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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]

Abstract: Aims: To determine the prevalence and risk factors for painful diabetic peripheral neuropathy (PDPN) and evaluate sleep impairment and quality of life in patients with PDPN. Methods: Data from the Korean Diabetes Association Neuropathy Study Group were used to evaluate 3999 patients with type 2 diabetes. PDPN was diagnosed using visual analogue scales (VAS) and medical history. The patients were asked to answer the Brief Pain Inventory-Short Form (BPI-SF), Medical Outcomes Study Sleep (MOS-Sleep) Scale, EuroQol (EQ-5D), and VAS. Results: Among the patients with diabetic peripheral neuropathy (n =1338), 577 (43.1%) were diagnosed with PDPN (14.4% of all patients with type 2 diabetes). PDPN was independently associated with age, female gender, fasting plasma glucose, hypertension, and previous cerebrovascular events. All pain severity and interference measures were higher in patients with PDPN than in non-PDPN patients, and patients with PDPN reported more impaired sleep and lower EQ-5D and VAS scores. Conclusions: The prevalence of PDPN in Koreans was comparable to that in Western populations. PDPN may impair sleep and quality of life compared with non-PDPN, and physicians should carefully consider pain symptoms in patients with diabetic peripheral neuropathy. [Copyright &y& Elsevier]

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. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To evaluate the association between serum 25-hydroxyvitamin D [25(OH)D] and arterial stiffness in patients with type 2 diabetes. Methods: Serum 25(OH)D was measured in a cross-sectional sample of 131 men and 174 women aged 30 years and over in Korea. Arterial stiffness was assessed by pulse wave velocity (PWV) obtained with a VP-2000 pulse wave unit. Fasting plasma glucose, insulin, lipid profile, HbA1c, calcium, phosphorous, and HS-CRP were measured. Results: The prevalence of vitamin D deficiency was high (85.9%). Those with lower vitamin D levels had increased PWV. Using multivariate regression analysis, low 25(OH)D concentrations independently predicted PWV (p <0.001) in people with type 2 diabetes after adjustment for other risk factors such as age, smoking, hypertension, HS-CRP, diabetes duration, hypertension duration, HbA1c, and BMI. Conclusions: Vitamin D deficiency is common in type 2 diabetes, and a low 25(OH)D level is significantly associated with increased arterial stiffness in these patients. Vitamin D may influence the development of cardiovascular disease. Clinical intervention studies are needed to clarify whether treatment with vitamin D decreases the risk of cardiovascular disease in patients with type 2 diabetes. [Copyright &y& Elsevier]

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]

Abstract: Aims: We aimed to evaluate the association between diabetic microangiopathy and subclinical atherosclerosis as a marker of cardiovascular disease (CVD) risk in patients with newly diagnosed type 2 diabetes. Methods: A total of 142 newly diagnosed type 2 diabetics who were free from CVD underwent evaluation of diabetic microangiopathy. Subclinical atherosclerosis was assessed by measuring carotid intima-media thickness (IMT), and the 10-year absolute risk of CVD was estimated using the UK Prospective Diabetes Study (UKPDS) Risk Engine. Results: Subclinical atherosclerosis was found in 27 subjects (19.0%). The rates of hypertension and diabetic retinopathy were significantly higher among patients with subclinical atherosclerosis. The UKPDS 10-year risk for CVD was significantly increased in subjects with subclinical atherosclerosis. Old age, hypertension and the presence of diabetic retinopathy showed a significant association to subclinical atherosclerosis after further adjustments for gender, body mass index, smoking status, HbA1c, HDL cholesterol, LDL cholesterol and the presence of diabetic nephropathy. Conclusions: This study shows that diabetic retinopathy is an independent risk marker for subclinical atherosclerosis in patients with newly diagnosed type 2 diabetes. We suggest that a diagnosis of diabetic retinopathy may warrant a more careful cardiovascular assessment even in the early stages of diabetes. [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]