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Abstract: Aims/Introduction: We investigated the failure of monotherapy in patients with type 2 diabetes mellitus in real practice settings. Materials and Methods: The Korean National Diabetes Program was a prospective, multicenter observational cohort study of type 2 diabetes mellitus patients in Korea. Of the 3,950 patients enrolled in the study, we studied 998 who were continuously maintained on monotherapy for at least 90 days at six participating centers. To balance the baseline characteristics of patients in each group, we used propensity matching at a 1:1 ratio (metformin vs sulfonylureas) and 4:1 ratio (metformin vs meglitinides and metformin vs alpha‐glucosidase inhibitors [aGIs]). The hazard ratios (HRs) of treatments (compared with metformin) were determined by Cox's proportional hazards regression modeling. Results: The median follow‐up time was 56 months, and monotherapy failed in 45% of all patients. The annual incidences of failure were 15.6%, 21.3%, 27% and 9.6% in the metformin, sulfonylurea, meglitinide and aGI groups. Compared with metformin, sulfonylureas and meglitinides were associated with higher risks of monotherapy failure (HR 1.39, 95% confidence interval [CI] 1.08–1.80; HR 1.92, 95% CI 1.13–3.27), and aGIs with risks similar to that of metformin (HR 0.80, 95% CI 0.44–1.45). When analyzed by failure type, sulfonylureas, meglitinides and aGIs were associated with a higher risk of a switch to other agents (HR 4.43, 95% CI 2.14–9.17; HR 18.80, 95% CI 6.21–56.93; HR 4.25, 95% CI 1.49–12.13), and aGIs with a lower risk of prescription of add‐on second agents (HR 0.16, 95% CI 0.04–0.64). Conclusions: Metformin was associated with a lower failure risk than were sulfonylureas and meglitinides, but a comparable aGI failure rate. [ABSTRACT FROM AUTHOR]

Background: With the increased incidence of diabetes mellitus, the importance of early intervention in prediabetes has been emphasized. We previously reported that fermented kimchi, a traditional Korean food, reduced body weight and improved metabolic factors in overweight participants. We hypothesized that kimchi and its fermented form would have beneficial effects on glucose metabolism in patients with prediabetes. Methods: A total of 21 participants with prediabetes were enrolled. During the first 8 weeks, they consumed either fresh (1-day-old) or fermented (10-day-old) kimchi. After a 4-week washout period, they switched to the other type of kimchi for the next 8 weeks. Results: Consumption of both types of kimchi significantly decreased body weight, body mass index, and waist circumference. Fermented kimchi decreased insulin resistance, and increased insulin sensitivity, QUICKI and disposition index values (p = 0.004 and 0.028, respectively). Systolic and diastolic blood pressure (BP) decreased significantly in the fermented kimchi group. The percentages of participants who showed improved glucose tolerance were 9.5 and 33.3% in the fresh and fermented kimchi groups, respectively. Conclusions: Consumption of kimchi had beneficial effects on glucose metabolism-related and anthropometric factors in participants with prediabetes. Fermented kimchi had additional effects on BP and insulin resistance/sensitivity. The percentage of participants who showed improvement in glucose tolerance was high in the fermented kimchi group. © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

AMP-activated protein kinase (AMPK) is activated under a variety of conditions that signify cellular stress, usually in response to a change in the intracellular ATP-to-AMP ratio. This is well known as a major drug target of diabetes. Ginseng has been shown to antidiabetic properties in many clinical and experimental studies. In previous our study, Panax ginseng (Korean red ginseng :KRG) showed improvement of insulin resistance and preventive effect on type 2 diabetes. Here, we evaluated the hypothesis that the insulin-sensitizing effect of KRG is mediated through the action of AMPK. To investigate the chronic effect of KRG on AMPK regulation in skeletal muscle and liver in vivo, OLETF rats were randomly allocated into two experimental groups: control and KRG. KRG was given orally once daily at a dose of 200 mg/kg to 10 week-old male OLETF rats for 32 weeks. To investigate the acute effect ofKRG on AMPK signaling in skeletal muscle and liver in vitro, L6 myotubles and HepG2 cells were incubated for 1hr, 6hr and 24 hr with KRG. Western blot analysis was performed to evaluate the expression of AMPK; ACC, PPARα and glucose transport (GLUT)-4. Thr 172 phosphorylation of AMPKα was significantly decreased in liver and skeletal muscle (gastrocnemius) of untreated OLETF rats. However, KRG treatment resulted in increased phosphorylation of AMPK in both tissues. Similarly, Ser79 acetyl-coA carbosylase (ACC) phosphorylation was increased in KRG-treated OLETF rats. The expression of PPARα was also increased in skeletal muscle and liver of KRG treated OLETF rats. In addition, the expression of GLUT4 was increased in skeletal muscle. In HepG2 cell line, KRG treatment during 1hr, 6hr and 24 hr was increased phosphorylation of AMPK. This effect mimicked those of metformin 2mM. ACC phosphorylation also increased in KRG treatment. Similarly, KRG treatment was increased phoshorylation of AMPK and ACC in differentiated L6 myotubules. In summary, KRG may enhance fatty acid oxidation via the activation of AMPK in skeletal muscle and liver, which contribute to the improvement of hyperglycemia, hyperlipidemia and insulin resistance. We suggest that KRG may have potential role in treatment and prevention of metabolic syndrome and type 2 diabetes. [ABSTRACT FROM AUTHOR]

Background: Posttransplantation diabetes mellitus (PTDM) is a major metabolic complication in renal transplant recipients. Recent genome-wide association studies have identified several genes associated with type 2 diabetes. Here, we examined the association between PTDM and 17 single nucleotide polymorphisms (SNPs) located within 15 genes in a cohort of renal allograft recipients in Korea., Materials and Methods: A total of 589 patients who received kidney transplants between 1989 and 2007, without a history of diabetes and had a pretransplant fasting glucose less than 5.5 mmol/L were included in this study. We analyzed the association between the PTDM development and the following SNPs: TCF7L2 rs7903146, SLC30A8 rs13266634, HHEX (rs1111875, rs7923837, and rs5015480), CDKAL1 rs10946398, CDKN2A/B rs10811661, IGF2BP2 rs4402960, FTO rs8050136, WFS1 rs734312, JAZF1 rs864745, CDC123/CAMK1D rs12779790, TSPAN8 rs7961581, THADA rs7578597, ADAMTS9 rs4607103, NOTCH2 rs1092391, and KCNQ1 rs2237892., Results: Eight SNPs in six genes were significantly associated with the PTDM development: TCF7L2 rs7903146 (odds ratio [OR]=2.20, P =0.016), SLC30A8 rs13266634 (OR=1.52, P =0.003), HHEX rs1111875 (OR=1.47, P =0.007), HHEX rs7923837 (OR=2.32, P =0.014), HHEX rs5015480 (OR=1.59, P =0.003), CDKAL1 rs10946398 (OR=1.43, P =0.008), CDKN2A/B rs10811661 (OR=1.33, P =0.039), and KCNQ1 rs2237892 (OR=1.46, P =0.009)., Conclusions: These data suggest that genetic variations in TCF7L2, SLC30A8, HHEX, CDKAL1, CDKN2A/B, and KCNQ1 are associated with PTDM in Korea.