Diabetes & Metabolism Journal

Original Article

Metabolic Risk/Epidemiology
Birth Weight, Adult Fat Distribution, and Type 2 Diabetes Mellitus Risk: Sex-Specific Study in a Large Prospective Cohort: Ding Ding, Xiaoyi Luo, Shuhao Chen, Zhilin Liu, Xiaojing Kuang, Tianrui Zhuang, Gaoli She, Hailan Huang, Xingfen Yang, Jie Li, Ran An; Received June 29, 2025 Accepted October 23, 2025 Published online January 29, 2026; DOI: https://doi.org/10.4093/dmj.2025.0569 [Epub ahead of print]

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Abstract PDF Supplementary Material PubReader ePub: Background
Regional fat distribution is a key determinant of metabolic risk, independent of total adiposity. However, the developmental origins of fat depot-specific accumulation and its contribution to type 2 diabetes mellitus (T2DM) remain unclear. We aimed to investigate whether adult fat distribution mediates the association between birth weight (BW) and T2DM risk.
Methods
We analyzed 30,718 diabetes-free UK Biobank participants with magnetic resonance imaging/dual-energy X-ray absorptiometry derived measures of visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue, and gynoid adipose tissue (GAT), liver fat fraction (LFF), pancreatic fat fraction (PFF), and muscle fat infiltration (MFI). Fat depots were adjusted for body mass index (BMI) using sex-specific residuals. Cox regression assessed associations of BW and fat depots with T2DM risk. Mediation analysis assessed indirect effects of fat distribution.
Results
Lower BW was associated with a higher risk of T2DM (hazard ratio per 1 kg increase, 0.71; 95% confidence interval, 0.64 to 0.79), with stronger effects in women. Lower BW was linked to greater VAT, LFF, and PFF, and lower GAT, independent of BMI. Higher levels of VAT, LFF, and PFF were associated with increased T2DM risk, while GAT was protective. Mediation analysis revealed that fat distribution partially mediated the BW-T2DM relationship, with LFF showing the strongest mediation effect (11%). Mediation patterns differed by sex: LFF and VAT were the predominant mediators in women, while LFF and GAT contributed substantially in men.
Conclusion
Fat distribution—particularly liver and visceral fat—partially mediates the BW-T2DM relationship, independent of BMI. These findings highlight the clinical importance of fat depot profiling in understanding the developmental origins of diabetes and guiding early risk stratification.

Review

Lifestyle and Behavioral Interventions
Management of Early-Onset Type 2 Diabetes in Adults: Current Evidence and Future Directions: Matthew J. Savage, Jonathan Goldney, Tommy Slater, Priscilla Sarkar, Jack A. Sargeant, Emma G. Wilmot, Melanie J. Davies; Diabetes Metab J. 2025;49(5):934-950. Published online September 1, 2025; DOI: https://doi.org/10.4093/dmj.2025.0561

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The global prevalence of early-onset type 2 diabetes (EOT2D) is rising rapidly. Adults with EOT2D represent a high-risk population characterised by increased rates of microvascular and macrovascular complications, adverse psychological wellbeing and psychiatric comorbidities such as depression, and premature mortality compared to those with later-onset type 2 diabetes mellitus. This emerging population faces unique challenges, including high levels of diabetes-related stigma, clinical inertia, and competing life demands, such as starting a family. This review synthesises current evidence on the clinical management of EOT2D. Key therapeutic targets include weight reduction, preservation of β-cell function, cardiometabolic risk management, and psychological support. Overall, there are few randomized controlled trials (RCTs) undertaken specifically in adults with EOT2D. However, we summarise early data from the few RCTs that do report outcomes specific in young adults, with bariatric surgery, tirzepatide and intensive lifestyle interventions emerging as particularly effective treatments. There is a strong rationale that technology-based inventions and structured education programs may prove to be effective treatments but data from RCTs is lacking. We provide broad recommendations for future research and clinical practice based on the current evidence. In conclusion, substantial further research is required to inform tailored, evidence-based guidelines and improve long-term outcomes in this underserved population.

Citations

Citations to this article as recorded by

Identification of oral microbial biomarkers for prediabetes in young adults: A two-stage population-based study
Jiaqi Li, Guishao Tang, Zhiguo Xie, Lin Yang, Zhiguang Zhou, Keyu Guo
Diabetes Research and Clinical Practice.2026; 232: 113101. CrossRef

Original Articles

Technology/Device
First Trimester Mean Glucose Level on Continuous Glucose Monitoring Is Associated with Infant Birth Weight: Phaik Ling Quah, Lay Kok Tan, Serene Pei Ting Thain, Ngee Lek, Shephali Tagore, Bernard Su Min Chern, Seng Bin Ang, Ann Wright, Michelle Jong, Kok Hian Tan; Diabetes Metab J. 2025;49(6):1262-1271. Published online June 2, 2025; DOI: https://doi.org/10.4093/dmj.2024.0700

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Abstract PDF Supplementary Material PubReader ePub: Background
Comparisons between continuous glucose monitoring (CGM) metrics during the first and second trimesters and conventional mid-pregnancy oral glucose tolerance test (OGTT) values in pregnant women without pre-existing diabetes for predicting infant birth weight are scarce.
Methods
In a longitudinal observational study, 113 participants had first and second trimester CGM data collected over a 7- to 14-day period, as well as three-point OGTT (fasting, 1-hour, and 2-hour) performed at mid-pregnancy (24 to 28 weeks). Multinomial logistic regression, adjusting for maternal ethnicity, education level, age, pre-pregnancy body mass index, parity, gestational diabetes mellitus diagnosis, gestational age at delivery, and type of CGM sensor was used to analyse the relationship between CGM metrics, OGTT glucose values and infant birth weight tertile (Clinical trial identification number: NCT05123248).
Results
In the univariate analysis, CGM-derived metrics including higher mean glucose in the first trimester, higher % time above range in the second trimester, and higher % time in range (TIR) and lower % time below range (TBR) in both the first and second trimesters were associated with infants in the highest birth weight tertile. After adjusting for confounders, a 1-standard deviation increase in mean glucose level during the first trimester was significantly associated with the likelihood of the neonatal birthweight being in the highest tertile (adjusted odds ratio, 3.11; 95% confidence interval, 1.18 to 8.21; P=0.022). No significant associations were found between OGTT glucose values and infant birth weight outcomes.
Conclusion
CGM-derived mean glucose levels in early pregnancy may be a better predictor of an infant’s birth weight within the highest tertile, compared to mid-pregnancy OGTT glucose values.

Metabolic Risk/Epidemiology
Birth Weight, Cardiovascular Health, and Microvascular Complications in Individuals with Diabetes Mellitus: Chaolun Yu, Anping Feng, Xia Zou, Siqi Chen, Lingyan Dai, Qingmei Cui, Xiaojing Kuang, Gaoli She, Ying Ma, Haixia Guan, Jie Li; Diabetes Metab J. 2025;49(5):1075-1086. Published online May 23, 2025; DOI: https://doi.org/10.4093/dmj.2024.0518

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Abstract PDF Supplementary Material PubReader ePub: Background
Diabetes often leads to microvascular complications, including nephropathy, neuropathy, and retinopathy. Understanding the impact of early-life factors like birth weight and modifiable behaviors such as cardiovascular health (CVH) is essential for preventing these complications.
Methods
We included 11,515 participants with diabetes but without microvascular complications at baseline from the UK Biobank Study. CVH was evaluated using the Life’s Essential 8 score. Independent and joint associations of birth weight and CVH with microvascular complications were analyzed using Cox proportional hazard models. Two-sample Mendelian randomization (MR) analyses estimated unconfounded associations between birth weight and microvascular complications.
Results
Over a median follow-up of 13.1 years, 3,010 microvascular complications occurred. Compared with normal birth weight (2.5–4.0 kg), low birth weight (LBW; <2.5 kg) was associated with 15% higher risk of diabetic nephropathy (hazard ratio [HR], 1.15; 95% confidence interval [CI], 1.01 to 1.31), but not with neuropathy and retinopathy. High birth weight (>4.0 kg) was not associated with the risk of diabetic microvascular complications. MR analysis confirmed the association between LBW and nephropathy. Adherence to high CVH was associated with a reduced risk of microvascular complications compared to low CVH, regardless of birth weight. The HRs were 0.70 (95% CI, 0.59 to 0.84) for the LBW group and 0.74 (95% CI, 0.68 to 0.80) for the group with birth weight ≥2.5 kg (P for interaction=0.69).
Conclusion
LBW was an independent risk factor for nephropathy among diabetic patients. However, the detrimental effects of LBW might be mitigated by improvement in CVH.

Metabolic Risk/Epidemiology
Pregravid Weight Gain Is Associated with an Increased Risk of Gestational Diabetes: Sunmie Kim, Kyungdo Han, Su-Yeon Choi, Min Joo Kim, Sun Young Yang, Seung Ho Choi, Jeong Yoon Yim, Jin Ju Kim, Min-Jeong Kim; Diabetes Metab J. 2025;49(4):826-836. Published online March 26, 2025; DOI: https://doi.org/10.4093/dmj.2024.0491

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Background
Studies have reported a significant association between pregravid weight gain and the subsequent development of gestational diabetes mellitus (GDM) in various populations. The current study aims to investigate this relationship using data from the Korean National Health Insurance Service database.
Methods
We conducted a retrospective nationwide population-based cohort study, involving 159,798 women who gave birth between 2015 and 2017 and had undergone two national health screening examinations: 1 year (index checkup) and 3 years before (baseline checkup) their respective estimated conception date. Participants were categorized into five groups based on the extent of weight change between the two examinations: more than 10%, 5% to 10%, –5% to 5% (reference group), –10% to –5%, and more than –10%. The study assessed the association between pregravid weight change and GDM risk.
Results
Among the 146,363 women analyzed, 11,012 (7.52%) were diagnosed with GDM. Multiple regression analysis revealed that women who gained 5% to 10% of their weight had a 12% increased risk of GDM (adjusted odds ratio [aOR], 1.12; 95% confidence interval [CI], 1.06 to 1.17), while those who gained ≥10% had a 34% higher risk (aOR, 1.34; 95% CI, 1.26 to 1.43). Notably, pregravid weight gain was particularly associated with GDM risk in non-obese or non-metabolic syndrome groups at index checkup.
Conclusion
Pregravid weight gain showed a dose-dependent association with a higher risk of GDM. This association was more pronounced in non-obese individuals emphasizing the importance of minimizing pregravid weight gain for GDM prevention, even in non-obese women.

Citations

Citations to this article as recorded by

Advancing Early Prediction of Gestational Diabetes Mellitus with Circular RNA Biomarkers
Joon Ho Moon, Sung Hee Choi
Diabetes & Metabolism Journal.2025; 49(3): 403. CrossRef
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Reviews

Lifestyle
Type 2 Diabetes Mellitus and Sarcopenia as Comorbid Chronic Diseases in Older Adults: Established and Emerging Treatments and Therapies: Jakub Mesinovic, Jackson J. Fyfe, Jason Talevski, Michael J. Wheeler, Gloria K.W. Leung, Elena S. George, Melkamu T. Hunegnaw, Costas Glavas, Paul Jansons, Robin M. Daly, David Scott; Diabetes Metab J. 2023;47(6):719-742. Published online September 14, 2023; DOI: https://doi.org/10.4093/dmj.2023.0112

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Type 2 diabetes mellitus (T2DM) and sarcopenia (low skeletal muscle mass and function) share a bidirectional relationship. The prevalence of these diseases increases with age and they share common risk factors. Skeletal muscle fat infiltration, commonly referred to as myosteatosis, may be a major contributor to both T2DM and sarcopenia in older adults via independent effects on insulin resistance and muscle health. Many strategies to manage T2DM result in energy restriction and subsequent weight loss, and this can lead to significant declines in muscle mass in the absence of resistance exercise, which is also a first-line treatment for sarcopenia. In this review, we highlight recent evidence on established treatments and emerging therapies targeting weight loss and muscle mass and function improvements in older adults with, or at risk of, T2DM and/or sarcopenia. This includes dietary, physical activity and exercise interventions, new generation incretin-based agonists and myostatin-based antagonists, and endoscopic bariatric therapies. We also highlight how digital health technologies and health literacy interventions can increase uptake of, and adherence to, established and emerging treatments and therapies in older adults with T2DM and/or sarcopenia.

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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
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Cardiovascular Risk/Epidemiology
Association between Variability of Metabolic Risk Factors and Cardiometabolic Outcomes: Min Jeong Park, Kyung Mook Choi; Diabetes Metab J. 2022;46(1):49-62. Published online January 27, 2022; DOI: https://doi.org/10.4093/dmj.2021.0316

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Despite strenuous efforts to reduce cardiovascular disease (CVD) risk by improving cardiometabolic risk factors, such as glucose and cholesterol levels, and blood pressure, there is still residual risk even in patients reaching treatment targets. Recently, researchers have begun to focus on the variability of metabolic variables to remove residual risks. Several clinical trials and cohort studies have reported a relationship between the variability of metabolic parameters and CVDs. Herein, we review the literature regarding the effect of metabolic factor variability and CVD risk, and describe possible mechanisms and potential treatment perspectives for reducing cardiometabolic risk factor variability.

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Original Articles

Metabolic Risk/Epidemiology
Postprandial Free Fatty Acids at Mid-Pregnancy Increase the Risk of Large-for-Gestational-Age Newborns in Women with Gestational Diabetes Mellitus: So-Yeon Kim, Young Shin Song, Soo-Kyung Kim, Yong-Wook Cho, Kyung-Soo Kim; Diabetes Metab J. 2022;46(1):140-148. Published online August 9, 2021; DOI: https://doi.org/10.4093/dmj.2021.0023

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Background
To investigate the association between free fatty acid (FFA) level at mid-pregnancy and large-for-gestational-age (LGA) newborns in women with gestational diabetes mellitus (GDM).
Methods
We enrolled 710 pregnant women diagnosed with GDM from February 2009 to October 2016. GDM was diagnosed by a ‘two-step’ approach with Carpenter and Coustan criteria. We measured plasma lipid profiles including fasting and 2-hour postprandial FFA (2h-FFA) levels at mid-pregnancy. LGA was defined if birthweights of newborns were above the 90th percentile for their gestational age.
Results
Mean age of pregnant women in this study was 33.1 years. Mean pre-pregnancy body mass index (BMI) was 22.4 kg/m². The prevalence of LGA was 8.3% (n=59). Levels of 2h-FFA were higher in women who delivered LGA newborns than in those who delivered non-LGA newborns (416.7 μEq/L vs. 352.5 μEq/L, P=0.006). However, fasting FFA was not significantly different between the two groups. The prevalence of delivering LGA newborns was increased with increasing tertile of 2h-FFA (T1, 4.3%; T2, 9.8%; T3, 10.7%; P for trend <0.05). After adjustment for maternal age, pre-pregnancy BMI, and fasting plasma glucose, the highest tertile of 2h-FFA was 2.38 times (95% confidence interval, 1.11 to 5.13) more likely to have LGA newborns than the lowest tertile. However, there was no significant difference between groups according to fasting FFA tertiles.
Conclusion
In women with GDM, a high 2h-FFA level (but not fasting FFA) at mid-pregnancy is associated with an increasing risk of delivering LGA newborns.

Citations

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Longitudinal Trajectory of Free Fatty Acids in Pregnancy According to First-Trimester Maternal Metabolic Status and the Presence of Gestational Diabetes
Otilia Perichart-Perera, Isabel González-Ludlow, Omar Piña-Ramírez, Maricruz Tolentino-Dolores, Guadalupe Estrada-Gutierrez, Sandra B. Parra-Hernández, Maribel Sánchez-Martínez, Omar Granados-Portillo, Ameyalli M. Rodríguez-Cano
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Haoyi Du, Danyang Li, Laura Monjowa Molive, Na Wu
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Fetal Abdominal Obesity Detected at 24 to 28 Weeks of Gestation Persists until Delivery Despite Management of Gestational Diabetes Mellitus (Diabetes Metab J 2021;45:547-57)
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Metabolic Risk/Epidemiology
Dose-Dependent Effect of Smoking on Risk of Diabetes Remains after Smoking Cessation: A Nationwide Population-Based Cohort Study in Korea: Se Eun Park, Mi Hae Seo, Jung-Hwan Cho, Hyemi Kwon, Yang-Hyun Kim, Kyung-Do Han, Jin-Hyung Jung, Yong-Gyu Park, Eun-Jung Rhee, Won-Young Lee; Diabetes Metab J. 2021;45(4):539-546. Published online March 4, 2021; DOI: https://doi.org/10.4093/dmj.2020.0061

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Background
This study aimed to evaluate the dose-dependent effects of smoking on risk of diabetes among those quitting smoking.
Methods
We analyzed clinical data from a total of 5,198,792 individuals age 20 years or older who received health care check-up arranged by the national insurance program of Korea between 2009 and 2016 using the Korean National Health Insurance Service database. Cumulative smoking was estimated by pack-years. Smokers were classified into four categories according to the amount of smoking: light smokers (0.025 to 5 smoking pack-years), medium smokers (5 to 14 smoking pack-years), heavy smokers (14 to 26 smoking pack-years), and extreme smokers (more than 26 smoking pack-years).
Results
During the study period, 164,335 individuals (3.2% of the total population) developed diabetes. Compared to sustained smokers, the risk of diabetes was significantly reduced in both quitters (hazard ratio [HR], 0.858; 95% confidence interval [CI], 0.838 to 0.878) and nonsmokers (HR, 0.616; 95% CI, 0.606 to 0.625) after adjustment for multiple risk factors. The risk of diabetes gradually increased with amount of smoking in both quitters and current smokers. The risk of diabetes in heavy (HR, 1.119; 95% CI, 1.057 to 1.185) and extreme smokers (HR, 1.348; 95% CI, 1.275 to 1.425) among quitters was much higher compared to light smokers among current smokers.
Conclusion
Smoking cessation was effective in reducing the risk of diabetes regardless of weight change. However, there was a potential dose-dependent association between smoking amount and the development of diabetes. Diabetes risk still remained in heavy and extreme smokers even after smoking cessation.

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Review

Drug/Regimen
Comprehensive Review of Current and Upcoming Anti-Obesity Drugs: Jang Won Son, Sungrae Kim; Diabetes Metab J. 2020;44(6):802-818. Published online December 23, 2020; DOI: https://doi.org/10.4093/dmj.2020.0258

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Abstract PDF PubReader ePub

Obesity is among the leading causes of morbidity and mortality worldwide and its prevalence continues to increase globally. Because obesity is a chronic, complex, and heterogeneous disease influenced by genetic, developmental, biological, and environmental factors, it is necessary to approach obesity with an integrated and comprehensive treatment strategy. As it is difficult to achieve and sustain successful long-term weight loss in most patients with obesity through lifestyle modifications (e.g., diet, exercise, and behavioral therapy), pharmacological approaches to the treatment of obesity should be considered as an adjunct therapy. Currently, four drugs (orlistat, naltrexone extended-release [ER]/bupropion ER, phentermine/topiramate controlled-release, and liraglutide) can be used long-term (>12 weeks) to promote weight loss by suppressing appetite or decreasing fat absorption. Pharmacotherapy for obesity should be conducted according to a proper assessment of the clinical evidence and customized to individual patients considering the characteristics of each drug and comorbidities associated with obesity. In this review, we discuss the mechanisms of action, efficacy, and safety of these available long-term anti-obesity drugs and introduce other potential agents under investigation. Furthermore, we discuss the need for research on personalized obesity medicine.

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Original Articles

Clinical Diabetes & Therapeutics
Effectiveness of Exercise Intervention in Reducing Body Weight and Glycosylated Hemoglobin Levels in Patients with Type 2 Diabetes Mellitus in Korea: A Systematic Review and Meta-Analysis: Ji-Eun Jang, Yongin Cho, Byung Wan Lee, Ein-Soon Shin, Sun Hee Lee; Diabetes Metab J. 2019;43(3):302-318. Published online November 19, 2018; DOI: https://doi.org/10.4093/dmj.2018.0062

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Abstract PDF Supplementary Material PubReader ePub

Background

This study aimed to assess the effectiveness of exercise intervention in reducing body weight and glycosylated hemoglobin (HbA1c) level in patients with type 2 diabetes mellitus (T2DM) in Korea.

Methods

Cochrane, PubMed, Embase, KoreaMed, KMbase, NDSL, KCI, RISS, and DBpia databases were used to search randomized controlled trials and controlled clinical trials that compared exercise with non-exercise intervention among patients with non-insulin-treated T2DM in Korea. The effectiveness of exercise intervention was estimated by the mean difference in body weight changes and HbA1c level. Weighted mean difference (WMD) with its corresponding 95% confidence interval (CI) was used as the effect size. The pooled mean differences of outcomes were calculated using a random-effects model.

Results

We identified 7,692 studies through literature search and selected 23 articles (723 participants). Compared with the control group, exercise intervention (17 studies) was associated with a significant decline in HbA1c level (WMD, −0.58%; 95% CI, −0.89 to −0.27; I²=73%). Although no significant effectiveness on body weight was observed, eight aerobic training studies showed a significant reduction in body weight (WMD, −2.25 kg; 95% CI, −4.36 to −0.13; I²=17%) in the subgroup analysis.

Conclusion

Exercise significantly improves glycemic control; however, it does not significantly reduce body weight. Aerobic training can be beneficial for patients with non-insulin-treated T2DM in Korea.

Citations

Citations to this article as recorded by

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Obesity and Metabolic Syndrome
Air Pollution Has a Significant Negative Impact on Intentional Efforts to Lose Weight: A Global Scale Analysis: Morena Ustulin, So Young Park, Sang Ouk Chin, Suk Chon, Jeong-taek Woo, Sang Youl Rhee; Diabetes Metab J. 2018;42(4):320-329. Published online April 24, 2018; DOI: https://doi.org/10.4093/dmj.2017.0104

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52 Download
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Abstract PDF PubReader ePub

Background

Air pollution causes many diseases and deaths. It is important to see how air pollution affects obesity, which is common worldwide. Therefore, we analyzed data from a smartphone application for intentional weight loss, and then we validated them.

Methods

Our analysis was structured in two parts. We analyzed data from a cohort registered to a smartphone application in 10 large cities of the world and matched it with the annual pollution values. We validated these results using daily pollution data in United States and matching them with user information. Body mass index (BMI) variation between final and initial login time was considered as outcome in the first part, and daily BMI in the validation. We analyzed: daily calories intake, daily weight, daily physical activity, geographical coordinates, seasons, age, gender. Weather Underground application programming interface provided daily climatic values. Annual and daily values of particulate matter PM10 and PM2.5 were extracted. In the first part of the analysis, we used 2,608 users and then 995 users located in United States.

Results

Air pollution was highest in Seoul and lowest in Detroit. Users decreased BMI by 2.14 kg/m² in average (95% confidence interval, −2.26 to −2.04). From a multilevel model, PM10 (β=0.04, P=0.002) and PM2.5 (β=0.08, P<0.001) had a significant negative effect on weight loss when collected per year. The results were confirmed with the validation (β_AQI*time=1.5×10^–5; P<0.001) by mixed effects model.

Conclusion

This is the first study that shows how air pollution affects intentional weight loss applied on wider area of the world.

Citations

Citations to this article as recorded by

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Others
The Effect of 12 Weeks Aerobic, Resistance, and Combined Exercises on Omentin-1 Levels and Insulin Resistance among Type 2 Diabetic Middle-Aged Women: Zeinab AminiLari, Mohammad Fararouei, Sasan Amanat, Ehsan Sinaei, Safa Dianatinasab, Mahmood AminiLari, Nima Daneshi, Mostafa Dianatinasab; Diabetes Metab J. 2017;41(3):205-212. Published online May 18, 2017; DOI: https://doi.org/10.4093/dmj.2017.41.3.205

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149 Download
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Abstract PDF PubReader ePub

Background

Recent studies have shown that omentin-1 derived from adipokines can affect physiological regulations and some metabolic dis-eases such as type 2 diabetes mellitus (T2DM).

Methods

The purpose of this study was to examine the impact of 12 weeks of aerobic (cycle ergometer), resistance, and combined exercises on omentin-1 level, glucose and insulin resistance indices in overweight middle age women with T2DM. In this study, 60 overweight middle age diabetic women were selected using simple random sampling and they were assigned to three groups of aerobic exercise (n=12), resistant exercise (n=12) and combined exercise (n=13), and one control group (n=15). Exercises were done in a three times per week sessions for a total of 12 weeks. Blood samples were collected before each exercise session and 24 hours after of the last session.

Results

Present study showed that fasting blood sugar decreased significantly in all intervention groups, while homeostasis model assessment of insulin resistance (HOMA-IR) decreased only in the aerobic and combined exercises groups. Furthermore, there was a significant increase in the omentin-1 level only in the combined exercise group.

Conclusion

Compared to aerobic and resistance exercises, 12 weeks of combined exercise was more efficient in improving HOMA-IR and increasing serum omentin-1 among women with T2DM.

Citations

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Brief Report

Obesity and Metabolic Syndrome
A Cutoff for Age at Menarche Predicting Metabolic Syndrome in Egyptian Overweight/Obese Premenopausal Women: Ibrahim Elsehely, Hala Abdel Hafez, Mohammed Ghonem, Ali Fathi, Rasha Elzehery; Diabetes Metab J. 2017;41(2):146-149. Published online November 30, 2016; DOI: https://doi.org/10.4093/dmj.2017.41.2.146

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Previous studies showed that early age at menarche is associated with increased risk of metabolic syndrome. However, the definition of early menarche at these studies was based on background data in the communities at which these studies was carried on. The aim of this work is to determine a cutoff for age at menarche discriminating presence or absence of metabolic syndrome in overweight/obese premenopausal women. This study included 204 overweight/obese women. Metabolic syndrome was defined according to NCEP-ATP III (National Cholesterol Education Program Adult Treatment Panel III) criteria. Of a total 204 participants, 82 (40.2%) had metabolic syndrome. By using receiver operating characteristic analysis, age at menarche ≤12.25 year discriminated individuals with from those without metabolic syndrome. The area under the curve was 0.76 (95% confidence interval, 0.70 to 0.83). Sensitivity, specificity, negative predictive value, and positive predictive value were 82%, 70%, 85%, and 64%, respectively. Age at menarche ≤12.25 years predicts the presence of metabolic syndrome in overweight/obese women.

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Original Articles

Obesity and Metabolic Syndrome
Importance of Lean Muscle Maintenance to Improve Insulin Resistance by Body Weight Reduction in Female Patients with Obesity: Yaeko Fukushima, Satoshi Kurose, Hiromi Shinno, Ha Cao Thu, Nana Takao, Hiromi Tsutsumi, Yutaka Kimura; Diabetes Metab J. 2016;40(2):147-153. Published online March 27, 2016; DOI: https://doi.org/10.4093/dmj.2016.40.2.147

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Background

It has recently been suggested that skeletal muscle has an important role in insulin resistance in obesity, in addition to exercise tolerance and the fat index. The aim of this study was to identify body composition factors that contribute to improvement of insulin resistance in female patients with obesity who reduce body weight.

Methods

We studied 92 female obese patients (age 40.9±10.4 years, body mass index 33.2±4.6 kg/m²) who reduced body weight by ≥5% after an intervention program including diet, exercise therapy, and cognitive behavioral therapy. Before and after the intervention, body composition was evaluated by dual-energy X-ray absorptiometry to examine changes in skeletal muscle mass. Homeostasis model assessment of insulin resistance (HOMA-IR) was measured as an index of insulin resistance. Cardiopulmonary exercise was also performed by all patients.

Results

There were significant improvements in body weight (–10.3%±4.5%), exercise tolerance (anaerobic threshold oxygen uptake 9.1%±18.4%, peak oxygen uptake 11.0%±14.2%), and HOMA-IR (–20.2%±38.3%). Regarding body composition, there were significant decreases in total body fat (–19.3%±9.6%), total fat-free mass (–2.7%±4.3%), and % body fat (–10.1%±7.5%), whereas % skeletal muscle significantly increased (8.9%±7.2%). In stepwise multiple linear regression analysis with change in HOMA-IR as the dependent variable, the change in % skeletal muscle was identified as an independent predictor (β=–0.280, R²=0.068, P<0.01).

Conclusion

Improvement of insulin resistance in female obese patients requires maintenance of skeletal muscle mass.

Citations

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The Association of Unintentional Changes in Weight, Body Composition, and Homeostasis Model Assessment Index with Glycemic Progression in Non-Diabetic Healthy Subjects: Eun-Jung Rhee, Ji-Hun Choi, Seung-Hyun Yoo, Ji-Cheol Bae, Won-Jun Kim, Eun-Suk Choi, Se Eun Park, Cheol-Young Park, Seok Won Park, Ki-Won Oh, Sung-Woo Park, Sun-Woo Kim, Won-Young Lee; Diabetes Metab J. 2011;35(2):138-148. Published online April 30, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.2.138

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Background

We performed a retrospective longitudinal study on the effects of changes in weight, body composition, and homeostasis model assessment (HOMA) indices on glycemic progression in subjects without diabetes during a four-year follow-up period in a community cohort without intentional intervention.

Methods

From 28,440 non-diabetic subjects who participated in a medical check-up program in 2004, data on anthropometric and metabolic parameters were obtained after four years in 2008. Body composition analyses were performed with a bioelectrical impedance analyzer. Skeletal muscle index (SMI, %) was calculated with lean mass/weight×100. Subjects were divided into three groups according to weight change status in four years: weight loss (≤-5.0%), stable weight (-5.0 to 5.0%), weight gain (≥5.0%). Progressors were defined as the subjects who progressed to impaired fasting glucose or diabetes.

Results

Progressors showed worse baseline metabolic profiles compared with non-progressors. In logistic regression analyses, the increase in changes of HOMA-insulin resistance (HOMA-IR) in four years presented higher odds ratios for glycemic progression compared with other changes during that period. Among the components of body composition, a change in waist-hip ratio was the strongest predictor, and SMI change in four years was a significant negative predictor for glycemic progression. Changes in HOMA β-cell function in four years was a negative predictor for glycemic progression.

Conclusion

Increased interval changes in HOMA-IR, weight gain and waist-hip ratio was associated with glycemic progression during a four-year period without intentional intervention in non-diabetic Korean subjects.

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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: 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.

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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 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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Abstract PDF PubReader ePub

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.

Citations

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Randomized Controlled Trial

The Effects of Low-Calorie Diets on Abdominal Visceral Fat, Muscle Mass, and Dietary Quality in Obese Type 2 Diabetic Subjects.: Hee Jung Ahn, Youn Ok Cho, Hwi Ryun Kwon, Yun Hyi Ku, Bo Kyung Koo, Kyung Ah Han, Kyung Wan Min; Korean Diabetes J. 2009;33(6):526-536. Published online December 1, 2009; DOI: https://doi.org/10.4093/kdj.2009.33.6.526

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Abstract PDF

BACKGROUND
Weight loss through low-calorie diets (LCDs) decreases visceral fat (VF). However, the effects on muscle mass, changes of dietary quality, and insulin sensitivity are unknown for Korean obese type 2 diabetic subjects. Therefore, this study examined such effects of LCDs. METHODS: A total of 30 obese type 2 diabetic subjects (body mass index, 27.0 +/- 2.2 kg/m2) were randomly assigned to an LCD or control group. Subjects on LCDs took 500~1,000 kcal fewer energy than their usual dietary intake (1,000~1,500 kcal/day) over the course of 12 weeks. The abdominal VF and femoral muscle mass were evaluated by computed tomography, and insulin sensitivity was assessed using an insulin tolerance test (Kitt; rate constant for plasma glucose disappearance, %/min). Dietary nutrient intake consumed by subjects was assessed by 3-day food records. RESULTS: The percent VF reduction was -23.4 +/- 17.2% in the LCD group and -9.8 +/- 11.8% in the control group after 12 weeks (P < 0.001, P = 0.002). However, significant decrease in femoral mass or proportional change of marcronutrient intake and mean adequacy ratio were not found in the LCD group, as compared to the control group. Insulin sensitivity improved in the LCD group, as compared to the control group (P = 0.040). CONCLUSION: LCD effectively improved insulin sensitivity and reduced abdominal VF without reduction of femoral muscle and dietary quality in obese type 2 diabetic subjects.

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The Effects of Low-Calorie Diets on Abdominal Visceral Fat, Muscle Mass, and Dietary Quality in Obese Type 2 Diabetic Subjects (Korean Diabetes J 2009;33:526-36)
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Original Articles

Prevention of Diabetes by Fenofibrate in OLETF Rats: Hepatic Mechanism for Reducing Visceral Adiposity.: Hye Jeong Lee, Mi Kyoung Park, Kyung Il Lee, Young Jun An, Ji Min Kim, Ja Young Park, Young Han, Sook Hee Hong, Sun Seob Choi, Young Hyun Yoo, Joon Duk Suh, Duk Kyu Kim; Korean Diabetes J. 2007;31(1):63-74. Published online January 1, 2007; DOI: https://doi.org/10.4093/jkda.2007.31.1.63

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Abstract PDF

BACKGROUND
The aim of this study is to evaluate the hepatic mechanism of fenofibrate that has the diabetes protective action in rats. METHODS: We chose OLETF rats and divided them into three groups. Fenofibrate (DF) group was fed with diet and fenofibrate (300 mg/kg/day). Paired feeding (Dd) group and free diet (DD) group were fed with diet. After 36 weeks of treatment, all the rats were sacrificed. RESULTS: The fasting blood glucose level of DF group (8.5 +/- 0.9 mmol/L) showed normal. The fasting blood glucose level of Dd group (22.4 +/- 3.0 mmol/L) and DD group (16.9 +/- 3.7 mmol/L) showed significantly increased than that of DF group (P < 0.01, respectively). The body weight, visceral adipose tissue and subcutaneous adipose tissue of DF group were significantly decreased compared to those of Dd and DD groups (P < 0.01, P < 0.05, P < 0.05). DF group showed significantly increased state-3 respiration rate, ATP synthetic activity, state-4 respiration rate and their blood beta-keton body levels than those of control groups (P < 0.01, respectively). DF group showed normal morphology of hepatocytes but DD and Dd groups showed hepatic steatosis with mitochondrial swellings. CONCLUSION: Chronic fenofibrate treatment prevents the development of diabetes in OLETF rats with inhibiting gain of body weight and abdominal adiposity. The hepatic mechanism for reducing visceral adiposity is that fenofibrate leads to increasing oxidative phosphorylation, uncoupling and ketogenesis as well as increasing beta-oxidation of fatty acids. Moreover, fenofibrate treatment prevents the development of hepatic steatosis.

Citations

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The Differences of Metabolic Syndrome Risk Factors according to Obesity and Abdominal Obesity in Elderly Korean Women
Kyung-A Shin
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Jae-Joon Lee, Ah-Ra Kim, Hae-Choon Chang, Hae-Ok Jung, Myung-Yul Lee
Journal of the Korean Society of Food Science and Nutrition.2012; 41(8): 1086. CrossRef
Comparative analysis of fat and muscle proteins in fenofibratefed type II diabetic OLETF rats: the fenofibrate-dependent expression of PEBP or C11orf59 protein
Jong-Ryeal Hahm, Jin-Sook Ahn, Hae-Sook Noh, Seon-Mi Baek, Ji-Hye Ha, Tae-Sik Jung, Yong-Jun An, Duk-Kyu Kim, Deok-Ryong Kim
BMB Reports .2010; 43(5): 337. CrossRef
Comparative analysis of fat and muscle proteins in fenofibratefed type II diabetic OLETF rats: the fenofibrate-dependent expression of PEBP or C11orf59 protein
Jong-Ryeal Hahm, Jin-Sook Ahn, Hae-Sook Noh, Seon-Mi Baek, Ji-Hye Ha, Tae-Sik Jung, Yong-Jun An, Duk-Kyu Kim, Deok-Ryong Kim
BMB Reports.2010; 43(5): 337. CrossRef

The percent change of body weight in patients with type 2 diabetes using rosiglitazone for 1 year.: Seong Bin Hong, Hwi Ra Park, Eun A Kim, Kyung wook Lee, Moonsuk Nam, Yong Seong Kim; Korean Diabetes J. 2006;30(1):47-53. Published online January 1, 2006; DOI: https://doi.org/10.4093/jkda.2006.30.1.47

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Abstract PDF: BACKGROUND
Rosiglitazone(RSG) is known as a potent agonist for the PPARgamma. It improves glycemic control by improving insulin sensitivity in peripheral tissues. And it is associated with body weight gain. The Pro12Ala polymorphism of the gene encoding the peroxisome proliferator-activated receptor(PPAR)gamma2 has recently been shown to be associated with insulin sensitivity. This study was performed to evaluate the body weight change during the long term rosiglitazone treatment and the role of PPARgamma2 polymorphism, Pro12Ala as an indicator to predict the clinical response of RSG in type 2 diabetes patients. METHOD: The study subjects were 214 type 2 diabetic patients(117 male, 97 female) who were received a daily 1 year course of 4 mg RSG combined with sulfonylurea or metformin. The Pro12Ala polymorphism of the PPARgamma2 was determined by the restriction fragment length polymorphism(RFLP) method. Body weight, height, waist circumference, fasting glucose, insulin, c-peptide and lipid profile were measured. RESULTS: After RSG treatment, body weight change was 2.4 +/- 3.8%, 4.5 +/- 9.8% of baseline body weight at 12, 24 weeks respectively. Body weight gains were increased to 5.6 +/- 10.1% at the end of 1 year. The HbA1C, serum insulin level and HOMA index were decreased following the rosiglitazone therapy. The allele frequency of the Ala12Pro polymorphism of the PPARgamma2 was 0.016. The number of Ala12Pro variant of the PPARgamma2 was too low to predict clinical response of RSG. Body weight gain was correlated with basal fasting plasma glucose, post-prandial 2 hour glucose and HbA1c level(p<0.05). There was no correlation between baseline body weight and change. CONCLUSION: This results showed that Pro12Ala polymorphism was not acceptable for the predictor of RSG induced weight gain and clinical response. However, body weight gain was increased in who had high glucose level, and correlated positively with glucose decrease. 1st 3 month weight gain was best predictor of weight change during 1 year.

The long term effects of rosiglitazone on serum lipid concentration and body weight.: Wan Sub Shim, Mi Young Do, Soo Kyung Kim, Hae Jin Kim, Kyu Yeon Hur, Eun Seok Kang, Yu Mie Rhee, Chul Woo Ahn, Sung Kil Lim, Kyung Rae Kim, Hyun Chul Lee, Bong Soo Cha; Korean Diabetes J. 2006;30(1):17-24. Published online January 1, 2006; DOI: https://doi.org/10.4093/jkda.2006.30.1.17

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Abstract PDF: BACKGROUND
Although rosiglitazone, an insulin sensitizer, is known to have beneficial effects on high density lipoprotein cholesterol (HDL-C) concentration and low density lipoprotein (LDL) particle size, it has adverse effects on the increment of total cholesterol (TC) and LDL cholesterol (LDL-C), and body weight in some studies. Such adverse effects of rosiglitazone on the serum lipid profiles and body weight seem to be attributed to the fact that most studies with rosiglitazone are limited to a short period of follow up. The aim of this study was to evaluate the long term effects of rosiglitazone on the serum lipid levels and body weight. MATERIALS AND METHODS: We prospectively evaluated fasting serum glucose, HbA1c, TC, LDL-C, triglyceride, HDL-C and body weight at baseline and every three months after rosiglitazone usage (4mg/d) in 202 type 2 diabetic patients. RESULTS: TC levels had increased maximally at 3 months and thereafter decreased, but were significantly higher at 18 months than those at baseline. LDL-C levels from the first 3 months to 12 months were significantly higher than those at baseline, but after 15 months, LDL-C concentration was not significantly different from the basal LDL-C concentration. HDL-C levels had increased after first 3 months and the increment of HDL-C concentration were maintained. The increment of HDL-C was more prominent in patients with low basal HDL-C concentration than in patients with high basal HDL-C concentration. Body weight from 3 months to 18 months were higher than that at baseline, but after 3 months, body weight did not increase furthermore significantly. CONCLUSIONS: The adverse effects on lipid concentration and body weight of rosiglitazone may attenuate after long term usage of rosiglitazone.

Insulin Resistance in Normal Weight Women with Polycystic Ovary Syndrome.: Eun Kyung Byun, Hye Jin Lee, Jee Young Oh, Young Sun Hong, Hye Won Chung, Yeon Ah Sung; Korean Diabetes J. 2004;28(4):315-323. Published online August 1, 2004

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Abstract PDF: BACKGROUND
Insulin resistance is considered a regular component of polycystic ovary syndrome (PCOS). However, several studies have failed to confirm insulin resistance in non-obese women with PCOS. The aim of the study was to identify whether insulin resistance is present in normal weight women with PCOS and the factors associated with insulin sensitivity. METHODS: Twenty-two normal weight (body mass index, BMI < 25 kg/m2) women with PCOS, and 16 age and BMI comparable control women with regular menstrual cycles were examined during their early follicular phase. The levels of serum hormones and lipids were measured. The visceral fat area was assessed by computed tomography at umbilical level. The standard 75g oral glucose tolerance test was performed to determine the glucose tolerance status. The insulin sensitivity was measured using the euglycemic hyperinsulinemic clamp technique (target glucose 90 mg/dL, insulin~1 mu/kg/min). RESULTS: The levels of free testosterone (1.9+/-0.6 pg/mL vs. 0.8+/-0.3 pg/mL, p<0.001), androstenedione (14.5+/-3.7 nmol/L vs. 8.8+/-1.3 nmol/L, p<0.001), LH (10.7+/-4.5 IU/L vs 4.6+/-4.8 IU/L, p<0.001) and FSH (5.8+/-1.7 IU/L vs. 4.2+/-2.4 IU/L, p<0.05) of the women with PCOS were significantly higher than those of the control subjects. The fasting plasma glucose (4.92+/-0.31 mmol/L vs. 4.42+/-0.61 mmol/L, p<0.01) and post glucose load plasma insulin (233.2+/-119.5pmol/L vs. 109.0+/-46.4 pmol/L, p<001) levels of women with PCOS were significantly higher than those of the control subjects. The glucose disposal rate (M value) was significantly lower in women with PCOS compared to the controls (5.3+/-1.2 mg/kg min vs. 6.7+/-1.6 mg/kg min, p<0.05), even after adjusting for age and BMI. There was no significant correlation of the M value with the anthropometric and a metabolic indices, and a multiple regression analysis of the M value showed no significant variables. CONCLUSION: Our non-obese women with PCOS showed significant insulin resistance compared to their age and BMI comparable control subjects, and-their insulin resistance may be an intrinsic defect not associated with other features, such as hyperandrogenemia or body fat distribution patterns.

The Role of Chromium as an Insulin Sensitizer in Rats Receivieng Corticosteroid.: Dong Sun Kim, Chang Beom Lee, Yong Soo Park, You Hern Ahn, Tae Wha Kim, Ho Soon Choi, Il Kyu Park, Hyun Jin Shin, Ju Seop Kang; Korean Diabetes J. 2001;25(3):211-217. Published online June 1, 2001

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Abstract PDF: BACKGROUND
Chromium (Cr) has been known to be essential for the regulation of insulin action. Recently it has been reported that corticosteroid increases urinary loss of Cr, and that Cr supplementation recovers steroid induced diabetes mellitus. METHODS: Rats were daily treated with dexamethasone (0.2 mg/kg, ip) for first 7 days and were further treated daily with dexamethasone plus either chromium picolinate (30 mg/kg) or a placebo for a period of 14 days. RESULTS: At the end of experiment (Day 21), the control rats treated only with dexamethasone weighed 320 gram (80% of initial weight) in average, but the Cr treated rats weighed 364 gram (91% of initial weight. p<0.05). An insulin sensitivity test [subcutaneous injection of insulin (5 U/kg) plus intraperitoneal injection of glucose (30 minutes after insulin injection)] were conducted. During the insulin sensitivity tests, the area under curves (AUC(0->120 min)) of the time-glucose concentrations curves in the Cr-treated group were decreased compared to those in the control group (5250 vs 15883 mg-min/dL, p<0.01). Fasting serum insulin levels in the Cr-treated rats were clearly decreased by 46.9% compared to those in the control group (2.98 vs 5.60 ng/mL, p<0.05). CONCLUSIONS: We conclude that chromium supplementation reverse a catabolic state, and increase insulin sensitivity in dexamethasone treated rats.

Relationship of Insulin-like Growth Factor(IGF)-1, IGF-2, IGF Binding Protein(IGFBP)-3, and Mitochondrial DNA Amount in the Umbilical Cord Blood to Birth Weight.: Yun Yong Lee, Do Joon Park, Chan Soo Shin, Kyong Soo Park, Hong Kyu Lee, Jong Kwan Jun, Boh Yun Yoon, Jih Yeun Song, Bong Sun Kang; Korean Diabetes J. 1999;23(1):36-45. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Reaven proposed a syndrome (syndrome X), consisting of glucose intolerance, hypertension, hyperinsulinemia, dyslipidemia, as a clinical entity. The fundamental metabolic defect of this syndrome was recognized as insulin resistance, but the pathophysiology of insulin resistance is not clarified as of yet. Recent evidence, suggests that non-insulin dependent diabetes mellitus (NIDDM) ancl lipid and cardiovascular abnormalities-syndrome X-are associated with intrauterine growth retar- dation (IUGR). Recently Shin reported that the amounts of mitochondrial DNA (mtDNA) in a given amount of genomic DNA were lower in NIDDM patients than in healthy controls, and the amount of mtDNA is negatively correlated with blood pressure ancl waist-hip ratio. Birth weight is known to be correlated with levels of insulin-like growth factors (IGFs). The purpose of this study was to identify the correlation of low birth weight with reduced mtDNA and syndrome X. We investigated the relationship of birth weight to IGFs and the amount of mtDNA METHODS: 72 singleton pregnancy babies and their mathers admitted in Seoul National University Hospital from March to May, 1997 were studied. After delivery, the cord blcxxl and maternal venous blood sampling was done. Using the imnnmoradiometric assay (IRMA) the IGF-l, IGF-2, IGFBP-3 was measured from cord and maternal plasma. Among them only 27 pairs samples were measured mtDNA amount with competitive PCR method in their buffy coat. Then statistical analysis was done within these paratneters. RESULTS: Birth weight is correlated significantly with cord plasma IGF-1 (r=0.32, p<0.01), IGFBP-3 (r=0.44, p<0.01), prepregnancy maternal body weight (r=0.45, p<0.01), maternal mtDNA amount (r=0.63, p<0.01). Cord blood mtDNA is correlated with maternal mtDNA amount (r=0.55, p<0,01). In multiple regression analysis, the maternal mtDNA was found to be the only independent factor related to birth weight (p<0.01). COMCLUSION: We have found the correlation between birth weight and maternal prepregnancy body weight and mtDNA amount. The clinical implications of this result remain yet to be deiermined.

A Comparative Study on the side Effects of Low Molecular Weight Heparin and Unfractionated Heparin Therapy in non-insulin-Dependent Diabetes Mellitus Patients.: Tae Sun Park, Sung Kwang Park, Hong Sun Baek, Sung Kyew Kang; Korean Diabetes J. 1998;22(3):344-352. Published online January 1, 2001

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Abstract PDF: BACKGROUND
We compared the known side effects of low dose low-molecular weight heparin (LMWH) and unfractionated heparin(UH) therapy for prevention of the thrombosis in patients with type 2 diabetes mellitus. METHODS: Changes in plasma aldosterone, renin activity, potassium concentration, platelet counts and bleeding tendency were investigated in 68 patients with type 2 diabetes mellitus 7days after LMWH and UH therapy. LMWH and UH was administered by subcutaneous route at dases of 5000 and 7500 units/day respectively. RESULTS: Although plasma aldosterone concentration was decreased from 323.8+219.2pmol/1 to 142.7+111.lpmo.l/l(p<0.05) in LMWH therapy and from 200.3+177.0pmol/l to 99.6+68.6pmol/l(p<0.05) in UH therapy, decrease rate is significantly greater in UH therapy(p<0.05). Plasma renin activity was decreased from 0.76+0.73ng/L/s to 0.29+ 0.21ng/L/s(p<0.05) in LMWH therapy and from 0.51+0.23ng/L/s to 0.22+0.11ng/L/s(p<0.05) in UH therapy, but decrease rate is not significantly different in both group(p>0.05). Plasma potassium was increased from 4.22+0.82mmol/L to 4.40+ 0.81mmol/L(p>0.05) in LMWH therapy and from 3.98+0.55mmol/L to 4.34+0.82mmol/L(p>0.05) in UH therapy and platelet counts were decreased from 217,875+56,783 to 206,375+67,855/mm(p>0.05) during LMWH and from 273,958+93,519 to 236,708+62,414/mm(p<0.01) in UH therapy. Other complications of heparin therapy were similar in both groups. CONCLUSION: Low-dose LMWH and UH treated patients are not significantly different in clinical and laboratory characteristics, except that heparin-induced thrombocytopenia was less common in type 2 DM patients treated with LMWH than in those treated with UH.

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