Diabetes & Metabolism Journal

Original Articles

Intima-media Thickness of the Common Carotid Artery and Carotid Atherosclerotic Plaques as Predictors for Occurrence of Clinical Macrovascular Complication in Type 2 Diabetes.: Byoung Hyun Park, Chung Gu Cho; Korean Diabetes J. 2000;24(5):603-613. Published online January 1, 2001

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Abstract: BACKGROUND
This study was undertaken to investigate that intima-media thickness and plaque of the carotid artery, as measured by high resolution B-mode ultrasonography, can be used as predictors for occurrence of clinical macrovascular complication in type 2 diabetes patients. METHODS: High resolution B-mode ultrasonographic examination was performed in 39 type 2 diabetes, including 16 diabetes with macrovascular complication, and in 18 non-diabetic control subjects. Concurrently serum total cholesterol, HDL cholesterol, triglyceride, lipoprotein (a), HbA1c, C-peptide levels and body mass index (BMI) were measured and history of hypertension, smoking, duration of diabetes and occurrence of macrovascular complication during the last 6 months were investigated. RESULTS: 1) Significant differences in common carotid IMT (0.72+/-0.08 mm, vs 0.93+/- 0.26 mm), existence of atherosclerotic plaque (50%, vs 69%), plaque number (0.5+/- 0.86, vs 0.69+/-2.37) and carotid stenosis (0%, vs 18%) were found between control and type 2 diabetes (p<0.05). 2) Significant differences in age (67.63+/-4.30, vs 60.6+/-12.0), lipoprotein (a) (63.65+/- 32.2 mg/dL, vs 35.22+/-34.74 mg/dL), common carotid IMT (1.08+/-0.27 mm, vs 0.82+/- 0.20 mm), existence of atherosclerotic plaque (87.5%, vs 56.5%), plaque number (2.88+/-3.16, vs 0.91+/-1.02), end diastolic ventricular septal thickness (10.82+/-1.88 mm, vs 8.76+/-2.92 mm) and end diastolic left ventricular posterior wall thickness (10.79+/-1.60 mm, vs 9.1+/-2.56 mm) were found between type 2 diabetes patients with macrovascular complication and without macrovascular complication (p<0.05). 3) Age (r=0.363, p=0.023), hypertension (r=0.32, p=0.047), carotid plaque existence (r=0.377, p=0.018) and plaque number (r=0.662, p=0.000) showed a correlation with the IMT in type 2 diabetes. 4) Most common involving site of atherosclerotic plaques was carotid bulb and more extensive involvement was showed in type 2 diabetes with macrovascular complication than without macrovascular complication. 5) The sensitivity of common carotid IMT (> control mean IMT + 2 SD; >1.22 mm) for prediction of macrovascular complication in type 2 diabetes patients was 25%, the specificity 95.7%, the positive predictive value 80%, the negative predictive value 61.8%. 6) The sensitivity of existence of carotid plaque for prediction of macrovascular complication in type 2 diabetes patients was 87.5%, the specificity 60.9%, the positive predictive value 60.9%, the negative predictive value 87.5%. CONCLUSION: Increases in IMT and plaque of the carotid artery, as measured by high resolution B-mode ultrasonography, can be used as predictors for occurrence of clinical macrovascular complication in type 2 diabetes patients.

Fetal Hyperinsulinemia and Ultrasonographic Measurement of Fetal Growth in Pregnancy Complicated by Gestational Diabetes Mellitus.: In Kwon Han, Chang Hoon Yim, Ho Yeon Jeong, Hak Chul Chang, Ki Ok Han, Hyun Ku Yoon, Park Jeong Eun, Soo Young Lee, Young Ho Lee; Korean Diabetes J. 1999;23(4):506-517. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Recently we reported that the large for gestational age (LGA) fetus of women with gestational diabetes mellitus (GDM) had disproportionate growth characterized by larger abdominal circumference (AC) but similar biparietal diameter (BPD) at third trimester compared to the fetus of normal pregnant women. The AC of LGA fetus appeared to be accelerated after 33 weeks gestation, and measurement of AC could be an effective method for prediction of LGA. Thus this study was performed to find the relationship between fetal hyperinsulinemia and disproportionate growth and to find the highly sensitive index for prediction of LGA infant in GDM. METHODS: We prospectively studied ultrasono- graphic growth patterns at 30, 34, 38 gestational weeks in 20 women with GDM and 15 normal pregnant women. The ultrasonographic measurements of fetus included biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), mid-thigh circumference (MTC), mid-upper arm circumference (MUAC), mid-thigh subcutaneous fat thickness (MTFT), mid-upper arm subcutaneous fat thickness (MUAFT), fetal liver length (FLL), chest circumference (CC) and heart circumference (HTC). RESULTS: Compared to the fetus of normal pregnant women and appropriate for gestational age (AGA) fetus of GDM, LGA fetus of GDM had thicker MUAFT (3.9+0.9, 5.0+1.1, 5.6+1.7 mm, p=0.008) at 34 weeks, MUAFT (5.3+0.8, 5.6+0.9, 7.2+1.4 mm p=0.045) at 38 weeks and MTFT (5.2 +1.1, 5.5+0.8, 7.1+1.5 mm, p=0.019) at 38 weeks. They also had longer MUAC (120.3+9.9, 119.4+ 8.3, 138.7+11.2 mm, p=0.020) and CC(322.6+11.7, 324.4+15.7, 351.7+15.0mm, p=.025, respectively). There was a positive correlation between umbilical venous C-peptide concentration and birthweight (r=0.626, p=0.005) and symmetry index (r=0.523, p=0.03) of newborns. There was also a positive correlation between C-peptide concentration and MUAC (r=0.449, p=0.038) and MUAFT (r=0.426, p=0.045) in GDM group. CONCLUSION: The LGA fetus of women with GDM showed an accelerated growth of predominantly subcutaneous fat tissues that should be caused by the fetal hyperinsulinemia. Ultrasonographic measurement of subcutaneous tissues may be the most sensitive index for prediction of growth abnormalities in GDM at late gestation.

Prediction of Large for Gestational Age Infant in Women with Gestational Age Infant in Women with Gestational Diabetes Mellitus by Yltrasound Examination.: In Kwon Han, Hun Kee Min, Chang Hoon Yim, Ho Yeon Jeong, Hak Chul Chang, Ki Ok Han, Hyun Ku Yoon, Jeong Eun Park, Jae Eun Park, So Ra Park, Soo Young Lee, Young Ho Lee; Korean Diabetes J. 1999;23(3):326-335. Published online January 1, 2001

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Abstract PDF: BACKGROUND
In pregnancies complicated by diabetes, fetal hyperinsulinemia increases the deposition of fat, protein and glycogen in insulin-sensitive tissues leading to macrosomia, characterized by shoulder and truncal obesity. This may result in a shoulder dystocia, birth injury or fetal asphyxia. Thus, antenatal prediction of a large fetus for gestational age (LGA) can provide important information for the prevention of obstetric and perinatal complications. However, the measurement of materrml blood glucose concentration has yielded a low sensitivity for the prediction of LGA infants. This study was performed to determine whether fetal ultrasound examination could establish the onset of accelerated fetal growth in women with gestational diabetes mellitus (GDM) and to find the ultrasound indices for prediction of LGA infant. METHODS: The study subjects consisted of 77 women with GDM who had a singleton, and 156 women with a negative screen for GDM matched for age, height, and weight. All subjects had an early ultrasound examination before 14 weeks, assuring accurate dating and did not have any other medical condition that might affect fetal growth. Two ultrasound measurements including biparietal diameter (BPD), abdominal circumference (AC) and femur length (FL) were performed at the 2nd trimester (24.7+2.7 vs. 24.1+2.4 wks, p>0.05) and the 3rd trimester (35.0+1.9 vs. 35.3+1.3 wks,p>0.05, respectively). RESULTS: Although gestational age at delivery of GDM group was earlier than the control group (39.0 +1.4 vs. 39.7+1.1, p<0.01), birth weight and frequency of LGA infant were similar between two groups (3204+439 vs. 3288+371 g, p>0.05; 27.3% vs. 20.5%, p>0.05, respectively). However, the LGA subgroup of GDM had a larger AC and longer FL at the 3rd trimester compared to the appropriate gestational age (AGA) subgroup and control group. The AC of LGA subgroup of GDM appeared to be accelerated at 33 weeks gestation compared to the control group. When the upper limit of 95% confidential interval of AC of the control group was used for a cutoff value for predicting LGA in GDM at the 3rd trimester, sensitivity and specificity was 71% and 78%, respectively. CONCLUSION: The prediction of LGA infant in women with GDM might be achieved by an ultrasound examination of fetal AC at the 3rd trimester, especially after 33 weeks gestation.

Relationship between Carotid Artery Plaque Measured by Ultrasound and Cerebral infarction in Patients with Non-insulin Dependent Diabetes.: Kil Hong Rhee, Sang In Choi, Seung Ok Lee, Cheol Su Lim, Tae Sun Park, Hong Sun Baek; Korean Diabetes J. 1997;21(4):469-475. Published online January 1, 2001

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Abstract PDF: BACKGROUND
The frequency of cerebral infarction is significantly increased in diabetic patients. Early detection of artherosclerotic lesions will be a useful to predict and delay the occurence of cerebral infarction in diabetic patients. The purpose of this study was to investigate the relationship between extracranial carotid artery plaque and cerebral infarction in NIDDM patients, who have cerebral infarction or not, using non-invasive B-mode ultrasonography. METHODS: Ultrasound high resolution B-mode imaging of carotid arteries was conducted on cerebral infaretion patients with NIDDM and non cerebral infaretion patients with NIDDM to determine the presence of the carotid artery plaque. RESULTS: The incidence rate of cerebral infarction was increased in relation to extracranial carotid artery plaquie existence. The exeistence of carotid artery plaque was higher in NIDDM patients with cerebral infarction than without cerebral infarction(p<01050). Multiple logistic regression analysis showed that development of cerebral infarction in NIDDM patients, who had carotid plaque, was 2.8 fold higher than NIDDM patients who had not carotid plaque(p<0.05), Conclusions: Existence of carotid plaque was closely related to cerebral infarction. Therefore, early detection of extraeranial carotid plaque by B-mode ultrasonography is very useful in predicting cerebral mfarction in NIDDM patients.

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