No abstract available.
Diabetes Mellitus*

Type 2 diabetes mellitus (T2DM) is a multifactorial disease with a complex and progressive pathogenesis. The two primary mechanisms of T2DM pathogenesis are pancreatic β-cell dysfunction and insulin resistance. Pancreatic β-cell dysfunction is recognized to be a prerequisite for the development of T2DM. Therapeutic modalities that improve β-cell function are considered critical to T2DM management; however, blood glucose control remains a challenge for many patients due to suboptimal treatment efficacy and the progressive nature of T2DM. Incretin-based therapies are now the most frequently prescribed antidiabetic drugs in Korea. Incretin-based therapies are a favorable class of drugs due to their ability to reduce blood glucose by targeting the incretin hormone system and, most notably, their potential to improve pancreatic β-cell function. This review outlines the current understanding of the incretin hormone system in T2DM and summarizes recent updates on the effect of incretin-based therapies on β-cell function and β-cell mass in animals and humans.
Animals ; Blood Glucose ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Humans ; Hypoglycemic Agents ; Incretins ; Insulin Resistance ; Korea ; Treatment Outcome

No abstract available.
Biomarkers* ; Cardiovascular Diseases* ; Diabetes Mellitus, Type 2*

Peripheral arterial disease is an arteriosclerotic disease that can affect the arteries of the whole body except the coronary arteries and the aorta. In general, disease of the descending aorta, iliac artery, and lower limb arteries below the renal artery is referred to as peripheral artery disease (PAD) or lower extremity artery disease. PAD is highly associated with ischemic heart disease, cerebrovascular disease, and mortality. Diabetes mellitus (DM) is a major risk factor for a variety of cardiovascular diseases, especially PAD. Recent studies have shown that PAD patients with DM have a significantly higher rate of major adverse cardiovascular events, all-cause mortality, and limb amputation compared with patients with PAD alone. To prevent and manage various complications of patients with DM, aggressive diagnosis and management and treatment of PAD play an important role in prevention of complications threatening quality of life such as cardiovascular disease and limb amputation.
Amputation ; Aorta ; Aorta, Thoracic ; Arteries ; Cardiovascular Diseases ; Cerebrovascular Disorders ; Coronary Vessels ; Diabetes Mellitus ; Diagnosis ; Extremities ; Humans ; Iliac Artery ; Lower Extremity ; Mortality ; Myocardial Ischemia ; Peripheral Arterial Disease ; Quality of Life ; Renal Artery ; Risk Factors

Lifestyle modifications including medical nutrition, exercise, and behavioral psychological therapy play a pivotal role in the treatment of diabetes mellitus. In this study, we discuss the fundamental and essential aspects of medical nutrition therapy for treatment of diabetes mellitus based on the medical nutrition recommendations of the Korean Diabetes Association.Current Concepts: Patients with diabetes should receive education for individualized medical nutrition therapy from a qualified clinical dietitian. Overweight adults or those with obesity must lose at least 5% of their body weight. The percentages of carbohydrate, protein, and fat intake are individualized based on treatment goals and preferences. A Mediterranean, vegetarian, low-fat, low-carbohydrate, and Dietary Approaches to Stop Hypertension diet may be used based on individualized plans and priorities. Patients with diabetes are recommended to consume carbohydrates from fiber-rich whole grains, legumes, vegetables, raw fruits, and dairy products and to reduce intake of sweetened beverages. It is not necessary to limit protein intake. Patients with diabetes are recommended to replace foods high in saturated and trans fatty acids with foods rich in unsaturated fatty acids. Routine administration of unsaturated fatty acid supplements is not recommended. Sodium intake should not exceed 2,300 mg/day. Routine use of micronutrient supplements such as vitamins and minerals to improve blood glucose levels is not recommended. Patients using insulin or insulin secretagogues should be counseled to avoid hypoglycemia if they consume alcohol.Discussion and Conclusion: Medical nutrition therapy, which has been shown to treat diabetes and prevent a variety of cardiovascular risk factors and complications, should be utilized aggressively by all healthcare providers who treat patients with diabetes.

No abstract available.
Adrenal Cortex Neoplasms/*complications/diagnosis/surgery ; Adrenalectomy ; Adrenocortical Adenoma/*complications/diagnosis/surgery ; Adult ; Biopsy ; Coronary Angiography ; Drug-Eluting Stents ; Humans ; Hyperaldosteronism/diagnosis/*etiology ; Male ; Myocardial Infarction/diagnosis/*etiology/therapy ; Percutaneous Coronary Intervention/instrumentation ; Tomography, X-Ray Computed ; Treatment Outcome

We describes a patient with hypokalemia-induced rhabdomyolysis due to primary aldosteronism (PA), who suffered from slowly progressive muscle weakness after laparoscopic adrenalectomy, and was later diagnosed with coexisting sporadic inclusion body myositis (sIBM). A 54-year-old Asian male presented with severe muscle weakness of both lower extremities. Laboratory findings showed profound hypokalemia, and extreme elevation of the serum creatine phosphokinase levels, suggestive of hypokalemia-induced rhabdomyolysis. Further evaluation strongly suggested PA by an aldosterone-producing adenoma, which was successfully removed surgically. However, muscle weakness slowly progressed one year after the operation and a muscle biopsy demonstrated findings consistent with sIBM. This case is the first report of hypokalemia-induced rhabdomyolysis by PA coexistent with sIBM, to the best of our knowledge.
Adenoma ; Adrenalectomy ; Asian Continental Ancestry Group ; Biopsy ; Creatine Kinase ; Humans ; Hyperaldosteronism* ; Hypokalemia ; Lower Extremity ; Male ; Middle Aged ; Muscle Weakness ; Myositis, Inclusion Body* ; Rhabdomyolysis*

The impaired insulin secretion and increased insulin resistance (or decreased insulin sensitivity) play a major role in the pathogenesis of all types of diabetes mellitus (DM). It is very important to assess the pancreatic β-cell function and insulin resistance/ sensitivity to determine the type of DM and to plan an optimal management and prevention strategy for DM. So far, various methods and indices have been developed to assess the β-cell function and insulin resistance/sensitivity based on static, dynamic test and calculation of their results. In fact, since the metabolism of glucose and insulin is made through a complex process related with various stimuli in several tissues, it is difficult to fully reflect the real physiology. In order to solve the theoretical and practical difficulties, research on new index is still in progress. Also, it is important to select the appropriate method and index for the purpose of use and clinical situation. This review summarized a variety of traditional methods and indices to evaluate pancreatic β-cell function and insulin resistance/sensitivity and introduced novel indices.

The impaired insulin secretion and increased insulin resistance (or decreased insulin sensitivity) play a major role in the pathogenesis of all types of diabetes mellitus (DM). It is very important to assess the pancreatic β-cell function and insulin resistance/ sensitivity to determine the type of DM and to plan an optimal management and prevention strategy for DM. So far, various methods and indices have been developed to assess the β-cell function and insulin resistance/sensitivity based on static, dynamic test and calculation of their results. In fact, since the metabolism of glucose and insulin is made through a complex process related with various stimuli in several tissues, it is difficult to fully reflect the real physiology. In order to solve the theoretical and practical difficulties, research on new index is still in progress. Also, it is important to select the appropriate method and index for the purpose of use and clinical situation. This review summarized a variety of traditional methods and indices to evaluate pancreatic β-cell function and insulin resistance/sensitivity and introduced novel indices.

Patients with diabetes have many different kinds of complications involving multiple organs, but those involving the musculoskeletal system are relatively uncommon. Diabetic muscle infarction (DMI) is a rare, painful, and potentially serious condition in patients with poorly controlled diabetes mellitus. A 35-year-old man diagnosed with type 2 diabetes eight years ago, visited with severe muscle pain in the right anteromedial thigh without any event of trauma. He had been treated with metformin, but his glycemic control was very poor with a glycated hemoglobin of 14.5%. Evaluation of his painful thigh lesion did not reveal any evidence of infection or vasculitis, but the magnetic resonance imaging and bone scan showed findings of DMI at vastus medialis muscle and an insufficiency fracture at the right medial tibial condyle. He was diagnosed with retinopathy, neuropathy and microalbuminuria but not macrovascular complications. We also diagnosed his diabetes as latent autoimmune diabetes in adults (LADA) based on his low C-peptide level, positive anti-glutamic acid decarboxylase (GAD) antibody and early onset diabetes. Instead of antibiotics, bed rest, analgesics and strict blood glucose control with multiple daily insulin injections led to symptom improvement. This is an unusual case of a young man with LADA experiencing severe musculoskeletal complication of DMI and insufficiency fracture. If a poorly controlled diabetic patient appears to have unaccounted soft tissue pain, musculoskeletal complications such as DMI associated with hyperglycemia should be considered.
Adult* ; Analgesics ; Anti-Bacterial Agents ; Bed Rest ; Blood Glucose ; C-Peptide ; Diabetes Mellitus ; Diabetes Mellitus, Type 1* ; Fractures, Stress ; Hemoglobin A, Glycosylated ; Humans ; Hyperglycemia ; Infarction ; Insulin ; Magnetic Resonance Imaging ; Metformin ; Musculoskeletal System ; Myalgia ; Nociceptive Pain ; Quadriceps Muscle ; Thigh ; Vasculitis