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Volume 40(6); December 2016
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Reviews
Complications
Risk Factors and Adverse Outcomes of Severe Hypoglycemia in Type 2 Diabetes Mellitus
Jae-Seung Yun, Seung-Hyun Ko
Diabetes Metab J. 2016;40(6):423-432.   Published online October 5, 2016
DOI: https://doi.org/10.4093/dmj.2016.40.6.423
  • 4,920 View
  • 85 Download
  • 44 Web of Science
  • 41 Crossref
AbstractAbstract PDFPubReader   

Hypoglycemia has been considered as a major barrier to achieving the proper glycemic target in type 2 diabetes mellitus patients. In particular, severe hypoglycemia (SH), which is defined as a hypoglycemic episode requiring the assistance of another person to raise the patient's glucose level, is a serious complication of diabetes because of its possible fatal outcomes. Recently, the recommendations for diabetes care have emphasized a patient-centered approach, considering the individualized patient factors including hypoglycemia. Many studies have been performed which analyzed the risk factors and clinical outcomes for SH. From the studies, researchers recommend that targeting a less stringent glycosylated hemoglobin level and selecting a safer class of drugs for hypoglycemia are appropriate for patients with a high risk of SH. Also, careful clinical attention to prevent hypoglycemia, including intensive education, is necessary to minimize the risk of SH and SH-related fatal outcomes.

Citations

Citations to this article as recorded by  
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    Lixin Guo, Xinhua Xiao
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    Heart & Lung.2023; 62: 43.     CrossRef
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    Diabetes Therapy.2023; 14(11): 1757.     CrossRef
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    Current Diabetes Reviews.2023;[Epub]     CrossRef
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  • Effects of Co‐administration of Sulfonylureas and Antimicrobial Drugs on Hypoglycemia in Patients with Type 2 Diabetes Using a Case‐Crossover Design
    Sera Lee, Miyoung Ock, Hun‐Sung Kim, Hyunah Kim
    Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy.2020; 40(9): 902.     CrossRef
  • Non-invasive marker-independent high content analysis of a microphysiological human pancreas-on-a-chip model
    Aline Zbinden, Julia Marzi, Katharina Schlünder, Christopher Probst, Max Urbanczyk, Scott Black, Eva M. Brauchle, Shannon L. Layland, Udo Kraushaar, Garry Duffy, Katja Schenke-Layland, Peter Loskill
    Matrix Biology.2020; 85-86: 205.     CrossRef
  • Associations Between the Knowledge of Different Food Categories and Glycemia in Chinese Adult Patients With Type 2 Diabetes
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    Clinical Nursing Research.2020; 29(5): 313.     CrossRef
  • Deterioration of Sleep Quality According to Glycemic Status
    Myung Haeng Hur, Mi-Kyoung Lee, Kayeon Seong, Jun Hwa Hong
    Diabetes & Metabolism Journal.2020; 44(5): 679.     CrossRef
  • Higher versus standard starting dose of insulin glargine 100 U/mL in overweight or obese Chinese patients with type 2 diabetes: Results of a multicentre, open‐label, randomized controlled trial (BEYOND VII)
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    Sangmo Hong, Kyungdo Han, Cheol-Young Park
    Mayo Clinic Proceedings.2020; 95(1): 101.     CrossRef
  • Integrating oral semaglutide into clinical practice in primary care: for whom, when, and how?
    Stephen A. Brunton, Ofri Mosenzon, Eugene E. Wright Jr
    Postgraduate Medicine.2020; 132(sup2): 48.     CrossRef
  • The Safety and Efficacy of Second-Generation Basal Insulin Analogues in Adults with Type 2 Diabetes at Risk of Hypoglycemia and Use in Other Special Populations: A Narrative Review
    Alice Y. Y. Cheng, Jencia Wong, Nick Freemantle, Shamasunder H. Acharya, Elif Ekinci
    Diabetes Therapy.2020; 11(11): 2555.     CrossRef
  • Predisposing factors of hypoglycemia in patients with type 2 diabetes mellitus presented with symptomatic hypoglycemia in a tertiary hospital of Bangladesh
    AjitK Paul, A.B.M. Kamrul-Hasan
    Journal of Diabetology.2020; 11(3): 163.     CrossRef
  • Development of a hypoglycaemia risk score to identify high‐risk individuals with advanced type 2 diabetes in DEVOTE
    Simon Heller, Ildiko Lingvay, Steven P. Marso, Athena Philis‐Tsimikas, Thomas R. Pieber, Neil R. Poulter, Richard E. Pratley, Elise Hachmann‐Nielsen, Kajsa Kvist, Martin Lange, Alan C. Moses, Marie Trock Andresen, John B. Buse
    Diabetes, Obesity and Metabolism.2020; 22(12): 2248.     CrossRef
  • Real-world risk of hypoglycemia-related hospitalization in Japanese patients with type 2 diabetes using SGLT2 inhibitors: a nationwide cohort study
    Takeshi Horii, Yoichi Oikawa, Narumi Kunisada, Akira Shimada, Koichiro Atsuda
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  • Common inpatient hypoglycemia phenotypes identified from an automated electronic health record–based prediction model
    Yoonyoung Choi, Ben Staley, Rene Soria-Saucedo, Carl Henriksen, Amy Rosenberg, Almut G Winterstein
    American Journal of Health-System Pharmacy.2019; 76(3): 166.     CrossRef
  • Severe hypoglycemia and the risk of cardiovascular disease and mortality in type 2 diabetes: a nationwide population-based cohort study
    Jae-Seung Yun, Yong-Moon Park, Kyungdo Han, Seon-Ah Cha, Yu-Bae Ahn, Seung-Hyun Ko
    Cardiovascular Diabetology.2019;[Epub]     CrossRef
  • Analysis of the characteristics of patients with diabetes mellitus who attend a tertiary hospital emergency department for a hypoglycemic event
    Jordi Caballero-Corchuelo, Fernando Guerrero-Pérez, Paula García-Sancho de la Jordana, Manuel Pérez-Maraver
    Endocrinología, Diabetes y Nutrición (English ed.).2019; 66(1): 19.     CrossRef
  • Management of hypoglycemia in older adults with type 2 diabetes
    Jeffrey Freeman
    Postgraduate Medicine.2019; 131(4): 241.     CrossRef
  • Impact of Carbohydrate on Glucose Variability in Patients with Type 1 Diabetes Assessed Through Professional Continuous Glucose Monitoring: A Retrospective Study
    Yi-Hsuan Lin, Yu-Yao Huang, Hsin-Yun Chen, Sheng-Hwu Hsieh, Jui-Hung Sun, Szu-Tah Chen, Chia-Hung Lin
    Diabetes Therapy.2019; 10(6): 2289.     CrossRef
  • Association between BMI and risk of severe hypoglycaemia in type 2 diabetes
    J.-S. Yun, Y.-M. Park, K. Han, S.-A. Cha, Y.-B. Ahn, S.-H. Ko
    Diabetes & Metabolism.2019; 45(1): 19.     CrossRef
  • Análisis de las características de los pacientes con diabetes mellitus que consultan por hipoglucemia en el servicio de urgencias de un hospital terciario
    Jordi Caballero-Corchuelo, Fernando Guerrero-Pérez, Paula García-Sancho de la Jordana, Manuel Pérez-Maraver
    Endocrinología, Diabetes y Nutrición.2019; 66(1): 19.     CrossRef
  • The association between hypoglycemia and hospital use, food insufficiency, and unstable housing conditions: a cross-sectional study among patients with type 2 diabetes in Sudan
    Hyder Osman Mirghani
    BMC Research Notes.2019;[Epub]     CrossRef
  • Hypoglycemia after initiating insulin therapy based on the results of structured self-control and monitoring of blood glucose
    A. V. Petrov, L. G. Strongin
    Medical Council.2018; (12): 112.     CrossRef
  • Monotherapy in Patients with Type 2 Diabetes Mellitus
    Sang Youl Rhee, Hyun Jin Kim, Seung-Hyun Ko, Kyu-Yeon Hur, Nan-Hee Kim, Min Kyong Moon, Seok-O Park, Byung-Wan Lee, Kyung Mook Choi, Jin Hwa Kim
    Diabetes & Metabolism Journal.2017; 41(5): 349.     CrossRef
  • Monotherapy in patients with type 2 diabetes mellitus
    Sang Youl Rhee, Hyun Jin Kim, Seung-Hyun Ko, Kyu Yeon Hur, Nan-Hee Kim, Min Kyong Moon, Seok-O Park, Byung-Wan Lee, Kyung Mook Choi, Jin Hwa Kim
    The Korean Journal of Internal Medicine.2017; 32(6): 959.     CrossRef
  • Antihyperglycemic agent therapy for adult patients with type 2 diabetes mellitus 2017: a position statement of the Korean Diabetes Association
    Seung-Hyun Ko, Kyu-Yeon Hur, Sang Youl Rhee, Nan-Hee Kim, Min Kyong Moon, Seok-O Park, Byung-Wan Lee, Hyun Jin Kim, Kyung Mook Choi, Jin Hwa Kim
    The Korean Journal of Internal Medicine.2017; 32(6): 947.     CrossRef
  • Antihyperglycemic Agent Therapy for Adult Patients with Type 2 Diabetes Mellitus 2017: A Position Statement of the Korean Diabetes Association
    Seung-Hyun Ko, Kyu-Yeon Hur, Sang Youl Rhee, Nan-Hee Kim, Min Kyong Moon, Seok-O Park, Byung-Wan Lee, Hyun Jin Kim, Kyung Mook Choi, Jin Hwa Kim
    Diabetes & Metabolism Journal.2017; 41(5): 337.     CrossRef
Obesity and Metabolic Syndrome
Metabolic Surgery for Type 2 Diabetes Mellitus: Experience from Asia
Wei-Jei Lee, Lwin Aung
Diabetes Metab J. 2016;40(6):433-443.   Published online December 2, 2016
DOI: https://doi.org/10.4093/dmj.2016.40.6.433
  • 4,323 View
  • 76 Download
  • 15 Web of Science
  • 16 Crossref
AbstractAbstract PDFPubReader   

Type 2 diabetes mellitus (T2DM) is a current global health priority and Asia is the epicenter of this epidemic disease. Unlike in the west, where older population is most affected, the burden of diabetes in Asian countries is disproportionately high in young to middle-age adults. The incidence of diabetic nephropathy is alarmingly high in patients with early onset T2DM, especially in those with poor glycemic control. How to control this chronic and debilitating disease is currently a very important health issue in Asia. Bariatric surgery has proven successful in treating not just obesity but also T2DM in morbid obese patients (body mass index [BMI] >35 kg/m2). Gastrointestinal metabolic surgery recently has been proposed as a new treatment modality for obesity related T2DM for patients with BMI <35 kg/m2. Many studies from Asia reported promising results of metabolic surgery to treat obese patients with T2DM which is not well controlled. It has been demonstrated that changes in gastrointestinal hormone secretion after gastrointestinal surgery would favor an early improvement of T2DM in Asians. New procedures have also been designed and proposed specifically for the treatment of diabetes in Asia. This article examines clinical trial data and accepted algorithms with a view toward elucidating the application of metabolic surgery for the treatment of T2DM in the Asia. We propose a systematic approach to surgical treatment, addressing current evidences, patient selection, procedure of choice, and timing and guideline for new procedures.

Citations

Citations to this article as recorded by  
  • Insulin resistance levels predicted metabolic improvement and weight loss after metabolic surgery in Chinese patients with type 2 diabetes
    Yaoquan Cao, Ping Luo, Haibo Tang, Pengzhou Li, Guohui Wang, Weizheng Li, Zhi Song, Zhihong Su, Xulong Sun, Xianhao Yi, Zhibing Fu, Beibei Cui, Shaihong Zhu, Liyong Zhu
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    Scientific Reports.2021;[Epub]     CrossRef
  • Insulin Resistance Remission Following Laparoscopic Roux-en-Y Gastric Bypass and Laparoscopic Sleeve Gastrectomy in Chinese Type 2 Diabetes Mellitus Patients With a Body Mass Index of 27.5–32.5 kg/m2
    Ping Luo, Yaoquan Cao, Pengzhou Li, Guohui Wang, Zhi Song, Weizheng Li, Zhihong Su, Hui Zhou, Xianhao Yi, Zhibing Fu, Xulong Sun, Haibo Tang, Beibei Cui, Qianqian Yu, Liyong Zhu, Shaihong Zhu
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  • Laparoscopic metabolic surgery for the treatment of type 2 diabetes in Asia: a scoping review and evidence-based analysis
    Zhiyong Dong, Sheikh Mohammed Shariful Islam, Ashley M. Yu, Rui Qu, Bingsheng Guan, Junchang Zhang, Zhao Hong, Cunchuang Wang
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    Salahedeen Abusnana, Mohammad Fargaly, Shaima Hasan Alfardan, Fatema Hasan Al Hammadi, Alaaeldin Bashier, Ghaida Kaddaha, Barbara McGowan, Rita Nawar, Amena Sadiya
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    Nian-Cun Qiu, Wei Li, Miao-E Liu, Xiao-Xia Cen, Cheng-Xiang Shan, Wei Zhang, Qing Liu, Yang Wang, Ya-Ting Zhu, Ming Qiu
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    Ivy H.Y. Ng, Kitty K.T. Cheung, Tiffany T.L. Yau, Elaine Chow, Risa Ozaki, Juliana C.N. Chan
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    Phong Ching Lee, Kwang Wei Tham, Sonali Ganguly, Hong Chang Tan, Alvin Kim Hock Eng, John B. Dixon
    Obesity Surgery.2018; 28(6): 1511.     CrossRef
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    Xiao-Jun Cai, Lei Wang, Chun-Mei Hu
    Bioscience Reports.2018;[Epub]     CrossRef
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  • Pulmonary function evaluation in type 2 diabetes mellitus patients submitted to metabolic surgery
    Ariana de Melo Tosta, Marisa de Carvalho Borges, Élida Mara Carneiro da Silva, Tharsus Dias Takeuti, Júverson Alves Terra Júnior, Eduardo Crema
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Editorial
Complications
Determinants of the Risk of Diabetic Kidney Disease and Diabetic Retinopathy Independent of Glucose Exposure
Bo Kyung Koo
Diabetes Metab J. 2016;40(6):444-446.   Published online December 14, 2016
DOI: https://doi.org/10.4093/dmj.2016.40.6.444
  • 2,863 View
  • 28 Download
PDFPubReader   
Original Articles
Clinical Care/Education
Factors Associated with Participation in Diabetes Education: The Korea National Health and Nutrition Examination Survey 2007 to 2009
Jung Min Kim, Jae Won Hong, Jung Hyun Noh, Dong-Jun Kim
Diabetes Metab J. 2016;40(6):447-453.   Published online September 20, 2016
DOI: https://doi.org/10.4093/dmj.2016.40.6.447
  • 4,357 View
  • 34 Download
  • 8 Web of Science
  • 9 Crossref
AbstractAbstract PDFPubReader   
Background

A recent study revealed that the participation rate in diabetes education among diabetic patients was only about 50% in Korea. We investigated the factors associated with participation in diabetes education.

Methods

The study included 1,255 patients (≥19 years old) diagnosed with diabetes drawn from the total Korea National Health and Nutrition Examination Survey 2007 to 2009 population comprising 30,705 individuals. We compared age, sex, and age- and sex-adjusted clinical characteristics in patients who had received diabetes education versus those who had not.

Results

Of the 1,255 patients, 19.8% (n=248) had received diabetes education. Patients in the group who received diabetes education were younger, diagnosed at an earlier age, had a longer diabetes duration and were more likely to be using insulin therapy compared with the group who did not receive diabetes education (P<0.001). The group who received diabetes education included fewer manual workers (P<0.001) but more college graduates (P=0.004) compared with the group who did not receive diabetes education. Logistic regression analysis revealed that longer diabetes duration increased the likelihood of receiving diabetes education (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01 to 1.06; P=0.004). Junior high school (OR, 0.47; 95% CI, 0.24 to 0.91; P=0.026) and elementary school education levels (OR, 0.34; 95% CI, 0.17 to 0.65; P=0.001) versus college graduation were inversely correlated with participation in diabetes self-management education. Non-insulin therapy reduced the likelihood of receiving diabetes education (OR, 0.37; 95% CI, 0.21 to 0.64; P<0.001).

Conclusion

Longer diabetes duration, insulin therapy, and higher education level were positively associated with the completion of diabetes education.

Citations

Citations to this article as recorded by  
  • Management Status of Patients with Type 2 Diabetes Mellitus at General Hospitals in Korea: A 5-Year Follow-Up Study
    Jin Hee Jung, Jung Hwa Lee, Hyang Mi Jang, Young Na, Hee Sun Choi, Yeon Hee Lee, Yang Gyo Kang, Na Rae Kim, Jeong Rim Lee, Bok Rye Song, Kang Hee Sim
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    Junrong Shi, Yong Li
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    Lifeng Fan, Souraya Sidani
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    Seung-Hyun Ko, Kyu-Yeon Hur, Sang Youl Rhee, Nan-Hee Kim, Min Kyong Moon, Seok-O Park, Byung-Wan Lee, Hyun Jin Kim, Kyung Mook Choi, Jin Hwa Kim
    The Korean Journal of Internal Medicine.2017; 32(6): 947.     CrossRef
  • Antihyperglycemic Agent Therapy for Adult Patients with Type 2 Diabetes Mellitus 2017: A Position Statement of the Korean Diabetes Association
    Seung-Hyun Ko, Kyu-Yeon Hur, Sang Youl Rhee, Nan-Hee Kim, Min Kyong Moon, Seok-O Park, Byung-Wan Lee, Hyun Jin Kim, Kyung Mook Choi, Jin Hwa Kim
    Diabetes & Metabolism Journal.2017; 41(5): 337.     CrossRef
Clinical Care/Education
Reduction of Sulfonylurea with the Initiation of Basal Insulin in Patients with Inadequately Controlled Type 2 Diabetes Mellitus Undergoing Long-Term Sulfonylurea-Based Treatment
Yeoree Yang, Jeong-Ah Shin, Hae Kyung Yang, Seung-Hwan Lee, Seung-Hyun Ko, Yu-Bae Ahn, Kun-Ho Yoon, Jae-Hyoung Cho
Diabetes Metab J. 2016;40(6):454-462.   Published online October 11, 2016
DOI: https://doi.org/10.4093/dmj.2016.40.6.454
  • 4,486 View
  • 45 Download
  • 4 Web of Science
  • 4 Crossref
AbstractAbstract PDFPubReader   
Background

There were a limited number of studies about β-cell function after insulin initiation in patients exposed to long durations of sulfonylurea treatment. In this study, we aimed to evaluate the recovery of β-cell function and the efficacy of concurrent sulfonylurea use after the start of long-acting insulin.

Methods

In this randomized controlled study, patients with type 2 diabetes mellitus (T2DM), receiving sulfonylurea for at least 2 years with glycosylated hemoglobin (HbA1c) >7%, were randomly assigned to two groups: sulfonylurea maintenance (SM) and sulfonylurea reduction (SR). Following a 75-g oral glucose tolerance test (OGTT), we administered long-acting basal insulin to the two groups. After a 6-month follow-up, we repeated the OGTT.

Results

Among 69 enrolled patients, 57 completed the study and were analyzed: 31 in the SM and 26 in the SR group. At baseline, there was no significant difference except for the longer duration of diabetes and lower triglycerides in the SR group. After 6 months, the HbA1c was similarly reduced in both groups, but there was little difference in the insulin dose. In addition, insulin secretion during OGTT was significantly increased by 20% to 30% in both groups. A significant weight gain was observed in the SM group only. The insulinogenic index was more significantly improved in the SR group.

Conclusion

Long-acting basal insulin replacement could improve the glycemic status and restore β-cell function in the T2DM patients undergoing sulfonylurea-based treatment, irrespective of the sulfonylurea dose reduction. The dose reduction of the concurrent sulfonylurea might be beneficial with regard to weight grain.

Citations

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  • Initiating or Switching to Insulin Degludec/Insulin Aspart in Adults with Type 2 Diabetes: A Real-World, Prospective, Non-interventional Study Across Six Countries
    Gregory R. Fulcher, Shahid Akhtar, Saleh J. Al-Jaser, Johan Medina, Mafauzy Mohamed, Nemencio A. Nicodemus, Anne Helene Olsen, Kiran P. Singh, Adri Kok
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  • Insulin therapy for adult patients with type 2 diabetes mellitus: a position statement of the Korean Diabetes Association, 2017
    Byung-Wan Lee, Jin Hwa Kim, Seung-Hyun Ko, Kyu Yeon Hur, Nan-Hee Kim, Sang Youl Rhee, Hyun Jin Kim, Min Kyong Moon, Seok-O Park, Kyung Mook Choi
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Complications
Baseline-Corrected QT (QTc) Interval Is Associated with Prolongation of QTc during Severe Hypoglycemia in Patients with Type 2 Diabetes Mellitus
Seon-Ah Cha, Jae-Seung Yun, Tae-Seok Lim, Yoon-Goo Kang, Kang-Min Lee, Ki-Ho Song, Ki-Dong Yoo, Yong-Moon Park, Seung-Hyun Ko, Yu-Bae Ahn
Diabetes Metab J. 2016;40(6):463-472.   Published online October 5, 2016
DOI: https://doi.org/10.4093/dmj.2016.40.6.463
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AbstractAbstract PDFPubReader   
Background

We investigated an association between baseline heart rate-corrected QT (QTc) interval before severe hypoglycemia (SH) and prolongation of QTc interval during SH in patients with type 2 diabetes mellitus (T2DM).

Methods

Between January 2004 and June 2014, 208 patients with T2DM, who visited the emergency department because of SH and underwent standard 12-lead electrocardiography within the 6-month period before SH were consecutively enrolled. The QTc interval was analyzed during the incidence of SH, and 6 months before and after SH. QTc intervals of 450 ms or longer in men and 460 ms or longer in women were considered abnormally prolonged.

Results

The mean age and diabetes duration were 68.1±12.1 and 14.1±10.1 years, respectively. The mean QTc intervals at baseline and SH episodes were 433±33 and 460±33 ms, respectively (P<0.001). One hundred and fourteen patients (54.8%) had a prolonged QTc interval during SH. There was a significant decrease in the prolonged QTc interval within 6 months after SH (QTc interval prolongation during SH vs. after recovery, 54.8% vs. 33.8%, P<0.001). The prolonged QTc interval was significantly associated with baseline QTc interval prolongation (odds ratio, 2.92; 95% confidence interval, 1.22 to 6.96; P=0.016) after adjusting for multiple confounders.

Conclusion

A prolonged QTc interval at baseline was significantly associated with prolongation of the QTc interval during SH in patients with T2DM, suggesting the necessity of QTc interval monitoring and attention to those with a prolonged QTc interval to prevent SH.

Citations

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  • Prevalence of QT prolongation and its risk factors in patients with type 2 diabetes
    Khaled Aburisheh, Mohammad F. AlKheraiji, Saleh I. Alwalan, Arthur C. Isnani, Mohamed Rafiullah, Muhammad Mujammami, Assim A. Alfadda
    BMC Endocrine Disorders.2023;[Epub]     CrossRef
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    Seung-Hyun Ko
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    Seon-Ah Cha
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    Soo-Yeon Choi, Seung-Hyun Ko
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    Cristina Amione, Sara Giunti, Paolo Fornengo, Sabita S. Soedamah-Muthu, Nish Chaturvedi, J. H. Fuller, Federica Barutta, Gabriella Gruden, Graziella Bruno
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Complications
Risk Factors for the Development and Progression of Diabetic Kidney Disease in Patients with Type 2 Diabetes Mellitus and Advanced Diabetic Retinopathy
Kyung-Jin Yun, Hye Ji Kim, Mee Kyoung Kim, Hyuk-Sang Kwon, Ki-Hyun Baek, Young Jung Roh, Ki-Ho Song
Diabetes Metab J. 2016;40(6):473-481.   Published online September 20, 2016
DOI: https://doi.org/10.4093/dmj.2016.40.6.473
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AbstractAbstract PDFPubReader   
Background

Some patients with type 2 diabetes mellitus (T2DM) do not develop diabetic kidney disease (DKD) despite the presence of advanced diabetic retinopathy (DR). We aimed to investigate the presence of DKD and its risk factors in patients with T2DM and advanced DR.

Methods

We conducted a cross-sectional study in 317 patients with T2DM and advanced DR. The phenotypes of DKD were divided into three groups according to the urine albumin/creatinine ratio (uACR, mg/g) and estimated glomerular filtration rate (eGFR, mL/min/1.73 m2): no DKD (uACR <30 and eGFR ≥60), non-severe DKD (uACR ≥30 or eGFR <60), and severe DKD (uACR ≥30 and eGFR <60). Mean systolic and diastolic blood pressure, mean glycosylated hemoglobin (HbA1c) level, and HbA1c variability (standard deviation [SD] of serial HbA1c values or HbA1c-SD) were calculated for the preceding 2 years.

Results

The prevalence of no DKD, non-severe DKD, and severe DKD was 37.2% (n=118), 37.0% (n=117), and 25.8% (n=82), respectively. HbA1c-SD and the triglyceride/high density lipoprotein cholesterol (TG/HDL-C) ratio correlated positively with uACR and negatively with eGFR. Multiple linear regression analyses showed that the HbA1c-SD and TG/HDL-C ratio were significantly related with eGFR. Multiple logistic regression analyses after adjusting for several risk factors showed that HbA1c-SD and the TG/HDL-C ratio were significant risk factors for severe DKD.

Conclusion

The prevalence of DKD was about 60% in patients with T2DM and advanced DR. HbA1c variability and TG/HDL-C ratio may affect the development and progression of DKD in these patients.

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Complications
Clinical Course and Risk Factors of Diabetic Retinopathy in Patients with Type 2 Diabetes Mellitus in Korea
Jae-Seung Yun, Tae-Seok Lim, Seon-Ah Cha, Yu-Bae Ahn, Ki-Ho Song, Jin A Choi, Jinwoo Kwon, Donghyun Jee, Yang Kyung Cho, Yong-Moon Park, Seung-Hyun Ko
Diabetes Metab J. 2016;40(6):482-493.   Published online October 5, 2016
DOI: https://doi.org/10.4093/dmj.2016.40.6.482
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AbstractAbstract PDFSupplementary MaterialPubReader   
Background

We investigated clinical course and risk factors for diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM).

Methods

A total of 759 patients with T2DM without DR were included from January 2001 to December 2004. Retinopathy evaluation was performed at least annually by ophthalmologists. The severity of the DR was classified into five categories according to the International Clinical Diabetic Retinopathy Severity Scales.

Results

Of the 759 patients, 523 patients (68.9%) completed the follow-up evaluation. During the follow-up period, 235 patients (44.9%) developed DR, and 32 patients (13.6%) progressed to severe nonproliferative DR (NPDR) or proliferative DR (PDR). The mean duration of diabetes at the first diagnosis of mild NPDR, moderate NPDR, and severe NPDR or PDR were 14.8, 16.7, and 17.3 years, respectively. After adjusting multiple confounding factors, the significant risk factors for the incidence of DR risk in patients with T2DM were old age, longer duration of diabetes, higher mean glycosylated hemoglobin (HbA1c), and albuminuria. Even in the patients who had been diagnosed with diabetes for longer than 10 years at baseline, a decrease in HbA1c led to a significant reduction in the risk of developing DR (hazard ratio, 0.73 per 1% HbA1c decrement; 95% confidence interval, 0.58 to 0.91; P=0.005).

Conclusion

This prospective cohort study demonstrates that glycemic control, diabetes duration, age, and albuminuria are important risk factors for the development of DR. More aggressive retinal screening for T2DM patients diagnosed with DR should be required in order to not miss rapid progression of DR.

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Pathophysiology
Investigating Susceptibility to Diabetes Using Features of the Adipose Tissue in Response to In Utero Polycyclic Aromatic Hydrocarbons Exposure
Worlanyo E. Gato, Daniel A. Hunter, Shamaya L. Whitby, Christopher A. Mays, Wilson Yau
Diabetes Metab J. 2016;40(6):494-508.   Published online August 12, 2016
DOI: https://doi.org/10.4093/dmj.2016.40.6.494
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AbstractAbstract PDFSupplementary MaterialPubReader   
Background

In recent times, there has been an increase in the incidence of type 2 diabetes mellitus (T2DM) particularly in children. Adipocyte dysfunction provide a critical link between obesity and insulin resistance resulting in diabetes outcome. Further, environmental chemical exposure during early years of life might be a significant contributing factor to the increase in the incidence of T2DM. This study tests the idea that exposure to environmental contaminants (2-aminoanthracene [2AA]) in utero will show effects in the adipose tissue (AT) that signify T2DM vulnerability. 2AA is a polycyclic aromatic hydrocarbon found in a variety of products.

Methods

To accomplish the study objective, pregnant dams were fed various amounts of 2AA adulterated diets from gestation through postnatal period. The neonates and older offspring were analyzed for diabetic-like genes in the ATs and analysis of serum glucose. Furthermore, weight monitoring, histopathology and immunohistochemical (IHC) staining for CD68 in AT, adipocyte size determination and adiponectin amounts in serum were undertaken.

Results

Up-regulation of adiponectin and interleukin-6 genes were noted in the pups and older rats. Combination of intrauterine 2AA toxicity with moderate high fat diet exhibited gene expression patterns similar to those of the neonates. Elevated serum glucose levels were noted in treated groups. IHC of the AT indicated no significant malformations; however, CD68+ cells were greater in the animals treated to 2AA. Similarly, mean sizes of the adipocytes were larger in treated and combined 2AA and moderate high fat animals. Adiponectin was reduced in 2AA groups.

Conclusion

From the preceding, it appears intrauterine 2AA disturbance, when combined with excess fat accumulation will lead to greater risk for the diabetic condition.

Citations

Citations to this article as recorded by  
  • The Role of Persistent Organic Pollutants in Obesity: A Review of Laboratory and Epidemiological Studies
    Jan Aaseth, Dragana Javorac, Aleksandra Djordjevic, Zorica Bulat, Anatoly Skalny, Irina Zaitseva, Michael Aschner, Alexey Tinkov
    Toxics.2022; 10(2): 65.     CrossRef
  • The Association between Urinary Polycyclic Aromatic Hydrocarbons Metabolites and Type 2 Diabetes Mellitus
    Xue Wang, Ang Li, Qun Xu
    International Journal of Environmental Research and Public Health.2022; 19(13): 7605.     CrossRef
  • Dietary ingestion of 2-aminoanthracene (2AA) and the risk for type-1 diabetes (T1D)
    Isaiah Seise, Zachary A. Pilz, Moses Yeboah Kusi, Bethany Bogan, Brittany Jean McHale, Worlanyo E. Gato
    Journal of Environmental Science and Health, Part A.2020; 55(14): 1638.     CrossRef
  • Association of the IL6 Gene Polymorphism with Component Features of Metabolic Syndrome in Obese Subjects
    Elham Barati, Hamideh Ghazizadeh, Fatemeh Sadabadi, Elham Kazemi, Gordon A. Ferns, Amir Avan, Majid Ghayour-Mobarhan
    Biochemical Genetics.2019; 57(5): 695.     CrossRef
  • The hepatic effects in dams that ingested 2-aminoanthracene during gestation and lactation
    Raven E Ulieme, Surjania Awer, John C Stagg, Wilson Yau, Worlanyo E Gato
    Toxicology and Industrial Health.2019; 35(9): 568.     CrossRef
Letter
Response
Response: Investigating Susceptibility to Diabetes Using Features of the Adipose Tissue in Response to In Utero Polycyclic Aromatic Hydrocarbons Exposure (Diabetes Metab J 2016;40:494-508)
Worlanyo E. Gato, Daniel A. Hunter, Shamaya L. Whitby, Christopher A. Mays, Wilson Yau
Diabetes Metab J. 2016;40(6):511-512.   Published online December 14, 2016
DOI: https://doi.org/10.4093/dmj.2016.40.6.511
  • 2,676 View
  • 33 Download
  • 2 Crossref
PDFPubReader   

Citations

Citations to this article as recorded by  
  • Response: Investigating Susceptibility to Diabetes Using Features of the Adipose Tissue in Response toIn UteroPolycyclic Aromatic Hydrocarbons Exposure (Diabetes Metab J2016;40:494-508)
    Worlanyo E. Gato, Daniel A. Hunter, Shamaya L. Whitby, Christopher A. Mays, Wilson Yau
    Diabetes & Metabolism Journal.2016; 40(6): 511.     CrossRef
  • Letter: Investigating Susceptibility to Diabetes Using Features of the Adipose Tissue in Response toIn UteroPolycyclic Aromatic Hydrocarbons Exposure (Diabetes Metab J2016;40:494-508)
    Myoung Jin Ji, Sung Hee Choi
    Diabetes & Metabolism Journal.2016; 40(6): 509.     CrossRef

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