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Arsh H, Ali A, Khenhrani RR, Simran F, Dino U, Tamang S, Manoj F, Bai S, Bai M, Panjwani GR, Kumar D, Rani D, Partab F, Malik J. Efficacy and Safety of Pitavastatin in Patients with Impaired Glucose Tolerance: An Updated Review. Curr Probl Cardiol 2023; 48:101981. [PMID: 37473935 DOI: 10.1016/j.cpcardiol.2023.101981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/16/2023] [Indexed: 07/22/2023]
Abstract
This review provides an updated overview of the efficacy and safety of pitavastatin in patients with impaired glucose tolerance (IGT). IGT is a prediabetic state characterized by elevated blood glucose levels that do not meet the criteria for diabetes. The review explores the potential benefits of pitavastatin in reducing cardiovascular risk and improving lipid profiles in individuals with IGT. It also examines the glycemic effects of pitavastatin, including its impact on fasting blood glucose levels, insulin sensitivity, and beta-cell function. The review highlights the need for individualized treatment approaches, taking into account the patient's overall cardiovascular risk profile and glycemic control needs. While pitavastatin has shown modest improvements in glycemic control, it is not a substitute for lifestyle modifications or standard antidiabetic medications. Future directions for research include long-term follow-up studies, mechanistic investigations, and comparative analyses to further understand the glycemic effects of pitavastatin in IGT. Overall, this narrative review provides valuable insights for healthcare professionals involved in the management of individuals with IGT, emphasizing the importance of a comprehensive approach to reduce cardiovascular risk and optimize glycemic control.
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Affiliation(s)
- Hina Arsh
- Department of Medicine, THQ Hospital, Pasrur, Pakistan
| | - Asif Ali
- Department of Medicine, Chandka Medical College, Larkana, Pakistan
| | - Raja Ram Khenhrani
- Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Lyari, Pakistan
| | - Fnu Simran
- Department of Medicine, Sheikh Khalifa Bin Zayed Al Nayhan Medical and Dental College, Lahore, Pakistan
| | - Umbish Dino
- Department of Medicine, Sheikh Khalifa Bin Zayed Al Nayhan Medical and Dental College, Lahore, Pakistan
| | - Sweta Tamang
- Nepal Medical College and Teaching Hospital, Nepal
| | - Fnu Manoj
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Shuaita Bai
- Department of Medicine, People's University of Medical and Health Sciences, Nawabshah, Pakistan
| | - Monika Bai
- Department of Medicine, People's University of Medical and Health Sciences, Nawabshah, Pakistan
| | | | - Deepak Kumar
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Deepa Rani
- Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Lyari, Pakistan
| | - Fnu Partab
- Department of Medicine, Chandka Medical College, Larkana, Pakistan
| | - Jahanzeb Malik
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Islamabad, Pakistan.
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Abstract
PURPOSE OF REVIEW The purpose of this review was to summarize recent advances in the genomics of type 2 diabetes (T2D) and to highlight current initiatives to advance precision health. RECENT FINDINGS Generation of multi-omic data to measure each of the "biologic layers," developments in describing genomic function and annotation in T2D relevant tissue, along with the increasing recognition that T2D is a heterogeneous disease, and large-scale collaborations have all contributed to advancing our understanding of the molecular basis of T2D. Substantial advances have been made in understanding the molecular basis of T2D pathogenesis, such that precision health diabetes is increasingly becoming a reality. For precision diabetes to become a routine in clinical and public health, additional large-scale multi-omic initiatives are needed along with better assessment of our environment to delineate an individual's diabetes subtype for improved detection and management.
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Affiliation(s)
- Yuan Lin
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | - Jennifer Wessel
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA.
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
- Diabetes Translational Research Center, Indiana University School of Medicine, Indianapolis, IN, USA.
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Richter B, Hemmingsen B, Metzendorf M, Takwoingi Y. Development of type 2 diabetes mellitus in people with intermediate hyperglycaemia. Cochrane Database Syst Rev 2018; 10:CD012661. [PMID: 30371961 PMCID: PMC6516891 DOI: 10.1002/14651858.cd012661.pub2] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Intermediate hyperglycaemia (IH) is characterised by one or more measurements of elevated blood glucose concentrations, such as impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and elevated glycosylated haemoglobin A1c (HbA1c). These levels are higher than normal but below the diagnostic threshold for type 2 diabetes mellitus (T2DM). The reduced threshold of 5.6 mmol/L (100 mg/dL) fasting plasma glucose (FPG) for defining IFG, introduced by the American Diabetes Association (ADA) in 2003, substantially increased the prevalence of IFG. Likewise, the lowering of the HbA1c threshold from 6.0% to 5.7% by the ADA in 2010 could potentially have significant medical, public health and socioeconomic impacts. OBJECTIVES To assess the overall prognosis of people with IH for developing T2DM, regression from IH to normoglycaemia and the difference in T2DM incidence in people with IH versus people with normoglycaemia. SEARCH METHODS We searched MEDLINE, Embase, ClincialTrials.gov and the International Clinical Trials Registry Platform (ICTRP) Search Portal up to December 2016 and updated the MEDLINE search in February 2018. We used several complementary search methods in addition to a Boolean search based on analytical text mining. SELECTION CRITERIA We included prospective cohort studies investigating the development of T2DM in people with IH. We used standard definitions of IH as described by the ADA or World Health Organization (WHO). We excluded intervention trials and studies on cohorts with additional comorbidities at baseline, studies with missing data on the transition from IH to T2DM, and studies where T2DM incidence was evaluated by documents or self-report only. DATA COLLECTION AND ANALYSIS One review author extracted study characteristics, and a second author checked the extracted data. We used a tailored version of the Quality In Prognosis Studies (QUIPS) tool for assessing risk of bias. We pooled incidence and incidence rate ratios (IRR) using a random-effects model to account for between-study heterogeneity. To meta-analyse incidence data, we used a method for pooling proportions. For hazard ratios (HR) and odds ratios (OR) of IH versus normoglycaemia, reported with 95% confidence intervals (CI), we obtained standard errors from these CIs and performed random-effects meta-analyses using the generic inverse-variance method. We used multivariable HRs and the model with the greatest number of covariates. We evaluated the certainty of the evidence with an adapted version of the GRADE framework. MAIN RESULTS We included 103 prospective cohort studies. The studies mainly defined IH by IFG5.6 (FPG mmol/L 5.6 to 6.9 mmol/L or 100 mg/dL to 125 mg/dL), IFG6.1 (FPG 6.1 mmol/L to 6.9 mmol/L or 110 mg/dL to 125 mg/dL), IGT (plasma glucose 7.8 mmol/L to 11.1 mmol/L or 140 mg/dL to 199 mg/dL two hours after a 75 g glucose load on the oral glucose tolerance test, combined IFG and IGT (IFG/IGT), and elevated HbA1c (HbA1c5.7: HbA1c 5.7% to 6.4% or 39 mmol/mol to 46 mmol/mol; HbA1c6.0: HbA1c 6.0% to 6.4% or 42 mmol/mol to 46 mmol/mol). The follow-up period ranged from 1 to 24 years. Ninety-three studies evaluated the overall prognosis of people with IH measured by cumulative T2DM incidence, and 52 studies evaluated glycaemic status as a prognostic factor for T2DM by comparing a cohort with IH to a cohort with normoglycaemia. Participants were of Australian, European or North American origin in 41 studies; Latin American in 7; Asian or Middle Eastern in 50; and Islanders or American Indians in 5. Six studies included children and/or adolescents.Cumulative incidence of T2DM associated with IFG5.6, IFG6.1, IGT and the combination of IFG/IGT increased with length of follow-up. Cumulative incidence was highest with IFG/IGT, followed by IGT, IFG6.1 and IFG5.6. Limited data showed a higher T2DM incidence associated with HbA1c6.0 compared to HbA1c5.7. We rated the evidence for overall prognosis as of moderate certainty because of imprecision (wide CIs in most studies). In the 47 studies reporting restitution of normoglycaemia, regression ranged from 33% to 59% within one to five years follow-up, and from 17% to 42% for 6 to 11 years of follow-up (moderate-certainty evidence).Studies evaluating the prognostic effect of IH versus normoglycaemia reported different effect measures (HRs, IRRs and ORs). Overall, the effect measures all indicated an elevated risk of T2DM at 1 to 24 years of follow-up. Taking into account the long-term follow-up of cohort studies, estimation of HRs for time-dependent events like T2DM incidence appeared most reliable. The pooled HR and the number of studies and participants for different IH definitions as compared to normoglycaemia were: IFG5.6: HR 4.32 (95% CI 2.61 to 7.12), 8 studies, 9017 participants; IFG6.1: HR 5.47 (95% CI 3.50 to 8.54), 9 studies, 2818 participants; IGT: HR 3.61 (95% CI 2.31 to 5.64), 5 studies, 4010 participants; IFG and IGT: HR 6.90 (95% CI 4.15 to 11.45), 5 studies, 1038 participants; HbA1c5.7: HR 5.55 (95% CI 2.77 to 11.12), 4 studies, 5223 participants; HbA1c6.0: HR 10.10 (95% CI 3.59 to 28.43), 6 studies, 4532 participants. In subgroup analyses, there was no clear pattern of differences between geographic regions. We downgraded the evidence for the prognostic effect of IH versus normoglycaemia to low-certainty evidence due to study limitations because many studies did not adequately adjust for confounders. Imprecision and inconsistency required further downgrading due to wide 95% CIs and wide 95% prediction intervals (sometimes ranging from negative to positive prognostic factor to outcome associations), respectively.This evidence is up to date as of 26 February 2018. AUTHORS' CONCLUSIONS Overall prognosis of people with IH worsened over time. T2DM cumulative incidence generally increased over the course of follow-up but varied with IH definition. Regression from IH to normoglycaemia decreased over time but was observed even after 11 years of follow-up. The risk of developing T2DM when comparing IH with normoglycaemia at baseline varied by IH definition. Taking into consideration the uncertainty of the available evidence, as well as the fluctuating stages of normoglycaemia, IH and T2DM, which may transition from one stage to another in both directions even after years of follow-up, practitioners should be careful about the potential implications of any active intervention for people 'diagnosed' with IH.
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Affiliation(s)
- Bernd Richter
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupPO Box 101007DüsseldorfGermany40001
| | - Bianca Hemmingsen
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupPO Box 101007DüsseldorfGermany40001
| | - Maria‐Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupPO Box 101007DüsseldorfGermany40001
| | - Yemisi Takwoingi
- University of BirminghamInstitute of Applied Health ResearchEdgbastonBirminghamUKB15 2TT
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Vahid F, Shivappa N, Karamati M, Naeini AJ, Hebert JR, Davoodi SH. Association between Dietary Inflammatory Index (DII) and risk of prediabetes: a case-control study. Appl Physiol Nutr Metab 2016; 42:399-404. [PMID: 28177734 DOI: 10.1139/apnm-2016-0395] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The possible relationship between diet-related inflammation and the risk of prediabetes requires further investigation, especially in non-Western populations. We examined the ability of the dietary inflammatory index (DII) to predict the risk of prediabetes in a case-control study conducted at specialized centers in Esfahan, Iran. A total of 214 incident cases of prediabetes were selected with the nonrandom sampling procedure, and the 200 controls randomly selected from the same clinics were frequency-matched on age (±5 years) and sex. DII scores were computed based on dietary intake assessed using a validated and reproducible 168-item food-frequency questionnaire. Linear and logistic regression models were used to estimate multivariable beta estimates and odds ratios (ORs). Subjects in tertile 3 versus tertile 1 (T3VS1) of DII had significantly higher fasting plasma glucose (DIIT3VS1: b = 4.49; 95% CI 1.89, 7.09), oral glucose tolerance (DIIT3VS1: b = 8.76; 95% CI 1.78, 15.73), HbA1c (DIIT3VS1: b = 0.30; 95% CI 0.17, 0.42), low-density lipoprotein (DIIT3VS1: b = 16.37; 95% CI 11.04, 21.69), triglyceride (DIIT3VS1: b = 21.01; 95% CI 8.61, 33.42) and body fat (DIIT3VS1: b = 2.41; 95% CI 0.56, 4.26) and lower high-density lipoprotein (DIIT3VS1: b = -3.39; 95% CI -5.94, -0.84) and lean body mass (DIIT3VS1: b = -3.11; 95% CI -4.83, -1.39). After multivariate adjustment, subjects in the most pro-inflammatory DII group had 19 times higher odds of developing prediabetes compared with subjects in tertile 1 (DIIT3VS1: OR = 18.88; 95% CI 7.02, 50.82). Similar results were observed when DII was used as a continuous variable, (DIIcontinuous: OR = 3.62; 95% CI 2.50, 5.22). Subjects who consumed a more pro-inflammatory diet were at increased risk of prediabetes compared with those who consumed a more anti-inflammatory diet.
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Affiliation(s)
- Farhad Vahid
- a Department of Nutritional Sciences, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nitin Shivappa
- b Cancer Prevention and Control Program, University of South Carolina, Columbia, SC 29208, USA.,c Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.,d Connecting Health Innovations LLC, Columbia, SC 29201, USA
| | - Mohsen Karamati
- e Department of Nutrition Sciences, Varastegan Institute for Medical Sciences, Mashhad, Iran
| | | | - James R Hebert
- b Cancer Prevention and Control Program, University of South Carolina, Columbia, SC 29208, USA.,c Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.,d Connecting Health Innovations LLC, Columbia, SC 29201, USA
| | - Sayed Hossein Davoodi
- a Department of Nutritional Sciences, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,g Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Kim NH, Cho HJ, Kim S, Seo JH, Lee HJ, Yu JH, Chung HS, Yoo HJ, Seo JA, Kim SG, Baik SH, Choi DS, Shin C, Choi KM. Predictive Mortality Index for Community-Dwelling Elderly Koreans. Medicine (Baltimore) 2016; 95:e2696. [PMID: 26844511 PMCID: PMC4748928 DOI: 10.1097/md.0000000000002696] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
There are very few predictive indexes for long-term mortality among community-dwelling elderly Asian individuals, despite its importance, given the rapid and continuous increase in this population. We aimed to develop 10-year predictive mortality indexes for community-dwelling elderly Korean men and women based on routinely collected clinical data.We used data from 2244 elderly individuals (older than 60 years of age) from the southwest Seoul Study, a prospective cohort study, for the development of a prognostic index. An independent longitudinal cohort of 679 elderly participants was selected from the Korean Genome Epidemiology Study in Ansan City for validation.During a 10-year follow-up, 393 participants (17.5%) from the development cohort died. Nine risk factors were identified and weighed in the Cox proportional regression model to create a point scoring system: age, male sex, smoking, diabetes, systolic blood pressure, triglyceride, total cholesterol, white blood cell count, and hemoglobin. In the development cohort, the 10-year mortality risk was 6.6%, 14.8%, 18.2%, and 38.4% among subjects with 1 to 4, 5 to 7, 8 to 9, and ≥10 points, respectively. In the validation cohort, the 10-year mortality risk was 5.2%, 12.0%, 16.0%, and 16.0% according to these categories. The C-statistic for the point system was 0.73 and 0.67 in the development and validation cohorts, respectively.The present study provides valuable information for prognosis among elderly Koreans and may guide individualized approaches for appropriate care in a rapidly aging society.
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Affiliation(s)
- Nan H Kim
- From the Department of Internal Medicine, Division of Endocrinology and Metabolism, College of Medicine, Korea University, Seoul (NHK, HJC, JHS, HJL, JHY, HSC, HJY, JAS, SGK, SHB, DSC, KMC); Division of Epidemiology and Health Index, Center for Genome Science, Korea National Institute of Health, Korea Center for Disease Control and Prevention, Cheongju (SK); Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, College of Medicine, Korea University, Seoul, Korea (CS)
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Hsu WC, Araneta MRG, Kanaya AM, Chiang JL, Fujimoto W. BMI cut points to identify at-risk Asian Americans for type 2 diabetes screening. Diabetes Care 2015; 38:150-8. [PMID: 25538311 PMCID: PMC4392932 DOI: 10.2337/dc14-2391] [Citation(s) in RCA: 321] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- William C Hsu
- Asian American Diabetes Initiative, Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - Maria Rosario G Araneta
- Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA
| | - Alka M Kanaya
- Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA
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Liu J, Zhao D, Liu J, Qi Y, Sun J, Wang W. Prevalence of diabetes mellitus in outpatients with essential hypertension in China: a cross-sectional study. BMJ Open 2013; 3:e003798. [PMID: 24259390 PMCID: PMC3840347 DOI: 10.1136/bmjopen-2013-003798] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To investigate the prevalence of diabetes mellitus (DM) and new detection of DM using fasting plasma glucose (FPG) and 2 h plasma glucose (2-hPG) in hypertensive outpatients in China. DESIGN Multicenter cross-sectional study. SETTING 46 hospitals in China. PARTICIPANTS Study patients were consecutively recruited from June to December 2009 from hypertension outpatient clinics in 46 hospitals in 22 provinces, autonomous regions and municipalities in China. At least 100 consecutive patients were recruited in each hospital. FPG was measured for all patients and 2-hPG was measured in those without a history of DM. A total of 4942 hypertensive outpatients aged ≥20 years were included. RESULTS Prevalence of DM was 24.3% (which included both previously and newly diagnosed cases). Among the 1202 patients with DM, 417 (34.7%) were newly detected. In patients aged <45 years, 52.6% of cases of DM were newly detected. Of the 417 cases of newly detected diabetes, 54.9% were identified using FPG tests and the remaining 45.1% by 2-hPG tests; 27.1% of patients with newly detected DM had FPG <6.1 mmol/L and 16.5% had FPG <5.6 mmol/L. Among the elderly patients (≥65 years), 32.4% had normal FPG (<6.1 mmol/L) and 24.5% had optimal FPG (<5.6 mmol/L). CONCLUSIONS Our findings showed a high prevalence of DM and newly detected DM among Chinese hypertensive outpatients. Application of additional 2-hPG testing to FPG assay can improve the detection rate of DM, especially in elderly patients.
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Affiliation(s)
- Jun Liu
- Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
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Choi KM, Cho HJ, Choi HY, Yang SJ, Yoo HJ, Seo JA, Kim SG, Baik SH, Choi DS, Kim NH. Higher mortality in metabolically obese normal-weight people than in metabolically healthy obese subjects in elderly Koreans. Clin Endocrinol (Oxf) 2013; 79:364-70. [PMID: 23330616 DOI: 10.1111/cen.12154] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 12/08/2012] [Accepted: 01/12/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the impact of body mass index (BMI) and the presence of metabolic syndrome (MetS) on all-cause and cardiovascular mortality in elderly Korean men and women, and especially to compare metabolically obese normal-weight (MONW) and metabolically healthy obese (MHO) subjects. PATIENTS AND METHODS A total of 2317 elderly people (over 60 years of age) were studied using follow-up data from the South-West Seoul (SWS) Study, a prospective cohort study. Mortality from all causes and cardiovascular disease (CVD) were evaluated according to the combination of the presence or absence of MetS and Asian-specific body mass index (BMI) criteria (BMI <23 kg/m²; normal weight, BMI 23-24·9 kg/m²; overweight, BMI ≥25 kg/m²; obesity). RESULTS During a median follow-up of 10·3 years, 393 subjects died, including 126 from CVD. Among subjects with MetS, all-cause and CVD mortality were significantly higher in normal-weight subjects than overweight or obese individuals in Cox proportional-hazard models adjusted for confounding factors. Furthermore, among six groups with various MetS/BMI combinations, MONW individuals had the highest risk, whereas overweight subjects without MetS had the lowest risk of death from all causes and CVD [HR = 2·2 (95% CI = 1·4-3·4), HR = 3·0 (95% CI = 1·4-6·6) respectively]. Interestingly, all-cause mortality was significantly higher in MONW than MHO individuals. CONCLUSIONS In contrast to MHO subjects, elderly individuals with the MONW phenotype exhibited greater all-cause mortality during 10 years of follow-up.
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Affiliation(s)
- Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
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Ko SH, Kim SR, Kim DJ, Oh SJ, Lee HJ, Shim KH, Woo MH, Kim JY, Kim NH, Kim JT, Kim CH, Kim HJ, Jeong IK, Hong EK, Cho JH, Mok JO, Yoon KH. 2011 clinical practice guidelines for type 2 diabetes in Korea. Diabetes Metab J 2011; 35:431-6. [PMID: 22111032 PMCID: PMC3221016 DOI: 10.4093/dmj.2011.35.5.431] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
As in other countries, type 2 diabetes is major health concern in Korea. A dramatic increase in the prevalence of type 2 diabetes and its chronic complications has led to an increase in health costs and economic burdens. Early detection of high risk individuals, hidden diabetic patients, and improvement in the quality of care for the disease are the first steps to mitigate the increase in prevalence. The Committee of Clinical Practice Guidelines of the Korean Diabetes Association revised and updated the '3rd Clinical Practice Guidelines' at the end of 2010. In the guidelines, the committee recommended active screening of high risk individuals for early detection and added the hemoglobin A1c level to the diagnostic criteria for type 2 diabetes based on clinical studies performed in Korea. Furthermore, the committee members emphasized that integrating patient education and self-management is an essential part of care. The drug treatment algorithm based on the degree of hyperglycemia and patient characteristics were also updated.
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Affiliation(s)
- Seung-Hyun Ko
- Division of Endocrinology & Metabolism, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Rea Kim
- Division of Endocrinology & Metabolism, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Joon Kim
- Department of Internal Medicine, Inje University College of Medicine, Goyang, Korea
| | - Seung-Joon Oh
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hye-Jin Lee
- Division of Endocrinology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Kang-Hee Shim
- Department of Diabetes Education, Samsung Medical Center, Seoul, Korea
| | - Mi-Hye Woo
- Department of Clinical Nutrition, Kyung Hee University Medical Center, Seoul, Korea
| | - Jun-Young Kim
- Department of Socialwork, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Nan-Hee Kim
- Department of Internal Medicine, Korea University College of Medicine, Ansan, Korea
| | - Jae-Taik Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Chong Hwa Kim
- Division of Endocrinology & Metabolism, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hae Jin Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - In-Kyung Jeong
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Eun-Kyung Hong
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jae-Hyoung Cho
- Division of Endocrinology & Metabolism, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji-Oh Mok
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Kun-Ho Yoon
- Division of Endocrinology & Metabolism, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
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Kim NH, Cho HJ, Kim YJ, Cho MJ, Choi HY, Eun CR, Kim JH, Yang SJ, Yoo HJ, Kim HY, Seo JA, Kim SG, Baik SH, Choi DS, Choi KM. Combined effect of high-normal blood pressure and low HDL cholesterol on mortality in an elderly Korean population: the South-West Seoul (SWS) study. Am J Hypertens 2011; 24:918-23. [PMID: 21525969 DOI: 10.1038/ajh.2011.78] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND It is unclear whether prehypertension by the seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) criteria (systolic blood pressure (SBP) 120-139 or diastolic blood pressure (DBP) 80-89 mm Hg) or high-normal blood pressure (HNBP) by the European Society of Hypertension and European Society of Cardiology (ESH/ESC) criteria (SBP 130-139 or DBP 85-89 mm Hg) predicts mortality in elderly Koreans. We compared the mortality risk between those with prehypertension and HNBP and evaluated whether the presence of components of metabolic syndrome (MetS) can improve the prediction of mortality in subjects with HNBP. METHODS We analyzed all-cause and cardiovascular disease (CVD) mortality according to the JNC-7 and ESH/ESC categories using follow-up data of the South-West Seoul (SWS) Study, a prospective cohort study of 2,376 elderly Koreans, aged >60 years. RESULTS During the median follow-up of 7.6 years, 353 deaths occurred from all causes, and 113 of these were attributed to CVD. Prehypertension was nonsignificantly associated with an increased risk of mortality (hazard ratio (HR): 1.06, 95% confidence interval (CI): 0.68-1.64). Subjects with HNBP exhibited a nonsignificantly higher risk of mortality compared with those with optimal blood pressure by the ESH/ESC guideline (HR: 1.35, 95% CI: 0.84-2.18). However, the combination of low high-density lipoprotein (HDL) cholesterol and HNBP showed a twofold higher risk of all-cause mortality (HR: 2.01, 95% CI: 1.11-3.64) independent of other risk factors. CONCLUSIONS Although prehypertension was not associated with increased risk of mortality, individuals in the elderly Korean population with HNBP, especially when combined with low HDL cholesterol, showed a significantly increased risk of all-cause mortality.
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Abstract
The term prediabetes refers to subjects with impaired fasting glucose and/or impaired glucose tolerance who are at increased risk for type 2 diabetes mellitus. Although both types of patients are at increased risk for developing type 2 diabetes mellitus and cardiovascular disease, they manifest distinct metabolic abnormalities. In this article, we summarize the metabolic abnormalities that characterize each state and the contribution of these metabolic abnormalities to the increased risk of diabetes and cardiovascular disease.
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Affiliation(s)
- Muhammad A Abdul-Ghani
- Diabetes Division, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
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Oh JY, Lim S, Kim DJ, Kim NH, Kim DJ, Moon SD, Jang HC, Cho YM, Song KH, Ahn CW, Sung YA, Park JY, Shin C, Lee HK, Park KS. A report on the diagnosis of intermediate hyperglycemia in Korea: A pooled analysis of four community-based cohort studies. Diabetes Res Clin Pract 2008; 80:463-8. [PMID: 18339440 DOI: 10.1016/j.diabres.2008.01.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Accepted: 01/17/2008] [Indexed: 11/16/2022]
Abstract
Many studies show poor agreement between fasting plasma glucose (FPG)-based and 2-h postchallenge glucose (2-h PG)-based criteria to assess glucose metabolism. We examined the rate of agreement between FPG- and 2-h PG-based criteria in the diagnosis of intermediate hyperglycemia in four representative cohort studies in South Korea and compared the clinical characteristics and biochemical parameters in subjects with impaired fasting glucose (IFG) according to their FPG values. Of 6234 subjects from four population-based studies performed from 1993 to 2000, 4610 individuals with data from a 75g oral glucose tolerance test (OGTT) and no previous history of diabetes were selected. We examined the concordance rate between the FPG and 2-h PG-based criteria. We also investigated the differences in the clinical characteristics and biochemical parameters between individuals with IFG according to their FPG values. The fasting and 2-h PG criteria had large discordance rates in the diagnosis of diabetes and impaired glucose tolerance (IGT) in Korean adults. When individuals with IFG were classified into stage 1 [5.6-6.1mmol/L (100-109mg/dL)] and stage 2 [6.1-7.0mmol/L (110-125mg/dL)] IFG, individuals with stage 2 IFG are more obese and had higher blood pressure and total cholesterol and triglycerides concentrations compared with those with stage 1 IFG. In addition, more individuals with stage 2 IFG were with diabetes as determined by a 2-h PG>or=11.1mmol/L (14.1% vs. 1.9%) (P<0.05). Considering the poorer metabolic profile and higher percentage of people with diabetes by OGTT, these data indicate that, in the Korean population, individuals with stage 2 IFG should be treated differently from those with stage 1 IFG. To detect more cases of diabetes, the OGTT is recommended for all individuals with stage 2 IFG and cases with stage 1 IFG with some additional risk factors for diabetes.
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Affiliation(s)
- Jee-Young Oh
- Department of Internal Medicine, School of Medicine Ewha Womans University, Seoul, Korea
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Kim SH, Shim WS, Kim EA, Kim EJ, Lee SH, Hong SB, Kim YS, Park SG, Lim JW, Lee HJ, Nam M. The effect of lowering the threshold for diagnosis of impaired fasting glucose. Yonsei Med J 2008; 49:217-23. [PMID: 18452257 PMCID: PMC2615324 DOI: 10.3349/ymj.2008.49.2.217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the effect of lowering the fasting plasma glucose (FPG) criteria for impaired fasting glucose (IFG) on the prevalence of IFG and the risk for the development of diabetes associated with IFG in Koreans. MATERIALS AND METHODS A total of 7,211 subjects who had normal glucose tolerance (NGT) or IFG were recruited. Subjects were evaluated at baseline and after two years follow up. Clinical data including total cholesterol, FPG and blood pressure were examined. RESULTS Lowering the criteria for IFG from 6.1 mmol/L (110 mg/dL) to 5.6 mmol/L (100 mg/dL) increased the prevalence of IFG from 6.6% (494 subjects) to 24.4% (1829 subjects). After the 2 years follow up period, 91 subjects (1.3%) developed diabetes. Twenty one (0.3%) subjects developed diabetes among 5,382 NGT subjects and 70 (3.8%) subjects developed diabetes among 1,829 IFG (5.6-7.0 mmol/L) subjects. Lowering the IFG threshold from 6.1 mmol/L to 5.6 mmol/L resulted in a 18.4% decrease in specificity and 23.9% increase in sensitivity for predicting diabetes. The baseline FPG for predicting the development of diabetes after 2 years at a point on the receiver operating characteristic curve that was closest to the ideal 100% sensitivity and 100% specificity was 5.7 mmol/L (103 mg/dL). CONCLUSION Lowering the FPG criterion of IFG should have benefits in predicting new onset type 2 diabetes mellitus in Koreans. The economic and health benefits of applying the new IFG criteria should be evaluated in future studies.
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Affiliation(s)
- So Hun Kim
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Wan Sub Shim
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Eun A Kim
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Eun Joo Kim
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Seung Hee Lee
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Seong Bin Hong
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Yong Seong Kim
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Shin Goo Park
- Department of Occupational and Environmental Medicine, Inha University College of Medicine, Incheon, Korea
| | - Jong Whan Lim
- Department of Occupational and Environmental Medicine, Inha University College of Medicine, Incheon, Korea
| | - Hun-Jae Lee
- Department of Preventive and Social Medicine, Inha University College of Medicine, Incheon, Korea
| | - Moonsuk Nam
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
- Center for Advanced Medical Education (BK 21 project), Inha University College of Medicine, Incheon, Korea
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Sicree RA, Zimmet PZ, Dunstan DW, Cameron AJ, Welborn TA, Shaw JE. Differences in height explain gender differences in the response to the oral glucose tolerance test- the AusDiab study. Diabet Med 2008; 25:296-302. [PMID: 18307457 DOI: 10.1111/j.1464-5491.2007.02362.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AIM To determine the extent of gender-related differences in the prevalence of glucose intolerance for the Australian population and whether body size may explain such differences. METHODS Cross-sectional data were collected from a national cohort of 11 247 Australians aged > or = 25 years. Glucose tolerance status was assessed according to both fasting plasma glucose (FPG) and 2-h plasma glucose (2hPG) levels following a 75-g oral glucose tolerance test (OGTT). Anthropometric and glycated haemoglobin measurements were also made. RESULTS Undiagnosed diabetes and non-diabetic glucose abnormalities were more prevalent among men than women when based only on the FPG results (diabetes: men 2.2%, women 1.6%, P = 0.02; impaired fasting glycaemia: men 12.3%, women 6.6%, P < 0.001). In contrast 16.0% of women and 13.0% of men had a 2hPG abnormality (either diabetes or impaired glucose tolerance, P = 0.14). Women had a mean FPG 0.3 mmol/l lower than men (P < 0.001), but 2hPG 0.3 mmol/l higher (P = 0.002) and FPG-2hPG increment 0.5 mmol/l greater (P < 0.001). The gender difference in mean 2hPG and FPG-2hPG increment disappeared following adjustment for height. For both genders, those in the shortest height quartile had 2hPG levels 0.5 mmol/l higher than the tallest quartile, but height showed almost no relationship with the FPG. CONCLUSIONS Men and women had different glycaemic profiles; women had higher mean 2hPG levels, despite lower fasting levels. It appeared that the higher 2hPG levels for women related to lesser height and may be a consequence of using a fixed glucose load in the OGTT, irrespective of body size.
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Affiliation(s)
- R A Sicree
- International Diabetes Institute, Melbourne, Victoria, Australia.
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Oh JY, Lim S, Kim DJ, Kim NH, Kim DJ, Moon SD, Jang HC, Cho YM, Song KH, Park KS. The diagnosis of diabetes mellitus in Korea: a pooled analysis of four community-based cohort studies. Diabet Med 2007; 24:217-8. [PMID: 17257287 DOI: 10.1111/j.1464-5491.2007.02051.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Stookey JD, Pieper CF, Cohen HJ. Is the prevalence of dehydration among community-dwelling older adults really low? Informing current debate over the fluid recommendation for adults aged 70+years. Public Health Nutr 2007; 8:1275-85. [PMID: 16372923 DOI: 10.1079/phn2005829] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AbstractObjectiveThe fluid recommendation for adults aged 70+ years has been criticised on the basis of a low prevalence of dehydration in community-dwelling older adults. This study explores whether the low prevalence might reflect limitations of individual dehydration indices.DesignCross-sectional data on plasma sodium, blood urea nitrogen (BUN), creatinine, glucose and potassium were used to classify 1737 participants of the 1992 Established Populations for Epidemiologic Studies of the Elderly (EPESE) (70+ years) according to multiple dehydration indices. Associations between dehydration indices, health and functional status were evaluated.ResultsDepending on the indicator used, the prevalence of dehydration ranged from 0.5% for hypotonic hypovolaemia only (plasma tonicity <285 mOsm l−1 with orthostatic hypotension) to 60% with dehydration defined as either plasma sodium ≥145 mEq l−1, BUN/creatinine ratio ≥20, tonicity ≥295 mOsm l−1, or hypotonic hypovolaemia. Elevated tonicity and BUN/creatinine ratio were respectively associated with chronic disease and functional impairment.ConclusionsThe true prevalence of dehydration among community-dwelling adults may be low or high, depending on the indicator(s) used to define dehydration. Before we can pinpoint a generalisable prevalence of dehydration for community-dwelling seniors and draw conclusions about fluid recommendations, validation studies of dehydration indices and longitudinal studies of dehydration, health and functional status are needed.
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Affiliation(s)
- Jodi Dunmeyer Stookey
- Center for the Study of Aging and Human Development, Claude D Pepper Older Americans Independence Center, Duke University Medical Center, Box 3003, Durham, NC 27710, USA.
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Daniel M, Rowley KG, Marks E, O'Dea K. Test agreement for classifying diabetes in indigenous Australians. Aust N Z J Public Health 2006; 30:128-31. [PMID: 16681332 DOI: 10.1111/j.1467-842x.2006.tb00104.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To evaluate for Indigenous Australians the agreement between a fasting plasma glucose (FPG) criterion of 7.0 mmol/L and diabetes test results using a two-hour oral glucose tolerance test (OGTT), comparing relationships between test agreement and prevalence to similar studies. METHODS Screening was undertaken in 25 remote settlements. Agreement between FPG and OGTT results was evaluated using the kappa coefficient (chance-corrected agreement). RESULTS Participants (n=3,249) ranged from 15-94 years. Kappa ranged from 0.70-0.77 for diabetes prevalence of 5-30%, with overall agreement of 0.76. In comparison studies, the relationship between kappa and diabetes prevalence was similar, but with kappa 0.21-0.48. CONCLUSIONS AND IMPLICATIONS A FPG test with a 7.0 mmol/L cut-off is a reliable screening method, relative to the OGTT, for remote Indigenous settlements. The level of agreement between the FPG test and the OGTT for the Indigenous population surveyed is superior by far to agreement reported for non-Indigenous samples.
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Affiliation(s)
- Mark Daniel
- Département de Médecine Sociale et Préventive, Université de Montréal, Canada.
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Abdul-Ghani MA, Tripathy D, DeFronzo RA. Contributions of beta-cell dysfunction and insulin resistance to the pathogenesis of impaired glucose tolerance and impaired fasting glucose. Diabetes Care 2006. [PMID: 16644654 DOI: 10.2337/dc05-2179] [Citation(s) in RCA: 551] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) are intermediate states in glucose metabolism that exist between normal glucose tolerance and overt diabetes. Epidemiological studies demonstrate that the two categories describe distinct populations with only partial overlap, suggesting that different metabolic abnormalities characterize IGT and IFG. Insulin resistance and impaired beta-cell function, the primary defects observed in type 2 diabetes, both can be detected in subjects with IGT and IFG. However, clinical studies suggest that the site of insulin resistance varies between the two disorders. While subjects with IGT have marked muscle insulin resistance with only mild hepatic insulin resistance, subjects with IFG have severe hepatic insulin resistance with normal or near-normal muscle insulin sensitivity. Both IFG and IGT are characterized by a reduction in early-phase insulin secretion, while subjects with IGT also have impaired late-phase insulin secretion. The distinct metabolic features present in subjects with IFG and IGT may require different therapeutic interventions to prevent their progression to type 2 diabetes.
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Affiliation(s)
- Muhammad A Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA.
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Ryu S, Shin H, Chang Y, Sung KC, Song J, Lee SJ. Should the lower limit of impaired fasting glucose be reduced from 110 mg/dL in Korea? Metabolism 2006; 55:489-93. [PMID: 16546479 DOI: 10.1016/j.metabol.2005.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2005] [Accepted: 10/17/2005] [Indexed: 10/24/2022]
Abstract
The aims of this study were to determine if impaired fasting glucose should be redefined as a fasting plasma glucose (FPG) of 100 to 125 mg/dL (5.6-6.9 mmol/L) in Korea. A prospective cohort study was undertaken involving 13189 male workers aged 30 to 59 years who did not have medication for diabetes, a history of any cancer, or a fasting glucose level of 126 mg/dL or higher at the initial examination between January 1999 to December 2000. Subjects were reexamined at periodic annual health examination over a 5-year period. The receiver operating characteristic curve for predicting the future onset of diabetes was derived by plotting the sensitivity against 1 - specificity for a baseline FPG of less than 126 mg/dL. The age- and body mass index-adjusted incidence density of type 2 diabetes mellitus was examined according to the percentile of the distribution for the baseline FPG. The baseline FPG for predicting the future onset of diabetes at a point on the receiver operating characteristic curve that was closest to the ideal 100% sensitivity and 100% specificity was 92 mg/dL. There was a threshold for the age- and body mass index-adjusted incidence density of diabetes in the group with FPG of 93 to 95 mg/dL, at a mean of 93.9 mg/dL. Lowering the lower limit of impaired fasting glucose to 100 mg/dL (5.6 mmol/L) would optimize its sensitivity and specificity for predicting the future onset of diabetes in Korea.
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Affiliation(s)
- Seungho Ryu
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul 110-746, South Korea
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Kim SM, Lee JS, Lee J, Na JK, Han JH, Yoon DK, Baik SH, Choi DS, Choi KM. Prevalence of diabetes and impaired fasting glucose in Korea: Korean National Health and Nutrition Survey 2001. Diabetes Care 2006; 29:226-31. [PMID: 16443864 DOI: 10.2337/diacare.29.02.06.dc05-0481] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to estimate the prevalence of diabetes and impaired fasting glucose (IFG) and their association with risk factors in the Korean population. RESEARCH DESIGN AND METHODS The Korean National Health and Nutrition Survey 2001 was a nationally representative survey with a stratified multistage sampling design. Data from a comprehensive questionnaire, a physical examination, and blood tests were obtained from 5,844 Korean adults (2,513 men and 3,331 women) aged >20 years. RESULTS The age-adjusted prevalence of diabetes in this Korean population was 7.6%, and the age-adjusted prevalences of previously diagnosed diabetes and newly diagnosed diabetes were 4.4 and 3.3%, respectively (fasting plasma glucose > or = 7.0 mmol/l). Overall, these results indicate that 8.1% or 1.4 million Korean men and 7.5% or 1.3 million Korean women have diabetes. The age-adjusted prevalence of IFG was 23.9%, using the new American Diabetes Association criteria (fasting plasma glucose 5.6-6.9 mmol/l). Diabetes prevalence increased with age and peaked in the oldest age-group; however, IFG prevalence did not show the same trend. Diabetes was found to be associated with age, BMI, blood pressure, triglyceride, HDL cholesterol, education levels, alcohol consumption, exercise, and a family history of diabetes. CONCLUSIONS This study shows that diabetes and IFG are common in Korea, and about one-half of diabetes cases remain undiagnosed. These results emphasize the need to develop an urgent public program to improve the detection, prevention, and treatment of diabetes.
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Affiliation(s)
- S M Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
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Kim DJ, Cho NH, Noh JH, Kim HJ, Choi YH, Jung JH, Min YK, Lee MS, Lee MK, Kim KW. Fasting plasma glucose cutoff value for the prediction of future diabetes development: a study of middle-aged Koreans in a health promotion center. J Korean Med Sci 2005; 20:562-5. [PMID: 16100444 PMCID: PMC2782148 DOI: 10.3346/jkms.2005.20.4.562] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We determined optimal fasting plasma glucose (FPG) cutoff values predictive of future diabetes development in a group of middle-aged Koreans who visited a health promotion center. The medical records of 2,964 subjects, who attended the Health Promotion Center in 1998 and 2003, were examined. Subjects were classified into four groups according to their baseline FPG values (Group 1:FPG <5.0 mM/L; Group 2: 5.0< or =FPG <5.6 mM/L; Group 3: 5.6< or =FPG <6.1 mM/L; Group 4: 6.1< or =FPG <7.0 mM/L). No significant difference was observed between Group 1 and Group 2 in terms of diabetes incidence. However, incidence in Group 3 was significantly higher than that in Group 1 [hazards ratio 4.88 (1.65-14.41), p=0.004] and the hazards ratio in Group 4 for diabetes was 36.91 (13.11-103.61), p<0.001, versus Group 1. Receiver operator characteristics curve analysis showed that an FPG of 5.97 mM/L represents the lower limit and gives the best combination of sensitivity and specificity. Our data shows that the risk of future diabetes development started to increase below an FPG of 6.1 mM/L and suggests the importance of efforts to modify diabetes development risk factors at lower impaired fasting glucose levels.
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Affiliation(s)
- Dong-Jun Kim
- Department of Internal Medicine, Ilsan-Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Nam-Han Cho
- Department of Preventive Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Jung-Hyun Noh
- Department of Internal Medicine, Ilsan-Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Hyun-Jin Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon-Ho Choi
- Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Hoon Jung
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong-Ki Min
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myung-Shik Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Moon-Kyu Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang-Won Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Choi KM, Lee KW, Kim SG, Kim NH, Park CG, Seo HS, Oh DJ, Choi DS, Baik SH. Inflammation, insulin resistance, and glucose intolerance in acute myocardial infarction patients without a previous diagnosis of diabetes mellitus. J Clin Endocrinol Metab 2005; 90:175-80. [PMID: 15509644 DOI: 10.1210/jc.2004-1795] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
We examined the prevalence of impaired glucose metabolism and its association with inflammation and insulin resistance (IR) in acute myocardial infarction (AMI) patients without a previous diagnosis of diabetes. This prospective study enrolled 52 AMI patients, and 75-g oral glucose tolerance testing was performed on 30 patients at discharge and again 3 months later. We also measured serum adiponectin, high sensitive C-reactive protein, and IL-6 on both occasions. Data were compared with those of 30 type 2 diabetic patients without a history of AMI. Forty percent and 36.7% of AMI patients had impaired glucose tolerance (IGT) at discharge and at 3 months, respectively. The corresponding proportions for newly diagnosed diabetes are 33.0% and 30.0%. At discharge, AMI patients with IGT or diabetes showed higher high sensitive C-reactive protein and IL-6 levels compared with AMI patients with normal glucose tolerance or control type 2 diabetic patients. Furthermore, AMI patients with IGT or diabetes exhibited higher IR and lower serum adiponectin levels than AMI patients with normal glucose tolerance at 3 months after discharge. Previously undiagnosed diabetes and IGT are common in Korean patients with AMI. These glycometabolic abnormalities are associated with inflammation, IR, and serum adiponectin levels.
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Affiliation(s)
- K M Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University, 80 Guro-Dong, Guro-Gu, Seoul 152-050, Korea.
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Choi KM, Lee J, Lee KW, Seo JA, Oh JH, Kim SG, Kim NH, Choi DS, Baik SH. Serum adiponectin concentrations predict the developments of type 2 diabetes and the metabolic syndrome in elderly Koreans. Clin Endocrinol (Oxf) 2004; 61:75-80. [PMID: 15212647 DOI: 10.1111/j.1365-2265.2004.02063.x] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To determine whether low serum adiponectin concentrations are able to predict the future developments of type 2 diabetes and the metabolic syndrome using the National Cholesterol Education Programme (NCEP) criteria. We also investigated the stability of adiponectin levels and the relationships between baseline adiponectin levels and changes in the parameters related to the metabolic syndrome over a period of 3 years. PATIENTS AND MEASUREMENTS This prospective cohort study included 372 elderly Koreans who participate in the SWS (South-West Seoul) study, which was conducted in 1999 and 2002 in Seoul, Korea. Fasting and postchallenge 2-h plasma glucose, body mass index (BMI), waist-to-hip ratio (WHR), blood pressure, lipid profiles and serum adiponectin data obtained in 1999 and 2002 were examined. RESULTS The within-person variation between 1999 and 2002 of serum adiponectin was not significant (P = 0.61). Serum adiponectin was closely correlated with the risks factors of cardiovascular disease (CVD), that is negatively with BMI, WHR, blood pressure, triglyceride and blood glucose levels, and positively with high density lipoprotein (HDL)-cholesterol levels. Subjects with the metabolic syndrome showed lower serum adiponectin concentrations than those without the metabolic syndrome (P < 0.0001). Baseline adiponectin levels were found to be correlated with subsequent changes in WHR, low density lipoprotein (LDL)-cholesterol, fasting and postload 2-h glucose over the 3-year period, after adjusting for baseline values. Multiple logistic regression analysis showed that lower baseline serum adiponectin concentrations were significantly associated with the developments of type 2 diabetes and the metabolic syndrome after adjusting for age, sex, obesity, history of impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), hypertension and dyslipidaemia. CONCLUSIONS Reduced concentrations of adiponectin were found to be independently associated with increased risk of both type 2 diabetes and the metabolic syndrome in elderly Koreans.
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Affiliation(s)
- K M Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
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Choi KM, Lee J, Lee KW, Seo JA, Oh JH, Kim SG, Kim NH, Choi DS, Baik SH. Comparison of serum concentrations of C-reactive protein, TNF-alpha, and interleukin 6 between elderly Korean women with normal and impaired glucose tolerance. Diabetes Res Clin Pract 2004; 64:99-106. [PMID: 15063602 DOI: 10.1016/j.diabres.2003.10.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2003] [Indexed: 11/24/2022]
Abstract
This study was performed to compare concentrations of pro-inflammatory cytokines, such as interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-alpha) as well as acute-phase protein, such as C-reactive protein (CRP) between subjects with normal glucose tolerance (NGT) and impaired glucose tolerance (IGT). The purpose of this study was to verify whether the pro-inflammatory cytokine-induced acute-phase response is a pathogenic mechanism in type 2 diabetes in elderly Korean women. A total of 1737 elderly subjects aged over 60 years participated in a population based study in Seoul, Korea (SWS Study 1999). Amongst them, a total of 232 non-smoking and non-diabetic female subjects aged 60-89 years was randomly selected and compared with each other. Higher serum high-sensitivity CRP (hs-CRP) concentrations were shown in subjects with IGT than those with normal glucose tolerance (median 1.2 versus 0.9, P < 0.05). Moreover, a relationship between serum hs-CRP concentrations and many components of the metabolic syndrome were detected. Serum pro-inflammatory cytokine IL-6 or TNF-alpha concentrations, however, were neither increased in subjects with IGT nor closely correlated with the components of the metabolic syndrome. In multiple regression analysis with stepwise selection method using hs-CRP as a dependent variable, it was found that white blood cell (WBC) counts, body mass index (BMI), fasting insulin, post-load 2h glucose, hematocrit and LDL cholesterol were significant independent variables. Our study confirms that increased acute-phase reaction is associated with impaired glucose tolerance and the metabolic syndrome in elderly Korean women. However, the hypothesis that pro-inflammatory cytokine-induced systemic inflammation is an early metabolic defect prior to onset of type 2 diabetes, is not supported in our study of elderly Korean women.
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Affiliation(s)
- K M Choi
- Department of Internal Medicine, Korea University Guro Hospital, 80 Guro-Dong, Guro-Gu, Seoul 152-050, South Korea
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Agarwal MM, Punnose J, Dhatt GS. Gestational diabetes: implications of variation in post-partum follow-up criteria. Eur J Obstet Gynecol Reprod Biol 2004; 113:149-53. [PMID: 15063951 DOI: 10.1016/j.ejogrb.2003.09.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2003] [Revised: 08/01/2003] [Accepted: 09/05/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To compare the recommendations of the American Diabetes Association (ADA) with the World Health Organization (WHO) for evaluating women with gestational diabetes (GDM) after delivery. STUDY DESIGN During a 5-year period, 549 patients underwent the 2h, 75 g oral glucose tolerance test (OGTT), 4-8 weeks after delivery. They were classified by the criteria of WHO (1985), the ADA [1997, fasting glucose (FPG)] and the revised WHO (1999). RESULTS The prevalence of diabetes by WHO-1985 and ADA-1997 were similar (8.2% versus 6.6%) but estimates of impaired glucose homeostasis varied widely (15.5% impaired glucose tolerance (IGT) versus 9.3% impaired fasting glucose, respectively). 118 (21.5%) women and 83 (15.1%) women showed a classification discrepancy between ADA-1997 with the WHO-1985 and -1999, respectively. The receiver-operating characteristic (ROC) curve area of the FPG was 0.94 for DM by the OGTT (WHO-1985 criteria) but only 0.59 for IGT by the 2h post-glucose. CONCLUSIONS The various guidelines for GDM follow-up after delivery, often based on expert opinion, produce similar estimates for diabetes prevalence but widely discordant results for glucose intolerance. Until more uniform evidence-based criteria become available, the various strategies for GDM follow-up will continue to cause confusion in clinical practice.
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Affiliation(s)
- Mukesh M Agarwal
- Department of Pathology, Faculty of Medicine, UAE University, PO Box 17666, Al Ain, United Arab Emirates.
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Gu D, Reynolds K, Duan X, Xin X, Chen J, Wu X, Mo J, Whelton PK, He J. Prevalence of diabetes and impaired fasting glucose in the Chinese adult population: International Collaborative Study of Cardiovascular Disease in Asia (InterASIA). Diabetologia 2003; 46:1190-8. [PMID: 12879248 DOI: 10.1007/s00125-003-1167-8] [Citation(s) in RCA: 315] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2002] [Revised: 05/28/2003] [Indexed: 12/14/2022]
Abstract
AIMS/HYPOTHESIS To estimate the prevalence of diagnosed and undiagnosed diabetes and impaired fasting glucose in the general adult population of China. METHODS The International Collaborative Study of Cardiovascular Disease in ASIA, conducted from 2000 to 2001, included a nationally representative sample of 15 540 adults, aged 35 to 74 years. An overnight fasting blood specimen was collected to measure serum glucose and information on history of diabetes and use of hypoglycaemic medications was obtained by a standard questionnaire. Undiagnosed diabetes (fasting glucose > or =7.0 mmol/l) and impaired fasting glucose (6.1-6.9 mmol/l) were defined using the American Diabetes Association criteria. RESULTS Prevalence of self-reported diagnosed diabetes, undiagnosed diabetes, and impaired fasting glucose in Chinese adults were 1.3%, 4.2%, and 7.3%, respectively. Overall, 5.2% or 12.7 million men and 5.8% or 13.3 million women in China aged 35 to 74 years had diabetes (self-reported diagnosis plus undiagnosed diabetes). The age-standardized prevalence of diabetes was higher in residents of northern compared to southern China (7.4% vs 5.4%, p<0.001) and in those living in urban compared to rural areas (7.8% vs 5.1%, p<0.001). CONCLUSIONS/INTERPRETATION Our results show that the prevalence of diabetes in the adult population in China is much higher than previously reported. Three out of every four diabetes patients are undiagnosed, indicative of a lack of population-based screening programmmes and a relatively rapid and recent increase in incidence of diabetes. These results indicate that diabetes has become a major public health problem in China and underscore the need for national strategies aimed at prevention and treatment of diabetes.
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Affiliation(s)
- D Gu
- Cardiovascular Institute and Fuwai Hospital of Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Choi KM, Lee J, Kim YH, Kim KB, Kim DL, Kim SG, Shin DH, Kim NH, Park IB, Choi DS, Baik SH. Relation between insulin resistance and hematological parameters in elderly Koreans-Southwest Seoul (SWS) Study. Diabetes Res Clin Pract 2003; 60:205-12. [PMID: 12757983 DOI: 10.1016/s0168-8227(03)00059-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In this study, we investigated the relation between insulin resistance and hematological parameters in elderly Koreans. This study included 1314 non-diabetic subjects over the age of 60, selected from a cross-sectional study, which was conducted in 1999 in Seoul, Korea. We measured fasting and post-load 2 h plasma glucose, insulin levels, lipid profiles, anthropometric measures, and hematological parameters. The degree of insulin resistance was assessed using the homeostasis model assessment (HOMA). We found a correlation between insulin resistance and hemoglobin concentrations in non-smoking men (r=0.20, P=0.0186). In non-smoking women, insulin resistance correlated with hemoglobin (r=0.10, P=0.0017) and with white blood cell (WBC) count (r=0.15, P=0.001). Hemoglobin concentrations and WBC counts were also associated with other components of the insulin resistance syndrome such as body mass index, blood pressure, lipid profiles and fasting plasma insulin levels (surrogate for insulin resistance). Furthermore, the group in the upper quartile for insulin resistance showed higher hemoglobin concentrations and WBC counts than the lower quartile, independent of smoking status and serum iron concentrations. Using HOMA-IR as a dependent variable in a multiple regression analysis, age, body mass index (BMI), waist-to-hip ratio (WHR), systolic blood pressure, HDL cholesterol, triglyceride, WBC count, hemoglobin, hematocrit and serum TIBC were significant. Our results provide support for a relation between insulin resistance/hyperinsulinemia and hematological parameters such as hemoglobin concentrations and WBC counts in elderly Koreans. This suggests that increased erythropoiesis and subclinical inflammation could be part of the metabolic syndrome in elderly Koreans.
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Affiliation(s)
- K M Choi
- Department of Internal Medicine, College of Medicine, Korea University Guro Hospital, 80 Guro-Dong, Guro-Gu, Seoul 152-050, South Korea
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Choi KM, Lee J, Kim KB, Kim DR, Kim SK, Shin DH, Kim NH, Park IB, Choi DS, Baik SH. Factor analysis of the metabolic syndrome among elderly Koreans--the South-west Seoul Study. Diabet Med 2003; 20:99-104. [PMID: 12581260 DOI: 10.1046/j.1464-5491.2003.00890.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS To examine the relationship between the components of the metabolic syndrome and to explore whether insulin resistance unifies the clustering of components of the metabolic syndrome among urban elderly Koreans using exploratory factor analysis. METHODS We included 1314 non-diabetic subjects over the age of 60 years, selected from a cross-sectional study, which was conducted in 1999 in Seoul, Korea. Factor analysis was carried out using the principle components analysis with Varimax orthogonal rotation of the components of the metabolic syndrome. RESULTS We found four major factors of cardiovascular disease risk variables in our study subjects. Impaired glucose tolerance, dyslipidaemia, hypertension and obesity aggregated as the major domain. Obesity and dyslipidaemia variables were closely related and loaded on the same factor. However, hypertension was not linked closely with other factors of the metabolic syndrome. CONCLUSIONS Insulin resistance is not the only contributor to the metabolic syndrome among urban elderly Koreans. Although the components of the metabolic syndrome were closely related, the finding of more than one factor suggests that more than one pathophysiological mechanism underlies full expression of the metabolic syndrome among elderly Koreans.
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Affiliation(s)
- K M Choi
- Department of Internal Medicine, College of Medicine, Korea University, Seoul, South Korea
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Current literature in diabetes. Diabetes Metab Res Rev 2003; 19:76-83. [PMID: 12592647 DOI: 10.1002/dmrr.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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