Diabetes & Metabolism Journal

Original Article

Metabolic Risk/Epidemiology
A Prospective 1-Year Follow-Up of Glycemic Status and C-Peptide Levels of COVID-19 Survivors with Dysglycemia in Acute COVID-19 Infection: David Tak Wai Lui, Chi Ho Lee, Ying Wong, Carol Ho Yi Fong, Kimberly Hang Tsoi, Yu Cho Woo, Kathryn Choon Beng Tan; Received June 5, 2023 Accepted October 13, 2023 Published online March 11, 2024; DOI: https://doi.org/10.4093/dmj.2023.0175 [Epub ahead of print]

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Abstract PDF PubReader ePub: Background
We evaluated changes in glycemic status, over 1 year, of coronavirus disease 2019 (COVID-19) survivors with dysglycemia in acute COVID-19.
Methods
COVID-19 survivors who had dysglycemia (defined by glycosylated hemoglobin [HbA1c] 5.7% to 6.4% or random glucose ≥10.0 mmol/L) in acute COVID-19 were recruited from a major COVID-19 treatment center from September to October 2020. Matched non-COVID controls were recruited from community. The 75-g oral glucose tolerance test (OGTT) were performed at baseline (6 weeks after acute COVID-19) and 1 year after acute COVID-19, with HbA1c, insulin and C-peptide measurements. Progression in glycemic status was defined by progression from normoglycemia to prediabetes/diabetes, or prediabetes to diabetes.
Results
Fifty-two COVID-19 survivors were recruited. Compared with non-COVID controls, they had higher C-peptide (P< 0.001) and trend towards higher homeostasis model assessment of insulin resistance (P=0.065). Forty-three COVID-19 survivors attended 1-year reassessment. HbA1c increased from 5.5%±0.3% to 5.7%±0.2% (P<0.001), with increases in glucose on OGTT at fasting (P=0.089), 30-minute (P=0.126), 1-hour (P=0.014), and 2-hour (P=0.165). At baseline, 19 subjects had normoglycemia, 23 had prediabetes, and one had diabetes. Over 1 year, 10 subjects (23.8%; of 42 non-diabetes subjects at baseline) had progression in glycemic status. C-peptide levels remained unchanged (P=0.835). Matsuda index decreased (P=0.007) and there was a trend of body mass index increase from 24.4±2.7 kg/m² to 25.6±5.2 (P=0.083). Subjects with progression in glycemic status had more severe COVID-19 illness than non-progressors (P=0.030). Reassessment was not performed in the control group.
Conclusion
Subjects who had dysglycemia in acute COVID-19 were characterized by insulin resistance. Over 1 year, a quarter had progression in glycemic status, especially those with more severe COVID-19. Importantly, there was no significant deterioration in insulin secretory capacity.

Short Communication

Others
Comparison of Insulin-Treated Patients with Ambiguous Diabetes Type with Definite Type 1 and Type 2 Diabetes Mellitus Subjects: A Clinical Perspective: Insa Laspe, Juris J. Meier, Michael A. Nauck; Diabetes Metab J. 2023;47(1):140-146. Published online March 22, 2022; DOI: https://doi.org/10.4093/dmj.2021.0322

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Abstract PDF Supplementary Material PubReader ePub: In clinical practice, the distinction between type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) can be challenging, leaving patients with “ambiguous” diabetes type. Insulin-treated patients (n=115) previously diagnosed with T2DM had to be re-classified based on clinical phenotype and laboratory results, and were operationally defined as having an ambiguous diabetes type. They were compared against patients with definite T1DM and T2DM regarding 12 clinical and laboratory features typically different between diabetes types. Characteristics of patients with ambiguous diabetes type, representing approximately 6% of all patients with T1DM or T2DM seen at our specialized clinic, fell in between those of patients with definite T1DM and T2DM, both regarding individual features and with respect to a novel classification based on multi-variable regression analysis (P<0.0001). In conclusion, a substantial proportion of diabetes patients in a tertiary care centre presented with an “ambiguous” diabetes type. Their clinical characteristics fall in between those of definite T1DM or T2DM patients.

Original Articles

Technology/Device
Glutamic Acid Decarboxylase Autoantibody Detection by Electrochemiluminescence Assay Identifies Latent Autoimmune Diabetes in Adults with Poor Islet Function: Yuxiao Zhu, Li Qian, Qing Liu, Jing Zou, Ying Zhou, Tao Yang, Gan Huang, Zhiguang Zhou, Yu Liu; Diabetes Metab J. 2020;44(2):260-266. Published online November 12, 2019; DOI: https://doi.org/10.4093/dmj.2019.0007

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Abstract PDF PubReader

Background

The detection of glutamic acid decarboxylase 65 (GAD65) autoantibodies is essential for the prediction and diagnosis of latent autoimmune diabetes in adults (LADA). The aim of the current study was to compare a newly developed electrochemiluminescence (ECL)-GAD65 antibody assay with the established radiobinding assay, and to explore whether the new assay could be used to define LADA more precisely.

Methods

Serum samples were harvested from 141 patients with LADA, 95 with type 1 diabetes mellitus, and 99 with type 2 diabetes mellitus, and tested for GAD65 autoantibodies using both the radiobinding assay and ECL assay. A glutamic acid decarboxylase antibodies (GADA) competition assay was also performed to assess antibody affinity. Furthermore, the clinical features of these patients were compared.

Results

Eighty-eight out of 141 serum samples (62.4%) from LADA patients were GAD65 antibody-positive by ECL assay. Compared with ECL-GAD65 antibody-negative patients, ECL-GAD65 antibody-positive patients were leaner (P<0.0001), had poorer β-cell function (P<0.05), and were more likely to have other diabetes-associated autoantibodies. The β-cell function of ECL-GAD65 antibody-positive patients was similar to that of type 1 diabetes mellitus patients, whereas ECL-GAD65 antibody-negative patients were more similar to type 2 diabetes mellitus patients.

Conclusion

Patients with ECL-GAD65 antibody-negative share a similar phenotype with type 2 diabetes mellitus patients, whereas patients with ECL-GAD65 antibody-positive resemble those with type 1 diabetes mellitus. Thus, the detection of GADA using ECL may help to identify the subtype of LADA.

Citations

Citations to this article as recorded by

2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2024
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Diabetes Care.2024; 47(Supplement): S20. CrossRef
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Correlations between Glucagon Stimulated C-peptide Levels and Microvascular Complications in Type 2 Diabetes Patients: Hye-Jin Yoon, Youn-Zoo Cho, Ji-young Kim, Byung-Joon Kim, Keun-Young Park, Gwan-Pyo Koh, Dae-Ho Lee, Dong-Mee Lim; Diabetes Metab J. 2012;36(5):379-387. Published online October 18, 2012; DOI: https://doi.org/10.4093/dmj.2012.36.5.379

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Abstract PDF PubReader

Background

This study aimed to investigate whether stimulated C-peptide is associated with microvascular complications in type 2 diabetes mellitus (DM).

Methods

A cross-sectional study was conducted in 192 type 2 diabetic patients. Plasma basal C-peptide and stimulated C-peptide were measured before and 6 minutes after intravenous injection of 1 mg glucagon. The relationship between C-peptide and microvascular complications was statistically analyzed.

Results

In patients with retinopathy, basal C-peptide was 1.9±1.2 ng/mL, and stimulated C-peptide was 2.7±1.6 ng/mL; values were significantly lower compared with patients without retinopathy (P=0.031 and P=0.002, respectively). In patients with nephropathy, basal C-peptide was 1.6±0.9 ng/mL, and stimulated C-peptide was 2.8±1.6 ng/mL; values were significantly lower than those recorded in patients without nephropathy (P=0.020 and P=0.026, respectively). Stimulated C-peptide level was associated with increased prevalence of microvascular complications. Age-, DM duration-, and hemoglobin A1c-adjusted odds ratios for retinopathy in stimulated C-peptide value were 4.18 (95% confidence interval [CI], 1.40 to 12.51) and 3.35 (95% CI, 1.09 to 10.25), respectively. The multiple regression analysis between nephropathy and C-peptide showed that stimulated C-peptide was statistically correlated with nephropathy (P=0.03).

Conclusion

In patients with type 2 diabetes, the glucagon stimulation test was a relatively simple method of short duration for stimulating C-peptide response. Stimulated C-peptide values were associated with microvascular complications to a greater extent than basal C-peptides.

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Review

Challenges in Diagnosing Type 1 Diabetes in Different Populations: Marian Rewers; Diabetes Metab J. 2012;36(2):90-97. Published online April 17, 2012; DOI: https://doi.org/10.4093/dmj.2012.36.2.90

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Abstract PDF PubReader

Diabetes affects today an estimated 366 million people world-wide, including 20 million to 40 million of patients with type 1 diabetes (T1D). While T1D accounts for 5% to 20% of those with diabetes, it is associated with higher morbidity, mortality and health care cost than the more prevalent type 2 diabetes. Patients with T1D require exogenous insulin for survival and should be identified as soon as possible after diagnosis to avoid high morbidity due to a delay in insulin treatment. It is also important to present to the patient correct prognosis that differs by the type of diabetes. From the research point of view, correct classification should help to identify the etiologies and to develop specific prevention for T1D. This review summarizes evidence that may be helpful in diagnosing T1D in various ethnic groups. Challenges in interpretation of results commonly used to determine the type of diabetes are highlighted.

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Original Articles

Factors Associated with Long-Term Oral Hypoglycemic Agent Responsiveness in Korean Patients with Type 2 Diabetes Mellitus: Bo-Yeon Kim, Chan-Hee Jung, Ji-Oh Mok, Chul-Hee Kim; Diabetes Metab J. 2011;35(3):282-289. Published online June 30, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.3.282

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Abstract PDF PubReader

Background

This study was performed to determine the factors associated with long-term oral hypoglycemic agent (OHA) responsiveness in Korean type 2 diabetic patients.

Methods

Two groups of patients were selected among the type 2 diabetic patients who were followed for more than two years at a university hospital diabetes clinic. The OHA responsive group consisted of 197 patients whose HbA1c levels were maintained at ≤7% with OHA for more than two years. The OHA failure group consisted of 180 patients whose HbA1c levels were >8% in spite of optimal combined OHA therapy or patients who required insulin therapy within the two years of the study.

Results

The OHA failure group had higher baseline values of fasting and postprandial glucose, HbA1c, and lower fasting, postprandial, and delta C-peptide compared to those of the OHA responsive group. The OHA failure group also had a higher proportion of female patients, longer diabetic duration, and more family history of diabetes. There were no significant differences in body mass index (BMI) or insulin resistance index between the two groups. Multiple logistic regression analysis showed that the highest quartile of baseline fasting, postprandial glucose, and HbA1c and the lowest quartile of postprandial and delta C-peptide were associated with an increased odds ratio of OHA failure after adjustment for age, sex, body mass index, and family history of diabetes.

Conclusion

Lower baseline values of postprandial and delta C-peptide and elevated fasting glucose and HbA1c are associated with long-term OHA responsiveness in Korean patients with type 2 diabetes mellitus.

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Basal C-peptide Level as a Surrogate Marker of Subclinical Atherosclerosis in Type 2 Diabetic Patients: Sung-Tae Kim, Byung-Joon Kim, Dong-Mee Lim, In-Geol Song, Jang-Han Jung, Kang-Woo Lee, Keun-Young Park, Youn-Zoo Cho, Dae-Ho Lee, Gwan-Pyo Koh; Diabetes Metab J. 2011;35(1):41-49. Published online February 28, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.1.41

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Background

Recent studies have revealed that C-peptide induces smooth muscle cell proliferation and causes human atherosclerotic lesions in diabetic patients. The present study was designed to examine whether the basal C-peptide levels correlate with cardiovascular risk in type 2 diabetes mellitus (T2DM) patients.

Methods

Data was obtained from 467 patients with T2DM from two institutions who were followed for four years. The medical findings of all patients were reviewed, and patients with creatinine >1.4 mg/dL, any inflammation or infection, hepatitis, or type 1 DM were excluded. The relationships between basal C-peptide and other clinical values were statistically analyzed.

Results

A simple correlation was found between basal C-peptide and components of metabolic syndrome (MS). Statistically basal C-peptide levels were significantly higher than the three different MS criteria used in the present study, the Adult Treatment Panel III (ATP III) of the National Cholesterol Education Program's (NCEP's), World Health Organization (WHO), and the International Diabetes Federation (IDF) criteria (NCEP-ATP III, P=0.001; IDF, P<0.001; WHO, P=0.029). The multiple regression analysis between intima-media thickness (IMT) and clinical values showed that basal C-peptide significantly correlated with IMT (P=0.043), while the analysis between the 10-year coronary heart disease risk by the United Kingdom Prospective Diabetes Study risk engine and clinical values showed that basal C-peptide did not correlate with IMT (P=0.226).

Conclusion

Basal C-peptide is related to cardiovascular predictors (IMT) of T2DM, suggesting that basal C-peptide does provide a further indication of cardiovascular disease.

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Diabetes, Metabolic Syndrome and Obesity.2023; Volume 16: 2617. CrossRef
Blood C‐peptide concentration as a proxy marker of cardiovascular disease: An observational cross‐sectional study
Laurinda Adusu‐Donkor, Emmanuel Kwaku Ofori, Fleischer C. N. Kotey, Francis Kwaku Dogodzi, Wormenor Dziedzorm, Alfred Buabeng, Segla Kwame Bernard, Seth K. Amponsah, Henry Asare‐Anane
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The impact of insulin induced lipohypertrophy on carotid intima-media thickness in patients with type 2 diabetes mellitus
Cem Onur Kirac, Vehbi Sirikci, Huseyin Avni Findikli
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Effects of Serum C-Peptide Level on Blood Lipid and Cardiovascular and Cerebrovascular Injury in Patients with Type 2 Diabetes Mellitus: A Meta-Analysis
Juan Qin, Rongli Sun, Ding Ding, Yuvaraja Teekaraman
Contrast Media & Molecular Imaging.2022; 2022: 1. CrossRef
Correlation between serum C-peptide-releasing effects and the risk of elevated uric acid in type 2 diabetes mellitus
Yanyan Liu, Xue Zhao, Zequn Yang, Shurui Wang, Cong Han, Huijuan Zhang
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Human C-peptide is a ligand of the elastin-receptor-complex and therewith central to human vascular remodelling and disease in metabolic syndrome
Gert Wensvoort
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Influence of blood glucose fluctuation, C-peptide level and conventional risk factors on carotid artery intima–media thickness in Chinese Han patients with type 2 diabetes mellitus
Min Liu, Li Ao, Xinyu Hu, Jianning Ma, Kena Bao, Ye Gu, Jing Zhao, Weiping Huang
European Journal of Medical Research.2019;[Epub] CrossRef
Serum C peptide and carotid intima-medial thickness are independent markers of glucose intolerance among patients with ischemic cerebrovascular stroke
Nearmeen M. Rashad, Ghada M. Samir, Hanan M. Sabry, Nesreen M. Mohy, Shereen M. El Shabrawy
The Egyptian Journal of Internal Medicine.2019; 31(3): 368. CrossRef
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Haseeb A. Khan, Samia H. Sobki, Aishah Ekhzaimy, Isra Khan, Mona A. Almusawi
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Shamha Beegum Mariyam, Saboora Beegum Muthubeevi, Sandhya Chandrasekharan Vasantha
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A. O. Shpakov
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Hemolysis Affects C‐Peptide Immunoassay
Zhi‐Qi Wu, Ju Lu, Hua‐Guo Xu
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Itahisa Marcelino Rodríguez, José Oliva García, José Juan Alemán Sánchez, Delia Almeida González, Santiago Domínguez Coello, Buenaventura Brito Díaz, Fadoua Gannar, María del Cristo Rodríguez Pérez, Roberto Elosua, Antonio Cabrera de León
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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.

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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
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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

Relationship between C-peptide, Metabolic Control and Chronic Complications in Type 2 Diabetes.: Jeung Mook Kang, Won Young Lee, Ji Youn Kim, Jung Won Yun, Sun Woo Kim; Korean Diabetes J. 2002;26(6):490-499. Published online December 1, 2002

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Abstract PDF: BACKGROUND
Type 2 diabetes mellitus is a heterogeneous disease characterized by variable degrees of insulin resistance, impaired insulin secretion and increased glucose production. As the decline of beta-cell function in type 2 diabetes is very slow, the relationship between the insulin secretory capacity, the degree of metabolic control and chronic complications is still unclear. The determination of plasma C-peptide allows for the assessment of the endogenous insulin production, even in the presence of exogenous insulin administration. The aim of this study was to evaluate the relationship between the serum C-peptide level and metabolic parameters, and the complications in type 2 diabetes. METHOD: The clinical characteristics and laboratory findings, such as lipid profile, fasting plasma glucose, HbA1C and uric acid, were evaluated, and their relationships with chronic complications analyzed. We measured the serum C-peptide level by radioimmunoassay (RIA) in 384 type 2 diabetes mellitus patients. The patients were divided into quartile groups according to their fasting C-peptide levels (quartile 1: <1.73 ng/mL, n=95; quartile 2:>or=1.73 ng/mL and <2.38 ng/mL, n=95; quartile 3:>or=2.38 ng/mL and <3.18 ng/mL, n=98; quartile 4:>or=3.18 ng/mL, n=96). RESULTS: Patients in the lowest C-peptide quartile showed significantly higher durations of diabetes, HbA1C and postprandial plasma glucose values, and HDL-cholesterol. Conversely, the BMI, systolic blood pressure, total cholesterol and triglyceride were significantly higher in the highest C-peptide quartile. The prevalence of diabetic retinopathy and urinary protein excretion were higher in lowest quartile, and the diastolic blood pressure was highest in the upper quartile, but these were not statistically significant. The associations between C-peptide, and the duration of diabetes, BMI, total cholesterol, triglyceride, HDL cholesterol, postprandial 2 plasma glucose and systolic blood pressure remained significant, even after multiple adjustments. CONCLUSION: In type 2 diabetes, higher C-peptide levels are associated with a component of metabolic syndrome and lower C-peptide levels due to decreased cell reserves, associated with hyperglycemia and microvascular complications

Peripheral Polyneruopathy and Hypoinsulinemia in Patients with Type 2 Diabetes.: Y S Jung, K Y Lee, S K Lee, H K Kim, H Y Park, M H Kang; Korean Diabetes J. 2000;24(2):256-266. Published online January 1, 2001

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Abstract PDF: BACKGROUND
There is little information on the risk factors for diabetic polyneuro-pathy other than glycemic control and duration of diabetes. The relation between diabetic polyneuropathy and hypoinsulinemia is controversial. This study is to determine whether hypoinsulinemia is an additional factor influencing the development of polyneuropathy in patients with type 2 diabetes. METHODS: We performed an oral glucose tolerance test with C-peptide measure-ment in 1'P2 patients with type 2 diabetes. Peripheral polyneuropathy was diagnosed when the patients had both typical symptoms of polyneuropathy and abnormal physical findings or NCV. We analysed the relation between metabolic variables including fasting and postprandial C-peptide levels and diabetic polyneuropathy. RESULTS: In addition to retinopathy and nephropathy, duration of diabetes, low C-peptide level (fasting and postprandial), insulin use, and high HDL-cholesterol level were associated with diabetic polyneuropathy. Multivariate logistic regression model revealed that an independent assoclation of diabetes duration and postprandial 2-hour C-peptide concentration with polyneuropathy. When we stratified the patients into the two groups according to the median duration of diabetes (8 years), the association of low postprandial C-peptide concentration with polyneuro-pathy was significant only in the shorter duration group(< 8 years). However, significant association of HbA(1c) level was shown in the longar duration group. CONCLUSION: Decreased insulin secretory function of the pancreas as well as increased duration of diabetes was indepandently associated with diabetic polyneuropathy in patients with type 2 diabetes. Hypoinsulinemia might be an additional risk factor for the development of diabetic polyneuropathy in type 2 diabetic patients, particularly with short duration, To confirm these relationship further longitudinal study in a large cohort is necessary.

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.

Floow-up Study of Clinical and Immunogenetic Chracteristics and Basal C-peptidein Korea Young Age Onset Diabetic Patients.: Hyun Chul Lee, Duk Hi Kim, Jae Hyun Nam, Chul Woo Ahn, Seong Kil Lim, Kap Bum Huh, Soo Yeon Nam, Seok Won Park, Young Deuk Song, Hyun Soo Kim, Jin Wook Kweon, Kyung Hee Chang, Kyung Rae Kim; Korean Diabetes J. 1999;23(3):288-298. Published online January 1, 2001

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Abstract PDF: BACKGROUND
This study was undertaken to observe the changes of basal C-peptide level and to compare the clinical and immunogenetic characteristics in newly dignosed young age-onset diabetics in Korea. We studied predictors effecting the change of insulin secretory capacity in these patients. METHODS: 82 newly diagnosed young diabetic patients (mean age; 23.0+7.1, M:F=46:36) were divided into 3 groups according to the initial fasting serum C-peptide level (Classification I, group 1; C-peptide < 0.6 ng/mL, group 2; 0.6 ng/mL C-peptide <1.2 ng/mL, and group 3; 1.2 ng/mL C-peptide) and reclassified by the follow-up (mean follow-up; 3.7 year) fasting serum C-peptide level. RESULTS: According to the initial fasting serum C-peptide level, 17.1% (14/82) of the patients were classified as group 1, 35.4% (29/82) as group 2, and 47.5%(39/82) as group 3. In group 3, body mass index (BMI, p<0.01) and maximal BMI (p<0.01) at onset, family history of diabetes (p=0.01) and stimulated C-peptide increment were significantly higher than those in group 1 and 2. Presence of urine ketone (p<0.01), history of diabetic keto- acidosis (p<0.01), and frequency of insulin therapy at diagnosis (p<0.01) were significantly lower than those in group 1 and 2. No significant differences in onset age, sex, weight loss at onset, HbA1c, anti GAD antibody and HLA-DR were found among the 3 groups. After certain follow-up periods, 37.8% (31/82) of the patients were reclassified as group 1, 24.4% (20/82) as group 2, and 37.8% (31/82) as group 3 according to the follow-up fasting serum C-peptide level(classification II). All of the patients in group 1 in classification I were reclassified as group 1 in classification II. In group 2, 44.8% were reclassified as group 1 and 17.3% were reclassified in group 3. In group 3, 15.4% (6/39) of patients showed a significant decrease in insulin secretory capacity and were reclassified as type I diabetes, and their predictors for decreased insulin secretory capacity were low BMI at onset, low slimulated C-peptide increment, and antiGAD antibody. CONCLUSION: Our study showed that classification of newly diagnosed young diabetics by fasting C-peptide level is not always easy. Therefore follow-up measurement of C-peptide and consideration of clinical characteristics are needed in discriminating the type of diabetes in these groups of diabetics in Korea.

Disturbance of Cutaneous Microcirculation assessed by Laser Doppler Flowmetry in Non-Insulin Dependent Diabetic patients.: Jeong Hyun Park, Sang Hee Nam; Korean Diabetes J. 1997;21(1):56-64. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Diabetic microangiopathies are well-known long-term complication of diabetes mellitus, These are wide-spread phenomena, but little is known about the nature of cutaneous microcirculatory disturbance in diabetic patients which could be considered as cutaneous diabetic microangiopathy. To assess the cutaneous microcirculatory disturbance of diabetic patients, we performed this study. METHODS: We performed the laser Doppler flowmetry which has been known to be an accurate device for measuring cutaneous microcirculatory blood flow to 14 control subjects and 16 non-insulin dependent diabetic patients. We used thermal reactive hyperemic technique to the dorsum of right index finger and right great toe for measuring both baseline and maximum cutaneous microcirculatory blood flow. RESULTS: The baseline microcirculatory blood flow measured at 35C did not show any statistically significant differences between control subjects and diabetic patients, on both finger dorsum and toe dorsum. The maximurn microcirculatory blood flow measured at 44C showed statistically significant difference between control subjects and diabetic patients only at toe dorsum, but not at finger dorsum (p<0.05). CONCLUSION: From the above results, we conclude that cutaneous microcirculation is disturbed in noninsulin dependent diabetic patients, which was manifested at the toe dorsum in the condition of maximum blood flow induced by thermal stimulation. Further studies an exact pathophysiology and possible correlations with diabetic microangiopathies, diabetic duration and the level of glycemic control are needed along with more refinement of measurement techniques.

Significance of Serum Anticardiolipin Antibody in Non-Insulin Dependent Diabetes Mellitus.: Hee Jin Kim, Young Sun Hong, Yeon Ah Sung, Nan Ho Kyung; Korean Diabetes J. 1997;21(1):39-48. Published online January 1, 2001

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Abstract PDF: BACKGROUND
The antiphospholipid antibodies have been characteristically found in the patients with autoimmune diseases. Some previous studies revealed that antiphospholipid antibodies are increased in the sera of patients with diabetes and correlate with the extent of neuropathy and measurements of amiphospholipid antibodies may constitute a marker for ongoing damage to nerves. We measured serum anticardiolipin antibodies(IgG, IgM) to assess the prevalence and significance of anticardiolipin antibodies in NIDDM patients. METHOD: Ninety NIDDM patients were screened for lgG/IgM isotypes of anticardiolipin antibodies by enzyme-linked immunosorbent assay and compared with 30 control subjects. RESULTS: 1) The titers and positivities of IgG anticardiolipin antibodies were significantly higher in the sera of NIDDM patients than those of control subjects(P<0.05). 2) In NIDDM patients with IgG anticardiolipin antibody, the titer of serum c-peptide was significantly lower(P<0.05) and the body mass index tended to be lower(P=0.08). 3) There were no significant differences of positivities of IgG anticardiolipin antibodies according to the state of chronic diabetic complications and the mode of treatment(P>0.05). 4) In the patients with NIDDM, no significant association was found between the titers of IgG anticardiolipin antibodies and age, diabetic duration, fasting blood glucose, HbAlc, total cholesterol and triglyceride. CONCLUSION: The titers and positivities of IgG anticardiolipin antibodies were elevated in NIDDM. In the NIDDM patients with IgG anticardiolipin antibody, the serum titers of c-peptide were significantly lower and the body mass index tended to be lower. It seems that serum IgG anticardiolipin antibodies might have autoimmune relationship with slowly progressive IDDM, but further prospective mass studies will be requird.

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