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Efficacy and Safety of IDegAsp in a Real-World Korean Population with Type 2 Diabetes Mellitus
Shinae Kang, Yu-Bae Ahn, Tae Keun Oh, Won-Young Lee, Sung Wan Chun, Boram Bae, Amine Dahaoui, Jin Sook Jeong, Sungeun Jung, Hak Chul Jang
Received August 24, 2023  Accepted November 22, 2023  Published online February 27, 2024  
DOI: https://doi.org/10.4093/dmj.2023.0297    [Epub ahead of print]
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
This study investigated the real-world efficacy and safety of insulin degludec/insulin aspart (IDegAsp) in Korean adults with type 2 diabetes mellitus (T2DM), whose insulin treatment was switched to IDegAsp.
Methods
This was a multicenter, retrospective, observational study comprising two 26-week treatment periods, before and after switching to IDegAsp, respectively. Korean adults with uncontrolled T2DM treated with basal or premix insulin (±oral antidiabetic drugs) were enrolled. The primary objective was to compare the degree of glycosylated hemoglobin (HbA1c) change in each 26-week observation period. The analyses included changes in HbA1c, fasting plasma glucose (FPG), body weight, proportion of participants achieving HbA1c <7.0%, hypoglycemic events, and total daily insulin dose (ClinicalTrials.gov, number NCT04656106).
Results
In total, 196 adults (mean age, 65.95 years; mean T2DM duration, 18.99 years) were analyzed. The change in both HbA1c and FPG were significantly different between the pre-switching and the post-switching period (0.28% vs. –0.51%, P<0.001; 5.21 mg/dL vs. –23.10 mg/dL, P=0.005), respectively. After switching, the rate of achieving HbA1c <7.0% was significantly improved (5.10% at baseline vs. 11.22% with IDegAsp, P=0.012). No significant differences (before vs. after switching) were observed in body weight change, and total daily insulin dose. The rates of overall and severe hypoglycemia were similar in the two periods.
Conclusion
In real-world clinical practice in Korea, the change of insulin regimen to IDegAsp was associated with an improvement in glycemic control without increase of hypoglycemia, supporting the use of IDegAsp for patients with T2DM uncontrolled with basal or premix insulin.
Metabolic Risk/Epidemiology
Higher Muscle Mass Protects Women with Gestational Diabetes Mellitus from Progression to Type 2 Diabetes Mellitus
Yujin Shin, Joon Ho Moon, Tae Jung Oh, Chang Ho Ahn, Jae Hoon Moon, Sung Hee Choi, Hak Chul Jang
Diabetes Metab J. 2022;46(6):890-900.   Published online April 28, 2022
DOI: https://doi.org/10.4093/dmj.2021.0334
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  • 2 Web of Science
  • 3 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
We evaluated whether postpartum muscle mass affects the risk of type 2 diabetes mellitus (T2DM) in Korean women with gestational diabetes mellitus (GDM).
Methods
A total of 305 women with GDM (mean age, 34.9 years) was prospectively evaluated for incident prediabetes and T2DM from 2 months after delivery and annually thereafter. Appendicular skeletal muscle mass (ASM) was assessed with bioelectrical impedance analysis at the initial postpartum visit, and ASM, either divided by body mass index (BMI) or squared height, and the absolute ASM were used as muscle mass indices. The risk of incident prediabetes and T2DM was assessed according to tertiles of these indices using a logistic regression model.
Results
After a mean follow-up duration of 3.3 years, the highest ASM/BMI tertile group had a 61% lower risk of incident prediabetes and T2DM compared to the lowest tertile group, and this remained significant after we adjusted for covariates (adjusted odds ratio, 0.37; 95% confidence interval [CI], 0.15 to 0.92; P=0.032). Equivalent findings were observed in normal weight women (BMI <23 kg/m2), but this association was not significant for overweight women (BMI ≥23 kg/m2). Absolute ASM or ASM/height2 was not associated with the risk of postpartum T2DM.
Conclusion
A higher muscle mass, as defined by the ASM/BMI index, was associated with a lower risk of postpartum prediabetes and T2DM in Korean women with GDM.

Citations

Citations to this article as recorded by  
  • More appendicular lean mass relative to body mass index is associated with lower incident diabetes in middle-aged adults in the CARDIA study
    Melanie S. Haines, Aaron Leong, Bianca C. Porneala, Victor W. Zhong, Cora E. Lewis, Pamela J. Schreiner, Karen K. Miller, James B. Meigs, Mercedes R. Carnethon
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  • The Association of the Triglyceride and Muscle to Fat Ratio During Early Pregnancy with the Development of Gestational Diabetes Mellitus
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  • Correlation of body composition in early pregnancy on gestational diabetes mellitus under different body weights before pregnancy
    Li Xintong, Xu Dongmei, Zhang Li, Cao Ruimin, Hao Yide, Cui Lingling, Chen Tingting, Guo Yingying, Li Jiaxin
    Frontiers in Endocrinology.2022;[Epub]     CrossRef
Review
Metabolic Risk/Epidemiology
Article image
Gestational Diabetes Mellitus: Diagnostic Approaches and Maternal-Offspring Complications
Joon Ho Moon, Hak Chul Jang
Diabetes Metab J. 2022;46(1):3-14.   Published online January 27, 2022
DOI: https://doi.org/10.4093/dmj.2021.0335
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  • 68 Web of Science
  • 69 Crossref
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReader   ePub   
Gestational diabetes mellitus (GDM) is the most common complication during pregnancy and is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. GDM is associated with adverse pregnancy outcomes and long-term offspring and maternal complications. For GDM screening and diagnosis, a two-step approach (1-hour 50 g glucose challenge test followed by 3-hour 100 g oral glucose tolerance test) has been widely used. After the Hyperglycemia and Adverse Pregnancy Outcome study implemented a 75 g oral glucose tolerance test in all pregnant women, a one-step approach was recommended as an option for the diagnosis of GDM after 2010. The one-step approach has more than doubled the incidence of GDM, but its clinical benefit in reducing adverse pregnancy outcomes remains controversial. Long-term complications of mothers with GDM include type 2 diabetes mellitus and cardiovascular disease, and complications of their offspring include childhood obesity and glucose intolerance. The diagnostic criteria of GDM should properly classify women at risk for adverse pregnancy outcomes and long-term complications. The present review summarizes the strengths and weaknesses of the one-step and two-step approaches for the diagnosis of GDM based on recent randomized controlled trials and observational studies. We also describe the long-term maternal and offspring complications of GDM.

Citations

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    International Journal of Molecular Sciences.2022; 23(23): 14574.     CrossRef
  • Higher Muscle Mass Protects Women with Gestational Diabetes Mellitus from Progression to Type 2 Diabetes Mellitus
    Yujin Shin, Joon Ho Moon, Tae Jung Oh, Chang Ho Ahn, Jae Hoon Moon, Sung Hee Choi, Hak Chul Jang
    Diabetes & Metabolism Journal.2022; 46(6): 890.     CrossRef
  • Identification of human placenta-derived circular RNAs and autophagy related circRNA-miRNA-mRNA regulatory network in gestational diabetes mellitus
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  • The Role of Dietary Polyphenols in Pregnancy and Pregnancy-Related Disorders
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Original Articles
Technology/Device
Article image
Glucose Profiles Assessed by Intermittently Scanned Continuous Glucose Monitoring System during the Perioperative Period of Metabolic Surgery
Kyuho Kim, Sung Hee Choi, Hak Chul Jang, Young Suk Park, Tae Jung Oh
Diabetes Metab J. 2022;46(5):713-721.   Published online January 24, 2022
DOI: https://doi.org/10.4093/dmj.2021.0164
  • 5,272 View
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  • 3 Web of Science
  • 3 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Continuous glucose monitoring (CGM) has been widely used in the management of diabetes. However, the usefulness and detailed data during perioperative status were not well studied. In this study, we described the immediate changes of glucose profiles after metabolic surgery using intermittently scanned CGM (isCGM) in individuals with type 2 diabetes mellitus (T2DM).
Methods
This was a prospective, single-center, single-arm study including 20 participants with T2DM. The isCGM (FreeStyle Libre CGM) implantation was performed within 2 weeks before surgery. We compared CGM metrics of 3 days before surgery and 3 days after surgery, and performed the correlation analyses with clinical variables.
Results
The mean glucose significantly decreased after surgery (147.0±40.4 to 95.5±17.1 mg/dL, P<0.001). Time in range (TIR; 70 to 180 mg/dL) did not significantly change after surgery in total. However, it was significantly increased in a subgroup of individuals with glycosylated hemoglobin (HbA1c) ≥8.0%. Time above range (>250 or 180 mg/dL) was significantly decreased in total. In contrast, time below range (<70 or 54 mg/dL) was significantly increased in total and especially in a subgroup of individuals with HbA1c <8.0% after surgery. The coefficient of variation significantly decreased after surgery. Higher baseline HbA1c was correlated with greater improvement in TIR (rho=0.607, P=0.005).
Conclusion
The isCGM identified improvement of mean glucose and glycemic variability, and increase of hypoglycemia after metabolic surgery, but TIR was not significantly changed after surgery. We detected an increase of TIR only in individuals with HbA1c ≥8.0%.

Citations

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  • Comparative Effect of Glucose-Lowering Drugs for Type 2 Diabetes Mellitus on Stroke Prevention: A Systematic Review and Network Meta-Analysis
    Ji Soo Kim, Gyeongsil Lee, Kyung-Il Park, Seung-Won Oh
    Diabetes & Metabolism Journal.2024; 48(2): 312.     CrossRef
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    Yang Yu, Susan W. Groth
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    Sang-Man Jin
    Diabetes & Metabolism Journal.2022; 46(5): 675.     CrossRef
Complications
Article image
SUDOSCAN in Combination with the Michigan Neuropathy Screening Instrument Is an Effective Tool for Screening Diabetic Peripheral Neuropathy
Tae Jung Oh, Yoojung Song, Hak Chul Jang, Sung Hee Choi
Diabetes Metab J. 2022;46(2):319-326.   Published online September 16, 2021
DOI: https://doi.org/10.4093/dmj.2021.0014
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Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Screening for diabetic peripheral neuropathy (DPN) is important to prevent severe foot complication, but the detection rate of DPN is unsatisfactory. We investigated whether SUDOSCAN combined with Michigan Neuropathy Screening Instrument (MNSI) could be an effective tool for screening for DPN in people with type 2 diabetes mellitus (T2DM) in clinical practice.
Methods
We analysed the data for 144 people with T2DM without other cause of neuropathy. The presence of DPN was confirmed according to the Toronto Consensus criteria. Electrochemical skin conductance (ESC) of the feet was assessed using SUDOSCAN. We compared the discrimination power of following methods, MNSI only vs. SUDOSCAN only vs. MNSI plus SUDOSCAN vs. MNSI plus 10-g monofilament test.
Results
Confirmed DPN was detected in 27.8% of the participants. The optimal cut-off value of feet ESC to distinguish DPN was 56 μS. We made the DPN screening scores using the corresponding odds ratios for MNSI-Questionnaire, MNSI-Physical Examination, SUDOSCAN, and 10-g monofilament test. For distinguishing the presence of DPN, the MNSI plus SUDOSCAN model showed higher areas under the receiver operating characteristic curve (AUC) than MNSI only model (0.717 vs. 0.638, P=0.011), and SUDOSCAN only model or MNSI plus 10-g monofilament test showed comparable AUC with MNSI only model.
Conclusion
The screening model for DPN that includes both MNSI and SUDOSCAN can detect DPN with acceptable discrimination power and it may be useful in Korean patients with T2DM.

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    Ming Wang, Niuniu Chen, Yaxin Wang, Jiaying Ni, Jingyi Lu, Weijing Zhao, Yating Cui, Ronghui Du, Wei Zhu, Jian Zhou
    Endocrine.2024;[Epub]     CrossRef
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    Sijia Fei, Jingwen Fan, Jiaming Cao, Huan Chen, Xiaoxia Wang, Qi Pan
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    Okti Sri Purwanti, Nursalam Nursalam, Moses Glorino Rumambo Pandin
    Frontiers in Endocrinology.2024;[Epub]     CrossRef
  • Peripheral Neuropathy in Diabetes Mellitus: Pathogenetic Mechanisms and Diagnostic Options
    Raffaele Galiero, Alfredo Caturano, Erica Vetrano, Domenico Beccia, Chiara Brin, Maria Alfano, Jessica Di Salvo, Raffaella Epifani, Alessia Piacevole, Giuseppina Tagliaferri, Maria Rocco, Ilaria Iadicicco, Giovanni Docimo, Luca Rinaldi, Celestino Sardu, T
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    Ken Munene Nkonge, Dennis Karani Nkonge, Teresa Njeri Nkonge
    Diabetology & Metabolic Syndrome.2023;[Epub]     CrossRef
  • The value of electrochemical skin conductance measurement by Sudoscan® for assessing autonomic dysfunction in peripheral neuropathies beyond diabetes
    Jean-Pascal Lefaucheur
    Neurophysiologie Clinique.2023; 53(2): 102859.     CrossRef
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    Bedia Fulya Calikoglu, Selda Celik, Cemile Idiz, Elif Bagdemir, Halim Issever, Jean-Henri Calvet, Ilhan Satman
    Primary Care Diabetes.2023; 17(5): 499.     CrossRef
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    Heung Yong Jin, Tae Sun Park
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  • Validation of the Body Scan®, a new device to detect small fiber neuropathy by assessment of the sudomotor function: agreement with the Sudoscan®
    Jean-Pierre Riveline, Roberto Mallone, Clarisse Tiercelin, Fetta Yaker, Laure Alexandre-Heymann, Lysa Khelifaoui, Florence Travert, Claire Fertichon, Jean-Baptiste Julla, Tiphaine Vidal-Trecan, Louis Potier, Jean-Francois Gautier, Etienne Larger, Jean-Pas
    Frontiers in Neurology.2023;[Epub]     CrossRef
  • Electrochemical Skin Conductance by Sudoscan in Non-Dialysis Chronic Kidney Disease Patients
    Liang-Te Chiu, Yu-Li Lin, Chih-Hsien Wang, Chii-Min Hwu, Hung-Hsiang Liou, Bang-Gee Hsu
    Journal of Clinical Medicine.2023; 13(1): 187.     CrossRef
  • The Presence of Clonal Hematopoiesis Is Negatively Associated with Diabetic Peripheral Neuropathy in Type 2 Diabetes
    Tae Jung Oh, Han Song, Youngil Koh, Sung Hee Choi
    Endocrinology and Metabolism.2022; 37(2): 243.     CrossRef
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    Frontiers in Neurology.2022;[Epub]     CrossRef
  • Detection of sudomotor alterations evaluated by Sudoscan in patients with recently diagnosed type 2 diabetes
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COVID-19
Article image
Effects of Social Distancing on Diabetes Management in Older Adults during COVID-19 Pandemic
Soo Myoung Shin, Tae Jung Oh, Sung Hee Choi, Hak Chul Jang
Diabetes Metab J. 2021;45(5):765-772.   Published online August 30, 2021
DOI: https://doi.org/10.4093/dmj.2021.0096
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Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
On March 22, 2020, intense social distancing (SD) was implemented in Korea to prevent the spread of coronavirus disease 19 (COVID-19). This study examined the impact of SD on diabetes control in older adults with diabetes.
Methods
Adults aged 60 to 90 years with type 2 diabetes mellitus who were physically and mentally independent were recruited. Participants who had complete blood chemistry data from April to July 2019 (pre-SD era) and April to July 2020 (SD era) were enrolled. Data were obtained about physical activity, nutrition, sarcopenia, and psychological and mental health from questionnaires in April to July 2020. Calf circumference was measured.
Results
In total, 246 people (100 men, 146 women; mean age, 73.8±5.7 years) participated in this study. The levels of glycated hemoglobin (HbA1c, 7.4%±1.0% vs. 7.1%±0.8%, P<0.001), fasting glucose (142.2±16.7 mg/dL vs. 132.0±27.7 mg/dL, P<0.001), and body weight (62.6±9.4 kg vs. 61.8±10.1 kg, P<0.01) were higher in the SD era than in the pre-SD era. Total physical activity was lower in the SD era (2,584.6±2,624.1 MET-min/week–1 vs. 1,987.3±2,295.0 MET-min/week–1, P<0.001). A larger increase in HbA1c level was associated with increased body weight and decreased physical activity.
Conclusion
SD had negative effects on diabetes management in older adults with diabetes. Fasting glucose and HbA1c levels and body weight increased during the SD era. Participants with reduced physical activity gained more weight and had higher blood glucose levels. Given that the COVID-19 pandemic is ongoing, health professionals and diabetes educators should monitor changes in lifestyle factors in older adults with diabetes.

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Metabolic Risk/Epidemiology
Article image
Maternal Hyperglycemia during Pregnancy Increases Adiposity of Offspring
Hye Rim Chung, Joon Ho Moon, Jung Sub Lim, Young Ah Lee, Choong Ho Shin, Joon-Seok Hong, Soo Heon Kwak, Sung Hee Choi, Hak Chul Jang
Diabetes Metab J. 2021;45(5):730-738.   Published online February 22, 2021
DOI: https://doi.org/10.4093/dmj.2020.0154
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Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
The effect of intrauterine hyperglycemia on fat mass and regional fat proportion of the offspring of mothers with gestational diabetes mellitus (OGDM) remains to be determined.
Methods
The body composition of OGDM (n=25) and offspring of normoglycemic mothers (n=49) was compared using dualenergy X-ray absorptiometry at age 5 years. The relationship between maternal glucose concentration during a 100 g oral glucose tolerance test (OGTT) and regional fat mass or proportion was analyzed after adjusting for maternal prepregnancy body mass index (BMI).
Results
BMI was comparable between OGDM and control (median, 16.0 kg/m2 vs. 16.1 kg/m2 ). Total, truncal, and leg fat mass were higher in OGDM compared with control (3,769 g vs. 2,245 g, P=0.004; 1,289 g vs. 870 g, P=0.017; 1,638 g vs. 961 g, P=0.002, respectively), whereas total lean mass was lower in OGDM (15,688 g vs. 16,941 g, P=0.001). Among OGDM, total and truncal fat mass were correlated with fasting and 3-hour glucose concentrations of maternal 100 g OGTT during pregnancy (total fat mass, r=0.49, P=0.018 [fasting], r=0.473, P=0.023 [3-hour]; truncal fat mass, r=0.571, P=0.004 [fasting], r=0.558, P=0.006 [3-hour]), but there was no correlation between OGDM leg fat mass and maternal OGTT during pregnancy. Regional fat indices were not correlated with concurrent maternal 75 g OGTT values.
Conclusion
Intrauterine hyperglycemia is associated with increased fat mass, especially truncal fat, in OGDM aged 5 years.

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Clinical Diabetes & Therapeutics
Effects of Lobeglitazone, a Novel Thiazolidinedione, on Bone Mineral Density in Patients with Type 2 Diabetes Mellitus over 52 Weeks
Soo Lim, Kyoung Min Kim, Sin Gon Kim, Doo Man Kim, Jeong-Taek Woo, Choon Hee Chung, Kyung Soo Ko, Jeong Hyun Park, Yongsoo Park, Sang Jin Kim, Hak Chul Jang, Dong Seop Choi
Diabetes Metab J. 2017;41(5):377-385.   Published online October 24, 2017
DOI: https://doi.org/10.4093/dmj.2017.41.5.377
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AbstractAbstract PDFPubReader   
Background

The aim of this multicenter, randomized, double-blind study was to examine the effect of lobeglitazone, a novel thiazolidinedione, on the changes in bone mineral density (BMD) in patients with type 2 diabetes mellitus.

Methods

A 24-week, double-blinded phase was followed by a 28-week, open-label phase, in which the placebo group also started to receive lobeglitazone. A total of 170 patients aged 34 to 76 years were randomly assigned in a 2:1 ratio to receive lobeglitazone 0.5 mg or a matching placebo orally, once daily. BMD was assessed using dual-energy X-ray absorptiometry at week 24 and at the end of the study (week 52).

Results

During the double-blinded phase, the femur neck BMD showed decreasing patterns in both groups, without statistical significance (−0.85%±0.36% and −0.78%±0.46% in the lobeglitazone and placebo groups, respectively). The treatment difference between the groups was 0.07%, which was also not statistically significant. Further, minimal, nonsignificant decreases were observed in both groups in the total hip BMD compared to values at baseline, and these differences also did not significantly differ between the groups. During the open-label phase, the BMD was further decreased, but not significantly, by −0.32% at the femur neck and by −0.60% at the total hip in the lobeglitazone group, and these changes did not significantly differ compared with the original placebo group switched to lobeglitazone.

Conclusion

Our results indicate that treatment with lobeglitazone 0.5 mg over 52 weeks showed no detrimental effect on the BMD compared to the placebo.

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Clinical Care/Education
Comparison of Antidiabetic Regimens in Patients with Type 2 Diabetes Uncontrolled by Combination Therapy of Sulfonylurea and Metformin: Results of the MOHAS Disease Registry in Korea
Sung Hee Choi, Tae Jung Oh, Hak Chul Jang
Diabetes Metab J. 2017;41(3):170-178.   Published online May 11, 2017
DOI: https://doi.org/10.4093/dmj.2017.41.3.170
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AbstractAbstract PDFPubReader   
Background

The aim of this study was to investigate the glucose-lowering efficacy of antidiabetic treatments in patients with type 2 diabetes mellitus (T2DM) uncontrolled by sulfonylurea plus metformin.

Methods

This open-label, multicenter, prospective, observational study was conducted in 144 centers in Korea, from June 2008 to July 2010, and included patients with T2DM who had received sulfonylurea and metformin for at least 3 months and had levels of glycosylated hemoglobin (HbA1c) >7.0% in the last month. Data of clinical and biochemical characteristics were collected at baseline and 6 months after treatment. The treatment option was decided at the physician's discretion. Subjects were classified into the following three groups: intensifying oral hypoglycemic agents (group A), adding basal insulin (group B), or starting intensified insulin therapy (group C).

Results

Of 2,995 patients enrolled, 2,901 patients were evaluated, and 504 (17.4%), 2,316 (79.8%), and 81 patients (2.8%) were classified into groups A, B, and C, respectively. Subjects in group C showed relatively higher baseline levels of HbA1c and longer duration of diabetes. The mean decrease in HbA1c level was higher in the insulin treated groups (−0.9%±1.3%, −1.6%±1.3%, and −2.4%±2.3% in groups A, B, and C, respectively, P=0.042). The proportion of patients who achieved target HbA1c <7.0% was comparable among the groups; however, intensified insulin therapy seemed to be the most effective in achieving the target HbA1c of 6.5%.

Conclusion

These findings suggest that insulin-based therapy will be an important option in the improved management of Korean patients with T2DM whose glycemic control is not sufficient with sulfonylurea and metformin.

Citations

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Epidemiology
Application of the 2013 American College of Cardiology/American Heart Association Cholesterol Guideline to the Korean National Health and Nutrition Examination Surveys from 1998 to 2012
Young Shin Song, Tae Jung Oh, Kyoung Min Kim, Jae Hoon Moon, Sung Hee Choi, Hak Chul Jang, Kyong Soo Park, Soo Lim
Diabetes Metab J. 2017;41(1):38-50.   Published online December 16, 2016
DOI: https://doi.org/10.4093/dmj.2017.41.1.38
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AbstractAbstract PDFSupplementary MaterialPubReader   
Background

The 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline for the treatment of blood cholesterol recommends statin therapy for individuals at high risk of atherosclerotic cardiovascular disease (ASCVD). The aim of this study was to investigate serial trends in the percentages of Korean adults considered eligible for statin therapy according to the new ACC/AHA cholesterol guideline.

Methods

Data from the Korean National Health and Nutrition Examination Survey (KNHANES) I (1998, n=7,698), II (2001, n=5,654), III (2005, n=5,269), IV (2007 to 2009, n=15,727), and V (2010 to 2012, n=16,304), which used a stratified, multistage, probability sampling design, were used as representative of the entire Korean population.

Results

The percentage of adults eligible for statin therapy according to the ACC/AHA cholesterol guideline increased with time: 17.0%, 19.0%, 20.8%, 20.2%, and 22.0% in KNHANES I, II, III, IV, and V, respectively (P=0.022). The prevalence of ASCVD was 1.4% in KNHANES I and increased to 3.3% in KNHANES V. The percentage of diabetic patients aged 40 to 75 years with a low density lipoprotein cholesterol levels of 70 to 189 mg/dL increased from 4.8% in KNHANES I to 6.1% in KNHANES V. People with an estimated 10-year ASCVD risk ≥7.5% and aged 40 to 75 years accounted for the largest percentage among the four statin benefit groups: 9.1% in KNHANES I and 11.0% in KNHANES V.

Conclusion

Application of the 2013 ACC/AHA guideline has found that the percentage of Korean adults in the statin benefit groups has increased over the past 15 years.

Citations

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Response
Response: Hyperglycemia Is Associated with Impaired Muscle Quality in Older Men with Diabetes: The Korean Longitudinal Study on Health and Aging (Diabetes Metab J 2016;40:140-6)
Ji Won Yoon, Hak Chul Jang
Diabetes Metab J. 2016;40(3):250-251.   Published online June 20, 2016
DOI: https://doi.org/10.4093/dmj.2016.40.3.250
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PDFPubReader   

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Sulwon Lecture 2015
Clinical Care/Education
Sarcopenia, Frailty, and Diabetes in Older Adults
Hak Chul Jang
Diabetes Metab J. 2016;40(3):182-189.   Published online April 20, 2016
DOI: https://doi.org/10.4093/dmj.2016.40.3.182
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AbstractAbstract PDFPubReader   

Populations are aging and the prevalence of diabetes mellitus is increasing tremendously. The number of older people with diabetes is increasing unexpectedly. Aging and diabetes are both risk factors for functional disability. Thus, increasing numbers of frail or disabled older patients with diabetes will increase both direct and indirect health-related costs. Diabetes has been reported as an important risk factor of developing physical disability in older adults. Older people with diabetes have lower muscle mass and weaker muscle strength. In addition, muscle quality is poorer in diabetic patients. Sarcopenia and frailty have a common soil and may share a similar pathway for multiple pathologic processes in older people. Sarcopenia is thought to be an intermediate step in the development of frailty in patients with diabetes. Thus, early detection of sarcopenia and frailty in older adults with diabetes should be routine clinical practice to prevent frailty or to intervene earlier in frail patients.

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Original Articles
Clinical Care/Education
Feasibility of a Patient-Centered, Smartphone-Based, Diabetes Care System: A Pilot Study
Eun Ky Kim, Soo Heon Kwak, Seungsu Baek, Seung Lyeol Lee, Hak Chul Jang, Kyong Soo Park, Young Min Cho
Diabetes Metab J. 2016;40(3):192-201.   Published online April 8, 2016
DOI: https://doi.org/10.4093/dmj.2016.40.3.192
  • 5,396 View
  • 55 Download
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AbstractAbstract PDFPubReader   
Background

We developed a patient-centered, smartphone-based, diabetes care system (PSDCS). This study aims to test the feasibility of glycosylated hemoglobin (HbA1c) reduction with the PSDCS.

Methods

This study was a single-arm pilot study. The participants with type 2 diabetes mellitus were instructed to use the PSDCS, which integrates a Bluetooth-connected glucometer, digital food diary, and wearable physical activity monitoring device. The primary end point was the change in HbA1c from baseline after a 12-week intervention.

Results

Twenty-nine patients aged 53.9±9.1 years completed the study. HbA1c and fasting plasma glucose levels decreased significantly from baseline (7.7%±0.7% to 7.1%±0.6%, P<0.0001; 140.9±39.1 to 120.1±31.0 mg/dL, P=0.0088, respectively). The frequency of glucose monitoring correlated with the magnitude of HbA1c reduction (r=–0.57, P=0.0013). The components of the diabetes self-care activities, including diet, exercise, and glucose monitoring, were significantly improved, particularly in the upper tertile of HbA1c reduction. There were no severe adverse events during the intervention.

Conclusion

A 12-week application of the PSDCS to patients with inadequately controlled type 2 diabetes resulted in a significant HbA1c reduction with tolerable safety profiles; these findings require confirmation in a future randomized controlled trial.

Citations

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Clinical Care/Education
Hyperglycemia Is Associated with Impaired Muscle Quality in Older Men with Diabetes: The Korean Longitudinal Study on Health and Aging
Ji Won Yoon, Yong-Chan Ha, Kyoung Min Kim, Jae Hoon Moon, Sung Hee Choi, Soo Lim, Young Joo Park, Jae Young Lim, Ki Woong Kim, Kyong Soo Park, Hak Chul Jang
Diabetes Metab J. 2016;40(2):140-146.   Published online March 31, 2016
DOI: https://doi.org/10.4093/dmj.2016.40.2.140
  • 7,747 View
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  • 87 Web of Science
  • 93 Crossref
AbstractAbstract PDFPubReader   
Background

The study aimed to investigate the influence of hyperglycemia on muscle quality in older men with type 2 diabetes.

Methods

This was a subsidiary study of the Korean Longitudinal Study of Health and Aging. Among 326 older men consenting to tests of body composition and muscle strength, 269 men were ultimately analyzed after the exclusion because of stroke (n=30) and uncertainty about the diagnosis of diabetes (n=27). Body composition was measured using dual-energy X-ray absorptiometry and computed tomography. Muscle strength for knee extension was measured using an isokinetic dynamometer. Muscle quality was assessed from the ratio of leg strength to the entire corresponding leg muscle mass.

Results

The muscle mass, strength, and quality in patients with type 2 diabetes did not differ significantly from controls. However, when patients with diabetes were subdivided according to their glycemic control status, patients with a glycosylated hemoglobin (HbA1c) level of ≥8.5% showed significantly decreased leg muscle quality by multivariate analysis (odds ratio, 4.510; P=0.045) after adjustment for age, body mass index, smoking amount, alcohol consumption, physical activity, and duration of diabetes. Physical performance status was also impaired in subjects with an HbA1c of ≥8.5%.

Conclusion

Poor glycemic control in these older patients with diabetes was associated with significant risk of decreased muscle quality and performance status. Glycemic control with an HbA1c of <8.5% might be needed to reduce the risk of adverse skeletal and functional outcomes in this population.

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Clinical Care/Education
Clinical Characteristics and Metabolic Predictors of Rapid Responders to Dipeptidyl Peptidase-4 Inhibitor as an Add-on Therapy to Sulfonylurea and Metformin
Ye An Kim, Won Sang Yoo, Eun Shil Hong, Eu Jeong Ku, Kyeong Seon Park, Soo Lim, Young Min Cho, Kyong Soo Park, Hak Chul Jang, Sung Hee Choi
Diabetes Metab J. 2015;39(6):489-497.   Published online November 27, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.6.489
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AbstractAbstract PDFPubReader   
Background

Dipeptidyl peptidase-4 (DPP-4) inhibitor add-on therapy is a new option for patients with inadequately controlled type 2 diabetes who are taking combined metformin and sulfonylurea (SU). We evaluated the efficacy and safety of this triple therapy and the characteristics of rapid responders and hypoglycemia-prone patients.

Methods

We included 807 patients with type 2 diabetes who were prescribed a newly added DPP-4 inhibitor to ongoing metformin and SU in 2009 to 2011. Glycemia and other metabolic parameters at baseline, 12, 24, and 52 weeks, as well as episodes of hypoglycemia were analyzed. Rapid responders were defined as patients with ≥25% reduction in glycosylated hemoglobin (HbA1c) within 12 weeks.

Results

At baseline, while on the submaximal metformin and SU combination, the mean HbA1c level was 8.4%. Twelve weeks after initiation of DPP-4 inhibitor add-on, 269 patients (34.4%) achieved an HbA1c level ≤7%. Sixty-six patients (8.2%, 47 men) were rapid responders. The duration of diabetes was shorter in rapid responders, and their baseline fasting plasma glucose (FPG), HbA1c, C-peptide, and homeostasis model assessment of insulin resistance were significantly higher. Patients who experienced hypoglycemia after taking DPP-4 inhibitor add-on were more likely to be female, to have a lower body weight and lower triglyceride and FPG levels, and to have higher homeostasis model assessment of β-cells.

Conclusion

An oral hypoglycemic triple agent combination including a DPP-4 inhibitor was effective in patients with uncontrolled diabetes. Proactive dose reduction of SU should be considered when a DPP-4 inhibitor is added for rapid responders and hypoglycemia-prone patients.

Citations

Citations to this article as recorded by  
  • A genetic variant in GLP1R is associated with response to DPP-4 inhibitors in patients with type 2 diabetes
    Eugene Han, Hye Sun Park, Obin Kwon, Eun Yeong Choe, Hye Jin Wang, Yong-ho Lee, Sang-Hak Lee, Chul Hoon Kim, Lee-Kyung Kim, Soo Heon Kwak, Kyong Soo Park, Chul Sik Kim, Eun Seok Kang
    Medicine.2016; 95(44): e5155.     CrossRef

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