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Volume 39(1); February 2015
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Reviews
Pancreatic α-Cell Dysfunction in Type 2 Diabetes: Old Kids on the Block
Jun Sung Moon, Kyu Chang Won
Diabetes Metab J. 2015;39(1):1-9.   Published online February 16, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.1.1
  • 5,216 View
  • 83 Download
  • 38 Web of Science
  • 37 Crossref
AbstractAbstract PDFPubReader   

Type 2 diabetes (T2D) has been known as 'bi-hormonal disorder' since decades ago, the role of glucagon from α-cell has languished whereas β-cell taking center stage. Recently, numerous findings indicate that the defects of glucagon secretion get involve with development and exacerbation of hyperglycemia in T2D. Aberrant α-cell responses exhibit both fasting and postprandial states: hyperglucagonemia contributes to fasting hyperglycemia caused by inappropriate hepatic glucose production, and to postprandial hyperglycemia owing to blunted α-cell suppression. During hypoglycemia, insufficient counter-regulation response is also observed in advanced T2D. Though many debates still remained for exact mechanisms behind the dysregulation of α-cell in T2D, it is clear that the blockade of glucagon receptor or suppression of glucagon secretion from α-cell would be novel therapeutic targets for control of hyperglycemia. Whereas there have not been remarkable advances in developing new class of drugs, currently available glucagon-like peptide-1 and dipeptidyl peptidase-IV inhibitors could be options for treatment of hyperglucagonemia. In this review, we focus on α-cell dysfunction and therapeutic potentials of targeting α-cell in T2D.

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Hepatokines as a Link between Obesity and Cardiovascular Diseases
Hye Jin Yoo, Kyung Mook Choi
Diabetes Metab J. 2015;39(1):10-15.   Published online February 16, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.1.10
  • 4,915 View
  • 55 Download
  • 68 Web of Science
  • 69 Crossref
AbstractAbstract PDFPubReader   

Non-alcoholic fatty liver disease, which is considered a hepatic manifestation of metabolic syndrome, independently increases the risks of developing cardiovascular disease (CVD) and type 2 diabetes mellitus. Recent emerging evidence suggests that a group of predominantly liver-derived proteins called hepatokines directly affect the progression of atherosclerosis by modulating endothelial dysfunction and infiltration of inflammatory cells into vessel walls. Here, we summarize the role of the representative hepatokines fibroblast growth factor 21, fetuin-A, and selenoprotein P in the progression of CVD.

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The Optimal Cutoff Value of Glycated Hemoglobin for Detection of Diabetic Retinopathy
Jung Min Kim, Dong-Jun Kim
Diabetes Metab J. 2015;39(1):16-26.   Published online February 16, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.1.16
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AbstractAbstract PDFPubReader   

With standardization of measurement of glycated hemoglobin (A1C), the International Expert Committee Report in 2009 and the American Diabetes Association in 2010 recommended incorporating A1C ≥6.5% into the previous diagnostic criteria using fasting plasma glucose and/or 2-hour plasma glucose. Whereas the association of A1C with cardiovascular diseases and other diabetic microvascular complications was linear without evidence of a distinct threshold, several studies suggested a threshold value for A1C in diabetic retinopathy (DR). In studies about the optimal cutoff value for A1C in DR, the A1C values range from 5.2% to 7.8%. There are several possible reasons why these values for DR differ so widely (differences in the definition and/or methods for DR, variation in statistical methods, differences in study population, differences in exclusion criteria, and difference in methods for measuring A1C). With these wide variations in the study method, drawing a conclusive cutoff value for A1C in DR is impossible. In published studies, the cutoff values for moderate or severe DR were higher than those for any or mild DR (6.4% to 7.0% vs. 5.5% to 6.5%).

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Editorial
Can Tea Extracts Exert a Protective Effect Against Diabetes by Reducing Oxidative Stress and Decreasing Glucotoxicity in Pancreatic β-Cells?
Heeyoung Chae, Patrick Gilon
Diabetes Metab J. 2015;39(1):27-30.   Published online February 16, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.1.27
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PDFPubReader   

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  • Tea consumption and long-term risk of type 2 diabetes and diabetic complications: a cohort study of 0.5 million Chinese adults
    Jia Nie, Canqing Yu, Yu Guo, Pei Pei, Lu Chen, Yuanjie Pang, Huaidong Du, Ling Yang, Yiping Chen, Shichun Yan, Junshi Chen, Zhengming Chen, Jun Lv, Liming Li
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Original Articles
Subjective Assessment of Diabetes Self-Care Correlates with Perceived Glycemic Control but not with Actual Glycemic Control
Jung Hun Ohn, Ju Hee Lee, Eun Shil Hong, Bo Kyung Koo, Sang Wan Kim, Ka Hee Yi, Min Kyong Moon
Diabetes Metab J. 2015;39(1):31-36.   Published online February 16, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.1.31
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AbstractAbstract PDFPubReader   
Background

We investigated whether patients' perceived glycemic control and self-reported diabetes self-care correlated with their actual glycemic control.

Methods

A survey was administered among patients with diabetes mellitus at an outpatient clinic with structured self-report questionnaires regarding perceived glycemic control and diabetes self-management. Actual glycemic control was defined as a change in glycated hemoglobin (A1C) or fasting plasma glucose (FPG) since the last clinic visit.

Results

Patients who perceived their glycemic control as "improved" actually showed a mild but significant decrease in the mean A1C (-0.1%, P=0.02), and those who perceived glycemic control as "aggravated" had a significant increase in the mean FPG (10.5 mg/dL or 0.59 mmol/L, P=0.04) compared to the "stationary" group. However, one-half of patients falsely predicted their actual glycemic control status. Subjective assessment of diabetes self-care efforts, such as adherence to a diet regimen or physical activity, correlated positively with perceived glycemic control but showed no association with actual glycemic control.

Conclusion

Patients should be encouraged to assess and monitor diabetes self-care more objectively to motivate behavioral modifications and improve their actual glycemic control.

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  • Social Networking Services-Based Communicative Care for Patients with Diabetes Mellitus in Korea
    Hun-Sung Kim, Yoo Jeong, Sun Baik, So Yang, Tong Kim, Hyunah Kim, Hyunyong Lee, Seung-Hwan Lee, Jae Cho, In-Young Choi, Kun-Ho Yoon
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Appendicular Skeletal Muscle Mass and Insulin Resistance in an Elderly Korean Population: The Korean Social Life, Health and Aging Project-Health Examination Cohort
Seung Won Lee, Yoosik Youm, Won Joon Lee, Wungrak Choi, Sang Hui Chu, Yeong-Ran Park, Hyeon Chang Kim
Diabetes Metab J. 2015;39(1):37-45.   Published online February 16, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.1.37
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AbstractAbstract PDFPubReader   
Background

Increasing evidence supports an association between age-related loss of muscle mass and insulin resistance. However, the association has not been fully investigated in the general population. Thus, we investigated the association between appendicular skeletal muscle mass (ASM) and insulin resistance in an elderly Korean population.

Methods

This cross-sectional study included 158 men (mean age, 71.8) and 241 women (mean age, 70.6) from the Korean Social Life, Health and Aging Project, which started in 2011. In this study, ASM was measured by bioelectrical impedance analysis and was analyzed in three forms: ASM (kg), ASM/height2 (kg/m2), and ASM/weight (%). The homeostasis model assessment of insulin resistance (HOMA-IR) was used as a measure of insulin resistance. The relationships between the ASM values and the HOMA-IR were investigated by multiple linear regression models.

Results

The HOMA-IR was positively associated with ASM (β=0.43, P<0.0001) and ASM/height2 (β=0.36, P<0.0001) when adjusted for sex and age. However, after additional adjustment for body weight, HOMA-IR was inversely associated with ASM (β=-0.43, P<0.001) and ASM/height2 (β=-0.30, P=0.001). Adjustment for other potential confounders did not change these associations. Conversely, HOMA-IR was consistently and inversely associated with ASM/weight before and after adjustment for other potential confounders.

Conclusion

Our results support the idea that lower skeletal muscle mass is independently associated with insulin resistance in older adults. When evaluating sarcopenia or muscle-related conditions in older adults, their whole body sizes also need to be considered.

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Intravitreal Ranibizumab for Subfoveal Choroidal Neovascularization from Age-Related Macular Degeneration with Combined Severe Diabetic Retinopathy
So Young Han, Jeong Hun Bae, Jaeryung Oh, Hyeong Gon Yu, Su Jeong Song
Diabetes Metab J. 2015;39(1):46-50.   Published online February 16, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.1.46
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AbstractAbstract PDFPubReader   
Background

To evaluate the efficacy of intravitreal ranibizumab for subfoveal choroidal neovascularization (CNV) from age-related macular degeneration (AMD) with combined severe diabetic retinopathy (DR).

Methods

This retrospective, interventional case series included eleven patients (mean age, 70.09 years; range, 54 to 83 years) with at least severe non-proliferative DR and subfoveal CNV secondary to AMD. Each subject was treated with intravitreal injections of 0.5 mg ranibizumab. The primary outcomes included change in best-corrected visual acuity and central subfield thickness (CST) on optical coherence tomography (OCT).

Results

The mean follow-up time was 16.7±14 months (range, 6 to 31 months). Mean visual acuity improved from 1.21±0.80 logarithm of the minimum angle of resolution (logMAR) to 1.0±0.6 logMAR (P=0.107), 0.95±0.62 logMAR (P=0.044), 1.10±0.68 logMAR (P=0.296), and 1.13±0.66 logMAR (P=0.838) at 1, 3, 6, and 12 months after injection, respectively. Eight patients (72.7%) gained or maintained vision (mean 0.32 logMAR), whereas three patients (27.3%) lost more than one line of vision (mean 0.51 logMAR). The mean OCT CST was 343.9±134.6 µm at baseline, and the mean CST at 1, 3, 6, 12 months after the injection was 367.8±172.1 (P=0.864), 346.2±246.2 (P=0.857), 342±194.1 (P=0.551), and 294.2±108.3 µm (P=0.621), respectively.

Conclusion

Intravitreal ranibizumab injection can be considered to be a therapy for the stabilization of subfoveal CNV secondary to AMD with combined severe DR. However, these patients might exhibit limited visual improvement after treatment.

Citations

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  • Comparative study of widefield swept-source optical coherence tomography angiography in eyes with concomitant age-related macular degeneration and diabetic retinopathy
    Matthew Finn, Grace Baldwin, Itika Garg, Hannah E Wescott, Thomas Koch, Filippos Vingopoulos, Rebecca Zeng, Hanna Choi, Diane Sayah, Deeba Husain, Nimesh A Patel, Leo A Kim, Joan W Miller, David M Wu, Demetrios G Vavvas, John B Miller
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Hexane Extract of Orthosiphon stamineus Induces Insulin Expression and Prevents Glucotoxicity in INS-1 Cells
Hae-Jung Lee, Yoon-Jung Choi, So-Young Park, Jong-Yeon Kim, Kyu-Chang Won, Jong-Keun Son, Yong-Woon Kim
Diabetes Metab J. 2015;39(1):51-58.   Published online February 16, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.1.51
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AbstractAbstract PDFPubReader   
Background

Hyperglycemia, a characteristic feature of diabetes, induces glucotoxicity in pancreatic β-cells, resulting in further impairment of insulin secretion and worsening glycemic control. Thus, preservation of insulin secretory capacity is essential for the management of type 2 diabetes. In this study, we evaluated the ability of an Orthosiphon stamineus (OS) extract to prevent glucotoxicity in insulin-producing cells.

Methods

We measured insulin mRNA expression and glucose-stimulated insulin secretion (GSIS) in OS-treated INS-1 cells after exposure to a high glucose (HG; 30 mM) concentration.

Results

The hexane extract of OS elevated mRNA expression of insulin as well as pancreatic and duodenal homeobox-1 of INS-1 cells in a dose-dependent manner. The hexane OS extract also increased the levels of phosphorylated phosphatidylinositol 3-kinase (PI3K) in a concentration-dependent manner. Additionally, Akt phosphorylation was elevated by treatment with 100 and 200 µmol of the hexane OS extract. Three days of HG exposure suppressed insulin mRNA expression and GSIS; these expressions were restored by treatment with the hexane OS extract. HG elevated peroxide levels in the INS-1 cells. These levels were unaffected by OS treatment under both normal and hyperglycemic conditions.

Conclusion

Our results suggested that the hexane extract of OS elevates insulin mRNA expression and prevents glucotoxicity induced by a 3-day treatment with HG. This was associated with the activation of PI-3K and Akt.

Citations

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Myeloperoxidase Is Associated with Insulin Resistance and Inflammation in Overweight Subjects with First-Degree Relatives with Type 2 Diabetes Mellitus
Anel Gómez García, Mireya Rivera Rodríguez, Carlos Gómez Alonso, Daysi Yazmin Rodríguez Ochoa, Cleto Alvarez Aguilar
Diabetes Metab J. 2015;39(1):59-65.   Published online February 16, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.1.59
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AbstractAbstract PDFPubReader   
Background

Family history of type 2 diabetes mellitus (T2DM) is one of risk factors for that in future a subject can develop diabetes. Insulin resistance (IR) is important in the pathogenesis of T2DM. There is evidence that oxidative stress plays an important role in the etiology and/or progression of diabetes. Myeloperoxidase (MPO) participates in developing of inflammation. The objective was to investigate if MPO is associated with IR and inflammation in individuals with first-degree relatives of T2DM.

Methods

Cross-sectional study in 84 overweight individuals with family history of T2DM divided in two groups according to IR, group with IR (homeostasis model assessment [HOMA] ≥2.5; n=43) and control group (CG; HOMA <2.5; n=41). Complete clinical history and a venous blood sample were collected for measuring glucose and lipids profile, insulin, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), MPO, glutathione reductase (GRd), glutathione peroxidase, and superoxide dismutase.

Results

MPO, TNF-α, and IL-6 were higher in patients with IR than in CG (MPO: 308.35 [190.85 to 445.42] vs. 177.35 [104.50 to 279.85], P=0.0001; TNF-α: 13.46 [10.58 to 18.88] vs. 9.39 [7.53 to 11.25], P=0.0001; IL-6: 32.93 [24.93 to 38.27] vs. 15.60 [12.93 to 26.27]; P=0.0001, respectively). MPO was associated with IR (rho de Spearman=0.362, P=0.001). In the analysis of lineal regression, MPO predicts IR (β, 0.263; t, 2.520; P=0.014). In the univariate analysis, MPO had an odds ratio of 9.880 for risk of IR (95% confidence interval, 2.647 to 36.879).

Conclusion

MPO had relation with IR and inflammation parameters in overweight subjects with first-degree relatives of T2DM. We need studies on a casual relationship and molecular mechanisms among the increased serum MPO levels, inflammation markers, and IR.

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Pattern of Thyroid Dysfunction in Patients with Metabolic Syndrome and Its Relationship with Components of Metabolic Syndrome
Prabin Gyawali, Jyoti Shrestha Takanche, Raj Kumar Shrestha, Prem Bhattarai, Kishor Khanal, Prabodh Risal, Rajendra Koju
Diabetes Metab J. 2015;39(1):66-73.   Published online February 16, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.1.66
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AbstractAbstract PDFPubReader   
Background

Thyroid dysfunction (TD) and metabolic syndrome (MetS) are known risk factors for atherosclerotic cardiovascular disease (ASCVD). TD is risk factor for ASCVD mediated by the effects of thyroid hormones on lipid metabolism and blood pressure hence the components of MetS. It is possible that coexistence of these two disease entities and unrecognized TD in patients with MetS might substantially increase ASCVD risk. Moreover, little is known about the relationship between TD and the components of MetS. Thus, the purpose of this study was to evaluate the pattern of TD in patients with MetS and its relationship with components of the MetS.

Methods

A total of 358 previously diagnosed patients with MetS were recruited in the study. The thyroid function test parameters were measured to classify TD at Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal. Statistical analyses were performed using SPSS version 16.0 to evaluate pattern and relationship.

Results

The overall prevalence of TD in patients with MetS was 31.84% with high prevalence of subclinical hypothyroidism (29.32%). We found no evidence of a relationship between TD and components of MetS, although there was significant difference in waist circumference between four groups of TD.

Conclusion

Patients with MetS had subclinical hypothyroidism greatly. Although there was no evidence of any relationship between thyroid status and all components of MetS, TD should be taken into account when evaluating and treating patients with MetS to reduce the impending risk.

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Economic Impact of Combining Metformin with Dipeptidyl Peptidase-4 Inhibitors in Diabetic Patients with Renal Impairment in Spanish Patients
Antoni Sicras-Mainar, Ruth Navarro-Artieda
Diabetes Metab J. 2015;39(1):74-81.   Published online February 16, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.1.74
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AbstractAbstract PDFPubReader   
Background

To evaluate resource use and health costs due to the combination of metformin and dipeptidyl peptidase-4 (DPP-4) inhibitors in patients with diabetes and renal impairment in routine clinical practice.

Methods

An observational, retrospective study was performed. Patients aged ≥30 years treated with metformin who initiated a second oral antidiabetic treatment in 2009 to 2010 were included. Two groups of patients were analysed: metformin+DPP-4 inhibitors and other oral antidiabetics. The main measures were: compliance, persistence, metabolic control (glycosylated hemoglobin< 7%) and complications (hypoglycemia, cardiovascular events) and total costs. Patients were followed up for 2 years.

Results

We included 395 patients, mean age 70.2 years, 56.5% male: 135 patients received metformin+DPP-4 inhibitors and 260 patients received metformin+other oral antidiabetics. Patients receiving DPP-4 inhibitors showed better compliance (66.0% vs. 60.1%), persistence (57.6% vs. 50.0%), and metabolic control (63.9% vs. 57.3%), respectively, compared with those receiving other oral antidiabetics (P<0.05), and also had a lower rate of hypoglycemia (20.0% vs. 47.7%) and lower total costs (€ 2,486 vs. € 3,002), P=0.001.

Conclusion

Despite the limitations of the study, patients with renal impairment treated with DPP-4 inhibitors had better metabolic control, lower rates (association) of hypoglycaemia, and lower health costs for the Spanish national health system.

Citations

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  • Characteristics of Hypoglycemia Pateints Visiting the Emergency Department of a University Hospital
    Sang-Hyeon Choi, Deok-Ki Youn, Moon-Gi Choi, Ohk-Hyun Ryu
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  • Response: Economic Impact of Combining Metformin with Dipeptidyl Peptidase-4 Inhibitors in Diabetic Patients with Renal Impairment in Spanish Patients (Diabetes Metab J2015;39:74-81)
    Antoni Sicras-Mainar, Ruth Navarro-Artieda
    Diabetes & Metabolism Journal.2015; 39(2): 173.     CrossRef
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    Wellington Santana da Silva Júnior, Amélio Fernando de Godoy-Matos, Luiz Guilherme Kraemer-Aguiar
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  • Letter: Economic Impact of Combining Metformin with Dipeptidyl Peptidase-4 Inhibitors in Diabetic Patients with Renal Impairment in Spanish Patients (Diabetes Metab J2015;39:74-81)
    Hannah Seok
    Diabetes & Metabolism Journal.2015; 39(2): 171.     CrossRef
Letter
Letter: GDF15 Is a Novel Biomarker for Impaired Fasting Glucose (Diabetes Metab J 2014;38:472-9)
Bo Kyung Koo
Diabetes Metab J. 2015;39(1):82-83.   Published online February 16, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.1.82
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Citations

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  • GDF15plays a critical role in insulin secretion in INS-1 cells and human pancreatic islets
    Mohammad G Mohammad, Rania Saeed, Abdul Khader Mohammed, Anila Khalique, Mohamad Hamad, Waseem El-Huneidi, Mawieh Hamad, Jalal Taneera
    Experimental Biology and Medicine.2023; 248(4): 339.     CrossRef
Response
Response: GDF15 Is a Novel Biomarker for Impaired Fasting Glucose (Diabetes Metab J 2014;38:472-9)
Jun Hwa Hong, Bon Jeong Ku, Minho Shong
Diabetes Metab J. 2015;39(1):84-86.   Published online February 16, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.1.84
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