Diabetes & Metabolism Journal

Volume 27(1); February 2003

Review

Transplantation Source for Islet Replacement.: Soon Jib Yoo; Korean Diabetes J. 2003;27(1):1-14. Published online February 1, 2003

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Abstract PDF: No abstract available.

Editorial

Evaluation of Peripheral Neurovascular Dysfunction in Type 2 Diabetic Complication.: Tae Sun Park; Korean Diabetes J. 2003;27(1):15-17. Published online February 1, 2003

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Abstract PDF: No abstract available.

Original Articles

Changes in Cutaneous Blood Flow in Type 2 Diabetics with or without Neuropathy and Retinopathy.: Chang Hoon Choi, Ju Young Lee, Sin Won Lee, Gui Hwa Jung, Jung Guk Kim, Sung Woo Ha, Bo Wan Kim; Korean Diabetes J. 2003;27(1):18-25. Published online February 1, 2003

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Abstract PDF: BACKGROUND
Although diabetic microangiopathy has its greatest clinical effects in the retina, kidneys and nerves there is much evidence that the process is generalized, and that these lesions involve most capillary beds. However, the potential relationship between the presence of diabetic neuropathy, and/or retinopathy, and skin blood flow has not been fully evaluated. Therefore we measured the cutaneous blood flow in diabetics, both with and without microangiopathy, to determine the relationship between microangiopathy and the cutaneous blood flow. METHODS: One hundred-and nineteen type 2 diabetic patients were classified into four categories, based on the presence of polyneuropathy or retinopathy. The skin blood flow was measured in the diabetic patients with or without neuropathy and retinopathy, before, during and after exposure to cold. Before, during and 1 min after the application of a cold-pack, skin blood flow measurements were performed using a laser Doppler techniques at the following right-sided locations: (1) the dorsum of the wrist and ankle, as nutritive microvasculatures, and (2) the pulp of tip of the index finger and big toe, as themoregulatory ones. RESULTS: During the 1-min cold applications, the percentage changes in the decrement of the skin blood flow, at the 4 skin sites, showed decreasing trends in the neuropathy group. However, the differences in the diabetics with neuropathy were not significantly greater than in those without neuropathy. The changes at the same sites in the group with retinopathy were similar to those with neuropathy. The percentage changes in the increment of the skin blood flow were measured at the 4 skin sites 1 min after exposure to cold, and also showed a blunted tendency in both the diabetic neuropathy and retinopathy groups. The percentage changes in the flow increment at the pulp of the big toe were greater in the diabetics without neuropathy or retinopathy, compared to those with these complications (p<0.05). CONCLUSION: These results suggest that changes in the cutaneous blood flow would be more predominant at the thermoregulatory vasculature sites in the type 2 diabetics with neuropathy or retinopathy, and seems to be related to diabetic microangiopathy.

Effect of Gi-proteins on Insulin Binding, Internalization and Recycling of Insulin Receptor in Bovine Aorta Endothelial Cell.: Hyuk Ho Kwon, Hyun Shik Son, Jung Min Lee, Seung Hyun Ko, Ok Ki Hong, Sung Dae Moon, Sang Ah Chang, Kun Ho Yoon, Bong Yun Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang; Korean Diabetes J. 2003;27(1):26-38. Published online February 1, 2003

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Abstract PDF: BACKGROUND
Guanine nucleotide binding proteins (G-proteins) play important roles in the hormonal actions of many signal transduction systems. Possible roles for the Gi-protein in insulin action have been suggested. It is reported that Gi-protein is associated with insulin actions to a greater extent than Gs-protein. There are at least three different subtypes of Gi-proteins (Gi(alpha1), Gi(alpha2), and Gi(alpha3)), however, it is not certain which subtypes are associated with insulin receptors and their action. METHODS: To investigate the effects of Gi-proteins on insulin action, the Gi-proteins were overexpressed in cultured bovine aortic endothelial cells (BAEC), using the DNA-polylysine-adenovirus complex transfection method. After incubating for 24 hours, the BAEC were treated with 200 ng/mL insulin to evaluate the insulin binding, receptor internalization and recycling. RESULTS: The following results were found : 1) The binding of specific insulin bindings to the insulin receptors of endothelial cells were time-dependent, reaching their maximal levels in all cells after 30 minutes. The maximal specific bindings of the control, Gi(alpha1), Gi(alpha2), and Gi(alpha3) were 0.58+/-0.1, 0.54+/-0.08, 0.54+/-0.1, 0.53+/-0.09%, respectively. 2) The internalization of 125I-insulin, into endothelial cells, was assessed by the acid washing dissociation method, and occurred rapidly. There was a significant difference in the internalized radioactivity of the 125I-insulin in the overexpressed Gi(alpha2) protein group compared to the two groups. 3) The recycling of the insulin receptors in the three types of Gi-protein showed no significant difference between the three group. CONCLUSION: In conclusion, the Gi(alpha2) protein may be associated with internalization of the insulin-insulin receptor complex, and appears to be important in both the action of insulin and the intracellular processing of insulin receptors.

Impaired Insulin Secretion in Normoglycemic Offspring of Patients with Type 2 Diabetes.: Eun Kyung Byun, Young Sun Hong, Jee Young Oh, Yeon Ah Sung, Yeon Jin Jang; Korean Diabetes J. 2003;27(1):39-48. Published online February 1, 2003

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Abstract PDF: BACKGROUND
Although it is well known that insulin secretory defects and insulin resistance are major pathogenetic factors of type 2 diabetes, their relative importance still remains controversial in various ethnic groups. Increased levels of proinsulin, and the proinsulin/insulin (PI/I) ratio, are considered markers of pancreatic dysfunction, and predictors for the development of type 2 diabetes. To reveal which pathogenetic abnormality is most prominent in Koreans with type 2 diabetes, we measured the insulin sensitivity and secretory capacity in the normal glucose tolerant offspring of patients with type 2 diabetes. METHODS: Sixty-two offspring, with normal glucose tolerance (mean age 40.4+/-6.5 BMI 23.4+/-2.7 kg/m2), of type 2 diabetes parents, were compared with and 20, age and BMI-matched control subjects, with on family history of diabetes. We measured the serum levels of proinsulin (PI), specific insulin (I), and C-peptide(C) and calculated the PI/I and C/I ratios, as parameters of hepatic insulin clearance. The insulin sensitivity index (SI) was measured by the intravenous glucose tolerance test (IVGTT) using the MINMOD program, as a marker of insulin sensitivity. The acute insulin response to glucose (AIRg), AIRg by product, SI and the area under the insulin curve (AUCinsulin) were measured by IVGTT, and used as a marker of the insulin secretory capacity. We also evaluated the association between the proinsulin and insulin secretory capacities. RESULTS: Offspring of the type 2 diabetic patients had significantly lower AIRg SI and AUCinsulin (p<0.05), and tended to have lower AIRg (p=0.06), than the control subjects. However, there was no significant difference in the SI between the two groups. However, with the proinsulin, and the insulin, PI/I and C/I ratios, not significant differences were found between the offspring and the control subjects, and the PI/I ratio was not correlated with AIRg, AIRg x SI or SI. CONCLUSION: Insulin secretory defect could be a more prominent factor in the development of type 2 diabetes in Koreans, with no change in the proinsulin secretion.

High Sensitive C-reactive Protein and Carotid Intima Media Thickness in Korean Population.: Dae Jung Kim, Seung Hee Choi, Se Hwa Kim, Sang Su Chung, Chul Woo Ahn, Bong Soo Cha, Young Duk Song, Sung Kil Lim, Kyung Rae Kim, Hyun Chul Lee, Kap Bum Huh; Korean Diabetes J. 2003;27(1):49-62. Published online February 1, 2003

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Abstract PDF: BACKGROUND
A chronic inflammatory response is an important component in the development and progression of atherosclerosis. Since the development of the high-sensitive C-reactive protein (hs-CRP) assay, the association between subtle increases in the hs-CRP concentration and the development of atherosclerosis, has recently been reported. In this study, the relationship between hs-CRP, conventional cardiovascular risk factors and carotid intima media thickness (IMT), were investigated, and whether hs-CRP concentrations analyzed to see if it could be used as an independent risk factor, of early subclinical atherosclerosis in apparently healthy subjects. METHODS: This report was conducted as part of the Korean Metabolic Syndrome Study. Of 1,230 individuals having undergone a routine check-up, 849 were selected, based on their medical history of cardiovascular diseases. The hs-CRP was measured by an ELISA method, using human anti-CRP (CRP II Latex X2, Denka Seiken, Japan). RESULTS: The distribution of the hs-CRP concentration was positively skewed, and the hs-CRP levels ranged from 0.10 to 43.7 mg/L (mean 2.06, median 0.77 mg/L). There were significant positive correlations between the hs-CRP and age, BMI, waist, BP, insulin resistance (HOMA-IR) and the TC/HDL-C ratio. From a multiple regression analysis, independent relationships between the hs-CRP and obesity, hypertension, age ( 60 years), current smoking, male and insulin resistance were found. There were positive correlations between the carotid IMT and age, BMI, waist circumference, SBP, DBP, TC, TG, LDL-C, fasting blood glucose, HOMA-IR and hs-CRP, and a negative correlation between the carotid IMT and the HDL-C. From the multiple regression analysis, independent relationships between the carotid IMT and age, SBP, TC/HDLc, HOMA-IR, waist circumference, and DBP also persisted. After adjusting for the conventional risk factors in the multiple regression, there was no longer a significant relationship between the hs-CRP and the carotid IMT. CONCLUSION: There were strong correlations between the hs-CRP and the conventional cardiovascular risk factors, especially with that of obesity. Also, a highly significant association was also found between the hs-CRP and the carotid IMT. However, the hs-CRP, per se, is not a major independent risk factor of early subclinical atherosclerosis in Koreans.

Sex Hormone Binding Globulin, Body Fat Distribution and Insulin Resistance in Premenopausal Women.: Young Sook Lee, Hye Jin Lee, Jee Young Oh, Young Sun Hong, Yeon Ah Sung; Korean Diabetes J. 2003;27(1):63-72. Published online February 1, 2003

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Abstract PDF: BACKGROUND
Low levels of sex-hormone binding globulin (SHBG), an indirect index of androgenicity, have been reported to be associated with obesity, especially central obesity. In women, increased androgenicity is related to hyperinsulinemia, impaired glucose tolerance and the development of type 2 diabetes mellitus. Recent studies have suggested that the relationship between SHBG and insulin resistance was mediated by the change in total or visceral adiposity, and that ethnical differences in the relationship between sex hormone and body fat distribution might exist. METHODS: We examined the associations of SHBG to the body fat distribution and insulin resistance in Korean premenopausal women. The fasting serum level of SHBG was measured by RIA, and the insulin sensitivity by the minimal model derived sensitivity index (SI), using the insulin modified intravenous glucose tolerance test. The amount of body fat, and its distribution, were assessed by anthropometric measurement, bioelectric impedance analyses, and computed tomography at the level of the umbilicus. RESULTS: 1. SHBG was significantly inversely correlated with the body mass index (BMI), waist circumference, visceral fat area, and fasting insulin levels, and was significantly positively correlated to the SI. 2. SHBG was significantly lower in premenopausal women with an impaired glucose tolerance, compared to those with a normal glucose tolerance, and significantly lower in those with hypertension (systolic BP> or =140 mmHg or diastolic BP> or =90 mmHg), compared to those with normal blood pressure. SHBG was also significantly lower in persons with central obesity(waist circumference > or = 80 cm) compared to those without. 3. In a multiple linear regression analysis, the SI was significantly associated with SHBG, after adjustment for age, BMI, systolic blood pressure, triglycerides, HDL- cholesterol, and percentage body fat, but this association disappeared after additional adjustment for visceral fat area. 4. In a multiple linear regression analysis, the fasting plasma insulin, BMI and percentage body fat were significant independent factors associated with SHBG. CONCLUSION: Increased androgenicity as assessed by decreased serum SHBG concentrations, is strongly associated with an unfavorable body fat distribution, hypertension, glucose intolerance, hyperinsulinemia, and insulin resistance.

The Prevalence and Incidence of Diabetes in Mokdong, Seoul.: Jee Young Oh, Hye Jin Lee, Eun Soon Hong, Young Sun Hong, Yeon Ah Sung, Sun Hee Lee; Korean Diabetes J. 2003;27(1):73-83. Published online February 1, 2003

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Abstract PDF: BACKGROUND
Diabetes has recently become a major public health problem due to the socioeconomic changes in Korea. Epidemiological data for diabetes are needed to establish disease control and health improvement programs in the community. Considering the tendency for larger concentrations of the population in the urban areas of Korea, epidemiological studies in these areas are essential. This this was performed to determine the epidemiologic characteristics, prevalence, and incidence of diabetes in Korean urban communities. METHODS: The target cohort of this study was randomly selected from 20,222 residents living in the Mokdong apartment areas one, two, five and six, Yangcheon-Gu, Seoul. Of the 20,222 residents, 1,011 were residents, of which 766 (male 264, female 502) subjects participated and 372 subjects without diabetes at baseline examination followed up for 2 years. At the baseline and follow-up examination, all subjects underwent a 75g oral glucose tolerance test (OGTT) and anthropometric measurements (height, weight, waist to hip ratio, pulse rate, blood pressure, and subcutaneous skin fold thickness) were performed. RESULTS: There was an 8.5% prevalence of diabetes and 7.8% with impaired glucose regulation (IGR), including impaired glucose tolerance (IGT) and impaired fasting glucose (IFG). The age-adjusted prevalence of diabetes IGR were 8.4% and 7.1%, respectively. The prevalence of diabetes or IGR increased with increasing age. The prevalence of diabetes was associated with aging, family history of diabetes, and high levels of waist to hip ratio. The age-adjusted annual incidence rate of diabetes for subjects over 40 years of age at the baseline was 1.3%. The risk factors for the development of incident diabetes, from a multiple logistic regression analysis, were the waist to hip ratio and the 2-hour postload serum glucose concentrations. CONCLUSION: The prevalence of diabetes in the Mokdong apartment area was slightly higher than in Yonchon, Jungup, or Beijing. The annual incidence of diabetes was lower than that found in the studies in Yonchon or in Pima Indian, but higher than those of Caucasians or American Hispanics.

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