Among the 324 patients, 77 (23.8%) had ABI 0.91 to 1.40 but were diagnosed with PAD. Color Doppler ultrasonography demonstrated that suprapopliteal arterial stenosis, bilateral lesions, and multivessel involvement were less common in PAD patients with ABI 0.91 to 1.40 than in those with ABI ≤0.90. A multivariate logistic regression analysis demonstrated that older age, current smoking status, presence of leg symptoms, and high CIMT were significantly associated with the presence of PAD in patients with ABI 0.91 to 1.40 after adjusting for conventional risk factors. CIMT showed significant power in predicting the presence of PAD in patients with ABI 0.91 to 1.40.

Conclusion

Color Doppler ultrasonography is a useful tool for the detection of PAD in T2DM patients with ABI 0.91 to 1.40 but a high CIMT.

Citations

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The Correlation Between Visceral Fat Distance Measured by Ultrasonography and Visceral Fat Amount by Computed Tomography in Type 2 Diabetes.: Eui Dal Jung, Duck Soo Chung, Ji Yun Lee; Korean Diabetes J. 2008;32(5):418-427. Published online October 1, 2008; DOI: https://doi.org/10.4093/kdj.2008.32.5.418

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Abstract PDF

BACKGROUND
Visceral adipose tissue accumulation highly correlates with metabolic abnormalities and cardiovascular disease. Computed tomography (CT) is considered to be the standard method for visceral fat evaluation, but it is not used as a routine procedure. Ultrasonography (US) is a safe method, fairly inexpensive and widely available modality for measuring abdominal fat thickness. The aim of this study was to investigate the correlation between the intra-abdominal fat distance by US measurement and the visceral fat amount by CT and cardiovascular risk factors and to evaluate whether the intra-abdominal fat distance is better correlate with visceral fat amount by CT than other anthropometric parameters and to assess the cut-off value of intra-abdominal fat distance for visceral obesity in type 2 diabetic patients. METHODS: We obtained abdominal subcutaneous and intra-abdominal fat distance by using a high-resolution US (HDI 5000, ATL, Phillps, USA) at 1 cm above umbilical level in one hundred twenty-eight type 2 diabetic patients. CT scan (Light Speed plus, GE, USA) for the measurement of subcutaneous and intra-abdominal visceral fat area was also performed in the supine position at the L4-5 level. Lean body mass and % body fat were measured in a bioimpedance using DSM (Direct Segmental Measurement by 8-point electrode) method (InBody 3.0, Biospace, Seoul, Korea). We measured patient's height, weight, BMI (Body mass index), waist circumference, WHR(Waist-hip ratio) and blood pressure and also measured fasting blood glucose, HbA1c and lipid profiles. RESULTS: Abdominal subcutaneous and visceral fat distance measured by US is 2.05 +/- 0.52 cm, 4.43 +/- 1.54 cm, respectively. In pearson's correlations, visceral fat distance were correlated with BMI (r = 0.681, P < 0.001), waist circumference (r = 0.661, P < 0.001), WHR (r = 0.571, P < 0.001), triglyceride (r = 0.316, P < 0.001), HDL-cholesterol (r = -0.207, P < 0.004). US-determined visceral fat distance was also correlated with visceral fat amount by CT (r = 0.674, P < 0.001) and BMI (r = 0.610, P < 0.001), waist circumference (r = 0.626, P < 0.001), WHR (r = 0.557, P < 0.001). When we used waist circumference (men: 90 cm, women: 85 cm) as parameters for visceral obesity, the cutoff value of visceral fat distance, obtained by the receiver operating characteristic curve analysis, were 4.670 cm in men, 3.695 cm in women diabetic patients. CONCLUSION: Intra-abdominal fat distance measured by US reveals strongly correlated with visceral fat area, which is determined by CT and also well correlated with anthropometric parameters and lipid profiles. We suggest that US provided a better index compared to anthropometry for the prediction of visceral obesity and could be an alternative method for CT for visceral fat determination in diabetic patients.

Citations

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Aspects of transthoracic echocardiography protocol in obese patients
O. N. Dzhioeva, O. A. Maksimova, E. A. Rogozhkina, O. M. Drapkina
Russian Journal of Cardiology.2023; 27(12): 5243. CrossRef
Ultrasound-assisted assessment of visceral and subcutaneous adipose tissue thickness. Methodological guidelines
O. M. Drapkina, R. K. Angarsky, E. A. Rogozhkina, O. A. Maksimova, A. A. Ivanova, E. V. Zyatenkova, O. N. Dzhioeva
Cardiovascular Therapy and Prevention.2023; 22(3): 3552. CrossRef
The Correlations between Extremity Circumferences with Total and Regional Amounts of Skeletal Muscle and Muscle Strength in Obese Women with Type 2 Diabetes
Hwi Ryun Kwon, Kyung Ah Han, Hee Jung Ahn, Jae Hyuk Lee, Gang Seo Park, Kyung Wan Min
Diabetes & Metabolism Journal.2011; 35(4): 374. 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 Relationship between Visceral & Subcutaneous Fat and Small Dense Low Density Lipoprotein Cholesterol Concentration in Type 2 Diabetic Patients.: Wan Sub Shim, Soo Kyung Kim, Hae Jin Kim, Eun Seok Kang, Chul Woo Ahn, Sung Kil Lim, Hyun Chul Lee, Bong Soo Cha; Korean Diabetes J. 2006;30(3):207-216. Published online May 1, 2006; DOI: https://doi.org/10.4093/jkda.2006.30.3.207

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Abstract PDF: BACKGROUND
Visceral obesity is closely associated with cardiovascular disease (CVD). Small dense (sd) LDL is closely associated with CVD. The aim of this study was to evaluate the relationship between visceral and subcutaneous fat accumulation and sd LDL-C concentration. METHODS: 264 type 2 diabetic patients underwent ultrasonography to estimate visceral & subcutaneous fat accumulation and sd LDL-C concentrations were measured. RESULTS: BMI, total cholesterol, sd LDL-C concentration and percentage of sd LDL-C were higher in highest tertile of visceral fat length in male than those in lowest tertile. BMI, total cholesterol, triglyceride, LDL-C, sd LDL-C concentration and percentage of sd LDL-C were higher in highest tertile of visceral fat length in female than those in lowest tertile. But sd LDL-C concentration and percentage of sd LDL-C were not different among three groups based on the tertile of subcutaneous fat length in male and female. Visceral fat length was correlated with sd LDL-C concentration and percentage of sd LDL-C, total cholesterol, triglyceride, LDL-C, but negatively with percentage of large buoyant LDL-C and HDL-C after adjustment of age, sex and BMI. Subcutaneous fat length was not correlated with sd LDL-C and percentage of sd LDL-C, total cholesterol, triglyceride, HDL-C and LDL-C. CONCLUSION: The association between visceral fat length and sd LDL-C could be a factor that explains the association between visceral obesity and CVD.

The Correlation Between Femoral Artery Intima-Media Thickness (IMT) and Atherosclerotic Risk Factors in Type 2 Diabetes Mellitus Patients.: Ji Hyun Lee, Ho Sang Shon, Duck Soo Chung; Korean Diabetes J. 2003;27(6):467-475. Published online December 1, 2003

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Abstract PDF: BACKGROUND
High resolution B-Mode ultrasound is increasingly used in epidemiological and clinical research to noninvasively study the atherosclerotic process in the carotid artery. An increase in the intimamedia thickness (IMT) of the carotid artery has previously been reported in patients with diabetes, compared with a control group, and is related to atherosclerotic risk factors. There have been few reports on the relationship between the IMT of the femoral artery, another large artery, and atherosclerotic risk factors in diabetic patients. The aim of the present investigation was to evaluate the relationship between the femoral artery IMT and the atherosclerotic risk factors in type 2 diabetics, and to assess if such a measurement might provide further information on the extent of the atherosclerotic disease in these patients. METHODS: The carotid and femoral IMT were measured using high resolution B-mode ultrasonography in 55 type 2 diabetes patients and 25 age- and sex-matched control subjects. The femoral artery was examined distal to the inguinal ligament, at the site the artery divides into the superficial femoral and the profound femoral arteries. At the same time, patient's characteristics, including height, weight, body mass index, blood pressure, duration of diabetes and histories of hypertension and smoking, were analyzed. Examinations of the laboratory parameters, such as serum glucose, HbA1C, lipid profile, blood urea nitrogen and serum creatinine, were included in this study. RESULTS: The carotid and femoral IMT values were significantly increased in the type 2 diabetes patients compared with the control subjects. There was a significant relationship between the IMT values of the two arteries in the diabetic patients (r=0.419, p< 0.001). In a simple regression analysis, age (r=0.534, p=0.001), systolic blood pressure (r=0.499, p=0.001), diastolic blood pressure (r=0.350, p=0.003), high density lipoprotein cholesterol (r=-0.262, p=0.037) and the serum creatinine level (r=0.280, p=0.020) were statistically significant for the femoral artery IMT value. In a multiple regression analysis, age, smoking and systolic blood pressure were statistically significant for the femoral artery IMT values in diabetic patients (R2=0.379). CONCLUSION: The femoral IMT values were significantly increased in the type 2 diabetes patients. Increases in the IMT of the femoral artery are affected by the atherosclerotic risk factors; age, smoking and blood pressure. Therefore, it is suggest that measurement of the femoral IMT, using high resolution B-mode ultrasonography, is also a useful method for the detection of macrovascular complications in type 2 diabetes patients.

The Comparison between Doppler Ultrasonography and Digital Infrared Thermographic Imaging (DITI) in Detecting the Diabetic Peripheral Angiopathy.: Yoon Sang Choi, Hyun Ju Um, Seung Oh Song, Si Yong Kim, Byong Ik Kim, Young Uk Lee, Seok Won Park, Yoo Lee Kim, Hwa Young Lee, Yong Wook Cho, Sang Jong Lee; Korean Diabetes J. 1999;23(5):686-694. Published online January 1, 2001

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Abstract PDF: BACKGROUND
The frequency of nontraumatic lower extremities amputation has significantly increased in patients with type 2 diabetes (DM). Digital Infrared Thermographic (DITI) has been used to demonstrate the skin temperature and its change. mellitus Imaging regional Doppler ultrasonography was developed to show excellent images of superficial arteries. In this study, we observed the relationship between DITI and doppler ultrasonography for detection or evaluation of diabetic peripheral angiopathy. METHODS: 71 patients with type 2 DM were divided to groups with and without peripheral arterial obliteration (PAO) by ankle pressure index (API). For all patients, doppler ultrasonography of lower extremities was performed in measuring inner diameter, wall thickness and calcification of femoral, popliteal and dorsalis pedis artery. DITI was done also. We analized the result of doppler ultrasono-graphy and DITI findings. RESULT: 1) In clinical characteristics of patients between nonperipheral arterial obliteration (NPAO) and PAO : there was no significant differences between two groups with respect to age, sex, smoking, BMI (body mass index), FPG (fasting plasma glucose)/2HPG (2 hour plasma glucose), HbA(1C), serum lipid profile and/or the frequency of NPDR (nonproliferative diabetic retinopathy). However, the number of patients with hypertension and 24hr urine total protein amount were significantly increased in PAO group. 2) The results of doppler ultrasonographic imaging of lower extremities: In PAO group, inner diameters of common femoral artery and dorsalis pedis artery were significantly narrower than in those of NPAO group. However, no difference was detected in respect to vessel wall thickness. The numbers of calcified vessel wall have significantly increased in all vessels in PAO group 3) The results of DITI patterns of big toes after cold stimulus: (1) In 49 patients with NPAO: 11 showed as normal, 14 an increased, 15 a decreased, and 9 flat patterns, respectively. (2) All of 22 patients with PAO showed abnormal patterns. Among them, 2 showed a decreased, but 20 a flat pattern. 4) The comparison between the results of doppler ultrasonography and DITI: In all groups, inner diameter of common femoral artery, which was measured by doppler ultrasonography, were narrow in the flat pattern. Also, the number of calcified vessel walls in common femoral artery and dorsalis pedis artery increased more in the same patterns. No significant difference of vessel wall thickness was found between both groups. CONCLUSION : Vasoreaction of lower extremities after cold stimulus was mainly related to PAO of the common femoral artery and dorsalis pedis artery. DITI is a useful method used in detecting the early state of artherosclerosis. As a result, it can be employed in early prevention and treatment of diabetic angiopathy. If DITI is combined with doppler ultrasonography, we can practice more precise diagnosis and follow-up in diabetic peripheral angiopathy.

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