Diabetes & Metabolism Journal

Volume 22(3); September 1998

Original Articles

Oxidative Stress in Diabetes.: Sung Hee Ihm; Korean Diabetes J. 1998;22(3):249-252. Published online January 1, 2001

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The Oxidative Stress and the Antioxidant System in Type 2 Diabetics with Complications.: Ae Wha Ha, Hye Lim Noh, Yoon Sok Chung, Kawn Woo Lee, Hyeon Man Kim, Jung Soon Cho; Korean Diabetes J. 1998;22(3):253-261. Published online January 1, 2001

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Diabetes mellitus represents a state of increased oxidative stress which is based on the evidence of increased peroxidation and glycosylation, and reduced antioxidant system. It has been suggested that increased oxidative stress may play an important role on the pathogenesis of diabetic complication in type 2 diabetes. However, limited informations regarding the oxidative stress and antioxidant system in diabetic complications are available. Therefore the purpose of this study is to determine the oxidative stress and antioxidant system in type 2 diabetes with diabetic complications. METHODS: The study population consisted of 94 type 2 diabetic patients and 44 normal subjects. The concentration of thiobarbituric acid reactive substance(TBA-RS) and the activities of antioxidants enzymes, catalase, superoxide dismutase(SOD), glutathione peroxidase(GSH-Px) in erythrocyte were detennined by using spectrophotometer. The plasma concantrations of b-carotene, lycopene, lutein, a-tocopherol and retinol were determined by using HPLC. RESULTS: The TBA-RS concentrations in type 2 diabetes(1.33+0.30nmol/mL) were significantly higher than those in normal subjects(1.10+0.17nmol/ mL). Also the TBA-RS concentrations between subjects with complications(1.37+0.27nmol/mL) and without complications(1.28+0.17nmol/mL) differed (p<0.05). The activities of SOD and GSH-Px in type 2 diabetes(2.99+0.80U/mgHb, 2.88+0.39U/ mgHb) were significantly lower than those in normal subjects(3.54+0.44U/mgHb, 3.14+0.39U/mgHb). GSH-Px between diabetics with(2.81+0.6U/mgHb) and without complications(3.17+0.4U/mgHb) differed significantly. The plasma concentrations of lycopene and b-carotene were significantly lower in type 2 diabetes(0.07+0.05umol/L, 0.54+0.27umol/L) than in control subjects(0.14+0.06umol/L, 0.67+0.32umol/L). Also, lycopene and b-carotene in subjects with complications(0.05+0.04umol/L, 0.45+0.23umol/L) were lower than in subjects without complications(0.08+0.05umol/L, 0.62+0.30umol/L). No significant differences in plasma a-tocopherol concentrations between subjects with and without complications(19.42+0.93umol/L vs 18.66+ 0.79umoll/L). CONCLUSION: This study showed that in diabetes with diabetic complications, the lipid peroxidation of erythrocytes are highly increased and the antioxidant reserves are significmtly depleted, compared with diabetes without diabetic complications, which suggests that diabetes with complications are under high oxidative stress and the supplementations of carotenoids could decrease the oxidative stress in diabetes with diabetic complications.

Effects of Free Fatty Acids on Glutathione Redox Status in Cultured Endothelial Cells.: Joong Yeol Park, Chul Hee Kim, Yun Ey Chung, Hong Kyu Kim, Young Il Kim, Sung Kwan Hong, Jae Dam Lee, Ki Up Lee; Korean Diabetes J. 1998;22(3):262-270. Published online January 1, 2001

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Although plasma free fatty acids (FFA) are frequently elevated in diabetes mellitus, its role in the pathogenesis of diabetic vascular complications has not been well investigated. Recent stuclies reported that FFA may cause endothelial dysfunction through an enhancement of oxidative damage by decreasing glutathione redox cycle, an important anti-oxidant defense system in endothelial cells. In this study, we examined the effects of increased availability of FFA on intracellular glutathione redox cycle. METHODS: Bovine pulonary endothelial cells were exposed to 90 umol/L linoleic acid with or without 0.1 mM 2-bromopalmitate, an inhibitor of mitochondrial fatty acid oxidation, for 6hr. Components of the glutathione redox cycle such as total glutathione, reduced glutathione(GSH) and oxidized glutathione(GSSG) concentrations were measured by HPLC. RESULTS: Total glutathione concentration in cultured endothelial cells exposed to linoleic acid was significantly lower than that in control cells (10.8+ 0.5 vs 14.1+0.8 umol/g protein, P<0.05). Linoleic acid significantly decreased GSH concentrations (10.5+0.4 vs. 13.8+0.5 pmol/g protein, P<0.05) and the ratio of GSH/GSSG(26.3+1.3 vs. 47.0+2,1, P<0.05). Compared to cells exposed linoleic acid alone, total glutathione(13.5+0.5umol/g protein, P<0.05) and GSH concentration(13.2+0.4 pmol/g protein, P<0.05) significantly increased in cells treated with 2-bromopalmitate and linoleic acid. The ratio of GSH/GSSG in cells treated with 2-bromopalmitate and linoleic acid was higher th.an that in cells exposed to linoleic acid alone(44.1+1.3, P<0.05). CONCLUSION: Increased provision of FFA resulted in a derangement of glutathione redox cycle in cultured endothelial cells, which appears to be related to an increase in mitochondrial FFA oxidation. These results suggested that FFA can increase the risk of diabetic vascular complications.

The Effect of High Glucose on the Activity of Superoxide Dismutase in NIN6N8a Cells.: Hak Yeon Bae, Byoung Rai Lee, Kwang Sam Kho; Korean Diabetes J. 1998;22(3):271-289. Published online January 1, 2001

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Reactive oxygen species play a role in the pathogenesis of diabetes mellitus. Hyperglycemia may cause increased production of free radicals, and peroxide formation was increased in high glucose solution. It has been demonstrated that active oxygen species induce antioxidant enzyme expression in some tissues and cells. This study was designed to investigate the effect of high glucose on the activity of superoxide dismutase(SOD) in mouse insulinoma(MIN6N8a) cells. METHODS: MIN6N8a cells were grown in RPMI1640 medium with l0% fetal bovine serum and NIH3T3 cells used as a control cells. The cells were cultured in 5.6 and 22.2 mM glucose cnntained medium. The activities of SOD, catalase and GPX were determined in crude cell extract after 7 days of culture. The levels of CuZn-SOD were also measured with ELISA using anti-CuZn-SOD antibody. RESULTS: In MIN6NSa cells, the catalase activity was very low compared with NIH3T3 cells, but there was no difference in activities of CuZn-SOD and GPX between MIN6N8a cells and NIH3T3 cells. The activity of CuZn-SOD was decreased, while Mn-SOD was increased in MIN6NSa cells cultured with high glucose(22.2 mM) medium compared with those of normoglucose(5.6 mM) medium. However, the level of CuZn-SOD in MIN6NSa cells, when measured with ELISA was high in cells of cultured with high glucose medium. The SOD activity was not effected in MIN6N8a cells cultured with insulin contained medium. CONCLUSION: These experimental result suggest that the CuZn-SOD activity was decreased in MIN6N8a cells cultured with high glucose contained medium and this effect may be resulted from the protein inactivation rather than decrement of protein level.

Effect of High Glucose Concentration on Expression of Adhesion Molecules in Endothelial Cells.: In Ju Kim, Seok Man Son, Min Ki Lee, Hee Jeong, Yong Ki Kim; Korean Diabetes J. 1998;22(3):280-289. Published online January 1, 2001

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Accelerated atherosclerotic vascular disease is the leading cause of mortality in patients with diabetes mellitus. Endothelial dysfunction, monocytes, and platelets are well known pathogenic factors in atherogenesis. Changes in the neutrophils and endothelial cells, an important early events in all inflammatory process, may contribute to the atherogenesis at early stage, but the significance of this process is not established yet. So we investigated the effects of glucose on the expression of adhesion molecules in endothelial cells, which retlects the change in endothelial-neutrophil adhesive interactions.METHODS: The human umbilical vein endothelial cells(HUVECs) are purchased from American Type Culture Collection. The cells were incubated upto 24 hours to evaluate the expression of E-selectin, PECAM-1, and P-selectin on the cell surface using whole cell ELISA method and soluble P-selectin under different glucose concentration(5.5, 15, and 30 mmol/L). Neutrophil adherence was also measured hy incubation of isolated human neutrophils with monolayers of HUVECs under same different glucose concentration. RESULTS: After 24h incubation with a various concentration of glucose, neutrophil adherence to high concentration of glucose(15 and 30mmol/L)- treated endothelium was significantly increased(5.0 +0.4 and 10.4+0.5%, respectively) compared with adhesion to low concentration of glucose(5.5mmol/ L)-treated endothelium(2.9.+0.4%). Incubation of HUVECs for 24 h in 30mmol/L glucose increased absorbance of E-selectin to 1.36+0.16(P<0.01) and reduced that of P-selectin to 0.56+0.04 compared with the results of respective control culture in 5.5mmol/L glucose(p<0.01), but not changed PECAM-1 expression. In addition, 24 h exposure of HUVECs to 30mmol/L glucose decreased soluble P-selectin concentration to 0.33+0.06ng/mL(P<0.01). CONCLUSION: The results of this study demonstrate that high concentration of glucose stimulates neutrophil adhesion to endothelial cells in association with increased expression of E-selectin. These results suggest that high glucose can directly affect interaction between neutrophil and endothelial cell through a adhesion molecule, especially E-selectin dependent mechanism. Further study should be necessary to investigate the significance of this phenomenon.

Upregulation of Aldose Reductase mRNA by Hyperglycemia in Claf Pulmonary Artery Endothelial Cells.: Sang Yiup Nam, Jung Hyun Oh, Jin Chul Park, Ji Sung Yoon, Kyu Chang Won, Chan Woo Lee, Ihn Ho Cho, Choong Ki Lee, In Kyu Lee, Hyoung Woo Lee; Korean Diabetes J. 1998;22(3):290-298. Published online January 1, 2001

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Hyperglycemia is thought to be an important etiologic factor in the development of diabetic macro- and microangiopathies. Several theories have been proposed to explain why diabetic patients are at an increased risk for such vascular disorders. In uncontrolled diabetes, excess glucose causes a glycation of various proteins, an increase in oxidative stress, an increase in DAG or PKC and an increase in polyol pathway. And, it has been proposed that hyperglycemia leads to the dysfunction or damage of endothelial cells through the activation of cellular aldose reductase(polyol pathway). METHODS: To verify this hypothesis, we quantitated AR(Aldose reductase) activity and mRNA in CPAE(Calf pulmonary artery endothelial) cell under normal and high ambient glucose levels in the culture medium. The time course of AR mRNA expression after exposure of CPAE cells to 22mM glucose was determined using PCR quantitative analysis. RESULTS: AR mRNA levels began to increase at 6h after glucose exposure, reached a maximum at 24h (about 2.3 fold increase), and then gradually decreased. Aldose reductase activity was found to strongly correlate with aldose reductase mRNA expression after cells were exposed to 22mM glucose. In contrast, aldose reductase mRNA expression at 24h after glucose exposure decreased following exposure to 50mM glucose. By testing other osmolytes, we also examined whether the AR activity is specific for glucose. There was an increase in AR activity only after the addition of 20mM mannitol to the medium. CONCLUSION: These observations suggest that hyperglycemia could induce the overexpression of aldose reductase mRNA in cultured CPAE cells and this could be an important step in the pathogenesis of diabetic complications.

Changes of CGRP- and VIP-containing Nerve Fibers in the pancreas of Streptozotocin-Induced Diabetic Rat.: Young Joo Kim, Moo Ho Won, Gun Gyo Suh, Je Kyung Seong, Joon Sup Lee, Hwan Mook Kim, Yang Seok Oh; Korean Diabetes J. 1998;22(3):299-311. Published online January 1, 2001

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Abstract PDF: BACKGROUND
The peptidergic nerves, namely the third nerve, are distributed in the pancreas with adreniergic and cholinergic nerves. However, it has been known that the peptidergic nerves control the pancreatic endocrine and exocrine functions, only a few morphological studies has been done. Therefore we tried to investigate the distribution patterns of the pancreatic calcitonin gene-related peptide(CGRP) and vasoactive intestinal polypeptide(VIP) containing nerves in the pancreas of the streptozotocin-induced diabetic rats. METHODS: Eight week old male WKY rats were used in this study. Insulin-dependent diabetic animals were produced by the intraperitoneal injection of streptozotocin(60 mg/Kg) dissolved in cold citrate buffer(pH 4.2) to WKY rats. The control rats were treated with the vehicle. Immnunohistochemical studies were carried out to observe the changes of CGRP containing nerve fibers and VIP containing nerve fibers in the pancreas at 0, 3, 14, and 28 days after the injection of streptozotocin. RESULTS: In insulin-dependent diabetic animal group, the density and the innervation patr.erns of CGRP containing nerve fitrs were significantly increased on day 3 and thereafter decreased to the level of control group at the end of experiment. The immunoreactivities of VIP containing nerve fibers were not altered in the pancreatic islers. The immunoreaetivities, however, were gradually increased in the periphery of the acini, the connective tissues, and the periphery of the ducts and vasculatures. CONCLUSION: The results of the present imvestigation suggest that the distribution patterns of CGRP and VIP containing nerve fibers in the insulin-dependent diabetic rats are related to the development of diabetes and may provide a morphological bases for the possible role of nueropeptides in pancreas of the diabetic rats. Further study are required about the relationships between the distribution patterns and the functions of the peptidergic nerve in pancreas.

The Frequency of ICA and anti-GAD Antibody in Korean IDDM and NIDDM Patients.: Kyung Soo Ko, Sung Kwan Hong, Ki Up Lee, Nan Hee Kim, Dong Seop Choi, Sung Hee Ihm, Sung Woo Park, Chul Hee Kim, Dong Won Byun, Kyo Il Suh, Hak Chul Chang, Byoung Doo Rhee; Korean Diabetes J. 1998;22(3):312-319. Published online January 1, 2001

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It has been suggested that the clinical and immunological characteristics of diabetes mellitus in Koreans are different from those of Caucasians. This study was undertaken to investigate the prevalence of autoimmune markers in Korean adults with IDDM and recent-onset NIDDM. METHODS: Seventy-seven Korean adults with IDDM and 245 recently(within 2 years) diagnosed NIDDM were included in the study. Islet cell cytoplasmic antibody was measured by immunohistochemical method, and anti-glutamic acid decarboxylase (anti-GAD) antibody was measured by radioimmunoassay. RESULTS: 1) The prevalence of ICA, anti-GAD antibody positivity was 27% and 40% in IDDM patients, and 5% and 4% in recent-onset NIDDM patients, respectively. 2) The prevalence of ICA positivity in IDDM patients decreased from 42% within one year to 21% over one year after clinical onset of disease. On the other hand, the positivity of anti-GAD antibody did not change according to the duration of diabetes. 3) The prevalence of ICA tends to be lower in IDDW patients with low serum C-peptide concentrations. In contrast, the prevalence of anti-GAD antibody was not different according to sernm C-peptide levels. CONCLUSION: These results suggested that the prevalence of ICA and antii-GAD antibody was lower in Korean adult IDDM and recent-onset NIDDM patients than that in Caucasians.

Insulin Secretory Dysfunction in the Patients with Untreated Hyperthyroidism.: Moon Suk Nam, Seung Yong Shin, Young Wan Kim, Seong Bin Hong, Yeo Joo Kim, Mi Rim Kim, Won Sick Choe, Yong Seong Kim; Korean Diabetes J. 1998;22(3):320-327. Published online January 1, 2001

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Abnormal glucose metabolism with impaired glucose tolerance has been documented in patients with thyrotoxicosis, but the pathogenesis is not fully understood. Therefore, the aim of the present study was to study the secretory dysfunction of pancreatic 9-cell and to confirm hyperinsulinemia and hyperproinsulinemia during oral glucose tolerance test(OGTT) in patients with thyrotoxicosis. METHODS: After an overnight fast, 75 g OGTT was performed in 10 patients with hyperthyroidism and in 10 healthy control subjects matched for age, sex and hody mass index. Plasma insulin(immuno-reactive insulin, IRI), C-peptide, proinsulin levels were measured by radioimmunoassay. RESULTS: Fasting plasma glucose, insulin and C-peptide levels were similar in the two groups, but plasma proinsulin level was increased in patients with hyperthyroidism(p<0.05). A twofold rise of plasma proinsulin and the proinsulin/insulin ratio was also found in patients with hyperthyroidism during OGTT. The molar ratio of C-peptide and insulin(IRI) was similar in the two groups. CONCLUSION: Hyperinsulinemia and hyperproinsulinemia were found in patients with hyperthyroidism compared with controls. Disproportionally increased proinsulin level suggested a pancreatic secretory dysfunction in the patients with hyperthyroidism.

Dehydroepiandrosterone-Sulfate, Sex Hormone Binding Globulin, Body Fat Distribution Pattern and Insulin Resistance in Women.: Young Sun Hong, Jee Young Oh, Yeon Ah Sung, Nan Ho Kyung, Yeon Jin Jang; Korean Diabetes J. 1998;22(3):328-337. Published online January 1, 2001

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Sex hormone-binding globulin (SHBG) has been known to be associated with obesity, central fat accumulation and insulin resistance and thought to be a indirect marker for androgenicity in women. The relationships between circulating dehydroepiandrosterone(DHEA). dehydroepiandrosterone sulfate(DHEA-S) levels and body fat accumulation are still controversial. We conducted a cross-sectional study to eva]uate the relationships between serum levels of SHBG, DHEA-S, body fat distribution pattern and insulin sensitivity in women. METHODS: We tested 57 women(age 30~65yr; BMI 18.5~32.8kg/m, 45 premenopausal on the 5~10 day of the menstrual cycle, 12 postmenopausal who were not using hormone replacement therapy) with varying degree of glucose tolerance(32 normal glucose tolerance(NGT), 17 impaired glucose tolerance(IGT) and 8 newly diagnosed diabetes). lnsulin sensitivity was measured as minimal model derived sensitivity index(S) using insulin modified IV glucose tolerance test and fasting serum levels of SHBG and DHEA-S were measured by RIA. Body fat distribution pattern was assessed by waist to hip ratio(WHR),% body fat measured by bioelectrical impedance analyzer, subcutaneous fat area(SFA), visceral fat area(VFA) and VFA to SFA ratio(VSR) at the level of umbilicus using the computed tomography. RESULTS: 1) Measured SHBG and DHEA-S levels were not significantly different among subjects with NGT, IGT and diabetes. 2) SHBG was inversely associated with age, BMI, WHR, diastolic blood pressure, VFA, SFA, VSR,% body fat, fasting insulin and positively associated with S, whereas DHEA-S did not show any significant correlation with above variables except diastolic blood pressure. 3) SHBG level was significantly lower(p<0.05) and DHEA-S level was insignificantly lower (p=0.05) in postmenopausal women than in premenopausal women but the significance disappeared after adjustment for age, BMI, WHR and% body fat. 4) BMI was independently and negatively related to S, WHR and fasting insulin to SHBG by multiple regression analysis. CONCLUSION: We confirmed that SHBG was independently associated with central obesity and fasting hyperinsulinemia. However, S was independently associated with BMI only. It suggested that hyperinsulinemia in insulin resistance might cause the decreased level of SHBG even thaugh the directionality of the association was uncertain because of a cross-sectional nature of this study.

High Serum Lipoprotein ( a ) Levels in Korean Type 2 Diabetic Patients with Proliferative Diabetic retinopathy.: Hyung Joo Park, Chul Hee Kim, Yun Ey Chung, Sang Wook Kim, Jin Yub Kim, Eun Sook Kim, Sung Kwan Hong, Ki Up Lee; Korean Diabetes J. 1998;22(3):338-343. Published online January 1, 2001

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To examine the possible association between serum lipoprotein(a) (Lp(a)) concentration and proliferative diabetic retinopathy(PDR) in Korean patients with type 2 diabetes mellitus. METHODS: A total of 412 Korean outpatients with type 2 diabetes were examined. Diabetic retinopathy was determined by fundoscopic examination by an ophthalmologist and/or by fluorecein angiography. Semm Lp(a) levels were measured by one step sandwich ELISA method. RESULTS: The patient with PDR had higher serum Lp(a) levels than those with no retinopathy or non-proliferative diabetic retinopathy(NPDR). Multiple logistic regression analysis showed that serum Lp(a) level and the presence of diabetic nephropathy were independent variables having a statistically significant association with PDR. CONCLUSION: Korean type 2 diabetic patients with PDR had higher serum Lp(a) levels compared with those with no retinopathy or NPDR. Although these results suggested that Lp(a) might play a role in the occlusion of retinal capillaries leading to PDR, further prospective studies are required to prove causal relationship.

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

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

Clinical Characteristics and Pregnancy Outcome in Korean Women with Type I & Type II Diabetes Mellitus.: Yoon Huh, Dong Won Suh, Hak Chul Jang, Chang Hoon Yim, Ki Ok Han, Hyun Ku Yoon, In Kwon Han, Hun Ki Min, Eun Sung Kim, Moon Young Kim, Hyun Mi Ryu, Sung Won Yang, Hae Kyoung Han; Korean Diabetes J. 1998;22(3):353-362. Published online January 1, 2001

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Abstract PDF: BACKGROUND
The prevalence of diabetes is gradually increasing iin Korean. Moreover, the prevalence of pregnancy complicated by established diabetes seems to be increasing. During the past decades, advances in the diabetes care as well as advances in fetal surveillance and neonatal care, have continued to improve pregnancy outcome of women with diabetes. However, the incidence of congenital anomalies and spontaneous abortion as well as the perinatal morbidity in the women with diabetes are still higher compared to those of the general population. In this study, we estimated the prevalence of prepmncy complicated by both type 1 and type 2 diabetes and described the clinical characteristics and outcome of diabetic pregnancies. METHODS: We analyzed data from four sources: 1) the mother(type and duration of diabetes, diabetic complication, preconceptional care), 2) obstetric outcome(method of delivery, obstetric complication), 3) neonatal outcome(birth weight, perinatal complication, congenital anomaly), 4) glycemic control during pregnancy, of women with pregestational diabetes delivered newborns at Samsung Cheil Hospital from 1992 to 1995. RESULTS: During the study period, 34 singleton infants were delivered by the 28 women with diabetes. The diabetic pregnancy was present in 0.14% of total deliveries in Samsung Cheil Hospital. Patients with IDDM comprised 18%(6/34) of total diabetic pregnancies, 82%(28/34) had NIDDM. The duration of diabetes was 6.3 and 2.1 years in patients with IDDM and NIDDM, respectively. Two IDDM patients presented with proliferative retinopathy, and 3 background retinopathy, one in IDDM and 2 in NIDDM. Three patients with IDDM and 2 patients with NIDDM had diabetic nephropathy. Insulin requirement during pregnancy was increased about 2 times at the time of delivery when compared to the initial in women with IDDM and NIDDM. Preeclampsia was the most common obstetric compliications, which were more frequently observed in women with diabetic complications. LGA was present in 43% of women with NIDDM. One infant of mother with NIDDM, delivered at 28 weeks gestation, was died because of respiratory distress and one infant of mother with IDDM had a congenital heart disease(TOF). Only 3 patients scught for the preconceptional care before pregnancy. CONCLUSION: Pregnancies complicated by diabetes was more frequent than was expected, even though it was much less than the rates in North America. Only 9% of women with diabetes had preconceptional care before pregnancy. The importance of planned pregnancy and prepregnancy counseling should be addressed in women with diabetes of child bearing age.

Prevalence of Diabetes Mellitus and Impaired Glucose Tolerance in Korean Adults Living in Jungup District, South Korea.: Young Il Kim, Chul Soo Choi, Sang Wook Kim, Jong Soo Lee, Hyeong Ho Kim, Moo Sung Lee, Sang Il Lee, Joong Yeoul Park, Sung Kwan Hong, Ki Up Lee; Korean Diabetes J. 1998;22(3):363-371. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Similar to other countries that underwent industrialization in recent years, the prevalence of diabetes has increased dramatically in Far East Asian countries. While the prevalence of diabetes in South Korean adults was estimated to be less than 0.5% in 1960s, a recent study from Yonchon County showed a dramatic increase to 7.2%. This was the only study performed in population-based subjects. We studied the prevalence of diabetes and impaired glucose tolerance(IGT) among subjects living in Jungup clistrict, Chonlabuk-do, South Korea. METHODS: Among a total of 28,380 subjects aged over 40 years living in Jungup district a sample of 1,791 subjects living in six villages was selected using a random cluster sampling method. Among these subjects, 1,108 subjects(61.9%) completed 75g oral glucose tolerance test(OGTT). RESULTS: When the WHO criteria were used, the prevalence of diabetes and IGT were 7.1% and 8.5%, respectively, after correction for Segi's standard world population. Among the diabetic subjects, 62% of the patients did not know that they had diabetes previously. When the 1997 ADA criteria after OGTT were employed, the prevalence of diabetes and IGT/IFG(impaired fasting glucose) was 8.5% and 11.1%, respectively. The mean body mass index(BMI) of whole subjects was 22.9+2.7 for men and 24.3+3.2kg/m for women. Among subjects with normal glucose tolerance, IGT and diabetes, 31.5%, 42.3% and 50.0% of subjects were currently obese(BMI >25kg/m), respectively. The prevalence of both diabetes and IGT increased with inereasing waist-to-hip ratio(WHR) in men and women. On the other hand, the prevalence of diabetes and glucose intolerance increased with increasing BMI only in women but not in men. CONCLUSION: The prevalence of diabetes and IGT in the present study was quite similar to that in the previous Yonchon study. This prevalence of diabetes is higher than or similar to that reported in the Caucasian(~ 3% 8%), even though mean BMI of this community population(23.9 kg/m) is lower than that in the Caucasian (24.5~28.0 kg/m). It can be speculated that Far East Asian penple are more prone to develop diabetes for their degree of obesity.

Evaluation of Fasting Plasma Glucose to Diagnose Diabetes in Yonchon County.: Young Joo Park, In Kyoung Chung, Chan Soo Shin, Kyong Soo Park, Seong Yeon Kim, Hong Kyu Lee, Sun Ja Kwon; Korean Diabetes J. 1998;22(3):372-380. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Recently, many studies were performed to evaluate the diagnostic value of fasting plasma glucose to diagnose diabetes, and the diagnostic criteria were revised by ADA in 1997 to avoid discrepancy between the fasting plasma glucose (FPG) and 2 hour post-load plasma glucose(2hPG) cutpoint values after 75g oral glucose loading and to alsc facilitate and encourage the use of test for diagnosing diabetes. This study was performed to assess the performance of different cutpoint of fasting plasma glucose in the diagnosis of diabetes and to compare the prevalence and incidence of diabetes using revised 1997 ADA FPG criterion with those using 1985 WHO criteria in Yonchon County of Korea. METHODS: Two thousand three hundred fifty-six subjects who participated in population based cross-sectional study in Yonchon County in 1993. We have also analysed the data from 1141 subjects who were non-diabetic in 1993 and participated in the follow-up survey in 1995. The relationship between FPG and 2hPG were determined using sensitivity, specificity and the prevalence of diabetes according to FPG and/or 2hPG values. We have determined the prevalence and the incidence of diabetes using the ADA criterion. RESULTS: Based on WHO criteria, a FPG of 6.1 mmol/L(110mg/dL) was determined to yield optimal sensitivity(83.6%) and specificity(82.4%), but it showed low positive predictive value(27.2%) and high prevalence(24.5%). The FPG cutpoint which showed same prevalence with the criterion ot the 2hPG >11.1mmol/L(87 in 2251) was 7.4mmol/L (133mg/dL, 87 in 2251), The crude prevalence of diabetes and impaired fasting glucose by ADA criterion were 9.6% and 14.9%, respectively, where as the crude prevalence of diabetes and IGT were 9.4% and 11.5% by WHO criteria. The crude incidence of diabetes was 5.1% as defined by ADA criterion and 34.4% of subjects who showed impaired fasting glucose in 1993 converted to diabetes in 1995, whereas the incidence was 2.5% by WHO criteria and 13% of IGT subjeets converted to diabetes in 2 years. Conclusions: The adequate cutpoint for FPG seems to lie between 6.1mmol/L and 7.4mmol/L. The 1997 ADA criterion of the FPG > 7.0mmol/L produced similar prevalence and higher incidence than those obtained from 1985 WHO criteria and the former seems to be better to detect the risk group who may progress to diabetes.

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