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Comparison of Insulin-Treated Patients with Ambiguous Diabetes Type with Definite Type 1 and Type 2 Diabetes Mellitus Subjects: A Clinical Perspective
Insa Laspe, Juris J. Meier, Michael A. Nauck
Diabetes Metab J. 2023;47(1):140-146.   Published online March 22, 2022
DOI: https://doi.org/10.4093/dmj.2021.0322
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
In clinical practice, the distinction between type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) can be challenging, leaving patients with “ambiguous” diabetes type. Insulin-treated patients (n=115) previously diagnosed with T2DM had to be re-classified based on clinical phenotype and laboratory results, and were operationally defined as having an ambiguous diabetes type. They were compared against patients with definite T1DM and T2DM regarding 12 clinical and laboratory features typically different between diabetes types. Characteristics of patients with ambiguous diabetes type, representing approximately 6% of all patients with T1DM or T2DM seen at our specialized clinic, fell in between those of patients with definite T1DM and T2DM, both regarding individual features and with respect to a novel classification based on multi-variable regression analysis (P<0.0001). In conclusion, a substantial proportion of diabetes patients in a tertiary care centre presented with an “ambiguous” diabetes type. Their clinical characteristics fall in between those of definite T1DM or T2DM patients.
Original Articles
Complications
Prevalence of Diabetic Retinopathy in Undiagnosed Diabetic Patients: A Nationwide Population-Based Study
Han Na Jang, Min Kyong Moon, Bo Kyung Koo
Diabetes Metab J. 2022;46(4):620-629.   Published online February 23, 2022
DOI: https://doi.org/10.4093/dmj.2021.0099
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  • 217 Download
  • 2 Web of Science
  • 4 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
We investigated the prevalence of diabetic retinopathy (DR) in patients with undiagnosed diabetes through a nationwide survey, compared to those with known diabetes.
Methods
Among the participants of the Korean National Health and Nutrition Examination Surveys (KNHANES) from 2017 to 2018, individuals aged ≥40 years with diabetes and fundus exam results were enrolled. Sampling weights were applied to represent the entire Korean population. Newly detected diabetes patients through KNHANES were classified under “undiagnosed diabetes.”
Results
Among a total of 9,108 participants aged ≥40 years, 951 were selected for analysis. Of them, 31.3% (standard error, ±2.0%) were classified under “undiagnosed diabetes.” The prevalence of DR in patients with known and undiagnosed diabetes was 24.5%±2.0% and 10.7%±2.2%, respectively (P<0.001). The DR prevalence increased with rising glycosylated hemoglobin (HbA1c) levels in patients with known and undiagnosed diabetes (P for trend=0.001 in both). Among those with undiagnosed diabetes, the prevalence of DR was 6.9%±2.1%, 8.0%±3.4%, 5.6%±5.7%, 16.7%±9.4%, and 42.6%±14.8% for HbA1c levels of <7.0%, 7.0%–7.9%, 8.0%–8.9%, 9.0%–9.9%, and ≥10.0% respectively. There was no difference in the prevalence of hypertension, dyslipidemia, hypertriglyceridemia, or obesity according to the presence or absence of DR.
Conclusion
About one-third of patients with diabetes were unaware of their diabetes, and 10% of them have already developed DR. Considering increasing the prevalence of DR according to HbA1c level was found in patients with undiagnosed diabetes like those with known diabetes, screening and early detection of diabetes and DR are important.

Citations

Citations to this article as recorded by  
  • Risk factors of peripheral occlusive arterial disease in patients with diabetic retinopathy due to type 2 diabetes
    Milos Maksimovic
    Srpski arhiv za celokupno lekarstvo.2024; 152(1-2): 50.     CrossRef
  • Gene Expression Analysis in T2DM and Its Associated Microvascular Diabetic Complications: Focus on Risk Factor and RAAS Pathway
    Laxmipriya Jena, Prabhsimran Kaur, Tashvinder Singh, Kangan Sharma, Sushil Kotru, Anjana Munshi
    Molecular Neurobiology.2024;[Epub]     CrossRef
  • Novel Asian-Specific Visceral Adiposity Indices Are Associated with Chronic Kidney Disease in Korean Adults
    Jonghwa Jin, Hyein Woo, Youngeun Jang, Won-Ki Lee, Jung-Guk Kim, In-Kyu Lee, Keun-Gyu Park, Yeon-Kyung Choi
    Diabetes & Metabolism Journal.2023; 47(3): 426.     CrossRef
  • Prevalence of osteosarcopenic obesity and related factors among Iranian older people: Bushehr Elderly Health (BEH) program
    Mozhgan Ahmadinezhad, Mohammad Ali Mansournia, Noushin Fahimfar, Gita Shafiee, Iraj Nabipour, Mahnaz Sanjari, Kazem Khalagi, Mohammad Javad Mansourzadeh, Bagher Larijani, Afshin Ostovar
    Archives of Osteoporosis.2023;[Epub]     CrossRef
Metabolic Risk/Epidemiology
Prevalence of Type 2 Diabetes Mellitus among Korean Children, Adolescents, and Adults Younger than 30 Years: Changes from 2002 to 2016
Yong Hee Hong, In-Hyuk Chung, Kyungdo Han, Sochung Chung, on Behalf of the Taskforce Team of the Obesity Fact Sheet of the Korean Society for the Study of Obesity
Diabetes Metab J. 2022;46(2):297-306.   Published online October 26, 2021
DOI: https://doi.org/10.4093/dmj.2021.0038
  • 9,599 View
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  • 11 Web of Science
  • 14 Crossref
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Despite the importance of and social concern regarding prevention of diabetes at younger ages, limited data are available. This study sought to analyze changes in the prevalence of type 2 diabetes mellitus (T2DM) in Koreans younger than 30 years according to sex, age, and level of income.
Methods
The dataset analyzed in this study was derived from health insurance claims recorded in the National Health Insurance Service (NHIS) database. Participants’ level of income was categorized as low (quintile 1, <20% of insurance premium) or others (quintile 2–5).
Results
In males and females, the prevalence of T2DM per 10,000 people steadily increased from 2.57 in 2002 to 11.41 in 2016, and from 1.96 in 2002 to 8.63 in 2016. The prevalence of T2DM in girls was higher in the age group of 5 to 14 years. Even though the prevalence was higher among those older than 20 years, the increase had started earlier, in the early 2000s, in younger age group. Adolescents aged 10 to 19 years in low-income families showed a remarkable increase in prevalence of T2DM, especially in boys.
Conclusion
The prevalence of T2DM in young Koreans increased more than 4.4-fold from 2002 to 2016, and the increase started in the early 2000s in younger age groups and in low-income families. This is the first study to examine the trend in prevalence of T2DM in children, adolescents, and young adults in Korea. Future studies and collaborations with social support systems to prevent T2DM at an early age group should be performed.

Citations

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  • SCORE and SCORE2 in East Asian Population
    JungMin Choi, Soseul Sung, Sue K. Park, Seyong Park, Hyoyeong Kim, Myeong-Chan Cho, Bryan Williams, Hae-Young Lee
    JACC: Asia.2024; 4(4): 265.     CrossRef
  • Characteristics and management of juvenile type 2 diabetes mellitus
    Young-Jun Rhie
    Journal of the Korean Medical Association.2024; 67(5): 342.     CrossRef
  • Suggestions for the management of pediatric obesity in Korea
    Yong Hee Hong
    Journal of the Korean Medical Association.2024; 67(5): 306.     CrossRef
  • Chronic disease management program applied to type 2 diabetes patients and prevention of diabetic complications: a retrospective cohort study using nationwide data
    Min Kyung Hyun, Jang Won Lee, Seung-Hyun Ko
    BMC Public Health.2023;[Epub]     CrossRef
  • Clinical and pathological characteristics of DKD patients with early-onset type 2 diabetes
    Liang Wu, Yi-Yang Zhao, Meng-Rui Li, Dong-Yuan Chang, Ming-Hui Zhao, Min Chen
    Journal of Diabetes and its Complications.2023; 37(8): 108520.     CrossRef
  • Type 2 Diabetes and Its Association With Psychiatric Disorders in Young Adults in South Korea
    Min-Kyung Lee, Su-Young Lee, Seo-Young Sohn, Jiyeon Ahn, Kyungdo Han, Jae-Hyuk Lee
    JAMA Network Open.2023; 6(6): e2319132.     CrossRef
  • Glycemic control and complications of type 2 diabetes mellitus in children and adolescents during the COVID-19 outbreak
    Kyeong Eun Oh, Yu Jin Kim, Ye Rim Oh, Eungu Kang, Hyo-Kyoung Nam, Young-Jun Rhie, Kee-Hyoung Lee
    Annals of Pediatric Endocrinology & Metabolism.2023; 28(4): 275.     CrossRef
  • Position Statement on the Appropriateness and Significance of Adding the Glycated Hemoglobin Test to the National Health Examination
    Ji Hye Kim, Dae Jung Kim, Jaehyun Kim, Sangjoon Park, Kyunghoon Lee, Jun Goo Kang, Eu Jeong Ku, Su Kyoung Kwon, Won Jun Kim, Young Sang Lyu, Jang Won Son, Young Sil Eom, Kyung Ae Lee, Jeongrim Lee, Jung Min Lee, Jung Hwa Lee, Jung Hwa Jung, Hochan Cho, Da
    The Journal of Korean Diabetes.2023; 24(4): 178.     CrossRef
  • Trends and Risk Factors of Metabolic Syndrome among Korean Adolescents, 2007 to 2018 (Diabetes Metab J 2021;45:880-9)
    Dae Jung Kim
    Diabetes & Metabolism Journal.2022; 46(2): 349.     CrossRef
  • Prevalence trends of type 1 and type 2 diabetes in children and adolescents in North Rhine-Westphalia, the most populous federal state in Germany, 2002-2020
    C. Baechle, A. Stahl-Pehe, N. Prinz, T. Meissner, C. Kamrath, R.W. Holl, J. Rosenbauer
    Diabetes Research and Clinical Practice.2022; 190: 109995.     CrossRef
  • Diagnostic and Therapeutic Strategies of Type 2 Diabetes Mellitus in Youth
    Hwa Young Kim, Jae Hyun Kim
    The Ewha Medical Journal.2022;[Epub]     CrossRef
  • Factors Affecting High-Risk for Diabetes among Korean Adolescents: An Analysis Using the Eighth Korea National Health and Nutrition Examination Survey (2020)
    Kyung-Sook Bang, Sang-Youn Jang, Ji-Hye Choe
    Children.2022; 9(8): 1249.     CrossRef
  • Characteristics of Glycemic Control and Long-Term Complications in Patients with Young-Onset Type 2 Diabetes
    Han-sang Baek, Ji-Yeon Park, Jin Yu, Joonyub Lee, Yeoree Yang, Jeonghoon Ha, Seung Hwan Lee, Jae Hyoung Cho, Dong-Jun Lim, Hun-Sung Kim
    Endocrinology and Metabolism.2022; 37(4): 641.     CrossRef
  • 젊은 2형 당뇨병 환자의 관리
    재현 배
    Public Health Weekly Report.2022; 15(35): 2474.     CrossRef
Type 1 Diabetes
Association between Metabolic Syndrome and Microvascular Complications in Chinese Adults with Type 1 Diabetes Mellitus
Qianwen Huang, Daizhi Yang, Hongrong Deng, Hua Liang, Xueying Zheng, Jinhua Yan, Wen Xu, Xiangwen Liu, Bin Yao, Sihui Luo, Jianping Weng
Diabetes Metab J. 2022;46(1):93-103.   Published online August 31, 2021
DOI: https://doi.org/10.4093/dmj.2020.0240
  • 5,918 View
  • 204 Download
  • 7 Web of Science
  • 8 Crossref
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Both type 1 diabetes mellitus (T1DM) and metabolic syndrome (MetS) are associated with an elevated risk of morbidity and mortality yet with increasing heterogeneity. This study primarily aimed to evaluate the prevalence of MetS among adult patients with T1DM in China and investigate its associated risk factors, and relationship with microvascular complications.
Methods
We included adult patients who had been enrolled in the Guangdong T1DM Translational Medicine Study conducted from June 2010 to June 2015. MetS was defined according to the updated National Cholesterol Education Program criterion. Logistic regression models were used to estimate the odds ratio (OR) for the association between MetS and the risk of diabetic kidney disease (DKD) and diabetic retinopathy (DR).
Results
Among the 569 eligible patients enrolled, the prevalence of MetS was 15.1%. While female gender, longer diabetes duration, higher body mass index, and glycosylated hemoglobin A1c (HbA1c) were risk factors associated with MetS (OR, 2.86, 1.04, 1.14, and 1.23, respectively), received nutrition therapy education was a protective factor (OR, 0.46). After adjustment for gender, age, diabetes duration, HbA1c, socioeconomic and lifestyle variables, MetS status was associated with an increased risk of DKD and DR (OR, 2.14 and 3.72, respectively; both P<0.05).
Conclusion
Although the prevalence of MetS in adult patients with T1DM in China was relatively low, patients with MetS were more likely to have DKD and DR. A comprehensive management including lifestyle modification might reduce their risk of microvascular complications in adults with T1DM.

Citations

Citations to this article as recorded by  
  • Prevalence of Metabolic Syndrome and Its Risk Factors Influence on Microvascular Complications in Patients With Type 1 and Type 2 Diabetes Mellitus
    Asad Riaz, Shoaib Asghar, Salman Shahid, Haider Tanvir, Muhammad Hamza Ejaz, Mamuna Akram
    Cureus.2024;[Epub]     CrossRef
  • Simplified integration of optimal self-management behaviors is associated with improved HbA1c in patients with type 1 diabetes
    C. Deng, Y. Xie, F. Liu, X. Tang, L. Fan, X. Yang, Y. Chen, Z. Zhou, X. Li
    Journal of Endocrinological Investigation.2024;[Epub]     CrossRef
  • Dynamic Changes in Metabolic Status Are Associated With Risk of Ocular Motor Cranial Nerve Palsies
    Daye Diana Choi, Kyung-Ah Park, Kyungdo Han, Sei Yeul Oh
    Journal of Neuro-Ophthalmology.2023;[Epub]     CrossRef
  • Development and validation of an age-sex-ethnicity-specific metabolic syndrome score in the Chinese adults
    Shujuan Yang, Bin Yu, Wanqi Yu, Shaoqing Dai, Chuanteng Feng, Ying Shao, Xing Zhao, Xiaoqing Li, Tianjing He, Peng Jia
    Nature Communications.2023;[Epub]     CrossRef
  • Association of Endotoxemia with Low-Grade Inflammation, Metabolic Syndrome and Distinct Response to Lipopolysaccharide in Type 1 Diabetes
    Aleksejs Fedulovs, Leonora Pahirko, Kaspars Jekabsons, Liga Kunrade, Jānis Valeinis, Una Riekstina, Valdis Pīrāgs, Jelizaveta Sokolovska
    Biomedicines.2023; 11(12): 3269.     CrossRef
  • Association between Metabolic Syndrome and Microvascular Complications in Chinese Adults with Type 1 Diabetes Mellitus (Diabetes Metab J 2022;46:93-103)
    Qianwen Huang, Sihui Luo
    Diabetes & Metabolism Journal.2022; 46(3): 515.     CrossRef
  • Association between Metabolic Syndrome and Microvascular Complications in Chinese Adults with Type 1 Diabetes Mellitus (Diabetes Metab J 2022;46:93-103)
    Gyuri Kim
    Diabetes & Metabolism Journal.2022; 46(3): 512.     CrossRef
  • Metabolic syndrome associated with higher glycemic variability in type 1 diabetes: A multicenter cross-sectional study in china
    Keyu Guo, Liyin Zhang, Jianan Ye, Xiaohong Niu, Hongwei Jiang, Shenglian Gan, Jian Zhou, Lin Yang, Zhiguang Zhou
    Frontiers in Endocrinology.2022;[Epub]     CrossRef
Lifestyle
Persistent Anxiety Is Associated with Higher Glycemia Post-Transition to Adult Services in Asian Young Adults with Diabetes
Ling Zhu, Suresh Rama Chandran, Wee Boon Tan, Xiaohui Xin, Su-Yen Goh, Daphne Su-Lyn Gardner
Diabetes Metab J. 2021;45(1):67-76.   Published online June 15, 2020
DOI: https://doi.org/10.4093/dmj.2019.0226
  • 5,489 View
  • 106 Download
  • 5 Web of Science
  • 6 Crossref
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background

There is little longitudinal information on psychological burden and metabolic outcomes in young adults with diabetes (YAD) in Asia. We aimed to evaluate the association between psychological status and glycemia at baseline and 2 years following transition in a cohort of YAD in Singapore.

Methods

Subjects with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM), aged 17 to 25 years, were recruited from the YAD clinic in Singapore General Hospital. The Hospital Anxiety and Depression and Problem Areas for Diabetes scales were administered at transition (baseline) and at 18 to 24 months. Glycosylated hemoglobin (HbA1c) assessed during routine visits was tracked longitudinally.

Results

A total of 98 T1DM (74.8%) and 33 T2DM (25.2%) subjects were recruited between January 2011 and November 2017. At baseline, mean HbA1c was 8.6%±1.7%. Only 26.0% achieved HbA1c of ≤7.5% and 16.8% achieved HbA1c of <7%. At baseline, prevalence of anxiety was 29.8%. At 24 months, 14.1% had persistent anxiety. Those with persistent anxiety had the highest mean HbA1c, particularly at 6 months (persistently anxious vs. persistently non-anxious: 9.9%±1.2% vs. 8.2%±1.9%, P=0.009). At baseline, 9.2% of subjects had depression. This group also had poorer glycemia at baseline (HbA1c of depressed vs non-depressed: 9.6%±2.1% vs. 8.5%±1.6%, P=0.04), which persisted up to 24 months.

Conclusion

The majority of YAD in Singapore have suboptimal glycemia. Psychological distress is a critical harbinger of poorer metabolic outcomes.

Citations

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  • The Cost-Effectiveness of an Advanced Hybrid Closed-Loop System Compared to Standard Management of Type 1 Diabetes in a Singapore Setting
    Daphne Gardner, Mrinmayee Lakkad, Zhiyu Qiu, Yuta Inoue, Suresh Rama Chandran, Kael Wherry
    Diabetes Technology & Therapeutics.2024; 26(5): 324.     CrossRef
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    Hye-Sun Park, Yongin Cho, Da Hea Seo, Seong Hee Ahn, Seongbin Hong, Young Ju Suh, Suk Chon, Jeong-Taek Woo, Sei Hyun Baik, Kwan Woo Lee, So Hun Kim
    Scientific Reports.2024;[Epub]     CrossRef
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    Grace E. Shearrer
    Brain Sciences.2023; 13(7): 1086.     CrossRef
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    Kelly Ann Kershaw, Ben Storer, Taylor Braund, Cassandra Chakouch, Matthew Coleshill, Sam Haffar, Samuel Harvey, Jill Newby, Gemma Sicouri, Michael Murphy
    Psychoneuroendocrinology.2023; 158: 106357.     CrossRef
  • Increased Levels of Serum Glycosylated Hemoglobin are Associated with Depressive Symptoms in a Population with Cancer (≥49 Years): An Antidepressant-Stratified Analysis
    Ying Huang, Yilin Xu, Anwen Liu
    Clinical Interventions in Aging.2021; Volume 16: 205.     CrossRef
  • The Burden of Type 2 Diabetes and the Value of Achieving Near Normoglycemia from the Patient Perspective
    Heather Gelhorn, Zaneta Balantac, Shraddha Shinde, Vivian Thuyanh Thieu, Kristina S. Boye
    Diabetes Therapy.2021; 12(7): 1821.     CrossRef
Technology/Device
Glutamic Acid Decarboxylase Autoantibody Detection by Electrochemiluminescence Assay Identifies Latent Autoimmune Diabetes in Adults with Poor Islet Function
Yuxiao Zhu, Li Qian, Qing Liu, Jing Zou, Ying Zhou, Tao Yang, Gan Huang, Zhiguang Zhou, Yu Liu
Diabetes Metab J. 2020;44(2):260-266.   Published online November 12, 2019
DOI: https://doi.org/10.4093/dmj.2019.0007
  • 5,551 View
  • 128 Download
  • 12 Web of Science
  • 13 Crossref
AbstractAbstract PDFPubReader   
Background

The detection of glutamic acid decarboxylase 65 (GAD65) autoantibodies is essential for the prediction and diagnosis of latent autoimmune diabetes in adults (LADA). The aim of the current study was to compare a newly developed electrochemiluminescence (ECL)-GAD65 antibody assay with the established radiobinding assay, and to explore whether the new assay could be used to define LADA more precisely.

Methods

Serum samples were harvested from 141 patients with LADA, 95 with type 1 diabetes mellitus, and 99 with type 2 diabetes mellitus, and tested for GAD65 autoantibodies using both the radiobinding assay and ECL assay. A glutamic acid decarboxylase antibodies (GADA) competition assay was also performed to assess antibody affinity. Furthermore, the clinical features of these patients were compared.

Results

Eighty-eight out of 141 serum samples (62.4%) from LADA patients were GAD65 antibody-positive by ECL assay. Compared with ECL-GAD65 antibody-negative patients, ECL-GAD65 antibody-positive patients were leaner (P<0.0001), had poorer β-cell function (P<0.05), and were more likely to have other diabetes-associated autoantibodies. The β-cell function of ECL-GAD65 antibody-positive patients was similar to that of type 1 diabetes mellitus patients, whereas ECL-GAD65 antibody-negative patients were more similar to type 2 diabetes mellitus patients.

Conclusion

Patients with ECL-GAD65 antibody-negative share a similar phenotype with type 2 diabetes mellitus patients, whereas patients with ECL-GAD65 antibody-positive resemble those with type 1 diabetes mellitus. Thus, the detection of GADA using ECL may help to identify the subtype of LADA.

Citations

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  • 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2024
    Nuha A. ElSayed, Grazia Aleppo, Raveendhara R. Bannuru, Dennis Bruemmer, Billy S. Collins, Laya Ekhlaspour, Jason L. Gaglia, Marisa E. Hilliard, Eric L. Johnson, Kamlesh Khunti, Ildiko Lingvay, Glenn Matfin, Rozalina G. McCoy, Mary Lou Perry, Scott J. Pil
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    Xixi Nan, Xia Li, Yufei Xiang, Xiang Yan, Houde Zhou, Xiaohan Tang, Jin Cheng, Xiaohong Niu, Jing Liu, Qiuhe Ji, Linong Ji, Gan Huang, Zhiguang Zhou
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    Xiaofan Jia, Ling He, Dongmei Miao, Kathleen Waugh, Cristy Geno Rasmussen, Fran Dong, Andrea K Steck, Marian Rewers, Liping Yu
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    Lucia Mihaela Custură, Oana Deteşan, Raluca Maria Tilinca, Reka Annamaria Schmiedt, Brigitta Irén Bacso, Mariana Cornelia Tilinca
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    Messripour Manoochehr, Mesripour Azadeh
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Review
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
  • 13,285 View
  • 520 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.

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Original Articles
Epidemiology
Discrepancies between Glycosylated Hemoglobin and Fasting Plasma Glucose for Diagnosing Impaired Fasting Glucose and Diabetes Mellitus in Korean Youth and Young Adults
Jieun Lee, Young Ah Lee, Jae Hyun Kim, Seong Yong Lee, Choong Ho Shin, Sei Won Yang
Diabetes Metab J. 2019;43(2):174-182.   Published online November 2, 2018
DOI: https://doi.org/10.4093/dmj.2018.0046
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  • 9 Web of Science
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AbstractAbstract PDFSupplementary MaterialPubReader   
Background

Glycosylated hemoglobin (HbA1c) has been recommended as a diagnostic test for prediabetes and diabetes. Here, we evaluated the level of agreement between diagnoses based on fasting plasma glucose (FPG) versus HbA1c levels and determined optimal HbA1c cutoff values for these diseases in youth and young adults.

Methods

The study included 7,332 subjects (n=4,129, aged 10 to 19 years in youth group; and n=3,203 aged 20 to 29 years in young adult group) from the 2011 to 2016 Korea National Health and Nutrition Examination Survey. Prediabetes and diabetes were defined as 100 to 125 mg/dL (impaired fasting glucose [IFG]) and ≥126 mg/dL for FPG (diabetes mellitus [DM] by FPG [DMFPG]), and 5.7% to 6.4% and ≥6.5% for HbA1c, respectively.

Results

In the youth group, 32.5% with IFG had an HbA1c level of 5.7% to 6.4%, and 72.2% with DMFPG had an HbA1c ≥6.5%. In the young adult group, 27.5% with IFG had an HbA1c level of 5.7% to 6.4%, and 66.6% with DMFPG had an HbA1c ≥6.5%. Kappa coefficients for agreement between the FPG and HbA1c results were 0.12 for the youth group and 0.19 for the young adult group. In receiver operating characteristic curve analysis, the optimal HbA1c cutoff for IFG and DMFPG were 5.6% and 5.9% in youths and 5.5% and 5.8% in young adults, respectively.

Conclusion

Usefulness of HbA1c for diagnosis of IFG and DMFPG in Koreans aged <30 years remains to be determined due to discrepancies between the results of glucose- and HbA1c-based tests. Additional testing might be warranted at lower HbA1c levels to detect IFG and DMFPG in this age group.

Citations

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Clinical Care/Education
Diabetes Camp as Continuing Education for Diabetes Self-Management in Middle-Aged and Elderly People with Type 2 Diabetes Mellitus
So Young Park, Sun Young Kim, Hye Mi Lee, Kyu Yeon Hur, Jae Hyeon Kim, Moon-Kyu Lee, Kang-Hee Sim, Sang-Man Jin
Diabetes Metab J. 2017;41(2):99-112.   Published online March 3, 2017
DOI: https://doi.org/10.4093/dmj.2017.41.2.99
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AbstractAbstract PDFSupplementary MaterialPubReader   
Background

Despite the established benefits of diabetes camps for the continuing education of children with type 1 diabetes mellitus, little is known about the long-term metabolic benefits of diabetes camps for middle-aged and elderly people with type 2 diabetes mellitus (T2DM), especially in terms of glycosylated hemoglobin (HbA1c) variability.

Methods

The 1-year mean and variability of HbA1c before and after the diabetes camp was compared between the participants of the diabetes camp (n=57; median age 65 years [range, 50 to 86 years]; median diabetes duration 14 years [range, 1 to 48 years]). Additional case-control analysis compared the metabolic outcomes of the participants of the diabetes camp and their propensity score-matched controls who underwent conventional diabetes education (n=93).

Results

The levels of HbA1c during the first year after the diabetes camp were comparable to those of the matched controls (P=0.341). In an analysis of all participants of the diabetes camp, the 1-year mean±standard deviation (SD) of HbA1c decreased (P=0.010 and P=0.041) after the diabetes camp, whereas the adjusted SD and coefficient of variance (CV) of HbA1c did not decrease. The adjusted SD and CV significantly decreased after the diabetes camp in participants whose 1-year mean HbA1c was ≥6.5% before the diabetes camp (n=40) and those with a duration of diabetes less than 15 years (n=32).

Conclusion

The 1-year mean and SD of HbA1c decreased after the diabetes camp, with significant reduction in the adjusted SD and CV in those with higher baseline HbA1c and a shorter duration of diabetes.

Citations

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The Relationship between the Level of Fatness and Fitness during Adolescence and the Risk Factors of Metabolic Disorders in Adulthood
Yoonsuk Jekal, Ji Eun Yun, Sang Wook Park, Sun Ha Jee, Justin Y Jeon
Korean Diabetes J. 2010;34(2):126-134.   Published online April 30, 2010
DOI: https://doi.org/10.4093/kdj.2010.34.2.126
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AbstractAbstract PDFPubReader   
Background

The purpose of the current study was to investigate the association between the level of obesity and physical fitness (PF) during adolescence and the risk factors of metabolic disorders during adulthood.

Methods

In the current analysis, 3,993 Korean adults (mean age, 38.70 ± 1.69 years) were recruited. The level of body index (BI) and PF were examined during adolescence through high school record, and their health examination data, including systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting glucose (FG), total cholesterol (TC), and current body mass index (BMI) were obtained from National Health Insurance Corporation Data. Gender-specific analyses were administered to compare health exam data across the level of BI, the level of PF, and a mixed level of BI and PF.

Results

Most obese males during high school had statistically higher SBP, DBP, FG, and BMI in adulthood, and most obese females had higher BMI, as compared to most lean males or females. Least fit males during high school had statistically higher BMI in adulthood, and least fit females had statistically higher SBP, DBP, FG, TC, and BMI, as compared to most fit males or females. There was a significant relationship between the mixed level of BI and PF and SBP, DBP, TC and current BMI in both genders.

Conclusion

Maintaining a healthy level of body weight and PF during adolescence is recommended to prevent the development of metabolic diseases in adulthood.

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Prevalence of Diabetic Retinopathy in Diabetics Who are Positive for GAD Autoantibody.
Seon Joong Moon, Chan Hee Lee, Jun Sung Moon, Hee Jung Moon, Ji Eun Lee, Kyung Ah Chun, Ji Sung Yoon, Ihn Ho Cho, Kyu Chang Won, Hyoung Woo Lee
Korean Diabetes J. 2007;31(5):429-434.   Published online September 1, 2007
DOI: https://doi.org/10.4093/jkda.2007.31.5.429
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AbstractAbstract PDF
BACKGROUND
Diabetic retinopathy is a leading cause of adult blindness. Some patients show early development and progression of diabetic retinopathy despite of apparently good glycemic control. This is suggesting the involvement of other contributing factors. Recent studies have shown that retinopathy and GAD autoantibody (GADA) show an inverse relationship immunologically. This study is designed to investigate the clinical manifestation of diabetes who are positive for GADA and the relationship between GADA and diabetic retinopathy. METHODS: Type 1 diabetic patients & LADA patients who had visited Yeungnam university Medical Center from 1988 to 2005 were involved. We reviewed the pathologic and laboratory records of these patients and investigated the development of diabetic microvascular complications. RESULTS: Compared with patients who had GADA negative diabetes, patients with GADA positive diabetes had lower prevalence of diabetic retinopathy (GADA negative subject: 25.8% vs. GADA positive subject: 9.6%, P < 0.05). CONCLUSION: We confirmed that diabetic retinopathy and GADA showed an inverse relationship. It seems quite probable that GADA may contribute to the prevention of retinopathy. Further research should be needed concerning the effect of GADA on diabetic retinopathy.

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    Jin Ook Chung, Dong Hyeok Cho, Dong Jin Chung, Min Young Chung
    Korean Diabetes Journal.2009; 33(2): 124.     CrossRef
Clinical Characteristics of Non-obese, Adult-onset Diabetes Requiring Insulin Treatment.
Se Eun Park, Wan Sub Shim, Mi Young Do, Eun Seok Kang, Yumie Rhee, Chul Woo Ahn, Sung Kil Lim, Kyung Rae Kim, Hyun Chul Lee, Bong Soo Cha
Korean Diabetes J. 2005;29(6):557-565.   Published online November 1, 2005
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AbstractAbstract PDF
BACKGROUND
The aim of this study is to clarify the clinical characteristics of non-obese, adult-onset diabetes requiring insulin treatment and to compare the different characteristics of the three groups categorized according to diabetes classification. METHODS: Total 128 diabetic patients who were non-obese (BMI < 25kg/m2) and had been diagnosed with diabetes after 20 years old, requiring insulin treatment were enrolled in the study. We divided the patients into three groups : 56 patients with type 1, 37 with unclassifiable, and 35 with type 2 diabetes. The type of diabetes was assigned by comparing serum C-peptide concentration and clinical phenotypes. RESULTS: Type 2 and unclassifiable diabetes had no differences in BMI, the interval to use insulin, daily insulin dose, the level of HDL cholesterol and the positive rate for GAD Ab, but type 1 diabetes didn't. However, type 1 diabetes and unclassifiable group was lower prevalence of microvascular complications than type 2 diabetes (retinopathy 38.2, 52.8, 84.8 % ; nephropathy 37.7, 36.7, 74.2 % ; neuropathy 36.7, 36.7, 72.7 %, P<0.05). The prevalence of macrovascular complications was higher in the order of type 1, unclassifiable, and type 2 diabetes (11.1, 29.4, 72.7 %, respectively, all P<0.05). CONCLUSION: The clinical characteristics were similar between unclassifiable and type 2 diabetes, but the prevalence of microvascular complication in unclassifiable group had no significant difference compared with type 1 diabetes. The prevalence of macrovascular complications was significantly higher in the order of type 1, unclassifiable, and type 2 diabetes.
Case Report
A Case of Diabetic Ketoacidosis in a GAD Antibody-positive Diabetes Patients who Recently Experienced Hyperglycemic Hyperosmolar State.
Jang Won Son, Seok Hong Lee, Jung Ahn Lee, Jaetaek Kim, Yeon Sahng Oh, Soon Hyun Shinn
Korean Diabetes J. 2005;29(3):267-270.   Published online May 1, 2005
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AbstractAbstract PDF
The term latent autoimmune diabetes in adults(LADA) was introduced to define adult diabetic patients who initially do not require insulin, but they have the immune markers of type 1 diabetes and in a number of cases, these patients progress to insulin dependency. LADA patients have several features of classic type 1 diabetes in addition to islet cell antibody positivity, including high rates of HLA-DR3 and DR4. We describe here a case of a patient with a diagnosis of LADA who, having been diagnosed with type 2 diabetes, was affected with diabetic ketoacidosis. In April 2000, a 65-year-old man was admitted to Chung-Ang University Hospital due to his decreased cognitive ability. The patient was diagnosed with type 2 diabetes 30-years ago and he was diagnosed 6-month ago as being in a hyperglycemic hyperosmolar state. He was positive for antibodies against GAD(anti-GAD, 31U/mL). His weight was 70kg, height 167cm, BMI 25 kg/m2 and the blood pressure was 86/52mmHg. No abnormalities on the physical examination were found. His acid-base balance was pH 6.937, serum bicarbonate 2.2mmol/L and the anion gap 38; he also had a strong positive reaction for ketones in his urine and serum. During half a year, the fasting C-peptide level decreased from 0.65nmol/L to 0.13nmol/L, which means the rapid progression of beta-cell destruction. Intensive treatment of LADA with insulin may improve this type of patients' quality of life, and so potentially save the beta-cell function and perhaps lessening the risk of a hyperglycemic crisis
Original Articles
Self-Management and Health-Related Quality of Life in Adolescent and Adulthood Diabetic Patients.
Bong Suk Park, Gi Nam Jin, Youn Chung Choi, Ji Hee Chung, Kyoung Hoe Kim, Mi Young Lee, Jang Hyun Koh, Choon Hee Chung
Korean Diabetes J. 2005;29(3):254-261.   Published online May 1, 2005
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AbstractAbstract PDF
BACKGROUND
The purposes of this study are to analyze the factors that influence selfmanagement and health-related QOL, and to provide useful informations to improve the QOL in adolescent and adult diabetic patients. METHODS: For this study, we interviewed 126 adolescent and adult diabetic patients who visited the Yonsei University Wonju Christian Hospital from March 4th, 2004 to April 5th, 2004. RESULTS: We examined the relationship between the socio-demographic characteristics and the health-related quality of life(QOL). There were statistically significant relationships between the QOL-and employment, years of education, income level and marriage status, but not between the health-related QOL and age and gender. Furthermore, there were no statistically significant relationships between the health-related QOL and smoking or drinking, nor between type 1 and 2 diabetic patients. The health-related QOL was significantly higher for an increased diabetes duration and for a greater number of symptoms, but the QOL was significantly lower in the presence of complications and hospital admission. The health-related QOL was lower when the preprandial blood glucose levels and HbA1c concentrations were higher, but it was higher when the hemoglobin and hematocrit levels were higher. Regarding the treatment methods, the health-related QOL was significantly lower for those patients who took insulin injection. The QOL was higher when the general self-management and diet therapy were well-controlled. Meanwhile, those subjects who had obtained medical informations from doctors, the media(including the internet and TV) and nurses in that order, they selected diet therapy as the hardest factor in the management of their diabetes. CONCLUSION: Adolescent and adult diabetic patients need continuous education and assistance to improve their health-related QOL and to keep from developing complications
Humoral Immunological Marks in Patients with Child-onset and Adult-onset Type 1 Diabetes.
Hyun Dae Yoon, Jae Hong Kim, Jung Hyun Oh, Jin Chul Park, Sang Yub Nam, Ji Soon Yoon, Kyu Chang Won, In Ho Cho, Choong Ki Lee, Joong Yeol Park, Sung Kwan Hong, Ki Up Lee, Hyoung Woo Lee
Korean Diabetes J. 2000;24(4):444-456.   Published online January 1, 2001
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AbstractAbstract PDF
BACKGROUND
Type 1 diabetes mellitus is an autoimmune disease in which serum antibodies against islet antigens have been recognized. These antibodies include cytoplasmic islet cell antibodies (ICA), and glutamic acid decarboxylase (GAD)65 antibodies and IA2 antibodies. It has been reported that the prevalence of these autoantibodies is different among Caucacian and Asian and Korean type 1 diabetes patients. And the natural course of type 1 diabetes can differ according to the age of onset. But, in contrast to the classic juvenile onset type 1 diabetes, the adult onset type 1 diabetes is poorly characterized about clinical and autoimmune differences at presentation. Thus, this study was perfomed to evaluate clinical and autoimmune characteristics at presentation in subjects with either child onset or adult onset type 1 diabetes and to establish an autoimmune pathogenesis in Korean type 1 diabetes. METHOD: We examined the clinical characteristics of child onset type 1 diabetes (n=32) and adult onset type 1 diabetes (n=40) retrospectively. At the same time, ICA from these patients was measured by standard indirect immunofluorescence, GADA and IA2A from these patients were measured by radioimmunoassay. RESULTS: The mean duration of disease was longer in the adult onset and their serum fasting C-peptide concentration at diagnosis were higer. The prevalence of ICA, GADA, IA2A in sera from 32 patients with child onset type 1 diabetes was 50%, 38% and 31% respectively. And, the prevalence of ICA, GADA and IA2A in sera from 40 patients with adult onset type 1 diabetes was 30%, 25% and 18% respectively.The prevalence of ICA, GADA and IA2A in sera from 39 patients with typical type 1 diabetes was 46%, 30% and 16% respectively. And, the prevalence of ICA, GADA and IA2A in sera from 33 patients with atypical type 1 diabetes was 30%, 30% and 25% respectively. The concordance rate of ICA and GADA in child onset and adult onset diabetes was 81% (26/32), 80% (32/40) respectively. In a subset of these patients with recent onset type 1 diabetes (duration of diabetes < or = 1 year), the prevalence of ICA, GADA and IA2A was 75% (3/4), 75% (3/4), 100% (1/1) respectively, in the child onset type 1 diabetes. CONCLUSION: These observations show that autoantibodies in Korean patients with child onset type 1 diabetes is similar compaired with other Asian groups but is lower than Caucasian patients with type 1 diabetes and the prevalence of humoral immunologic makers in child onset type 1 diabetes was higher than that of adult onset diabetes. These results suggest that autoimmune response is a significant cause of Korean type 1 diabetes but other factors except autoimmunity may play an important role in the pathogenesis of Korean type 1 diabetes.

Diabetes Metab J : Diabetes & Metabolism Journal