Circulating immune complexes (ClC) were detected by platelet aggregation test (PAT) in 40.0% of 45 diabetics and by polyethylene glycol precipitation-complement consumption test (PEG-CC test) in 30.6% of 36 diabetics as compared to 5% and 10% of 20 normal control subjects for each test. The prevalence of CIC in diabetics was significantly higher than in the normal controls (P < 0.05%). There were no correlations between the presence of ClC detected by PAT and the duration of the disease, insulin treatment, or diabetic complications. Thus multiple factors must contribute to the increase of ClC in diabetics. The role of these various factors needs to be studied.
Antigen-Antibody Complex/metabolism* ; Diabetes Mellitus/complications ; Diabetes Mellitus/immunology* ; Diabetes Mellitus, Insulin-Dependent/drug therapy ; Diabetes Mellitus, Insulin-Dependent/immunology ; Diabetes Mellitus, Non-Insulin-Dependent/immunology ; Human ; Insulin/therapeutic use ; Platelet Aggregation ; Time Factors

The prevalence of diabetes is increasing worldwide. The World Health Organisation has estimated that there will be around 300 million diabetics by 2025. The largest increase will occur in Asia. The prevalence of type 2 diabetes is increasing due to a combination of factors: increasing lifespan, sedentary lifestyle, excessive intake of high energy foods, increasing prevalence of overweight/obese people. The Finnish Diabetes Prevention Study Group has clearly shown that changes in the lifestyle of both overweight men and women with impaired glucose tolerance can reduce the incidence of type 2 diabetes by 58%. This finding was confirmed by the Diabetes Prevention Programme which found that lifestyle intervention in individuals with impaired fasting glucose or impaired glucose tolerance reduced the risk of developing type 2 diabetes by 58%, whereas treatment with metformin reduced the risk of type 2 diabetes by only 31%. Both acarbose and troglitazone have also been shown to reduce the progression to diabetes in individuals who are at high risk of developing type 2 diabetes. Since the cure for diabetes remains some way off our concerted efforts should be directed at prevention of diabetes in order to curb the increasing prevalence of diabetes worldwide. Lifestyle changes are more beneficial than long term drug therapy in the prevention of diabetes and should be actively promoted.
Diabetes Mellitus, Non-Insulin-Dependent ; Prevention ; Diabetes ; Prevalence aspects ; Life Style

Impaired glucose tolerance (IGT) and type 2 diabetes including undiagnosed isolated postchallenge hyperglycemia (IPH) are common in the elderly. The aim of this study was to investigate the insulin secretion and sensitivity in Korean elderly lean diabetic women. Forty-one lean women aged 65-88 years took 2 hr oral glucose tolerance test (OGTT) and were stratified according to the WHO criteria (normal glucose tolerance [NGT], n=20; IGT, n=6; and type 2 diabetics, n=15 including seven IPH). HbA1c and fructosamine progressively increased from the NGT to the diabetic subjects (p=0.006 and p=0.001, respectively). Compared with subjects with NGT, the insulinogenic index, a marker of early insulin secretion and the AUCins, a marker of total insulin secretion, decreased significantly in diabetic group [0.53 (-0.44 -1.45) vs. 0.18 (0.00 -1.11), p=0.03 and 306 +/- 165 vs. 199 +/- 78 pmol/L, p=0.02 respectively]. A significant difference was found in the AUCc-peptide among each group (221 +/- 59 vs. 206 +/- 34 vs. 149 +/- 51 pmol/L, p=0.001 for each). The homeostasis model assessment of insulin resistance (HOMA-IR), a marker of insulin resistance, was not different among the groups. We conclude that compared with NGT subjects, elderly lean women with diabetes have impaired oral glucose-induced insulin secretion but have relatively preserved insulin sensitivity. This suggests that insulin resistance is not necessarily an essential component of Korean elderly lean diabetic women.
Aged ; Aged, 80 and over ; Diabetes Mellitus, Non-Insulin-Dependent/*metabolism ; Female ; Glucose Tolerance Test ; Human ; Insulin/*secretion ; *Insulin Resistance ; Thinness

Objective: Clinical studies suggest that maintaining a lower postprandial glycemic response is important for improvement and prevention of metabolic syndrome and type 2 diabetes mellitus. Amylose, an ingredient in many food grains, is a major factor for the lowering of postprandial glycemic and insulinemic response. The aim of the present study was to determine the influence of rice with different level of amylose on postprandial glycemic and insulinemic response in mice and humans.Materials and Methods: The two types of rice used in the study contained 29 wt% (high amylose rice) or 17 wt% (low amylose rice) amylose. In mice and humans, postprandial glycemic and insulinemic responses were measured and then the area under the response curves of both rice groups were compared.Results: In mice, comparisons of postprandial glycemic response showed high amylose rice was lower than that for low amylose rice in all time points. Notably postprandial glycemic responses for high amylose rice at 15, 30, 45 and 60 min were significantly lower (19%, 31%, 16% and 17% respectively). The area under the glycemic response curve for high amylose rice was a remarkably 16% less than for the low amylose rice. In humans, postprandial glycemic response at 30 min and insulinemic response at 60 min for high amylose rice were significantly lower than for low amylose rice (15% and 40% lower, respectively). Furthermore, general linear measurement multivariate analysis after adjustment for eating time and hemoglobin A1c at baseline showed that postprandial glycemic response at 30 and 60 min and insulinemic response at 60 min, and the area under the glycemic response curve for high amylose rice were significantly lower than for low amylose rice in human.Conclusion: The higher amylose content of the rice lowered the postprandial glycemic and insulinemic response, demonstrating the potential to prevent or improve metabolic syndrome and type 2 diabetes mellitus.
Rice ; Minute of time ; Laboratory mice ; Syndrome ; Diabetes Mellitus, Non-Insulin-Dependent

A simplified colorimetric method for measurement of the levels of glycosylation of proteins was developed by a modification of an existing method. Employing this method, the extent of nonenzymatic glycosylation of apolipoprotein B subspecies(B-100, B-74, B-26), LDL, VLDL and total serum proteins in human plasma obtained from patients with diabetes mellitus and control subjects was compared. Plasma LDL (1.019 < d < 1.063) and VLDL(d < 1.006) were separated using the sequential ultracentrifugation method, and the subspecies of apolipoprotein B were isolated by extracting them from polyacrylamide gels after they were separated by preparative SDS-polyacrylamide gel electrophoresis. Increases in the level of glycosylation of serum proteins, LDL, VLDL, and apo B subspecies obtained from diabetic patients were observed. Among them, the increases of glycosylated LDL and apo B-26 were most significant (p < .001). Also, good correlations were found between glycosylations of apo B-26 and LDL (r=.88), and glycosylation of LDL and LDL cholesterol level(r=.79). The results also showed an excellent correlation between levels of HbA1c and glycosylated apo B-26(r=.93).
Adult ; Colorimetry/methods* ; Diabetes Mellitus, Non-Insulin-Dependent/blood* ; Glycosylation ; Human ; Lipoproteins, LDL/blood*

BACKGROUND: Although insulin resistance and decreased insulin secretion are characteristics of established type 2 DM, which of these metabolic abnormalities is the primary determinant of type 2 DM is controversial. It is also not well known how insulin resistance and beta cell dysfunction influence serum insulin, proinsulin, proinsulin/insulin ratio in type 2 DM. METHODS: We compared serum insulin, proinsulin and proinsulin/insulin ratio in type 2 diabetic patients and control subjects. We also investigated the relationship between serum insulin, proinsulin and proinsulin/insulin ratio and several biochemical markers which represent insulin resistance or beta cell function. RESULTS: Insulin, proinsulin and proinsulin/insulin ratio were significantly higher in type 2 DM than control(p < 0.001). In diabetic patients, total insulin level was correlated with urinary albumin excretion rates(r = 0.224, p = 0.025) and body mass index(r = 0.269, p = 0.014). Proinsulin level was correlated with fasting C-peptide(r = 0.43, p = 0.002), postprandial 2 hour blood glucose(r = 0.213, p = 0.05) and triglyceride(r = 0.28, p = 0.022). Proinsulin/insulin ratio was positively correlated with fasting C-peptide(r = 0.236, p = 0.031), fasting blood glucose (r = 0.264, p = 0.015), postprandial 2 hour blood glucose(r = 0.277, p = 0.001) and triglyceride(r = 0.428, p < 0.001). In control subjects, insulin level was correlated with triglyceride(r = 0.366, p = 0.002). Proinsulin/insulin ratio was correlated with age(r = 0.241, p = 0.044). CONCLUSION: The serum levels of insulin and proinsulin seem to be associated with several markers of insulin resistance. Whereas proinsulin/insulin ratio might represent beta cell function rather than insulin resistance. But more studies are needed to clarify the mechanisms of elevated proinsulin/insulin ratio in type 2 DM.
Aged ; Diabetes Mellitus, Non-Insulin-Dependent/etiology ; Diabetes Mellitus, Non-Insulin-Dependent/blood* ; Female ; Human ; Insulin/blood* ; Insulin Resistance* ; Islets of Langerhans/physiopathology* ; Male ; Middle Age ; Proinsulin/blood* ; Sulfonylurea Compounds/pharmacology

In order to study the relationship between the serum ferritin level and the components of the insulin resistance syndrome in type 2 diabetic patients, we evaluated fifty type 2 diabetic patients who were selected according to NDDG/WHO criteria from those patients attending Korea University Hospital from 1997 to 1998. Twenty-five healthy non-diabetic subjects of comparable age and sex distribution acted as a control group. The results showed that the value of log ferritin was higher in the type 2 diabetes patients than the control subjects, but not at a statistically significant level (p = 0.09). Log ferritin was correlated with fasting blood sugar level (r = 0.235, p = 0.048) and body mass index (BMI) (r = 0.285, p = 0.05). In the type 2 diabetic patients, log ferritin was correlated with fasting C-peptide (r = 0.478, p = 0.009). In the control subjects, log ferritin was correlated only with BMI (r = 0.477, p = 0.012). In a stepwise multiple regression analysis, the diabetic group showed a significant correlation between fasting C-peptide and log ferritin (p = 0.001). In the control group, the fasting sugar level was significantly correlated with log ferritin (p = 0.034). These results suggest that serum ferritin can be employed as a marker of not only glucose homeostasis but also insulin resistance both in type 2 diabetic and control subjects.
Aged ; Body Mass Index ; C-Peptide/blood ; Carbohydrates/blood ; Diabetes Mellitus, Non-Insulin-Dependent/blood* ; Female ; Ferritin/blood* ; Human ; Male ; Middle Age ; Reference Values

BACKGROUND: The risk of developing diabetes is high in the offspring of patients with type 2 diabetes. There have been no studies to assess the offspring's awareness of the risk of developing diabetes. The aim of this study was to investigate how the male offspring of type 2 diabetic patients assess their likelihood of developing diabetes. METHODS: One hundred and one non-diabetic men with one or both parents having type 2 diabetes, aged 19-28 years, were recruited. RESULTS: Thirty-nine subjects (38.6%) were concerned about diabetes and 85 (84.2%) considered diabetes a serious problem. However, only 10 (9.9%) thought they might develop diabetes and 9 (8.9%) had previously attended diabetes education programs with their parents. The educational level amongst the diabetic parents was the only independent predictor of perception of the increased risk. Age, body mass index, waist-to-hip ratio, educational level and the perception of diabetes as a serious problem were not associated with perception of the increased risk. CONCLUSION: Most offspring of diabetic parents lacked knowledge about the increased risk amongst family members. We suggest that physicians and diabetic educators should provide knowledge about the increased risk of developing diabetes in offspring and the benefit of lifestyle modification to delay or prevent the development of the disease.
Adult ; Body Mass Index ; Diabetes Mellitus, Non-Insulin-Dependent/epidemiology/*genetics ; Educational Status ; Family ; Human ; *Knowledge, Attitudes, Practice ; Korea ; Logistic Models ; Male ; Military Personnel ; Questionnaires ; Risk Factors

Most Korean patients with non-insulin-dependent diabetes mellitus (NIDDM) have been reported not to be obese, and many of them lost weight significantly during the course of their disease. In this regard, a retrospective cohort study was conducted to determine the relationship between body mass index (BMI, kg/m2) and the risk for NIDDM among Koreans. Subjects who had received a medical examination from 1990 to 1991 and who were available for the detection of NIDDM until September 1999 were included. Subjects who initially had diabetes or were diagnosed as diabetic within 1 yr after enrollment were excluded. We reviewed the medical records of final cohort of 2,531 subjects. Follow-up of this cohort revealed 117 cases with diabetes with an incident of 7.8 per 1,000 person-years. Compared with those with BMI less than 23 kg/m2, the adjusted relative risks for diabetes mellitus for those with BMI of 23-24.9, 25-26.9, and greater than 27 kg/m2 were 0.85 (0.47-1.50), 1.29 (0.72-2.31), and 3.38 (1.22-4.63), respectively, for men (p for trend<0.01) and as for 9.14 (1.99-41.8), 7.36 (1.47-36.8), and 14.5 (3.03-69.2), respectively, for women (p for trend<0.01). These data indicate a direct relationship between obesity and the risk for the development of diabetes, emphasizing the importance of weight control for the prevention of NIDDM in Koreans.
Adolescence ; Adult ; Aged ; Aged, 80 and over ; Body Mass Index ; Cohort Studies ; Diabetes Mellitus, Non-Insulin-Dependent/*etiology ; Female ; Human ; Male ; Middle Age ; Obesity/*complications ; Retrospective Studies

The diagnosis of diabetic nephropathy (DN) is almost always based on clinical grounds. The diagnosis is supported by a long history of diabetes, evidence of target organ damage and proteinuria preceding azotemia. The validity of this clinical approach is well established in insulin dependent diabetes mellitus but not in non-insulin dependent diabetes mellitus (NIDDM). It is thus important to determine which patients with NIDDM accompanied by non-diabetic renal disease (NDRD) should have a biopsy. However, factors clinically associated with NDRD in patients with NIDDM remain unclear. Therefore we reviewed clinical data, laboratory data and renal biopsies from 22 NIDDM patients who underwent renal biopsy between 1992 and 1998 in Wonju Christian Hospital. From this data, we identified important features that would discriminate between DN and NDRD. There were 8 women and 14 men. Age ranged from 33 to 68 (51.2 +/- 10.7) years. The duration of diabetes at biopsy ranged from 0 to 13 (4.2 +/- 4.2) years. Nephrotic syndrome was present in 13 patients. The patients with NDRD (n = 14) and DN (n = 8) had comparable 24-hour proteinuria, 24-hour albuminuria, creatinine clearance, serum creatinine, albumin, as well as incidences of neuropathy and hypertension. The significant factors that predict the NDRD included a short duration of the diabetes mellitus, the presence of dysmorphic red blood cells in urine, the absence of retinopathy and HbA1c below 9% (p < 0.05, respectively). NDRD included IgA nephropathy (n = 6), minimal change disease (n = 3), membranous nephropathy (n = 3), membranous lupus nephritis (n = 1) and acute interstitial nephritis (n = 1). Multiple logistic regression analysis revealed that the short duration of DM and the absence of retinopathy were factors significantly associated with NDRD. In summary, when there is a short duration of diabetes mellitus, or an absence of retinopathy seen in patients with NIDDM, then renal biopsy in diabetic patients aids in the detection of NDRD.
Adult ; Aged ; Biopsy ; Diabetes Mellitus, Non-Insulin-Dependent/complications* ; Diabetic Nephropathies/diagnosis ; Diagnosis, Differential ; Female ; Human ; Kidney/pathology ; Kidney Diseases/pathology ; Kidney Diseases/diagnosis ; Kidney Diseases/complications* ; Male ; Middle Age