Diabetes mellitus is a major chronic disease worldwide, and its prevalence is expected to increase in the near future. Because cardiovascular disease continues to be the leading cause of morbidity and mortality in diabetic patients, it is important to detect and address other risk factors of cardiovascular disease such as hypertension and dyslipidemia. Moreover, presence of diabetes increases the risk of developing hypertension. Despite significant advances in the understanding of the pathophysiology and treatment of hypertension, there are still many debates regarding the management of hypertension, especially in patients with diabetes. The most important unresolved questions are at what blood pressure to initiate drug therapy and the target blood pressure. Recently, the Korean Diabetes Association published "Treatment Guideline for Diabetes 2015." This review will compare major guidelines from other countries and discuss how to determine the target goal for blood pressure control in Korean diabetic patients.
Blood Pressure ; Cardiovascular Diseases ; Chronic Disease ; Diabetes Mellitus ; Drug Therapy ; Dyslipidemias ; Humans ; Hypertension* ; Mortality ; Prevalence ; Risk Factors

BACKGROUND: The prevalence of hypertension reaches 29% in adults over 30 years of age in the Korean population; however, the control rate is merely 44%. The aim of this study was to investigate the associated factors for target blood pressure achievement after triple combination therapy in hypertensive patients. METHODS: From February 2016 to May 2018, 10 family physicians recruited 348 patients, who newly started a triple combination antihypertensive medication. Target blood pressure was defined as a systolic blood pressure (SBP) <140 mmHg and diastolic blood pressure (DBP) <90 mmHg after 6 months of triple combination therapy. Multivariate logistic regression analyses were performed to analyze the associated factors for target blood pressure achievement. RESULTS: Among the 348 study participants, 317 completed 6 months of treatment. The target achievement rate was 76.3% (242/317). The mean absolute difference and 95% confidence interval (CI) for the SBP and DBP were 10.8 mmHg (8.8 to 12.7) and 6.4 mmHg (5.1 to 7.8), respectively (P<0.05). The odds ratio (OR) for the target blood pressure achievement increased in those with college education or higher (OR, 2.69; 95% CI, 1.22–5.92), those with dyslipidemia (OR, 1.74; 95% CI, 1.01–2.99), and those who were satisfied with the medication (OR, 29.91; 95% CI, 3.70–241.92). CONCLUSIONS: The presence of dyslipidemia and patient's satisfaction with the medication were associated with target blood pressure achievement in our analyses. Our findings suggest the importance of patient's factor in the control of blood pressure.
Adult ; Blood Pressure ; Drug Therapy, Combination ; Dyslipidemias ; Education ; Humans ; Hypertension ; Logistic Models ; Odds Ratio ; Physicians, Family ; Prevalence

OBJECTIVETo evaluate the effect of probiotics (bifidobacterium breve and lactobacillus acidophilus) on serum lipid, serum insulin and insulin resistance in high-fat diet (HFD)-induced obese rats.

METHODSFifty male Sprague-Dawley rats were randomly assigned to a control (n=10) and a high fat diet groups (n=40) and were fed with standard diet and HFD respectively. Four weeks later, thirty-six HFD-induced obese rats were randomly administered with normal saline (NS), bifidobacterium breve and lactobacillus acidophilus daily (n=12 each). Four weeks later, body lengths, body weights and abdomen circumference of rats were measured, blood lipid, glucose and insulin levels were measured, and Lee's index and insulin resistance index were calculated.

RESULTSBody weight, abdomen circumference, Lee's index, fasting glucose, triglyceride (TG), total cholesterol (TC), low density lipoprotein (LDL) in the NS-treated HFD group were significantly higher than the control group (P<0.05). The bifidobacterium breve and lactobacillus acidophilus-treated groups had significantly lower levels of body weight, abdomen circumference, Lee's index, fasting glucose, TC, TG and LDL than the NS-treated HFD group (P<0.05), but the levels of the parameters in the bifidobacterium breve and lactobacillus acidophilus-treated groups were significantly higher than the control group (P<0.05). High density lipoprotein (HDL) and insulin sensitivity index in the NS-treated HFD group were significantly lower than the control group (P<0.05). Bifidobacterium breve and lactobacillus acidophilus treatment dramatically increased HDL levels and insulin sensitivity index compared with the NS-treated HFD group (P<0.05), although the levels of the two parameters did not reach to the levels of the control group. There were significant differences in the levels of fasting insulin, insulin resistance index and insulin secretion index between the bifidobacterium breve and lactobacillus acidophilus groups (P<0.05).

CONCLUSIONSLactobacillus acidophilus and bifidobacterium breve can decrease serum levels of lipid and glucose and improve insulin resistance in obese rats. Bifidobacterium breve seems to be more effective on attenuating insulin resistance than lactobacillus acidophilus.

Animals ; Bifidobacterium ; Diet, High-Fat ; Dyslipidemias ; blood ; drug therapy ; Insulin Resistance ; Lactobacillus acidophilus ; Lipids ; blood ; Male ; Obesity ; blood ; Probiotics ; pharmacology ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo compare the physicians' lipid lowering drug prescribing behavior and knowledge on dyslipidemia before and at 8 months after new-issued blood-lipid reports in our hospital.

METHODBlood-lipid reports in our hospital is newly modified in that the classification of dyslipidemia and lipid-lowering guideline and target lipid level are listed on the back of lipid report besides the normal lipid value listed immediately after the measured lipid levels. Physicians' lipid lowering drug prescribing behavior and knowledge on dyslipidemia before and at 8 months after new-issued blood-lipid reports were examined in 143 doctors from various departments before and at 8 months after new-issued lipid reports.

RESULTSAt 8 months after the new issued lipid reports, doctors' cognition rate about the guideline was significantly increased [83.9% (120/143) vs. 67.1% (96/143), P < 0.001] and the guideline was considered more helpful on daily practice [75.3% (58/77) vs. 55.8% (43/77), P = 0.005] compared to baseline. However, the prescription rate of dyslipidemia therapy did not change significantly (69.2% vs. 63.2%, P = 0.117) at 8 months after the new issued lipid reports.

CONCLUSIONSThe modification of the blood-lipid reports improved doctors' knowledge on dyslipidemia and on the "Chinese guidelines on prevention and treatment of dyslipidemia in adults". However, the lipid lowering drug prescribing behavior remained unchanged at 8 months after the modification of the lipid reports. Further investigation is warranted to see if the lipid lowering drug prescribing behavior could be changed in the long-term.

Dyslipidemias ; blood ; drug therapy ; Guideline Adherence ; Health Knowledge, Attitudes, Practice ; Humans ; Hypolipidemic Agents ; administration & dosage ; therapeutic use ; Lipids ; blood ; Physicians ; Practice Patterns, Physicians' ; Prescriptions ; Research Report

OBJECTIVETo observe the efficacy of fenofibrate for hepatic steatosis in rats after severe burn.

METHODSTwenty-seven male SD rats were divided into sham injury group, burn group, and burn+ fenofibrate group according to the random number table, with 9 rats in each group. Rats in sham injury group were sham injured on the back by immersing in 37 ℃ warm water for 15 s and then remained without other treatment. Rats in burn group and burn+ fenofibrate group were inflicted with 30% total body surface area full-thickness scald (hereinafter referred to as burn) on the back by immersing in 98 ℃ hot water for 15 s, and then they were intraperitoneally injected with lactated Ringer's solution at post injury hour (PIH) 1. From PIH 24 to post injury day (PID) 8, rats in burn+ fenofibrate group were treated with fenofibrate in the dose of 80 mg·kg(-1)·d(-1), while those in burn group were treated with equivalent volume of saline. (1) Three rats of each group were respectively selected on PID 4, 6, and 8 for the collection of inferior vena caval blood samples. Serum content of total cholesterol (TC), triglyceride (TG), free fatty acid (FFA), high density lipoprotein (HDL), and low density lipoprotein (LDL) was determined with fully automatic biochemical analyzer. Body mass of each rat was measured immediately after blood sampling, and then rats were sacrificed to collect liver tissue for weighing wet mass. The ratio of wet mass of liver tissue to body mass (liver index) was calculated. Meanwhile, gross observation of liver was performed. (2) One liver tissue sample was harvested from each rat at each time point to observe histopathologic changes with HE staining. One liver tissue slice of each rat at each time point was collected to evaluate degree of hepatic steatosis, and the number of rats in each group in each grade of hepatic steatosis was recorded. Measurement data were processed with analysis of variance of factorial design and SNK test, and enumeration data were processed with Kruskal-Wallis test and Nemenyi test.

RESULTS(1) The content of TC, TG, FFA, and HDL of rats in burn group on PID 4 was obviously different from that in sham injury group (with P values below 0.05). Compared with that in burn group, the content of TC, TG, and FFA of rats was significantly decreased (with P values below 0.05), while the content of HDL of rats was not obviously changed in burn+ fenofibrate group on PID 4 (P>0.05). There were no obvious differences in the content of LDL of rats among 3 groups on PID 4 (with P values above 0.05). The content of TC, TG, and HDL of rats in burn group on PID 6 was obviously different from that in sham injury group (with P values below 0.05). Compared with that in burn group, the content of TC and TG of rats was significantly decreased (with P values below 0.05), while the content of HDL of rats was significantly increased in burn+ fenofibrate group on PID 6 (P<0.05). There were no obvious differences in the content of FFA and LDL of rats among 3 groups on PID 6 (with P values above 0.05). The content of TC and HDL of rats in burn group on PID 8 was obviously different from that in sham injury group (with P values below 0.05). Compared with that in burn group, the content of TC of rats was significantly decreased (P<0.05), while the content of HDL of rats was not obviously changed in burn+ fenofibrate group on PID 8 (P>0.05). There were no obvious differences in content of TG, FFA, and LDL of rats among 3 groups on PID 8 (with P values above 0.05). (2) The texture of liver tissue of rats in burn+ fenofibrate group at each time point was tender and soft, without oil or fat on the section, which was close to the gross condition of liver of rats in sham injury group. Dark yellow plaque scattered on the surface of liver tissue of rats in burn group at each time point with oil and fat on the section, which was especially obvious on PID 6. There was no obvious difference in liver index of rats among 3 groups on PID 4 (F=1.63, P>0.05). On PID 6 and 8, the liver indexes of rats in sham injury group, burn group, and burn+ fenofibrate group were 0.0416±0.0016, 0.0533±0.0054, and 0.0370±0.0069; 0.0423±0.0034, 0.0624±0.0005, and 0.0444±0.0042 respectively. The liver indexes of rats in burn group on PID 6 and 8 were significantly higher than those in the other two groups (with P values below 0.05). There were no obvious differences in the liver indexes of rats between burn+ fenofibrate group and sham injury group on PID 6 and 8 (with P values above 0.05). (3) The liver tissue structure of rats in sham injury group was normal at each time point. Hepatic steatosis of rats in burn group at each time point appeared microvesicular and disperse, which was especially obvious on PID 6. Mild hepatic steatosis was observed in rats of burn+ fenofibrate group on PID 4, and then the structure of liver tissue gradually recovered to normal level from PID 6 on. The degree of hepatic steatosis of rats in sham injury group was 0 grade. One rat in I grade, 1 rat in II grade, and 7 rats in III grade were observed in hepatic steatosis of rats in burn group. Three rats in 0 grade, 4 rats in I grade, and 2 rats in II grade were observed in hepatic steatosis of rats in burn+ fenofibrate group. The degree of hepatic steatosis of rats in burn group was more severe than that in the other two groups (with χ(2) values respectively 56.25 and 162.44, P values below 0.05). The degree of hepatic steatosis of rats in burn+ fenofibrate group was more severe than that in sham injury group (χ(2)=27.51, P<0.05).

CONCLUSIONSFenofibrate can ameliorate the dyslipidemia of severely burned rat, and it can alleviate the degree of hepatic steatosis in certain degree.

Animals ; Burns ; pathology ; Cholesterol, HDL ; blood ; Cholesterol, LDL ; blood ; Dyslipidemias ; drug therapy ; Fatty Acids ; blood ; Fenofibrate ; pharmacology ; Liver ; pathology ; Liver Cirrhosis ; drug therapy ; Male ; Rats ; Rats, Sprague-Dawley ; Triglycerides ; blood

HELP (Heparin-mediated extracorporeal low-density lipoprotein fibrinogen precipitation) is an LDL apheresis system which has been utilized as a last therapeutic option for drug resistant hypercholesterolemia. Recently the scope of the treatment has been expanded to coronary artery obstructive disease (CAOD) or peripheral arterial obstructive disease (PAOD) with dyslipidemia. We applied six sessions of HELP therapy with a week interval to a patient with diabetic gangrene of both feet and PAOD who had elevated LDL-cholesterol and fibrinogen despite maximal drug therapy. Lipids, Lp (a) and fibrinogen were measured on plasma samples before and after treatment. Changes of symptoms and physical findings were reported before, immediately after and 3 month after treatment. In every session, LDL cholesterol level was reduced more than 40%. Mean LDL cholesterols were reduced from 133.5 mg/dL to 55.0 mg/dL (59%). Total cholesterol (104.5 mg/dL;51% decrease), triglycerides (142.0 mg/dL;47% decrease) and Lp (a) (24.3 mg/dL; 58% decrease) levels were also reduced. Mean HDL cholesterol was reduced to 6.3 mg/dL (25%) with prompt recovery to pretreatment level within one week. Mean fibrinogen decreased from 571.0 mg/dL to 253.3 mg/dL (58%) without bleeding complications. Two episodes of dizziness with spontaneous resolution were observed during or over three days after treatment. Two sessions of HELP made diabetic gangrene on toes improved. After six sessions, the gangrenes showed near-complete healing. So we report a case of a patient who had persistent diabetic gangrene of both feet despite proper revascularization, which was completely healed by HELP without significant side effects.
Arterial Occlusive Diseases ; Blood Component Removal ; Cholesterol* ; Cholesterol, HDL ; Cholesterol, LDL ; Coronary Vessels ; Dizziness ; Drug Therapy ; Dyslipidemias ; Fibrinogen* ; Foot* ; Gangrene* ; Hemorrhage ; Humans ; Hypercholesterolemia ; Lipoproteins ; Plasma ; Toes ; Triglycerides

To examine the efficacy and safety for metformin in treating antipsychotic-induced dyslipidemia.
 Methods: Two randomized placebo-controlled trials were included in the analysis. A total of 201 schizophrenia patients with dyslipidemia after treatment with an antipsychotic were collected, and the patients were divided into two groups: a 1 000 mg/d metformin group (n=103) and a placebo group (n=98). The clinical symptoms and metabolic indicators such as body weight, blood glucose, and blood lipids were assessed at baseline, the 12th week and the 24th week after treatment respectively.
 Results: After metformin treatment, the mean difference in the low-density lipoprotein cholesterol (LDL-C) value between the metformin group and the placebo group was from 0.16 mmol/L at baseline to -0.86 mmol/L at the end of the 24th week, which was decreased by 1.02 mmol/L 
(P<0.01). At the 24th week, the LDL-C was more than 3.37 mmol/L in 25.3% patients in the metformin group, which was significantly lower than that in the placebo group (64.8%) (P<0.01). Compared with the placebo group, there were significant changes in the weight, body mass index (BMI), insulin, insulin resistance index, total cholesterol and triglyceride, and high-density lipoprotein cholesterol (HDL-C) in the metformin group (all P<0.05). The treatment effects on weight and insulin resistance appeared at the 12th week and further improved at the 24th week, but the effects on improving dyslipidemia only significantly occurred at the end of the 24th week.
 Conclusion: The metformin treatment is effective in improving antipsychotic-induced dyslipidemia and insulin resistance, and the effect to reduce the antipsychotic-induced insulin resistance appears earlier than the effect to improve dyslipidemia.
Antipsychotic Agents ; adverse effects ; Blood Glucose ; Diabetes Mellitus, Type 2 ; Double-Blind Method ; Dyslipidemias ; chemically induced ; drug therapy ; Humans ; Hypoglycemic Agents ; Metformin ; therapeutic use

No abstract available.
Cholesterol, LDL/*blood ; Dyslipidemias/*drug therapy ; Female ; Heart Failure/*drug therapy ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/*administration & dosage ; Male ; Myocardial Ischemia/*drug therapy ; Pravastatin/*administration & dosage ; Quinolines/*administration & dosage

This study aimed to determine whether taurine supplementation improves metabolic disturbances and diabetic complications in an animal model for type 2 diabetes. We investigated whether taurine has therapeutic effects on glucose metabolism, lipid metabolism, and diabetic complications in Otsuka Long-Evans Tokushima fatty (OLETF) rats with long-term duration of diabetes. Fourteen 50-week-old OLETF rats with chronic diabetes were fed a diet supplemented with taurine (2%) or a non-supplemented control diet for 12 weeks. Taurine reduced blood glucose levels over 12 weeks, and improved OGTT outcomes at 6 weeks after taurine supplementation, in OLETF rats. Taurine significantly reduced insulin resistance but did not improve beta-cell function or islet mass. After 12 weeks, taurine significantly decreased serum levels of lipids such as triglyceride, cholesterol, high density lipoprotein cholesterol, and low density lipoprotein cholesterol. Taurine significantly reduced serum leptin, but not adiponectin levels. However, taurine had no therapeutic effect on damaged tissues. Taurine ameliorated hyperglycemia and dyslipidemia, at least in part, by improving insulin sensitivity and leptin modulation in OLETF rats with long-term diabetes. Additional study is needed to investigate whether taurine has the same beneficial effects in human diabetic patients.
Adipokines/blood ; Animals ; Blood Glucose ; Diabetes Mellitus, Type 2/drug therapy ; Dietary Supplements ; Dyslipidemias/blood/*drug therapy ; Glucose Tolerance Test ; Hyperglycemia/blood/*drug therapy ; Hypoglycemic Agents/administration & dosage/*pharmacology ; Hypolipidemic Agents/administration & dosage/*pharmacology ; Insulin/physiology/secretion ; Insulin Resistance ; Insulin-Secreting Cells/physiology/secretion ; Leptin/*blood ; Lipid Metabolism/drug effects ; Lipids/blood ; Male ; Organ Specificity ; Rats ; Rats, Long-Evans ; Taurine/administration & dosage/*pharmacology

Thiazolidinediones (TZD), which are widely used as insulin sensitizers, and fibrates, which are lipid-lowering drugs, are used in the treatment of dyslipidemia that commonly accompanies diabetes. Several reports suggest elevated levels of high-density lipoprotein (HDL) cholesterol, but the paradoxical reduction of HDL cholesterol level during single or combined TZD and fibrate therapies has been occasionally reported. Herein, we report a case of paradoxical decrease in HDL cholesterol and apolipoprotein A-1 levels during rosiglitazone and fenofibrate treatment for the first time in Korea. The patient was a 56-yr-old man presenting with type 2 diabetes mellitus and dyslipidemia. His HDL cholesterol and apolipoprotein A-1 levels returned to normal after the cessation of fenofibrate therapy. Since diabetes is an established risk factor of cardiovascular diseases, low HDL cholesterol can be a key cause of concern for patients with diabetes. Therefore, HDL cholesterol level should be determined before and after starting TZD and/or fibrate therapy in diabetic patients.
Apolipoprotein A-I/metabolism ; Cholesterol, HDL/*blood ; Diabetes Mellitus, Type 2/complications/*drug therapy ; Dyslipidemias/complications/*drug therapy ; Fenofibrate/*therapeutic use ; Humans ; Hypolipidemic Agents/*therapeutic use ; Male ; Middle Aged ; Thiazolidinediones/*therapeutic use