Diabetes & Metabolism Journal

Original Articles

Prevalence of Metabolic Syndrome in Type 2 DM Patients with Non-alcoholic Fatty Liver.: Ji Min Kim, Ja Young Park, Hyn Kyung Nam, Ja Won Kim, Su Kyung Park, Kyung Jin Nam, Mi Kyoung Park, Hye Jeong Lee, Duk Kyu Kim; Korean Diabetes J. 2006;30(6):442-449. Published online November 1, 2006; DOI: https://doi.org/10.4093/jkda.2006.30.6.442

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BACKGROUND
Non-alcoholic fatty liver is rendered as one component of metabolic syndrome (MS). We evaluated the prevalence of MS as well as clinical and laboratory characteristics of Type 2 DM patients with non-alcoholic fatty liver. METHODS: Fatty liver group (n = 71) who showed significant fatty change by ultrasonography and age, sex matched control group (n = 40) were studied retrospectively. We compared demographic and laboratory findings and prevalence of MS by modified WHO criteria and new IDF criteria between both groups. RESULTS: There were no significant difference in age, DM duration, BMI, prevalence of hypertension, coronary artery disease, CVA, diabetic retinopathy, neuropathy, nephropathy between both groups. In fatty liver group, the plasma level of FBS, TG, ALT, total protein, albumin and GGT were significantly higher than those of control group (P = 0.033, P = 0.000, P = 0.002, P = 0.008, P = 0.003, P = 0.001). The plasma levels of HDL-C in fatty liver group were significantly lower than those of control group (P = 0.013). The plasma level of FBS, FFA, TG, total protein, albumin, ALT, HOMA(IR) and BMI were significantly related to the severity of fatty liver. The prevalence of MS in fatty liver group was significantly higher than that of control group by modified WHO criteria (P = 0.001) or new IDF criteria (P = 0.036). CONCLUSION: Type 2 DM patients with nonalcoholic fatty liver frequently accompanied the metabolic syndrome. They showed nonspecific changes in the liver function tests.

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Cardio-Metabolic Features of Type 2 Diabetes Subjects Discordant in the Diagnosis of Metabolic Syndrome
Sa Rah Lee, Ying Han, Ja Won Kim, Ja Young Park, Ji Min Kim, Sunghwan Suh, Mi-Kyoung Park, Hye-Jeong Lee, Duk Kyu Kim
Diabetes & Metabolism Journal.2012; 36(5): 357. CrossRef
Metabolic Syndrome and Serum Alanine Aminotransferase Levels in Korean Adults : The Third Korea National Health and Nutrition Examination Survey (KNHANES III), 2005.
Mi Ah Han, So Yeon Ryu, Jong Park, Myung Geun Kang, Ki Soon Kim
Korean Journal of Epidemiology.2008; 30(1): 25. CrossRef

The Influence of Metabolic Syndrome on the Intima-Medial Thickness and Cardiovascular Risk Factors in Type 2 Diabetes.: Kwang Pyo Son, Young Je Chae, Tae Yu Lee, In Kyung Jeong, Mina Hur, Gu Young Jo, Young Lee, Seong Jin Lee, Chul Young Park, Ki Won Oh, Eon Kyung Hong, Hyun Kyu Kim, Jae Myoung Yu, Doo Man Kim, Sung Hee Lim, Moon Ki Choi, Hyung Jun Yoo, Sung Woo Park; Korean Diabetes J. 2004;28(5):392-406. Published online October 1, 2004

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Abstract PDF: BACKGROUND
Metabolic syndrome (MS) is usually present in type 2 DM (T2DM), and it is associated with atherosclerosis. The aim of this study is to exam the influence of MS on the intima-medial thickness(IMT) and the cardiovascular risk factors for type 2 diabetic patients. SUBJECTS AND METHODS: A cross sectional study was performed on 82 patients with Type 2 diabetes mellitus (DM) and 84 healthy controls. MS was defined according to the NCEP-ATP III criteria. Those subjects with any history of cerebro vascular accident, ischemic heart disease or acute inflammation were excluded. The cardiovascular risk factors (hsCRP, lipid profile, homocysteine, and uric acid), the status of glucose metabolism (HbA1c, fasting glucose, insulin, and HOMA-IR), the diabetic microvascular complications and the IMT at both common carotid arteries were measured. RESULTS: 1) For patients with T2DM, the levels of waist circumference, blood pressure, TG (1.7+/-1.4 vs 2.2+/-1.4 mmol/L), HDL-C (1.5+/-0.4 vs. 1.3+/-0.3 mmol/L), LDL-C (2.7+/-0.7 vs 3.1+/-0.9 mmol/L), TC/HDL-C (3.5 vs. 41), log of (hsCRP) (-0.11+/-0.4 vs 0.17+/-0.4), mean carotid IMT (0.63+/-0.12 vs. 0.74+/-0.12 mm) and max IMT (0.68+/-0.14 vs. 0.86+/-0.15 mm) were significantly different from the healthy control group. 2) The prevalence of MS in the T2DM groups was 64%. However, a decrease of the waist circumference, as measured by the modified Asian criteria, increased the crude prevalence of MS by up to 75%. 3) Diabetic patients with MS had a higher incidence of hypertension, a lower level of HDL-C, and higher levels of waist circumference, HOMA-IR, TG, and TC/HDL-C, a greater extent of microvasculopathy, an increased log (hsCRP), homocysteine, and carotid IMT than did diabetic patients without MS. 4) Among the component of MS, the presence of hypertriglyceridemia had an influence on the IMT mean and max. 5) The carotid IMT of patients with DM correlated with age, homocysteine, log (hsCRP), and uric acid on univariate analysis, and age and homocysteine we found to be independent risk factors of carotid IMT on multivariated analysis. CONCLUSION: Metabolic syndrome in subjects with glucose intolerance increases the risk of atherosclerosis.

Evaluation of Glycemic Control in Type 2 Diabetic Patients have been Treated in General Hospital.: Joung Ho Park, Kwan Woo Kim, Eun Jin Kang, Tak Young Kim, Sa Ra Lee, Su Chan Bae, Mi Kyung Kim, Sin Yeong Choi, Jeong Hyun Park; Korean Diabetes J. 2004;28(3):208-218. Published online June 1, 2004

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Abstract PDF: BACKGROUND
Good metabolic control is one of the most important parts of managing diabetes. Several studies in western countries have shown glycemic control in type 2 diabetic patients to be poorer than expected. Similar reports in Korea are very limited. Therefore, this study was performed to estimate the degree in glycemic control of type 2 diabetic patients that have been treated in general hospitals in Korea. METHODS: This was a cross-sectional retrospective study conducted on 1012 type 2 diabetic patients treated at the Maryknoll Hospital. Subjects with type 1 diabetes or a treatment duration of less than 6 month were excluded. The glycemic control was estimated by HbA1c and the clinical characteristics, including duration of diabetes, age, height and body weight, checked. The treatment methods were divided into four groups, namely diet, oral hypoglycemic agent, insulin alone, and insulin and oral hypoglycemic agent combination. Data were analyzedsed by SPSS version 11.0. RESULTS: The mean age, BMI, duration of diabetes and HbA1c of the subjects were 61.6+/-9.8 years, 24.6+/-3.2kg/m(2), 12.1+/-6.5 year and 7.6+/-1.3%, respectively, and the percentage of those achieving the goal of glycemic control(HbA1c<7%) was 35.7%. Those who achieved glycemic control were older than those who could not and also had a shorter duration of diabetes(p<0.001). There were no significant differences in the BMI, gender and HbA1c levels before treatment between the four groups. The subjects on diet treatment had a lower mean HbA1c level than those on insulin alone or combined therapy(p<0.05) CONCLUSION: The percentage of type 2 diabetic patients in good glycemic control in our general hospital was less than 40%, which was similar to previous western data. It is our suggestion that a large nationwide study is required to more accurately evaluate the state of glycemic control and find the reasons why certain patients could not reach this goal.

Change of Cardiac Function and NT-proBNP According to Degree of Albuminuria in Type 2 Diabetic Patients.: Bon Jeong Ku, Jeong Hee Kim, Jin Ok Jeong, Eun Seok Jeon, Dong Hyun Seo, Jae Min Lee, Si Wan Choi, In Whan Seong, Young Kun Kim; Korean Diabetes J. 2004;28(1):28-35. Published online February 1, 2004

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Abstract PDF: BACKGROUND
The prevalence of diabetes mellitus has increased recently. The morbidity and mortality of diabetic patients are mainly caused by chronic complications, especially cardiovascular events. N-terminal proB-type natriuretic peptide(NT-proBNP) is a neurohormone that is secreted from ventricular myocardium due to myocardial dilatation or pressure overload. NT-proBNP has prognostic value, and reflects cardiac function in patients with myocardial infarction or heart failure. This study was performed to evaluate functional changes of the heart, according to the degree of albuminuria and the prognostic value of NT-proBNP in type 2 diabetic patients. METHODS: 57 patients with type 2 diabetes were divided into three groups according to their degree of albuminuria, these being normal(below 30mg/day), microalbuminuria(30 between 300mg/day) and overt proteinuria(over 300mg/ day). The clinical parameters in each of the patients were evaluated, echocardiography performed and the levels of NT-proBNP checked, and compared between the three groups. RESULTS: Of the 57 patients with type 2 diabetes the male:female ratio of 32:25, with mean age, duration of diabetes and BMI of 55.8+/-10.1 and 11.3+/-8.2 years, and 23.2+/-4.0kg/m2, respectively. Twenty-eight patients showed normal(49.1%), 15 microalbuminuria(26.3%) and 14 overt proteinuria(24.6%). The age, BMI, diastolic BP and glycosylated hemoglobin showed no significant difference between the three groups. The duration of diagnosed diabetes was significantly longer, the systolic blood pressure and serum creatinine levels significantly higher and the serum hemoglobin significantly lower (p<0.05) in the overt proteinuria compared to the normal group. The duration of diabetes was significantly longer and serum creatinine levels significantly higher in the overt proteinuria than the microalbuminuria group(p<0.05). The echocardiographic data showed no difference among the groups. The NT-proBNP levels also showed no significant difference, but tended to be elevated toward albuminuria. CONCLUSION: The cardiac function and NT-proBNP levels showed no significant difference between each of the albuminuric groups. This study suggests that the degree of albuminuria is not a predictive factor for changes of the cardiac function and NT-proBNP levels

The Effect of Alpha-lipoic Acid on Endothelial Dysfunction in Postmenopausal Uncomplicated Type 2 Diabetes.: Ho Chan Cho, Sang Jun Lee, Mi Jung Kim, Hye Sun Kim, Tae Sung Yun, Sung Jae Kim, Sang Hyon Kim, Seung Ho Hur, Kyo Chul Moon, Jae Hoon Bae, In Kyu Lee; Korean Diabetes J. 2002;26(4):242-252. Published online August 1, 2002

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Abstract PDF: BACKGROUND
Recently, increased oxidative stress has been proposed as a major cause of vascular complications of patients with diabetes mellitus. Increased generation of oxygen free radicals in patients with diabetes mellitus could deplete cellular antioxidants and inactivate endothelial dependent vasodilating factor (EDRF), such as nitric oxide (NO). The purpose of this study was to evaluate whether the antioxidant alpha-lipoic acid (ALA) is effective in endothelial dysfunction of brachial artery, which induced by increased oxidative stress in postmenopausal diabetic women using high resolution ultrasound technique and initial reaction time (IRT) measurement. METHODS: We enrolled 11 menopausal women (mean age, 56.5+/-5.1 years) with uncomplicated type 2 diabetes. All patients were taking 1200 mg of ALA (Thioctacid(R), Bukwang, Korea). We measured of superoxide anion (O2-) in neutrophils as a marker of oxidative stress. Flow-mediated dilation (FMD) was measured using a high-resolution ultrasound. RESULTS: After treatment of ALA, fasting blood glucose was decreased significantly, the endothelium-dependent vasodilation of the brachial artery was increased, and O2- production was also decreased significantly. CONCLUSION: These results show that short term ALA treatment could improve the endothelial dysfunction in patients with type 2 diabetes mellitus. This improvement might be related with the antioxidants effect of ALA.

Free Testosterone and Sex Hormone-Binding Globulin Level in Type 2 Diabetic Men.: Ki Deuk Nam, Young Seol Kim, Cheol Young Park, Seung Joon Oh, Deog Yoon Kim, Jeong Taek Woo, Sung Woon Kim, In Myung Yang, Jin Woo Kim, Young Kil Choi; Korean Diabetes J. 2000;24(6):699-707. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Insulin resistance is a risk factor for cardiovascular disease and type 2 diabetes mellitus. There are many previous studies indicating that insulin lowers serum sex hormone-binding globulin levels, and there is inverse correlation between insulin resistance and serum sex hormone-binding globulin levels in women. However, in men, a limited number of studies are available to explain the effect of sex hormone on age and insulin. Therefore, the present study was undertaken to investigate the relationship among free testosterone, hormone- binding globulin and age in type 2 diabetic men and control subjects. METHOD: Age, body mass index, total cholesterol, triglyceride, fasting blood sugar, and insulin concentrations were examined on 89 type 2 diabetic men and 47 control subjects. The free testosterone level was measured by commercially available double-antibody system (Radioimmunoassay). The sex hormone-binding globulin level was also measured by commercially available double-antibody system(Immunoradiometric assay). RESULTS: 1) Sex hormone-binding globulin level was significantly increased in patients with type 2 diabetes. However, there was no significant difference in free testosterone level between the two groups. 2) Sex hormone-binding globulin was positively correlated with age (r=0.4, p<0.001) in patients with type 2 diabetes. Sex hormone-binding globulin and free testos terone were not correlated with age in control sujects. 3) Free testosterone and sex hormone-binding globulin concentrations were not significantly related to serum insulin concentration after adjusting for age and body mass index. CONCLUSIONS: We observed increased sex hormone-binding globulin concentration in diabetes man, and was a positively related to age. Further studies are needed to understand the relationships between age, insulin resistance, testosterone, and sex hormone-binding globulin concentrations.

The Comparison between Doppler Ultrasonography and Digital Infrared Thermographic Imaging (DITI) in Detecting the Diabetic Peripheral Angiopathy.: Yoon Sang Choi, Hyun Ju Um, Seung Oh Song, Si Yong Kim, Byong Ik Kim, Young Uk Lee, Seok Won Park, Yoo Lee Kim, Hwa Young Lee, Yong Wook Cho, Sang Jong Lee; Korean Diabetes J. 1999;23(5):686-694. Published online January 1, 2001

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Abstract PDF: BACKGROUND
The frequency of nontraumatic lower extremities amputation has significantly increased in patients with type 2 diabetes (DM). Digital Infrared Thermographic (DITI) has been used to demonstrate the skin temperature and its change. mellitus Imaging regional Doppler ultrasonography was developed to show excellent images of superficial arteries. In this study, we observed the relationship between DITI and doppler ultrasonography for detection or evaluation of diabetic peripheral angiopathy. METHODS: 71 patients with type 2 DM were divided to groups with and without peripheral arterial obliteration (PAO) by ankle pressure index (API). For all patients, doppler ultrasonography of lower extremities was performed in measuring inner diameter, wall thickness and calcification of femoral, popliteal and dorsalis pedis artery. DITI was done also. We analized the result of doppler ultrasono-graphy and DITI findings. RESULT: 1) In clinical characteristics of patients between nonperipheral arterial obliteration (NPAO) and PAO : there was no significant differences between two groups with respect to age, sex, smoking, BMI (body mass index), FPG (fasting plasma glucose)/2HPG (2 hour plasma glucose), HbA(1C), serum lipid profile and/or the frequency of NPDR (nonproliferative diabetic retinopathy). However, the number of patients with hypertension and 24hr urine total protein amount were significantly increased in PAO group. 2) The results of doppler ultrasonographic imaging of lower extremities: In PAO group, inner diameters of common femoral artery and dorsalis pedis artery were significantly narrower than in those of NPAO group. However, no difference was detected in respect to vessel wall thickness. The numbers of calcified vessel wall have significantly increased in all vessels in PAO group 3) The results of DITI patterns of big toes after cold stimulus: (1) In 49 patients with NPAO: 11 showed as normal, 14 an increased, 15 a decreased, and 9 flat patterns, respectively. (2) All of 22 patients with PAO showed abnormal patterns. Among them, 2 showed a decreased, but 20 a flat pattern. 4) The comparison between the results of doppler ultrasonography and DITI: In all groups, inner diameter of common femoral artery, which was measured by doppler ultrasonography, were narrow in the flat pattern. Also, the number of calcified vessel walls in common femoral artery and dorsalis pedis artery increased more in the same patterns. No significant difference of vessel wall thickness was found between both groups. CONCLUSION : Vasoreaction of lower extremities after cold stimulus was mainly related to PAO of the common femoral artery and dorsalis pedis artery. DITI is a useful method used in detecting the early state of artherosclerosis. As a result, it can be employed in early prevention and treatment of diabetic angiopathy. If DITI is combined with doppler ultrasonography, we can practice more precise diagnosis and follow-up in diabetic peripheral angiopathy.

The Relation of Carotid Arterial Plaque to Apolipoprotein E Polymorphism in Subjects with Type 2 Diabetes Mellitus.: Seung Hyun Lee, Chi Young Moon, Jeong Ki Choi, Kyoung Deok Shin, Hyun Kag Kim, Wan Hee Yoo, Tae Sun Park, Hong Sun Baek, Dal Sik Kim; Korean Diabetes J. 1999;23(5):678-685. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Apolipoproiein (Apo E) is one of the major proteins involved in catabolism of triglyceride (TG)-rich lipoproteins. Apo E poly-morphism contributes to the variation in plasma cholesterol levels and may influence the risk of atherosclerosis. This study was undertaken to know whether apo E polymorphism is associated with carotid artery intima, media thickness and plaque formation in type 2 diabetic patients. METHODS: We determined the apo E genotypes of 130 type 2 diabetic patients by modified Amplification Refractory Mutation System (ARMS) and classified all patients into E2, E3, E4 subgroups. The carotid artery IMT and plaque formation were determined with B-mode ultrasonography. RESULT: The apo E allele frequency of patients were E2 11.5%, E3 76.2%, FA 12.3% (p=0.0001). LDL-cholesterol levels were higher in patients with E4 allele, and HDL-cholesterol levels were lower in patients with FA allele than in patients with E2, E3 subgroups. The patients with carotid artery plaque have more E4 alleles in comparison to the patients without it(p=0.0001). FA allele group has higher carotid IMT than E2 and E3 allele groups (p=0.013). CONCLUSIONS: Apo E polymorphism is associated with carotid artery IMT and plaque formation in type 2 diabetic patients. Patients with E4 isoform is more likely to develop the atherosclerosis, carotid and coronary artery diseases than other apo E isoforms.

Serum Levels of Sialic acid, CRP, and TNF-a in Type 2 Diabetin Patients with Syndrome X.: Dong Seop Choi, Sang Jin Kim, Se Hyeon Paek, Kyung Mook Choi, Nan Hee Kim, Jung Heon Oh, Young Hyun Kim; Korean Diabetes J. 1999;23(3):307-314. Published online January 1, 2001

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Abstract PDF: diabetic nephropathy and macro- vascular complications. Thus it is possible to conBACKGROUND: Type 2 diabetes is associated with increased blood concentrations of acute phase reactants including; sialic acid, ai-acid glycoprotein, serum amyloid A, and the main cytokine mediator of acute phase response, interleukin-6. Through the action of cytokines on many tissues, acute phase response could be a major contributor of biochemical and clinical features of metabolic syndrome X and type 2 DM. We investigated whether sialic acid, CRP, and TNF-a levels were elevated in type 2 diabetic patients who had features of syndrome X and whether they were correlated with diabetic vascular complications. METHODS: Group 1 was type 2 diabetic patients with any of 4 or 5 features of syndrome X (n=24). Group 2 was type 2 diabetic patients with 0 or 1 features of syndrome X (n=29), and group 3 was healthy nondiabetic control subjects (n=19). We compared the levels of sialic acid, CRP, and TNF-a in group 1, 2 and 3. We also observed the relationship between sialic acid, CRP, TNF-a levels and diabetic micro, macrovascular complications and studied the correlation between these markers and components of syndrome X. RESULTS: Group 1 had significantly higher sialic acid levels than group 2 (68.3+19 vs. 59.9+9.7 mg/dL, p=0.047). But the CRP, and TNF-a levels were similar in three groups. Serum sialic acid levels were signifieantly higher in proteinuria group than in normo- and microalbuminuria groups (81+27.6 vs. 59.9+7.1, 61.2+7.9 mg/dL, p=0.001, 0.005). Serum CRP levels were also higher in proteinuria groups (32.9+59.8 vs. 6.4+1.9, 6.0+3.1mg/L, p=0.017, p=0.037). Serum sialic acid levels were significantly higher in the macrovascular complication group (70.5 +21.3 vs. 60.5+ 6.8 mg/dL, p=0.015). Levels of sialic acid were correlated with urinary albumin excretion rate, log triglyceride, CRP, and fasting C-peptide. Levels of CRP were correlated with sialic acid and fasting C-peptide. CONCLUSION: Serum sialic acid levels were significantly elevated in type 2 diabetic patients who had features of syndrome X, and were also elevated in patients with sider that the mechanisms involved in the acute phase response can contribute to the pathophysiology of type 2 diabetes and syndrome X. Vascular complications do further increase stress reactions in type 2 diabetes.

Serum Levels of Transforming Growth Factor ( TGF ) -beta1 in Type 2 Diabetic Patients.: Nan Hee Kim, Jung Heon Oh, Young Hyun Kim, Ie Byung Park, Sang Jin Kim, Sei Hyun Baik, Dong Seop Choi; Korean Diabetes J. 1998;22(4):522-530. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Transforming growth factor(TGF)-Bl is a potent inducer of extracellular matrix production and of fibrogenesis and has been associated wnh the occurrence of diabetic complications. Our aim was to determine whether circulating levels of TGF-gl are altered in type 2 DM and, if so, whether they are correlated with blorxi glucose levels and show an association with diabetic complications. METHOD: Serum levels of TGF-gl were measured by quantitative sandwitch enzyme immunoassay in 76 type 2 DM patients and were correlated with clinical and biochemical parameters and the presence of diabetic complications. Result: 1) Serum TGF-B1 levels were correlated with fasting blood glucose levels (r=0.30, p=0.007) and inversely correlated with duration of diabetes (r=-0.31, p=0.007), BUN (r=-0.31, p=0.034), and creatinine (r=-0.40, p=0.004). In linear logistic regression analysis, duration of diabetes and HbA 1C <- were independently related to serum TGF-B1 levels. 2) Serum levels of TGF-B1 were significantly decreased in proteinuria group (n=23) than in normoalbuminuria group (n=26) (69.5+27.5 vs 85.7 +23 ng/mL, p=0.022). TGF-B1 concentrations were inversely correlated with serum creatinine and age in normoalbuminuria group (r=-0.40, p

The Role of Insulin Secretion and Insulin Resistance in the Development of Korean Type 2 Diabetes Mellitus.: Bong Nam Chae, Seong Kyu Lee, Eun Gyoung Hong, Yoon Sok Chung, Kwan Woo Lee, Hyeon Man Kim; Korean Diabetes J. 1998;22(4):491-503. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Impaired insulin secretinn, peripheral insulin resistance, a disproportionately elevated rate of hepatic glucose production and influence of inherited or enviromental factors contribute to the pathogenesis of type 2 diabetes mellitus(DM). But, which defect is primary is still controversial To determine whether insulin resistance or insulin deficiency is primary in the pathogenesis of type 2 DM, we studied normal glucose tolerant offsprings of type 2 diabetic patients. METHODS: 22 offsprings of type 2 diabetic patients with normal glucose tolerance, ranging in age from 20 to 40 years, and 17 control subjects in same age range who had no family history of diabetes, and 21 diabetic subjects were included. We performed 75 g oral glucose tolerance test, euglycemic hyper-insulinemic clamp test and hyperglycemic clamp test. RESULTS: With euglycemic clamp test, the values of peripheral insulin sensitivity, M, were 8.59+0.94 mg/kg/min in control group, 6.98+0.65 mg/kg/min in offspring group, and 5.19+0.89 mg/kg/min in diabetes group (P<0.05). Considering that lower limit of the normal range were 3.78 mg/kg/min in M and 3.10 mg/kg/min in M/I, the frequency of insulin resistance was 14.3% in the offspring group and 33.3 % in diabetes group. First and second phase insulin secretion during hyperglycemic clamp test were blunted in diabetes group. In the offspring group, first and second phase insulin secretion during hyperglycemic clamp test were increased greater than control group, though statistically insignificant. The mean first phase insulin secretion were 38.55+6.81 pU/mL in control group, 55.09+9.40 pU/mL in the offspring group and 6.02+0.98 pU/mL in diabetes group (P<0.05). The mean second phase insulin secretion were 65.11+15.5 pU/mL in control group, 90.25 + 11.9 pU/mL in the offspring group and 17.6 +2.71 pUmL in diabetes group(P<0,05). Considering that lower limit of the normal range were 19.5 pU/mL in the first phase insulin secretion and 26.1 pU/mL in the second phase insulin secretion, the frequency of impaired insulin secretion was 14.3 % in the offspring group and 100 % in diabetes group. There was an inverse relation between insulin resistance and insulin secretion in control subjects. But in the offspring group, this relation was absent. CONCLUSION: Our results show that both insulin resistance and impaired insulin secretion contribute to the development of type 2. DM in Koreans. In addifion, diabetic subjects had more severe impairment in insulin secretory capacity than insulin resistance.

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