Background: Despite the well-recognized health benefits of fresh fruit consumption, there is still substantial uncertainty about its potential effects on glycemic control in patients with type 2 diabetes mellitus (T2DM). Methods: We examined the association of fresh fruit consumption and glycemic control in patients with T2DM using data from the 6th Korea National Health and Nutrition Examination Survey. The study sample was divided into three groups based on weekly fruit consumption frequency for the analysis. Results: Patients with the highest fruit intake were older than those in the other two groups, and women were more likely to consume fruits in general. Being a current smoker and weekly alcohol intake also showed negative correlations according to the fruit intake tertiles. Fruit consumption was positively correlated with better hemoglobin A1c (HbA1c) levels. Moreover, patients in the highest tertile of fruit intake were 3.48 times more likely to be in good glycemic control defined as HbA1c <7%. Conclusion We observed that fruit consumption can be helpful in glycemic control in Korean patients with T2DM.

With the success of the genome-wide association studies (GWASs), many candidate loci for complex human diseases have been reported in the GWAS catalog. Recently, many disease prediction models based on penalized regression or statistical learning methods were proposed using candidate causal variants from significant single-nucleotide polymorphisms of GWASs. However, there have been only a few systematic studies comparing existing methods. In this study, we first constructed risk prediction models, such as stepwise linear regression (SLR), least absolute shrinkage and selection operator (LASSO), and Elastic-Net (EN), using a GWAS chip and GWAS catalog. We then compared the prediction accuracy by calculating the mean square error (MSE) value on data from the Korea Association Resource (KARE) with body mass index. Our results show that SLR provides a smaller MSE value than the other methods, while the numbers of selected variables in each model were similar.
Body Mass Index* ; Decision Support Techniques ; Genome-Wide Association Study ; Humans ; Korea ; Learning ; Linear Models

The success of genome-wide association studies (GWASs) has enabled us to improve risk assessment and provide novel genetic variants for diagnosis, prevention, and treatment. However, most variants discovered by GWASs have been reported to have very small effect sizes on complex human diseases, which has been a big hurdle in building risk prediction models. Recently, many statistical approaches based on penalized regression have been developed to solve the “large p and small n” problem. In this report, we evaluated the performance of several statistical methods for predicting a binary trait: stepwise logistic regression (SLR), least absolute shrinkage and selection operator (LASSO), and Elastic-Net (EN). We first built a prediction model by combining variable selection and prediction methods for type 2 diabetes using Affymetrix Genome-Wide Human SNP Array 5.0 from the Korean Association Resource project. We assessed the risk prediction performance using area under the receiver operating characteristic curve (AUC) for the internal and external validation datasets. In the internal validation, SLR-LASSO and SLR-EN tended to yield more accurate predictions than other combinations. During the external validation, the SLR-SLR and SLR-EN combinations achieved the highest AUC of 0.726. We propose these combinations as a potentially powerful risk prediction model for type 2 diabetes.
Area Under Curve ; Dataset ; Decision Support Techniques ; Diabetes Mellitus, Type 2 ; Diagnosis ; Genome-Wide Association Study* ; Humans ; Logistic Models ; Risk Assessment ; ROC Curve

BACKGROUND: To determine whether an internet-based mentoring program can improve glycemic control in subjects with type 1 diabetes mellitus (T1DM). METHODS: Subjects with T1DM on intensive insulin therapy and with hemoglobin A1c (HbA1c) > or =8.0% were randomized to mentored (glucometer transmission with feedback from mentors) or control (glucometer transmission without feedback) groups and were examined for 12 weeks. Five mentors were interviewed and selected, of which two were T1DM patients themselves and three were parents with at least one child diagnosed with T1DM since more than 5 years ago. RESULTS: A total of 57 T1DM adult subjects with a mean duration after being diagnosed with diabetes of 7.4 years were recruited from Samsung Medical Center. Unfortunately, the mentored group failed to show significant improvements in HbA1c levels or other outcomes, including the quality of life, after completion of the study. However, the mentored group monitored their blood glucose (1.41 vs. 0.30) and logged into our website (http://ubisens.co.kr/) more frequently (20.59 times vs. 5.07 times) than the control group. CONCLUSION: A 12-week internet-based mentoring program for T1DM patients with inadequate glycemic control did not prove to be superior to the usual follow-up. However, the noted increase in the subjects' frequency of blood glucose monitoring may lead to clinical benefits.
Adult ; Blood Glucose ; Child ; Diabetes Mellitus, Type 1 ; Humans ; Insulin ; Internet ; Mentors* ; Parents ; Quality of Life

BACKGROUND: Metabolic syndrome (MetS) is a condition characterized by a cluster of metabolic disorders and is associated with increased risk of cardiovascular disease (CVD). This study analyzed data from the Korean Health and Genome Study to examine the impact of MetS on CVD. METHODS: A total of 8,898 subjects (4,241 males and 4,657 females), 40 to 69 years of age, were enrolled and evaluated for the development of new onset CVD from 2001 to 2012 (median 8.1 years of follow-up). RESULTS: The prevalence of MetS at baseline was 22.0% (932/4,241) and 29.7% (1,383/4,657) in males and females, respectively. MetS was associated with increased risk of coronary heart disease (CHD; hazard ratio [HR], 1.818; 95% confidence interval [CI], 1.312 to 2.520 in males; HR, 1.789; 95% CI, 1.332 to 2.404 in females) and CVD (HR, 1.689; 95% CI, 1.295 to 2.204 in males; HR, 1.686; 95% CI, 1.007 to 2.192 in females). Specifically, MetS was associated with risk of future stroke in females only (HR, 1.486; 95% CI, 1.007 to 2.192). Among MetS components, abdominal obesity and hypertension were independent predictors of both CHD and CVD. In addition, a higher number of MetS components correlated with higher CVD risk. CONCLUSION: MetS is a significant risk factor for the development of CVD although its impact varies between sexes.
Cardiovascular Diseases* ; Coronary Disease ; Female ; Genome ; Humans ; Hypertension ; Male ; Obesity, Abdominal ; Prevalence ; Risk Factors ; Sex Factors* ; Stroke

BACKGROUND: Despite improvements in surgical technique and immunosuppression, infection following liver transplantation (LT) remains a significant problem. Vancomycin-resistant Enterococcuscus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) have become important nosocomial pathogens. This study was undertaken in attempt to evaluate clinical impact of VRE and MRSA in LT recipients. METHODS: LT recipients with VRE or MRSA colonization from 2001 to 2004 were identified and matched (age, gender, United Network for Organ Sharing status, liver disease, and transplant date) to control groups without MRSA or VRE colonization. Demographics, clinical factors, length of stay, duration of the use of the mechanical ventilator, complications and survival rates were compared with matched controls. RESULTS: Eleven patients were colonized by VRE (4.7%) and thirty patients by MRSA (13%). The common sites of VRE culture included the tip of the urinary catheter and urine. The VRE colonized group experienced more biliary complications, relaparotomies, longer length of stay at ICU and ward, and longer use of the mechanical ventilator. One year survival rate was lower in the VRE group. MRSA was commonly cultured from sputum, tip of the central venous catheter or intraarterial catheter, and blood. The MRSA group experienced more relaparotomies, pneumonia, longer stay at ICU and ward, and longer use of mechanical ventilator compared to the control. One year survival rate was lower in the MRSA group. Rejection was not associated with VRE or MRSA infection. CONCLUSIONS: VRE or MRSA colonization is associated with higher incidence of posttransplant complications and lower survival rate than LT recipients without VRE or MRSA colonization. The patients with VRE or MRSA colonization also utilized more hospital resources.
Catheters ; Central Venous Catheters ; Colon* ; Demography ; Enterococcus* ; Humans ; Immunosuppression ; Incidence ; Length of Stay ; Liver Diseases ; Liver Transplantation ; Liver* ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Pneumonia ; Sputum ; Survival Rate ; Transplantation* ; Urinary Catheters ; Ventilators, Mechanical

Background: Fatty liver is associated with increased risk of developing type 2 diabetes. We aimed to evaluate whether the severity of hepatic steatosis is associated with incident diabetes. Methods: We conducted a longitudinal analysis using data from 1,798 participants who underwent a comprehensive health checkup and abdominal computed tomography (CT). We assessed the association between baseline liver attenuation value on non-contrast CT images and risk of incident diabetes. All the participants were categorized into three groups based on the baseline liver attenuation value on non-contrast CT images: without hepatic steatosis (>57 Hounsfield unit [HU]), mild hepatic steatosis (41–57 HU), and moderate to severe hepatic steatosis (≤40 HU). Results: During a median follow-up period of 5 years, 6.0% of the study participants progressed to diabetes. The incidence of diabetes was 17.3% in the moderate to severe hepatic steatosis group, 9.0% in the mild steatosis group, and 2.9% in those without hepatic steatosis. In a multivariate adjustment model, as compared with participants without hepatic steatosis, those with moderate to severe steatosis had a hazard ratio (HR) of 3.24 (95% confidence interval [CI], 1.64 to 4.2) for the development of diabetes, and those in the mild steatosis group had a HR of 2.33 (95% CI, 1.42 to 3.80). One standard deviation decrease in mean CT attenuation values of the liver was associated with a 40% increase in the development of diabetes (multivariate adjusted HR, 1.40; 95% CI, 1.2 to 1.63). Conclusion We found a positive association between severity of hepatic steatosis and risk of incident diabetes. Greater severity of steatosis was associated with a higher risk of incident diabetes.

BACKGROUND: Small dense low density lipoprotein (sdLDL) has recently emerged as an important risk factor of coronary heart disease. METHODS: The mean LDL particle size was measured in 203 patients with type 2 diabetes mellitus (T2DM) and 212 matched subjects without diabetes using polyacrylamide tube gel electrophoresis. Major vascular complications were defined as stroke, angiographically-documented coronary artery disease or a myocardial infarction. Peripheral vascular stenosis, carotid artery stenosis (> or =50% in diameter) or carotid artery plaque were considered minor vascular complications. Overall vascular complications included both major and minor vascular complications. RESULTS: Diabetic patients had significantly smaller mean-LDL particle size (26.32 nm vs. 26.49 nm) and a higher percentage of sdLDL to total LDL compared to those of subjects without diabetes (21.39% vs. 6.34%). The independent predictors of sdLDL in this study were serum triglyceride level and body mass index (odds ratio [OR], 1.020 with P<0.001 and OR 1.152 with P<0.027, respectively). However, no significant correlations were found between sdLDL and major vascular complications (P=0.342), minor vascular complications (P=0.573) or overall vascular complications (P=0.262) in diabetic subjects. CONCLUSION: Diabetic patients had a smaller mean-LDL particle size and higher proportion of sdLDL compared to those of subjects without diabetes. Obese diabetic patients with hypertriglyceridemia have an increased risk for atherogenic small dense LDL. However, we could not verify an association between LDL particle size and vascular complications in this study.
Acrylic Resins ; Body Mass Index ; Carotid Stenosis ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Disease ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Electrophoresis ; Heart ; Humans ; Hypertriglyceridemia ; Lipoproteins ; Myocardial Infarction ; Particle Size ; Risk Factors ; Stroke

BACKGROUND: Primary hypophysitis causes varying degrees of endocrine dysfunction and mass effect. The natural course and best treatment have not been well established. METHODS: Medical records of 22 patients who had been diagnosed with primary hypophysitis between January 2001 and March 2013 were retrospectively reviewed. Based on the anatomical location, we classified the cases as adenohypophysitis (AH), infundibuloneurohypophysitis (INH), and panhypophysitis (PH). Clinical presentation, endocrine function, pathologic findings, magnetic resonance imaging findings, and treatment courses were reviewed. RESULTS: Among 22 patients with primary hypophysitis, 81.8% (18/22) had involvement of the posterior pituitary lobe. Two patients of the AH (2/3, 66.6%) and three patients of the PH (3/10, 30%) groups initially underwent surgical mass reduction. Five patients, including three of the PH (3/10, 33.3%) group and one from each of the AH (1/3, 33.3%) and INH (1/9, 11.1%) groups, initially received high-dose glucocorticoid treatment. Nearly all of the patients treated with surgery or high-dose steroid treatment (9/11, 82%) required continuous hormone replacement during the follow-up period. Twelve patients received no treatment for mass reduction due to the absence of acute symptoms and signs related to a compressive mass effect. Most of them (11/12, 92%) did not show disease progression, and three patients recovered partially from hormone deficiency. CONCLUSION: Deficits of the posterior pituitary were the most common features in our cases of primary hypophysitis. Pituitary endocrine defects responded less favorably to glucocorticoid treatment and surgery. In the absence of symptoms related to mass effect and with the mild defect of endocrine function, it may not require treatment to reduce mass except hormone replacement.
Diabetes Insipidus ; Disease Progression ; Follow-Up Studies ; Humans ; Hydrogen-Ion Concentration ; Hypopituitarism ; Magnetic Resonance Imaging ; Medical Records ; Retrospective Studies ; Steroids

BACKGROUND: Diabetes self-management education has an important role in diabetes management. The efficacy of education has been proven in several randomized trials. However, the status of diabetes education programs in real Korean clinical practice has not yet been evaluated in terms of patient compliance with the education prescription. METHODS: We retrospectively analyzed clinical and laboratory data from all patients who were ordered to undergo diabetes education during 2009 at Samsung Medical Center, Seoul, Korea (n=2,291). After excluding ineligible subjects, 588 patients were included in the analysis. RESULTS: Among the 588 patients, 433 received education. The overall compliance rate was 73.6%, which was significantly higher in the subjects with a short duration or living in a rural area compared to those with a long duration (85.0% vs. 65.1%, respectively; P<0.001) or living in an urban area (78.2% vs. 70.4%, respectively; P=0.037). The hemoglobin A1c decreased greater in the compliant group (from 7.84+/-1.54 at baseline to 6.79+/-1.06 at 3 months and 6.97+/-1.20 at 12 months after prescription in the compliant group vs. from 7.74+/-1.25 to 7.14+/-1.02 and 7.24+/-1.24 in the non-compliant group; P=0.001). The decrease in hemoglobin A1c was greater in the subjects with a short duration (P=0.032). CONCLUSION: In our study a large percent of patients refuse to get education despite having a prescription from their physician. This refusal rate was higher in the patients with long-standing diabetes or in urban residence. Furthermore, education was more effective in patients with a short duration of diabetes in clinical practice.
Compliance ; Diabetes Mellitus, Type 2 ; Disulfiram ; Hemoglobins ; Humans ; Korea ; Patient Compliance ; Prescriptions ; Retrospective Studies ; Self Care