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Objectives. Patients with diabetic peripheral neuropathy (DPN) is the most common complication. However, patients are usually suffering from not only diverse sensory deficit but also neuropathy-related discomforts. The aim of this study is to identify distinct groups of patients with DPN with respect to its clinical impacts on symptom patterns and comorbidities. Methods. A hierarchical cluster analysis and factor analysis were performed to identify relevant subgroups of patients with DPN (n=1338) and symptom patterns. Results. Patients with DPN were divided into three clusters: asymptomatic (cluster 1, n=448, 33.5%), moderate symptoms with disturbed sleep (cluster 2, n=562, 42.0%), and severe symptoms with decreased quality of life (cluster 3, n=328, 24.5%). Patients in cluster 3, compared with clusters 1 and 2, were characterized by higher levels of HbA1c and more severe pain and physical impairments. Patients in cluster 2 had moderate pain levels but disturbed sleep patterns comparable to those in cluster 3. The frequency of symptoms on each item of MNSI by “painful” symptom pattern showed a similar distribution pattern with increasing intensities along the three clusters. Conclusions. Cluster and factor analysis endorsed the use of comprehensive and symptomatic subgrouping to individualize the evaluation of patients with DPN. [ABSTRACT FROM AUTHOR]

Objective Patients with type 2 diabetes mellitus are at greater risk of bone fractures than nondiabetics. However, the risk factors for fractures in patients with diabetes have not been fully evaluated. This study was designed to evaluate the relative frequency of fractures at different sites and the diabetes-associated factors that affect nontraumatic bone fracture in patients with type 2 diabetes. Patients and design This retrospective case-control study recruited 144 patients with type 2 diabetes, who presented with nontraumatic fractures between March 2004 and March 2009 and 150 age-, gender-, body mass index (BMI)- and duration of diabetes-matched control subjects. Nontraumatic fractures were confirmed using patients' medical records and radiological findings. All subjects were examined for their diabetes status and associated factors for fracture, including bone mineral density (BMD). Results Of 150 reported bone fractures, the hip was the most frequent fracture site (32·7%), followed by the upper extremity (19·3%). Nontraumatic fractures were associated with diabetic retinopathy, diabetic peripheral neuropathy, stroke history, previous fracture and insulin treatment ( P < 0·05). In multivariate analyses, independently associated factors for bone fracture were diabetic peripheral neuropathy [odds ratio (OR) = 37·3, 95% confidence interval (CI) = 1·46-652·57] and previous fracture (OR = 9·54, 95% CI = 1·18-77·37; P < 0·05). Conclusions The hip was the most frequent site of nontraumatic fracture, and diabetic peripheral neuropathy was significantly associated with an increased risk of nontraumatic fractures in patients with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To determine the relationship between serum uric acid, metabolic syndrome (MetS), and albuminuria in type 2 diabetic patients. Methods: A total of 504 Korean patients with type 2 diabetes aged 57.3 years were retrospectively evaluated for clinical histories, anthropometric measurements, and biochemical studies. Urinary albumin excretion (UAE) was measured by a 24-h urine collection. Results: Prevalence of MetS increased according to the quartiles of uric acid levels (≤3.7, 3.8 to 4.5, 4.6 to 5.5, and >5.5 mg/dl; 52.1%, 52.1%, 57.5%, and 71.6%, respectively, P<.001). Individual components of MetS (abdominal obesity, hypertriglyceridemia, low HDL-cholesterol, high blood pressure) were also significantly associated with the highest quintile of uric acid levels. Serum uric acid levels had significantly increased risk of albuminuria [odds ratio (OR) 1.425, 95% confidence interval (CI) 1.085-1.873] after adjusting for age, gender, and conventional risk factors. Uric acid level remains a significant predictor for abnormal albuminuria after adjusting for MetS presence as well as the use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) (OR 1.414, 95% CI 1.071-1.868). Conclusion: An elevated uric acid level was significantly associated with MetS and was an independent predictor of albuminuria after adjusting for conventional risk factors and MetS. Regular measurements of uric acid level could give information for predicting the presence of MetS and albuminuria in Korean type 2 diabetic patients. [Copyright &y& Elsevier]

OBJECTIVE -- We investigated whether cardiovascular autonomic dysfunction was associated with glycemic control status over time in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS-- From 1999 to 2000, cardiovascular autonomic nerve function testing (AFT) was performed on patients with type 2 diabetes (n = 1,021) and was followed-up in 2006 and February 2008. Tests for cardiovascular autonomic functions measured heart rate variability parameters (expiration-to-inspiration [E/I] ratio, responses to the Valsalva maneuver, and standing). AFT scores were determined from the results of the each test as follows: 0 for normal and 1 for abnormal. We began with those who had a score of 0 and assessed the changes in total score along with biannual A1C levels. RESULTS-- At follow-up, the development of cardiovascular autonomic dysfunction was 34.5% (E/I ratio 21.9%, Valsalva maneuver 77.8%, and posture 58.9%; n = 783). The development of cardiovascular autonomic dysfunction was higher in older patients (P < 0.001); in those with longer duration of diabetes (P < 0.001); of hypertension (P = 0.005), and of diabetic retinopathy (P < 0.001); and in those who had higher levels of microalbuminuria (P = 0.002). Logistic regression analysis revealed that the development of cardiovascular autonomic dysfunction was strongly associated with the mean A1C level during the follow-up period (mean A1C >9.0% vs. ≤7.0%, odds ratio 2.984, 95% CI 1.177-7.561; P = 0.021). CONCLUSIONS-- The development of cardiovascular autonomic dysfunction was independently associated with microvascular complications and glycemic control status during this 7.5-year follow-up in patients with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Abstract: We aimed to establish the prevalence and characteristics of latent autoimmune diabetes in adults (LADA) and compare it with type 2 diabetes in 1370 Korean patients. The prevalence of LADA was 5.1%. Low C-peptide level and absence of metabolic syndrome were variables independently associated with the diagnosis of LADA. [Copyright &y& Elsevier]

Diabetic autonomic neuropathy has a significantly negative impact on survival and quality of life in type 2 diabetic patients. Especially, cardiovascular autonomic neuropathy (CAN) is clinically important, because of its association with cardiovascular death. We investigated whether the progression of CAN is related to the cardiovascular events in type 2 diabetic patients. Total 683 type 2 diabetic patients, 244 males and 439 females, visited Diabetes Clinic. Autonomic function test at baseline was conducted from January 2000 to December 2000, and was followed from January 2006 to December 2006. Standard tests for CAN were composed of heart rate variability (E/I ratio, response to the Valsalva maneuver and standing). CAN score was determined by the results of each test as following: 0=normal, 1 =abnormal (total score 3). Progress was defined when the total score at follow was higher than the baseline score. Total 425 patients were evaluated after six years. Mean age and duration of diabetes were 58.1 ± 10.3, and 8.3 ± 7.0 years, respectively. Among the total number of patients, 106 patients (24.9%) were the group in progress. 53 patients (12.5%) developed cerebral infarction (CVA), and 46 patients (10.8%) experienced ischemic heart attack (CAD; angina, myocardial infarction) during the observation period. There were no differences in body mass index, postprandial hyperglycemia, and HbA1c level between two groups. Compared to group in non-progress, both CAD and CVA were developed more frequently in 'progress' group (21.7 vs. 14.7%, P<0.05). The incidence of vascular events were higher in patients with older age (P=0.008), longer diabetic duration (P=0.003), hypertension (P<0.001), and diabetic retinopathy (p=0.0013). Patients with CVA or CHD had lower HDL cholesterol level (39.1 ± 10.7 vs. 42.1 ± 10.8 mg/dl, p < 0.05), and higher fasting insulin (14.0 ± 14.2 vs. 9.6 ± 10.1 µIU/ml, p < 0.05) than patients without CVA or CHD. Logistic regression analysis revealed the progress of CAN score to be deeply related to the development of vascular event (OR 2.487, CI 1.134-5.458, P=0.023). These results suggest that cardiovascular autonomic function could predict the development of CVA or CAD, therefore, it could be a good screening method for the cardiovascular events in type 2 diabetic patients. [ABSTRACT FROM AUTHOR]