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Volume 42(6); December 2018
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Reviews
Clinical Diabetes & Therapeutics
Latent Autoimmune Diabetes in Adults: A Review on Clinical Implications and Management
Silvia Pieralice, Paolo Pozzilli
Diabetes Metab J. 2018;42(6):451-464.   Published online December 17, 2018
DOI: https://doi.org/10.4093/dmj.2018.0190
  • 12,838 View
  • 498 Download
  • 51 Web of Science
  • 60 Crossref
AbstractAbstract PDFPubReader   

Latent autoimmune diabetes in adults (LADA) is a heterogeneous disease characterized by a less intensive autoimmune process and a broad clinical phenotype compared to classical type 1 diabetes mellitus (T1DM), sharing features with both type 2 diabetes mellitus (T2DM) and T1DM. Since patients affected by LADA are initially insulin independent and recognizable only by testing for islet-cell autoantibodies, it could be difficult to identify LADA in clinical setting and a high misdiagnosis rate still remains among patients with T2DM. Ideally, islet-cell autoantibodies screening should be performed in subjects with newly diagnosed T2DM, ensuring a closer monitoring of those resulted positive and avoiding treatment of hyperglycaemia which might increase the rate of β-cells loss. Thus, since the autoimmune process in LADA seems to be slower than in classical T1DM, there is a wider window for new therapeutic interventions that may slow down β-cell failure. This review summarizes the current understanding of LADA, by evaluating data from most recent studies, the actual gaps in diagnosis and management. Finally, we critically highlight and discuss novel findings and future perspectives on the therapeutic approach in LADA.

Citations

Citations to this article as recorded by  
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    Diabetes/Metabolism Research and Reviews.2022;[Epub]     CrossRef
  • Prevalence of Latent Autoimmune Diabetes in Adult Based on the Presence of GAD 65 Antibodies in North-Eastern Uttar Pradesh, India
    Himalina Sangma, Anshul Singh, Anubha Srivastava, Vatsala Misra
    Annals of the National Academy of Medical Sciences (India).2022; 58(01): 017.     CrossRef
  • Serum Bile Acid Profiles in Latent Autoimmune Diabetes in Adults and Type 2 Diabetes Patients
    Yu Zhou, Deli Ye, Xiaofen Yuan, Yonglie Zhou, Jun Xia, Giuseppe Pugliese
    Journal of Diabetes Research.2022; 2022: 1.     CrossRef
  • Early life Bacillus Calmette-Guerin vaccination and incidence of type 1, type 2, and latent autoimmune diabetes in adulthood
    Philippe Corsenac, Marie-Élise Parent, Hélène Mansaray, Andrea Benedetti, Hugues Richard, Simona Stäger, Marie-Claude Rousseau
    Diabetes & Metabolism.2022; 48(3): 101337.     CrossRef
  • Atypical Diabetes and Management Considerations
    Shivajirao Prakash Patil
    Primary Care: Clinics in Office Practice.2022; 49(2): 225.     CrossRef
  • Efficacy and safety of sitagliptin and insulin for latent autoimmune diabetes in adults: A systematic review and meta‐analysis
    Tong Lin, Yinhe Cai, Liting Tang, Youwei Lian, Min Liu, Chaonan Liu
    Journal of Diabetes Investigation.2022; 13(9): 1506.     CrossRef
  • Latent autoimmune diabetes in youth shows greater autoimmunity than latent autoimmune diabetes in adults: Evidence from a nationwide, multicenter, cross‐sectional study
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    Pediatric Diabetes.2022; 23(5): 578.     CrossRef
  • Latent Autoimmune Diabetes in Adults and Metabolic Syndrome—A Mini Review
    Niansi Pan, Shimei Yang, Xiaohong Niu
    Frontiers in Endocrinology.2022;[Epub]     CrossRef
  • Lifestyle or Environmental Influences and Their Interaction With Genetic Susceptibility on the Risk of LADA
    Sofia Carlsson
    Frontiers in Endocrinology.2022;[Epub]     CrossRef
  • Antigen-specific immunotherapies in type 1 diabetes
    Xuejiao Zhang, Ying Dong, Dianyuan Liu, Liu Yang, Jiayi Xu, Qing Wang
    Journal of Trace Elements in Medicine and Biology.2022; 73: 127040.     CrossRef
  • Latent autoimmune diabetes in adults: a focus on β-cell protection and therapy
    Wenfeng Yin, Shuoming Luo, Zilin Xiao, Ziwei Zhang, Bingwen Liu, Zhiguang Zhou
    Frontiers in Endocrinology.2022;[Epub]     CrossRef
  • Diagnostic camouflage: A case report on Latent autoimmune diabetics of adulthood
    Sandhya kiran Neupane, Prakash Paudel Jaishi, Divyaa Koirala, Arjun Kandel, Prabhat Kiran Neupane
    Annals of Medicine & Surgery.2022;[Epub]     CrossRef
  • Clinical characteristics and cardiovascular risk profile in children and adolescents with latent autoimmune diabetes: Results from the German/Austrian prospective diabetes follow‐up registry
    Alena Welters, Sascha R. Tittel, Thomas Reinehr, Daniel Weghuber, Susanna Wiegand, Wolfram Karges, Clemens Freiberg, Thomas Meissner, Nanette C. Schloot, Reinhard W. Holl
    Pediatric Diabetes.2022; 23(8): 1602.     CrossRef
  • The utility of assessing C-peptide in patients with insulin-treated type 2 diabetes: a cross-sectional study
    Tuccinardi Dario, Giorgino Riccardo, Pieralice Silvia, Watanabe Mikiko, Maggi Daria, Palermo Andrea, Defeudis Giuseppe, Fioriti Elvira, Pozzilli Paolo, Manfrini Silvia
    Acta Diabetologica.2021; 58(4): 411.     CrossRef
  • Cross-reactive peptide epitopes of Enterovirus Coxsackie B4 and human glutamic acid decarboxylase detecting antibodies in latent autoimmune diabetes in adults versus type 1 diabetes
    Feliciana Real-Fernández, Alessandra Gallo, Francesca Nuti, Lorenzo Altamore, Gloria Giovanna Del Vescovo, Pietro Traldi, Eugenio Ragazzi, Paolo Rovero, Annunziata Lapolla, Anna Maria Papini
    Clinica Chimica Acta.2021; 515: 73.     CrossRef
  • Treating latent autoimmune diabetes in adults in the era of cardiovascular outcomes trials: Old dog should learn new tricks
    Theocharis Koufakis, Prashanth Vas, Kalliopi Kotsa
    Diabetic Medicine.2021;[Epub]     CrossRef
  • Defining and Classifying New Subgroups of Diabetes
    Ashok Balasubramanyam
    Annual Review of Medicine.2021; 72(1): 63.     CrossRef
  • Slowly evolving, immune-mediated diabetes in 14-year-old patient: a case report
    M. R. Ragimov, D. D. Omelchuk, L. I. Ibragimova, O. S. Derevyanko, T. V. Nikonova
    Diabetes mellitus.2021; 24(1): 70.     CrossRef
  • The role of autoimmunity in the pathophysiology of type 2 diabetes: Looking at the other side of the moon
    Theocharis Koufakis, George Dimitriadis, Symeon Metallidis, Pantelis Zebekakis, Kalliopi Kotsa
    Obesity Reviews.2021;[Epub]     CrossRef
  • Dapagliflozin as an Adjunct Therapy to Insulin in Patients with Type 1 Diabetes Mellitus: Efficacy and Safety of this Combination
    Johan H Jendle, Francisco J Ampudia-Blasco, Martin Füchtenbusch, Paolo Pozzilli
    European Endocrinology.2021; 1(1): 12.     CrossRef
  • Dapagliflozin as an Adjunct Therapy to Insulin in Patients with Type 1 Diabetes Mellitus: Efficacy and Safety of this Combination
    Johan H Jendle, Francisco J Ampudia-Blasco, Martin Füchtenbusch, Paolo Pozzilli
    touchREVIEWS in Endocrinology.2021; 17(1): 12.     CrossRef
  • Toward an Improved Classification of Type 2 Diabetes: Lessons From Research into the Heterogeneity of a Complex Disease
    Maria J Redondo, Ashok Balasubramanyam
    The Journal of Clinical Endocrinology & Metabolism.2021; 106(12): e4822.     CrossRef
  • Bacillus Calmette-Guerin 's beneficial impact on glucose metabolism: Evidence for broad based applications
    Gabriella F. Shpilsky, Hiroyuki Takahashi, Anna Aristarkhova, Michele Weil, Nathan Ng, Kacie J. Nelson, Amanda Lee, Hui Zheng, Willem M. Kühtreiber, Denise L. Faustman
    iScience.2021; 24(10): 103150.     CrossRef
  • Masqueraders: how to identify atypical diabetes in primary care
    Sumera Ahmed, Sana Saeed, Jay H. Shubrook
    Journal of Osteopathic Medicine.2021; 121(12): 899.     CrossRef
  • Lada or Type 2 Diabetes Mellitus - A Challenging Diagnosis in Clinical Approach
    Lucia Mihaela Custură, Oana Deteşan, Raluca Maria Tilinca, Reka Annamaria Schmiedt, Brigitta Irén Bacso, Mariana Cornelia Tilinca
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  • Antioxidant, Anti-Inflammatory, and Immunomodulatory Properties of Tea—The Positive Impact of Tea Consumption on Patients with Autoimmune Diabetes
    Anna Winiarska-Mieczan, Ewa Tomaszewska, Karolina Jachimowicz
    Nutrients.2021; 13(11): 3972.     CrossRef
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    Marta Guimarães, Sofia S. Pereira, Mário Nora, Mariana P. Monteiro
    Obesity Facts.2021; 14(4): 425.     CrossRef
  • Особливості перебігу діабетичної хвороби нирок у хворих на латентний автоімунний діабет дорослих
    I.O. Tsaryk, N.V. Pashkovska
    INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine).2021; 17(2): 116.     CrossRef
  • Latenter Autoimmundiabetes im Erwachsenen- und Kindesalter
    Alena Welters, Nanette C. Schloot
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    Mitra Mosslemi, Hannah L. Park, Christine E. McLaren, Nathan D. Wong
    Cardiovascular Endocrinology & Metabolism.2020; 9(1): 9.     CrossRef
  • Case 6-2020: A 34-Year-Old Woman with Hyperglycemia
    Richard C. Cabot, Eric S. Rosenberg, Virginia M. Pierce, David M. Dudzinski, Meridale V. Baggett, Dennis C. Sgroi, Jo-Anne O. Shepard, Kathy M. Tran, Emily K. McDonald, Tara Corpuz, Miriam S. Udler, Camille E. Powe, Christina A. Austin-Tse
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  • Therapeutic approaches for latent autoimmune diabetes in adults: One size does not fit all
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    Michael Hummel
    MMW - Fortschritte der Medizin.2020; 162(11): 60.     CrossRef
  • The Differential Expression of Long Noncoding RNAs in Type 2 Diabetes Mellitus and Latent Autoimmune Diabetes in Adults
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    Military Medicine.2020; 185(9-10): e1843.     CrossRef
  • Hombre de 28 años con presentación de diabetes
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    Alessandro P. Delitala
    AIMS Medical Science.2019; 6(2): 132.     CrossRef
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  • The Influence of Type 2 Diabetes–Associated Factors on Type 1 Diabetes
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Others
A Journey to Understand Glucose Homeostasis: Starting from Rat Glucose Transporter Type 2 Promoter Cloning to Hyperglycemia
Yong Ho Ahn
Diabetes Metab J. 2018;42(6):465-471.   Published online November 2, 2018
DOI: https://doi.org/10.4093/dmj.2018.0116
  • 3,916 View
  • 49 Download
  • 6 Web of Science
  • 5 Crossref
AbstractAbstract PDFPubReader   

My professional journey to understand the glucose homeostasis began in the 1990s, starting from cloning of the promoter region of glucose transporter type 2 (GLUT2) gene that led us to establish research foundation of my group. When I was a graduate student, I simply thought that hyperglycemia, a typical clinical manifestation of type 2 diabetes mellitus (T2DM), could be caused by a defect in the glucose transport system in the body. Thus, if a molecular mechanism controlling glucose transport system could be understood, treatment of T2DM could be possible. In the early 70s, hyperglycemia was thought to develop primarily due to a defect in the muscle and adipose tissue; thus, muscle/adipose tissue type glucose transporter (GLUT4) became a major research interest in the diabetology. However, glucose utilization occurs not only in muscle/adipose tissue but also in liver and brain. Thus, I was interested in the hepatic glucose transport system, where glucose storage and release are the most actively occurring.

Citations

Citations to this article as recorded by  
  • Physiological functions of glucose transporter-2: From cell physiology to links with diabetes mellitus
    Zhean Shen, Yingze Hou, Guo Zhao, Libi Tan, Jili Chen, Ziqi Dong, Chunxiao Ni, Longying Pei
    Heliyon.2024; 10(3): e25459.     CrossRef
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    Zhen Qiao, Julia Sidorenko, Joana A. Revez, Angli Xue, Xueling Lu, Katri Pärna, Harold Snieder, Peter M. Visscher, Naomi R. Wray, Loic Yengo
    Nature Communications.2023;[Epub]     CrossRef
  • Umbilical Cord-Mesenchymal Stem Cell-Conditioned Medium Improves Insulin Resistance in C2C12 Cell
    Kyung-Soo Kim, Yeon Kyung Choi, Mi Jin Kim, Jung Wook Hwang, Kyunghoon Min, Sang Youn Jung, Soo-Kyung Kim, Yong-Soo Choi, Yong-Wook Cho
    Diabetes & Metabolism Journal.2021; 45(2): 260.     CrossRef
  • Aging-related modifications to G protein-coupled receptor signaling diversity
    Jaana van Gastel, Hanne Leysen, Jan Boddaert, Laura vangenechten, Louis M. Luttrell, Bronwen Martin, Stuart Maudsley
    Pharmacology & Therapeutics.2021; 223: 107793.     CrossRef
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Editorials
Others
Is Diabetes & Metabolism Journal Eligible to Be Indexed in MEDLINE?
Sun Huh
Diabetes Metab J. 2018;42(6):472-474.   Published online December 17, 2018
DOI: https://doi.org/10.4093/dmj.2018.0089
  • 3,342 View
  • 25 Download
  • 2 Web of Science
  • 2 Crossref
PDFPubReader   

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    Sun Huh
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  • DMJ, Better than Yesterday, More Brilliant Tomorrow
    Kyu Chang Won
    Diabetes & Metabolism Journal.2019; 43(1): 1.     CrossRef
Others
Fifty Years of Compassionate Care and Harmonious Collaboration of the Korean Diabetes Association: The 50th Anniversary of Korean Diabetes Association
Jong Chul Won, Eun-Jung Rhee, Hyung Joon Yoo
Diabetes Metab J. 2018;42(6):475-479.   Published online December 17, 2018
DOI: https://doi.org/10.4093/dmj.2018.0231
  • 5,106 View
  • 34 Download
  • 2 Web of Science
  • 1 Crossref
PDFPubReader   

Citations

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  • DMJ, Better than Yesterday, More Brilliant Tomorrow
    Kyu Chang Won
    Diabetes & Metabolism Journal.2019; 43(1): 1.     CrossRef
Original Articles
Clinical Care/Education
Frequency of Self-Monitoring of Blood Glucose during the School Day Is Associated with the Optimal Glycemic Control among Korean Adolescents with Type 1 Diabetes
Eun Young Joo, Ji-Eun Lee, Hee Sook Kang, Shin Goo Park, Yong Hee Hong, Young-Lim Shin, Min Sohn
Diabetes Metab J. 2018;42(6):480-487.   Published online June 29, 2018
DOI: https://doi.org/10.4093/dmj.2018.0018
  • 4,280 View
  • 65 Download
  • 7 Web of Science
  • 7 Crossref
AbstractAbstract PDFPubReader   
Background

This study aimed to evaluate the relationship between the frequency of self-monitoring of blood glucose (SMBG) and glycosylated hemoglobin (HbA1c) levels among Korean adolescents with type 1 diabetes mellitus (T1DM). Factors affecting the SMBG frequency were analyzed in order to improve their glycemic control.

Methods

Sixty-one adolescents aged 13 to 18 years with T1DM were included from one tertiary center. Clinical and biochemical variables were recorded. Factors associated with SMBG frequency were assessed using structured self-reported questionnaires.

Results

Average total daily SMBG frequency was 3.8±2.1 and frequency during the school day was 1.3±1.2. The mean HbA1c level was 8.6%±1.4%. As the daily SMBG frequency increased, HbA1c levels declined (P=0.001). The adjusted odds of achieving the target HbA1c in participants who performed daily SMBG ≥5 significantly increased 9.87 folds (95% confidence interval [CI], 1.58 to 61.70) compared with those performed SMBG four times a day. In the subjects whose SMBG frequency <1/day during the school day, an 80% reduction in the adjusted odds ratio 0.2 (95% CI, 0.05 to 0.86) showed compared to the group with performing two SMBG measurements in the school setting. The number of SMBG testing performed at school was significantly high for individuals assisted by their friends (P=0.031) and for those who did SMBG in the classrooms (P=0.039).

Conclusion

Higher SMBG frequency was significantly associated with lower HbA1c in Korean adolescents with T1DM. It would be necessary to establish the school environments that can facilitate adequate glycemic control, including frequent SMBG.

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    Yu. A. Kononova, V. B. Bregovskiy, A. Yu. Babenko
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  • Adherence as a Predictor of Glycemic Control Among Adolescents With Type 1 Diabetes: A Retrospective Study Using Real-world Evidence
    Sohayla A. Ibrahim, Maguy Saffouh El Hajj, Yaw B. Owusu, Maryam Al-Khaja, Amel Khalifa, Dalia Ahmed, Ahmed Awaisu
    Clinical Therapeutics.2022; 44(10): 1380.     CrossRef
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    Jai-Chang Park, Seongbeom Kim, Je-Hoon Lee
    Applied Sciences.2021; 11(5): 2006.     CrossRef
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    Kathleen M. Hanna, Jed R. Hansen
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    Hye Jin Yoo
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    Ayman A Al Hayek, Asirvatham A Robert, Mohamed A Al Dawish
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Epidemiology
Association of Thigh Muscle Mass with Insulin Resistance and Incident Type 2 Diabetes Mellitus in Japanese Americans
Seung Jin Han, Edward J. Boyko, Soo-Kyung Kim, Wilfred Y. Fujimoto, Steven E. Kahn, Donna L. Leonetti
Diabetes Metab J. 2018;42(6):488-495.   Published online September 5, 2018
DOI: https://doi.org/10.4093/dmj.2018.0022
  • 4,583 View
  • 63 Download
  • 34 Web of Science
  • 34 Crossref
AbstractAbstract PDFPubReader   
Background

Skeletal muscle plays a major role in glucose metabolism. We investigated the association between thigh muscle mass, insulin resistance, and incident type 2 diabetes mellitus (T2DM) risk. In addition, we examined the role of body mass index (BMI) as a potential effect modifier in this association.

Methods

This prospective study included 399 Japanese Americans without diabetes (mean age 51.6 years) who at baseline had an estimation of thigh muscle mass by computed tomography and at baseline and after 10 years of follow-up a 75-g oral glucose tolerance test and determination of homeostasis model assessment of insulin resistance (HOMA-IR). We fit regression models to examine the association between thigh muscle area and incidence of T2DM and change in HOMA-IR, both measured over 10 years.

Results

Thigh muscle area was inversely associated with future HOMA-IR after adjustment for age, sex, BMI, HOMA-IR, fasting plasma glucose, total abdominal fat area, and thigh subcutaneous fat area at baseline (P=0.033). The 10-year cumulative incidence of T2DM was 22.1%. A statistically significant interaction between thigh muscle area and BMI was observed, i.e., greater thigh muscle area was associated with lower risk of incident T2DM for subjects at lower levels of BMI, but this association diminished at higher BMI levels.

Conclusion

Thigh muscle mass area was inversely associated with future insulin resistance. Greater thigh muscle area predicts a lower risk of incident T2DM for leaner Japanese Americans.

Citations

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Complications
Cardiovascular Autonomic Neuropathy Predicts Higher HbA1c Variability in Subjects with Type 2 Diabetes Mellitus
Yeoree Yang, Eun-Young Lee, Jae-Hyoung Cho, Yong-Moon Park, Seung-Hyun Ko, Kun-Ho Yoon, Moo-Il Kang, Bong-Yun Cha, Seung-Hwan Lee
Diabetes Metab J. 2018;42(6):496-512.   Published online September 28, 2018
DOI: https://doi.org/10.4093/dmj.2018.0026
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AbstractAbstract PDFSupplementary MaterialPubReader   
Background

This study aimed to investigate the association between the presence and severity of cardiovascular autonomic neuropathy (CAN) and development of long-term glucose fluctuation in subjects with type 2 diabetes mellitus.

Methods

In this retrospective cohort study, subjects with type 2 diabetes mellitus who received cardiovascular autonomic reflex tests (CARTs) at baseline and at least 4-year of follow-up with ≥6 measures of glycosylated hemoglobin (HbA1c) were included. The severity of CAN was categorized as normal, early, or severe CAN according to the CARTs score. HbA1c variability was measured as the standard deviation (SD), coefficient of variation, and adjusted SD of serial HbA1c measurements.

Results

A total of 681 subjects were analyzed (294 normal, 318 early, and 69 severe CAN). The HbA1c variability index values showed a positive relationship with the severity of CAN. Multivariable logistic regression analysis showed that CAN was significantly associated with the risk of developing higher HbA1c variability (SD) after adjusting for age, sex, body mass index, diabetes duration, mean HbA1c, heart rate, glomerular filtration rate, diabetic retinopathy, coronary artery disease, insulin use, and anti-hypertensive medication (early CAN: odds ratio [OR], 1.65; 95% confidence interval [CI], 1.12 to 2.43) (severe CAN: OR, 2.86; 95% CI, 1.47 to 5.56). This association was more prominent in subjects who had a longer duration of diabetes (>10 years) and lower mean HbA1c (<7%).

Conclusion

CAN is an independent risk factor for future higher HbA1c variability in subjects with type 2 diabetes mellitus. Tailored therapy for stabilizing glucose fluctuation should be emphasized in subjects with CAN.

Citations

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Complications
Association between Serum Cystatin C and Vascular Complications in Type 2 Diabetes Mellitus without Nephropathy
Hye Jeong Kim, Dong Won Byun, Kyoil Suh, Myung Hi Yoo, Hyeong Kyu Park
Diabetes Metab J. 2018;42(6):513-518.   Published online October 15, 2018
DOI: https://doi.org/10.4093/dmj.2018.0006
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AbstractAbstract PDFPubReader   
Background

Recent studies have correlated serum cystatin C (CysC) with vascular complications, but few studies have investigated this correlation in diabetes patients without nephropathy. This study aimed to evaluate if higher serum CysC levels increase the risk for vascular complications in type 2 diabetes mellitus patients with normal renal function or mild renal impairment.

Methods

A total of 806 consecutive patients with type 2 diabetes mellitus who were admitted to the diabetes center of Soonchunhyang University Hospital for blood glucose control were retrospectively reviewed. Patients with nephropathy were excluded. Subjects were categorized into quartiles of serum CysC levels (Q1, ≤0.65 mg/L; Q2, 0.66 to 0.79 mg/L; Q3, 0.80 to 0.94 mg/L; and Q4, ≥0.95 mg/L).

Results

The proportion of patients with diabetic retinopathy (DR) (P for trend <0.001), coronary heart disease (CHD) (P for trend <0.001), and stroke (P for trend <0.001) increased across the serum CysC quartiles. After adjustment for confounding factors, the highest serum CysC level remained a significant risk factor for DR (odds ratio [OR], 1.929; 95% confidence interval [CI], 1.007 to 4.144; P=0.040). Compared with Q1, a significant positive association was observed between serum CysC and CHD in Q2 (OR, 7.321; 95% CI, 1.114 to 48.114; P=0.012), Q3 (OR, 6.027; 95% CI, 0.952 to 38.161; P=0.020), and Q4 (OR, 8.122; 95% CI, 1.258 to 52.453; P=0.007). No associations were observed between CysC and stroke after additional adjustment for confounding variables.

Conclusion

Serum CysC levels are independently associated with DR and CHD, suggesting that CysC may be useful for identifying type 2 diabetes mellitus patients without nephropathy who are at high risk for vascular complications.

Citations

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    Tiwalade Modupe Usman, Yakub Kayode Saheed, Augustine Nsang, Abel Ajibesin, Sandip Rakshit
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Complications
Patterns of Nerve Conduction Abnormalities in Patients with Type 2 Diabetes Mellitus According to the Clinical Phenotype Determined by the Current Perception Threshold
Joong Hyun Park, Jong Chul Won
Diabetes Metab J. 2018;42(6):519-528.   Published online October 24, 2018
DOI: https://doi.org/10.4093/dmj.2018.0068
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AbstractAbstract PDFPubReader   
Background

Clinical manifestations of diabetic peripheral neuropathy (DPN) vary along the course of nerve damage. Nerve conduction studies (NCS) have been suggested as a way to confirm diagnoses of DPN, but the results have limited utility for evaluating clinical phenotypes. The current perception threshold (CPT) is a complementary method for diagnosing DPN and assessing DPN symptoms. We compared NCS variables according to clinical phenotypes determined by CPT measurements.

Methods

We retrospectively enrolled patients with type 2 diabetes mellitus who underwent both NCS and CPT tests using a neurometer. CPT grades were used to determine the clinical phenotypes of DPN: normoesthesia (0 to 1.66), hyperesthesia (1.67 to 6.62), and hypoesthesia/anesthesia (6.63 to 12.0). The Michigan Neuropathy Screening Instrument (MNSI) was used to determine a subjective symptom score. DPN was diagnosed based on both patient symptoms (MNSI score ≥3) and abnormal NCS results.

Results

A total of 202 patients (117 men and 85 women) were included in the final analysis. The average age was 62.6 years, and 71 patients (35.1%) were diagnosed with DPN. The CPT variables correlated with MNSI scores and NCS variables in patients with diabetes. Linear regression analyses indicated that hypoesthesia was associated with significantly lower summed velocities and sural amplitudes and velocities, and higher summed latencies, than normoesthesia. Sural amplitude was significantly lower in patients with hyperesthesia than in patients with normoesthesia.

Conclusion

NCS variables differed among patients with diabetes according to clinical phenotypes based on CPT and decreased sural nerve velocities was associated with hyperesthesia.

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Obesity and Metabolic Syndrome
Utility of Serum Albumin for Predicting Incident Metabolic Syndrome According to Hyperuricemia
You-Bin Lee, Ji Eun Jun, Seung-Eun Lee, Jiyeon Ahn, Gyuri Kim, Jae Hwan Jee, Ji Cheol Bae, Sang-Man Jin, Jae Hyeon Kim
Diabetes Metab J. 2018;42(6):529-537.   Published online September 28, 2018
DOI: https://doi.org/10.4093/dmj.2018.0012
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AbstractAbstract PDFSupplementary MaterialPubReader   
Background

Serum albumin and uric acid have been positively linked to metabolic syndrome (MetS). However, the association of MetS incidence with the combination of uric acid and albumin levels has not been investigated. We explored the association of albumin and uric acid with the risk of incident MetS in populations divided according to the levels of these two parameters.

Methods

In this retrospective longitudinal study, 11,613 non-MetS participants were enrolled among 24,185 individuals who had undergone at least four annual check-ups between 2006 and 2012. The risk of incident MetS was analyzed according to four groups categorized by the sex-specific medians of serum albumin and uric acid.

Results

During 55,407 person-years of follow-up, 2,439 cases of MetS developed. The risk of incident MetS increased as the uric acid category advanced in individuals with lower or higher serum albumin categories with hazard ratios (HRs) of 1.386 (95% confidence interval [CI], 1.236 to 1.554) or 1.314 (95% CI, 1.167 to 1.480). However, the incidence of MetS increased with higher albumin levels only in participants in the lower uric acid category with a HR of 1.143 (95% CI, 1.010 to 1.294).

Conclusion

Higher levels of albumin were associated with an increased risk of incident MetS only in individuals with lower uric acid whereas higher levels of uric acid were positively linked to risk of incident MetS regardless of albumin level.

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Short Communication
Complications
The Prevalence and Risk Factors for Diabetic Retinopathy in Shiraz, Southern Iran
Haleh Ghaem, Nima Daneshi, Shirin Riahi, Mostafa Dianatinasab
Diabetes Metab J. 2018;42(6):538-543.   Published online August 9, 2018
DOI: https://doi.org/10.4093/dmj.2018.0047
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AbstractAbstract PDFPubReader   

Globally, diabetic retinopathy (DR) is one of the leading causes of blindness, that diminishes quality of life. This study aimed to describe the prevalence of DR, and its associated risk factors. This cross-sectional study was carried out among 478 diabetic patients in a referral center in Fars province, Iran. The mean±standard deviation age of the participants was 56.64±12.45 years old and DR prevalence was 32.8%. In multivariable analysis, lower education levels (adjusted odds ratio [aOR], 0.43; 95% confidence interval [CI], 0.24 to 0.76), being overweight (aOR, 1.70; 95% CI, 1.02 to 2.83) or obese (aOR, 1.88; 95% CI, 1.09 to 3.26), diabetes duration of 10 to 20 years (aOR, 2.35; 95% CI, 1.48 to 3.73) and over 20 years (aOR, 5.63; 95% CI, 2.97 to 10.68), receiving insulin (aOR, 1.99; 95% CI, 1.27 to 3.10), and having chronic diseases (aOR, 1.71; 95% CI, 1.02 to 2.85) were significantly associated with DR. In conclusion, longer diabetes duration and obesity or having chronic diseases are strongly associated with DR suggesting that control of these risk factors may reduce both the prevalence and impact of retinopathy in Iran.

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Letter
Response
Response: The Necessity of the Simple Tests for Diabetic Peripheral Neuropathy in Type 2 Diabetes Mellitus Patients without Neuropathic Symptoms in Clinical Practice (Diabetes Metab J 2018;42:442–6)
Jung Hwan Park, Dong Sun Kim
Diabetes Metab J. 2018;42(6):546-547.   Published online December 17, 2018
DOI: https://doi.org/10.4093/dmj.2018.0248
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