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Volume 38(6); December 2014
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In Memoriam
In Memoriam
Moon-Gi Choi
Diabetes Metab J. 2014;38(6):405-405.   Published online December 15, 2014
DOI: https://doi.org/10.4093/dmj.2014.38.6.405
  • 2,571 View
  • 33 Download
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A Gut Feeling to Cure Diabetes: Potential Mechanisms of Diabetes Remission after Bariatric Surgery
Young Min Cho
Diabetes Metab J. 2014;38(6):406-415.   Published online December 15, 2014
DOI: https://doi.org/10.4093/dmj.2014.38.6.406
  • 6,128 View
  • 66 Download
  • 55 Web of Science
  • 43 Crossref
AbstractAbstract PDFPubReader   

A cure for type 2 diabetes was once a mere dream but has now become a tangible and achievable goal with the unforeseen success of bariatric surgery in the treatment of both obesity and type 2 diabetes. Popular bariatric procedures such as Roux-en-Y gastric bypass and sleeve gastrectomy exhibit high rates of diabetes remission or marked improvement in glycemic control. However, the mechanism of diabetes remission following these procedures is still elusive and appears to be very complex and encompasses multiple anatomical and physiological changes. In this article, calorie restriction, improved β-cell function, improved insulin sensitivity, and alterations in gut physiology, bile acid metabolism, and gut microbiota are reviewed as potential mechanisms of diabetes remission after Roux-en-Y gastric bypass and sleeve gastrectomy.

Citations

Citations to this article as recorded by  
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  • The Long-Term Effects of Bariatric Surgery on Type 2 Diabetes Remission, Microvascular and Macrovascular Complications, and Mortality: a Systematic Review and Meta-Analysis
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  • THE ROLE OF THE SLEEVE GASTRECTOMY AND THE MANAGEMENT OF TYPE 2 DIABETES
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Current Concepts in Diabetic Retinopathy
Su Jeong Song, Tien Yin Wong
Diabetes Metab J. 2014;38(6):416-425.   Published online December 15, 2014
DOI: https://doi.org/10.4093/dmj.2014.38.6.416
  • 6,166 View
  • 58 Download
  • 38 Web of Science
  • 35 Crossref
AbstractAbstract PDFPubReader   

For the past several decades, tremendous efforts have been made to decrease the complications of diabetes, including diabetic retinopathy. New diagnostic modalities like ultrawide field fundus fluorescein angiography and spectral domain optical coherence tomography has allowed more accurate diagnosis of early diabetic retinopathy and diabetic macular edema. Antivascular endothelial growth factors are now extensively used to treat diabetic retinopathy and macular edema with promising results. There remains uncertainty over the long term effects and the socioeconomic costs of these agents.

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Therapeutic Approaches for Preserving or Restoring Pancreatic β-Cell Function and Mass
Kyong Yeun Jung, Kyoung Min Kim, Soo Lim
Diabetes Metab J. 2014;38(6):426-436.   Published online December 15, 2014
DOI: https://doi.org/10.4093/dmj.2014.38.6.426
  • 7,210 View
  • 157 Download
  • 20 Web of Science
  • 20 Crossref
AbstractAbstract PDFPubReader   

The goal for the treatment of patients with diabetes has today shifted from merely reducing glucose concentrations to preventing the natural decline in β-cell function and delay the progression of disease. Pancreatic β-cell dysfunction and decreased β-cell mass are crucial in the development of diabetes. The β-cell defects are the main pathogenesis in patients with type 1 diabetes and are associated with type 2 diabetes as the disease progresses. Recent studies suggest that human pancreatic β-cells have a capacity for increased proliferation according to increased demands for insulin. In humans, β-cell mass has been shown to increase in patients showing insulin-resistance states such as obesity or in pregnancy. This capacity might be useful for identifying new therapeutic strategies to reestablish a functional β-cell mass. In this context, therapeutic approaches designed to increase β-cell mass might prove a significant way to manage diabetes and prevent its progression. This review describes the various β-cell defects that appear in patients with diabetes and outline the mechanisms of β-cell failure. We also review common methods for assessing β-cell function and mass and methodological limitations in vivo. Finally, we discuss the current therapeutic approaches to improve β-cell function and increase β-cell mass.

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Editorial
Is GDF15 a Novel Biomarker to Predict the Development of Prediabetes or Diabetes?
Kyu Yeon Hur
Diabetes Metab J. 2014;38(6):437-438.   Published online December 15, 2014
DOI: https://doi.org/10.4093/dmj.2014.38.6.437
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  • Response: GDF15 Is a Novel Biomarker for Impaired Fasting Glucose (Diabetes Metab J2014;38:472-9)
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Original Articles
Arterial Stiffness by Aerobic Exercise Is Related with Aerobic Capacity, Physical Activity Energy Expenditure and Total Fat but not with Insulin Sensitivity in Obese Female Patients with Type 2 Diabetes
Ji Yeon Jung, Kyung Wan Min, Hee Jung Ahn, Hwi Ryun Kwon, Jae Hyuk Lee, Kang Seo Park, Kyung Ah Han
Diabetes Metab J. 2014;38(6):439-448.   Published online December 15, 2014
DOI: https://doi.org/10.4093/dmj.2014.38.6.439
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AbstractAbstract PDFPubReader   
Background

Arterial stiffness is an important factor in atherosclerosis. Thus we examined whether aerobic exercise could reduce arterial stiffness in obese women with type 2 diabetes without diabetic complication.

Methods

A total of 35 women with type 2 diabetes (body mass index, 26.6±2.8 kg/m2; age, 56.4±1.9 years; duration of diabetes, 4.7±4.8 years) were assigned to aerobic exercise group (AEG) or control group (CG). AEG completed a 12-week exercise program (3.6 to 5.2 metabolic equivalents, 3 day/week, 60 min/day), with their exercise activities monitored by accelerometers. We measured abdominal total fat area (TFA), visceral fat area (VFA), and subcutaneous fat area (SFA) by computed tomography, insulin sensitivity by insulin tolerance test (KITT), and augmentation index (AIx) by SphygmoCor at baseline and at the end of the 12-week program.

Results

The AIx was improved in the AEG compared with the CG (P<0.001). The percent change of AIx had significant correlation with the improvement of physical activity energy expenditure (PAEE), aerobic capacity, TFA, and SFA (r=-0.416, P=0.013; r=0.560, P<0.001; r=0.489, P=0.003; r=0.531, P=0.001, respectively), but not with insulin sensitivity, energy intake, or VFA.

Conclusion

Improvement in aortic stiffness by aerobic exercise is related with the improvement of aerobic capacity, PAEE, and total fat but not with insulin sensitivity or energy intake in obese women with type 2 diabetes.

Citations

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    Aparna Narendrula, Ellen Brinza, Christine Horvat Davey, Chris T Longenecker, Allison R Webel
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Effectiveness of 3-Day Continuous Glucose Monitoring for Improving Glucose Control in Type 2 Diabetic Patients in Clinical Practice
Soo Kyoung Kim, Hye Jeong Kim, Taehun Kim, Kyu Yeon Hur, Sun Wook Kim, Moon-Kyu Lee, Yong-Ki Min, Kwang-Won Kim, Jae Hoon Chung, Jae Hyeon Kim
Diabetes Metab J. 2014;38(6):449-455.   Published online December 15, 2014
DOI: https://doi.org/10.4093/dmj.2014.38.6.449
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AbstractAbstract PDFPubReader   
Background

The aim of this study was to investigate whether adjusting diabetic treatment regimens according to the information obtained from a continuous glucose monitoring system (CGMS) might lead to improved glycemic control in patients with type 2 diabetes.

Methods

We reviewed the medical charts of 172 patients who used the CGMS for 1 year starting in December 2008 and the records of 1,500 patients who visited their regular outpatient clinics during December 2008. Of these patients, a total of 65 CGMS patients and 301 regular outpatients (control group) were enrolled in the study after propensity score matching. There were no differences in baseline glycated hemoglobin (HbA1c), age, and duration of diabetes between the CGMS and the control groups after propensity score matching. The changes in the HbA1c levels from baseline to 6 months were calculated.

Results

The CGMS group showed a significant improvement in the HbA1c level compared to the control group at 3 months (7.9%±1.6% vs. 7.4%±1.2%, P=0.001) and at 6 months (7.4%±1.2% vs. 7.9%±1.6%, P=0.010). There were significant differences in the treatment modality changes between the CGMS group and the control group.

Conclusion

Using a 3-day CGMS was advantageous for improving glucose control in patients with type 2 diabetes and may help these patients to optimize glycemic control in clinical practice.

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  • Biological and Clinical Impacts of Glucose Metabolism in Pancreatic Ductal Adenocarcinoma
    Zhao Liu, Hiromitsu Hayashi, Kazuki Matsumura, Norio Uemura, Yuta Shiraishi, Hiroki Sato, Hideo Baba
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    Sergio Di Molfetta, Irene Caruso, Angelo Cignarelli, Annalisa Natalicchio, Sebastio Perrini, Luigi Laviola, Francesco Giorgino
    Diabetes, Obesity and Metabolism.2023; 25(5): 1301.     CrossRef
  • American Association of Clinical Endocrinology Clinical Practice Guideline: The Use of Advanced Technology in the Management of Persons With Diabetes Mellitus
    George Grunberger, Jennifer Sherr, Myriam Allende, Thomas Blevins, Bruce Bode, Yehuda Handelsman, Richard Hellman, Rosemarie Lajara, Victor Lawrence Roberts, David Rodbard, Carla Stec, Jeff Unger
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    Cindy Park, Quang A. Le
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The Glycated Albumin to Glycated Hemoglobin Ratio Might Not Be Associated with Carotid Atherosclerosis in Patients with Type 1 Diabetes
Wonjin Kim, Kwang Joon Kim, Byung-Wan Lee, Eun Seok Kang, Bong Soo Cha, Hyun Chul Lee
Diabetes Metab J. 2014;38(6):456-463.   Published online December 15, 2014
DOI: https://doi.org/10.4093/dmj.2014.38.6.456
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AbstractAbstract PDFPubReader   
Background

The ratio of glycated albumin to glycated hemoglobin (GA/A1c) is known to be elevated in subjects with type 2 diabetes mellitus (T2DM) who had decreased insulin secretion. Additionally, the carotid intima media thickness (IMT) is greater in T2DM patients with higher GA/A1c ratios. We investigated whether increased GA/A1c ratio and IMT are also associated in type 1 diabetes mellitus (T1DM), which is characterized by lack of insulin secretory capacity.

Methods

In this cross-sectional study, we recruited 81 T1DM patients (33 men, 48 women; mean age 44.1±13.0 years) who underwent carotid IMT, GA, and HbA1c measurements.

Results

The mean GA/A1c ratio was 2.90. Based on these results, we classified the subjects into two groups: group I (GA/A1c ratio <2.90, n=36) and group II (GA/A1c ratio ≥2.90, n=45). Compared with group I, the body mass indexes (BMIs), waist circumferences, and IMTs were lower in group II. GA/A1c ratio was negatively correlated with BMI, urine albumin to creatinine ratio (P<0.001 for both), and both the mean and maximal IMT (P=0.001, both). However, after adjusting the confounding factors, we observed that IMT was no longer associated with GA/A1c ratio.

Conclusion

In contrast to T2DM, IMT was not significantly related to GA/A1c ratio in the subjects with T1DM. This suggests that the correlations between GA/A1c ratio and the parameters known to be associated with atherosclerosis in T2DM could be manifested differently in T1DM. Further studies are needed to investigate these relationships in T1DM.

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A Cross-Sectional Study of the Phenotypes of Obesity and Insulin Resistance in Adults with Down Syndrome
Diego Real de Asua, Pedro Parra, Ramón Costa, Fernando Moldenhauer, Carmen Suarez
Diabetes Metab J. 2014;38(6):464-471.   Published online December 15, 2014
DOI: https://doi.org/10.4093/dmj.2014.38.6.464
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AbstractAbstract PDFPubReader   
Background

Despite the confluence of multiple cardiovascular risk factors, subclinical atherosclerotic damage and cardiovascular events remain extremely rare in adults with Down syndrome (DS). We aim to determine the prevalence of obesity and metabolic disorders in an adult cohort with DS and to compare our findings with adults without DS.

Methods

Cross-sectional study of 51 consecutively selected adults with DS living in the community and 51 healthy controls in an outpatient clinic of a tertiary care hospital in Madrid, Spain. Epidemiological data (age and gender), anthropometric data (body mass index and waist-to-height ratio), coexisting clinical conditions, and laboratory data (fasting glucose, insulin, glycated hemoglobin, creatinine, thyroid hormones, vitamins, and lipid profile) were measured and compared between the groups.

Results

Adults with DS were significantly younger and more often men with a higher prevalence of overweight and obesity than controls. Their waist-to-height ratio was higher, and they more frequently had abdominal obesity. The results of an analysis adjusted for age and gender revealed no differences in fasting insulin levels, homeostatic model assessment indexes, or lipid profile between adults with DS and controls.

Conclusion

Adults with DS presented a high prevalence of overweight and obesity. However, we found no differences in lipid profile, prevalence of insulin resistance, or metabolic syndrome between adults with DS and controls.

Citations

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GDF15 Is a Novel Biomarker for Impaired Fasting Glucose
Jun Hwa Hong, Hyo Kyun Chung, Hye Yoon Park, Kyong-Hye Joung, Ju Hee Lee, Jin Gyu Jung, Koon Soon Kim, Hyun Jin Kim, Bon Jeong Ku, Minho Shong
Diabetes Metab J. 2014;38(6):472-479.   Published online December 15, 2014
DOI: https://doi.org/10.4093/dmj.2014.38.6.472
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AbstractAbstract PDFPubReader   
Background

Growth differentiation factor-15 (GDF15) is a protein that belongs to the transforming growth factor β superfamily. An elevated serum level of GDF15 was found to be associated with type 2 diabetes mellitus (T2DM). T2DM is an inflammatory disease that progresses from normal glucose tolerance (NGT) to impaired fasting glucose (IFG). Hence, we aimed to validate the relationship between GDF15 and IFG.

Methods

The participants were divided into the following three groups: NGT (n=137), IFG (n=29), and T2DM (n=75). The controls and T2DM outpatients visited the hospital for routine health check-ups. We used fasting blood glucose to detect IFG in nondiabetic patients. We checked the body mass index (BMI), C-reactive protein level, metabolic parameters, and fasting serum GDF15 level.

Results

Age, BMI, triglyceride, insulin, glucose, homeostatic model assessment-insulin resistance (HOMA-IR), and GDF15 levels were elevated in the IFG and T2DM groups compared to the NGT group. In the correlation analysis between metabolic parameters and GDF15, age and HOMA-IR had a significant positive correlation with GDF15 levels. GDF15 significantly discriminated between IFG and NGT, independent of age, BMI, and HOMA-IR. The serum levels of GDF15 were more elevated in men than in women. As a biomarker for IFG based on the receiver operating characteristic curve analysis, the cutoff value of GDF15 was 510 pg/mL in males and 400 pg/mL in females.

Conclusion

GDF15 had a positive correlation with IR independent of age and BMI, and the serum level of GDF15 was increased in the IFG and T2DM groups. GDF15 may be a novel biomarker for detecting IFG in nondiabetic patients.

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Brief Report
Glycated Hemoglobin Value for Fasting Plasma Glucose of 126 mg/dL in Korean: The 2011 Korea National Health and Nutrition Examination Survey
Jung Min Kim, Jae Won Hong, Jong Chul Won, Jung Hyun Noh, Kyung Soo Ko, Byoung Doo Rhee, Dong-Jun Kim
Diabetes Metab J. 2014;38(6):480-483.   Published online December 15, 2014
DOI: https://doi.org/10.4093/dmj.2014.38.6.480
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AbstractAbstract PDFPubReader   

We aimed to estimate the cutoff value of glycated hemoglobin (HbA1c, A1c) for fasting plasma glucose (FPG) of 126 mg/dL in the Korean adult population, using the 2011 Korea National Health and Nutrition Examination Survey. A total of 5,421 participants without a history of diabetes and over 19 years of age were included in the analysis. A point-wise area under the receiver operating characteristic curve was used to estimate the optimal A1c cutoff value. A1c threshold of 6.1% produced the highest sum of sensitivity (85.2%) and specificity (90.5%) for FPG of 126 mg/dL (area under the curve, 0.941, P<0.001). A1c of 6.5% produced a sensitivity of 67.7% and specificity of 98.0% for FPG of 126 mg/dL. Considering A1c as one of three criteria for the diagnosis of diabetes and the specificity of an A1c cutoff of 6.5%, the current diagnostic criteria of A1c≥6.5% might be acceptable in the Korean adult population.

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