The metabolic syndrome is a constellation of interrelated risk factors of metabolic origin that appear to directly promote the development of cardiovascular disease. The syndrome is also strongly associated with type 2 diabetes mellitus or the risk for this condition. In this article, we propose preventive measures for the metabolic syndrome through reviewing recent clinical studies for diabetes prevention. Randomized, controlled trials conducted in 3 countries have established that the maintenance of modest weight loss through diet and physical activity reduces the incidence of type 2 diabetes in high-risk persons by about 40% to 60% over 3 to 4 years. Drug therapy to prevent or delay diabetes appears to be much less beneficial than lifestyle modification. The Diabetes Prevention Program shows that interventions that prevent diabetes will also reduce the development of the metabolic syndrome. Consequently, lifestyle interventions should be primarily considered for the prevention of the type 2 diabetes and metabolic syndrome.
Cardiovascular Diseases ; Diabetes Mellitus, Type 2 ; Diet ; Drug Therapy ; Humans ; Incidence ; Life Style ; Motor Activity ; Risk Factors ; Weight Loss

The prevalence of obesity is rapidly increasing worldwide, and its complications such as type 2 diabetes and cardiovascular disease are also increasing. To avoid long-term damage caused by obesity and its complications, we must develop preventive measures and therapeutic agents based on the pathophysiology of human obesity. However, genetically-modified rodents are mainly used for obesity research. This type of animal model is not very suitable for the study of human obesity because environmental factors such as excessive food intake and sedentary lifestyle are major causes of the recent explosion in human obesity. Therefore, diet-induced obesity rodent models are more appropriate for research in human obesity. Type of diet, animal species, duration of food intake, age, and sex can play a role in determining body weight and levels of glucose, insulin, triglycerides, and leptin. Animal housing conditions such as the number of animals per cage, ambient temperature, and length of the light-dark cycle also influence body weight and metabolic parameters. As a result, many influencing factors should be considered in the development of an appropriate diet-induced obesity rodent model for successful obesity research.
Animals ; Body Weight ; Cardiovascular Diseases ; Diabetes Mellitus, Type 2 ; Diet ; Eating ; Explosions ; Glucose ; Housing, Animal ; Humans ; Insulin ; Leptin ; Models, Animal ; Obesity ; Photoperiod ; Prevalence ; Rodentia ; Sedentary Lifestyle ; Triglycerides

No abstract available.
Obesity

Unlike minor operations, major surgeries require strict glycemic control using intravenous insulin infusion in patients with diabetes. The postoperative transition to subcutaneous insulin, if needed, can begin several hours before discontinuing intravenous insulin, by reinitiation of basal insulin re-initiation. Basal-bolus insulin regimens are safer and more effective in hospitalized patients than supplemental-scale regular insulin.
Diabetes Mellitus ; Humans ; Hyperglycemia ; Insulin ; Intraoperative Care ; Postoperative Care

BACKGROUND: We performed this study to identify factors related to intact incretin levels in patients with type 2 diabetes mellitus (T2DM). METHODS: We cross-sectionally analyzed 336 patients with T2DM. Intact glucagon-like peptide 1 (iGLP-1) and intact glucose-dependent insulinotropic polypeptide (iGIP) levels were measured in a fasted state and 30 minutes after ingestion of a standard mixed meal. The differences between 30 and 0 minute iGLP-1 and iGIP levels were indicated as ΔiGLP-1 and ΔiGIP. RESULTS: In simple correlation analyses, fasting iGLP-1 was positively correlated with glucose, C-peptide, creatinine, and triglyceride levels, and negatively correlated with estimated glomerular filtration rate. ΔiGLP-1 was positively correlated only with ΔC-peptide levels. Fasting iGIP showed positive correlations with glycosylated hemoglobin (HbA1c) and fasting glucose levels, and negative correlations with ΔC-peptide levels. ΔiGIP was negatively correlated with diabetes duration and HbA1c levels, and positively correlated with Δglucose and ΔC-peptide levels. In multivariate analyses adjusting for age, sex, and covariates, fasting iGLP-1 levels were significantly related to fasting glucose levels, ΔiGLP-1 levels were positively related to ΔC-peptide levels, fasting iGIP levels were related to fasting C-peptide levels, and ΔiGIP levels were positively related to ΔC-peptide and Δglucose levels. CONCLUSION: Taken together, intact incretin levels are primarily related to C-peptide and glucose levels. This result suggests that glycemia and insulin secretion are the main factors associated with intact incretin levels in T2DM patients.
C-Peptide ; Creatinine ; Diabetes Mellitus, Type 2 ; Eating ; Fasting ; Gastric Inhibitory Polypeptide ; Glomerular Filtration Rate ; Glucagon-Like Peptide 1 ; Glucose ; Hemoglobin A, Glycosylated ; Humans ; Incretins ; Insulin ; Meals ; Multivariate Analysis ; Triglycerides

Background: This study aimed to identify factors that affect fasting hyperglycemia (FHG) and postprandial hyperglycemia (PPG) and their contributions to overall hyperglycemia in Korean patients with type 2 diabetes mellitus (T2DM). Methods: This was a retrospective study conducted on 194 Korean T2DM patients with 7-point self-monitoring blood glucose (SMBG) profiles plotted in 4 days in 3 consecutive months. We calculated the areas corresponding to FHG and PPG (area under the curve [AUC]FHG and AUCPPG) and contributions (%) in the graph of the 7-point SMBG data. The levels of glycated hemoglobin (HbA1c) were categorized by tertiles, and the contributions of FHG and PPG were compared. Results: The relative contribution of FHG increased (44.7%±5.6%, 58.0%±4.4%, 66.5%±2.8%; PANOVA=0.002, PTREND <0.001), while that of PPG decreased (55.3%±5.5%, 42.0%±4.4%, 33.5%±2.8%; PANOVA=0.002, PTREND <0.001) with the elevated HbA1c. Multivariate analysis showed that HbA1c (β=0.615, P<0.001), waist circumference (β=0.216, P=0.042), and triglyceride (β=0.121, P=0.048) had a significant association with AUCFHG. Only HbA1c (β=0.231, P=0.002) and age (β=0.196, P=0.009) was significantly associated with AUCPPG. Conclusion The data suggested that in Korean T2DM patients, FHG predominantly contributed to overall hyperglycemia at higher HbA1c levels, whereas it contributed to PPG at lower HbA1c levels. It is recommended that certain factors, namely age, degree of glycemic control, obesity, or triglyceride levels, should be considered when prescribing medications for T2DM patients.

Kallmann's syndrome is a rare condition, and this is defined as hypogonadotropic hypogonadism and anosmia or hyposmia. The syndrome may be associated with cleft lip, cleft palate, color blindness, skeletal abnormalities, renal agenesis, sensory neural hearing loss, obesity, etc. About 10 cases of Kallmann's syndrome have been reported in Korea, but there are no reports on cases of Kallmann's syndrome with atrophy of the frontal lobe, severe mental retardation and unilateral renal agenesis. We experienced a case of 17-year-old boy with abnormalities of the olfactory system, as was noted on magnetic resonance imaging (MRI). He had an atrophy of the frontal lobe, mental retardation, a micropenis and unilateral renal agenesis. Hormonal assay documented low levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone and thyroid-stimulating hormone (TSH). So, we report here on an unusual case of Kallmann's syndrome along with briefly reviewing the relevant medical literature.
Adolescent ; Atrophy ; Cleft Lip ; Cleft Palate ; Color Vision Defects ; Congenital Abnormalities ; Follicle Stimulating Hormone ; Frontal Lobe ; Genital Diseases, Male ; Hearing Loss ; Humans ; Hypogonadism ; Intellectual Disability ; Kallmann Syndrome ; Kidney ; Kidney Diseases ; Korea ; Luteinizing Hormone ; Magnetic Resonance Imaging ; Obesity ; Olfaction Disorders ; Penis ; Testosterone ; Thyrotropin

BACKGROUND: Previous studies have reported that glypican-4 (GPC4) regulates insulin signaling by interacting with insulin receptor and through adipocyte differentiation. However, GPC4 has not been studied with regard to its effects on clinical factors in patients with type 2 diabetes mellitus (T2DM). We aimed to identify factors associated with GPC4 level in T2DM. METHODS: Between January 2010 and December 2013, we selected 152 subjects with T2DM and collected serum and plasma into tubes pretreated with aprotinin and dipeptidyl peptidase-4 inhibitor to preserve active gastric inhibitory polypeptide (GIP) and glucagon-like peptide 1 (GLP-1). GPC4, active GLP-1, active GIP, and other factors were measured in these plasma samples. We performed a linear regression analysis to identify factors associated with GPC4 level. RESULTS: The subjects had a mean age of 58.1 years, were mildly obese (mean body mass index [BMI], 26.1 kg/m2), had T2DM of long-duration (mean, 101.3 months), glycated hemoglobin 7.5%, low insulin secretion, and low insulin resistance (mean homeostatic model assessment of insulin resistance [HOMA-IR], 1.2). Their mean GPC4 was 2.0±0.2 ng/mL. In multivariate analysis, GPC4 was independently associated with age (β=0.224, P=0.009), and levels of active GLP-1 (β=0.171, P=0.049) and aspartate aminotransferase (AST; β=–0.176, P=0.043) after being adjusted for other clinical factors. CONCLUSION: GPC4 was independently associated with age, active GLP-1, and AST in T2DM patients, but was not associated with HOMA-IR and BMI, which are well known factors related to GPC4. Further study is needed to identify the mechanisms of the association between GPC4 and basal active GLP-1 levels.
Adipocytes ; Aprotinin ; Aspartate Aminotransferases ; Body Mass Index ; Diabetes Mellitus ; Diabetes Mellitus, Type 2* ; Gastric Inhibitory Polypeptide ; Glucagon-Like Peptide 1* ; Glypicans* ; Hemoglobin A, Glycosylated ; Humans ; Insulin ; Insulin Resistance ; Linear Models ; Multivariate Analysis ; Plasma ; Receptor, Insulin

BACKGROUND: The role of glycemic variability (GV) in development of cardiovascular diseases remains controversial, and factors that determine glucose fluctuation in patients with diabetes are unknown. We investigated relationships between GV indices, kinds of oral hypoglycemic agents (OHAs), and cardiovascular risk factors in patients with type 2 diabetes mellitus (T2DM). METHODS: We analyzed 209 patients with T2DM. The GV index (standard deviation [SD] and mean absolute glucose change [MAG]) were calculated from 7-point self-monitoring of blood glucose profiles. The patients were classified into four groups according to whether they take OHAs known as GV-lowering (A) and GV-increasing (B): 1 (A only), 2 (neither), 3 (both A and B), and 4 (B only). The 10-year risk for atherosclerotic cardiovascular disease (ASCVD) was calculated using the Pooled Cohort Equations. RESULTS: GV indices were significantly higher in patients taking sulfonylureas (SUs), but lower in those taking dipeptidyl peptidase-4 inhibitors. In hierarchical regression analysis, the use of SUs remained independent correlates of the SD (beta=0.209, P=0.009) and MAG (beta=0.214, P=0.011). In four OHA groups, GV indices increased progressively from group 1 to group 4. However, these did not differ according to quartiles of 10-year ASCVD risk. CONCLUSION: GV indices correlated significantly with the use of OHAs, particularly SU, and differed significantly according to combination of OHAs. However, cardiovascular risk factors and 10-year ASCVD risk were not related to GV indices. These findings suggest that GV is largely determined by properties of OHAs and not to cardiovascular complications in patients with T2DM.
Blood Glucose ; Cardiovascular Diseases ; Cohort Studies ; Diabetes Mellitus, Type 2 ; Glucose ; Humans ; Hypoglycemic Agents* ; Risk Factors*