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Aims: This study was performed to investigate whether ventilatory dysfunction is a predictor for the development of prediabetes and type 2 diabetes in Koreans. Methods: We analyzed the clinical and laboratory data of 16,195 Korean adults (age 20-79 years) who underwent routine medical checkups with a mean 4.7-years (range 3.0-5.9 years) interval. Spirometry results were categorized into three patterns: normal, obstructive ventilatory dysfunction [OVD; forced expiratory volume in 1 s (FEV)/forced vital capacity (FVC) <0.70], and restrictive ventilatory dysfunction (RVD; FVC < 80 % predicted, FEV/FVC ≥ 0.70). Results: Compared with subjects with normal ventilatory function, subjects with RVD had a higher incidence of type 2 diabetes (3.7 vs. 6.3 %; P < 0.001), whereas subjects with OVD did not (3.7 vs. 4.8 %; P = 0.119). On multivariate logistic regression analysis, the odds ratio (OR) of RVD for type 2 diabetes was significantly increased after adjusting for age, sex, and lifestyle factors (1.40; 95 % CI 1.10-1.78). However, further adjustment for body mass index (BMI), waist circumference, and baseline glucose level attenuated the OR to become insignificant (1.12; 95 % CI 0.86-1.47). Among the 9,461 participants who had normal fasting glucose and HbA1c levels at baseline, the OR for progression to prediabetes or diabetes in the RVD group was significantly increased (1.30; 95 % CI 1.12-1.51). The increased OR remained significant after adjusting for BMI, waist circumference, and baseline glucose level (1.26; 95 % CI 1.07-1.47). Conclusions: Our results indicate that restrictive, but not obstructive ventilatory dysfunction, is independently associated with development of prediabetes and precedes the development of type 2 diabetes. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Bilirubin, a natural product of heme catabolism by heme oxygenase, one of key antioxidant enzymes, has been recognized as a substance with potent antioxidant and cytoprotective properties. Several studies have shown a significant negative relationship between serum bilirubin levels and the risk of metabolic disorders, including type 2 diabetes. However, longitudinal studies investigating the association of elevated serum bilirubin levels and type 2 diabetes are lacking. In the present study, we aimed to investigate the longitudinal effects of baseline serum bilirubin concentrations on the development of type 2 diabetes in healthy Korean men. Materials and Methods: This 4year retrospective longitudinal observational study was conducted at the Asan Medical Center, Seoul, Republic of Korea. The study population consisted of 5960 men without type 2 diabetes who underwent routine health examinations in 2007 (baseline) and 2011 (follow-up). Baseline serum bilirubin concentrations were determined by the vanadate oxidation method. Results: During a 4year period, 409 incident cases of diabetes (6.9 %) were identified. Incident type 2 diabetes decreased across the baseline bilirubin quartile categories (P for trend <0.001). In multivariable-adjusted model, the relative risk (RR) for the development of type 2 diabetes was significantly lower in the highest (i.e., 1.30–2.00mg/dl) than in the lowest bilirubin quartile category (i.e., ≤0.90mg/dl), even after adjustment for confounding variables (RR=0.69, 95% confidence interval 0.48–0.99, P for trend=0.041). Conclusions: The results indicate that serum total bilirubin level may provide additional information for predicting future development of type 2 diabetes in healthy subjects. [Copyright &y& Elsevier]

Background: Elevated ferritin concentration has been implicated in the etiology of type 2 diabetes. Accumulating evidence, mostly from studies conducted on western populations, has demonstrated a strong association between the elevated ferritin concentrations and incident type 2 diabetes. In Asian populations, however, the longitudinal studies investigating the association of elevated serum ferritin levels and type 2 diabetes are lacking. In present study, we aimed to determine whether elevated serum ferritin levels are related to the incident type 2 diabetes in healthy Korean men. Methodology/Principal Findings: This 4 year longitudinal observational study was conducted at the Asan Medical Center, Seoul, Republic of Korea. The study population consisted of 2,029 men without type 2 diabetes who underwent routine health examination in 2007 (baseline) and 2011 (follow-up). Baseline serum ferritin concentrations were measured by chemiluminescent two-site sandwich immunoassay. In multiple-adjusted model, the relative risk (RR) for incident type 2 diabetes was significantly higher in highest compared with the lowest ferritin quartile category, even after adjusting for confounding variables including homeostasis model assessment of insulin resistance (RR = 2.17, 95% confidence interval 1.27–3.72, P for trend = 0.013). Conclusions/Significance: These results demonstrated that elevated level of serum ferritin at baseline was associated with incident type 2 diabetes in an Asian population. [ABSTRACT FROM AUTHOR]

Background: Although obesity and metabolic syndrome have been associated with the risk of type 2 diabetes mellitus (T2DM), it is unclear whether obese or overweight people without metabolic syndrome are at increased risk for T2DM. Methods: Clinical and laboratory data were assessed in 8,748 subjects without diabetes (5,707 men, 3,041 women; age 20-79 years) who underwent voluntary medical check-ups at a 5-year interval. The subjects were categorized by body mass index (BMI) and metabolic syndrome status at baseline, and the incidence of diabetes over 5 years was assessed. Results: Of the 8,748 subjects, 308 (3.5%) developed T2DM over 5 years. Compared with normal weight (BMI <25.0 kg/m2) individuals without metabolic syndrome, the adjusted odds ratios (ORs) were 1.61 (1.13-2.29) and 4.93 (1.90-12.79) for overweight (BMI 25.0-29.9 kg/m2) and obese (BMI ≥30.0 kg/m2) individuals without metabolic syndrome, respectively, and 6.94 (5.08-9.47) and 10.61 (5.59-20.14) for overweight and obese individuals with metabolic syndrome, respectively. Using the lower BMI cutoff points for Asian populations, compared with subjects with BMI <23 kg/m2 without metabolic syndrome, the adjusted ORs for subjects with BMI 23-27.4 kg/m2 and BMI ≥27.5 kg/m2 without metabolic syndrome were 2.64 (1.74-4.00) and 4.31 (2.36-7.86), respectively, and 10.11 (6.53-15.67) and 16.69 (10.40-26.77), respectively, for those with metabolic syndrome. Conclusions: Overweight/obesity and metabolic syndrome both are significant risk factors for development of T2DM in Koreans, and overweight or obesity without metabolic syndrome should not be considered a harmless condition. The lower BMI cutoffs for Asian populations can be useful in predicting risk of T2DM in Koreans. [ABSTRACT FROM AUTHOR]

Abstract: Increased serum ferritin concentrations in nonpathologic conditions, reflecting subclinical iron overload, have been reported to be associated with insulin resistance and an increased risk of type 2 diabetes mellitus (DM). However, serum ferritin concentrations differ significantly according to sex and ethnicity; and data concerning the relationship between serum ferritin concentrations and glucose metabolism abnormalities in Asian men and women are conflicting. This cross-sectional study investigated the association of serum ferritin concentrations with insulin resistance and impaired glucose metabolism in a large number of subjects with normal fasting glucose (NFG) level, impaired fasting glucose (IFG) level, or type 2 DM. We analyzed clinical and laboratory data from 12 090 subjects (6378 men and 5712 women; age, 20-89 years) who underwent general medical checkups. The study population included 1054 subjects with type 2 DM, 3783 subjects with IFG level, and 7253 subjects with NFG level. Serum ferritin, hemoglobin A1c, fasting glucose, lipid, and insulin levels were measured. Insulin resistance and β-cell function indices were derived from a homeostasis model assessment. Serum ferritin concentrations were highest in the DM group, followed by the IFG group and the NFG group, in both men and women (186 ± 127, 176 ± 108, and 156 ± 92 ng/mL, respectively, in men; 85 ± 62, 75 ± 55, and 59 ± 47 ng/mL, respectively, in women). After adjustment for other variables using multiple regression analysis, homeostasis model assessment of insulin resistance was independently associated with serum ferritin concentration in men, but not in women. When the fourth quartile of ferritin was compared with the first quartile, the age-adjusted odds ratio (OR) for type 2 DM was 1.71 (95% confidence interval, 1.38-2.12) in men and 1.50 (1.05-2.13) in women. The OR in men was attenuated to 1.27 (1.01-1.60) but remained significant after adjustment for body mass index (BMI), waist circumference, blood pressure, serum lipids, liver enzymes, and high-sensitivity C-reactive protein (hsCRP). In nondiabetic subjects, the age-adjusted OR for IFG in the fourth quartile of ferritin was 1.82 (1.56-2.13) in men and 1.68 (1.40-2.02) in women. The OR was attenuated to 1.31 (1.11-1.55) in men and 1.45 (1.19-1.78) in women after adjustment for BMI, waist circumference, blood pressure, serum lipids, liver enzymes, and hsCRP. In NFG subjects, the age-adjusted OR for metabolic syndrome in the fourth quartile of ferritin concentration was 2.85 (1.99-4.07) in men and 1.21 (0.82-1.79) in women. In men, the OR was attenuated to 1.58 (1.06-2.37) after adjustment for BMI, liver enzymes, and hsCRP. Increased serum concentrations of ferritin are associated with insulin resistance, type 2 DM, IFG, and metabolic syndrome in men, but only with IFG in women. These results suggest that iron overload is associated with insulin resistance in men, but not in women. [Copyright &y& Elsevier]

A correction to the article "Association of Metabolically Healthy Obesity With Subclinical Coronary Atherosclerosis in a Korean Population" that was published in a 2014 issue of the journal is presented.

Abstract: Aims: To determine the appropriate cutoff value of waist circumference associated with cardiometabolic risk factors in Koreans. Methods: Clinical and laboratory data on 31,076 Korean adults (age 20–89 years, 40% women) were recorded at regular health check-ups. Receiver operating characteristic curves were used to determine the cutoff values of waist circumference with respect to myocardial ischemia, hypertension, diabetes, and multiple risk factors for metabolic syndrome. Results: Age-adjusted odds ratios for myocardial ischemia, diabetes, hypertension, and multiple components of metabolic syndrome for one standard-deviation increase in waist circumference were 1.45, 1.37, 1.55, and 1.89 for men, and 1.28, 2.03, 1.64, and 2.08 for women, respectively. The cutoff value showing the maximum sensitivity plus specificity for detecting myocardial ischemia was 87cm for men and 74cm for women. The cutoff values for discrimination of hypertension, diabetes, and multiple risk factors for metabolic syndrome, were 84, 85, and 83cm, respectively, for men, and 77, 77, and 76cm, respectively, for women. Conclusions: The waist-circumference cutoff values for cardiometabolic disease and its risk factors are lower than those recommended for Asians by the WHO. Waist-circumference cutoff for defining metabolic syndrome should be lowered in the Korean population. [Copyright &y& Elsevier]

Aims: Visceral fat accumulation is known to be an independent risk factor for type 2 diabetes. We aimed to determine the optimal cutoff values of visceral fat area (VFA) for predicting incident type 2 diabetes in Koreans.Methods: Our study population consisted of 13,004 individuals initially free of type 2 diabetes the ages between 20 and 69 years, who underwent routine health examinations between January 2012 and December 2012 and returned for follow-up examinations between January 2016 and December 2016. VFA values were derived from bioelectrical impedance analysis (BIA) at baseline.Results: During a median follow-up of 4.02 years, a total of 481 (4.6% for men and 2.3% for women) incident cases of type 2 diabetes were identified. According to the receiver operating characteristic (ROC) curve, the optimal VFA cutoff values for predicting incident type 2 diabetes were 118.8 cm2 in men and 82.6 cm2 in women, respectively. In a multivariable-adjusted model including obesity and glycemic status, the odds ratios (ORs) of VFA over 120 cm2 in men and 80 cm2 in women were 1.72 and 3.56, respectively.Conclusions: Higher VFA at baseline was an independent risk factor for developing type 2 diabetes and the optimal VFA cutoff values were markedly different between men and women. Therefore, sex-specific reference values for visceral fat obesity such that men with a VFA ≥120 cm2 and women with a VFA ≥80 cm2 should be considered to predict incident type 2 diabetes. [ABSTRACT FROM AUTHOR]

Aims: To examine the abilities of HbA1c and fasting plasma glucose (FPG) criteria predicting 5-year progression rate to diabetes in Korean adults with prediabetes.Methods: Participants included 17,971 Koreans (aged 20-79years) who underwent routine medical check-ups at a mean interval of 5.2years (3.1-6.7years). Prediabetes was defined as FPG 5.6-6.9mmol/l or HbA1c 5.7-6.4% (39-46mmol/mol). Incident diabetes was defined as FPG⩾7.0mmol/l, HbA1c⩾6.5% (48mmol/mol), or initiation of antidiabetic medications.Results: At baseline, the prevalence of prediabetes was 30.6% (n=5495) by FPG and 20.4% (n=3664) by HbA1c criteria. The 5-year progression rate to diabetes was significantly higher in prediabetes identified by HbA1c than by FPG tests (14.7% vs. 10.4%, P<0.001). Of individuals diagnosed with prediabetes by only one test, those by HbA1c alone had a higher risk of progression to diabetes than those diagnosed by FPG alone (6.0% vs. 3.9%, P<0.001). Receiver operating characteristic curve analysis showed that area under the curve was greater for HbA1c (0.855, 95% CI 0.840-0.870) than for FPG (0.830, 0.813-0.846) (P=0.016). After adjustment for conventional risk factors, the odds ratio (OR) of developing diabetes was higher in participants with prediabetes identified by HbA1c (OR 9.91, 8.24-11.9) than by FPG (OR 7.29, 5.97-8.89) (P=0.026).Conclusions: Although fewer individuals with prediabetes were identified by HbA1c than by FPG criteria, the ability to predict progression to diabetes was stronger for HbA1c than for FPG in Koreans. [ABSTRACT FROM AUTHOR]

Abstract: To explore the utility of the HbA1c criterion in the definition of metabolic syndrome (MS) in Koreans, we cross-sectionally analyzed clinical and laboratory data on 11,293 non-diabetic Korean adults (aged 20–89years, 34% women) collected during regular health checkups. Dysglycemia was defined as either fasting plasma glucose (FPG) ≥5.6mmol/l or HbA1c ≥5.7%. The prevalence of MS as judged by the HbA1c criterion alone (17.8%) was significantly less than that determined by FPG level alone (24.5%). Use of a combination of both criteria slightly increased the prevalence of MS (26.0%). Among the 2953 subjects categorized as having MS using the combined criteria, 929 (31%) were diagnosed by the FPG criterion alone, 177 (6%) by the HbA1c criterion alone, and 1847 (63%) using both criteria. The group diagnosed using FPG values alone had significantly higher BMI, waist circumference, blood pressure, fasting plasma insulin levels, and insulin resistance index compared with those in the group diagnosed using HbA1c levels alone. In men, the brachial-ankle pulse wave velocity was significantly higher and the HDL-cholesterol level was lower in the HbA1c-alone group. Therefore, employment of the HbA1c criterion may be useful to define MS in subjects at increased risk for atherosclerosis. [Copyright &y& Elsevier]

Optical measurement of skin auto-fluorescence (SAF), most likely emanating from accumulated advanced glycation end-products (AGEs), has been proposed for the noninvasive diagnosis of glucose intolerance in clinical settings. Here, we developed a novel imaging system with transmission geometry for SAF measurement and compared its diagnostic performance in a Korean population. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this study was to examine the possible association between serum ceruloplasmin, a copper carrying protein, and albuminuria in 456 males with type 2 diabetes. Multivariate regression analysis demonstrated that elevated serum ceruloplasmin was a determinant of albuminuria independently of conventional risk factors. [Copyright &y& Elsevier]

Abstract: We analyzed data of 35,624 non-diabetic Koreans using fasting plasma glucose (FPG) criteria and HbA1c criteria in screening for diabetes. Among the 1,491 subjects newly diagnosed with diabetes, 473 (31.6%) met the FPG criteria only (≥7.0mmol/l), 350 (23.5%) met HbA1c criteria only (≥6.5%), and 668 (44.9%) met both criteria. The DM-by-HbA1c group had significantly older age, higher proportion of women, and lower hemoglobin concentration. The DM-by-FPG group had higher systolic and diastolic blood pressure, fasting serum insulin, and HOMA-IR. Further studies are needed to determine which of these criteria is superior in predicting the risks of long-term vascular complications of diabetes. [ABSTRACT FROM AUTHOR]