Diabetes & Metabolism Journal

Original Articles

Clinical Diabetes and Therapeutics
Cardio-Ankle Vascular Index as a Surrogate Marker of Early Atherosclerotic Cardiovascular Disease in Koreans with Type 2 Diabetes Mellitus: So Young Park, Sang Ook Chin, Sang Youl Rhee, Seungjoon Oh, Jeong-Taek Woo, Sung Woon Kim, Suk Chon; Diabetes Metab J. 2018;42(4):285-295. Published online July 27, 2018; DOI: https://doi.org/10.4093/dmj.2017.0080

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Background

Carotid artery intima medial thickness (IMT), brachial-ankle pulse wave velocity (baPWV), and ankle-brachial index (ABI) are commonly used surrogate markers of subclinical atherosclerosis in patients with type 2 diabetes mellitus (T2DM). The cardio-ankle vascular index (CAVI) is a complement to the baPWV, which is affected by blood pressure. However, it is unclear which marker is the most sensitive predictor of atherosclerotic cardiovascular disease (ASCVD).

Methods

This was a retrospective non-interventional study that enrolled 219 patients with T2DM. The correlations among IMT, ABI, and CAVI as well as the relationship of these tests to the 10-year ASCVD risk were also analyzed.

Results

Among the 219 patients, 39 (17.8%) had ASCVD. In the non-ASCVD group, CAVI correlated significantly with IMT after adjusting for confounding variables, but ABI was not associated with CAVI or IMT. The analyses after dividing the non-ASCVD group into three subgroups according to the CAVI score (<8, ≥8 and <9, and ≥9) demonstrated the significant increase in the mean IMT, 10-year ASCVD risk and number of metabolic syndrome risk factors, and decrease in the mean ABI in the high-CAVI group. A high CAVI was an independent risk factor in the non-ASCVD group for both a high 10-year ASCVD risk (≥7.5%; odds ratio [OR], 2.42; P<0.001) and atherosclerosis (mean IMT ≥1 mm; OR, 1.53; P=0.007).

Conclusion

In Korean patients with T2DM without ASCVD, CAVI was the most sensitive of several surrogate markers for the detection of subclinical atherosclerosis.

Citations

Citations to this article as recorded by

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Association of cardio-ankle vascular index and future major adverse cardiovascular events in older adults living with HIV
Amaraporn Rerkasem, Arunrat Tangmunkongvorakul, Linda Aurpibul, Patumrat Sripan, Wason Parklak, Sothida Nantakool, Kriengkrai Srithanaviboonchai, Kittipan Rerkasem
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Impact of Fasting Blood Glucose Levels on Blood Pressure Parameters among Older Adults with Prediabetes
Thapanee Roengrit, Ruchada Sri-Amad, Nawiya Huipao, Suphawadee Phababpha, Piyapong Prasertsri, Francesco Giallauria
The Scientific World Journal.2023; 2023: 1. CrossRef
A framework of biomarkers for vascular aging: a consensus statement by the Aging Biomarker Consortium
Le Zhang, Jun Guo, Yuehong Liu, Shimin Sun, Baohua Liu, Qi Yang, Jun Tao, Xiao-Li Tian, Jun Pu, Huashan Hong, Miao Wang, Hou-Zao Chen, Jie Ren, Xiaoming Wang, Zhen Liang, Yuan Wang, Kai Huang, Weiqi Zhang, Jing Qu, Zhenyu Ju, Guang-Hui Liu, Gang Pei, Jian
Life Medicine.2023;[Epub] CrossRef
Diastolic Pressure and ACR Are Modifiable Risk Factors of Arterial Stiffness in T2DM Without Cardiovascular Disease
Gateano Leto, Lida Tartaglione, Silverio Rotondi, Marzia Pasquali, Ernesto Maddaloni, Carmen Mignogna, Luca D’Onofrio, Simona Zampetti, Angela Carlone, Maria Luisa Muci, Daniela Mastroluca, Valeria Fassino, Raffaella Buzzetti, Sandro Mazzaferro
The Journal of Clinical Endocrinology & Metabolism.2022; 107(9): e3857. CrossRef
Risk assessment indicators and brachial-ankle pulse wave velocity to predict atherosclerotic cardiovascular disease
Hung-Ju Ko, Chuan-Chuan Liu, Po-Jui Hsu, Kuang-Chun Hu, Chung-Lieh Hung, Lo-Yip Yu, Yun-Chieh Huang, Shou-Chuan Shih
Medicine.2022; 101(32): e29609. CrossRef
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Jung-Hwa Kim, Jin-Woo Jeong
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Cardio-ankle vascular index represents the best surrogate for 10-year ASCVD risk estimation in patients with primary hypertension
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The Relationship Between Glycemic Control and Concomitant Hypertension on Arterial Stiffness in Type II Diabetes

Teonchit Nuamchit, Duangduan Siriwittayawan, Piyanuch Thitiwuthikiat
Vascular Health and Risk Management.2020; Volume 16: 343. CrossRef
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Association of Kidney Function Tests with a Cardio-Ankle Vascular Index in Community-Dwelling Individuals with a Normal or Mildly Decreased Estimated Glomerular Filtration Rate
Javad Alizargar, Chyi-Huey Bai, Nan-Chen Hsieh, Shu-Fang Vivienne Wu, Shih-Yen Weng, Jia-Ping Wu
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Sajad Hamal, Lavanya Cherukuri, Divya Birudaraju, Suguru Matsumoto, April Kinninger, Bhanu Chaganti, Ferdinand Flores, Kashif Shaikh, Sion Roy, Matthew Budoff
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Response: Cardio-Ankle Vascular Index as a Surrogate Marker of Early Atherosclerotic Cardiovascular Disease in Koreans with Type 2 Diabetes Mellitus (Diabetes Metab J 2018;42:285-95)
So Young Park, Suk Chon
Diabetes & Metabolism Journal.2018; 42(5): 449. CrossRef
Letter: Cardio-Ankle Vascular Index as a Surrogate Marker of Early Atherosclerotic Cardiovascular Disease in Koreans with Type 2 Diabetes Mellitus (Diabetes Metab J 2018;42:285-95)
Dongwon Yi
Diabetes & Metabolism Journal.2018; 42(5): 447. CrossRef

A Smartphone Application Significantly Improved Diabetes Self-Care Activities with High User Satisfaction: Yu Jin Kim, Sang Youl Rhee, Jong Kyu Byun, So Young Park, Soo Min Hong, Sang Ouk Chin, Suk Chon, Seungjoon Oh, Jeong-taek Woo, Sung Woon Kim, Young Seol Kim; Diabetes Metab J. 2015;39(3):207-217. Published online April 22, 2015; DOI: https://doi.org/10.4093/dmj.2015.39.3.207

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Abstract PDF PubReader

Background

We developed for the first time a smartphone application designed for diabetes self-management in Korea and registered a patent for the relevant algorithm. We also investigated the user satisfaction with the application and the change in diabetes related self-care activities after using the application.

Methods

We conducted a questionnaire survey on volunteers with diabetes who were using the application. Ninety subjects responded to the questionnaire between June 2012 and March 2013. A modified version of the Summary of Diabetes Self-Care Activities (SDSCA) was used in this study.

Results

The survey results exhibited a mean subject age of 44.0 years old, and males accounted for 78.9% of the subjects. Fifty percent of the subjects had diabetes for less than 3 years. The majority of respondents experienced positive changes in their clinical course after using the application (83.1%) and were satisfied with the structure and completeness of the application (86.7%). Additionally, the respondents' answers indicated that the application was easy to use (96.7%) and recommendable to others (97.7%) and that they would continue using the application to manage their diabetes (96.7%). After using the Diabetes Notepad application, diabetes related self-care activities assessed by SDSCA displayed statistically significant improvements (P<0.05), except for the number of days of drinking.

Conclusion

This smartphone-based application can be a useful tool leading to positive changes in diabetes related self-care activities and increase user satisfaction.

Citations

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Hemoglobin A1c May Be an Inadequate Diagnostic Tool for Diabetes Mellitus in Anemic Subjects: Jung Il Son, Sang Youl Rhee, Jeong-taek Woo, Jin Kyung Hwang, Sang Ouk Chin, Suk Chon, Seungjoon Oh, Sung Woon Kim, Young Seol Kim; Diabetes Metab J. 2013;37(5):343-348. Published online October 17, 2013; DOI: https://doi.org/10.4093/dmj.2013.37.5.343

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Abstract PDF PubReader

Background

Recently, a hemoglobin A1c (HbA1c) level of 6.5% has been determined to be a criterion for diabetes mellitus (DM), and it is a widely used marker for the diagnosis of DM. However, HbA1c may be influenced by a number of factors. Anemia is one of the most prevalent diseases with an influence on HbA1c; however, its effect on HbA1c varies based on the variable pathophysiology of anemia. The aim of this study was to determine the effect of anemia on HbA1c levels.

Methods

Anemic subjects (n=112) and age- and sex-matched controls (n=217) who were drug naive and suspected of having DM were enrolled. The subjects underwent an oral glucose tolerance test and HbA1c simultaneously. We compared mean HbA1c and its sensitivity and specificity for diagnosing DM between each subgroup.

Results

Clinical characteristics were found to be similar between each subgroup. Also, when glucose levels were within the normal range, the difference in mean HbA1c was not significant (P=0.580). However, when plasma glucose levels were above the diagnostic cutoff for prediabetes and DM, the mean HbA1c of the anemic subgroup was modestly higher than in the nonanemic group. The specificity of HbA1c for diagnosis of DM was significantly lower in the anemic subgroup (P<0.05).

Conclusion

These results suggest that the diagnostic significance of HbA1c might be limited in anemic patients.

Citations

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The Changes in Early Phase Insulin Secretion in Newly Diagnosed, Drug Naive Korean Prediabetes Subjects: Sang Youl Rhee, Joo Young Kim, Suk Chon, You Cheol Hwang, In Kyung Jeong, Seungjoon Oh, Kyu Jeung Ahn, Ho Yeon Chung, Jeong-taek Woo, Sung Woon Kim, Jin-Woo Kim, Young Seol Kim; Korean Diabetes J. 2010;34(3):157-165. Published online June 30, 2010; DOI: https://doi.org/10.4093/kdj.2010.34.3.157

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Abstract PDF PubReader

Background

There have been no systematic observations regarding changes in early phase insulin secretion among Korean prediabetes and early stage type 2 diabetes mellitus (T2DM) patients.

Methods

We conducted 75-g oral glucose tolerance tests (OGTT) in 873 subjects with suspected abnormal glucose tolerance. All subjects were diagnosed as having normal glucose tolerance (NGT), prediabetes (preDM), or T2DM according to the OGTT results and the insulin secretory and insulin resistance indices of each subject were calculated. Additionally, we analyzed the changes in early phase insulin secretion according to changes in fasting (Glc₀), post-prandial (Glc₁₂₀) glucose and HbA1c (A1c) levels.

Results

As compared to subjects with NGT, the insulin secretory indices of the preDM and T2DM subjects progressively declined, and the insulin resistance indices were progressively aggravated. Early phase insulin secretion decreased rapidly according to the increments of Glc₀, Glc₁₂₀ and A1c, and these changes were most prominent in the NGT stage. Compared to the control group, the early phase insulin secretion levels of the preDM or T2DM subjects were less than 50% when Glc₀ was over 100 mg/dL, Glc₁₂₀ was over 145 mg/dL, and A1c was over 5.8%.

Conclusion

This study suggests that progressive beta cell dysfunction in Koreans may be initiated and rapidly aggravated during the period generally designated as 'normal.'

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Retractions of Publication

Clinical Experience of the Reverse Iontophoresis Based Glucose Measuring System: Glucall(TM).: Sang Youl Rhee, Suk Chon, Gwanpyo Koh, Seungjoon Oh, Jeong taek Woo, Sung Woon Kim, Jin Woo Kim, Young Seol Kim; Korean Diabetes J. 2009;33(2):167-167. Published online April 1, 2009; DOI: https://doi.org/10.4093/kdj.2009.33.2.167

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Abstract PDF: To the editor, My original paper that published in Journal of Korean Diabetes Association 2005;29:167-172, entitled, Clinical Experience of the Reverse Iontophoresis Based Glucose Measuring System: Glucall(TM) was submitted to other international journals by me and the coauthor at the same time independently. I hereby retract the paper.

Retraction: Insulin Secretion and Insulin Resistance in Newly Diagnosed, Drug Naive Prediabetes and Type 2 Diabetes Patients With/Without Metabolic Syndrome.: Sang Youl Rhee, Suk Chon, Seungjoon Oh, Sung Woon Kim, Jin Woo Kim, Young Seol Kim, Jeong Taek Woo; Korean Diabetes J. 2007;31(2):184-184. Published online March 1, 2007; DOI: https://doi.org/10.4093/jkda.2007.31.2.184

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Abstract PDF: No abstract available.

Original Articles

Mechanism of 2-Deoxy-D-ribose-induced Damage in Pancreatic beta-cells.: Gwanpyo Koh, Jeong taek Woo, Dae Ho Lee, Seungjoon Oh, Sung Woon Kim, Jin Woo Kim, Young Seol Kim, Deok Bae Park; Korean Diabetes J. 2007;31(2):105-112. Published online March 1, 2007; DOI: https://doi.org/10.4093/jkda.2007.31.2.105

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Abstract PDF

BACKGROUND
Mechanism for glucose toxicity is known to be an increased oxidative stress produced by multiple pathways. In our previous report, 2-deoxy-d-ribose (dRib) promoted apoptosis by increasing oxidative stress in a pancreatic beta-cell line. We performed this study to investigate the mechanism of dRib-induced damage of beta-cells. METHODS: HIT-T15 cells were cultured in RPMI-1640 medium with 40 mM dRib for 24 hours after pretreatment with various concentrations of a metal chelator (DTPA) and inhibitors of protein glycation (aminoguanidine and pyridoxamine). Cell viability was determined by MTT assay. Apoptosis was analyzed by flow cytometry with annexin V/PI double staining. RESULTS: DTPA, which inhibits the monosaccharide autoxidation, partially reversed dRib-induced cytotoxicity in a dose-dependent manner (P < 0.01). The cytotoxicity was also suppressed dose-dependently by aminoguanidine (AG) and pyridoxamine (PM) (P < 0.05 and P < 0.01, repectively). Flow cytometric analysis showed that pretreatment of DTPA and AG also reversed the dRib-triggered apoptosis in a dose-dependent manner. We assessed the additional protective effects of inhibitors of protein glycation from dRib-induced cytotoxiciy in the presence of a metal chelator. The additions of AG (P < 0.05) and PM (P < 0.01) significantly reduced the cytotoxicity compared with DTPA alone group. CONCLUSION: This results suggest that dRib produce cytotoxicity and apoptosis through the mechanisms of advanced glycation endproducts (AGEs) formation including the monsaccharide autoxidation and protein glycation in pancreatic beta-cell. Thus, dRib could be a surrogate for glucose in the study of glucose toxicity and chronic diabetic complications.

Citations

Citations to this article as recorded by

Isolation of Citrus Peel Flavonoid Bioconversion Microorganism and Inhibitory Effect on the Oxidative Damage in Pancreatic Beta Cells
Chi-Deok Park, Hee-Kyung Jung, Chang-Ho Park, Yoo-Seok Jung, Joo-Heon Hong, Hee-Sun Ko, Dong-Hee Kang, Hyun-Soo Kim
KSBB Journal.2012; 27(1): 67. CrossRef
Kaempferol protects HIT‐T15 pancreatic beta cells from 2‐deoxy‐D‐ribose‐induced oxidative damage
Yun Jung Lee, Kwang Sik Suh, Moon Chan Choi, Suk Chon, Seungjoon Oh, Jeong‐Taek Woo, Sung‐Woon Kim, Jin‐Woo Kim, Young Seol Kim
Phytotherapy Research.2010; 24(3): 419. CrossRef

Insulin Secretion and Insulin Resistance in Newly Diagnosed, Drug Naive Prediabetes and Type 2 Diabetes Patients With/Without Metabolic Syndrome.: Sang Youl Rhee, Suk Chon, Seungjoon Oh, Sung Woon Kim, Jin Woo Kim, Young Seol Kim, Jeong Taek Woo; Korean Diabetes J. 2006;30(3):198-206. Published online May 1, 2006; DOI: https://doi.org/10.4093/jkda.2006.30.3.198

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Abstract PDF

BACKGROUND
To evaluate the relationships between deterioration in insulin secretion and aggravated insulin resistance in patients with newly diagnosed prediabetes (preDM) and type 2 diabetes mellitus (T2DM) according to the presence of metabolic syndrome (MS). METHODS: We performed oral glucose tolerance test (OGTT) on 322 drug naive subjects with a history of hyperglycemia of < or = 3 months, and divided these patients into 3 groups, normal glucose tolerance (NGT), preDM (IFG and/or IGT) and T2DM. We also diagnosed these subjects with respect to MS according to ATP III criteria modified by Asia-Pacific guidelines and compared IGI and HOMA-IR in the 3 groups. RESULTS: According to OGTT, 63 subjects were diagnosed with NGT, 81 with preDM, and 178 with T2DM. Using modified ATP III criteria, 218 (67.7%) subjects were diagnosed as MS. When compare groups stratified by the presence of MS, preDM and T2DM groups with MS showed significantly higher mean HOMA-IR and IGI than those without MS. When compare groups with respect to glucose tolerance, NGT, preDM, and T2DM subgroups in MS group showed significant higher HOMA-IR and lower IGI according to glucose tolerance. However, NGT, preDM, and T2DM subgroups in non-MS group showed a significant decrease in IGI but no significant difference in HOMA-IR as glucose tolerance worsened. CONCLUSION: Deterioration in IGI and aggravation of HOMA-IR are both important in the primary pathogenesis of diabetes in those with MS. However, IGI deterioration may be the only important factor in the primary pathogenesis of T2DM in the absence of MS.

Citations

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The Relationship between β-cell Function and Nutrient Intakes in Korean Adult - Using 4thKorea National Health and Nutrition Examination Survey 2009 -
You Mi Lee, Hye Kyung Chung, Heejin Kimm, Sun Ha Jee
Korean Journal of Community Nutrition.2012; 17(2): 243. CrossRef

The Clinical Characteristics of Young Onset Diabetes According to Etiology Based Classification.: Mina Park, Yang Il Kang, Suk Chon, Seung joon Oh, Jeong taek Woo, Sung Woon Kim, Jin Woo Kim, Young Seol Kim; Korean Diabetes J. 2006;30(3):190-197. Published online May 1, 2006; DOI: https://doi.org/10.4093/jkda.2006.30.3.190

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Abstract PDF

BACKGROUND
Recently, the number of young diabetic patients is increasing. It is important to understand the characteristics of young diabetes and classify it correctly to manage these patients successfully. We aimed to classify young onset diabetes according to etiology and evaluate the clinical characteristics. METHODS: Young patients (15~30 years old) who have been treated diabetes in Kyunghee medical center in 2004 were included. We investigated family history of diabetes, disease duration, body mass index (BMI), the history of diabetic ketoacidosis, HbA1c, fasting C-peptide, autoantibody, lipid profile and treatment method via medical records. RESULT: Total 85 patients (M:F 40:45) were evaluated. Type 1 diabetes was 45.9%, type 2 diabetes was 23.5% and unclassified group was 25.9%. Many type 2 diabetic patients were overweight or obese (94.8%). Most young diabetic patients were using insulin (95.4%). Many type 1 diabetic patients have been treated by insulin only and many type 2 diabetic patients have been received combined therapy of insulin and oral hypoglycemic agent. The recent HbA1c was average 8.32 +/- 2.7%. The prevalence of diabetic retinopathy, neuropathy and nephropathy was 32.9%, 22.4% and 16.4% as each. CONCLUSION: Nearly half of young onset diabetes was type 1 diabetes but many others were also classified to type 2 diabetes or unclassified group. It is important to provide a consistent algorithm for assessment and investigation for newly diagnosed young diabetic patients. More education and effort are required to control diabetes strictly and prevent its complication.

Citations

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The Difference in Risk Factors Between Adults With Early-Onset (<40 Years Old) Versus Late-Onset (≥40 Years Old) Type 2 Diabetes in a University Hospital From January 2015-December 2017
Marilyn Katrina C Caro, Elaine C Cunanan
Journal of Medicine, University of Santo Tomas.2022; 6(2): 1009. CrossRef
Lifestyle-related predictors affecting prediabetes and diabetes in 20-30-year-old young Korean adults
Kyong Sil Park, Seon Young Hwang
Epidemiology and Health.2020; 42: e2020014. CrossRef
The Clinical Characteristics of the Newly Diagnosed Early Onset (< 40 Years Old) Diabetes in Outpatients' Clinic
Kyung-Soo Kim, Hyun-Ju Oh, Ji-Woon Kim, Yeo-Kyung Lee, Soo-Kyung Kim, Seok-Won Park, Yoo-Lee Kim, Won-Keun Park, Yong-Wook Cho
Korean Diabetes Journal.2010; 34(2): 119. CrossRef
Anti-GAD Antibody in Patients with Adult-Onset Diabetes in Korea
Eun-Gyoung Hong
Korean Diabetes Journal.2009; 33(1): 13. CrossRef

Clinical Experience of the Reverse Iontopheresis Based Glucose Measuring System: GlucallTM.: Sang Youl Rhee, Suk Chon, Gwanpyo Koh, Seungjoon Oh, Jeong Taek Woo, Sung Woon Kim, Jin Woo Kim, Young Seol Kim; Korean Diabetes J. 2005;29(2):167-172. Published online March 1, 2005

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Abstract PDF: BACKGROUND
Finger pricking is currently the common method of blood glucose measurement in patients with diabetes mellitus. However, diabetes patients have proven reluctant to regularly check their glucose profiles because of the small amount of blood that is required. Recently, a non-invasive and continuous glucose monitoring device that is based on reverse iontophoresis(GlucallTM) has been developed. In this study we wanted to evaluate the accuracy and the clinical acceptability of this new device. METHODS: The study was conducted during the period from November 2003 to January 2004 on 19 in-patients who had been admitted to Kyung Hee University Hospital. Glucose measurements using GlucallTM were performed between 10am and 4pm. The concurrent plasma glucose levels were checked hourly and they were subsequently compared with the GlucallTM data. RESULTS: The mean error(ME) of the GlucallTM measurements was -3.45+/-52.99mg/dL with a mean absolute relative error(MARE) of 20+/-15.16%. Measurements obtained by GlucallTM had a correlation coefficient of 0.784(P<0.05) with the plasma glucose levels, as was determined by linear regression analysis. This correlation was consistent regardless of the time of data collection. However, after excluding such confounding variables as age and gender, the correlation coefficient exhibited a tendency to increase. 98.9% of the results were clinically acceptable according to Clarke error grid analysis. CONCLUSION: GlucallTM does not yet have the reliability and accuracy to wholly replace the conventional methods. However, further technical advancements to reduce its shortcomings will make this device useful for the management of diabetes patients

Case Report

A Case of Failure in Insulin Pump Treatment due to Abdominal Subcutaneous Fat Atrophy and Lipohypertrophied Nodules.: Sang Youl Rhee, Suk Chon, Gwanpyo Koh, Seungjoon Oh, Jeong taek Woo, Sung Woon Kim, Jin Woo Kim, Young Seol Kim; Korean Diabetes J. 2004;28(6):547-553. Published online December 1, 2004

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Abstract PDF: The insulin pump is an effective glycemic control device those function is analogous to the physiologic regulation of insulin in vivo. When sufficient patient education and proper selection of patients is done, the insulin pump is one of the most effective treatment modalities for diabetic patients. However, various side effects and complications might occur during its application. We report here on an unusual case of diabetic ketoacidosis that was caused by acute inflammatory colitis and insulin pump malfunction. Peculiarly, the cause of pump malfunction was far removed from its mechanical problem. We concluded that the cause of the insulin pump malfunction was due to abdominal subcutaneous fat atrophy and the lipohypertrophied nodules of the patient that developed due to the prolonged usage of the insulin pump.

Original Articles

The Effect of cAMP-Elevating Agents on High Glucose-Induced Apoptosis of Isolated Islets of Rat Pancreas.: Gwan Pyo Koh, Kwang Sik Suh, Suk Chon, Seung Joon Oh, Jeong Taek Woo, Sung Woon Kim, Jin Woo Kim, Young Seol Kim, Sun Hee Kwon; Korean Diabetes J. 2004;28(6):490-500. Published online December 1, 2004

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Abstract PDF: BACKGROUND
High glucose-induced apoptosis has been implicated in the loss of beta-cells of the pancreatic islets in animal models of type 2 diabetes. GLP-1 has been shown to reduce apoptosis by the cAMP-dependent mechanism in beta-cells. Other studies have also shown that elevated levels of intracellular cyclic AMP delayed apoptosis in other types of cells. We investigated whether cAMP-elevating agents could suppress the high glucose-induced apoptosis of isolated rat islets. METHODS: Pancreatic islets were isolated from Sprague-Dawley (SD) rats. The expression of phosphodiesterase (PDE) 3 subtypes was investigated by using extracts of freshly isolated islets and analyzing them by RT-PCR. After 2 days of isolation, the islets were cultured in RPMI-1640 media containing 5% FBS with various glucose concentrations (11.1, 16.7 and 27.8 mM), 5x10-6 M forskolin, 2x10-4 M 3-isobutyl-1-methylxanthine (IBMX), 10-5 M cilostazol, and 10-6, 5x10-6 and 10-5 M H-89 for 5 days. The islet apoptosis was measured by a sandwich enzyme-immunoassay using antihistone antibody. RESULTS: Apoptosis was lowest at 11.1 mM glucose concentration, and increased at higher glucose concentrations (1.00 +/- 0.04 A.U. (arbitrary unit) at 11.1 mM, 1.17 +/- 0.12 A.U. at 16.7 mM, and 1.65 +/-0.13 A.U. at 27.8 mM (P <0.05 for 11.1 mM). Both PDE 3A and 3B mRNA were expressed in the islet extracts. In 16.7 and 27.8 mM glucose concentrations, forskolin (P <0.01), IBMX (P <0.05) and cilostazol (P < 0.05) suppressed apoptosis of the islet cells. Protein kinase A (PKA) nhibitor, H-89, did not prevent the inhibition of apoptosis by forskolin. CONCLUSION: These results show that high glucose-induced apoptosis of the cells in rat islet is attenuated by such cAMP-elevating agents as cilostazol. However, cyclic AMP regulation of islet apoptosis may occur via a PKA-independent signaling pathway.

Homeostasis Model Assessment In Korean Type 2 Diabetes Patients.: Hyun Ha Chang, Jin Woo Kim, Mee Suk Rhu, Cheol Young Park, Seung Joon Oh, Jeong Taek Woo, Sung Woon Kim, Young Seol Kim, Young Kil Choi; Korean Diabetes J. 2002;26(4):296-305. Published online August 1, 2002

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Abstract PDF: BACKGROUND
Both insulin resistance and decreased insulin secretion have been known to be defects causing type 2 diabetes. However, decreased insulin secretion rather than insulin resistance has been suggested to be a more important factor in development of type 2 diabetes in Korea. Thus, we undertook this study to evaluate insulin resistance and beta cell function in Korean type 2 diabetes patients. METHODS: Retrospectively, we applied HOMA model to 1,233 type 2 diabetes pateints (575 males and 658 females) and assessed HOMA(beta cell) function and HOMA(IR). RESULTS: The HOMA(IR) of Korean male was 2.6 (0.05~39.53) and that of Korean female was 3.1 (0.04~53.54), and the HOMA(beta cell) of male was 22.3 (0.2~873.8)%, and that of female was 30.6 (0.37~1738.3)%. There was no significant difference. There was no significant correlation between HOMA(IR) and age and duration of diabetes, but there was significant correlation between HOMA(beta cell) and BMI, 0 min, 30 min insulin level and 0 min C-peptide level in oGTT. In the group of high HOMA(IR) than lower HOMA(IR), HOMA(beta cell) have more strong correlation with age at dignosis, BMI, duration of diabetes, FBS, 0 min and 60 min insulin, 0 min C-peptide and 24 hour urine C-peptide. CONCLUSION: In comparison with HOMA Model of San Antonio Heart Study, the HOMA(beta cell) and HOMA(IR) of Korean were lower, so the HOMA(beta cell) and HOMA(IR) may be different between ethnic groups. And further prospective analysis for the evaluation of insulin resistance and insulin secretion defect with HOMA model should be done in Korean type 2 diabeties.

Gastric Dysfunction Assessed by Electrogastrography and the Acetaminophen Absorption Technique in Patients with Diabetic Neuropathy.: Hyun Ha Chang, Young Seol Kim, Sang Hwa Kim, Cheol Young Park, Seung Joon Oh, Jeong Taek Woo, In Myung Yang, Sung Woon Kim, Jin Woo Kim, Young Kil Choi; Korean Diabetes J. 2001;25(1):83-92. Published online February 1, 2001

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Abstract PDF: BACKGROUND
In patients with diabetes mellitus, dysrhythmias of gastric myoelectrical activity are frequently associated with gastroparesis. Thus, we investigated the relationships between abnormal gastric myoelectrical activity and gastric emptying rate in patients with diabetes mellitus. METHODS: Using surface electrogastrography (Nippro, Tokyo, Japan) and acetaminophen absorption technique, we studied EGG and gastric emptying rate in 39 patients with diabetic neuropathy and 15 healthy volunteers as the control group. RESULTS: In two thirds of the patients with diabetes mellitus, fasting electrogastrography revealed instability of electrical control activity (ECA), as compared to 13% of the control. Postprandial amplitude and frequency increases in electrogastrography were observed in the control group. However, these postprandial responses were obtunded in patients with diabetes mellitus. In the assessment of gastric emptying rate, increases of plasma acetaminophen levels were delayed in obtunded postprandial responses of gastric myoelectrical activity. CONCLUSION: These results showed that the abnormal electrogastrography patterns were related to abnormal finding assessed acetaminophen absorption technique. Electrogastrography was thought to be a useful and non-invasive technique in assessing diabetic gastroparesis.

Free Testosterone and Sex Hormone-Binding Globulin Level in Type 2 Diabetic Men.: Ki Deuk Nam, Young Seol Kim, Cheol Young Park, Seung Joon Oh, Deog Yoon Kim, Jeong Taek Woo, Sung Woon Kim, In Myung Yang, Jin Woo Kim, Young Kil Choi; Korean Diabetes J. 2000;24(6):699-707. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Insulin resistance is a risk factor for cardiovascular disease and type 2 diabetes mellitus. There are many previous studies indicating that insulin lowers serum sex hormone-binding globulin levels, and there is inverse correlation between insulin resistance and serum sex hormone-binding globulin levels in women. However, in men, a limited number of studies are available to explain the effect of sex hormone on age and insulin. Therefore, the present study was undertaken to investigate the relationship among free testosterone, hormone- binding globulin and age in type 2 diabetic men and control subjects. METHOD: Age, body mass index, total cholesterol, triglyceride, fasting blood sugar, and insulin concentrations were examined on 89 type 2 diabetic men and 47 control subjects. The free testosterone level was measured by commercially available double-antibody system (Radioimmunoassay). The sex hormone-binding globulin level was also measured by commercially available double-antibody system(Immunoradiometric assay). RESULTS: 1) Sex hormone-binding globulin level was significantly increased in patients with type 2 diabetes. However, there was no significant difference in free testosterone level between the two groups. 2) Sex hormone-binding globulin was positively correlated with age (r=0.4, p<0.001) in patients with type 2 diabetes. Sex hormone-binding globulin and free testos terone were not correlated with age in control sujects. 3) Free testosterone and sex hormone-binding globulin concentrations were not significantly related to serum insulin concentration after adjusting for age and body mass index. CONCLUSIONS: We observed increased sex hormone-binding globulin concentration in diabetes man, and was a positively related to age. Further studies are needed to understand the relationships between age, insulin resistance, testosterone, and sex hormone-binding globulin concentrations.

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