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Genome-wide association studies have been used extensively to identify genetic variants linked to metabolic syndrome (MetS), but most of them have been conducted in non-Asian populations. This study aimed to evaluate the association between MetS and previously studied single nucleotide polymorphisms (SNPs), and their interaction with health-related behavior in Korean men. Methods: Seventeen SNPs were genotyped and their association with MetS and its components was tested in 1193 men who enrolled in the study at Seoul National University Hospital. Results: We found that rs662799 near APOA5 and rs769450 in APOE had significant association with MetS and its components. The SNP rs662799 was associated with increased risk of MetS, elevated triglyceride (TG) and low levels of high-density lipoprotein, while rs769450 was associated with a decreased risk of TG. The SNPs showed interactions between alcohol drinking and physical activity, and TG levels in Korean men. Conclusions: We have identified the genetic association and environmental interaction for MetS in Korean men. These results suggest that a strategy of prevention and treatment should be tailored to personal genotype and the population. [ABSTRACT FROM AUTHOR]

Background: Genome-wide association studies have been used extensively to identify genetic variants linked to metabolic syndrome (MetS), but most of them have been conducted in non-Asian populations. This study aimed to evaluate the association between MetS and previously studied single nucleotide polymorphisms (SNPs), and their interaction with health-related behavior in Korean men. Methods: Seventeen SNPs were genotyped and their association with MetS and its components was tested in 1193 men who enrolled in the study at Seoul National University Hospital. Results: We found that rs662799 near APOA5 and rs769450 in APOE had significant association with MetS and its components. The SNP rs662799 was associated with increased risk of MetS, elevated triglyceride (TG) and low levels of high-density lipoprotein, while rs769450 was associated with a decreased risk of TG. The SNPs showed interactions between alcohol drinking and physical activity, and TG levels in Korean men. Conclusions: We have identified the genetic association and environmental interaction for MetS in Korean men. These results suggest that a strategy of prevention and treatment should be tailored to personal genotype and the population. [ABSTRACT FROM AUTHOR]

The article informs A comprehensive whole-genome reference panel containing over 14,000 individuals from East Asian populations has been created, accelerating the identification of rare functional genetic variants. This reference panel greatly enhances imputation accuracy for rare and low-frequency variants within East Asian populations, leading to the discovery of previously unidentified associations and genes with significant effects on phenotypes.

Background: In the previous study, we introduced a new IT-based glucose control system, the Internet-based glucose monitoring system (IBGMS), and demonstrated its long-term effect. However, there has been no report on economic impact of such a new diabetes management system. In this study, we assessed the long-term economic impact of IBGMS given in addition to existing treatments in patients with type 2 diabetes. Methods: The CORE Diabetes Model, a peer-reviewed, published, validated computer simulation model, was used to project long-term clinical and cost outcomes in type 2 diabetes patients receiving the IBGMS in addition to their existing treatment. The model combined standard Markov sub-models to simulate the incidence and progression of diabetes-related complications and calculate costs over patient lifetimes. Direct costs were retrieved from published sources and projected over patient lifetimes from a third-party healthcare payer perspective in the US. Costs and clinical benefits were discounted at 5% per annum. Second order Monte Carlo simulation was used to account for multiple parameter uncertainty. Extensive sensitivity analyses were performed. Results: Predicted cumulative incidence of diabetic complications in subjects with type 2 diabetes was decreased with addition of the Internet based glucose monitoring system (IBGMS). The addition of IBGMS was associated with improvements in discounted life expectancy for IBGMS (11.71 years) compared to usual care (11.33 years) and QALE, 8.52 years for IBGMS and 8.11 years for usual care. The cost of IBGMS was USD 46,636 and usual care costing USD 49,822, thus leading to a cost saving of USD 3,186. Based on both life expectancy and QALE, ICER (the incremental cost effectiveness ratio) of IBGMS was dominant. Conclusions: This study demonstrated that the IBGMS compared to existing treatment was associated with improvements in life expectancy and QALE and provides excellent value for money over patient lifetimes in the Korean setting. [ABSTRACT FROM AUTHOR]

Background: The Modality of Insulin Treatment Evaluation (MOTIV) study was performed to provide real-world data concerning insulin initiation in Korean type 2 diabetes mellitus (T2DM) patients with inadequate glycemic control with oral hypoglycemic agents (OHAs). Methods: This multicenter, non-interventional, prospective, observational study enrolled T2DM patients with inadequate glycemic control (glycosylated hemoglobin [HbA1c] ≥7.0%) who had been on OHAs for ≥3 months and were already decided to introduce basal insulin by their physician prior to the start of the study. All treatment decisions were at the physician's discretion to reflect real-world practice. Results: A total of 9,196 patients were enrolled, and 8,636 patients were included in the analysis (mean duration of diabetes, 8.9 years; mean HbA1c, 9.2%). Basal insulin plus one OHA was the most frequently (51.0%) used regimen. After 6 months of basal insulin treatment, HbA1c decreased to 7.4% and 44.5% of patients reached HbA1c <7%. Body weight increased from 65.2 kg to 65.5 kg, which was not significant. Meanwhile, there was significant increase in the mean daily insulin dose from 16.9 IU at baseline to 24.5 IU at month 6 (P<0.001). Overall, 17.6% of patients experienced at least one hypoglycemic event. Conclusion: In a real-world setting, the initiation of basal insulin is an effective and well-tolerated treatment option in Korean patients with T2DM who are failing to meet targets with OHA therapy. [ABSTRACT FROM AUTHOR]

Background: This study aimed to compare the patterns of insulin secretion and resistance between Korean subjects in the 1990s and 2000s. Methods: Insulin secretion and resistance indices were calculated from subjects who underwent 75-g oral glucose tolerance tests in the year 1997 to 1999 and 2007 to 2011 at the Seoul St. Marys Hospital, Korea. Results: A total of 578 subjects from the 1990s (mean age, 48.5 years) and 504 subjects from the 2000s (mean age, 50.2 years) were enrolled. Compared with the subjects from the 1990s, those from the 2000s exhibited increased insulin resistance (increased homeostatic model assessment for insulin resistance), and reduced insulin sensitivity (reduced Matsuda index and quantitative insulin sensitivity check index), regardless of their glucose tolerance status. However, insulinogenic index did not reveal significant differences between the 2 decades in subjects with or without diabetes. A distinct relationship was confirmed between Matsuda index and total area under the curve (insulin/glucose) in each glucose tolerance group. The mean product of the Matsuda index and the total area under the curve (insulin/glucose) as well as the oral disposition index, was lower in subjects with normal glucose tolerance from the 2000s than in those from the 1990s. Conclusion: After rapid economic growth and changes in lifestyle patterns, insulin resistance has worsened across the glucose tolerance status; however, the insulin secretory function remained unchanged, which resulted in an increase in the susceptibility to the development of type 2 diabetes mellitus among Korean subjects without diabetes. We could not rule out the potential selection bias and therefore, further studies in general Korean population are needed. [ABSTRACT FROM AUTHOR]

Atypical antipsychotics have replaced conventional antipsychotics in the treatment of schizophrenia because they have less of a propensity to cause undesirable neurologic adverse events including extrapyramidal symptoms, tardive dyskinesia, and neurolep- tic malignant syndrome (NMS). However, atypical antipsychotics have been known to result in various metabolic complications such as impaired glucose tolerance, diabetes and even diabetic ketoacidosis (DKA). In addition, a number of NMS cases have been reported in patients treated with atypical antipsychotics, although the absolute incidence of neurologic side effects is currently sig- nificantly low. Here, we report a patient who simultaneously developed DKA, acute renal failure and NMS with rhabdomyolysis after olanzapine treatment. Olanzapine-induced metabolic complications and NMS were dramatically improved with cessation of the olanzapine treatment and initiation of supportive management including fluid therapy, hemodialysis, and intensive glycemic control using insulin. At short-term follow-up, insulin secretion was markedly recovered as evidenced by a restoration of serum C-peptide level, and the patient no longer required any hypoglycemic medications. Despite the dramatic increase in the use of atypical antipsychotics treatment, individualized treatments along with careful monitoring may be prudent for high risk or vulner- able patients in order to avoid the development of metabolic side effects. [ABSTRACT FROM AUTHOR]

Background: The aims of this study are to investigate the glycemic efficacy and predictive parameters of vildagliptin therapy in Korean subjects with type 2 diabetes. Methods: In this retrospective study, we retrieved data for subjects who were on twice-daily 50 mg vildagliptin for at least 6 months, and classified the subjects into five treatment groups. In three of the groups, we added vildagliptin to their existing medication regimen; in the other two groups, we replaced one of their existing medications with vildagliptin. We then analyzed the changes in glucose parameters and clinical characteristics. Results: Ultimately, 327 subjects were analyzed in this study. Vildagliptin significantly improved hemoglobin Atc (HbAlc) levels over 6 months. The changes in HbAlc levels (ΔHbAlc) at month 6 were -2.24% (P=0.000), -0.77% (P=0.000), -0.80% (P=0.001), -0.61% (P=0.000), and -0.34% (P=0.025) for groups 1, 2, 3, 4, and 5, respectively, with significance. We also found significant decrements in fasting plasma glucose levels in groups t, 2,3, and 4 (P<0.05). Of the variables, initial HbAlc levels (P= 0.032) and history of sulfonylurea use (P= 0.026) were independently associated with responsiveness to vildagliptin treatment. Conclusion: Vildagliptin was effective when it was used in subjects with poor glycemic control. It controlled fasting plasma glucose levels as well as sulfonylurea treatment in Korean type 2 diabetic subjects. [ABSTRACT FROM AUTHOR]

Background: While many studies have shown the good efficacy and safety of exenatide in patients with diabetes, limited information is available about exenatide in clinical practice in Korean populations. Therefore, this retrospective cohort study was designed to analyze the effects of exenatide on blood glucose level and body weight in Korean patients with type 2 diabetes mellitus. Methods: We reviewed the records of the patients with diabetes who visited Seoul St. Mary's Hospital and for whom exenatide was prescribed from June 2009 to October 2011. After excluding subjects based on their race/ethnicity, medical history, whether or not they changed more than 2 kinds of oral hypoglycemic agents with exenatide treatment, loss to follow-up, or whether they stopped exenatide therapy within 6 months, a total of 52 subjects were included in the final analysis. Results: The mean glycated hemoglobin (HbA1c) level and weight remarkably decreased from 8.5 ± 1.7% to 6.7 ± 1.0% (P< 0.001) and from 82.3 ± 15.8 kg to 78.6±16.3 kg (P< 0.00 1), respectively. The multiple regression analysis indicated that the reduction in HbAlc level was significantly associated with a shorter duration of diabetes, a higher baseline HbAlc level, and greater weight reduction, whereas weight loss had no significant correlation with other factors. No severe adverse events were observed. Conclusion: These results suggest that a 6-month exenatide injection therapy significantly improved patients' HbA1c levels and body weights without causing serious adverse effects in Korean patients with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Summary Objective To investigate the prevalence and identify the phenotype of individuals suspected to be metabolically obese but normal weight (MONW). Design and subjects Eight thousand nine hundred and eighty-seven nondiabetic subjects aged over 40 years were selected from the Chungju Metabolic disease Cohort study performed in 2003-2006 in Korea. Those within the highest quartile in the homeostasis model assessment of insulin resistance (HOMA-IR) with a normal body mass index (BMI) between 18·5 and 23 kg/m2 were classified as MONW. Measurements Data on anthropometry, lipid profiles and HOMA-IR values were analysed. Results The prevalence of MONW was 14·2% for men and 12·9% for women amongst normal-weight subjects. Multiple logistic regression analysis showed that total cholesterol (TC) levels over 5·17 m m (odds ratio, OR = 1·481; 95% confidence intervals, CI 1·086-2·021), triglyceride (TG) levels over 1·69 m m (OR = 1·507; 95% CI 1·093-2·077) and high-density lipoprotein-cholesterol levels lower than 1·03 m m (OR = 1·580; 95% CI 1·053-2·371) independently had higher odds of diagnosing MONW amongst men. For women, a BMI over 21·5 kg/m2 (OR = 1·405; 95% CI 1·034-1·909), TC levels over 5·17 m m (OR = 1·524; 95% CI 1·112-2·090) and TG levels over 1·69 m m (OR = 1·799; 95% CI 1·302-2·487) were independently associated with a diagnosis of MONW. Conclusions More than 10% of normal-weight subjects were classed as MONW in this cohort. Identification of these subjects based on lipid profiles could aid in the early detection of a high risk group of developing cardiometabolic diseases. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to determine the characteristics affecting insulin resistance in non-obese middle-aged adults in a rural community.Methods: A total of 1,270 non-diabetic adults aged between 40 and 64 years old with body mass index (BMI) less than 25 kg/m(2) were analyzed. Subjects with insulin resistance were defined as those who had the highest quartile value of the homeostasis model assessment of insulin resistance (HOMA-IR) in a non-diabetic population.Results: A total of 217 subjects (20.6%) had insulin resistance. Prevalence of metabolic syndrome was significantly higher in insulin-resistant subjects in both men (29.3% vs. 10.3%) and women (34.1% vs. 15.6%). Among metabolic syndrome components, elevated waist circumference and elevated triglyceride were higher in insulin-resistant subjects in both genders. After being controlled for socioeconomic status and lifestyle related covariates, the association between insulin resistance and BMI was statistically significant in the category of 23.0-24.9 kg/m(2) in men (adjusted OR, 4.63; 95% confidence interval [95% CI], 1.77-12.15) using the category of 18.5-20.9 kg/m(2) as a reference. In addition, the association between insulin resistance and abdominal obesity was statistically significant only for men (adjusted OR, 2.57; 95% CI, 1.29-5.11).Conclusion: Insulin resistance appears to be highly associated with high BMI and abdominal obesity, even in non-obese, non-diabetic middle-aged men. [ABSTRACT FROM AUTHOR]

Background:The association between autoimmune thyroiditis (AIT) and thyroid cancer is still not clear despite many previous reports. This study investigated whether serologic thyroid antibodies are predictive of thyroid cancer in patients with thyroid nodules.Method:We retrospectively reviewed records of patients with thyroid nodules evaluated by ultrasonography-guided fine-needle aspiration cytology at our institution between January 2006 and December 2008. Thyroid autoimmunity was assessed by measuring thyroglobulin antibody (TgAb) and thyroid peroxidase antibody (TPOAb). The final outcome deciding a benign or malignant status involved a combination of cytology and histology.Results:Of the 1638 patients, malignant nodules had a higher rate of positive TgAb (30.8% vs. 19.6%; p< 0.001) and elevated thyrotropin (TSH) levels (2.5 ± 2.8 mIU/L vs. 2.1 ± 2.0 mIU/L; p= 0.021) than benign nodules. The rate of positive TPOAb was not higher in malignant nodules, although both TPOAb and TgAb were well correlated with TSH levels and histological AIT. In the multivariate analysis, a positive TgAb was significantly associated with thyroid cancer (odds ratio [OR] = 1.61, 95% confidence interval [CI] 1.12–2.33) with upper tertile of normal range of TSH levels (OR = 1.72, 95% CI 1.12–2.63) and above normal range of TSH levels (OR = 1.98, 95% CI 1.06–3.70).Conclusion:We report for the first time that a positive serum TgAb test was an independent predictor for thyroid malignancy in thyroid nodules along with serum TSH levels regardless of the presence of AIT. Our results suggest that TgAb measurement could give additional information for predicting malignancy in cytologically indeterminate thyroid nodules in conjunction with clinical risk factors and TSH levels. [ABSTRACT FROM AUTHOR]

Background: Papillary thyroid microcarcinoma (PTMC) detection has been increasing explosively with the recent improvement and application of new diagnostic tools. However, the associations between clinical, histopathological, and molecular findings are often not fully evaluated in reaching a decision for the treatment of PTMC. Objective: To retrospectively evaluate the patients diagnosed with PTMC in terms of the clinical and histopathological features and the immunohistochemical findings of specific molecular markers, and thereby provide an association with the disease prognosis for the Korean patients. Design: We have reviewed the clinical records of patients who underwent surgery for thyroid cancer (during January 2000 to August 2006 interval) at St. Mary''s Hospital, Seoul, Korea. The clinical and histopathological characteristics of 217 PTMCs were evaluated cross-sectionally after surgery, and immunohistochemical staining of p53, epidermal growth factor receptor (EGFR), Ki-67, and cyclooxygenase-2 (COX-2) for 87 isolated specimens was performed. Main outcome: The proportions of extrathyroid extension, lymphatic invasion, and lymph node metastasis cited were 31.9, 19.2, and 17.8, respectively. However, distant metastasis was not noted. Fifty-three (27.1) patients had multiplicity, and 39 patients (20.0) had bilateral disease. A primary tumor larger than 5 mm was significantly associated with extrathyroid extension, lymphatic invasion, and lymph node metastasis. The absence of EGFR expression shown by immunohistochemical analysis was closely correlated with extrathyroid extension and lymph node metastasis, while the absence of COX-2 expression was associated with multiplicity and bilaterality. Conclusion: Many patients with PTMC had clinical and histopathological poor prognostic factors. The expression of molecular markers, such as EGFR and COX-2, may have a role in the prognosis of PTMC. When considering all of the prognostic factors, a more tailored management approach appears to be necessary for patients with PTMC. [ABSTRACT FROM AUTHOR]

Objective:We analyzed the sonographic characteristics of thyroid nodules and assessed the diagnostic value of ultrasonography in order to distinguish between benign and malignant lesions in terms of the management of thyroid nodules. Design:We retrospectively analyzed the sonographic features of thyroid nodules in 580 patients who had been examined with fine-needle aspiration cytology or who underwent surgery for a thyroid nodule. The sonographic features that suggested malignancy include microcalcifications, an irregular or microlobulated margin, marked hypoechogenicity, and a shape that was taller than it was wide. The presence of one or more of these features indicated classification as category 3 (malignant). The absence of all of these features indicated classification as category 2 (benign). Presence of an anechogenic cystic nodule was classified as category 1 (benign). Main outcome:Of 124 lesions classified as category 3, 60 of the lesions were malignant. Of 418 lesions classified as category 1 or 2, 409 were benign. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy based on the sonographic classification method were 87.0, 86.5, 48.4, 97.8, and 86.5, respectively. Conclusions:Our results identified this sonographic classification as a useful tool in the differentiation of malignant nodules from benign nodules. In view of the high negative predictive value of sonographic classification, a more aggressive approach is recommended only for category 3 nodules. [ABSTRACT FROM AUTHOR]

OBJECTIVE -- To investigate the long-term effectiveness of the Internet-based glucose monitoring system (IBGMS) on glucose control in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS -- We conducted a prospective, randomized, controlled trial in 80 patients with type 2 diabetes for 30 months. The intervention group was treated with the IBGMS, while the control group made conventional office visits only. HbA1c (A1C) was performed at 3-month intervals. For measuring of the stability of glucose control, the SD value of A1C levels for each subject was used as the A1C fluctuation index (HF1). RESULTS -- The mean A1C and HF1 were significantly lower in the intervention group (n = 40) than in the control group (n = 40). (A1C [mean ± SD] 6.9 ± 0.9 vs. 7.5 ± 1.0%, P = 0.009; HFI 0.47 ± 0.23 vs. 0.78 ± 0.51, P = 0.001; intervention versus control groups, respectively). Patients in the intervention group with a basal A1C ≥7% (n = 27) had markedly lower A1C levels than corresponding patients in the control group during the first 3 months and maintained more stable levels throughout the study (P = 0.022). Control patients with a basal A1C <7% (n = 15) showed the characteristic bimodal distribution of A1C levels, whereas the A1C levels in the intervention group remained stable throughout the study with low HF1. CONCLUSIONS -- Long-term use of the IBGMS has proven to be superior to conventional diabetes care systems based on office visits for controlling blood glucose and achieving glucose stability. [ABSTRACT FROM AUTHOR]

OBJECTIVE — The Internet is used worldwide as a communication tool. To improve the quality of diabetes control, we investigated the effectiveness of an Internet-based blood glucose monitoring system (IBGMS) on controlling the changes in HbA1c levels. RESEARCH DESIGN AND METHODS — We conducted a randomized clinical trial involving 110 patients who visited the outpatient clinic at the Kangnam St. Mary's Hospital for 3 months. The study subjects were treated with IBGMS for 12 weeks, and the control group received the usual outpatient management over the same period. HbA1c and other laboratory tests were performed twice, once at the beginning of the study and again at the end of the study. RESULTS — The test results from the beginning of the study established that there were no significant differences between the two groups with respect to age, sex, diabetes duration, BMI, blood pressure, HbA1c, and other laboratory data. On follow-up examination 12 weeks later, HbA1c levels were significantly decreased from 7.59 to 6.94% within the intervention group (P < 0.001). At the end of the study, HbA1c levels in the intervention group were significantly lower than in the control group after adjusting the baseline HbA1c (6.94 vs. 7.62%; P < 0.001, respectively). Among patients with baseline HbA1c <7.0%, the patients in the intervention group had lower HbA1c than those in the control group (6.38 vs. 6.99%; P < 0.05). Among the patients with a baseline HbA1c ≥7.0%, the difference between the two groups appeared more obvious: HbA1c levels at the end of the study were 8.12%. CONCLUSIONS — This new IBGMS resulted in a significant reduction of HbA1c during the study period. We propose that this IBGMS be used as a method for improving diabetes control. [ABSTRACT FROM AUTHOR]

OBJECTIVE--This study was conducted to investigate the association of diabetic peripheral neuropathy (DPN) with both arterial stiffness and intima-media thickness (IMT). RESEARCH DESIGN AND METHODS--We conducted a cross-sectional analysis of 731 subjects with type 2 diabetes. DPN was diagnosed on the basis of neuropathic symptoms, insensitivity to a 10-g monofilament, abnormal pin-prick sensation, and abnormal current perception threshold. Arterial stiffness was assessed by cardio-ankle vascular index (CAVI), and IMT was assessed by B-mode ultrasonography. RESULTS--Patients with DPN had higher CAVI than those without DPN in multivariateadjusted models, whereas no differences in IMT were observed between patients with and without DPN after adjustment for age and sex. In the multivariate analysis, CAVI was a significant determinant of DPN (odds ratio 1.36 [95% CI 1.13-1.65], P = 0.001). CONCLUSIONS--DPN is significantly associated with arterial stiffness without carotid intimal changes in patients with type 2 diabetes. [ABSTRACT FROM AUTHOR]

A major obstacle of islet transplantation in is an inadequate supply of insulin-producing tissue. Ad-PDX-1/VP16 overexpression and Exendin-4 treatment have been proved the effects on differentiation and proliferation of pancreatic stem cells. But, the study is insufficient using adult animal pancreatic stem cells. Pancreatic cells were prepared from the non-endocrine fraction of canine pancreases. These cells were cultured free floating state or monolayer culture after dispersion. The 5 days cultured floating pancreatic cell clusters were transplanted under the kidney capsule of normoglycaemic nude mice. After transplantation, the relative volume of the β-cells in the grafts was 23.4±13.1% at two weeks and 5.2±2.0% at eight weeks. The monolayer cultured pancreatic cells were infected with Ad-PDX-1/VP16 or Ad-GFP. After infection, those cells were reaggregated and transplanted into renal subcapsular space of normoglycaemic nude mice. After transplantation, nude mice were treated with either 1 nmol/kg exendin-4 or saline solution by intraperitoneal injection for l0 days. At eight weeks after transplantation, the relative volume of insulin-positive cells in the grafts was 11.8±5.9%, 8±7.3% and 16.6±7.4% in control, GFP and PDX-1/VP 16 treated groups respectively. Exendin-4 treatment didn't show any additive effects on transdifferentiation of canine adult pancreatic cells into β-cells. In conclusion, the expansion and transdifferentiation were not observed after the transplantation of the free floating cultured adult pancreatic cells isolated from the canines. PDX-1/VP16 overexpression induces the transdifferentiation of canine adult pancreatic cells into β-cells. However Exendin-4 treatment hasn't any effects on the expansion and transdifferentiation of the cells in the grafts. [ABSTRACT FROM AUTHOR]

Various parameters are used to evaluate insulin resistance and insulin secretory dysfunction, the two main pathogenesis of type 2 diabetes. But, controversy still exists on the role of these two factors. We aimed to define the main factors contributing to the progression of glucose intolerance in non-obese and obese people. Anthropometric measurements and biochemical tests including oral glucose tolerance test(OGTT) were done in 500 subjects without past history of diabetes but with incidentally detected hyperglycemia on routine examination. HOMA-β, HOMA-IR, insulinogenic index and ISI composite values were calculated. According to the glucose level from OGTT, the subjects were grouped as normal glucose tolerance(NGT), impaired fasting glucose and/or impaired glucose tolerance(IFG ± IGT), and diabetes mellitus(DM) by WHO criteria. The patients with DM were subdivided into patients diagnosed by isolated fasting hyperglycemia(DM-IFH), patients diagnosed by isolated postprandial hyperglycemia(DM-IPH), and patients fulfilling both criteria(DM-FPH). In non-obese people, the decrease in basal insulin secretion preceded when progressing from NGT to IFG, DM-IFH and the increase in insulin resistance led to overt DM. In obese people, the decrease in basal insulin secretion also preceded when progressing to fasting hyperglycemia. Although the insulinogenic index had decreased, the absolute value is thought to be not low enough to induce postprandial hyperglycemia. In the progression of postprandial hyperglycemia, the role of early-phase insulin secretion and muscle resistance was important. When progressing from NGT to IFG + IGT and to DM, all indexes deteriorated significantly in both non-obese and obese people. Different strategies in preventing and delaying the occurrence of diabetes may be applied according to the body mass index and the subgroups of glucose intolerance considering the underlying pathophysiology. Further large-scaled studies are needed to clarify the detailed characteristics of the subjects in risk of diabetes. [ABSTRACT FROM AUTHOR]

Oral glucose tolerance test [OGTT] is commonly employed in the diagnosis of diabetes mellitus. However, the relationship of fasting plasma glucose [FPG] and postchallenge 2hr plasma glucose levels [2h PG] to HbA1c in newly diagnosed diabetic patients is not determined. This study was undertaken to test the relationship during OGTT depends on the presence of obesity. The study group consisted of 387 newly diagnosed and untreated type 2 diabetic patients. Diabetic patients were divided into two groups, obese [OB] and nonobese [NOB] patients according to body mass index (BMI) and the proportion of obese diabetic patients (BMI≥25 kg/m² OB) were 152 (41.4%). OGTT was performed and blood samples were drawn before and 2 hr after glucose load for measurement of plasma glucose, insulin and C-peptide. HOMA beta cell function and resistant index were analyzed. Correlation of HbA1c with FPG and 2hr PG in the study population yielded the same r values of 0.53 and 0.54, respectively. FPG and 2hr PG individually correlated with HbA1c value especially in both OB and NOB patients demonstrating fair to poor glycemic control (HbA1c > 7.0%). Although FPG concentrations were found to be more strongly correlated with HbA1c levels than 2hr PG in OB (r=0.53 vs. 0.42), but not in NOB (r=0.53 vs. 0.58). During OGTT FPG did not differ between these two groups (166.6±68.4 vs. 179.1± 61.7 mg/dl, p>0.05) but NOB had significantly higher 2hr PG concentrations than OB (324.4±95.4 vs. 279.5±82.1 mg/dl, p<0.001). As for insulin level at baseline and 120 min after oral glucose load, there was significant differences between two groups (baseline: 9.5+7.8 vs. 5.7±5.5 µIU/ml, 120 min: p<0.01; 35.7±32.7 vs. 21.1±22.1 µIU/ml, p<0.001). HOMA beta cell function and resistant index of NOB are significantly lower than those of OB (25.8±36.8 vs. 48.3±54.6, p<0.001; 2.5±2.5 vs. 3.8±3.1, p<0.0001). Our results suggest that 2hr PG value might be more useful predictor for glycemic control especially in newly diagnosed NOB patients and it could be associated with more advanced defect of insulin secretion and relatively better insulin sensitivity than OB. [ABSTRACT FROM AUTHOR]

Objectives: This study was performed to investigate the prevalence and clinical characteristic of the metabolic syndrome in middle aged Korean adults. Subjects and Methods: This Chungju Metabolic Syndrome (CMS) study was performed for 4 consecutive years, 2003-2006 on total 11,526 individuals (4,711 men and 6,815 women) selected by the stratified random cluster sampling among adults over 40 years old in Korea. The metabolic syndrome was defined based on both the NCEP criteria and Modified NCEP (Mod-NCEP) criteria using the WHO-APR(Asian Pacific Region)'s abdominal obesity criteria (waist circumference >90 cm in men, >80 cm in women) as well as International Diabetes Federation (IDF) criteria. Results: Using NCEP criteria, the age-adjusted overall prevalence of metabolic syndrome was 24.0% (18.5% in men, 27.8% in women). Age-adjusted overall prevalence of metabolic syndrome as defined by Mod-NCEP and IDF criteria was 34.0% and 27.2%. Prevalences of the metabolic syndrome as defined by IDF criteria for each age group (40-49, 50-59, 60-69, ≥ 70) in men were as follows: 20.3%, 18.9%, 17.5%, 11.8%. In women: 26.5%, 37.9%, 41.9%, 37.8%. Amount of alcoholic drinking and current smoking status of men were highest in age 40-49 and then decreased with aging, whereas amount of exercise was highest and current smoking status of women was lowest in 40-49 year old women and then increased. Conclusions: Interestingly, peak age of the metabolic syndrome in men was age 40-49, and prevalence decreased with aging regardless of type of definition. On the other hand, prevalence of the metabolic syndrome in women was abruptly increased after menopause (in age 50-59) and then gradually increased. Some proposed that recent increments of obesity and the metabolic syndrome in Asian population including Korean are resulted from "thrifty gene hypothesis". Our study results might suggest that men are more susceptible to environmental factor than women, whereas women are likely to be influenced by aging process or menopausal status rather than "thrifty gene". [ABSTRACT FROM AUTHOR]

Latent autoimmune diabetes in adults(LADA) is a subgroup of diabetes which resembles the clinical characteristics of type 2 diabetes(T2DM) but positive for islet-related autoantibodies. We aimed to establish the prevalence and characteristics of LADA and compare it with T2DM in Korean patients. From 2003 to 2006, anthropometric measurements and biochemical studies including IA-2 antibodies and glutamic acid decarboxylase(GAD) antibodies were done in 938 adults who visited a tertiary care institution for the management of diabetes. Type 1 diabetes(n=49) and other types of diabetes(n=9) were excluded in this study. The diagnosis of LADA was made with the fulfillment of i) onset of diabetes at age>30, ii) presence of circulating islet autoantibodies, iii) lack of requirement of insulin at least 6 months after diagnosis. The prevalence of LADA was 4.8%(n=45). Among them, 32 were positive for GAD antibody, 8 were positive for IA-2 antibody, and 5 were positive for both antibodies. These patients had a significantly lower C-peptide level(0.81±0.76 vs 1.62±1.44 ng/mL; p<0.0001), waist circumference(83.8±9.6 vs 88.1±10.2 cm; p=0.02), waist-hip-ratio(0.91±0.07 vs 0.944±0.08; p=0.04) and triglyceride(l15.2±61.2 vs 163.1±130.6 mg/dL; p<0.0001) than patients with T2DM. They also had a significantly lower prevalence of hypertension(35.5% vs 55.1%; p=0.01) while the rate of insulin treatment(37.8% vs 25.5%; p=0.01) and history of weight loss and/or 3p sign(43.2% vs 26.9%; p=0.01) were higher than that of T2DM. LADA constituted 10% among the patients without metabolic syndrome, while it constituted 3.2% among the patients with metabolic syndrome. LADA takes a considerable proportion in Korean diabetic patients, and they are characterized by lower parameters of insulin resistance than T2DM. Therefore, LADA should be suspected in patients with low C-peptide level, especially in those without metabolic syndrome. [ABSTRACT FROM AUTHOR]

This study was performed to determine the prevalence of diabetic retinopathy and its association with various related parameters in rural Korean type 2 diabetic patients. A community based study was scheduled to perform on 1,317 subjects with known type 2 diabetes over 30 years living in Chungju city, South Korea. All of the study subjects were completed the survey consisting of anthropometric measurement, blood chemistry and interview and fundoscopic examination. Diabetic retinopathy was diagnosed by practicing ophthalmologists, we analyzed diabetic retinopathy prevalence and relationship between retinopathy and associated various parameters for detecting risk factors. The overall prevalence of diabetic retinopathy was 17.9%. Proliferative diabetic retinopathy (PDR) was found in 1.1% of the study subjects. Prevalence of mild, moderate and severe non-proliferative diabetic retinopathy (NPDR) were 9.8%, 3.3% and 3.7%, respectively. In logistic regression analysis, variables independently associated with diabetic retinopathy were duration of diabetes mellitus and post-prandial blood glucose level. Adjusted relative risk for diabetic retinopathy was increased by duration of diabetes mellitus [< 5 years: 2.23 (95% CI; 0.493-10.159), 5-10 years: 5.192 (95% CI; 1.138-23.684), > 10 years: 10.034 (95% CI; 2.284-44.075)] compared with their duration of diabetes less than 1 year and post-prandial glucose level [> 180 mg/dL: 1.96 (95% CI; 1.09-3.54)] compared with less than 180mg/dL. The overall prevalence of diabetic retinopathy was 17.9% in rural Korean type 2 diabetic patients. The presence of diabetic retinopathy was significantly associated with duration of diabetes, Hemoglobin Ale and post-prandial blood glucose level. [ABSTRACT FROM AUTHOR]

Background: Intensive insulin treatment in type2 diabetes can improve β-cell function. The rapid insulin analogs(lispro) used as prandial and the long acting insulin analogs (glargine)used as basal can simulate physiological insulin profile more closely. Subjects and Method: Type2 diabetic patients(18 males and 24 females) were hospitalized and treated with multiple split insulin injection (lispro + glargine). We performed oral glucose tolerance test on subjects and HbA1C, blood glucose, insulin, C-peptide and other indexes were measered before and after MSII. Result: Total patient insulin requirement is 40.97±14.04 IU(0.65±0.26IU per kg) and basal insulin(Glargine) requirement is 16.29±5.76 IU.(39.7% of total amount). According to DM duration, we divided these patients into 2 groups, drug naive group, secondary failure to sulfonylurea. After MSII, the AIR of naive group was significantly higher than before treatment.(0.07±0.05 vs 0.61 ±0.72 pmol/L/min, p<0.05) The HOMA-β and AUCi/AUCg were also elevated significantly.(HOMA-β 8.03 vs 195.20; AUCi/AUCg 0.02±0.01 vs 0.38±0.38, p<0.05). But WBISI(whole body insulin sensitivity index) increase from 7.66± 4.69 to 2.79±1.75 (p<0.05). Conclusion: HOMA-β, AIR, AUCi/AUCg were used for evaluating β cell function. These indexes were markedly improved after MSII. Our results showed that strict correction of hyperglycemia could greatly improve β cell function, especially in drug naive patients. [ABSTRACT FROM AUTHOR]

Objectives: This study was performed to compare which is better predict cardiovascular event between Metabolically obese but normal weight (MONW) and Metabolically health but obese (MHO). Subjects and methods: We analyzed the data from total 7,007 Korean subjects (2,843 men and 4,164 women) from population based cross-sectional study and their mean age was 62.0±10.5 years. We defined the highest quartile of HOMA-IR as "metabolically obese (highly insulin resistant)" group and the lowest quartile as "metabolically healthy (very insulin sensitive)" group. Furthermore, subjects with their BMI ≥ 25 kg/m² were defined as "obese" group and 18.5 ≤ BMI < 23 kg/m² was defined as "normal weight" group according to Asian-Pacific region criteria for obesity. Results: Waist circumference, diastolic blood pressure, non HDL cholesterol, total cholesterol/HDL cholesterol ratio of MOH were significantly higher than those of MONW. However, fasting glucose and insulin level was significantly higher in MONW than MOH. Among MOH, prevalences of the metabolic syndrome defined by both NCEP and IDF criteria were significantly higher that of MONW (44.6% vs 35.8% in NCEP, 40.7% vs 17.2% in IDF) whereas prevalences of type 2 diabetes mellitus (T2DM) and impaired fasting glucose (IFG) in MONW were significantly higher than MOH (27.2% vs 7.5% in T2DM, 8.8% vs 3.3% in IFG). Furthermore, estimated 10 year CHD risk using Framingham risk score in MONW was significantly higher than MOH (12.1±11.5 vs. 8.9±7.1). Conclusions: Our study results suggested that highly insulin resistant subjects with normal weight might have higher risk for T2DM and CV event compared with obese, but very insulin sensitive subjects. [ABSTRACT FROM AUTHOR]

The article discusses a study on searching for functional microRNA (miRNA) in the beta-cells especially related with the diabetic status such as glucolipotoxicity. The study isolated 30 µg of total RNA and performed the miRNA chip array using an Ncode miRNA chip with primary rat islets. The study found that among 36 selected miRNA, 16 might be related with glucolipotoxicity-induced beta-cell dysfunction.