In recent years, reports of diabetes mellitus (DM) cases that do not fit the traditional classification system have increased in prevalence. While insulin deficiency appears as type 1 DM (T1DM), the new type also has the clinical features of type 2 DM (T2DM); as such, this new type of DM is called ketosis-prone diabetes (KPD) and is correlated with findings of severe hyperglycemia and ketoacidosis. To provide a clear, clinical classification of DM, new classification systems are being studied. Among these, the Aβ system demonstrates the highest sensitivity and specificity in predicting clinical features and prognosis. We report 2 cases of KPD in Korean pediatric patients. The first patient was referred while in a state of diabetic ketoacidosis (DKA) and was considered to have T1DM. However, their blood glucose was well-controlled even with small doses of insulin, and the treatment was able to be changed to metformin therapy. The second patient seemed to be a typical case of T2DM because of his obesity and strong family history. However, blood glucose was not well-controlled with a regular diet, and ketosis occurred. After performing a glucagon stimulation test, both patients showed different clinical features that were finally diagnosed as type A-β+ KPD. The rapid and accurate diagnosis of KPD can reduce the duration of inappropriate insulin use and improve patients' quality of life. Further, the treatment of KPD children should be individualized according to each patient's lifestyle to preventing recurrent DKA.
Adolescent ; Blood Glucose ; Child ; Classification ; Diabetes Mellitus ; Diabetes Mellitus, Type 1 ; Diabetic Ketoacidosis ; Diagnosis ; Diet ; Glucagon ; Humans ; Hyperglycemia ; Insulin ; Ketosis ; Life Style ; Metformin ; Obesity ; Prevalence ; Prognosis ; Quality of Life ; Sensitivity and Specificity

The Committee of Clinical Practice Guidelines of the Korean Diabetes Association revised and updated the 6th Clinical Practice Guidelines in 2019. Targets of glycemic, blood pressure, and lipid control in type 2 diabetes mellitus (T2DM) were updated. The obese and overweight population is increasing steadily in Korea, and half of the Koreans with diabetes are obese. Evidence-based recommendations for weight-loss therapy for obesity management as treatment for hyperglycemia in T2DM were provided. In addition, evidence from large clinical studies assessing cardiovascular outcomes following the use of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide 1 receptor agonists in patients with T2DM were incorporated into the recommendations.
Blood Pressure ; Diabetes Mellitus, Type 2 ; Diagnosis ; Glucagon-Like Peptide 1 ; Humans ; Hyperglycemia ; Korea ; Obesity ; Overweight

A 32-year-old pregnant woman (34 + 5 weeks) was admitted with dizziness, nausea, and vomiting. Previously, she was diagnosed with gestational diabetes mellitus at 28 weeks with 100 g-OGTT and insulin therapy was started. Her average fasting glucose level was 97 mg/dL and postprandial 1-hour glucose level was 130 mg/dL with basal-bolus insulin therapy (total dose of 28-30 IU/day). At 34 + 0 weeks of gestational age, polyuria and unexpected weight loss (2 kg/week) with hyperglycemia occurred, and total dose of daily insulin requirement was increased up to 50 IU/day. At admission, her serum glucose level was high (502 mg/dL), and urinalysis revealed ketonuria +3. Arterial blood gas analysis revealed pH of 6.83, pCO2 of 9 mmHg, and bicarbonate of 2 mmol/L with an anion gap of 23.5 mmol/L. The diagnosis of diabetic ketoacidosis was established and emergency caesarean section was conducted due to fetal distress. She was finally diagnosed with fulminant type 1 diabetes mellitus, and multiple daily insulin injection therapy was continued after delivery.
Acid-Base Equilibrium ; Adult ; Blood Gas Analysis ; Blood Glucose ; Cesarean Section ; Diabetes Mellitus, Type 1 ; Diabetes, Gestational* ; Diabetic Ketoacidosis ; Diagnosis ; Dizziness ; Emergencies ; Fasting ; Female ; Fetal Distress ; Gestational Age ; Glucose ; Humans ; Hydrogen-Ion Concentration ; Hyperglycemia ; Insulin ; Ketosis ; Nausea ; Polyuria ; Pregnancy* ; Pregnant Women ; Urinalysis ; Vomiting ; Weight Loss

The primary causes of uncontrolled diabetes are poor life-style, infection, ischemic heart disease and inappropriate usage of oral anti-diabetic agents and insulin. Supplementary causes are stroke, acute pancreatitis and endocrine diseases. Multiple endocrine neoplasia type 1 (MEN 1) is an autosomal dominant syndrome characterized by primary hyperparathyroidism, pituitary neoplasia, and foregut lineage neuroendocrine tumors, and is associated with increased glucose levels. We present a case of a 69-year-old woman who had polyuria, polydipsia, weight loss and hyperglycemia over 6 months. She had hypertrophy of the face, hand, and foot, and active bleeding and large folds were observed in the stomach and duodenum upon esophagogastroduodenoscopy. She also had high levels of IGF-1 and gastrin and got the failure of growth hormone suppression after an oral glucose load (75 g). These findings suggested a diagnosis of acromegaly and gastrinoma, which was clinically diagnosed along with MEN 1. The patient improved glycemic control and symptoms after being treated with somatostatin analogues and insulin therapy over a 5-month follow-up period. Here, we report a case of MEN 1 in type 2 diabetes mellitus with a poorly controlled blood glucose level. Clinicians should consider endocrine disease in patients with poor glycemic control in diabetes.
Acromegaly ; Aged ; Blood Glucose ; Diabetes Mellitus* ; Diabetes Mellitus, Type 2 ; Diagnosis ; Duodenum ; Endocrine System Diseases ; Endoscopy, Digestive System ; Female ; Follow-Up Studies ; Foot ; Gastrinoma ; Gastrins ; Glucose ; Growth Hormone ; Hand ; Hemorrhage ; Humans ; Hyperglycemia ; Hyperparathyroidism, Primary ; Hypertrophy ; Insulin ; Insulin-Like Growth Factor I ; Multiple Endocrine Neoplasia Type 1* ; Multiple Endocrine Neoplasia* ; Myocardial Ischemia ; Neuroendocrine Tumors ; Pancreatitis ; Polydipsia ; Polyuria ; Somatostatin ; Stomach ; Stroke ; Weight Loss

Dietary fiber improves hyperglycemia in patients with type 2 diabetes through its physicochemical properties and possible modulation of gut hormone secretion, such as glucagon-like peptide 1 (GLP-1). We assessed the effect of dietary fiber-enriched cereal flakes (DC) on postprandial hyperglycemia and gut hormone secretion in patients with type 2 diabetes. Thirteen participants ate isocaloric meals based on either DC or conventional cereal flakes (CC) in a crossover design. DC or CC was provided for dinner, night snack on day 1 and breakfast on day 2, followed by a high-fat lunch. On day 2, the levels of plasma glucose, GLP-1, glucose-dependent insulinotropic polypeptide (GIP), and insulin were measured. Compared to CC, DC intake exhibited a lower post-breakfast 2-hours glucose level (198.5±12.8 vs. 245.9±15.2 mg/dL, P<0.05) and a lower incremental peak of glucose from baseline (101.8±9.1 vs. 140.3±14.3 mg/dL, P<0.001). The incremental area under the curve (iAUC) of glucose after breakfast was lower with DC than with CC (P<0.001). However, there were no differences in the plasma insulin, glucagon, GLP-1, and GIP levels. In conclusion, acute administration of DC attenuates postprandial hyperglycemia without any significant change in the representative glucose-regulating hormones in patients with type 2 diabetes (ClinicalTrials.gov. NCT 01997281).
Adult ; Aged ; Area Under Curve ; Blood Glucose/*analysis ; Cross-Over Studies ; Diabetes Mellitus, Type 2/complications/diagnosis/*diet therapy ; Dietary Fiber/*therapeutic use ; Female ; Gastric Inhibitory Polypeptide/blood ; Glucagon/blood ; Glucagon-Like Peptide 1/*blood ; Hemoglobin A, Glycosylated/analysis ; Humans ; Hyperglycemia/complications/diagnosis ; Insulin/blood ; Intestines/metabolism ; Male ; Middle Aged ; ROC Curve

PURPOSE: The study purposes were to explore school nurses' experience, perceived barriers, and education needs in diabetes management at school. METHODS: This study was a cross sectional study and the study participants were recruited conveniently at continuing education seminars for school nurses at Incheon Metropolitan City. RESULTS: Data for 101 school nurses were analyzed. The nurses were all women and their mean age was 46.9+/-9.3 years. About 66% of them had experience with children with diabetes at school. The school nurses reported that 74.6% of the students tested their blood glucose by themselves, the school clinic was the most common place for blood glucose tests (47.8%) and insulin injections (50.8%) and the nurses knew students' diagnosis through the student health survey (58.2%). About half of the nurses (53.7%) reported that glucagon should be available at school and 49.2% were willing to inject glucagon when necessary. The most frequently reported barrier in diabetes management was role confusion (6.0+/-1.3) and the most common educational need was emergency responses (5.9+/-1.4). CONCLUSIONS: School health policy for diabetes management and diabetes resources are necessary to minimize role confusion of school nurses, improve emergency response, and facilitate health promotion activities in diabetes management.
Adolescent* ; Blood Glucose ; Child* ; Diabetes Mellitus, Type 1 ; Diagnosis ; Disease Management ; Education ; Education, Continuing ; Emergencies ; Female ; Glucagon ; Health Promotion ; Health Surveys ; Humans ; Incheon ; Insulin ; School Health Services ; School Nursing

OBJECTIVETo test the feasibility of using 1,5-anhydroglucose alcohol (1,5-AG) as a diagnostic indicator of fulminant type 1 diabetes (FT1DM).

METHODSFifteen patients with newly diagnosed FT1DM and 52 with type 2 diabetes (T2DM) were examined for serum biochemistry, glycosylated hemoglobin (HbAlc), and serum 1, 5-AG level.

RESULTSThe patients with FT1DM and T2DM showed significantly different fasting levels of blood glucose (FBG), fructosamine (FMN), creatinine (Cr), urea, HbAlc and serum 1,5-AG (P<0.05). In FT1DM patients, serum 1,5-AG was found to inversely correlate with FBG (r=-0.646, P=0.032) and FMN (r=-0.680, P=0.021), and in T2DM patients, serum 1,5-AG was inversely correlated with FBG (r=-0.407, P=0.001), FMN (r=-0.314, P=0.01) and HbAlc (r=-0.576, P<0.01). Receiver-operating characteristic (ROC) curve analysis showed an area under the curve of serum 1,5-AG of 0.804 with a cutoff value of 67.95, a sensitivity of 82.9% and a specificity of 60% for FT1DM diagnosis.

CONCLUSIONSerum 1, 5-AG can reflect acute blood glucose fluctuation in FT1DM patients and is useful for differential diagnosis of FT1DM when combined with evaluations of the clinical characteristics of the patients and other related indicators.

Blood Glucose ; Diabetes Mellitus, Type 1 ; blood ; diagnosis ; Diabetes Mellitus, Type 2 ; blood ; diagnosis ; Diagnosis, Differential ; Ethanol ; Glycated Hemoglobin A ; chemistry ; Humans ; ROC Curve ; Sensitivity and Specificity

Type 1 diabetes mellitus (T1DM) is characterized by an immune-mediated beta-cell destruction that causes lifelong insulin dependency. Diagnosis of diabetes is based on fasting glucose, 2-h plasma glucose value after a 75-g oral glucose tolerance test, or hemoglobin A1c (HbA1c) levels. Differentiation between type 1 and 2 diabetes is important for both education and treatment. Diabetes-associated autoantibodies, c-peptide and clinical characteristics should be considered to confirm the diagnosis of T1DM. A single HbA1c target of < 7.5% across all pediatric age groups is recommended. In nonpregnant adults, a reasonable HbA1c goal is < 7.0% to reduce the incidence of microvascular complications of T1DM. Glycemic targets should be individualized according to lifestyle, psychosocial and medical circumstances.
Adult ; Autoantibodies ; Blood Glucose ; C-Peptide ; Diabetes Mellitus, Type 1 ; Diagnosis* ; Education ; Fasting ; Glucose ; Glucose Tolerance Test ; Humans ; Incidence ; Insulin ; Life Style

PURPOSE: To introduce a case of bilateral anterior ischemic optic neuropathy (AION) after blood loss due to gastrointestinal bleeding. CASE SUMMARY: A 50-year-old male patient with a history of type 1 diabetes mellitus and alcoholic liver cirrhosis presented with 3 days of melena and 1 day of general weakness and dizziness. Initial hemoglobin level was 4.7 g/dL and blood pressure was 100/55 mm Hg. On esophagogastroduodenoscopy, a peptic ulcer with evident recent bleeding was observed. After transfusion of packed red blood cells and endoscopic hemostasis of bleeding, his general condition improved but he complained of blurred vision in both eyes which developed immediately after the onset of melena. Initial best-corrected visual acuity (BCVA) was 0.5 in his right eye and 0.6 in the left eye. On fundus examination, swollen optic disc with blurred margin was noted and he had constricted visual fields. On follow-up, the patient received posterior subtenon triamcinolone injection in his right eye. After the procedure, the BCVA was improved to 0.8 in both eyes, but he still had bilateral pale optic disc with constricted visual field. CONCLUSIONS: In the case of visual loss after recent blood loss, AION should be considered as a diagnosis, which can present as bilateral involvement.
Blood Pressure ; Diabetes Mellitus, Type 1 ; Diagnosis ; Dizziness ; Endoscopy, Digestive System ; Erythrocytes ; Follow-Up Studies ; Hemorrhage* ; Hemostasis, Endoscopic ; Humans ; Liver Cirrhosis, Alcoholic ; Male ; Melena ; Middle Aged ; Optic Neuropathy, Ischemic* ; Peptic Ulcer ; Triamcinolone ; Visual Acuity ; Visual Fields

This study was done to characterize the natural course of C-peptide levels in patients with type 1 diabetes and identify distinguishing characters among patients with lower rates of C-peptide decline. A sample of 95 children with type 1 diabetes was analyzed to retrospectively track serum levels of C-peptide, HbA1c, weight, BMI, and diabetic complications for the 15 yr after diagnosis. The clinical characteristics were compared between the patients with low and high C-peptide levels, respectively. The average C-peptide level among all patients was significantly reduced five years after diagnosis (P < 0.001). The incidence of diabetic ketoacidosis was significantly lower among the patients with high levels of C-peptide (P = 0.038). The body weight and BMI standard deviation scores (SDS) 15 yr after diagnosis were significantly higher among the patients with low C-peptide levels (weight SDS, P = 0.012; BMI SDS, P = 0.044). In conclusion, C-peptide level was significantly decreased after 5 yr from diagnosis. Type 1 diabetes patients whose beta-cell functions were preserved might have low incidence of diabetic ketoacidosis. The declines of C-peptide level after diagnosis in type 1 diabetes may be associated with changes of body weight and BMI.
Adolescent ; Body Mass Index ; Body Weight ; C-Peptide/*blood ; Child ; Child, Preschool ; Diabetes Complications ; Diabetes Mellitus, Type 1/blood/*diagnosis ; Diabetic Ketoacidosis/epidemiology ; Diabetic Retinopathy/epidemiology ; Female ; Follow-Up Studies ; Hemoglobin A, Glycosylated/analysis ; Humans ; Incidence ; Infant ; Male ; Peripheral Nervous System Diseases/epidemiology ; Retrospective Studies