Diabetes & Metabolism Journal

Original Articles

Fracture Incidence and Risk of Osteoporosis in Female Type 2 Diabetic Patients in Korea: Jong Kwan Jung, Hyo Jeong Kim, Hong Kyu Lee, Sang Soo Kim, Chan Soo Shin, Jin Taek Kim; Diabetes Metab J. 2012;36(2):144-150. Published online April 17, 2012; DOI: https://doi.org/10.4093/dmj.2012.36.2.144

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Background

There are no published data regarding fracture risk in type 2 diabetic patients in Korea. In this study, we compared the fracture incidence and risk of osteoporosis of type 2 diabetic female patients with those in a non-diabetic hypertensive cohort.

Methods

The incidence of fracture in a type 2 diabetic cohort was compared with that in a non-diabetic hypertensive cohort over the course of 7 years. Female type 2 diabetic and non-diabetic hypertensive patients who visited Eulji General Hospital outpatient clinic from January 2004 to April 2004 were assigned to the diabetic cohort and the non-diabetic hypertensive cohort, respectively. Surveys on fracture event, use of anti-osteoporosis medications, and bone mineral density were performed.

Results

The number of fractures was 88 in the female diabetic cohort (n=1,268, 60.6±11.5 years) and 57 in the female non-diabetic hypertensive cohort (n=1,014, 61.4±11.7 years). The RR in the diabetic cohort was 1.38 (P=0.064; 95% confidence interval [CI], 0.98 to 1.94) when adjusted for age. Diabetic patients with microvascular complications (61.0%) showed a higher RR of 1.81 (P=0.014; 95% CI, 1.13 to 2.92) compared with those without these complications. The prevalence of osteoporosis was comparable between the groups, while use of anti-osteoporosis medication was more common in the diabetic cohort (12.8%) than in the hypertensive cohort (4.5%) (P<0.001).

Conclusion

In our study, a higher fracture risk was observed in female type 2 diabetics with microvascular complications. Special concern for this risk group is warranted.

Citations

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Research Progress on How to Prevent Osteoporosis in Diabetic Patients
婷玉牛
Advances in Clinical Medicine.2022; 12(02): 1178. CrossRef
Differences in the roles of types 1 and 2 diabetes in the susceptibility to the risk of fracture: a systematic review and meta-analysis
Jiaqing Dou, Jing Wang, Qiu Zhang
Diabetology & Metabolic Syndrome.2021;[Epub] CrossRef
The risk of hip and non-vertebral fractures in type 1 and type 2 diabetes: A systematic review and meta-analysis update
Tatiane Vilaca, Marian Schini, Susan Harnan, Anthea Sutton, Edith Poku, Isabel E. Allen, Steven R. Cummings, Richard Eastell
Bone.2020; 137: 115457. CrossRef
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Hao Wang, Ying Ba, Qian Xing, Jian-Ling Du
BMJ Open.2019; 9(1): e024067. CrossRef
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Khemayanto Hidayat, Xuan Du, Meng‐Jiao Wu, Bi‐Min Shi
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Type 2 diabetes and risk of low-energy fractures in postmenopausal women: meta-analysis of observational studies
Joanna Dytfeld, Michał Michalak
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Risk of low-energy fracture in type 2 diabetes patients: a meta-analysis of observational studies
P. Jia, L. Bao, H. Chen, J. Yuan, W. Liu, F. Feng, J. Li, H. Tang
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Yong Jun Choi, Yoon-Sok Chung
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Kwang Joon Kim, Yong-Ki Min, Jung-Min Koh, Yoon-Sok Chung, Kyoung Min Kim, Dong-Won Byun, In Joo Kim, Mikyung Kim, Sung-Soo Kim, Kyung Wan Min, Ki Ok Han, Hyoung Moo Park, Chan Soo Shin, Sung Hee Choi, Jong Suk Park, Dong Jin Chung, Ji Oh Mok, Hong Sun Ba
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Chien-Chang Liao, Chao-Shun Lin, Chun-Chuan Shih, Chun-Chieh Yeh, Yi-Cheng Chang, Yuan-Wen Lee, Ta-Liang Chen
Diabetes Care.2014; 37(8): 2246. CrossRef
Aortic Calcification and Bone Metabolism: The Relationship between Aortic Calcification, BMD, Vertebral Fracture, 25-Hydroxyvitamin D, and Osteocalcin
Kwang Joon Kim, Kyoung Min Kim, Kyeong Hye Park, Han Seok Choi, Yumie Rhee, Yong Ho Lee, Bong Soo Cha, Myong Jin Kim, Sun Min Oh, J. Keenan Brown, Sung Kil Lim
Calcified Tissue International.2012; 91(6): 370. CrossRef

Increasing Trend in the Number of Severe Hypoglycemia Patients in Korea: Jin Taek Kim, Tae Jung Oh, Ye An Lee, Jun Ho Bae, Hyo Jeong Kim, Hye Seung Jung, Young Min Cho, Kyong Soo Park, Soo Lim, Hak Chul Jang, Hong Kyu Lee; Diabetes Metab J. 2011;35(2):166-172. Published online April 30, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.2.166

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Abstract PDF PubReader

Background

To investigate whether the number of subjects with severe hypoglycemia who are brought to a hospital emergency department is increasing and to identify whether there have been changes in the demographic and clinical characteristics of those subjects.

Methods

We analyzed data from the Emergency Departments of two general hospitals in Seoul, Korea. We included data from all adult subjects with type 2 diabetes who presented to an emergency department with severe hypoglycemia between January 1, 2004 and December 30, 2009.

Results

A total of 740 cases of severe hypoglycemia were identified. The mean subject age was 69±12 years, mean duration of diabetes was 13.8±9.3 years, and 53.2% of subjects were receiving insulin therapy. We observed a sharp rise in the number of cases between 2006 and 2007. Stages 3-5 chronic kidney disease was diagnosed in 31.5% of subjects, and low C-peptide levels (<0.6 ng/mL) were found in 25.5%. The mean subject age, duration of diabetes, HbA1c level, and renal and insulin secretory function values did not change significantly during the study period. The proportion of glimepiride use increased, while use of gliclazide decreased among sulfonylurea users. Use of insulin analogues increased, while use of NPH/RI decreased among insulin users.

Conclusion

We identified a sharp increase in the number of subjects with severe hypoglycemia presenting to an emergency room since 2006. The clinical characteristics of these subjects did not change markedly during the study period. Nationwide studies are warranted to further clarify this epidemic of severe hypoglycemia.

Citations

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Cardiovascular Disease Predicts Severe Hypoglycemia in Patients with Type 2 Diabetes
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The Effects of D-Chiro-Inositol on Glucose Metabolism in 3T3-L1 Cells.: Kang Seo Park, Jae Min Lee, Bon Jeong Ku, Young Suk Jo, Seong Kyu Lee, Kyung Wan Min, Kyung Ah Han, Hyo Jeong Kim, Hyun Jin Kim; Korean Diabetes J. 2008;32(3):196-203. Published online June 1, 2008; DOI: https://doi.org/10.4093/kdj.2008.32.3.196

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Abstract PDF

BACKGROUND
The target of the treatment of metabolic syndrome and diabetes is an improvement of insulin resistance. D-chiro-inositol (DCI) plays a role in a phospholipid mediating intracellular insulin action. In the previous studies, the urine level of DCI were decreased in the diabetic animal with insulin resistance. Some clinical studies showed that DCI improved a glucose level and HbA1c. Therefore we studied the relationship between DCI and glucose metabolism, especially insulin resistance. METHODS: To investigate the mechanism of DCI affecting the glucose metabolism, we examined the effects of DCI on 2-deoxyglucose uptake, gene expression of adipocytokines and AMPK pathway by using RT-PCR and western blot in 3T3-L1 cells. RESULTS: Insulin-stimulated 2-deoxyglucose uptake increased in DCI-treated cells by about 1.2-fold (relative to the control) and was inhibited by phosphoinositide 3-kinase (PI3 Kinase) inhibitors (Wortmanin, LY294002) and AMPK inhibitor (STO-609). In Western blot analysis, it didn't show the difference of phosphorylation of Akt and AMPK between DCI-treated group and control in 3T3-L1 cells. However, DCI decreased the gene expression of resistin in 3T3-L1 cells. CONCLUSION: DCI may involve other pathway of insulin signaling, but not PI3 Kinase and AMPK signaling pathways and it may be useful in managing metabolic syndrome by improving insulin resistance through increasing glucose uptake and decreasing resistin relevant to insulin resistance.

Citations

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Variation of Pinitol Content for Domestic Legume Species in Korea
Seung-Min Seo, Yeon-Shin Jeong, Dhakal Krisna Hari, Dong-Hyun Shin, In-Jung Lee, Eun-Sook Park, Jeong-Dong Lee, Young-Hyun Hwang
Korean Journal of Crop Science.2011; 56(1): 50. CrossRef

Analysis of Meal Habits from the Viewpoint of Regularity in Korean Type 2 Diabetic Patients.: Hee Jung Ahn, Kyung Ah Han, Boo Kyung Koo, Hyun Jin Kim, Hyo Jeong Kim, Kang Seo Park, Kyung Wan Min; Korean Diabetes J. 2008;32(1):68-76. Published online February 1, 2008; DOI: https://doi.org/10.4093/kdj.2008.32.1.68

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Abstract PDF

BACKGROUND
The regular meal pattern with consistent day-to-day calorie and carbohydrate intake is one of the most important determinants of good glycemic control in diabetes. This study was aimed to investigate the meal pattern and their relationships with total energy intake, nutrients intake and glycemic and lipid profile in type 2 diabetes. METHODS: 1,084 subjects were divided according to glycemic status into three groups: the diabetes (DM), dysglycemia (DG) and normal (N). The meal frequency (MF), meal interval (MI) and daily intake of total energy, macronutrient and micronutrient were estimated with the 24 hours dietary recall from the Korean National Health and Nutrition Examination Survey (KNHANES) in 2001 and Eulji hospital. For analysis of meal pattern and it's relations with the nutrients intake, we regrouped into meal skipper (G1), non-meal skipper with unreasonable MI (G2), and non-meal skipper with reasonable MI (G3). RESULTS: 17.5% of DM, 21.8% of DG, 23.3% of N skipped at least one meal a day without significant difference across the groups. 55.9% of non-meal skipper had unreasonable MI. Meal was more regular in older age, lower educated person, employee, and female. G1 took higher fat, and more calories form snack and less micronutrient density, compared with G3 (P < 0.05). HbA1c, total cholesterol and triglyceride values were higher in G1 compared with other two groups (P < 0.05). CONCLUSION: Many type 2 diabetics had the irregular meal patterns, which was associated with poor glycemic control, lipid profiles and less micronutrient density. This suggested that another treatment strategy might be required for those who had irregular lifestyle.

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Haeun Jang, Jihyun Im, Kyong Park
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Ji Young Ye, Sung Hee Min, Min June Lee
Korean Journal of Food & Cookery Science.2017; 33(5): 601. CrossRef
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Mi-Ae Kim
Korean Journal of Occupational Health Nursing.2015; 24(2): 67. CrossRef
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Sun Young Jung, Sook Ja Lee, Sun Hee Kim, Kyung Mi Jung
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Relationship between Endothelial-dependent/-independent Vasodilation and Carotid Intimal- media Thickness in Newly-diagnosed Korean Type 2 Diabetic Patients.: Jung Ho Choi, Kyung Wan Min, Hyo Jeong Kim, Bo kyung Koo, Chae Young Lim, Hyun Jin Kim, Gang Seo Pak, Kyung Ah Han, Eung Jin Kim; Korean Diabetes J. 2007;31(6):498-506. Published online November 1, 2007; DOI: https://doi.org/10.4093/jkda.2007.31.6.498

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Abstract PDF: BACKGROUND
The relative effect of diabetes on the risk of cardiovascular disease in Asian population is much the same as that in Western populations. Although multiple atherosclerotic risk factors have been documented in Asia, precise estimates of vascular reactivity might provide more critical informations for the prevention and the control of diabetes-related cardiovascular mortality and morbidity. The aims of this study were to estimate the vascular reactivity directly and evaluate its relationship with other cardiovascular risk factors and carotid intimal-media thickness (IMT) in newly-diagnosed Korean type 2 diabetic patients. METHODS: We measured flow-mediated vasodilation (FMD) and endothelial-independent vasodilation (EID) of the brachial artery using high-resolution ultrasonography in total of 121 (M; N = 68, F; N = 53) diabetic patients. We assessed conventional cardiovascular risk factors such as age, smoking, obesity, hypertension, hyperlipidemia or family history of cardiovascular disease and analyzed the association among FMD/EID with cardiovascular risk factors, carotid IMT or the total number of risk factors. RESULTS: The mean values of age, smoking, BMI, waist, systolic blood pressure and diastolic blood pressure were 51.2 +/- 12.3 years, 11.0 +/- 15.8 pack years, 25.0 +/- 3.2 kg/m2, 86 +/- 9 cm, 123 +/- 16 mmHg and 79 +/- 12 mmHg. The mean values of HbA1c, fasting blood glucose, total cholesterol, triglyceride, LDL-cholesterol and HDL-cholesterol were 8.4 +/- 2.0%, 166 +/- 51 mg/dL, 187 +/- 37 mg/dL, 166 +/- 143 mg/dL, 114 +/- 30 mg/dL and 46 +/- 12 mg/dL. FMD and EID were estimated by 6.1 +/- 2.8% and 16.6 +/- 5.6% respectively. The mean/maximal carotid IMT were 0.63 +/- 0.12/0.76 +/- 0.16 mm and the number of risk factors besides diabetes mellitus were 2.3 +/- 1.3. After adjusting age, FMD was associated only with smoking, but EID was associated with smoking, systolic/diastolic blood pressure, mean/maximal carotid IMT and number of risk factors by partial correlations. Age, smoking and EID were independent risk variables for carotid IMT, analyzed by multiple regression test. CONCLUSION: These findings suggest that impaired vascular reactivity detected by EID is closely related to carotid IMT, an useful surrogate marker for atherosclerosis, in newly-diagnosed Korean type 2 diabetic patients.

Therapeutic Efficacy of Combined Therapy with Once Daily Insulin Glargine and Once Daily Glimepiride in Korean Type 2 Diabetic Patients.: Ji Young Park, Hyo Jeong Kim, Bo Kyung Koo, Hyun Jin Kim, Gang Seo Pak, Kyung Ah Han, Kyung Wan Min, Eung Jin Kim; Korean Diabetes J. 2007;31(5):391-401. Published online September 1, 2007; DOI: https://doi.org/10.4093/jkda.2007.31.5.391

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Abstract PDF: BACKGROUND
Once daily injection and 24 hour lasting glucose lowering effect of insulin glargine had recently changed a perception about the early insulin treatment of type 2 diabetic patients. This study was performed to investigate therapeutic efficacy of combined therapy with insulin glargine and glimepiride in Korean type 2 diabetic patients, who had received oral hypoglycemic agents (OHA) or conventional insulin therapy. METHODS: Total of 192 patients who needed to change the previous therapy because of uncontrolled diabetes or hypoglycemia were included and followed for about 6 months. Two groups of prior treatment modality were analyzed; OHA group (n = 54, 28.1%), conventional insulin therapy group in combination with or without OHA group (n = 138, 71.9%). The primary end point was changes in HbA1c according to baseline characteristics such as prior treatment modality, HbA1C, c-peptide, duration of diabetes mellitus, body mass index and prior used conventional insulin doses. Secondary end point was the dose conversion ratio of insulin glargine to prior used insulin in patients who had one or two insulin therapy. We also evaluated the level of the patients' satisfaction on the glucose lowering effects and the convenience for use of device. RESULTS: The differences of HbA1c according to prior treatment groups were -0.78 +/- 1.76 % in OHA group and 0.07 +/- 1.44 % in conventional insulin group with or without OHA group. The HbA1c improved better when baseline HbA1c was higher than 9%, c-peptide was higher than 0.6 ng/mL, duration of diabetes was shorter than 15 years, BMI was lower than 30 kg/m2 and prior conventional insulin dose was less than 30 IU. However, those effects were attenuated in subjects having duration of diabetes longer than 16 years, BMI higher than 30 kg/m2 and prior insulin dose more than 40 IU. Dose conversion ratio of the insulin glargine to prior insulin was 0.78 +/- 0.30 and showed a tendency to increase in patients who have prior insulin dose more than 40 IU. The scores of the patients' subjective satisfaction on insulin glargine were all high, irrespective of the changes of HbA1c. CONCLUSIONS: Once daily injection of insulin glargine and oral ingestion of glimepiride can be recommended as one of starting insulin regimen for patients who are not adequately controlled by OHA alone or as once daily regimen for whom treated with one or two conventional insulin therapy.

Randomized Controlled Trial

Efficacy and Safety of Mitiglinide in Korean Type 2 Diabetic Patients: Prospective Randomised Multicenter Comparative Phase III Study.: Se Young Kim, Hyo Jeong Kim, Kyung Ah Han, Se Hyun Baek, Hyun Sik Son, Bong Soo Cha, Kyung Wan Min; Korean Diabetes J. 2007;31(2):163-174. Published online March 1, 2007; DOI: https://doi.org/10.4093/jkda.2007.31.2.163

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Abstract PDF

BACKGROUND
Mitiglinide, one of the meglitinides, is expected to prevent postprandial hyperglycemia of type 2 diabetes by enhancing early phase insulin secretion. The aim of this study was to verify the efficacy and safety of mitiglinide compared to nateglinide. METHODS: One hundred eleven of diabetic patients were randomised and administered of mitiglinide (n = 56) and nateglinide (n = 55) before a meal time for 12 weeks. The changes of HbA1c, fasting plasma glucose (FPG) and postprandial plasma glucose (PPG) were analyzed. The safety of this drug was investigated as well. RESULTS: The change of HbA1c was not significantly different between two groups (-0.77 +/- 1.08% in mitiglinide vs. -0.66 +/- 0.79% in nateglinide, P = 0.57). The reduction of FPG (-12.2 +/- 25.0 mg/dL vs. -6.1 +/- 22.3 mg/dL, P = 0.218), PPG 1 hr (-48.0 +/- 47.1 mg/dL, vs. -29.4 +/- 43.2 mg/dL, P = 0.051), and PPG 2 hr (-59.2 +/- 58.0 mg/dL vs. -43.3 +/- 59.0 mg/dL, P = 0.194) were not significantly different between the mitiglinide and the nateglinide, respectively. Drug-related adverse effects were not different between two groups (16.1% in mitiglinide vs. 27.8% in nateglinide, P = 0.137). The frequency of hypoglycemic events were not different between two groups (8.9% in mitiglinide vs. 14.8% in nateglinide, P = 0.339). There were two patients who had complained shoulder pain in the mitiglinide or deterioration of visual acuity in the nateglinide, but those were found to be unrelated with medications. CONCLUSION: This study showed that mitiglinide had reduced HbA1c as similar to nateglinide and that significantly improved HbA1c, FPG and PPG during 12 weeks of treatment. The safety of mitiglinide was also comparable to nateglinide. Mitiglinide could be used as an effective glucose-lowering agent by enhancing early insulin secretion and reducing postprandial glucose excursion, and thereby might contribute long-term cardioprotective effect in Korean type 2 diabetic patients.

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Monotherapy in Type 2 Diabetes Mellitus Patients 2017: A Position Statement of the Korean Diabetes Association
Sang Youl Rhee
The Journal of Korean Diabetes.2018; 19(1): 15. 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
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

Original Article

The Appropriate Distance and Duration of Walking for Exercise in Patients with Type 2 Diabetes Mellitus.: Tae Seo Sohn, Jung Min Lee, Sang Ah Chang, Kyung Ah Han, Hyun Shik Son, Hyo Jeong Kim, Chul Woo Ahn, Yeon Ah Sung, Kyung Wan Min, Sei Hyun Baik, Jae Myeong Yu, Sung Woo Park; Korean Diabetes J. 2007;31(2):157-162. Published online March 1, 2007; DOI: https://doi.org/10.4093/jkda.2007.31.2.157

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Abstract PDF

BACKGROUND
For decades, exercise has been considered a cornerstone of diabetes managements, along with diet and medication. Many studies have shown that regular physical activity improves quality of life, reduces the risk of mortality from all causes, and is particularly advantageous in subjects with impaired glucose tolerance or type 2 diabetes mellitus. However, high-quality evidence and basic data on the importance of exercise and physical fitness in Korean diabetic patients were lacking until recent years. METHOD: This study included 240 diabetic patients (122 men, 118 women) recruited from 6 diabetic centers in Korea. To measure step length and walking velocity at normal walking speed, we made the patient walk 12 meter at normal speed. The patients wore the pedometer for 7 days and we got the equation between the walking steps per day and calorie expenditure for 7 days. From the equation, we calculated appropriate steps, distance and duration of walking in type 2 diabetic patients as exercise program RESULTS: In men, the walking velocity was 4.4 +/- 0.6 km/h and step length was 67.6 +/- 7.3 cm at normal walking speed. In women, the walking velocity was 4.0 +/- 0.6 km/h and step length was 58.4 +/- 5.5 cm at normal walking speed. The equation between kcal per week and steps per day was that kcal/week = (steps/day) x 0.268 + 64.074 (R2 = 0.854, P < 0.01) in men and kcal/week in women = (steps/day) x 0.256 - 39.005 (R2 = 0.890, P < 0.01). The steps/day, walking distance and walking duration which correspond to 700 kcal/week was 2,373 steps/day, 21.9 minutes and 1,604 meter in men, and 2,887 steps/day, 25.3 minutes and 1,690 meter in women at normal walking speed. CONCLUSION: To exert at least 700 kcal/week with exercise, it is recommended that type 2 diabetic patients walk at least 25 minutes/day or 1,700 meter/day or 2,500 steps/day in men and 30 minutes/day or 1,800 meter/day or 3,000 steps/day in women at normal walking speed.

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Effects of Tai Chi Exercise on Glucose Control, Neuropathy Scores, Balance, and Quality of Life in Patients with Type 2 Diabetes and Neuropathy
Sukhee Ahn, Rhayun Song
The Journal of Alternative and Complementary Medicine.2012; 18(12): 1172. CrossRef
Small Rice Bowl-Based Meal Plan for Energy and Marcronutrient Intake in Korean Men with Type 2 Diabetes: A Pilot Study
Hee Jung Ahn, Kyung Ah Han, Jin Young Jang, Jae Hyuk Lee, Kang Seo Park, Kyung Wan Min
Diabetes & Metabolism Journal.2011; 35(3): 273. CrossRef
Group Classification on Management Behavior of Diabetic Mellitus
Sung-Hong Kang, Soon-Ho Choi
Journal of the Korea Academia-Industrial cooperation Society.2011; 12(2): 765. CrossRef
Bowl-Based Meal Plan versus Food Exchange-Based Meal Plan for Dietary Intake Control in Korean Type 2 Diabetic Patients
Hee-Jung Ahn, Boo-Kyung Koo, Ji-Yeon Jung, Hwi-Ryun Kwon, Hyun-Jin Kim, Kang-Seo Park, Kyung-Ah Han, Kyung-Wan Min
Korean Diabetes Journal.2009; 33(2): 155. CrossRef

Randomized Controlled Trial

Titration with an Initially Lower Dose Increased Compliance of Cilostazol (Pletaal(R)) in Diabetic Patients.: Hyo Jeong Kim, Kyung Ah Han, Hyun Jin Kim, Kang Seo Park, Eung Jin Kim, Kyung Wan Min; Korean Diabetes J. 2006;30(5):388-397. Published online September 1, 2006; DOI: https://doi.org/10.4093/jkda.2006.30.5.388

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Abstract PDF: BACKGROUND
Headache is frequently reported by patients using cilostazol, which is a potent inhibitor of platelet aggregation with vasodilatory effects, for preventing atherosclerotic disease. The aims of this study were to think out a dosing schedule for improving compliance on headache and to investigate the possible mechanisms of headache associated with atherosclerosis measured as carotid intimal-media thickness (IMT) in Korean diabetic patients. METHODS: We therefore randomized patients into three groups according to the different dosing regimens for 6 weeks (1) group 1; 50 mg once daily, followed by 50 mg twice daily, and then 100 mg twice daily or (2) group 2; 50 mg twice daily, followed by 100 mg twice daily or (3) group 3; 100 mg twice daily without titration. We evaluated severity of the headache by visual analog scaled (VAS) symptom score from zero to ten and measured carotid IMT using high resolution ultrasound. RESULTS: A total of 122 diabetic patients were analyzed. The mean values of age, sex, duration of diabetes, BMI, HbA1c, lipid profiles, blood pressure, and smoking were not different among three groups. The proportion of headache was significantly lower in group 1 than group 2 and 3 (26% vs. 48% and 51%, P < 0.05). The proportion of severe headache was significantly lower in group 1 than group 2 and 3 (3% vs. 19% , 27%, P < 0.05). Among patients who had headache, the proportion of severe headache was significantly lower in group 1 than group 3. (10% vs. 52%, P < 0.05). The VAS symptom score of headache was significantly lower in group 1 than group 3 (4.9+/-2.1 vs. 7.0+/-2.4, P < 0.05). The proportion of the discontinuation of medication due to headache was significantly lower in group 1 than other two groups (8% vs. 24% and 29%, P < 0.05). The patients who had discontinued medication due to headache had lower carotid IMT than in whom were tolerable (Mean carotid IMT; 0.65+/-0.12 vs. 0.77+/-0.16 mm, P < 0.01, Maximal carotid IMT; 0.80+/-0.17 vs. 0.94+/-0.23 mm, P < 0.01). The proportion of patients who had discontinued medication due to headache was significantly lower in group 1 than other two groups (8% vs. 24%, 29%, P < 0.05] CONCLUSION: Titration with an initially lower dose of cilostazol could be considered to reduce the proportion and severity of headache and thereby increase compliance. Atherosclerosis estimated as carotid IMT may contribute to the tolerability of cilostazol.

Original Article

Usefulness of Insulin Sensitivity Indexes derived from Oral Glucose Tolerance Test in Women with Polycystic Ovary Syndrome.: Hyo Jeong Kim, Eun Kyung Byun, Jee Young Oh, Yeon Ah Sung, Hye Won Chung; Korean Diabetes J. 2006;30(4):277-284. Published online July 1, 2006; DOI: https://doi.org/10.4093/jkda.2006.30.4.277

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Abstract PDF

BACKGROUND
Insulin resistance is prevalent in women with polycystic ovary syndrome (PCOS), and it makes them to have high risk for development of type 2 diabetes. Evaluation of insulin sensitivity would be important to predict their risks. Although the euglycemic-hyperinsulinemic clamp technique is the gold standard for measuring insulin sensitivity, it is too hard to practice in large epidemiologic studies. The aim of this study is to verify the validity of various insulin sensitivity indexes from oral glucose tolerance test (OGTT) in women with PCOS. METHODS: We performed euglycemic-hyperinsulinemic clamp (target glucose; 90 mg/dL, insulin ;~1 mU/kg.min) to obtain insulin-mediated glucose disposal rate (M-value) in 62 non-diabetic women with PCOS (BMI < 23 kg/m2; n = 37, BMI > or = 23 kg/m2; n = 25). Homeostasis model assessment [HOMA(IR)], quantitative insulin sensitivity check index (QUICKI), glucose to insulin ratio (G/I ratio), whole body insulin sensitivity index [ISI(COMP)], metabolic clearance rate of glucose [MCR(est)-OGTT(1,2)], and insulin sensitivity indexes [ISI(est)-OGTT(1,2)] were calculated from plasma glucose and insulin levels from standard 75-g OGTT. The correlations of various insulin sensitivity indexes from OGTT with M-value were evaluated. RESULTS: In lean women with PCOS (BMI < 23 kg/m2, n = 37), ISI(COMP) (r = 0.36, P < 0.05), MCRest-OGTT1 (r = 0.49, P < 0.01), ISI(est)-OGTT(1) (r = 0.50, P < 0.01), MCR(est)-OGTT(2) (r = 0.45, P < 0.01) and ISI(est)-OGTT(2) (r = 0.40, P < 0.05) were significantly correlated with M-value. In overweight and obese women with PCOS (BMI > or = 23 kg/m2, n = 25), HOMA(IR) (r = -0.40, P < 0.05), QUICKI (r = 0.40, P < 0.05), MCR(est)-OGTT(1) (r = 0.76, P < 0.001), ISI(est)-OGTT(1) (r = 0.63, P < 0.001), MCR(est)-OGTT(2) (r = 0.58, P < 0.01) and ISI(est)-OGTT(2) (r = 0.42, P < 0.05) showed significant correlations with M-value. CONCLUSION: MCR(est)-OGTT(1) and ISI(est)-OGTT(1) were the most reliable and easily accessible insulin sensitivity indexes obtained from OGTT for measuring of insulin sensitivity in women with PCOS regardless of obesity.

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Insulin resistance in a large cohort of women with polycystic ovary syndrome: a comparison between euglycaemic-hyperinsulinaemic clamp and surrogate indexes
Flavia Tosi, Enzo Bonora, Paolo Moghetti
Human Reproduction.2017; 32(12): 2515. CrossRef

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