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We assessed the 24‐week efficacy and safety of teneligliptin, a novel dipeptidyl peptidase‐4 inhibitor, in Korean patients with type 2 diabetes mellitus (T2DM) that was inadequately controlled with diet and exercise. The present study was designed as a multicentre, randomized, double‐blind, placebo‐controlled, parallel‐group, phase III study. Patients (n = 142) were randomized 2 : 1 into two different treatment groups as follows: 99 received teneligliptin (20 mg) and 43 received placebo. The primary endpoint was change in glycated haemoglobin (HbA1c) level from baseline to week 24. Teneligliptin significantly reduced the HbA1c level from baseline compared with placebo after 24 weeks. At week 24, the differences between changes in HbA1c and fasting plasma glucose (FBG) in the teneligliptin and placebo groups were −0.94% [least‐squares (LS) mean −1.22, −0.65] and −1.21 mmol/l (−1.72, −0.70), respectively (all p

BACKGROUND The purpose of this study was to evaluate change in glycosylated hemoglobin (HbA1c), side effects, and quality of life (QOL) after a 16-week treatment period with Biphasic insulin aspart 30/70 (BIasp30) in patients with type 2 diabetes mellitus (T2DM) who had been suboptimally controlled with oral antidiabetic drugs (OADs). METHODS The study consisted of a 4-week titration period when concurrent OAD(s) were replaced with BIasp30 and followed by a 12-week maintenance period. All patients completed the Diabetes Treatment Satisfaction Questionnaire at the beginning and the end of the trial. Hypoglycemic episodes were recorded by the patient throughout the trial. RESULTS Sixty patients were included, of whom 55 patients (92%) completed the full 16-week treatment period. Seven-point blood glucose was significantly improved as compared with the baseline, except for the postlunch blood glucose level. HbA1c at the end of period was significantly improved from 9.2% to 8.2% (P

Diabet. Med. 29, e121–e125 (2012) Abstract Aims The influence of hyperglycaemia on the performance of glomerular filtration rate (GFR) estimating equations remains to be determined. We compared the performance of creatinine-based GFR with cystatin C-based GFR in patients with Type 2 diabetes according to glycaemic status. Methods In a cross-sectional study of 210 patients with Type 2 diabetes, we staged glycaemic status by HbA1c tertiles [HbA1c≤ 75 mmol/mol (9.0%) (n = 70), HbA1c 76–95 mmol/mol (9.1–10.8%) (n = 70), HbA1c >95 mmol/mol (10.8%) (n = 70)] and measured GFR. Isotopic GFR was measured using renal dynamic imaging with 99mTc-diethylene-triamine-penta-acetic acid. Estimated GFR (eGFR) was measured using creatinine-based formulae (Cockcroft–Gault-eGFR, the Modification of Diet in Renal Disease equation-eGFR and the Chronic Kidney Disease Epidemiology Collaboration formula-eGFR) and a cystatin C-based formula (cystatin C-eGFR). Results The isotopic GFR of all patients was 93.1 ± 34.1 ml min−1 1.73 m−2. All methods for estimating GFR underestimated isotopic GFR [Cockcroft–Gault-eGFR (68.8 ± 38.6 ml min−1 1.73 m−2) (P 95 mmol/mol (10.8%) where there was no difference between cystatin C-eGFR and isotopic GFR. Conclusions Performance of cystatin C-eGFR was superior to creatinine-based GFR in patients with Type 2 diabetes with HbA1c > 95 mmol/mol (10.8%).

Summary 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

Background: The First Basal Insulin Evaluation (FINE) Asia study is a multinational, prospective, observational study of insulin-naive Type 2 diabetes mellitus (T2DM) patients in Asia, uncontrolled (A1c ≥ 8%) on oral hypoglycemic agents, designed to evaluate the impact of basal insulin initiation. Methods: Basal insulin was initiated with or without concomitant oral therapy and doses were adjusted individually. All treatment choices, including the decision to initiate insulin, were at the physician’s discretion to reflect real-life practice. Results: Patients (n = 2679) from 11 Asian countries were enrolled (mean [±SD] duration of diabetes 9.3 ± 6.5 years; weight 68.1 ± 12.7 kg; A1c 9.8 ± 1.6%). After 6 months of basal insulin (NPH insulin, insulin glargine, or insulin detemir), A1c decreased to 7.7 ± 1.4%; 33.7% patients reached A1c

Background: Hypertension and type 2 diabetes mellitus are major risk factors for cardiovascular disease. This study analyzed the changes in central aortic waveforms and pulse wave velocity as well as related parameters after treatment with valsartan, an angiotensin II type 1 receptor blocker, in patients with type 2 diabetes and hypertension. Methods: We used pulse wave analysis to measure central aortic waveform in a total of 98 subjects. In 47 of these patients, pulse wave velocity measurements were obtained before and after 12 weeks of treatment with valsartan. Results: In the central aortic waveform analysis, the aortic pulse pressure and augmentation index were significantly decreased after valsartan treatment, as was the aortic pulse wave velocity. Factors contributing to the improvement in pulse wave velocity were the fasting blood glucose and haemoglobin A1c levels. Conclusion: Short-term treatment with valsartan improves arterial stiffness in patients with type 2 diabetes and hypertension, and the glucose status at baseline was associated with this effect.

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 (HFI). RESULTS—The mean A1C and HFI 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 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.

OBJECTIVE—The effect of lipoprotein(a) [Lp(a)] on the progression of diabetic nephropathy has not been evaluated yet. The aim of this study was to determine whether Lp(a) is an independent risk factor for deteriorating renal function in type 2 diabetic patients with nephropathy. RESEARCH DESIGN AND METHODS—We conducted this prospective study in type 2 diabetic patients with overt proteinuria. Patients were divided into two groups according to their baseline serum Lp(a) level. Group 1 had Lp(a) levels ≤30 mg/dl (n = 40) and group 2 had Lp(a) levels >30 mg/dl (n = 41). Patients were followed for 2 years. Progression of diabetic nephropathy was defined as a greater than twofold increase of follow-up serum creatinine concentration from the baseline value. RESULTS—At baseline and during the follow-up, there was no difference in HbA1c and lipid profile between groups 1 and 2. However, serum creatinine was significantly higher in group 2 than in group 1 after 1 year (148.3 ± 78.0 vs. 108.1 ± 34.9 μmol/l, P = 0.004) and after 2 years (216.9 ± 144.5 vs. 131.3 ± 47.3 μmol/l, P = 0.001), although baseline serum creatinine did not differ significantly between groups. In all, 13 of 14 patients with progression of diabetic nephropathy (progressors) were from group 2. Baseline Lp(a) levels were higher in the progressors than in the nonprogressors (62.9 ± 26.7 vs. 33.5 ± 27.5 mg/dl, P < 0.001). Multiple logistic regression showed that baseline Lp(a) level was a significant and independent predictor of the progression of diabetic nephropathy. CONCLUSIONS—Our study demonstrated that Lp(a) is an independent risk factor for the progression of diabetic nephropathy in type 2 diabetic patients with overt proteinuria.

We thank Byung-Wan Lee for his thoughtful and insightful comments on our study regarding "Efficacy and safety of biphasic insulin aspart 30/70 in type 2 diabetes suboptimally controlled on oral antidiabetic therapy" [1]. To the first point, there have been many guidelines regarding insulin initiation in type 2 diabetic patients. Therefore, various options are available, including the types of insulin to be chosen, the starting dose, and the ratio of prebreakfast to predinner insulin. At the time of the study design and initiation, dividing the premixed insulin dose with the ratio of 2:1 was usual clinical practice in Korea, which was adopted in our study. Regarding the time of single insulin injection in the morning, we wanted to avoid nocturnal hypoglycemia to enhance the adherence to insulin therapy. Second, as we mentioned in our article, oral antidiabetic drug (OAD) treatment should be combined with insulin, even after conversion to insulin treatment, as OAD(s) plays an important role in blood glucose control. Metformin can be used at full dose in concert with insulin, but it is uncertain whether sulfonylurea should be maintained with insulin therapy or decreased. Recent American Diabetes Association/European Association for the Study of Diabetes guideline showed some tips on combination use of insulin and OAD(s). It is recommended that insulin secretagogues be avoided once prandial insulin regimens are employed, and thiazolidinedions be reduced in dose (or stopped) to avoid edema and excessive weight gain [2,3]. Third, the major side effect of insulin therapy is weight gain. The disparity in weight gain between our study and Jang's study may be arise from study population (mean age of 57 years vs. over 65), study design (prospective vs. retrospective) and discontinuation of metformin in our study [1,4]. Finally, insulin therapy in Korean may not be different from other ethnic groups. When we use premixed insulin once or twice and cannot achieve target goals, further actions should be taken to control postlunch blood sugar, such as combining OAD(s) and/or adding prelunch insulin injection.

To evaluate the association between serum 25-hydroxyvitamin D [25(OH)D] and arterial stiffness in patients with type 2 diabetes.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.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 (p0.001) 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.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.

A conference was convened by the Korean Diabetes Association and the Korean Endocrine Society on September 7, 2009 to discuss and organize the results of research on intensive glucose control for the prevention of cardiovascular disease in patients with type 2 diabetes. Professor Kyung Soo Park led the conference, and Professors Kwang Won Kim and Ho Young Son acted as chairmen. Professors Doo Man Kim, Tae Sun Park, and Bong Soo Cha reported on intensive glucose control and diabetic complications, including the UK Prospective Diabetes Study (UKPDS), Diabetes Control and Complication Trial (DCCT) research results, the recently published Action to Control Cardiovascular Risk in Diabetes (ACCORD), Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE), and Veterans Affairs Diabetes Trial (VADT) research, as well as meta-analyses. Professor Jeong-Taek Woo reported on the manuscript written by the committee for the Korean Diabetes Association which dealt with the treatment of diabetes mellitus. Professors Kyung Soo Ko, Joong Yeol Park, Hyun Shik Son, Moon-Kyu Lee, Dong-Won Byun, and Yoon-Sok Chung participated in the discussion and collected information for the manuscript from all of the participants. The aim of the debate was to determine how to establish target goals for intensive glucose control and how to individualize those goals. The participants concluded that there was no need to modify the recommendation of maintaining an HbA1c under 6.5%, the current blood glucose treatment goal that is recommended by the Korean Diabetes Association. In addition, individual target goals for glucose control were recommended depending on the situation of each patient. We report on the consensus statement from the meeting.

Aims/Introduction: Mitiglinide is the newest drug in the meglitinide family. It increases the early‐phase insulin release through rapid association‐dissociation kinetics in the pancreatic β cells. The efficacy and safety of adding meglitinide to metformin monotherapy in patients with type 2 diabetes are unknown. Materials and Methods: We carried out a prospective, randomized, multicenter trial to assess the efficacy and safety of combined treatment with mitiglinide and metformin for patients with type 2 diabetes who showed inadequate glycemic control with metformin monotherapy. Subjects with glycated hemoglobin (HbA1c) >7.0% after an 8‐week metformin run‐in phase were randomized to a 16‐week trial phase with metformin plus mitiglinide (Met + Mit) or metformin plus placebo (Met + Pcb). Results: Compared with the Met + Pcb group, the Met + Mit group showed a greater reduction in HbA1c (−0.7 ± 0.6%vs−0.4 ± 0.7%, P = 0.002), fasting plasma glucose (−0.77 ± 1.76 mmol/L vs−0.05 ± 1.60 mmol/L, P = 0.015) and 2‐h postprandial glucose (−3.76 ± 3.57 mmol/L vs−0.84 ± 3.07 mmol/L, P

Evaluating increasing circulating adiponectin levels is becoming an important strategy in the prevention of diabetes mellitus and cardiovascular events. This study was designed to investigate the effect of the angiotensin II receptor blocker valsartan on blood adiponectin levels and insulin sensitivity in patients with type 2 diabetes and mild-to-moderate hypertension. A total of 91 Korean patients were treated with 80 mg/day valsartan for 4 weeks followed by 160 mg/day for a further 8 weeks. Blood pressure, adiponectin levels and metabolic parameters were measured before and after treatment. The homeostasis model assessment of insulin resistance (HOMA-IR) was calculated as an insulin sensitivity index. Valsartan significantly decreased mean blood pressure and increased circulating adiponectin levels. There were no differences in metabolic parameters, including HOMA-IR, glycosylated haemoglobin and lipid levels before and after treatment. These results indicated that valsartan increases circulating adiponectin levels, but does not change insulin sensitivity in patients with type 2 diabetes and mild-to-moderate hypertension.

This study was designed to investigate the relationship between adipokines in metabolic syndrome and insulin resistance. Sixty male and female subjects with or without metabolic syndrome and type 2 diabetes were included. The homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Compared with lean control subjects, patients with metabolic syndrome and type 2 diabetes had lower circulating levels of total adiponectin and high molecular weight (HMW) adiponectin, and higher levels of leptin and interleukin-6 (IL-6). Total and HMW adiponectin and the adiponectin/leptin (A/L) ratio were negatively correlated with HOMA-IR. After adjusting for age and sex, leptin, IL-6 and tumour necrosis factor-α (TNF-α) were positively correlated with HOMA-IR. After also adjusting for body mass index, HOMA-IR was found to be independently associated with leptin, A/L ratio and TNF-α levels. In conclusion, decreased total adiponectin and HMW adiponectin and increased leptin and IL-6 levels are characteristic of patients with metabolic syndrome and type 2 diabetes.

We appreciate the interest and comments on our study, "The effect of an angiotensin receptor blocker on arterial stiffness in type 2 diabetes mellitus patients with hypertension," which was published in Diabetes & Metabolism Journal 2011;35:236-242. Hypertension and type 2 diabetes mellitus are major risk factors for cardiovascular disease. In type 2 diabetes, hypertension often initiates and accelerates the progression of macrovascular events by increasing arterial stiffness [1,2]. Increased arterial stiffness was recently reported to be a powerful and independent risk factor for early mortality and had more clinical prognostic value than previously identified cardiovascular disease risk factors such as age, gender, smoking and dyslipidemia [3]. Previous studies have reported that angiotensin II type 1 receptor blockers reduce arterial stiffness [4-6]. In our study we assessed changes in central aortic waveforms and pulse wave velocity (PWV) as well as related parameters after treatment with valsartan in patients with type 2 diabetes and hypertension. We excluded patients concomitantly using insulin, thiazolidinedion or metformin as insulin resistance is associated with arterial stiffness and premature vascular sclerosis [7,8]. Our group of study subjects was homogeneous in terms of diabetes treatment, which had a minimal effect on insulin resistance. As Dr. Kim noted, our study has some limitations. There was no control group treated with other anti-hypertensive agents and confounding factors, such as lipid-lowering drugs, antiplatelet agents, and smoking, were not considered in the analysis. We were unable to measure PWV in all participants and the potential selection bias and diminished statistical power due to the small number of subjects was another limitation of this study. Although data was not shown in the article, there was no difference in baseline PWV values between the 'PWV decrease' and 'no PWV decrease' groups (11.0±1.8 vs. 10.5±2.0, P=0.297), and baseline PWV values were not associated with fasting blood glucose or HbA1c (P=0.462, P=0.641). We thought that if the number of subjects were larger, there might be association between them. Because there have been reported that fasting glucose and HbA1c were associated with PWV in type 2 diabetes patients with hypertension [9]. In our results, the baseline glucose level was significantly higher in 'no PWV decrease group.' Therefore, we concluded that the change in PWV was associated with baseline glycemic control status. Also, there were no differences between the two groups in terms of systolic or diastolic blood pressure at 12 weeks (P=0.183, P=0.396) or drug compliance, which was verified at every patient visit. Thus a difference in blood pressure control was excluded as a factor influencing the difference in PWV between the two groups. The results of our study suggested that the angiotensin receptor blocker, valsartan, had a modest beneficial effect in reducing arterial stiffness measured as PWV and the augmentation index in patients with type 2 diabetes and hypertension. Fasting glucose and HbA1c levels are likely to be independently associated with PWV improvement as a result of valsartan treatment. In future, further trials are needed to validate the effect observed in our study, to examine its stability over longer periods of follow-up, and to compare it with that obtained with other antihypertensive agents commonly used in clinical practice, and evaluate the pathogenic mechanism.

Cardiovascular disease (CVD) is the major cause of mortality in type 2 diabetes mellitus. CVD is a clinical manifestation of atherosclerosis, a chronic and progressive inflammatory disease characterized by a long asymptomatic phase. Progression of atherosclerosis can lead to the occurrence of acute cardiovascular events. Atherosclerosis can be identified during the subclinical phase by several methods, including using biomarkers, pulse wave velocity, augmentation index, flow-mediated dilation, carotid ultrasound, and calcium score. The appropriate criteria for identifying asymptomatic patients with type 2 diabetes who should undergo CVD screening and therapeutic intervention remain controversial. Non-invasive methods, such as markers of subclinical atherosclerosis, may aid in risk stratification and the design of tailored therapies for patients with type 2 diabetes mellitus.

Background: Type 2 diabetes is usually preceded by a long and clinically silent period of increasing insulin resistance. The purpose of this study is to demonstrate that rosiglitazone and metformin fixed-dose combination therapy (RSG/MET) will safely and effectively control glycemia as a first line of oral therapy, better than rosiglitazone (RSG) or metformin (MET) monotherapy in Korean type 2 diabetes patients. Methods: This study was a 32-week, multicenter, randomized, double-blind study. Twenty-seven type 2 diabetes patients (males 14; females 13) were included and randomly divided into the rosiglitazone, metformin group, or rosiglitazone /metformin combination groups. The primary objective of this study was to determine the change in HbA1c from baseline (week 0) to week 32. The secondary end-points were to determine changes in fasting plasma glucose (FPG) and homeostasis model assessment insulin resistance (HOMA-IR), from baseline to week 3 2. Other cardiovascular risk markers were also assessed. Results: At week 32, there were significant reductions in HbA1c and FPG, in all three treatment groups. There was no statistical difference in HbA1c among the three groups, but the decrease in FPG in the RSG/MET group was statistically significant compared to the MET group (P < 0.05). RSG/MET significantly reduced HOMA-IR at week 32 compared to baseline, but there was no difference among the three groups. RSG/MET significantly decreased high-sensitive C-reactive protein (hs-CRP) value at week 32, compared to baseline. There were increases in adiponectin from baseline to week 32 in the RSG and RSG/MET groups, and the increase in the RSG/MET group was statistically signifi cant compared to that of the MET group (P < 0.05). At week 32, there was a significant decrease in plasminogen activator inhibitor-1 (PAI-1) in all three treatment groups, but no statistically significant difference among them. The RSG/MET group significantly decreased in terms of urinary albumin-creatinine ratio at week 32, compared to baseline. Conclusions: In this study, rosiglitazone and metformin combination therapy was effective in glycemic control as an initial therapy, and it improved cardiovascular risk markers in Korean type 2 diabetes patients. (KOREAN DIABETES J 32:445-452, 2008)

Background: Obese type 2 diabetic subjects are recently increasing in Korea , indicating the importance of insulin resistance rather than insulin secretory defects in the pathophysioloy of type 2 diabetes. The purpose of this study is to evaluate the safety and efficacy of fixed dose rosiglitazone/metformin combination therapy in poorly controlled subjects with type 2 diabetes mellitus. Methods: 12 type 2 diabetic subjects who had a HbA1c > 11% or fasting plasma glucose > 15 mmol/L were included. After a 2 week screening period, the subjected took the fixed does rosiglitazone/metformin for 24 weeks. The treatment with rosiglitazone/metformin began at week 0 with an initial dose of 4 mg/1000 mg and, unless tolerability issues arose, subjects would be increa sed to 6 mg/1500 mg at week 4 and at week 8 to the maximum dose of 8 mg/2000 mg. The primary object of th is study was to characterize the magnitude of HbA1c reduction from baseline after 24 weeks of rosiglitazone and metformin treatment in poorly controlled type 2 diabetics. Results: The mean age of the subjects was 48.9 ± 10.6 years old, body mass index was 25.0 ± 3.5 kg/m 2 , HbA1c was 12.0 ± 1.0%, and fasting plasma glucose was 16.3 ± 3.1 mmol/L. HbA1c was reduced to 7.54 ± 1.45% and fasting plasma glucose reduced to 7.96 ± 2.38 mmol/L at week 24. The proportion of HbA1c responder who show ed the reduction from baseline of ≥ 0.7% or HbA1c < 7% was 11 among 12 subjects (91.7%). 41% of the subjects (5 among 12 subjects) achieved HbA1 c level < 7.0% and 75% (9 among 12 subjects) achieved HbA1c level < 8.0%. Conclusions: In this study, rosiglitazone and metformin combination therapy was effective in glycemic control in poorly controlled subjects with type 2 diabetes mellitus. (KOREAN DIABETES J 32:506-512, 2008)

Background: Adiponectin is adipose tissue derived hormone, which has been shown to play an important role in the regulation of glucose and lipid metabolism. Low adiponectin levels are associated with obesity and diabetes and coronary artery disease. In addition to adiponectin level, the adiponectin multimerization and its ratio to total adiponectin have also affect on metabolic risk factors and insulin resistance. However, the adiponectin multimerization pattern in type 2 diabetes of Korean has not been established. We investigated adiponectin levels and adiponectin multimerization pattern according to obesity in type 2 diabetes males of Korean. Method: The subjects of this study were 86 of diabetes patients and 89 of control subjects whose fasting blood glucose was below 110 mg/dL. They were divided into two subgroup, non-obese and obese, according to BMI (non-obese 25 < BMI). Anthropometric parameter and other metabolic risk factors were measured. Insulin resistance was presented by HOMA-IR. Plasma adiponectin level was measured by radioimmunoassay method. Adiponectin multimerization was fractionated by SDS-PAGE under non-reducing and non-heat denaturing state and performed immunoblotting. Result: Serum adiponectin levels were significantly reduced in obese than non obese group in diabetes patients (7.73 ± 5.2 versus 12.56 ± 8 μg/mL, P = 0.003). Correlational analyses demonstrated that BMI, body weight, waist circumference, diastolic pressure, glucose and height correlated significantly with adiponectin levels in the diabetes patients. The HOMA-IR did not affect the plasma adiponectin levels in diabetic patients. There were no differences in adiponectin multimerization distribution and ratio between obese and non-obese group in the diabetes, however middle molecular weight multimers (MMW, ~110~160 Kda, hexamer) ratio in the control subjects were significantly reduced in obese group than non-obese group (49 ± 9 versus 56 ± 11%, P < 0.05). Conclusion: The adipoenctin levels were lower in obese than non-obese group of diabetes males in Korea. Aiponectin levels correlated with BMI and weight but not insulin resistance. The differences of adiponectin multimerization distribution and ratio between obese and non-obese group in diabetes were not detected. (J Kor Diabetes Assoc 31:243~252, 2007)

Abstract - - Abstract - - Abstract - - Abstract - Background: Walking is a popular, convenient and relatively safe form of exercise. However, there is few objective data for walking exercise. The aim of this study was to evaluate pedometer-determined physical activity defined as steps/day in type 2 diabetes mellitus. Therefore, it could be the basic data for programming walking exercise in diabetes mellitus. Methods: Participants with type 2 diabetes who visited in 6 university hospitals on February, 2006 in Seoul and Kyung-gi area were recruited. The participants were asked their ambulatory activity with the given pedometer and calorimeter for 1 week. Total 240 (Male 122, Female 118) subjects who walked above 1000 steps/day were analyzed. We also collected their biochemical data from the medical records. Results: Participants took 8532 ± 4130 steps for day (step/day) and energy expenditure were 320 ± 161 Cal/day. Steps/day was not significantly different between male and female, but energy expenditure was higher in male than female ( P < 0.05). Steps/day was significantly lower in obese patients than non-obese patients ( P < 0.001). BMI (r = -0.325, P < 0.001), waist circumference (r = -0.287, P < 0.001), triglyceride (r = 0.164, P < 0.018) showed significant inverse correlation with steps/day, but BUN (r = 0.165, P = 0.019) and HDL-cholesterol (r = 0.164, P = 0.018) were positive correlated with steps/day significantly. BMI (r = -0.14, P < 0.032) and cholesterol (r = -0.139, P < 0.041) showed significantly inverse correlation with energy expenditure and BUN (r = 0.187, P = 0.008) and HDL cholesterol (r = 0.145, P < 0.037) positively correlated with energy expenditure. Pedometer-determined steps/day was positively associated with energy expenditure (r 2 = 0.824, P < 0.001).

Abstract - - Abstract - - Abstract - - Abstract - Background The regulation of tyrosine phosphorylation/dephosphorylation is an important mechanism in various intracellular metabolism. Also impaired insulin signal transduction is important in pathogenesis of type 2 diabetes. It has been reported that PTP1B is a negative regulator of insulin action, and G iα2-protein is related to the regulation of PTP1B. Herein we investigated the long-term effects of ramipril on PTP1B/insulin signal protein interaction and the relation between G iα2 and PTP1B in animal model of type 2 diabetes (OLETF rat). Methods OLETF rats and age-matched LETO rats were divided into two groups. One group of rats received ramipril (10 mg/kg body weight) for 12 weeks, and another group did not. Finally, each group was divided into 2 subgroups, with or without insulin injection intravenously, before sacrifice. After sacrifice, tissues extracts of liver, hind limb muscle, and epididymal fat were obtained for quantification of PTP1B, Giα2, and several insulin signal proteins by western blotting. Results: In liver and muscle, the levels of basal PTP1B and activated PTP1B of OLETF rats treated with ramipril and insulin were significantly decreased. The levels of G iα2, activated IRS-2, and activated p-85 α were significantly increased in OLETF rats treated with ramipril and insulin. In adipose tissue, the levels of G iα2 and activated p-85 α of OLETF rats treated with ramipril and insulin were slightly increased as in liver and muscle. But, the levels of basal PTP1B and activated PTP1B were significantly increased. And, the levels of activated IRS-1 and activated IRS-2 were decreased. Conclusion: These results suggest that the improvement of insulin sensitivity by treatment with ramipril was related to the decreased level of activated PTP1B. Also, we could suggest that the changes of activated PTP1B level was related with the changes of G iα 2-protein. However, the results of adipose tissue were different from those of liver and muscle. So it seemed likely that there would be various major modulators for regulation of insulin signal pathway according to tissue (J Kor Diabetes Assoc 30:25~38, 2006).