Diabetes & Metabolism Journal

Original Articles

Is A1C Variability an Independent Predictor for the Progression of Atherosclerosis in Type 2 Diabetic Patients?: Chul Sik Kim, So Young Park, Sung Hoon Yu, Jun Goo Kang, Ohk Hyun Ryu, Seong Jin Lee, Eun Gyung Hong, Hyeon Kyu Kim, Doo-Man Kim, Jae Myung Yoo, Sung Hee Ihm, Moon Gi Choi, Hyung Joon Yoo; Korean Diabetes J. 2010;34(3):174-181. Published online June 30, 2010; DOI: https://doi.org/10.4093/kdj.2010.34.3.174

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Background

Little is known about the relative contribution of long-term glycemic variability to the risk of macrovascular complications in type 2 diabetes. This study was conducted to evaluate the effect of A1C variability on the progression of carotid artery intima-media thickness (IMT) in type 2 diabetic patients.

Methods

Among type 2 diabetic patients who visited Hallym University Sacred Heart Hospital from March 2007 to September 2009, 120 patients who had carotid artery IMT measured annually and A1C checked every three months for at least one year were analyzed. Individual A1C variability was defined as the standard deviation (SD) of five A1C levels taken every three months for approximately one year. Change in IMT was defined as an increase in IMT on follow-up measurement. The association between the SD of A1C and changes in IMT was evaluated.

Results

With greater A1C variability, there was a greater increase in the mean IMT (r = 0.350, P < 0.001) of the carotid artery. After adjusting for confounding factors that may influence IMT, A1C variability was significantly associated with the progression of IMT (r = 0.222, P = 0.034). However, the SD of A1C was not a significant independent risk factor for the progression of IMT in multiple regression analysis (β = 0.158, P = 0.093).

Conclusion

Higher A1C variability is associated with IMT progression in type 2 diabetic patients; however, it is not an independent predictor of IMT progression. Overall glycemic control is the most important factor in the progression of IMT.

Citations

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Long-Term Risk of Cardiovascular Disease Among Type 2 Diabetes Patients According to Average and Visit-to-Visit Variations of HbA1c Levels During the First 3 Years of Diabetes Diagnosis
Hyunah Kim, Da Young Jung, Seung-Hwan Lee, Jae-Hyoung Cho, Hyeon Woo Yim, Hun-Sung Kim
Journal of Korean Medical Science.2023;[Epub] CrossRef
Association Between Long-Term Visit-to-Visit Hemoglobin A1c and Cardiovascular Risk in Type 2 Diabetes: The ACCORD Trial
Dan Huang, Yong-Quan Huang, Qun-Ying Zhang, Yan Cui, Tian-Yi Mu, Yin Huang
Frontiers in Cardiovascular Medicine.2021;[Epub] CrossRef
Association of Longitudinal Values of Glycated Hemoglobin With Cardiovascular Events in Patients With Type 2 Diabetes and Multivessel Coronary Artery Disease
Paulo Cury Rezende, Mark Andrew Hlatky, Whady Hueb, Rosa Maria Rahmi Garcia, Luciano da Silva Selistre, Eduardo Gomes Lima, Cibele Larrosa Garzillo, Thiago Luis Scudeler, Gustavo Andre Boeing Boros, Fernando Faglioni Ribas, Carlos Vicente Serrano, Jose An
JAMA Network Open.2020; 3(1): e1919666. CrossRef
Haemoglobin A1c variability as an independent correlate of atherosclerosis and cardiovascular disease in Chinese type 2 diabetes
Yifei Mo, Jian Zhou, Xiaojing Ma, Wei Zhu, Lei Zhang, Jie Li, Jingyi Lu, Cheng Hu, Yuqian Bao, Weiping Jia
Diabetes and Vascular Disease Research.2018; 15(5): 402. CrossRef
Relationship of HbA1c variability, absolute changes in HbA1c, and all-cause mortality in type 2 diabetes: a Danish population-based prospective observational study
Mette V Skriver, Annelli Sandbæk, Jette K Kristensen, Henrik Støvring
BMJ Open Diabetes Research & Care.2015; 3(1): e000060. CrossRef
Association between hemoglobin A1c variability and subclinical coronary atherosclerosis in subjects with type 2 diabetes
Hae Kyung Yang, Borami Kang, Seung-Hwan Lee, Kun-Ho Yoon, Byung-Hee Hwang, Kiyuk Chang, Kyungdo Han, Gunseog Kang, Jae Hyoung Cho
Journal of Diabetes and its Complications.2015; 29(6): 776. CrossRef
Glycated hemoglobin as a marker of subclinical atherosclerosis and cardiac remodeling among non-diabetic adults from the general population
Robin Haring, Sebastian E. Baumeister, Wolfgang Lieb, Bettina von Sarnowski, Henry Völzke, Stephan B. Felix, Matthias Nauck, Henri Wallaschofski
Diabetes Research and Clinical Practice.2014; 105(3): 416. CrossRef
HbA1c Variability and Micro- and Macrovascular Complications of Diabetes
Hae Kyung Yang, Seung-Hwan Lee
The Journal of Korean Diabetes.2014; 15(4): 202. CrossRef
HbA1c variability and the development of microalbuminuria in type 2 diabetes: Tsukuba Kawai Diabetes Registry 2
A. Sugawara, K. Kawai, S. Motohashi, K. Saito, S. Kodama, Y. Yachi, R. Hirasawa, H. Shimano, K. Yamazaki, H. Sone
Diabetologia.2012; 55(8): 2128. CrossRef

Risk Factors for Early Development of Macrovascular Complications in Korean Type 2 Diabetes.: Hae Ri Lee, Jae Myung Yu, Moon Gi Choi, Hyung Joon Yoo, Eun Gyoung Hong; Korean Diabetes J. 2009;33(2):134-142. Published online April 1, 2009; DOI: https://doi.org/10.4093/kdj.2009.33.2.134

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Abstract PDF

BACKGROUND
The average duration of diabetes and predictive factors of macrovascular complications in Korean diabetic patients remain to be elucidated. This study examines the average duration of diabetes up to the onset of macrovascular complications and clinically important factors of early development of these complications in Korean type 2 diabetic patients. METHODS: Clinical characteristics in type 2 diabetics with (n = 121) and without macrovascular complications (n = 115) were analyzed. In addition, early onset (< or = 5 years, n = 54) and late onset groups (> 5 years, n = 67) were compared, as were the clinical characteristics between male and female patients in the macrovascular complications group. RESULTS: The average duration of diabetes was 8.7 +/- 7.8 years in the macrovascular complications group. Average age, systolic and diastolic blood pressures and smoking history were all higher in the macrovascular complications group than the control group. However, HbA1c levels and prevalence of microvascular complications were higher in the controls. Average age was lower in the early onset group and many more patients of that group had a smoking history. In the analysis based on sex, marcrovascular complications developed earlier in male patients. In addition, the prevalence of family history of diabetes was higher in males and 77.8% of male patients had a smoking history (female: 3.4%). CONCLUSION: Our study confirms that older age, high blood pressure and smoking history are major risk factors for the development of macrovascular complications. Moreover, a smoking history in males can be both risk and predictive factors for earlier development of macrovascular complications in Korean type 2 diabetic patients. We also found that several clinical characteristics including age, family history of diabetes, hypertension and smoking history, vary between the sexes, and these findings can provide useful indices for the prevention of macrovascular complications.

Citations

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Impact of new-onset diabetes on clinical outcomes after ST segment-elevated myocardial infarction
Ji-Yeoun Seo, Jin-Sun Park, Kyoung-Woo Seo, Hyoung-Mo Yang, Hong-Seok Lim, Byoung-Joo Choi, So-Yeon Choi, Myeong-Ho Yoon, Gyo-Seung Hwang, Seung-Jea Tahk, Joon-Han Shin
Scandinavian Cardiovascular Journal.2019; 53(6): 379. CrossRef
Associations Between the Continuity of Ambulatory Care of Adult Diabetes Patients in Korea and the Incidence of Macrovascular Complications
Young-Hoon Gong, Seok-Jun Yoon, Hyeyoung Seo, Dongwoo Kim
Journal of Preventive Medicine and Public Health.2015; 48(4): 188. CrossRef
Relationship of Daily Activity and Biochemical Variables in the Elderly with Diabetes Mellitus
Ki-Wol Sung
Journal of Korean Academy of Nursing.2011; 41(2): 182. CrossRef
Epidemiology of Micro- and Macrovascular Complications of Type 2 Diabetes in Korea
Jung Hee Kim, Dae Jung Kim, Hak Chul Jang, Sung Hee Choi
Diabetes & Metabolism Journal.2011; 35(6): 571. CrossRef

The Relationship of Family Support with Blood Glucose Control in Elderly Type 2 Diabetic Patients.: Eun Suk Kim, Seong Jin Lee, Ohk Hyun Ryu, Jee Youn Lee, Hyun Suk Yun, Moon Gi Choi; Korean Diabetes J. 2007;31(5):435-443. Published online September 1, 2007; DOI: https://doi.org/10.4093/jkda.2007.31.5.435

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Abstract PDF

BACKGROUND
With the extension of human life span, the prevalence of diabetes in elderly population is increasing. The glycemic control is also important in elderly diabetics because the life expectancy in elderly is steadily increased. In this study, we investigated the role of family support on glycemic control in elderly type diabetic patients. METHODS: This study was conducted with 126 type 2 diabetic patients over 60 years of age who were enrolled between March and December, 2005. The data for glycemic control, family characteristics, and family support were collected by structured questionnaire, personal interview, and medical record review. We used total supportive index scores to evaluate family support. We evaluated the relationship between family support and glycemic control. RESULTS: Fasting plasma glucose was positively correlated with duration of diabetes (r = 0.277, P = 0.003). Postprandial 2 hour plasma glucose was negatively correlated with monthly incomes (r = -0.357, P = 0.002), assessment support (r = -0.201, P = 0.029). Hemoglobin A1c was positively correlated with duration with diabetes (r = 0.294, P = 0.002) and insulin use (r = 0.259, P = 0.004), but it was negatively correlated with diabetic self-management education (r = -0.190, P = 0.036). Adjusted for age, sex, duration of diabetes, and monthly incomes, there were no significant associations between glycemic control and family support. CONCLUSION: In this study, there were no significant associations between glycemic control and family support. More large prospective studies will be followed to exactly evaluate the role of family support in diabetic patients.

Citations

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The role of psychological insulin resistance in diabetes self‐care management
Ancho Lim, Youngshin Song
Nursing Open.2020; 7(3): 887. CrossRef
A Predictive Model of Health Outcomes for Young People with Type 2 Diabetes
Sun Young Jung, Sook Ja Lee, Sun Hee Kim, Kyung Mi Jung
Asian Nursing Research.2015; 9(1): 73. CrossRef
Factors Influencing Self-Care Behaviors Related to Insulin Therapy in Elders with Diabetes Mellitus
Na-Yeong Sohn, Jin-Hyang Yang
Journal of Korean Academy of Fundamentals of Nursing.2013; 20(1): 27. CrossRef
Perception of social support by individuals with diabetes mellitus and foot ulcers
Ana Laura Galhardo Figueira, Lílian Cristiane Gomes Villas Boas, Maria Cristina Foss de Freitas, Milton César Foss, Ana Emilia Pace
Acta Paulista de Enfermagem.2012; 25(spe1): 20. CrossRef
The impact of family support on metabolic control in patients with type 2 diabetes
Agata Matej-Butrym, Marek Butrym, Andrzej Jaroszyński
Zdrowie Publiczne.2012; 122(3): 265. CrossRef
Effects of Low Glycemic Index Nutrition Education on the Blood Glucose Control in Patients with Type 2 Diabetes Mellitus
Mi-Ja Kim, Sunja Kwon, Sun Yung Ly
The Korean Journal of Nutrition.2010; 43(1): 46. CrossRef
Relationships of family support, diet therapy practice and blood glucose control in typeII diabetic patients
Jeong-Ok Yun, Ki-Nam Kim
Nutrition Research and Practice.2009; 3(2): 141. CrossRef

Effects of Type 2 Diabetes Mellitus on Risk Factors of Acute Coronary Syndrome.: Hong Ju Moon, Jun Goo Kang, Min Ho Jo, Byung Wan Lee, Cheol Young Park, Seong Jin Lee, Eun Kyung Hong, Jae Myoung Yu, Doo Man Kim, Sung Hee Ihm, Hyun Kyu Kim, Chong Yun Rhim, Moon Gi Choi, Hyung Joon Yoo, Sung Woo Park; Korean Diabetes J. 2006;30(6):435-441. Published online November 1, 2006; DOI: https://doi.org/10.4093/jkda.2006.30.6.435

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Abstract PDF

BACKGROUND
Diabetes mellitus (DM) is equivalent as well a risk factor of cardiovascular disease. We analyzed the effects of DM on clinical risk factors of acute coronary syndrome by comparing DM group with Non-DM group. METHODS: A total of 847 (514 males and 333 females) patients with acute coronary syndrome was selected from 1664 patients who had undergone coronary angiography (CAG). These patients comprised 105 subjects with non-ST elevation myocardial infarction (MI), 313 with ST elevation MI and 429 with unstable angina. According to the presence of DM, we retrospectively reviewed the measured basic demographics, biochemical markers and coronary angiographic findings. RESULTS: In the multivariated analysis, history of hypertension (P = 0.001), C-reactive protein (CRP) level (P = 0.001) and triglyceride level (P = 0.018) were independent risk factors in type 2 diabetic group. Also the frequency of multiple coronary vessel disease was higher in DM group than non-DM group on the coronary angiographic finding CONCLUSIONS: Classic risk factors for acute coronary syndrome are strong predictors in patients with type 2 DM. Among these factors, the most important powerful risk factor is history of hypertension.

Citations

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Gender-Based Differences in the Management and Prognosis of Acute Coronary Syndrome in Korea
Hee Tae Yu, Kwang Joon Kim, Woo-Dae Bang, Chang-Myung Oh, Ji-Yong Jang, Sung-Soo Cho, Jung-Sun Kim, Young-Guk Ko, Donghoon Choi, Myeong-Ki Hong, Yangsoo Jang
Yonsei Medical Journal.2011; 52(4): 562. CrossRef

The Relationship Between the C1818T Polymorphism in Exon 4 of the klotho Gene with Fasting Glucose and Insulin Levels in Korean Women.: Ki Won Oh, Eun Joo Yun, Eun Jung Rhee, Won Young Lee, Ki Hyun Baek, Kun Ho Yoon, Moo Il Kang, Seong Gyun Kim, Cheol Young Park, Sung Hee Ihm, Moon Gi Choi, Hyung Joon Yoo, Sung Woo Park; Korean Diabetes J. 2005;29(3):189-197. Published online May 1, 2005

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Abstract PDF: BACKGROUND
A novel gene, termed klotho has been identified as a suppressor of several aging phenotypes, and a genetic defect of klotho in mice resulted in a syndrome resembling human aging, i.e., a short lifespan, infertility, arteriosclerosis, skin atrophy, osteoporosis, and pulmonary emphysema. Since klotho mice also showed an abnormal glucose metabolism, we investigated the relationship between the C1818T polymorphism in exon 4 of the klotho gene and fasting glucose and insulin resistance in Korean women to observe its contribution to glucose metabolism. METHODS: The weight, height, blood pressure, fasting blood glucose, insulin, and lipid profiles were measured in 241 women(mean age, 51.2+/-7.0yr) by using the standard methods. Homeostasis model assessment(HOMA)-insulin resistance(IR), the quantitative insulin sensitivity check index(QUICKI) and HOMAbeta-cell were calculated. The genotyping of the C1818T polymorphism in exon 4 of the klotho gene was performed by allelic discrimination with using a 5' nuclease polymerase chain reaction assay. RESULTS: The allele frequencies were 0.805 for the C allele and 0.195 for the T allele, and they were in Hardy-Weinberg equilibrium(P=0.290). The mean fasting blood glucose(P= 0.005) and HOMA IR(P=0.035) were significantly higher in the T allele carriers compared with the non-carriers. After adjustment was made for age, fasting blood glucose was persistently significant(P=0.015), but the HOMA-IR became marginally significant(P=0.063). In the premenopausal women, the T allele carriers showed a higher mean fasting blood glucose(P=0.038), insulin(P=0.024), HOMA-IR(P=0.010), total cholesterol(P=0.039), and triglyceride levels(P=0.031) than in the non-carriers. After adjustment was made for age, the fasting blood glucose, insulin, HOMA-IR and triglyceride were persistently significant(P= 0.043, P=0.026, P=0.011, P=0.040). Also, the QUICKI, total cholesterol and low-density ilpo-protein cholesterol became marginally significant(P=0.073, P=0.061, P=0.098). For the postmenopausal women, the T allele carriers showed a tendency for higher mean fasting blood glucose levels(P=0.065) and lower HOMA beta-cell levels(P=0.085) than in the noncarriers. These differences became non-significant after adjustment was made for age. CONCLUSION: We observed that the C1818T polymorphism in exon 4 of the klotho gene was partly associated with glucose metabolism in Korean women. Also, these data suggest that the C1818T polymorphism is related with some cardiovascular risk factors in Korean women. The mechanism linking this gene with glucose metabolism warrants further study

Effect of Glucose Concentrations on the Cell Proliferation and Expression of L-type Calcium Channel mRNA in Cultured Rat Aortic Vascular Smooth Muscle Cells.: Young Jung Cho, Hyung Joon Yoo, Hong Woo Nam, Ji Young Suh, In Kyung Jeong, Sung Hee Ihm, Hyeon Kyu Kim, Cheol Young Park, Jae Myung Yoo, Doo Man Kim, Moon Gi Choi, Sung Woo Park; Korean Diabetes J. 2003;27(3):253-259. Published online June 1, 2003

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Abstract PDF: BACKGROUND
Vascular smooth muscle cell (VSMC) proliferation is one of the major pathogenic mechanisms for atherosclerosis. It is known that L-type calcium channels play a role in VSMC proliferation in diabetic rats. However, there have been no studies that show an association between the L-type calcium channels and the VSMC proliferation due to various glucose concentrations in the culture media. Therefore, the association between the voltage-dependent L-type calcium channels of the VSMCs, and the growth of vascular smooth muscle cells, was examined. METHODS: Rat aortic VSMCs were isolated from the aorta of Sprague-Dawley and OLETF rats, using an enzymic method. The VSMCs were cultured in various concentrations of glucose (5.5, 11.0, 16.6, 25, 30 and 40 mM). The VSMCs (1x10(4) cells in 24-well plates) were incubated in the presence of Bay K 8644 (10(-6)M), both with and without verapamil (10(-6)M), for 48 hours. The proliferation was then assessed by the MTT (methylthiazole tetrazolium) assay, and the expression of L-type calcium channel mRNA by RT-PCR. RESULTS: The vascular smooth muscle cell proliferation was significantly increased, in a dose-dependent manner, with glucose concentrations below 25 mM in both in a dose-dependent manner, with glucose concentrations below 25 mM in both kinds of rat. However, the increase in the VSMC proliferation of the OLETF rat was significantly higher than in the Sprague-Dawley rat. After the Bay K 8644 treatment, with the same glucose concentration, the VSMC proliferation and the expression of L-type calcium channel mRNA were significantly increased in both kinds of rat. After treatment with verapamil, the increased VSMC proliferation and expression of L-type calcium channel mRNA, due to the Bay K 8644, were suppressed to control levels in both kinds of rat. CONCLUSION: The results suggest that below certain concentrations of glucose, 25 mM, the L-type calcium channels may play a role in the VSMC proliferation of OLETF and Sprague-Dawley rats. The growth of the VSMCs in OLETF rats, due to various glucose concentrations (< 25 mM), was significantly higher than in the Sprague-Dawley rats.

The Relation of Diabetes Control to Stress Amounts Associated with Life Events in Diabetics.: Jung Won Lim, Hyung Joon Yoo, Kyung Ae Choi, Sung Hee Lim, Yoo Sun Chung, Sung O Seo, Chul Su Choi, Hyun Kyu Kim, Jae Myung Yoo, Doo Man Kim, Moon Gi Choi, Sung Woo Park, Young Joong Cho; Korean Diabetes J. 2001;25(3):240-249. Published online June 1, 2001

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Abstract PDF: BACKGROUND
The life events which diabetic patients experience has an influence on conduct and communication pattern that is essential to control diabetes. The psychosocial life events which patients experienced in recently, as well as in the past has an important meanings in the process of the plan, implementation and evaluation of diabetic control. However, the most researches on this issues are scanty. Thus, we evaluated the relation of diabetic control to stress amounts associated with the life event which diabetic patients experience for the past one year. METHODS: In this study, 81 diabetic patients admitted to H hospital from March, 1999 to February 2000 were examined in stress amounts associated with life events, blood sugar, HbA1C, duration, complication, family history, treatment to inspect the hypothesis that stress experiences for recent 1 year are related to diabetic control. The 'Life Psychosocial Event Scale' invented by Lee was used. To examine the hypothesis that diabetic control may be influenced by the amount of stress, we investigated the difference of the means between the two groups (upper 30% of patients vs. lower 30% of patients) by T-test. RESULTS: The mean age was 56.9+/-15.1 years and the mean duration of diabetes was 8.9+/-7 years. Fasting plasma glucose (FPG) was 200.3+/-71.0 mg/dL, PP2 was 292.9+/-87.2 mg/dL, HbA1C was 10.5+/-2.6%, complication was 0.8+/-0.9. The age showed negative correlation with stress amounts. The other variables did not show significant correlation with stress amounts. Thus, our study indicated that the hypothesis that stress experiences for recent 1 year are related to diabetic control was rejected. However, considering the perception-phenomenological approach on stress, if we study the relationship between stress with diabetic control inclusively, it seems that we can recognize such relationship. CONCLUSION: To address relation between stress with diabetic control inclusively, we need to consider stress factors in diversified aspects more than only one. Therefore, we must investigate how do patients perceive and cope with stress inclusively, because the crisis of life is influenced on the stress coping skill of patients. The study on this issue must be continued to identified the key factors associated with stress in diabetes.

Risk Factors of Peripheral Vascular Disease (PVD) and Nutritional Factors in Diabetic Patients over 60 Years Old Complicated with PVD Diagnosed by Ankle-Brachial Index ( ABI ).: Yoo Sun Chung, Hyung Joon Yoo, Sung O Seo, Hyun Kyu Kim, Doo Man Kim, Jae Myung Yoo, Sung Hee Ihm, Moon Gi Choi, Sung Woo Park; Korean Diabetes J. 1999;23(6):814-821. Published online January 1, 2001

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Abstract PDF: BACKGROUND
The subjects with diabetes mellitus are at high risk for peripheral vascular disease (PVD). The ABI (Ankle-Brachial Index) was done for diagnosis of PVD in diabetes. Numerous studies have been conducted to determine the risk factors for diabetes PVD. Most of the risk factors have been found are largely affected by the age and patients nutritional status to some extent. Especially in older diabetes, risk factors cannot be evaluated by numerical values only, for most patients are in background of poor nutritional support. Therefore, in this study, our aim was to evaluate on the influences of the nutritional status as the risk factors for PVD in older patients, ie., 60 years and older. METHODS: We selected 59 patients who are above 60 years old and took neither anti-hypertensive drug nor lipid lowering agents. All subjects ABI was measured by IMEXLAB 9000 and the study group was stratified according to the ABI values: the normal (ABI >10), PVD group (ABI <0.9). The ABI (Ankle-Brachial Index) was measured by The data were analyzed using one-way analysis of variance. If statistically significant effect was found, post hoc analysis (e.g., Newman-Keuls' test) was performed to evaluate the difference between the groups. The values are expressed as the mean+/-standard error (SE). RESULT: There was significant difference in smoking (ABI < 0.9; 0.54+/-0.16 packs/day, ABI > 1.0; 0.35+/-0.08 packs/day), the serum level triglyceride(ABI < 0.9; 1.960.19 mmol/L, ABI > 1.0; 1.56 + 0.21 mmol/L), HDL-cholesterol(ABI < 0.9; 0.88+/-0.11 mmol/L, ABI > 1.0; 1.10+/-0.08 mmol/1) when compared between the normal and ABI decreased subjects(P < 0.05). However, we found no significant differences in systolic blood pressure, total cholesterol and LDL-C between the two groups. Serum level of the nutritional factors such as albumin, transferrin, total lympocyte count, folate, zinc were lower than the normal values in both groups. However, these levels were not statistically significant when two groups compared. CONCLUSION: The relationship between the known PVD risk factors and PVD in older diabetes was weak. Therefore, based on the findings from this study, we suggest that when investigators interpretate the risk factors of PVD in elderly patients one must consider nutritional effects along the other factors.

Proliferative Ability of Aortic Smooth Muscle Cells and Lipid Peroxidation of Red Blood Cell Membrane in Diabetic Rats.: Sae Young Park, Hyung Joon Yoo, Kyun Soo Kim, Hyun Kyu Kim, Doo Man Kim, Jae Myung Yoo, Sung Hee Ihm, Moon Gi Choi, Sung Woo Park; Korean Diabetes J. 1999;23(6):785-792. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Diabetes mellitus is a known risk factor for atherosclerosis, and lipid peroxidation, expression of oxidative stress, is also known to related to diabetes mellitus. The purpose of this study was to investigate the proliferative behaviour of cultured vascular smooth muscle cells (VSMCs) and the alteration of lipid peroxidation in relation to the pathogenesis of diabetic atherosclerosis. METHODS: Seven streptozotocin-induced insulin dependent diabetic Sprague Dawley rats and 7 normal rats were studied. Using enzyme method, aortic VSMCs was cultured in diabetic rats. and proliferation was compared between normal and diabetic rat. The membrane lipid peroxidaton of erythrocytes was determined by measurement of malonyl- dialdehyde(MDA), an end-product of fatty acid peroxidation with thiobarbituric acid (TBA) reaction. MDA-TBA colored complex concentration was calculated with the extinction coefficient of MDA-TBA complex at 532nm = 1.56X105cm-lM-1. RESULT: 1. The proliferative ability of cultured VSMCs was much higher in diabetic rats than in nondiabetic ones (p<0.05). 2. Compared with normal control rats, MDA concentration of diabetic rats was significantly increased (p<0.05). CONCLUSION: We concluded that proliferation of cultured VSMCs is due to oxidative stress in diabetes mellitus as a result of the increased proliferative ability of cultured VSMCs combined with increased lipid pemxidation in diabetic rats.

Metabolic Factors Influencing Serum Potassium Levels in Diabetic Ketoacidosis.: Sung Jin Kim, Seung Oh Suh, Sung Hee Ihm, Hyun Kyu Kim, Doo Man Kim, Jae Myung Yoo, Moon Gi Choi, Hyung Joon Yoo; Korean Diabetes J. 1999;23(5):661-668. Published online January 1, 2001

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Abstract PDF: BACKGROUND
The serum K level is normal or high in the majority of patients with diabetic ketoacidosis (DKA) despite significant total body K+ deficits. This might be due to the combined effects of severe acidosis, insulin deficiency, volume contraction, hyperglycemia and hypertonicity that usually accompany DKA. The aim of this study was to investigate the most likely determinants of the serum K+ levels among metabolic derangements observed in DKA patients. METHODS: The subjects were 88 DKA patients who had normal or high initial serum K+ levels. We anaylzed the correlation between initial serum K' levels and metabolic parameters (arterial pH, arterial HCO(3-) level, anion gap, serum glucose level, osmolality, BUN and fasting C-peptide levels), by simple linear regression analysis and stepwise multiple regression analysis. RESULT: Serum K+ levels correlated significantly with initial arterial pH(r=-0.38, p<0.001), HCO(3-) (r=-0.35, p<0.001), anion gap(r=0.21, p<0.05), serum glucose (r=0.22, p<0.05) and fasting C-peptide (r=-0.33, p<0.05) levels. Among these, arterial HCO(3-), serum glueose and fasting C-peptide levels had significant and independent effects on serum K+ levels. These levels could account for about 33% of the observed variance in serum K+ levels. CONCLUSION: These results suggest that metabolic acidosis and hyperglycemia in DKA, which result primarily from insulin deficit, are the main determinants of increased serum K+ levels.

HbA1c Concentration of Elderly Diabetic Patients with the Hypoglycemic Shock who were Admitted via Emergency Room.: Jin Cheol Park, Hyung Joon Yoo, Hae Seang Yim, Yong Tae Kim, Do Kyun Jin, Hyun Kyu Kim, Doo Man Kim, Jae Myung Yoo, Sung Hee Ihm, Moon Gi Choi, Sung Woo Park; Korean Diabetes J. 1998;22(4):546-551. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Mild degree of hypoglycemia is not unusual during drug therapy in elderly diabetic patients. However it is very difficult that the precise incidence of hypoglycemia is measured in elderly patients because the decreased cognitive function and autonomic dysfunction contribute to atypical hypoglycemic symptoms and signs. Therefore, most cases of elderly diabetic patients with hypoglycemia are discovered in comatose mental state. We did this study to evaluate the clinical charaeteristics of elderly diabetic patients with the hypoglycemic shock who were admitted via emergency room. METHODS: We analyzed the precipitating factors, mental status, and blood chemistries of the adult group(n=22, age 51+3.6 year, BMI-19 kg/m2) and elderly group(n=37, age=72+4.3 year, BMI=23 kg/m) that were classified by the point of 65 years old who were admitted via emergency room in state of the hypoglycemic shock. RESULTS: 1) In the precipitating factor of hypoglycemia, irregular oral intake was found in 64%(14/22) of the adult group and 64%(23/37) of the elderly group, and drug overdose was found in 27 %(1.6/22) of the adult group and 24%(9/37) of the elderly group. But there, was no significant difference between the adult and elderly group. 2) Those who arrived at the emerency room in comatose mental status were found in 45.5 % of adult group and 54.1 % of elderly group, that was no difference stastically. 3) HbA 1c was 5.8 +- 0.27% in elderly group and 8.0 +- 0.63% in the adult group who arrived at the emergency room, which was stastically significant difference between two groups. CONCLUSION: We concluded that lower HbA 1c in the elderly group than adult group who arrived at the emergency room suggest there was probability of unrecognized mild hypoglycemia before the onset of hypoglycemic shock.

Prognostic Factors in the Elderly Diabetic Hyperosmolar Non-ketotic Coma.: Min Sook Park, Hyung Joon Yoo, Sun Hwa Jung, Kwon Yeop Lee, Cheol Soo Park, Cheol Hong Kim, Hyun Gyu Kim, Jae Myeog Yoo, Du Man Kim, Sung Hee Ihm, Moon Gi Choi, Sung Woo Park; Korean Diabetes J. 1997;21(2):194-199. Published online January 1, 2001

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Abstract PDF: OBJECTIVES
: The diabetic hyperosmolar non-ketotic coma represents an acute complication of diabetes affecting mostly elderly persons with non-insulin dependent diabetes rnellitus. It is characterized by marked hyperglycemia, hyperosmolarity, severe dehydration, occasional neurologic signs, obtunded sensorium, and absence of ketonemia or acidosis. Most investigators have evaluated the relationship of predisposing conditions with HNKC, to evaluate outcome of the elderly HNKC we studied the prognostic factors in the elderly HNKC. Patients and METHODS: We retrospectively studied 43 patients with HNKC admitted to Hospital of Hallym University during an 6-year period, 1990 through 1995. All medical records of elderly patients (65 years old or more) discharged with the diagnosis of HNKC, were reviewed. To be included as a case, patients had to have a serum glucose level greater than 500mg/dL, measured plasma osmolarity greater than 320mOsm/L, pH greater than 7.30 and disoriented sensorium. 1nformation that was gathered age, glucose, blood urea nitrigen, creatinine, Na+, K+, HCO3-, anion gap, plasma osmolarity, urine osmolarity and whether the patients was discharged alive or died in the hospital. Data were analyzed by one-factor ANOVA and significance of difference between proportions was calculated by Newman-Keuls test. RESULTS: Survivors of 43 elderly HNKC were 22 patients and non-survivors were 21 patients. Mortality was 49%. Analysis revealed that the plasma osmolarity was significantly higher among those who non-survivors (376 +/- 10.8versus 331 +/- 5.0mOsm/L, p 0.01). Non-survivors also had significantly higher serum creatinine level than survivors (2.1+/-0.41versus 1.6 +/- 0.18mg/dL, p = 0.024) Conelusion: These results suggest that the prognostic factors of elderly HNKC were plasma osrnolarity and serum creatinine level.

Fasting plasma glucose levels determine insulin response to glucosein NIDDM.: Sung Woo Park, Young Bae Kwon, Chul Woo Lee, Sung Hee Ihm, Moon Gi Choi, Byung Tae Kim, Yeon Bok Chang, Hyung Joon Yoo, Ki Up Lee; Korean Diabetes J. 1992;16(4):289-297. Published online January 1, 2001

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