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ABSTRACT: AIM: To investigate the relationship between small dense LDL cholesterol and cardiac autonomic neuropathy among patients with Type 2 diabetes. METHODS: A total of 175 patients who had not taken lipid-lowering agents previously were enrolled consecutively in this study. Small dense LDL cholesterol level was measured using polyacrylamide tube gel electrophoresis, which fractionates LDL cholesterol into seven components according to particle size and charge. We analysed the mean LDL cholesterol particle size and the proportion of small dense LDL cholesterol. RESULTS: The mean (± sd) patient age was 56 (± 14) years, the mean (± sd) duration of diabetes was 10.3(± 8.3) years, the mean (± sd) proportion of small dense LDL cholesterol was 21.3 (± 17.6)% and the mean (± sd) LDL cholesterol size was 26.33 (± 0.8) nm. Men with cardiac autonomic neuropathy had a longer duration of diabetes compared with those without cardiac autonomic neuropathy. Women with cardiac autonomic neuropathy had a larger waist circumference, higher plasma triglyceride levels, smaller mean (± sd) LDL cholesterol size [26.8 (± 4.3) nm vs 26.4 (± 6.9) nm; P <0.01] and larger mean (± sd) proportion of small dense LDL cholesterol [10.1 (± 9.9)% vs 19.1 (± 16.8)%; P <0.01] compared with those without cardiac autonomic neuropathy. After adjusting for other confounding risk factors, the triglyceride/ HDL cholesterol ratio (odds ratio = 1.698, 95% CI: 1.07-2.69; P = 0.025) and mean LDL cholesterol size (odds ratio = 0.873, 95% CI: 0.77-0.99; P = 0.038) remained as independent risk factors for cardiac autonomic neuropathy in women. CONCLUSIONS: A more atherogenic lipid profile such as the triglyceride: HDL cholesterol ratio and a smaller mean LDL cholesterol particle size were related to the prevalence of cardiac autonomic neuropathy in women with Type 2 diabetes. © 2013 The Authors. Diabetic Medicine © 2013 Diabetes UK.
Diabetic Medicine 03/2013; · 2.90 Impact Factor
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ABSTRACT: Recent studies suggest an association of vitamin D with obesity, diabetes and cardiovascular diseases. We analyzed the association of serum vitamin D level assessed by 25-hydroxyvitamin D(3) {25(OH)D(3)} with nonalcoholic fatty liver disease (NAFLD) in apparently healthy men. We performed a cross-sectional study of 6,567 Korean men who participated in a health screening program, evaluating the association of serum 25(OH)D(3) levels with the risk of NAFLD assessed by abdominal ultrasonogram. Of the participants, 43.6% had NAFLD and 21.1% had metabolic syndrome. Age, serum calcium, and aspartate aminotransferase levels showed weak but significant positive correlations with 25(OH)D(3) level; total cholesterol, triglycerides, low-density lipoprotein cholesterol and fasting insulin level showed weak but significant negative correlations with 25(OH)D(3) level. The mean 25(OH)D(3) level was significantly lower in participants with NAFLD than in those without (38.7 ± 9.0 vs. 39.7 ± 9.7 nmol/L, p < 0.001). When participants were divided into tertiles based on mean 25(OH)D(3) level, the proportion with NAFLD significantly increased as mean 25(OH)D(3) level decreased (40.0, 45.0 and 45.9%, p for linear trend < 0.001). Multiple logistic regression analyses with NAFLD as the dependent variable showed that the tertiles with lower 25(OH)D(3) levels had a significantly increased risk for NAFLD compared with the highest tertile, even after adjusting for body mass index and metabolic syndrome (OR 1.247 and 1.408 vs. the highest tertile, p < 0.001). Thus, participants with higher serum 25(OH)D(3) showed a significantly reduced risk for NAFLD compared with the low 25(OH)D(3) groups, independent of obesity and metabolic syndrome.
Endocrine Journal 02/2013; · 2.03 Impact Factor
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ABSTRACT: BACKGROUND: A better way to define obesity is in terms of the percentage of body fat (BF). Subjects with normal weight, but excess BF are vulnerable to cardiovascular diseases. OBJECTIVE: To evaluate the prevalence and characteristics of subjects having normal-weight obesity (NWO) by using optimal cutoffs of the BF percentage reflecting risk factors for cardiovascular disease (CVD) in Korean adults. DESIGN AND SETTING: The Korea National Health and Nutrition Examination Survey in the Korean population conducted in 2009-2010. PARTICIPANTS: We surveyed 5,313 men and 6,904 women aged 20 years or older. MEASUREMENTS: We investigated the relations between the BF percentage (measured by dual-energy X-ray absorptiometry) and obesity-related risk factors for CVD (diabetes mellitus, hypertension and dyslipidemia) in Korean adults. NWO was defined as the combination of a normal BMI (18.5-22.9 kg/m(2) in Asian subjects) and BF percentages above the determined cutoff values. RESULTS: There were strong and graded associations of increasing BF percentages with the prevalence of CVD risk factors. The first cutoff values (defined as being overweight) in men and women were 20.6% and 33.4% BF, respectively, and the second cutoff values (defined as obesity) were 25.7% and 36.0% BF. Thirty-two percent of normal-weight adults had BF percentages greater than or equal to the overweight or obesity cutoffs (NWO). Subjects with NWO had a lower appendicular skeletal muscle mass, a more atherogenic lipid profile and greater insulin resistance. CONCLUSIONS: Obesity can be defined as 26% BF or greater in Korean men and 36% BF or greater in Korean women. There was a high prevalence of clustering of cardiometabolic abnormalities among subjects with NWO. © 2013 Blackwell Publishing Ltd.
Clinical Endocrinology 01/2013; · 3.17 Impact Factor
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ABSTRACT: Recent data suggest that variations in calcium intake may influence body weight and composition; however, the relationship between daily calcium intake and muscle mass has not been well established. The objective of this study was to assess the relationship between daily calcium intake and sarcopenia. We analyzed data for older adults (over 60 years) from the fourth Korea National Health and Nutrition Examination Survey (KNHANES) conducted in 2009. A total of 1339 Non-Obese (BMI between 18.5 and 25 kg/m(2)), older adults (592 men and 707 women) were enrolled. Dietary variables were assessed using a nutrition survey that used a 24-hour recall method. Daily calcium intake based on the consumption of each food item was calculated. Sarcopenia was defined as an appendicular skeletal muscle mass divided by body weight less than 2 SD below the sex-specific mean for young adults. We found that daily calcium intake was negatively correlated with total body fat percentage and positively correlated with appendicular skeletal mass (p<0.001). Participants with sarcopenia appear to have significantly lower daily calcium intakes than participants without sarcopenia (p<0.001). The unadjusted prevalence of sarcopenia according to daily calcium intake tertiles were 6.3%, 4.3%, and 2.7% in tertiles 1, 2, and 3, respectively. After adjustment for age, sex, BMI, total energy intake, and lifestyle factors, compared with those in the lowest tertile of daily calcium intake, participants in the highest tertile had an odds ratio for sarcopenia of 0.295 (95% confidence interval, 0.087-0.768; p for trend = 0.014). We found that daily calcium intake, corrected for total energy intake and serum 25(OH)D status, was significantly lower in subjects with sarcopenia than in those without. Our results suggest a strong inverse association between daily calcium intake and sarcopenia in non-obese, older Korean adults.
Endocrine Journal 01/2013; · 2.03 Impact Factor
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ABSTRACT: Some papers have suggested that alkaline phosphatase (ALP) level is a predictor of the metabolic syndrome (MetS) in the general population. However, the association is still controversial, and the mechanisms underlying an association between ALP level and the MetS have not been elucidated. We analyzed the association between serum ALP level and the development of the MetS over a 4-year period. A total of 14,224 subjects who visited the Health Promotion Center for a medical examination in 2005 were followed up after 4 years. Serum ALP level correlated positively with body fat mass and visceral fat mass. The adjusted geometric mean ALP levels were higher in subjects with elevated C-reactive protein level or greater fat mass (P < 0.001). None of the subjects had the MetS at baseline, but 1,179 exhibited the MetS at the 4-year follow-up. After multiple adjustments, the odds ratio (OR) was substantially higher for development of the MetS (OR 1.56, 95% confidence intervals, 1.21-2.01) in subjects in the highest ALP quintile compared with those in the lowest quintile. After adjusting for various covariates, we found significant associations between the quintile of serum ALP level and abdominal obesity, low high-density lipoprotein cholesterol level, and high triglyceride level. Higher serum ALP level was a significant predictor of the MetS in middle-aged Koreans. Serum ALP level correlated positively with body fat mass and independently with a more atherogenic lipid profile in the general population in Korea.
Endocrine Journal 11/2012; · 2.03 Impact Factor
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Jang-Won Son,
Eun-Hee Jang, Mee-Kyoung Kim,
Hyo-Lim Kim,
Ki-Hyun Baek,
Ki-Ho Song,
Soon Jib Yoo,
Kun-Ho Yoon,
Bong-Yun Cha,
Kwang-Woo Lee,
Ho-Young Son,
Hyuk-Sang Kwon
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ABSTRACT: The aim of the present study was to evaluate the independent predictors of coronary artery stenosis in patients with type 2 diabetes mellitus (DM) and subclinical atherosclerosis. A total of 232 patients with type 2 DM and subclinical atherosclerosis underwent multislice computed tomography coronary angiography. Subclinical atherosclerosis was determined by the carotid intima-media thickness (IMT) or carotid plaque. Multislice computed tomography coronary angiography revealed significant coronary stenosis (>50% in diameter) in 71 subjects (31%). The subjects who had significant coronary stenosis were much older and had had a longer duration of DM. In particular, the log-transformed albumin/creatinine ratio (ACR) was greater in the subjects with significant coronary stenosis compared to the subjects without significant coronary stenosis. The age- and gender-adjusted odds ratio for significant coronary stenosis increased in proportion to albuminuria with a given estimated glomerular filtration rate. The ACR as a continuous variable (odds ratio 4.167, 95% confidence interval 1.497 to 11.599) or categorical variable (ACR >30 μg/mg, odds ratio 4.619, 95% confidence interval 1.562 to 13.659) was associated with an increased risk of significant coronary stenosis, independent of conventional cardiovascular risk factors. In receiver operating characteristic analysis, the ACR had an additive effect with carotid IMT for predicting significant coronary stenosis (area under the curve 0.625 with carotid IMT; area under the curve 0.710 with carotid IMT plus ACR, p = 0.0144). In conclusion, the presence of albuminuria is an independent predictor for significant coronary stenosis in patients with type 2 DM and subclinical atherosclerosis.
The American journal of cardiology 08/2012; · 3.58 Impact Factor
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ABSTRACT: The aim of this study was to investigate the influences of visceral adiposity on cardiovascular autonomic neuropathy (CAN) in patients with type 2 diabetes mellitus.
Two hundred eleven patients with type 2 diabetes participated in this study. Anthropometric and metabolic parameters were measured, and the visceral fat area was assessed using computed tomography. CAN was diagnosed using a cardiovascular reflex test. We analyzed the correlation between the visceral fat area and each parameter in this test.
The mean age, body mass index (BMI), and duration of diabetes of the study population were 60±14 years (mean±standard deviation), 25.1±4.2 kg/m(2), and 12.3±8.9 years, respectively. The visceral fat area showed positive correlations with age, BMI, waist circumference, and subcutaneous fat area. There was no statistically significant difference in the cardiovascular reflex test outcome between genders. Univariate linear regression analysis showed that an increased visceral fat area diminished good heart rate response to a Valsalva maneuver (R(2)=4.9%, P=0.013 in an unadjusted model), but only in women. This statistical association was preserved after adjusting for age and BMI (R(2)=9.8%, P=0.0072).
The results of this study suggest that visceral adiposity contributes to an autonomic imbalance to some degree, as demonstrated by the impaired cardiovascular reflex test among women with type 2 diabetes.
Diabetes & metabolism journal 08/2012; 36(4):285-92.
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ABSTRACT: BACKGROUND: Transfusional iron overload primarily results in reticuloendothelial iron accumulation, which is considered to be less harmful than parenchymal iron accumulation. However, systematic and comprehensive data on endocrine function in transfusion-associated hemochromatosis are limited. METHODS: We examined 25 aplastic anemia patients (11 men and 14 women) diagnosed with transfusion-associated hemochromatosis at a single institution. Pituitary function was determined with a combined pituitary function test. On a different day, a 75 g oral glucose tolerance test was performed. The bone mineral density (BMD) of the lumbar spine and total hip was assessed with dual-energy X-ray absorptiometry. RESULTS: Twenty-two (88%) of these 25 patients had at least one endocrine abnormality, and 12 had more than one abnormality. The most common pituitary hormonal deficiency involved the pituitary-gonadal axis; 54% of the total subjects had hypogonadotropic hypogonadism. Two patients had an insufficient cortisol response to corticotropin-releasing hormone stimulation. No patient had a deficiency of growth hormone or thyroid-stimulating hormone. Twelve (48%) had diabetes mellitus and these patients tended to have higher concentrations of ferritin, alanine aminotransferase, and γ-glutamyl transferase. Osteoporosis (T-score < -2.5 SD) was observed in 48% of patients. The reduction in BMD was more pronounced in the lumbar spine than in the total hip. The patients with osteoporosis were accompanied by hypogonadism, which predominantly affected the trabecular bone. CONCLUSIONS: Our observations suggest that endocrinopathies are common in transfusion-associated hemochromatosis. © 2012 Blackwell Publishing Ltd.
Clinical Endocrinology 07/2012; · 3.17 Impact Factor
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ABSTRACT: Although various bariatric surgeries are widely known for their effect of ameliorating type 2 diabetes mellitus (T2DM), there are only a few reports demonstrating the effect of duodenojejunal bypass on T2DM. The aim of this study was to evaluate and report the clinical effects of laparoscopic duodenojejunal bypass (LDJB) in non-morbidly obese patients with T2DM.
Twelve non-morbidly obese patients with T2DM underwent LDJB. Changes in fasting blood glucose, body mass index glycosylated hemoglobin (HbA1c), and dose of antidiabetic medications were recorded prospectively during a 1-year period.
Reduction in HbA1c occurred 3 months after surgery and was maintained up to 1 year, and hyperglycemia was reversed within 1 month after surgery and remained controlled at 12 months. BMI decreased significantly 1 month after surgery and then remained steady through the year. Three patients (25.0 %) stopped antidiabetic medication, seven (58.3 %) patients maintained or decreased doses, and two (16.7 %) increased doses. Seven (58.3 %) patients had a decline in HbA1c.
LDJB demonstrated a glycemic control effect up to 1 year on T2DM in non-morbidly obese patients.
Surgical Endoscopy 06/2012; 26(11):3287-92. · 4.01 Impact Factor
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Guilsun Kim,
Ki Won Oh,
Eun-Hee Jang, Mee-Kyoung Kim,
Dong-Jun Lim,
Hyuk Sang Kwon,
Ki-Hyun Baek,
Kun-Ho Yoon,
Won Chul Lee,
Bong Yun Cha,
Kwang-Woo Lee,
Ho-Young Son,
Moo-Il Kang
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ABSTRACT: There is controversy regarding definition of vitamin D inadequacy. We analyzed threshold 25-hydroxyvitamin D (25[OH]D) below which intact parathyroid hormone (iPTH) increases, and examined age- and sex-specific changes of 25(OH)D and iPTH, and association of 25(OH)D and iPTH with bone mineral density (BMD) in elderly Koreans. Anthropometric parameters, serum 25(OH)D and iPTH, lumbar spine and femur BMD by dual-energy radiography absorptiometry (DXA) were measured in 441 men and 598 postmenopausal women. iPTH increased below serum 25(OH) of 36.7 ng/mL in men, but failed to reach plateau in women. Femur neck BMD above and below threshold differed when threshold 25(OH)D concentrations were set at 15-27.5 ng/mL in men, and 12.5-20 ng/mL in postmenopausal women. Vitamin D-inadequate individuals older than 75 yr had higher iPTH than those aged ≤ 65 yr. In winter, age-associated iPTH increase in women was steeper than in summer. In conclusion, vitamin D inadequacy threshold cannot be estimated based on iPTH alone, and but other factors concerning bone health should also be considered. Older people seemingly need higher 25(OH)D levels to offset age-associated hyperparathyroidism. Elderly vitamin D-inadequate women in the winter are most vulnerable to age-associated hyperparathyroidism.
Journal of Korean medical science 06/2012; 27(6):636-43. · 0.84 Impact Factor
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ABSTRACT: Papillary thyroid carcinoma with nodular fasciitis-like stroma (PTC-NFS) is an extremely rare variant of papillary thyroid
carcinoma characterized by prominent stromal cell proliferation. To our knowledge, sonographic findings of PTS-NFS have not
been reported. Here, we report a case of PTC-NFS that presented as a homogenous and hypoechoic mass in the peripheral portion
of the left thyroid gland on sonography in a 35-year-old pregnant woman.
KeywordsThyroid cancer-Ultrasound-Fine-needle aspiration (FNA)
Journal of Medical Ultrasonics 04/2012; 37(2):59-61. · 0.33 Impact Factor
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ABSTRACT: Gut hormones play a role in diabetes remission after a Roux-en-Y gastric bypass (RYGB). Our aim was to investigate differences in gut hormone secretion according to diabetes remission after surgery. Second, we aimed to identify differences in insulin secretion and sensitivity according to diabetes remission after RYGB.
Twenty-two severely obese patients with type 2 diabetes underwent RYGB. A meal tolerance test (MTT) was performed 12 months after RYGB. The secretions of active glucagon-like peptide-1 (active GLP-1), glucose-dependent insulinotropic peptide (GIP), peptide YY, C-peptide and insulin during the MTT test were calculated using total area under the curve values (AUC). Remission was defined as glycated haemoglobin (A(1C)) of <6.5% and a fasting glucose concentration of <126 mg/dL for 1 year or more without active pharmacological therapy.
Of the 22 patients, 16 (73%) had diabetes remission (remission group). The secretion CURVES of active GLP-1, GIP and peptide YY were not different between the groups. AUC of insulin and C-peptide were also not different. Homeostasis model assessment estimate of insulin resistance was significantly lower (1.26 ± 1.05 versus 2.37 ± 1.08, p = 0.006), and Matsuda index of insulin sensitivity was significantly higher in the remission group (10.5 ± 6.2 versus 5.8 ± 2.1, p = 0.039). The disposition index (functional reserve of beta cells) was significantly higher in the remission group compared with that in the non-remission group (5.34 ± 2.74 versus 1.83 ± 0.70, p < 0.001).
Remission of diabetes after RYGB is not associated with a difference in gut hormone secretion. Patients remaining diabetic had higher insulin resistance and decreased β cell functional reserve.
Diabetes/Metabolism Research and Reviews 03/2012; 28(5):439-46. · 3.37 Impact Factor
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ABSTRACT: We aimed to examine the relationship between iron status and hypertension as few studies have addressed this.
We analyzed the association between ferritin/total iron-binding capacity (TIBC) and the subsequent development of hypertension. A total of 8,580 men who visited the Health Promotion Center for a medical checkup in 2005 were followed-up after 4 years.
Of the 8,580 men who were not hypertensive at baseline, 818 were found to be hypertensive at the 4-year follow-up. Compared with those who remained normotensive, these hypertensive subjects had higher levels of ferritin and TIBC at baseline, but had no significant difference in iron levels. After adjustment for age and body mass index (BMI), the odds ratios (OR) was substantially higher for new hypertension (OR 1.54, 95% confidence intervals (CIs) 1.26-1.88; P for trend <0.001) in subjects with the highest ferritin quartiles compared with those in the lowest quartiles. The association of serum ferritin levels with the incidence of hypertension was unchanged after adjustment for baseline blood pressure (BP). Adjustment for insulin resistance as measured by the homeostasis model assessment and the presence of a fatty liver reduced the magnitude of the OR for hypertension (first quartile reference, fourth quartiles OR 1.24, 95% CI 1.01-1.53, P for trend = 0.012), but did not affect their statistical significance.
Serum ferritin, but not iron level, was a significant predictor of hypertension in middle-aged Korean men. Fatty liver disease and insulin resistance may be mediators of this high ferritin-hypertension association.
American Journal of Hypertension 01/2012; 25(4):492-7. · 3.18 Impact Factor
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Jang-Won Son,
Eun-Hee Jang, Mee-Kyoung Kim,
Ki-Hyun Baek,
Ki-Ho Song,
Kun-Ho Yoon,
Bong-Yun Cha,
Ho-Young Son,
Kwang-Woo Lee,
Hanjoong Jo,
Hyuk-Sang Kwon
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ABSTRACT: The aim of this study was to evaluate the association between the circulating BMP-4 levels and atherosclerosis in patients with Type 2 diabetes.
Serum BMP-4 levels were measured in 174 diabetic patients, and the degree of atherosclerosis was assessed by measuring the carotid intima-media thickness and the cardio-ankle vascular index.
Serum BMP-4 levels were inversely correlated with systolic blood pressure, triglycerides, free fatty acids, cardio-ankle vascular index and carotid intima-media thickness. Lower BMP-4 levels were shown to be an independent predictor of the increased cardio-ankle vascular index and carotid intima-media thickness after adjusting for conventional cardiovascular risk factors in patients with Type 2 diabetes.
Serum BMP-4 levels are inversely associated with surrogate markers of arterial stiffness and carotid atherosclerosis in patients with Type 2 diabetes.
Biomarkers in Medicine 12/2011; 5(6):827-35. · 0.86 Impact Factor
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ABSTRACT: An association between vitamin D status and sarcopenia has not been shown in a community-dwelling cohort, despite the well-documented relationship between vitamin D status and falls.
Our objective was to investigate whether vitamin D level is associated with sarcopenia in older Koreans.
The Fourth Korea National Health and Nutrition Examination Survey in the Korean population was conducted in 2009.
Participants included 1380 men and 1789 women aged 50 yr or older.
Serum 25-hydroxyvitamin D [25(OH)D] and PTH levels were measured. Sarcopenia was defined as an appendicular skeletal muscle mass divided by body weight that was less than 2 sd below the sex-specific mean for young adults. Obesity was defined as a body mass index (BMI) of 27.5 kg/m(2) or higher.
25(OH)D level correlated negatively with appendicular fat mass and positively with appendicular skeletal mass. The groups with sarcopenic obesity and sarcopenia only had lower 25(OH)D levels than did the nonsarcopenia groups. However, 25(OH)D levels did not differ between the sarcopenic obesity and sarcopenia groups. After adjustment for age, sex, BMI, and lifestyle factors, compared with those in the lowest quartile of 25(OH)D level, participants in the highest quartile had an odds ratio for sarcopenia of 0.47 (95% confidence interval = 0.30-0.73; P for trend = 0.001). There was no association between PTH and sarcopenia after adjustment of BMI.
Vitamin D levels were significantly lower in subjects with sarcopenia than in those without, regardless of obesity. We found a strong inverse association between 25(OH)D level and sarcopenia in the older Korean population.
The Journal of clinical endocrinology and metabolism 08/2011; 96(10):3250-6. · 6.50 Impact Factor
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ABSTRACT: Our aim was to identify preoperative anthropometric and clinical parameters that predict the remission of diabetes after Roux-en-Y gastric bypass (RYGB). Fifty severely obese Korean patients with type 2 diabetes underwent RYGB. Visceral and abdominal subcutaneous fat area (SFA) was assessed using computed tomography before and 6 and 12 months after RYGB. Remission was defined as a glycated hemoglobin (A(1C)) level <6.5% and a fasting glucose concentration <126 mg/dl for 1 year or more without the use of medication. The visceral-to-SFA ratio decreased from 0.60 ± 0.30 to 0.53 ± 0.29 (P = 0.001) after 6 months and decreased further to 0.42 ± 0.24 (P < 0.001) after 12 months. Thirty-four of the 50 patients (68%) had remission of diabetes (remission group). Compared with patients in the nonremission group, patients in the remission group had a shorter duration of diabetes and lower preoperative A(1C) level, and were less likely to use insulin preoperatively. Preoperative BMI did not differ in two groups. However, the preoperative visceral-to-SFA ratio was greater in the nonremission group compared with the remission group (0.79 ± 0.29 vs. 0.53 ± 0.26, P = 0.003). Finally, the preoperative visceral-to-SFA ratio was an independent predictor of the remission of diabetes after RYGB in multiple stepwise logistic regression analysis. In conclusion, our data suggest that visceral adiposity negatively influence the likelihood of the patient experiencing the remission of diabetes after RYGB.
Obesity 07/2011; 19(9):1835-9. · 4.28 Impact Factor
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ABSTRACT: Basal insulin requirement in patients with type 2 diabetes is difficult to determine because of individual variability in insulin sensitivity and secretion. We aimed to identify factors that influence basal insulin requirement in insulin-naïve patients with type 2 diabetes.
We studied 50 insulin-naïve patients with type 2 diabetes. Their basal insulin requirement was calculated by 8h overnight intravenous insulin infusion. Patients underwent abdominal computed tomography; subcutaneous and visceral fat areas were measured.
The basal insulin requirement was 31.3 ± 16.9 units/day, and it varied widely from 0.2 to 1.4 units/kg. It was positively correlated with visceral fat area (γ=0.485, P<0.001), body mass index (BMI, γ=0.339, P=0.008), glycated hemoglobin (HbA1C, γ=0.327, P=0.019), alanine aminotransferase (ALT, γ=0.310, P=0.027), and triglyceride (γ=0.305, P=0.032). However, body weight, waist circumference and total fat mass were not related to basal insulin requirement. Multiple linear regression analysis showed that visceral fat area, HbA1C, and ALT are independent predictors of basal insulin requirement.
Visceral obesity was a better predictor than generalized obesity for basal insulin requirement at the initiation of insulin therapy in patients with type 2 diabetes.
Diabetes research and clinical practice 05/2011; 93(2):174-8. · 2.16 Impact Factor
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ABSTRACT: The present study was designed to develop criteria for screening patients with type 2 diabetes mellitus (T2DM) for asymptomatic coronary artery disease (CAD).
A total of 213 patients with T2DM without typical angina or chest pain were studied between 2002 and 2007. We also evaluated 53 patients with T2DM who had reported chest discomfort using an exercise treadmill test (ETT).
Thirty-one of the 213 asymptomatic patients had positive ETT results. We performed coronary angiography on 23 of the 31 patients with a positive ETT and found that 11 of them had significant coronary stenosis. The main differences between the patients with significant stenosis and those with a negative ETT were age (63.1±9.4 vs. 53.7±10.1 years, P=0.008) and duration of diabetes (16.0±7.5 vs. 5.5±5.7 years, P<0.001). The positive predictive value (PPV) of the ETT was calculated to be 47.8%. The PPV of the ETT increased to 87.5% in elderly patients (≥60 years) with a long duration of diabetes (≥10 years). The latter value is similar to that of patients with T2DM who presented with chest discomfort or exertional dyspnea. The PPV of the ETT in symptomatic patients was 76.9%.
In the interest of cost-effectiveness, screening for asymptomatic CAD could be limited to elderly patients with a duration of diabetes ≥10 years.
Diabetes & metabolism journal 02/2011; 35(1):34-40.
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Jang-Won Son, Mee-Kyoung Kim,
Yong-Moon Park,
Ki-Hyun Baek,
Soon-Jib Yoo,
Ki-Ho Song,
Hyun Shik Son,
Kun-Ho Yoon,
Won Chul Lee,
Bong-Yun Cha,
Ho-Young Son,
Hyuk-Sang Kwon
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ABSTRACT: Bone morphogenetic protein 4 (BMP-4) is involved in the earliest stages of adipocyte differentiation and is recognized as an adipogenic factor for white adipose tissue. The association of serum BMP-4 levels with anthropometric and metabolic parameters has not been previously studied. We aimed to explore the relationship of serum BMP-4 levels with obesity and metabolic syndrome. Serum BMP-4 levels were measured in 104 non-diabetic individuals from the Chungju Metabolic Disease Cohort Study. Anthropometric measurements and components of metabolic syndrome were assessed in all patients. Serum BMP-4 levels were significantly increased in individuals with obesity or metabolic syndrome. After adjusting for age and gender, serum BMP-4 levels were positively correlated with body mass index, waist circumference (WC), waist-to-hip ratio, fasting plasma insulin, homeostasis model assessment index, and triglycerides and were negatively correlated with high-density lipoprotein (HDL) cholesterol. Among these parameters, WC and HDL cholesterol were found to be independent contributing factors for serum BMP-4 levels. Serum BMP-4 levels were also significantly higher in subjects with positive diagnostic criteria for each component of metabolic syndrome. The area under the receiver operating characteristic curve for BMP-4 was 0.661 (P = 0.022, 95% CI = 0.528 to 0.794) and the cut-off value was 2.84 pg/mL. This is the first demonstration that serum BMP-4 levels are associated with adiposity, insulin resistance, and the presence of metabolic syndrome. Whether BMP-4 may be involved in the pathogenesis of obesity and metabolic syndrome deserves further investigation.
Endocrine Journal 01/2011; 58(1):39-46. · 2.03 Impact Factor
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ABSTRACT: We aimed to determine the effects of thyroid hormone on A1C and glycated albumin (GA) in nondiabetic patients with overt hypothyroidism.
A1C levels were measured in 45 nondiabetic patients with overt hypothyroidism and 180 euthyroid control subjects. A1C, GA, fasting blood glucose (FBG), 1,5-anhydroglucitol, and erythrocyte indexes were determined in 30 nondiabetic patients with overt hypothyroidism before and after thyroid hormone replacement.
A1C levels were higher in patients with hypothyroidism compared with control subjects. A1C levels were decreased by thyroid hormone replacement. Thyroid hormone replacement increased serum erythropoietin, reticulocyte count, and mean corpuscular hemoglobin (MCH). The change in A1C level was significantly correlated with the change in reticulocyte count or MCH. Thyroid hormone replacement decreased serum levels of albumin and GA. However, FBG and 1,5-anhydroglucitol levels were not altered.
Levels of A1C and GA are spuriously high in nondiabetic patients with overt hypothyroidism.
Diabetes care 12/2010; 33(12):2546-8. · 8.09 Impact Factor
