[Show abstract][Hide abstract] ABSTRACT: Aims/Introduction
The goal of the present study was to evaluate predictive factors for good efficacy and durability to sitagliptin with ongoing metformin or metformin plus glimepiride therapy in a real practice situation. The present observational study was carried out over a 60‐week period and involved Korean patients with type 2 diabetes mellitus.
Materials and Methods
A total of 100 mg of sitagliptin were added once daily to the two most popular therapy regimens (group 1: metformin, group 2: metformin plus glimepiride). Before adding sitagliptin, mean initial glycated hemoglobin (HbA1c) levels were 7.8% (62 mmol/mol) and mean diabetes duration was 8.3 years.
After 60 weeks, the mean change in HbA1c from baseline was −0.9% (−10 mmol/mol) in group 1 and −1.0% (−11 mmol/mol) in group 2. Decreased HbA1c levels were significantly associated with higher initial HbA1c and lower log‐transformed C‐peptide levels in a multivariate regression analysis. Logistic regression analysis showed that a sustained reduction in HbA1c levels after 12 weeks was significantly associated with older age (≥60 years), higher baseline HbA1c (group 1 ≥ 7.0% [53 mmol/mol], group 2 ≥ 7.5% [58 mmol/mol]) and slower reduction of HbA1c (ΔHbA1c <1.0% [11 mmol/mol]) in group 1 and group 2. In group 2, a higher ratio of reduction of postprandial glucose/reduction of fasting plasma glucose (ΔPPG/ΔFPG) during 12 weeks was also associated with a sustained reduction in HbA1c levels after 12 weeks.
The effects of sitagliptin lasted more than 12 weeks in older patients with a higher baseline HbA1c, and slower reduction of HbA1c during 12 weeks.
[Show abstract][Hide abstract] ABSTRACT: Small dense low density lipoprotein (sdLDL) has recently emerged as an important risk factor of coronary heart disease.
The mean LDL particle size was measured in 203 patients with type 2 diabetes mellitus (T2DM) and 212 matched subjects without diabetes using polyacrylamide tube gel electrophoresis. Major vascular complications were defined as stroke, angiographically-documented coronary artery disease or a myocardial infarction. Peripheral vascular stenosis, carotid artery stenosis (≥50% in diameter) or carotid artery plaque were considered minor vascular complications. Overall vascular complications included both major and minor vascular complications.
Diabetic patients had significantly smaller mean-LDL particle size (26.32 nm vs. 26.49 nm) and a higher percentage of sdLDL to total LDL compared to those of subjects without diabetes (21.39% vs. 6.34%). The independent predictors of sdLDL in this study were serum triglyceride level and body mass index (odds ratio [OR], 1.020 with P<0.001 and OR 1.152 with P<0.027, respectively). However, no significant correlations were found between sdLDL and major vascular complications (P=0.342), minor vascular complications (P=0.573) or overall vascular complications (P=0.262) in diabetic subjects.
Diabetic patients had a smaller mean-LDL particle size and higher proportion of sdLDL compared to those of subjects without diabetes. Obese diabetic patients with hypertriglyceridemia have an increased risk for atherogenic small dense LDL. However, we could not verify an association between LDL particle size and vascular complications in this study.
[Show abstract][Hide abstract] ABSTRACT: We tested the correlation between diabetes and aggressiveness of colorectal polyps in diabetic patients and matched non-diabetic controls. We retrospectively studied 3,505 type 2 diabetes (T2DM) patients without gastrointestinal symptoms who underwent colonoscopy for colorectal cancer at Samsung Medical Center, Seoul, Korea from August 1995 to August 2009. We matched 495 non-diabetic subjects with colon polyps to the diabetic patients in whom polyps were detected by year of colonoscopy, age, sex and body mass index (BMI). Among the 3,505 T2DM patients screened, 509 were found to have 1,136 colon polyps. Those with diabetes had a greater proportion of adenomatous polyps (62.8% vs 53.6%) compared to the control. Multivariate logistic regression analysis identified DM, male gender, age and BMI as independent risk factors for multiple polyps (more than three polyps). Polyp multiplicity in diabetic patients was significantly associated with male gender (OR 2.360, P = 0.005), age (OR 1.033, P = 0.005) and BMI (OR 1.077, P = 0.028). Neither aspirin nor metformin use affected either size or number of polyps in diabetic patients. Male patients older than 65 yr with T2DM and BMI greater than 25 have increased risk for multiple adenomatous polyps and should be screened with colonoscopy to prevent colorectal cancer.
Journal of Korean medical science 09/2011; 26(9):1196-200. DOI:10.3346/jkms.2011.26.9.1196 · 1.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the clinical efficacy of sitagliptin for reducing plasma glucose levels in Korean subjects with type 2 diabetes mellitus during a 14-week treatment period.
Our study design involved the addition of 100 mg sitagliptin once-daily to three ongoing combination therapy regimens and changing from glimepiride and metformin to sitagliptin and metformin.
The addition of sitagliptin 100 mg/day produced a statistically significant reduction in mean HbA1c level (mean HbA1c reduction of 0.99±0.85%, P<0.01). In the group taking a combination of sitagliptin and metformin (n=143, initial mean HbA1c level=7.48%), the reductions in HbA1c, 2-hour postprandial glucose, and fasting glucose levels were 0.72±0.76% (P<0.01), 47±65 mg/dL (P<0.01), and 15±44 mg/dL (P<0.01), respectively. In the group taking a combination of sitagliptin, glimepiride, and metformin (n=125, initial mean HbA1c level=8.42%), the reductions in HbA1c, 2-hour postprandial glucose, and fasting glucose levels were 1.09±0.86% (P<0.01), 62±64 mg/dL (P<0.01), and 31±45 mg/dL (P<0.01), respectively. In the group taking a combination of sitagliptin, glimepiride, metformin, and α-glucosidase inhibitor (n=63, initial mean HbA1c level=9.19%), the reductions in HbA1c, 2-hour postprandial glucose, and fasting glucose levels were 1.27±0.70% (P<0.01), 72±65 mg/dL (P<0.01), and 35±51 mg/dL (P<0.01), respectively. In the group that had previous hypoglycemic events and that changed from glimepiride to sitagliptin, HbA1c level did not change but fasting glucose increased significantly (14±29 mg/dL, P<0.01).
Sitagliptin combination therapy for 14 weeks significantly improved glycemic control and was well-tolerated in Korean subjects with type 2 diabetes mellitus.
[Show abstract][Hide abstract] ABSTRACT: Recommended durations of low-iodine diet (LID) in preparation for radioactive iodine therapy (RAIT) vary among major guidelines and are important for patients in areas where iodine intake is high. The aim of this study was to investigate daily changes in urine iodine excretion after starting a LID.
The daily iodine/creatinine (I/Cr) ratios and simple iodine concentration (simple I) of morning spot urine from 19 patients with differentiated thyroid carcinoma were measured for 2 weeks from the start of LID for RAIT preparation. We set the cut-off of I/Cr and simple I for poor LID preparation at >66·2 μg/gCr and >150 μg/l, respectively. The day when daily I/Cr or simple I became equal to or below the cut-off both by 95% CI and 90th percentile was defined as the end-point for the appropriate duration of LID for RAIT.
On day 6 of LID, the I/Cr ratio decreased below the cut-off (≤66·2 μg/gCr) both by 95% CI (0-60·8) and by 90th percentile (51·9). Simple I reached the cut-off (≤150 μg/l) on day 3 by both parameters (95%CI: 2·3-90·5; 90th percentile: 126·5). The morning spot-urine I/Cr and simple I on day 7 and day 14 were significantly lower than on day 0 (P < 0·05).
One week of a strict LID is enough to decrease the level of urine iodine excretion in preparation for RAIT even in high iodine intake areas. These results provide essential data for future outcome studies regarding LID preparation for RAIT.
[Show abstract][Hide abstract] ABSTRACT: This study was to determine whether glycemic variability is related to hypoglycemic events in type 1 diabetic patients, and whether the hypoglycemic events during a short-term continuous glucose monitoring system (CGMS) period parallel those measured during a 4-week self-monitoring of blood glucose (SMBG) period. We also evaluated whether glycemic variability indexes from a short-term CGMS correlate with those from a 4-week SMBG. A total of 49 type 1 diabetic patients wore CGMS devices for 3 days. These patients also performed SMBG for 4 weeks. Several indexes from the CGMS data were compared with indexes from the SMBG data. Hypoglycemic events (glucose levels <70 mg/dL) that occurred during the 3-day CGMS and 4-week SMBG periods were evaluated and compared. Hypoglycemic events were detected in 33 patients (67%) during the 3-day CGMS period. The patients with hypoglycemic events had a significantly higher glycemic variability index divided by mean glucose of CGMS, and a higher number of hypoglycemic events during the 4-week SMBG, compared to those with non-hypoglycemic events during the 3-day CGMS period. The percentage of hypoglycemic events using the 3-day CGMS was correlated with that from the 4-week SMBG (r=0.49, P<0.05) and low blood glucose index (r=0.51, P<0.05). The glycemic variability indexes from the 4-week SMBG correlated with the glycemic variability indexes from the 3-day CGMS. The short-term CGMS appears to be clinically useful for rapidly assessing the risk of hypoglycemic events and glycemic variability.
[Show abstract][Hide abstract] ABSTRACT: The success of a low-iodine diet (LID) is best determined by measurement of 24-h urine iodine (U-I) excretion. The aim of this study was to determine reliable estimates for 24-h U-I based on spot-urine samples and to provide cut-offs to determine the effectiveness of LID preparation.
We prospectively measured iodine levels in 193 patients based on 24-h- and spot-urine samples before radioactive iodine therapy. The iodine was expressed as the 24-h U-I excretion (microg/day) and as two different indices from spot urine, simple iodine concentration (simple I) and the iodine/creatinine (I/Cr) ratio. Poor LID preparation was defined as I excretion of >150 microg/day according to the 24-h U-I measurement.
The measured 24-h U-I was significantly higher than the two indices from spot urine (P < 0.001). However, there were statistically significant correlations between the 24-h U-I values and the two spot-urine-based indices; the correlation coefficient was 0.539 for simple I and 0.773 for I/Cr ratio (P < 0.001). The cut-off of I/Cr ratio for poor LID preparation was >66.2 microg/g Cr (sensitivity 96.4%, specificity 83.6%, positive predictive value 50.0% and negative predictive value 99.3%).
We demonstrated that the I/Cr ratio from spot urine could serve as a useful and reliable alternative to 24-h urine collection as it has acceptable diagnostic values for detecting poor LID preparation.
[Show abstract][Hide abstract] ABSTRACT: We report here on a 34-year-old Korean woman with active acromegaly and who received Octreotide-LAR® for 12 months following transsphenoidal pituitary surgery. During Octreotide-LAR® treatment, the clinical improvement was paralleled with the decrease of the growth hormone levels to 1.1 ng/mL and the insulin-like growth factor-I (IGF-I) levels to 345.5 ng/mL. Octreotide-LAR® was discontinued when the patient was found to be at the 12th week of pregnancy. During pregnancy, the patient experienced clinical well-being and she maintained her IGF-I levels within the normal range for her age-matched despite discontinuation of Octreotide-LAR® treatment at early gestation. She delivered a full-term healthy male infant. The serum IGF-I levels of the patient increased progressively increased after delivery. This report describes a successful pregnancy in an acromegalic woman who was exposed to Octreotide-LAR® during the early gestational period. She and who showed an unexpected pattern of persistently normal IGF-I levels through the pregnancy despite discontinuation of Octreotide-LAR® therapy.