Publications by authors named "So Hun Kim"

52 Publications

Association between Metabolically Healthy Obesity and Subclinical Atherosclerosis in the Cardiovascular and Metabolic Diseases Etiology Research Center (CMERC) Cohort.

J Clin Med 2022 Apr 26;11(9). Epub 2022 Apr 26.

Department of Endocrinology and Metabolism, Inha University College of Medicine, Incheon 22212, Korea.

We aimed to investigate the association between a new definition of metabolic health (MH) and subclinical atherosclerosis in a cohort of patients without previous cardiovascular disease (CVD). In total, 7824 community-dwelling adults were categorized as normal weight, overweight, or obese. Metabolically healthy obesity (MHO) was defined as obesity accompanied by all of the following criteria: systolic blood pressure (BP) < 130 mmHg, no use of BP-lowering medication, waist-hip ratio <0.832 (women) and <0.887 (men), and no prevalent diabetes. Carotid atherosclerosis was defined as carotid plaque or mean carotid intima-media thickness ≥ 1.1 mm. The prevalence of carotid atherosclerosis was 8.3% and 1113 (14.2%) patients were classified as having MHO. All individuals classified as metabolically unhealthy were at an increased risk of carotid atherosclerosis independent of body mass index categories. Conversely, the risk of carotid atherosclerosis in individuals with MHO was not significantly increased compared to that in metabolically healthy normal weight participants (hazard ratio 1.20, 95% confidence interval 0.87-1.67). This new definition of MH was able to identify people with MHO without an increased risk of CVD in an Asian community cohort.
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http://dx.doi.org/10.3390/jcm11092440DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9103721PMC
April 2022

Relationships Between Pulmonary Function and Composite Indices of Femoral Neck Strength in Korean Men (KNHANES IV).

J Korean Med Sci 2022 Feb 28;37(8):e66. Epub 2022 Feb 28.

Department of Endocrinology and Metabolism, Inha University Hospital, Inha University School of Medicine, Incheon, Korea.

Background: Despite the close relationship between osteoporosis and chronic pulmonary diseases, few studies have evaluated relationships between pulmonary functions and bone quality. We investigated associations between pulmonary function test results and femoral neck strength indices (SIs) in Korean men.

Methods: This population-based, cross-sectional study was conducted using data from the Korea National Health and Nutrition Examination Survey IV on 936 men aged ≥ 19 years. Pulmonary functions (forced vital capacity [FVC] and forced expiratory volume in one second [FEV]) were measured using a dry rolling seal spirometer. Femoral neck SIs, relative to load, were calculated by hip dual-energy X-ray absorptiometry for compression strength index (CSI), bending strength index (BSI), and impact strength index (ISI).

Results: The 443 (47.3%) of the 936 men were current smokers. FVC, FVC percentage with respect to the expected normal value, FEV, and FEV percentage with respect to the expected normal value (FEVp) were positively associated with CSI and BSI after adjusting for confounders, including smoking history (β = 0.003-0.223, = 0.005-0.036). FEV and FEVp were positively associated with ISI (β = 0.000-0.014, = 0.010-0.025). Of components of femoral neck SIs, bone mineral density was correlated with FEV and FEVp (β = 0.001-0.037, = 0.017-0.019). After adjusting for all confounders, all femoral neck SIs increased with FVC quintiles ( for trends = 0.001-0.012), and CSI and BSI increased with FEV quintiles ( for trends = 0.034-0.043).

Conclusion: Reduced pulmonary function was correlated with reduced femoral neck strength, even after adjusting for smoking history in Korean men. Femoral neck SIs might be useful tools for evaluating bone health in men with reduced pulmonary function.
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http://dx.doi.org/10.3346/jkms.2022.37.e66DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8885450PMC
February 2022

Advanced Liver Fibrosis Is Associated with Chronic Kidney Disease in Patients with Type 2 Diabetes Mellitus and Nonalcoholic Fatty Liver Disease.

Diabetes Metab J 2022 Jan 26. Epub 2022 Jan 26.

Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea.

Background: Nonalcoholic fatty liver disease (NAFLD) is associated with chronic kidney disease (CKD). However, the causal relationship between NAFLD and CKD is uncertain, particularly in patients with type 2 diabetes mellitus (T2DM). We aimed to investigate the association between the presence and severity of NAFLD and incident CKD in patients with T2DM.

Methods: In this longitudinal cohort study of patients with T2DM, 3,188 patients with preserved renal function were followed up for the occurrence of incident CKD. NAFLD was defined as the presence of hepatic steatosis on ultrasonography, without any other causes of chronic liver disease. Advanced liver fibrosis of NAFLD was defined as a fibrosis-4 index ≥2.67. CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2.

Results: At baseline, 1,729 (54.2%) patients had NAFLD, of whom 94 (5.4%) had advanced liver fibrosis. During the follow-up of 8.3±3.6 years, 472 (14.8%) patients developed incident CKD: 220 (15.1%) in the non-NAFLD group, 231 (14.1%) in the NAFLD without advanced fibrosis group and 28 (31.1%) in the NAFLD with advanced fibrosis group. There was no increased risk of incident CKD in the NAFLD group compared to the non-NAFLD group (P=0.435). However, among patients with NAFLD, advanced liver fibrosis was associated with an increased risk of CKD (adjusted hazard ratio, 1.75; 95% confidence interval, 1.15 to 2.66; P=0.009).

Conclusion: Advanced liver fibrosis in patients with NAFLD is independently associated with an increased risk of incident CKD in patients with T2DM.
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http://dx.doi.org/10.4093/dmj.2021.0130DOI Listing
January 2022

Pathways Linking Health Literacy to Self-Management in People with Type 2 Diabetes.

Healthcare (Basel) 2021 Dec 15;9(12). Epub 2021 Dec 15.

Department of Internal Medicine, Chonnam National University Medical School, Gwangju 61469, Korea.

Health literacy is considered to be an emerging determinant of health behaviors and outcomes. The underlying mechanisms linking health literacy to diabetes self-management are currently unclear. This study assessed a mediation model consisting of a direct pathway between health literacy and self-management, and indirect pathways via social isolation only, self-efficacy only, and social isolation and self-efficacy serially in people with type 2 diabetes. A cross-sectional design was employed, and a total of 524 participants were recruited from outpatient clinics of multi-institutions from June 2020 to February 2021. The mediation model was analyzed using the PROCESS macro on SPSS with bootstrap bias-corrected 95% confidence intervals (CIs) with 10,000 bootstrapping iterations. Health literacy positively affected self-management. The estimated indirect effect of health literacy on self-management via social isolation was significant, at 0.018 (95% CI = 0.004-0.036). The indirect effect via self-efficacy was estimated at 0.214 (95% CI = 0.165-0.266). The indirect effect via social isolation and self-efficacy serially was 0.013 (95% CI = 0.006-0.023). The findings of this study suggest that clinical practice can be improved through more comprehensive diabetes self-management interventions that promote all of the components of health literacy, social contacts/networks, and self-efficacy in particular.
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http://dx.doi.org/10.3390/healthcare9121734DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8701917PMC
December 2021

A Serum Marker for Early Pancreatic Cancer With a Possible Link to Diabetes.

J Natl Cancer Inst 2022 02;114(2):228-234

Natural Product Research Institute, College of Pharmacy, Seoul National University, Seoul, Korea.

Background: Pancreatic cancer (PC) has a grim prognosis, and an early diagnostic biomarker has been highly desired. The molecular link between diabetes and PC has not been well established.

Methods: Bioinformatics screening was performed for a serum PC marker. Experiments in cell lines (5 PC and 1 normal cell lines), mouse models, and human tissue staining (37 PC and 10 normal cases) were performed to test asprosin production from PC. Asprosin's diagnostic performance was tested with serums from multi-center cohorts (347 PC, 209 normal, and 55 additional diabetic patients) and evaluated according to PC status, stages, and diabetic status, which was compared with that of CA19-9.

Results: Asprosin, a diabetes-related hormone, was found from the bioinformatics screening, and its production from PC was confirmed. Serum asprosin levels from multi-center cohorts yielded an age-adjusted diagnostic area under the curve (AUC) of 0.987 (95% confidence interval [CI] = 0.961 to 0.997), superior to that of CA19-9 (AUC = 0.876, 95% CI = 0.847 to 0.905), and a cut-off of 7.18 ng/mL, at which the validation set exhibited a sensitivity of 0.957 and a specificity of 0.924. Importantly, the performance was maintained in early-stage and non-metastatic PC, consistent with the tissue staining. A slightly lower performance against additional diabetic patients (n = 55) was restored by combining asprosin and CA19-9 (AUC = 0.985, 95% CI = 0.975 to 0.995).

Conclusions: Asprosin is presented as an early-stage PC serum marker that may provide clues for PC-induced diabetes. Larger prospective clinical studies are warranted to solidify its utility.
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http://dx.doi.org/10.1093/jnci/djab191DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8826585PMC
February 2022

Prevalence and clinical characteristics of fulminant type 1 diabetes mellitus in Korean adults: A multi-institutional joint research.

J Diabetes Investig 2022 Jan 31;13(1):47-53. Epub 2021 Aug 31.

Division of Endocrinology and Metabolism, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.

Aims/introduction: We aimed to determine the hospital-based prevalence and clinical features of fulminant type 1 diabetes mellitus in Korea.

Materials And Methods: We identified all patients with diabetes who regularly visited the Endocrinology outpatient clinics at eight centers for a period >1 year between January 2012 and June 2017. We investigated their medical records retrospectively.

Results: During this period, 76,309 patients with diabetes had been regularly followed up. Among them, 913 (1.2%) patients had type 1 diabetes mellitus . There were 462 patients with type 1 diabetes mellitus whose data at the time of the first diagnosis could be identified (359 and 103 with non-ketosis and ketosis onset, respectively). Of these, 15 (3.2% of type 1 diabetes mellitus, 14.6% of ketosis onset diabetes) patients had fulminant type 1 diabetes mellitus. The median ages at diagnosis were 40 and 27 years in the fulminant type 1 diabetes mellitus and non-fulminant type 1 diabetes mellitus groups, respectively. The patients with fulminant type 1 diabetes mellitus had higher body mass index, lower glycated hemoglobin and fasting/peak C-peptide, and lower frequent glutamic acid decarboxylase antibody-positive rate (P =0.0010) at diagnosis. Furthermore, they had lower glycated hemoglobin at the last follow-up examination than those with non-fulminant type 1 diabetes mellitus.

Conclusions: In this study, the prevalence of type 1 diabetes mellitus was 1.2% among all patients with diabetes, and that of fulminant type 1 diabetes mellitus was 3.2% among those newly diagnosed with type 1 diabetes mellitus. The glycated hemoglobin levels were lower in patients with fulminant type 1 diabetes mellitus than in those with non-fulminant type 1 diabetes mellitus at diagnosis and at the last follow-up examination.
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http://dx.doi.org/10.1111/jdi.13638DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8756324PMC
January 2022

Use of statin for the primary prevention of cardiovascular outcomes in elderly patients: A propensity-matched cohort study.

Atherosclerosis 2021 07 5;328:92-99. Epub 2021 Jun 5.

Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea. Electronic address:

Background And Aims: Herein, we investigate whether statin treatment as primary prevention reduces cardiovascular outcomes in elderly Asian patients.

Methods: Data were obtained from the Korean National Health Insurance Service-Senior Cohort database (n = 558,147). A total of 81,729 elderly patients (≥75 years) without clinically recognized atherosclerotic cardiovascular disease (CVD) were included. The patients who did not have a history of statin use in year 2003 were followed from January 2004 to the end of 2012. New statin users (n = 3670) were matched on the basis of the propensity score in a 1:2 ratio with non-users. Incidences of myocardial infarction, ischemic stroke, and death from CVD were compared using the Cox proportional hazards model.

Results: The risk of cardiovascular death was significantly reduced in the statin treatment group compared with the non-user group (hazard ratio [HR] 0.34, 95% confidence interval [CI] 0.29 to 0.40; p < 0.001). This effect was observed in both patient groups with and without diabetes. In patients with diabetes, the HR for statin use was 0.85 (95% CI 0.55 to 1.33) for myocardial infarction and 0.75 (95% CI 0.60 to 0.93) for ischemic stroke. In participants without diabetes, the HR of statin use was 0.95 (95% CI 0.73 to 1.24) for myocardial infarction and 1.13 (95% CI 1.01 to 1.26) for ischemic stroke. The presence of hypertension was also a significant factor in the prevention of ischemic stroke by statin treatment.

Conclusions: In elderly patients without clinically recognized atherosclerotic CVD, the risk of cardiovascular mortality was significantly reduced with statin treatment than with non-users. In participants with type 2 diabetes, statin treatment was associated with a reduction in ischemic stroke.
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http://dx.doi.org/10.1016/j.atherosclerosis.2021.05.022DOI Listing
July 2021

Effect of Teneligliptin versus Sulfonylurea on Major Adverse Cardiovascular Outcomes in People with Type 2 Diabetes Mellitus: A Real-World Study in Korea.

Endocrinol Metab (Seoul) 2021 02 24;36(1):70-80. Epub 2021 Feb 24.

Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea.

Background: Results regarding the cardiovascular (CV) effects of dipeptidyl peptidase-4 (DPP-4) inhibitors are inconsistent. This study aimed to assess the effects of teneligliptin, a DPP-4 inhibitor, on the risk of major CV outcomes in type 2 diabetes mellitus (T2DM) patients compared to sulfonylurea.

Methods: From January 1, 2015 to December 31, 2017, we conducted a retrospective cohort study using the Korean National Health Insurance Service database. A total of 6,682 T2DM patients who were newly prescribed DPP-4 inhibitors or sulfonylurea were selected and matched in a 1:1 ratio by propensity score. The hazard ratios (HRs) for all-cause mortality, hospitalization for heart failure (HHF), all-cause mortality or HHF, myocardial infarction (MI), stroke, and hypoglycemia were assessed.

Results: During 641 days of follow-up, the use of teneligliptin was not associated with an increased risk of all-cause mortality (HR, 1.00; 95% confidence interval [CI], 0.85 to 1.19), HHF (HR, 0.99; 95% CI, 0.86 to 1.14), all-cause mortality or HHF (HR, 1.02; 95% CI, 0.90 to 1.14), MI (HR, 0.90; 95% CI, 0.68 to 1.20), and stroke (HR, 1.00; 95% CI, 0.86 to 1.17) compared to the use of sulfonylurea. However, it was associated with a significantly lower risk of hypoglycemia (HR, 0.68; 95% CI, 0.49 to 0.94) compared to sulfonylurea therapy.

Conclusion: Among T2DM patients, teneligliptin therapy was not associated with an increased risk of CV events including HHF, but was associated with a lower risk of hypoglycemia compared to sulfonylurea therapy.
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http://dx.doi.org/10.3803/EnM.2020.777DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7937854PMC
February 2021

A New Self-management Scale with a Hierarchical Structure for Patients with Type 2 Diabetes.

Asian Nurs Res (Korean Soc Nurs Sci) 2020 Oct 27;14(4):249-256. Epub 2020 Aug 27.

Graduate School of Public Health, Ajou University, Suwon, Republic of Korea. Electronic address:

Purpose: The aims of this study were to develop a new instrument for measuring self-management with a hierarchical structure [the Diabetes Self-Management Scale (DSMS)] in patients with type 2 diabetes, and evaluate its psychometric properties.

Method: The DSMS instrument was developed in three phases: (1) conceptualization and item generation; (2) content validity and pilot testing; and (3) field testing of its psychometric properties. A convenience sample of 473 participants was recruited in three university hospitals and one regional health center, South Korea.

Results: Exploratory and confirmatory factor analyses yielded two second-order component models explaining the common variance among six first-order factors. Principal axis factoring with a varimax rotation accounted for 60.88% of the variance. Confirmatory factor analysis of the hierarchical structure revealed the following fit indices: χ/df = 1.373, standardized root-mean-square residual = .050, goodness-of-fit index = .935, incremental fit index = .975, comparative fit index = .974, and root-mean-square error of approximation = .039. All Cronbach' α values for internal consistency exceeded the criterion of .70. All of the intraclass correlation coefficients for test-retest reliability exceeded .70 except that for the taking-medication subscale. The components of the DSMS were moderately correlated with the comparator measures of self-efficacy and health literacy administered for convergent validity.

Conclusion: The DSMS is a new instrument for measuring the complex nature of self-management in patients with type 2 diabetes, comprising 17 items scored on a five-point Likert scale. The DSMS exhibits satisfactory psychometric properties for five reliability and validity metrics, and so is a suitable instrument to apply in both research and clinical practices.
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http://dx.doi.org/10.1016/j.anr.2020.08.003DOI Listing
October 2020

Serum Levels of Adipocyte Fatty Acid-Binding Protein Are Associated with Rapid Renal Function Decline in Patients with Type 2 Diabetes Mellitus and Preserved Renal Function.

Diabetes Metab J 2020 12 10;44(6):875-886. Epub 2020 Jul 10.

Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea.

Background: Recent studies have demonstrated that the levels of adipocyte fatty acid-binding protein (A-FABP) are closely associated with diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM). This study aimed to examine the association between serum A-FABP level and rapid renal function decline in patients with T2DM and preserved renal function.

Methods: This was a prospective observational study of 452 patients with T2DM and preserved renal function who had serial measurements of estimated glomerular filtration rate (eGFR). Rapid renal function decline was defined as an eGFR decline of >4% per year. The association between baseline serum A-FABP level and rapid renal function decline was investigated.

Results: Over a median follow-up of 7 years, 82 participants (18.1%) experienced rapid renal function decline. Median A-FABP levels were significantly higher in patients with rapid renal function decline, compared to non-decliners (20.2 ng/mL vs. 17.2 ng/mL, P=0.005). A higher baseline level of A-FABP was associated with a greater risk of developing rapid renal function decline, independent of age, sex, duration of diabetes, body mass index, systolic blood pressure, history of cardiovascular disease, baseline eGFR, urine albumin creatinine ratio, total cholesterol, glycosylated hemoglobin, high-sensitivity C-reactive protein and use of thiazolidinedione, insulin, angiotensin-converting-enzyme inhibitors and angiotensin II-receptor blockers and statin (odds ratio, 3.10; 95% confidence interval, 1.53 to 6.29; P=0.002).

Conclusion: A high level of serum A-FABP is associated with an increased risk of rapid renal function decline in patients with T2DM and preserved renal function. This suggests that A-FABP could play a role in the progression of DKD in the early stages.
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http://dx.doi.org/10.4093/dmj.2019.0221DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801760PMC
December 2020

Low muscle mass is associated with carotid atherosclerosis in patients with type 2 diabetes.

Atherosclerosis 2020 07 16;305:19-25. Epub 2020 Jun 16.

Department of Endocrinology and Metabolism, Inha University School of Medicine, Incheon, Republic of Korea. Electronic address:

Background And Aims: Sarcopenia leads to metabolic and vascular abnormalities. However, little is known regarding the independent relationship between skeletal muscle mass and atherosclerosis in patients with type 2 diabetes mellitus (T2DM). This study aimed to evaluate the association between skeletal muscle mass and carotid atherosclerosis in men and women with T2DM.

Methods: In this cross-sectional study, a total of 8202 patients with T2DM were recruited from the Seoul Metabolic Syndrome cohort. Skeletal muscle mass was estimated using bioimpedance analysis, while skeletal muscle mass index (SMI, %) was defined as total skeletal muscle mass (kg)/body weight (kg) × 100. Both carotid arteries were examined by B-mode ultrasound. Carotid atherosclerosis was defined by having a carotid plaque or mean carotid intima-media thickness (IMT) ≥1.1 mm.

Results: Among the entire population, 4299 (52.4%) subjects had carotid atherosclerosis. The prevalence of carotid atherosclerosis increased with decreasing SMI quartiles for both sexes. The odds ratios for carotid atherosclerosis were 2.33 (95% confidence interval [CI], 1.17-4.63) and 2.24 (95% CI, 1.06-4.741) in the lowest versus highest SMI quartile in men and women, respectively, after the adjustment for clinical risk factors. In men, the risk of atherosclerosis increased linearly with decreasing SMI quartiles (p for trend = 0.036).

Conclusions: Low skeletal muscle mass was independently associated with the presence of carotid atherosclerosis in men and women with T2DM.
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http://dx.doi.org/10.1016/j.atherosclerosis.2020.05.021DOI Listing
July 2020

Different Relationships Between Thyrotropin and Muscle Strength According to Sex and Age in Euthyroid Koreans (The 6th Korea National Health and Nutritional Examination Survey 2014-2015).

Thyroid 2020 12 29;30(12):1710-1717. Epub 2020 Jun 29.

Department of Endocrinology and Metabolism, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea.

Changes in muscle mass and strength can be caused by multiple endocrine factors, including thyroid dysfunction. However, the relationship between thyroid function and muscle strength in euthyroid individuals is not clear. In the present study, we investigated the relationship between thyroid function and handgrip strength (HGS) in euthyroid Koreans, especially according to sex and age. This was a population-based, cross-sectional study from the 6th Korea National Health and Nutrition Examination Survey including 2894 Koreans (1487 men and 1407 women) aged ≥19 years. Serum thyrotropin (TSH) and free thyroxine (fT4) levels were measured. HGS was measured using a digital grip strength dynamometer. Serum TSH level, but not serum fT4 level, was significantly associated with HGS in men, but neither TSH nor fT4 level was associated with HGS in women. Serum TSH showed a negative association with HGS in men aged <65 years ( = 1376;  = -0.566,  = 0.008), but a positive association in men aged ≥65 years ( = 111;  = 1.158,  = 0.010) after adjusting for confounders. HGS decreased as TSH tertile increased in men aged <65 years ( for trend = 0.010), but increased with TSH tertile in men aged ≥65 years ( for trend = 0.009) after adjusting for confounders. Odds ratios (ORs) for the lowest quartile of HGS increased in the highest tertile of TSH among men aged <65 years (OR = 1.657 [95% confidence interval {CI} 1.099-2.500],  = 0.006) and decreased in the highest tertile of TSH among men aged ≥65 years (OR = 0.176 [CI 0.032-0.966],  = 0.034) after adjusting for confounders. In euthyroid Koreans, serum TSH levels were significantly associated with HGS only in men and this relationship was found to depend significantly on age. These findings suggest that age has a distinct influence on the effect of even subtle change of thyroid function on muscle strength in men.
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http://dx.doi.org/10.1089/thy.2019.0601DOI Listing
December 2020

A New Objective Health Numeracy Test for Patients with Type 2 Diabetes: Development and Evaluation of Psychometric Properties.

Asian Nurs Res (Korean Soc Nurs Sci) 2020 May 7;14(2):66-72. Epub 2020 Feb 7.

Department of Internal Medicine, School of Medicine, Inha University, Incheon, Republic of Korea.

Purpose: Patients with diabetes frequently need to perform certain numeric tasks such as interpreting blood glucose levels. However, there is no psychometrically sound instrument for objectively measuring diabetes-specific health numeracy. This study aimed to develop a new objective diabetes health numeracy test (DHNT) and evaluate its psychometric properties in adult patients with type 2 diabetes.

Methods: An instrument development study was conducted. Initial items were evaluated by six experts for content validity. After a pilot test, a convenience sample of 257 participants with type 2 diabetes was recruited at 2 university hospitals from May to September 2018. The structural, convergent, and criteria validity, and internal consistency of the DHNT with binary item responses were evaluated. Data were analyzed using exploratory factor analysis, Rasch analysis, tetrachoric correlation, Spearman's correlation, and the Kuder-Richardson-20 formula.

Results: Exploratory factor analysis yielded a single-factor solution comprising seven items. Rasch analysis confirmed that no item did not fit with the single factor and identified that the item difficulty parameters had moderate values. The convergent and criterion validity of the instrument were demonstrated, with diabetes knowledge and subjective diabetes numeracy, respectively, as was its acceptable internal consistency, by a Kuder-Richardson-20 coefficient of .81.

Conclusion: The DHNT demonstrated satisfactory psychometric properties. The instrument with moderate levels of item difficulty may have a lower cognitive burden. The developed instrument can be applied in practice to tailor the education of diabetes self-management as per the levels of health numeracy of specific patients.
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http://dx.doi.org/10.1016/j.anr.2020.01.006DOI Listing
May 2020

Characterization of variable presentations of diabetic ketoacidosis based on blood ketone levels and major society diagnostic criteria: a new view point on the assessment of diabetic ketoacidosis.

Diabetes Metab Syndr Obes 2019 16;12:1161-1171. Epub 2019 Jul 16.

Department of Internal Medicine, Gachon University College of Medicine, Incheon, Republic of Korea.

Aim: We aimed to evaluate the clinical utility of blood ketone measurement and to test the performance of the diagnostic criteria for diabetic ketoacidosis (DKA) issued by the American Diabetes Association, the Joint British Diabetes Societies, and the American Association of Clinical Endocrinologists and the American College of Endocrinology.

Methods: This retrospective analysis included 278 patients with suspected DKA who were hospitalized at 4 university hospitals and aged ≥16 years with a blood glucose level of >200 mg/dL and a blood ketone level of ≥1.0 mmol/L as well as other biochemical data. The patients were categorized into four subgroups (ketosis, typical DKA, atypical DKA, and DKA + lactic acidosis). Atypical DKA in each analysis was defined by our supplementary criteria if the biochemical data did not meet each set of diagnostic criteria from the aforementioned societies.

Results: Blood ketone levels in patients with diabetic ketosis and those with DKA varied widely, 1.05-5.13 mmol/L and 1.02-15.9 mmol/L, respectively. Additionally, there were significant discrepancies between the guidelines in the diagnosis of DKA. Thus, the proportion of patients with atypical DKA ranged from 16.5% to 42.4%. Notably, the in-hospital mortality was comparable between patients with typical and atypical DKA, with a very high mortality in patients with DKA + lactic acidosis (blood lactate >5 mmol/L).

Conclusions: Our results showed that considering variable presentations of DKA, blood ketone data need to be interpreted cautiously along with other biochemical data and suggested that a new system is required to better characterize DKA.
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http://dx.doi.org/10.2147/DMSO.S209938DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6645697PMC
July 2019

Efficacy and Safety of Omega-3 Fatty Acids in Patients Treated with Statins for Residual Hypertriglyceridemia: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

Diabetes Metab J 2020 02 20;44(1):78-90. Epub 2019 Jun 20.

Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Background: Cardiovascular risk remains increased despite optimal low density lipoprotein cholesterol (LDL-C) level induced by intensive statin therapy. Therefore, recent guidelines recommend non-high density lipoprotein cholesterol (non-HDL-C) as a secondary target for preventing cardiovascular events. The aim of this study was to assess the efficacy and tolerability of omega-3 fatty acids (OM3-FAs) in combination with atorvastatin compared to atorvastatin alone in patients with mixed dyslipidemia.

Methods: This randomized, double-blind, placebo-controlled, parallel-group, and phase III multicenter study included adults with fasting triglyceride (TG) levels ≥200 and <500 mg/dL and LDL-C levels <110 mg/dL. Eligible subjects were randomized to ATOMEGA (OM3-FAs 4,000 mg plus atorvastatin calcium 20 mg) or atorvastatin 20 mg plus placebo groups. The primary efficacy endpoints were the percent changes in TG and non-HDL-C levels from baseline at the end of treatment.

Results: After 8 weeks of treatment, the percent changes from baseline in TG (-29.8% vs. 3.6%, <0.001) and non-HDL-C (-10.1% vs. 4.9%, <0.001) levels were significantly greater in the ATOMEGA group (=97) than in the atorvastatin group (=103). Moreover, the proportion of total subjects reaching TG target of <200 mg/dL in the ATOMEGA group was significantly higher than that in the atorvastatin group (62.9% vs. 22.3%, <0.001). The incidence of adverse events did not differ between the two groups.

Conclusion: The addition of OM3-FAs to atorvastatin improved TG and non-HDL-C levels to a significant extent compared to atorvastatin alone in subjects with residual hypertriglyceridemia.
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http://dx.doi.org/10.4093/dmj.2018.0265DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7043989PMC
February 2020

Presence of Carotid Plaque Is Associated with Rapid Renal Function Decline in Patients with Type 2 Diabetes Mellitus and Normal Renal Function.

Diabetes Metab J 2019 12 12;43(6):840-853. Epub 2019 Mar 12.

Department of Endocrinology and Metabolism, Inha University School of Medicine, Incheon, Korea.

Background: Recent evidences indicate that early rapid renal function decline is closely associated with the development and progression of diabetic kidney disease. We have investigated the association between carotid atherosclerosis and rapid renal function decline in patients with type 2 diabetes mellitus and preserved renal function.

Methods: In a prospective, multicenter cohort, a total of 967 patients with type 2 diabetes mellitus and preserved renal function were followed for 6 years with serial estimated glomerular filtration rate (eGFR) measurements. Common carotid intima-media thickness (CIMT) and presence of carotid plaque were assessed at baseline. Rapid renal function decline was defined as an eGFR decline >3.3% per year.

Results: Over a median follow-up of 6 years, 158 participants (16.3%) developed rapid renal function decline. While there was no difference in CIMT, the presence of carotid plaque in rapid decliners was significantly higher than in non-decliners (23.2% vs. 12.2%, <0.001). In multivariable logistic regression analysis, presence of carotid plaque was an independent predictor of rapid renal function decline (odds ratio, 2.33; 95% confidence interval, 1.48 to 3.68; <0.0001) after adjustment for established risk factors. The model including the carotid plaque had better performance for discrimination of rapid renal function decline than the model without carotid plaque (area under the receiver operating characteristic curve 0.772 vs. 0.744, =0.016).

Conclusion: Close monitoring of renal function and early intensive management may be beneficial in patients with type 2 diabetes mellitus and carotid plaques.
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http://dx.doi.org/10.4093/dmj.2018.0186DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6943261PMC
December 2019

Role of exercise in age-related sarcopenia.

J Exerc Rehabil 2018 Aug 24;14(4):551-558. Epub 2018 Aug 24.

Department of Kinesiology, Inha University, Incheon, Korea.

Sarcopenia is an age-associated decline of skeletal muscle mass and function and is known to lead to frailty, cachexia, osteoporosis, metabolic syndromes, and death. Notwithstanding the increasing incidence of sarcopenia, the molecular and cellular mechanisms driving age-related sarcopenia are not completely understood. This article reviews current definitions of sarcopenia, its potential mechanisms, and effects of exercise on sarcopenia. The pathogenesis of age-related sarcopenia is multifactorial and includes myostatin, inflammatory cytokines, and mitochondria-derived problems. Especially, age-induced mitochondrial dysfunction triggers the production of reactive oxygen species (ROS) by mitochondria, impedes mitochondrial dynamics, interrupts mitophagy, and leads to mitochondria-mediated apoptosis. Aerobic exercise provides at least a partial solution to sarcopenia as it ameliorates mitochondria-derived problems, and resistance exercise strengthens muscle mass and function. Furthermore, combinations of these exercise types provide the benefits of both. Collectively, this review summarizes potential mechanisms of age-related sarcopenia and emphasizes the use of exercise as a therapeutic strategy, suggesting that combined exercise provides the most beneficial means of combating age-related sarcopenia.
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http://dx.doi.org/10.12965/jer.1836268.134DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6165967PMC
August 2018

A new comprehensive diabetes health literacy scale: Development and psychometric evaluation.

Int J Nurs Stud 2018 Dec 10;88:1-8. Epub 2018 Aug 10.

Department of Internal Medicine, School of Medicine, Inha University, Incheon, Republic of Korea. Electronic address:

Background: The prevalence of diabetes is close to reaching an epidemic level, and health literacy has recently emerged as a concept that can influence the health outcomes of patients with diabetes. Health literacy was once defined from the perspective of basic reading and understanding skills, but this has now become more comprehensive to include the abilities and skills to assess, understand, appraise, communicate, and use health information. Nevertheless, there is no instrument reflecting the comprehensive health literacy relevant to diabetes.

Objectives: The aims of this study were to develop a comprehensive Diabetes Health Literacy Scale and to evaluate its psychometric properties.

Design: An instrument-development study was applied that comprised three steps: conceptualization, item generation and content validity, and field testing of the psychometric properties.

Settings: A convenience sample of 462 participants was recruited from December 2016 to September of 2017 at outpatient clinics in 2 Korean university hospitals.

Participants: The inclusion criteria for participants were being aged at least 19 years, articulate in the Korean language, and diagnosed with diabetes, while the presence of gestational diabetes was applied as an exclusion criterion. Approximately half of the participants were female (51.1%). The participants were aged 54.5 (SD, 11.0) years, 67.1% of them were taking an oral hypoglycemic agent, and 21.9% of them had well-controlled blood-glucose levels.

Methods: The content validity, factorial structure validity, convergent validity, criterion validity, internal consistent reliability, and test-retest reliability of the Diabetes Health Literacy Scale were evaluated. Data were analyzed using exploratory and confirmatory factor analyses, Pearson's correlation, Cronbach's alpha, and the intraclass correlation coefficient.

Results: The content validity was assessed by five experts. Exploratory and confirmatory factor analyses yielded a three-factor solution. Convergent validity was demonstrated using measures of diabetes knowledge and self-efficacy. Criterion validity was demonstrated with generic health-literacy questions. Internal consistency reliability and test-retest reliability were found to be acceptable, as indicated by a Cronbach's alpha of 0.91 and an intraclass correlation coefficient of 0.89, respectively.

Conclusions: The Diabetes Health Literacy Scale is a new instrument that measures comprehensive aspects of informational, numeracy, and communicative health literacy. It is a short instrument, comprising only 14 items scored on a 5-point Likert scale. The instrument exhibits good psychometric properties for four validity metrics (content, structural, convergent, and criterion validity) and two reliability metrics (internal consistency and test-retest reliability). These findings indicate that the instrument can be applied in both research and clinical practice.
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http://dx.doi.org/10.1016/j.ijnurstu.2018.08.002DOI Listing
December 2018

Impact of Socioeconomic Status on Health Behaviors, Metabolic Control, and Chronic Complications in Type 2 Diabetes Mellitus.

Diabetes Metab J 2018 Oct 29;42(5):380-393. Epub 2018 Jun 29.

Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea.

Background: The aim of the study was to assess the impact of socioeconomic status (SES) on health behaviors, metabolic control, and chronic complications in people with type 2 diabetes mellitus (T2DM) from South Korea, a country with universal health insurance coverage and that has experienced rapid economic and social transition.

Methods: A total of 3,294 Korean men and women with T2DM aged 30 to 65 years, participating in the Korean National Diabetes Program (KNDP) cohort who reported their SES and had baseline clinical evaluation were included in the current cross-sectional analysis. SES included the level of education and monthly household income.

Results: Lower education level and lower income level were closely related, and both were associated with older age in men and women. Women and men with lower income and education level had higher carbohydrate and lower fat intake. After adjustment for possible confounding factors, higher education in men significantly lowered the odds of having uncontrolled hyperglycemia (glycosylated hemoglobin ≥7.5%) (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.43 to 0.91 for highest education; (trend)=0.048), while higher household income in men significantly lowered the odds of having diabetic retinopathy (OR, 0.59; 95% CI, 0.37 to 0.95 for highest income level; (trend)=0.048). In women, lower income was associated with a higher stress level.

Conclusion: Men with lower SES had higher odds of having diabetic retinopathy and uncontrolled hyperglycemia, showing the need to improve care targeted to this population.
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http://dx.doi.org/10.4093/dmj.2017.0102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6202566PMC
October 2018

Beneficial Effects of Aerobic Exercise Training Combined with Rosiglitazone on Glucose Metabolism in Otsuka Long Evans Tokushima Fatty Rats.

Diabetes Metab J 2017 Dec 15;41(6):474-485. Epub 2017 Nov 15.

Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea.

Background: Regular aerobic exercise is essential for the prevention and management of type 2 diabetes mellitus and may be particularly beneficial for those treated with thiazolidinediones, since it may prevent associated weight gain. This study aimed to evaluate the effect of combined exercise and rosiglitazone treatment on body composition and glucose metabolism in obese diabetes-prone animals.

Methods: We analyzed metabolic parameters, body composition, and islet profiles in Otsuka Long Evans Tokushima Fatty rats after 28 weeks of aerobic exercise, rosiglitazone treatment, and combined exercise and rosiglitazone treatment.

Results: Combined exercise with rosiglitazone showed significantly less increase in weight and epididymal fat compared to rosiglitazone treatment. Aerobic exercise alone and combined rosiglitazone and exercise treatment led to similar retention of lean body mass. All experimental groups showed a decrease in fasting glucose. However, the combined exercise and rosiglitazone therapy group showed prominent improvement in glucose tolerance compared to the other groups. Rescue of islet destruction was observed in all experimental groups, but was most prominent in the combined therapy group.

Conclusion: Regular aerobic exercise combined with rosiglitazone treatment can compensate for the adverse effect of rosiglitazone treatment and has benefit for islet preservation.
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http://dx.doi.org/10.4093/dmj.2017.41.6.474DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5741557PMC
December 2017

ENOblock, a unique small molecule inhibitor of the non-glycolytic functions of enolase, alleviates the symptoms of type 2 diabetes.

Sci Rep 2017 03 8;7:44186. Epub 2017 Mar 8.

New Drug Targets Laboratory, School of Life Sciences, Gwangju Institute of Science and Technology, 1 Oryong-Dong, Buk-Gu, Gwangju, 61005, Republic of Korea.

Type 2 diabetes mellitus (T2DM) significantly impacts on human health and patient numbers are predicted to rise. Discovering novel drugs and targets for treating T2DM is a research priority. In this study, we investigated targeting of the glycolysis enzyme, enolase, using the small molecule ENOblock, which binds enolase and modulates its non-glycolytic 'moonlighting' functions. In insulin-responsive cells ENOblock induced enolase nuclear translocation, where this enzyme acts as a transcriptional repressor. In a mammalian model of T2DM, ENOblock treatment reduced hyperglycemia and hyperlipidemia. Liver and kidney tissue of ENOblock-treated mice showed down-regulation of known enolase target genes and reduced enolase enzyme activity. Indicators of secondary diabetic complications, such as tissue apoptosis, inflammatory markers and fibrosis were inhibited by ENOblock treatment. Compared to the well-characterized anti-diabetes drug, rosiglitazone, ENOblock produced greater beneficial effects on lipid homeostasis, fibrosis, inflammatory markers, nephrotoxicity and cardiac hypertrophy. ENOblock treatment was associated with the down-regulation of phosphoenolpyruvate carboxykinase and sterol regulatory element-binding protein-1, which are known to produce anti-diabetic effects. In summary, these findings indicate that ENOblock has potential for therapeutic development to treat T2DM. Previously considered as a 'boring' housekeeping gene, these results also implicate enolase as a novel drug target for T2DM.
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http://dx.doi.org/10.1038/srep44186DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5341156PMC
March 2017

Spectral-Domain Optical Coherence Tomography Features in Open-Angle Glaucoma With Diabetes Mellitus and Inadequate Glycemic Control.

Invest Ophthalmol Vis Sci 2016 06;57(7):3024-31

Department of Ophthalmology and Inha Vision Science Laboratory Inha University School of Medicine, Incheon, Republic of Korea.

Purpose: To evaluate spectral-domain optical coherence tomography (SD-OCT) features according to glycemic control status in open-angle glaucoma with diabetes mellitus.

Methods: Subjects underwent comprehensive ocular examination, visual field testing, and SD-OCT imaging (Cirrus HD-OCT). The relationship between glycosylated hemoglobin (HbA1c) and OCT measurements was compared between diabetic nonglaucomatous eyes and diabetic glaucomatous eyes. Glaucoma-discriminating ability was assessed using the area under the receiver operating characteristic curves (AUCs) for OCT parameters and compared between groups relative to the glycemic control group.

Results: Analysis was performed on 69 nonglaucomatous and 87 glaucomatous eyes in the nondiabetic group, and on 72 nonglaucomatous and 56 glaucomatous eyes in the diabetic group. Average, inferonasal, inferior, and inferotemporal ganglion cell-inner plexiform layer (GCIPL) thicknesses were positively correlated with HbA1c in diabetic nonglaucomatous eyes (P = 0.040, 0.037, 0.025, and 0.013, respectively). The AUC of the average cup-to-disc area ratio (CDR), vertical CDR, and cup volume in diabetic eyes with poor glycemic control was significantly higher than those in nondiabetic eyes (P = 0.011, 0.003, and 0.043, respectively). The AUC of cube volume, cube average thickness, and minimal GCIPL thickness in diabetic eyes with poor glycemic control was lower than those in nondiabetic eyes (P = 0.006, 0.007, and 0.004, respectively).

Conclusions: In this study, optic nerve head parameters had a superior ability to discriminate glaucoma in diabetic eyes with poor glycemic control. Conversely, the ability to discriminate glaucoma using macular parameters tended to be lower for diabetic eyes with inadequate glycemic control.
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http://dx.doi.org/10.1167/iovs.16-19457R1DOI Listing
June 2016

Serum Chemerin Levels Are Associated with Abdominal Visceral Fat in Type 2 Diabetes.

J Korean Med Sci 2016 Jun 26;31(6):924-31. Epub 2016 Apr 26.

Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea .

Chemerin is a recently identified adipokine suggested to play a role in obesity and its metabolic complications. The relationship between visceral obesity and serum chemerin levels in type 2 diabetes (T2DM) is unknown and may differ from that of subjects without diabetes. Therefore, we evaluated whether serum chemerin was associated with visceral abdominal obesity in patients with T2DM. A total of 218 Korean patients with T2DM were enrolled and metabolic parameters, abdominal visceral and subcutaneous fat areas, and serum chemerin levels were measured. Serum chemerin level showed positive correlation with fasting insulin, HOMA-IR, serum triglyceride, serum creatinine, urine albumin/creatinine ratio, high-sensitivity C-reactive protein (hsCRP), fibrinogen, abdominal visceral fat area, visceral to subcutaneous fat area ratio, and negatively correlation with high density lipoprotein cholesterol and creatinine clearance (CCr) after adjusting for age, gender and body mass index. Multiple linear stepwise regression analysis showed that abdominal visceral fat area (β = 0.001, P < 0.001), serum triglyceride (β = 0.001, P < 0.001), CCr (β = -0.003, P = 0.001), hsCRP (β = 0.157, P = 0.001), fibrinogen (β = 0.001, P < 0.001) and BMI (β = 0.02, P = 0.008) independently affected log transformed serum chemerin levels. Higher serum chemerin level was associated with higher level of abdominal visceral fat area, serum triglyceride, hsCRP and fibrinogen and lower level of CCr in patients with T2DM. Serum chemerin may be used as a biomarker of visceral adiposity and chemerin may play a role in inflammation, decreased renal function, and increased cardiovascular risk in T2DM.
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http://dx.doi.org/10.3346/jkms.2016.31.6.924DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4853672PMC
June 2016

Brown Fat and Browning for the Treatment of Obesity and Related Metabolic Disorders.

Diabetes Metab J 2016 Feb;40(1):12-21

Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Brown fat is a specialized fat depot that can increase energy expenditure and produce heat. After the recent discovery of the presence of active brown fat in human adults and novel transcription factors controlling brown adipocyte differentiation, the field of the study of brown fat has gained great interest and is rapidly growing. Brown fat expansion and/or activation results in increased energy expenditure and a negative energy balance in mice and limits weight gain. Brown fat is also able to utilize blood glucose and lipid and results in improved glucose metabolism and blood lipid independent of weight loss. Prolonged cold exposure and beta adrenergic agonists can induce browning of white adipose tissue. The inducible brown adipocyte, beige adipocyte evolving by thermogenic activation of white adipose tissue have different origin and molecular signature from classical brown adipocytes but share the characteristics of high mitochondria content, UCP1 expression and thermogenic capacity when activated. Increasing browning may also be an efficient way to increase whole brown fat activity. Recent human studies have shown possibilities that findings in mice can be reproduced in human, making brown fat a good candidate organ to treat obesity and its related disorders.
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http://dx.doi.org/10.4093/dmj.2016.40.1.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4768046PMC
February 2016

The effects of adiponectin and inflammatory cytokines on diabetic vascular complications in obese and non-obese patients with type 2 diabetes mellitus.

Diabetes Res Clin Pract 2016 Jan 21;111:58-65. Epub 2015 Oct 21.

Department of Endocrinology, Inha University School of Medicine, Incheon, Republic of Korea. Electronic address:

Aims: To evaluate the associations between inflammatory cytokines and adiponectin and various vascular complications in type 2 diabetes mellitus (T2DM).

Methods: A total of 761 patients with T2DM were divided into a non-obese group and an obese group to enable the effects of obesity and T2DM on vascular complications to be differentiated. The serum levels of circulating inflammatory cytokines, that is, tumor necrosis factor (TNF)-α, and interleukin (IL)-6, total adiponectin, and high molecular weight (HMW) adiponectin were measured, and carotid intima media thickness (IMT), the presence of carotid plaque, and the severities of retinopathy and nephropathy, were assessed.

Results: The obese group had significantly lower serum total and HMW adiponectin levels than the non-obese group. In the obese group, serum levels of total and HMW adiponectin, and TNF-α were significantly higher in patients with proliferative retinopathy than in those without retinopathy after adjusting for covariates. In the non-obese group, only IL-6 levels were significantly higher in patients with proliferative retinopathy than in those without. Serum levels of total and HMW adiponectin were significantly higher in patients with macroalbuminuria than in those with normoalbuminuria. No significant difference of three cytokines levels were observed depending on the carotid IMT or the presence of plaque. Logistic regression analysis revealed that serum total adiponectin (OR=1.209, P=0.038), diabetes duration (OR=1.230, P=0.014), and HbA1c (OR=2.359, P=0.006) were significantly associated with proliferative retinopathy in the obese group.

Conclusion: The study shows total adiponectin may influence proliferative retinopathy in obese patient with T2DM.
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http://dx.doi.org/10.1016/j.diabres.2015.10.017DOI Listing
January 2016

Change of Bone Mineral Density and Biochemical Markers of Bone Turnover in Patients on Suppressive Levothyroxine Therapy for Differentiated Thyroid Carcinoma.

J Bone Metab 2015 Aug 31;22(3):135-41. Epub 2015 Aug 31.

Department of Endocrinology, Inha University School of Medicine, Incheon, Korea.

Untreated hyperthyroidism and high-dose thyroid hormone are associated with osteoporosis, and increased bone mineral density (BMD) has been demonstrated in postmenopausal females with hypoparathyroidism. Studies on the effect of suppressive levothyroxine (LT4) therapy on BMD and bone metabolism after total thyroidectomy in patients with differentiated thyroid carcinoma have presented conflicting results, and few studies in relation to the status of hypoparathyroidism have been studied. One hundred postmenopausal women and 24 premenopausal women on LT4 suppression therapy were included in this study. BMD of lumbar spine and femur and bone turnover markers were measured at the baseline and during the follow-up period up to 18 months using dual energy X-ray absorptiometry. Biochemical marker of bone resorption was measured by urine deoxypyridinoline and bone formation by serum osteocalcin. The age ranged from 36 to 64 years old. Thyroid stimulating hormone (TSH) was suppressed during the study. The results showed that BMD of femur and lumbar spine were not significantly changed in both pre- and postmenopausal women except femur neck in postmenopausal women without hypoparathyroidism. Patients with hypoparathyroidism had higher BMD gain than those without hypoparathyroidism in total hip (1.25 vs. -1.18%, P=0.015). Biochemical markers of bone turnover, serum osteocalcin, and urine deoxypyridinoline did not show significant change. In conclusion, patients with well differentiated thyroid carcinoma are not at a great risk of bone loss after LT4 suppressive therapy. The state of hypoparathyroidism is associated with increased BMD, particularly in postmenopausal women.
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http://dx.doi.org/10.11005/jbm.2015.22.3.135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4572035PMC
August 2015

Antiangiogenic Activity of Acer tegmentosum Maxim Water Extract in Vitro and in Vivo.

J Korean Med Sci 2015 Jul 10;30(7):979-87. Epub 2015 Jun 10.

Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea. ; Department of Clinical Pharmacology, Inha University School of Medicine, Incheon, Korea.

Angiogenesis, the formation of new blood vessels, is critical for tumor growth and metastasis. Notably, tumors themselves can lead to angiogenesis by inducing vascular endothelial growth factor (VEGF), which is one of the most potent angiogenic factors. Inhibition of angiogenesis is currently perceived as one of the most promising strategies for the blockage of tumor growth. In this study, we investigated the effects of Acer tegmentosum maxim water extract (ATME) on angiogenesis and its underlying signal mechanism. We studied the antiangiogenic activity of ATME by using human umbilical vein endothelial cells (HUVECs). ATME strongly inhibited VEGF-induced endothelial cell proliferation, migration, invasion, and tube formation, as well as vessel sprouting in a rat aortic ring sprouting assay. Moreover, we found that the p44/42 mitogen activated protein (MAP) kinase signaling pathway is involved in the inhibition of angiogenesis by ATME. Moreover, when we performed the in vivo matrigel plug assay, VEGF-induced angiogenesis was potently reduced when compared to that for the control group. Taken together, these results suggest that ATME exhibits potent antiangiogenic activity in vivo and in vitro and that these effects are regulated by the extracellular regulated kinase (ERK) pathway.
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http://dx.doi.org/10.3346/jkms.2015.30.7.979DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4479955PMC
July 2015

Metformin-associated lactic acidosis: predisposing factors and outcome.

Endocrinol Metab (Seoul) 2015 Mar 18;30(1):78-83. Epub 2014 Jul 18.

Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea.

Background: Metformin is considered the first choice oral treatment for type 2 diabetes patients in the absence of contraindications. Rarely, life-threatening complications associated with metformin treatment are seen in some patients with underlying diseases. The aim of this study was to further investigate the clinical profiles and risk factors for metformin-associated lactic acidosis (MALA) and the treatment modalities according to survival.

Methods: To identify MALA, we performed a retrospective study in seven diabetic patients who were taking metformin and had been diagnosed with lactic acidosis at Inha University Hospital between 1995 and 2012. For each patient, we recorded the age, sex, daily metformin dosage, laboratory test results, admission diagnosis, and risk factors. Also, concurrent conditions, treatment modalities, and outcomes were evaluated.

Results: Six patients had risk factors for lactic acidosis before admission. All patients had renal impairment on admission as a precipitating risk factor. Five patients survived and two patients died despite early renal replacement therapy. Older patients tended to have a poorer prognosis.

Conclusion: Renal function must be monitored in elderly type 2 diabetes mellitus patients with underlying diseases and conditions causing renal impairment who begin metformin treatment. Accurate recognition of MALA and initiation of renal replacement are essential for treatment.
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http://dx.doi.org/10.3803/EnM.2015.30.1.78DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4384670PMC
March 2015

Effect of lifestyle modification on serum chemerin concentration and its association with insulin sensitivity in overweight and obese adults with type 2 diabetes.

Clin Endocrinol (Oxf) 2014 Jun 20;80(6):825-33. Epub 2013 Jun 20.

Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea.

Objective: Chemerin, a recently identified adipokine, has been linked to adiposity, insulin resistance, metabolic syndrome risk factors and inflammation. Here, we evaluated whether a 12-week lifestyle intervention in overweight and obese adults with type 2 diabetes could significantly affect the average blood glucose and serum chemerin levels over time.

Design: Thirty-five overweight or obese subjects with type 2 diabetes were randomized to receive intensive lifestyle modification including supervised exercise sessions or usual care for 12 weeks. Anthropometric and clinical data were collected before the intervention and after 12 weeks.

Results: Lifestyle intervention induced a significant decrease in HbA1c (-1·0 ± 0·5 vs 0·1 ± 0·6%, P < 0·001), BMI, total body fat content, serum lipocalin-2 and chemerin levels (-8·1 ± 21·6 vs + 8·2 ± 15·9 ng/ml, P = 0·021) and a significant increase in VO2 max after 12 weeks compared to the usual care group. Baseline chemerin levels were positively correlated with the homoeostasis model of assessment of insulin resistance (HOMA-IR), fasting insulin and the high-sensitivity C-reactive protein (hsCRP) and negatively correlated with insulin sensitivity index (ISI). Changes in the chemerin concentration during 12 weeks were independently negatively correlated with changes in ISI and positively correlated with changes in fasting plasma glucose, total cholesterol and lipocalin-2 levels.

Conclusions: A 12-week intensive lifestyle intervention significantly decreased serum chemerin level compared to usual care. Decrease in serum chemerin level was associated with improved insulin sensitivity, and this may be involved in the beneficial effects of lifestyle intervention in overweight and obese type 2 diabetic patients.
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http://dx.doi.org/10.1111/cen.12249DOI Listing
June 2014
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