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Volume 38(4); August 2014
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FGF21 as a Stress Hormone: The Roles of FGF21 in Stress Adaptation and the Treatment of Metabolic Diseases
Kook Hwan Kim, Myung-Shik Lee
Diabetes Metab J. 2014;38(4):245-251.   Published online August 20, 2014
DOI: https://doi.org/10.4093/dmj.2014.38.4.245
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AbstractAbstract PDFPubReader   

Fibroblast growth factor 21 (FGF21) is an endocrine hormone that is primarily expressed in the liver and exerts beneficial effects on obesity and related metabolic diseases. In addition to its remarkable pharmacologic actions, the physiological roles of FGF21 include the maintenance of energy homeostasis in the body in conditions of metabolic or environmental stress. The expression of FGF21 is induced in multiple organs in response to diverse physiological or pathological stressors, such as starvation, nutrient excess, autophagy deficiency, mitochondrial stress, exercise, and cold exposure. Thus, the FGF21 induction caused by stress plays an important role in adaptive response to these stimuli. Here, we highlight our current understanding of the functional importance of the induction of FGF21 by diverse stressors as a feedback mechanism that prevents excessive stress.

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Diabetic Kidney Disease: From Epidemiology to Clinical Perspectives
Cheol Whee Park
Diabetes Metab J. 2014;38(4):252-260.   Published online August 20, 2014
DOI: https://doi.org/10.4093/dmj.2014.38.4.252
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AbstractAbstract PDFPubReader   

With worldwide epidemic of diabetes mellitus, diabetic nephropathy which is one of the major causes of microvascular complication has become a serious concern in Korea as well as the rest of the world. In view of its significance, there is an urgent and paramount need for proper managements that could either deter or slow the progression of diabetic nephropathy. Despite advances in care, ever increasing number of patients suffering from diabetic kidney disease and from end-stage renal disease implies that the current management is not adequate in many aspects. The reasons for these inadequacies compromise lack of early diagnosis, failure to intervene with timely and aggressive manner, and lack of understanding on the kind of interventions required. Another issue equally important for the adequate care of patients with diabetic nephropathy is an understanding of past, present and future epidemiology of diabetic nephropathy which serves, especially in Korea, as a material determining standard diagnosis and treatment and a national health-policy decision.

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A Novel Therapeutic Agent for Type 2 Diabetes Mellitus: SGLT2 Inhibitor
Chang Hee Jung, Jung Eun Jang, Joong-Yeol Park
Diabetes Metab J. 2014;38(4):261-273.   Published online August 20, 2014
DOI: https://doi.org/10.4093/dmj.2014.38.4.261
  • 7,205 View
  • 125 Download
  • 62 Web of Science
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AbstractAbstract PDFPubReader   

Type 2 diabetes mellitus (T2DM) is a complex endocrine and metabolic disorder, and a major public health problem that is rapidly increasing in prevalence. Although a wide range of pharmacotherapies for glycemic control is now available, management of T2DM remains complex and challenging. The kidneys contribute immensely to glucose homeostasis by reabsorbing glucose from the glomerular filtrate. Sodium-glucose cotransporter 2 (SGLT2) inhibitors, a new class of antidiabetic agents that inhibit glucose absorption from the kidney independent of insulin, offer a unique opportunity to improve the outcomes of patients with T2DM. In this review, we provide an overview of two globally-approved SGLT2 inhibitors, dapagliflozin and canagliflozin, and discuss their effects and safety. This information will help clinicians to decide whether these drugs will benefit their patients.

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Editorial
Lipoproteins and β-Cell Functions: From Basic to Clinical Data
Dae Ho Lee
Diabetes Metab J. 2014;38(4):274-277.   Published online August 20, 2014
DOI: https://doi.org/10.4093/dmj.2014.38.4.274
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Original Articles
Clinical Usefulness of Serum Cystatin C as a Marker of Renal Function
Kwang-Sook Woo, Jae-Lim Choi, Bo-Ram Kim, Ji-Eun Kim, Jin-Yeong Han
Diabetes Metab J. 2014;38(4):278-284.   Published online August 20, 2014
DOI: https://doi.org/10.4093/dmj.2014.38.4.278
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AbstractAbstract PDFPubReader   
Background

Accurate renal function measurements are important in the diagnosis and treatment of kidney diseases. In contrast to creatinine, the production of serum cystatin C has been extensively reported to be unaffected by body muscle mass, age, gender, and nutritional status.

Methods

Our study included 37 samples from diabetic chronic kidney disease (CKD) patients for whom serum creatinine tests had been requested and 40 samples from a healthy populations in Dong-A University Hospital between May 2010 and June 2010. The assay precision (i.e., the coefficient of variation) and the reference range of the serum cystatin C test were evaluated. We compared the estimated glomerular filtration rates (GFRs) based on cystatin C with those based on creatinine. Moreover, we investigated the influences of age, gender, weight, and muscle mass on serum creatinine and serum cystatin C.

Results

There was a positive correlation between GFR based on creatinine and that based on cystatin C (r=0.79, P<0.0001) among the diabetic CKD patients. Serum creatinine and cystatin C were significantly correlated with body weight and muscle mass, but the strengths of these correlations were greater for serum creatinine. The precision study revealed excellent results for both the high and low controls. The 95% reference interval of cystatin C in the healthy population was 0.371 to 1.236 mg/L.

Conclusion

Based on these results, we conclude that, despite the strong correlation between serum creatinine and cystatin C, cystatin C is less affected by weight and muscle mass and might represent a better alternative for the assessment of renal function.

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Assessment of Diabetic Polyneuropathy and Autonomic Neuropathy Using Current Perception Threshold in Korean Patients with Diabetes Mellitus
Bo Kyung Koo, Jung Hun Ohn, Soo-Heon Kwak, Min Kyong Moon
Diabetes Metab J. 2014;38(4):285-293.   Published online August 20, 2014
DOI: https://doi.org/10.4093/dmj.2014.38.4.285
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AbstractAbstract PDFPubReader   
Background

The current perception threshold (CPT) could be quantified by stimulating Aβ and C fibers at 2,000 and 5 Hz, respectively. C fibers play a role in the autonomic nervous system and are involved in temperature and pain sensation. We evaluated the usefulness of CPT for diagnosing distal polyneuropathy (DPN) and cardiovascular autonomic neuropathy (CAN) in diabetic patients.

Methods

The CPT was measured in the index finger (C7 level) and in the third toe (L5 level) in diabetic patients aged 30 to 69 years. We assessed DPN according to the neuropathy total symptom score-6 (NTSS-6) and 10-g monofilament pressure sensation. Subjects with a NTSS-6 >6 or with abnormal 10-g monofilament sensation were defined to have DPN. CAN was evaluated by spectral analysis of heart rate variability and by Ewing's traditional tests.

Results

The subjects with DPN had significantly higher CPT at all of the frequencies than the subjects without DPN (P<0.05). Abnormal 10-g monofilament sensation and NTSS-6 >6 could be most precisely predicted by CPT at 2,000 and 5 Hz, respectively. However, only 6.5% and 19.6% of subjects with DPN had an abnormal CPT at 2,000 Hz at the C7 and L5 levels. Although CPT at 5 Hz showed a negative correlation with the power of low and high frequency in the spectral analysis (P<0.05), only 16.7% of subjects with CAN exhibited an abnormal CPT at the same frequency.

Conclusion

Although the CPT is significantly associated with neuropathic symptoms or signs corresponding to the nerve fiber stimulated, it provides little additional information compared with conventional evaluations.

Citations

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  • New Perspective in Diabetic Neuropathy: From the Periphery to the Brain, a Call for Early Detection, and Precision Medicine
    Heng Yang, Gordon Sloan, Yingchun Ye, Shuo Wang, Bihan Duan, Solomon Tesfaye, Ling Gao
    Frontiers in Endocrinology.2020;[Epub]     CrossRef
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    Joong Hyun Park, Jong Chul Won
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Impact of Serum Triglyceride and High Density Lipoprotein Cholesterol Levels on Early-Phase Insulin Secretion in Normoglycemic and Prediabetic Subjects
Masanori Shimodaira, Tomohiro Niwa, Koji Nakajima, Mutsuhiro Kobayashi, Norinao Hanyu, Tomohiro Nakayama
Diabetes Metab J. 2014;38(4):294-301.   Published online August 20, 2014
DOI: https://doi.org/10.4093/dmj.2014.38.4.294
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AbstractAbstract PDFPubReader   
Background

Increased triglycerides (TGs) and decreased high density lipoprotein cholesterol (HDL-C) levels are established as diabetic risks for nondiabetic subjects. The aim of this study was to investigate the relationship among TG, HDL-C, TG/HDL-C ratio, and early-phase insulin secretion in normoglycemic and prediabetic subjects.

Methods

We evaluated 663 Japanese subjects who underwent the 75-g oral glucose tolerance test. On the basis of these results, the subjects were divided into four groups: those with normal glucose tolerance (NGT; n=341), isolated impaired fasting glucose (i-IFG; n=211), isolated impaired glucose tolerance (i-IGT; n=71), and combined IFG and IGT (IFG+IGT; n=40). Insulin secretion was estimated by the insulinogenic index (IGI) (Δinsulin/Δglucose [30 to 0 minutes]) and disposition index (DI) (IGI/homeostasis model assessment of insulin resistance).

Results

In prediabetic subjects (i-IFG, i-IGT, and IFG+IGT), linear regression analyses revealed that IGI and DI were positively correlated with HDL-C levels. Moreover, in subjects with i-IGT and (IFG+IGT), but not with i-IFG, the indices of insulin secretion were negatively correlated with the log-transformed TG and TG/HDL-C ratio. In both the subjects with i-IGT, multivariate linear regression analyses revealed that DI was positively correlated with HDL-C and negatively with log-transformed TG and TG/HDL-C ratio. On the other hand, in subjects with NGT, there was no association between insulin secretion and lipid profiles.

Conclusion

These results revealed that serum TG and HDL-C levels have different impacts on early-phase insulin secretion on the basis of their glucose tolerance status.

Citations

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FTO Gene Variants Are Associated with PCOS Susceptibility and Hyperandrogenemia in Young Korean Women
Do Kyeong Song, Hyejin Lee, Jee-Young Oh, Young Sun Hong, Yeon-Ah Sung
Diabetes Metab J. 2014;38(4):302-310.   Published online August 20, 2014
DOI: https://doi.org/10.4093/dmj.2014.38.4.302
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AbstractAbstract PDFPubReader   
Background

The fat mass and obesity-associated (FTO) gene is associated with obesity and type 2 diabetes mellitus. Obesity and insulin resistance are also common features of polycystic ovary syndrome (PCOS). Therefore, the FTO gene might be a candidate gene for PCOS susceptibility. The aim of the present study was to evaluate the effects of FTO gene variants on PCOS susceptibility and metabolic and reproductive hormonal parameters.

Methods

We recruited 432 women with PCOS (24±5 years) and 927 healthy women with regular menstrual cycles (27±5 years) and performed a case-control association study. We genotyped the single nucleotide polymorphisms rs1421085, rs17817449, and rs8050136 in the FTO gene and collected metabolic and hormonal measurements.

Results

Logistic regression revealed that the G/G genotype (rs1421085, 1.6%), the C/C genotype (rs17817449, 1.6%), and the A/A genotype (rs8050136, 1.6%) were strongly associated with an increased risk of PCOS (odds ratio, 2.551 to 2.559; all P<0.05). The strengths of these associations were attenuated after adjusting for age and BMI. The women with these genotypes were more obese and exhibited higher free androgen indices (P<0.05) and higher free testosterone levels (P=0.053 to 0.063) compared to the other genotypes. However the significant differences disappeared after adjusting for body mass index (BMI). When we analyzed the women with PCOS and the control groups separately, there were no significant differences in the metabolic and reproductive hormonal parameters according to the FTO gene variants.

Conclusion

The rs1421085, rs17817449, and rs8050136 variants of the FTO gene were associated with PCOS susceptibility and hyperandrogenemia in young Korean women. These associations may be mediated through an effect of BMI.

Citations

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  • Free-androgen Index in Women with Polycystic Ovarian Syndrome: A Meta-Analysis
    Prakash Patil, Neevan D'Souza, Sudeep D. Ghate, Lakshmi Nagendra, Harish B. Girijashankar
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    Dan Yin, Yiyang Li, Xingyue Liao, Dewei Tian, Yunsi Xu, Cuilan Zhou, Jun Liu, Suyun Li, Jing Zhou, Yulin Nie, Hongqing Liao, Cuiying Peng
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    Hiral Chaudhary, Jalpa Patel, Nayan K. Jain, Sonal Panchal, Naresh Laddha, Rushikesh Joshi
    BMC Medical Genomics.2023;[Epub]     CrossRef
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The Effects of Propofol and Isoflurane on Blood Glucose during Abdominal Hysterectomy in Diabetic Patients
Shekoufeh Behdad, Abulghasem Mortazavizadeh, Vida Ayatollahi, Zahra Khadiv, Saidhossein Khalilzadeh
Diabetes Metab J. 2014;38(4):311-316.   Published online August 20, 2014
DOI: https://doi.org/10.4093/dmj.2014.38.4.311
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AbstractAbstract PDFPubReader   
Background

Acute hyperglycemia in the perioperative period is associated with significantly increased complications. In few human studies the effects of propofol and inhalational anesthetic on the glucose metabolism were compared. In this study we evaluated the effect of propofol and isoflurane on blood glucose during abdominal hysterectomy in diabetic patients.

Methods

After approval by the Ethical Committee and written informed consent, thirty 35 to 65 years old diabetic women underwent for elective abdominal hysterectomy under general anesthesia were studied in this randomized single blind clinical trial study. The plasma glucose was maintained at 100 to 180 mg/dL during the operation. Anesthesia protocol was similar in two groups except maintenance of anesthesia that was with infusion of propofol in the propofol group and with isoflurane in the isoflurane group. Blood glucose level and the rate of insulin intake during surgery compared between two groups.

Results

Mean blood glucose before induction of anesthesia did not have significant difference between two groups, but 60 and 90 minutes after starting the operation blood glucose in the propofol group was significantly lower than isoflurane group. Also with using Repeated Measure test, two groups was significantly different according to blood glucose (P=0.045). Mean of administration of insulin during the surgery did not have significant difference between two groups by using repeated measure test and P=0.271. Also mean of bispectral index in different times during the surgery between two groups didn't have significant difference (P=0.35 repeated measure test).

Conclusion

Blood glucose increased during maintenance of anesthesia with isoflurane compared to propofol during the surgery.

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Letter
Letter: The Effect of DPP-4 Inhibitors on Metabolic Parameters in Patients with Type 2 Diabetes (Diabetes Metab J 2014;38:211-9)
Seung-Hwan Lee
Diabetes Metab J. 2014;38(4):317-318.   Published online August 20, 2014
DOI: https://doi.org/10.4093/dmj.2014.38.4.317
  • 2,386 View
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Response
Response: The Effect of DPP-4 Inhibitors on Metabolic Parameters in Patients with Type 2 Diabetes (Diabetes Metab J 2014;38:211-9)
EunYeong Choe, Eun Seok Kang
Diabetes Metab J. 2014;38(4):319-320.   Published online August 20, 2014
DOI: https://doi.org/10.4093/dmj.2014.38.4.319
  • 2,349 View
  • 33 Download
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Diabetes Metab J : Diabetes & Metabolism Journal