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Background@#Post-transplant diabetes mellitus (PTDM) is a risk factor for poor outcomes after kidney transplantation (KT). However, the outcomes of KT have improved recently. Therefore, we investigated whether PTDM is still a risk factor for mortality, major atherosclerotic cardiovascular events (MACEs), and graft failure in KT recipients. @*Methods@#We studied a retrospective cohort of KT recipients (between 1994 and 2017) at a single tertiary center, and compared the rates of death, MACEs, overall graft failure, and death-censored graft failure after KT between patients with and without PTDM using Kaplan-Meier analysis and a Cox proportional hazard model. @*Results@#Of 571 KT recipients, 153 (26.8%) were diagnosed with PTDM. The mean follow-up duration was 9.6 years. In the Kaplan- Meier analysis, the PTDM group did not have a significantly increased risk of death or four-point MACE compared with the non-diabetes mellitus group (log-rank test, P=0.957 and P=0.079, respectively). Multivariate Cox proportional hazard models showed that PTDM did not have a negative impact on death or four-point MACE (P=0.137 and P=0.181, respectively). In addition, PTDM was not significantly associated with overall or death-censored graft failure. However, patients with a long duration of PTDM had a higher incidence of four-point MACE. @*Conclusion@#Patient survival and MACEs were comparable between groups with and without PTDM. However, PTDM patients with long duration diabetes were at higher risk of cardiovascular disease.
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Background@#There are no clear data to support the cardiovascular (CV) risk categories and low-density lipoprotein cholesterol (LDL-C) treatment goals in Korean people with type 2 diabetes mellitus (T2DM). We evaluated the incidence of cardiovascular disease (CVD) according to comorbidities and suggested LDL-C treatment goals in Korean people with T2DM in nationwide cohort data. @*Methods@#Using the Korean National Health Insurance Service database, 248,002 people aged 30 to 90 years with T2DM who underwent routine health check-ups during 2009 were included. Subjects with previous CVD were excluded from the study. The primary outcome was incident CVD, defined as a composite of myocardial infarction and ischemic stroke during the follow-up period from 2009 to 2018. @*Results@#The mean age of the study participants was 59.6±10.9 years, and median follow-up period was 9.3 years. CVD incidence increased in the order of DM duration of 5 years or more (12.04/1,000 person-years), hypertension (HT) (12.27/1,000 personyears), three or more CV risk factors (14.10/1,000 person-years), and chronic kidney disease (18.28/1,000 person-years). The risk of incident CVD increased linearly from an LDL-C level of ≥70 mg/dL in most patients with T2DM. In T2DM patients without HT or with a DM duration of less than 5 years, the CVD incidence increased from LDL-C level of ≥100 mg/dL. @*Conclusion@#For primary prevention of CVD in Korean adults with T2DM, it can be helpful to lower LDL-C targets when there are chronic kidney disease, HT, a long duration of diabetes mellitus, or three or more CV risk factors.
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Background@#To validate the treatment target of low-density lipoprotein cholesterol (LDL-C) level according to the cardiovascular disease (CVD) risk which was recommended by Korean dyslipidemia guideline. @*Methods@#We used the Korean National Health Insurance Service database which included 3,958,048 people aged 20 to 89 years who underwent regular health screening. The primary outcome was incident CVD, defined as a composite of myocardial infarction and stroke during the follow-up period from 2009 to 2018. @*Results@#The risk of CVD increased from LDL-C level of 70 mg/dL in very high-risk and high-risk groups and from 130 mg/dL in moderate-risk and low-risk groups. Adjusted hazard ratios (HRs) of LDL-C ranges 70–99, 100–129, 130–159, 160–189, and ≥190 mg/dL were 1.20 (95% confidence interval [CI], 1.08–1.33), 1.27 (1.15–1.42), 1.39 (1.23–1.56), 1.69 (1.45–1.96), and 1.84 (1.49– 2.27) in very high-risk group, and 1.07 (1.02–1.13), 1.16 (1.10–1.21), 1.29 (1.22–1.36), 1.45 (1.36–1.55), and 1.73 (1.58–1.90) in high-risk group. Adjusted HRs (95% CI) of LDL-C ranges 130–159, 160–189, and ≥190 mg/dL were 1.15 (1.11–1.20), 1.28 (1.22– 1.34), and 1.45 (1.36–1.54) in moderate-risk group and 1.07 (1.02–1.13), 1.20 (1.13–1.26), and 1.47 (1.37–1.57) in low-risk group. @*Conclusion@#We confirmed the incidence of CVD was increased in higher LDL-C range. The risk of CVD increased from ≥70 mg/dL of LDL-C in very high-risk and high-risk groups, and from ≥130 mg/dL of LDL-C in moderate-risk and low-risk groups in Korean adults.
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In May 2023, the Committee of Clinical Practice Guidelines of the Korean Diabetes Association published the revised clinical practice guidelines for Korean adults with diabetes and prediabetes. We incorporated the latest clinical research findings through a comprehensive systematic literature review and applied them in a manner suitable for the Korean population. These guidelines are designed for all healthcare providers nationwide, including physicians, diabetes experts, and certified diabetes educators who manage patients with diabetes or individuals at risk of developing diabetes. Based on recent changes in international guidelines and the results of a Korean epidemiological study, the recommended age for diabetes screening has been lowered. In collaboration with the relevant Korean medical societies, recently revised guidelines for managing hypertension and dyslipidemia in patients with diabetes have been incorporated into this guideline. An abridgment containing practical information on patient education and systematic management in the clinic was published separately.
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Background@#This study investigates the long-term efficacy and safety of evogliptin add-on therapy in patients with inadequately controlled type 2 diabetes mellitus (T2DM) previously received dapagliflozin and metformin (DAPA/MET) combination. @*Methods@#In this multicenter randomized placebo-controlled phase 3 trial, patients with glycosylated hemoglobin (HbA1c) levels 7.0% to 10.5% (n=283) previously used DAPA 10 mg plus MET (≥1,000 mg) were randomly assigned to the evogliptin 5 mg once daily or placebo group (1:1). The primary endpoint was the difference in the HbA1c level from baseline at week 24, and exploratory endpoints included the efficacy and safety of evogliptin over 52 weeks (trial registration: ClinicalTrials.gov NCT04170998). @*Results@#Evogliptin add-on to DAPA/MET therapy was superior in HbA1c reduction compared to placebo at weeks 24 and 52 (least square [LS] mean difference, –0.65% and –0.55%; 95% confidence interval [CI], –0.79 to –0.51 and –0.71 to –0.39; P<0.0001). The proportion of patients achieving HbA1c <7% was higher in the triple combination group at week 52 (32.14% vs. 8.51% in placebo; odds ratio, 5.62; P<0.0001). Evogliptin significantly reduced the fasting glucose levels and mean daily glucose levels with improvement in homeostatic model assessment of β-cell function (LS mean difference, 9.04; 95% CI, 1.86 to 16.21; P=0.0138). Adverse events were similar between the groups, and no serious adverse drug reactions were reported in the evogliptin group. @*Conclusion@#Long-term triple combination with evogliptin added to DAPA/MET showed superior HbA1c reduction and glycemic control compared to placebo at 52 weeks and was well tolerated.
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Objective@#We aimed to compare the aortic valve area (AVA) calculated using fast high-resolution three-dimensional (3D) magnetic resonance (MR) image acquisition with that of the conventional two-dimensional (2D) cine MR technique. @*Materials and Methods@#We included 139 consecutive patients (mean age ± standard deviation [SD], 68.5 ± 9.4 years) with aortic valvular stenosis (AS) and 21 asymptomatic controls (52.3 ± 14.2 years). High-resolution T2-prepared 3D steady-state free precession (SSFP) images (2.0 mm slice thickness, 10 contiguous slices) for 3D planimetry (3DP) were acquired with a single breath hold during mid-systole. 2D SSFP cine MR images (6.0 mm slice thickness) for 2D planimetry (2DP) were also obtained at three aortic valve levels. The calculations for the effective AVA based on the MR images were compared with the transthoracic echocardiographic (TTE) measurements using the continuity equation. @*Results@#The mean AVA ± SD derived by 3DP, 2DP, and TTE in the AS group were 0.81 ± 0.26 cm2 , 0.82 ± 0.34 cm2 , and 0.80 ± 0.26 cm2 , respectively (p = 0.366). The intra-observer agreement was higher for 3DP than 2DP in one observer: intraclass correlation coefficient (ICC) of 0.95 (95% confidence interval [CI], 0.94–0.97) and 0.87 (95% CI, 0.82–0.91), respectively, for observer 1 and 0.97 (95% CI, 0.96–0.98) and 0.98 (95% CI, 0.97–0.99), respectively, for observer 2. Inter-observer agreement was similar between 3DP and 2DP, with the ICC of 0.92 (95% CI, 0.89–0.94) and 0.91 (95% CI, 0.88–0.93), respectively. 3DP-derived AVA showed a slightly higher agreement with AVA measured by TTE than the 2DP-derived AVA, with the ICC of 0.87 (95% CI, 0.82–0.91) vs. 0.85 (95% CI, 0.79–0.89). @*Conclusion@#High-resolution 3D MR image acquisition, with single-breath-hold SSFP sequences, gave AVA measurement with low observer variability that correlated highly with those obtained by TTE.
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Objective@#We aimed to compare the aortic valve area (AVA) calculated using fast high-resolution three-dimensional (3D) magnetic resonance (MR) image acquisition with that of the conventional two-dimensional (2D) cine MR technique. @*Materials and Methods@#We included 139 consecutive patients (mean age ± standard deviation [SD], 68.5 ± 9.4 years) with aortic valvular stenosis (AS) and 21 asymptomatic controls (52.3 ± 14.2 years). High-resolution T2-prepared 3D steady-state free precession (SSFP) images (2.0 mm slice thickness, 10 contiguous slices) for 3D planimetry (3DP) were acquired with a single breath hold during mid-systole. 2D SSFP cine MR images (6.0 mm slice thickness) for 2D planimetry (2DP) were also obtained at three aortic valve levels. The calculations for the effective AVA based on the MR images were compared with the transthoracic echocardiographic (TTE) measurements using the continuity equation. @*Results@#The mean AVA ± SD derived by 3DP, 2DP, and TTE in the AS group were 0.81 ± 0.26 cm2 , 0.82 ± 0.34 cm2 , and 0.80 ± 0.26 cm2 , respectively (p = 0.366). The intra-observer agreement was higher for 3DP than 2DP in one observer: intraclass correlation coefficient (ICC) of 0.95 (95% confidence interval [CI], 0.94–0.97) and 0.87 (95% CI, 0.82–0.91), respectively, for observer 1 and 0.97 (95% CI, 0.96–0.98) and 0.98 (95% CI, 0.97–0.99), respectively, for observer 2. Inter-observer agreement was similar between 3DP and 2DP, with the ICC of 0.92 (95% CI, 0.89–0.94) and 0.91 (95% CI, 0.88–0.93), respectively. 3DP-derived AVA showed a slightly higher agreement with AVA measured by TTE than the 2DP-derived AVA, with the ICC of 0.87 (95% CI, 0.82–0.91) vs. 0.85 (95% CI, 0.79–0.89). @*Conclusion@#High-resolution 3D MR image acquisition, with single-breath-hold SSFP sequences, gave AVA measurement with low observer variability that correlated highly with those obtained by TTE.
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Glucagon-like peptide 1 (GLP-1) is a peptide hormone secreted by L cells of the small intestine in response to nutrients. GLP-1 presents a glucose-lowering effect via insulinotropic action on pancreatic β-cells. In addition to the insulinotropic effect, GLP-1 has pleiotropic actions associated with clinical benefits. GLP-1 receptor agonists (GLP-1RAs) are a well-established effective treatment for patients with type 2 diabetes mellitus (T2DM). GLP-1RAs have antihyperglycemic effects and help reduce glucose levels and body weight, with a low risk of hypoglycemia. Additionally, GLP-1RAs have beneficial effects on cardiovascular risk factors, such as blood pressure and lipid levels. Large randomized cardiovascular outcome trials and meta-analyses have demonstrated that GLP-1RAs reduce cardiovascular disease in T2DM patients. GLP-1RAs are recommended as part of glucose-lowering regimens in patients with T2DM and established cardiovascular disease or those at high risk. Renal protective effects and beneficial effects of GLP-1RAs on non-alcoholic fatty liver disease have been suggested.
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Background@#Sedentary behavior (SB) has emerged as a new risk factor for cardiovascular accidents. We investigated whether physical activity levels or SB were related to percent body fat (%BF) in type 2 diabetes mellitus (T2DM). @*Methods@#In this cross sectional study, we measured the duration of SB, light physical activity (LPA), moderate to vigorous physical activity (MVPA), total energy expenditure, and step counts using a wireless activity tracker (Fitbit HR; FB) for 7 days in freeliving conditions, along with %BF using a bio impedance analyzer (Inbody; Biospace) in 120 smartphone users with T2DM. Subjects were divided into exercise (Exe, n=68) and non-exercise (nonExe, n=52) groups based on self-reports of whether the recommended exercises (30 min/day, 3 days/week for 3 months) were performed. SBt, LPAt, MVPAt were transformed from SB, LPA, MVPA for normally distributed variables. @*Results@#Participants were: female, 59.2%; age, 59.3±8.4 years; body mass index, 25.5±3.4 kg/m2; glycosylated hemoglobin (HbA1c), 7.6%±1.2%; %BF, 30.4%±7.1%. They performed SB for 15.7±3.7 hr/day, LPA for 4.4±1.7 hr/day, and MVPA for 0.9±0.8 hr/day. The %BF was related to SBt and LPAt, but not to MVPA after adjustments for age, gender, and HbA1c. VPA was significantly higher in the Exe group than in the nonExe group, but SB, LPA, and moderate physical activity were not different. Predicted %BF was 89.494 to 0.105 (age), –13.047 (gender), –0.507 (HbA1c), –7.655 (LPAt) (F[4, 64]=62.929, P<0.001), with an R2 of 0.785 in multiple linear regression analysis. @*Conclusion@#Reduced body fat in elderly diabetic patients might be associated with reduced inactivity and increased LPA.
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BACKGROUND: Type 2 diabetes mellitus (T2DM) is associated with an increased risk for dementia. The effects of hypoglycemia on dementia are controversial. Thus, we evaluated whether hypoglycemia increases the risk for dementia in senior patients with T2DM.METHODS: We used the Korean National Health Insurance Service Senior cohort, which includes >10% of the entire senior population of South Korea. In total, 5,966 patients who had ever experienced at least one episode of hypoglycemia were matched with those who had not, using propensity score matching. The risk of dementia was assessed through a survival analysis of matched pairs.RESULTS: Patients with underlying hypoglycemic events had an increased risk for all-cause dementia, Alzheimer's dementia (AD), and vascular dementia (VaD) compared with those who had not experienced a hypoglycemic event (hazard ratio [HR], 1.254; 95% confidence interval [CI], 1.166 to 1.349; P<0.001 for all-cause dementia; HR, 1.264; 95% CI, 1.162 to 1.375; P<0.001 for AD; HR, 1.286; 95% CI, 1.110 to 1.490; P<0.001 for VaD). According to number of hypoglycemic episodes, the HRs of dementia were 1.170, 1.201, and 1.358 in patients with one hypoglycemic episode, two or three episodes, and more than three episodes, respectively. In the subgroup analysis, hypoglycemia was associated with an increased risk for dementia in both sexes with or without T2DM microvascular or macrovascular complications.CONCLUSION: Our findings suggest that patients with a history of hypoglycemia have a higher risk for dementia. This trend was similar for AD and VaD, the two most important subtypes of dementia.
Subject(s)
Humans , Cohort Studies , Dementia , Dementia, Vascular , Diabetes Mellitus, Type 2 , Hypoglycemia , Korea , National Health Programs , Propensity ScoreABSTRACT
In vascular smooth muscle, K⁺ channels, such as voltage-gated K⁺ channels (Kv), inward-rectifier K⁺ channels (Kir), and big-conductance Ca²⁺-activated K⁺ channels (BK(Ca)), establish a hyperpolarized membrane potential and counterbalance the depolarizing vasoactive stimuli. Additionally, Kir mediates endothelium-dependent hyperpolarization and the active hyperemia response in various vessels, including the coronary artery. Pulmonary arterial hypertension (PAH) induces right ventricular hypertrophy (RVH), thereby elevating the risk of ischemia and right heart failure. Here, using the whole-cell patch-clamp technique, we compared Kv and Kir current densities (I(Kv) and I(Kir)) in the left (LCSMCs), right (RCSMCs), and septal branches of coronary smooth muscle cells (SCSMCs) from control and monocrotaline (MCT)-induced PAH rats exhibiting RVH. In control rats, (1) I(Kv) was larger in RCSMCs than that in SCSMCs and LCSMCs, (2) I(Kv) inactivation occurred at more negative voltages in SCSMCs than those in RCSMCs and LCSMCs, (3) I(Kir) was smaller in SCSMCs than that in RCSMCs and LCSMCs, and (4) I(BKCa) did not differ between branches. Moreover, in PAH rats, I(Kir) and I(Kv) decreased in SCSMCs, but not in RCSMCs or LCSMCs, and I(BKCa) did not change in any of the branches. These results demonstrated that SCSMC-specific decreases in I(Kv) and I(Kir) occur in an MCT-induced PAH model, thereby offering insights into the potential pathophysiological implications of coronary blood flow regulation in right heart disease. Furthermore, the relatively smaller I(Kir) in SCSMCs suggested a less effective vasodilatory response in the septal region to the moderate increase in extracellular K⁺ concentration under increased activity of the myocardium.
Subject(s)
Animals , Rats , Coronary Vessels , Heart Diseases , Heart Failure , Hyperemia , Hypertension , Hypertrophy, Right Ventricular , Ischemia , Membrane Potentials , Monocrotaline , Muscle, Smooth , Muscle, Smooth, Vascular , Myocardium , Myocytes, Smooth Muscle , Patch-Clamp Techniques , Potassium Channels , Septum of BrainABSTRACT
BACKGROUND: Obesity is a risk factor for metabolic abnormalities. We investigated the relationship of adiponectin levels and visceral adiposity with insulin resistance and β-cell dysfunction. METHODS: This cross-sectional study enrolled 1,347 participants (501 men and 846 women aged 30–64 years) at the Cardiovascular and Metabolic Diseases Etiology Research Center. Serum adiponectin levels and visceral fat were measured using enzyme-linked immunosorbent assay kits and dual-energy X-ray absorptiometry, respectively. Insulin resistance was evaluated using the homeostatic model assessment of insulin resistance (HOMA-IR) and Matsuda insulin sensitivity index. β-cell dysfunction was evaluated using the homeostatic model assessment of β-cell function (HOMA-β), insulinogenic index, and disposition index. RESULTS: Regarding insulin resistance, compared with individuals with the highest adiponectin levels and visceral fat mass < 75th percentile, the fully adjusted odds ratios (ORs) for HOMA-IR ≥ 2.5 and Matsuda index < 25th percentile were 13.79 (95% confidence interval, 7.65–24.83) and 8.34 (4.66–14.93), respectively, for individuals with the lowest adiponectin levels and visceral fat ≥ 75th percentile. Regarding β-cell dysfunction, the corresponding ORs for HOMA-β< 25th percentile, insulinogenic index < 25th percentile, and disposition index < 25th percentile were 1.20 (0.71–2.02), 1.01 (0.61–1.66), and 1.87 (1.15–3.04), respectively. CONCLUSION: Low adiponectin levels and high visceral adiposity might affect insulin resistance and β-cell dysfunction.
Subject(s)
Female , Humans , Male , Absorptiometry, Photon , Adiponectin , Adiposity , Cross-Sectional Studies , Enzyme-Linked Immunosorbent Assay , Insulin Resistance , Insulin , Intra-Abdominal Fat , Metabolic Diseases , Obesity , Odds Ratio , Risk FactorsABSTRACT
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Dipeptidyl peptidase4 (DPP4) inhibitors such as gemigliptin are anti-diabetic drugs elevating plasma concentration of incretins such as GLP-1. In addition to the DPP4 inhibition, gemigliptin might directly improve the functions of vessels under pathological conditions. To test this hypothesis, we investigated whether the acetylcholine-induced endothelium dependent relaxation (ACh-EDR) of mesenteric arteries (MA) are altered by gemigliptin pretreatment in Spontaneous Hypertensive Rats (SHR) and in Wistar-Kyoto rats (WKY) under hyperglycemia-like conditions (HG; 2 hr incubation with 50 mM glucose). ACh-EDR of WKY was reduced by the HG condition, which was significantly recovered by 1 µM gemigliptin while not by saxagliptin and sitagliptin up to 10 µM. The ACh-EDR of SHR MA was also improved by 1 µM gemigliptin while similar recovery was observed with higher concentration (10 µM) of saxagliptin and sitagliptin. The facilitation of ACh-EDR by gemigliptin in SHR was not observed under pretreatment with NOS inhibitor, L-NAME. In the endotheliumdenuded MA of SHR, sodium nitroprusside induced dose-dependent relaxation was not affected by gemigliptin. The ACh-EDR in WKY was decreased by treatment with 30 µM pyrogallol, a superoxide generator, which was not prevented by gemigliptin. Exendin-4, a GLP-1 analogue, could not enhance the ACh-EDR in SHR MA. The present results of ex vivo study suggest that gemigliptin enhances the NOS-mediated EDR of the HG-treated MA as well as the MA from SHR via GLP-1 receptor independent mechanism.
Subject(s)
Animals , Rats , Endothelium , Glucagon-Like Peptide 1 , Glucagon-Like Peptide-1 Receptor , Hyperglycemia , Hypertension , Incretins , Mesenteric Arteries , NG-Nitroarginine Methyl Ester , Nitroprusside , Plasma , Pyrogallol , Rats, Inbred SHR , Relaxation , Sitagliptin Phosphate , Superoxides , VasodilationABSTRACT
Plumbagin, a hydroxy 1,4-naphthoquinone compound from plant metabolites, exhibits anticancer, antibacterial, and antifungal activities via modulating various signaling molecules. However, its effects on vascular functions are rarely studied except in pulmonary and coronary arteries where NADPH oxidase (NOX) inhibition was suggested as a mechanism. Here we investigate the effects of plumbagin on the contractility of skeletal artery (deep femoral artery, DFA), mesenteric artery (MA) and renal artery (RA) in rats. Although plumbagin alone had no effect on the isometric tone of DFA, 1 µM phenylephrine (PhE)-induced partial contraction was largely augmented by plumbagin (ΔT(Plum), 125% of 80 mM KCl-induced contraction at 1 µM). With relatively higher concentrations (>5 µM), plumbagin induced a transient contraction followed by tonic relaxation of DFA. Similar biphasic augmentation of the PhE-induced contraction was observed in MA and RA. VAS2870 and GKT137831, specific NOX4 inhibitors, neither mimicked nor inhibited ΔT(Plum) in DFA. Also, pretreatment with tiron or catalase did not affect ΔT(Plum) of DFA. Under the inhibition of PhE-contraction with L-type Ca²⁺ channel blocker (nifedipine, 1 µM), plumbagin still induced tonic contraction, suggesting Ca²⁺-sensitization mechanism of smooth muscle. Although ΔT(Plum) was consistently observed under pretreatment with Rho A-kinase inhibitor (Y27632, 1 µM), a PKC inhibitor (GF 109203X, 10 µM) largely suppressed ΔT(Plum). Taken together, it is suggested that plumbagin facilitates the PKC activation in the presence of vasoactive agonists in skeletal arteries. The biphasic contractile effects on the systemic arteries should be considered in the pharmacological studies of plumbagin and 1,4-naphthoquinones.
Subject(s)
Animals , Rats , 1,2-Dihydroxybenzene-3,5-Disulfonic Acid Disodium Salt , Arteries , Catalase , Coronary Vessels , Femoral Artery , Mesenteric Arteries , Muscle, Smooth , NADPH Oxidases , Phenylephrine , Plants , Protein Kinase C , Relaxation , Renal Artery , Vasoconstrictor AgentsABSTRACT
An adrenal incidentaloma is an adrenal mass found in an imaging study performed for other reasons unrelated to adrenal disease and often accompanied by obesity, diabetes, or hypertension. The prevalence and incidence of adrenal incidentaloma increase with age and are also expected to rise due to the rapid development of imaging technology and frequent imaging studies. The Korean Endocrine Society is promoting an appropriate practice guideline to meet the rising incidence of adrenal incidentaloma, in cooperation with the Korean Adrenal Gland and Endocrine Hypertension Study Group. In this paper, we discuss important core issues in managing the patients with adrenal incidentaloma. After evaluating core proposition, we propose the most critical 20 recommendations from the initially organized 47 recommendations by Delphi technique.
Subject(s)
Humans , Adrenal Glands , Delphi Technique , Hypertension , Incidence , Obesity , PrevalenceABSTRACT
BACKGROUND/AIMS: Oxidative stress plays an important role in the pathogenesis and progression of diabetic complications and antagonists of renin-angiotensin system and amlodipine have been reported previously to reduce oxidative stress. In this study, we compared the changes in oxidative stress markers after valsartan and amlodipine treatment in type 2 diabetic patients with hypertension and compared the changes in metabolic parameters. METHODS: Type 2 diabetic subjects with hypertension 30 to 80 years of age who were not taking antihypertensive drugs were randomized into either valsartan (n = 33) or amlodipine (n = 35) groups and treated for 24 weeks. We measured serum nitrotyrosine levels as an oxidative stress marker. Metabolic parameters including serum glucose, insulin, lipid profile, and urine albumin and creatinine were also measured. RESULTS: After 24 weeks of valsartan or amlodipine treatment, systolic and diastolic blood pressure decreased, with no significant difference between the groups. Both groups showed a decrease in serum nitrotyrosine (7.74 ± 7.30 nmol/L vs. 3.95 ± 4.07 nmol/L in the valsartan group and 8.37 ± 8.75 nmol/L vs. 2.68 ± 2.23 nmol/L in the amlodipine group) with no significant difference between the groups. Other parameters including glucose, lipid profile, albumin-to-creatinine ratio, and homeostasis model assessment of insulin resistance showed no significant differences before and after treatment in either group. CONCLUSIONS: Valsartan and amlodipine reduced the oxidative stress marker in type 2 diabetic patients with hypertension.
Subject(s)
Humans , Amlodipine , Antihypertensive Agents , Blood Glucose , Blood Pressure , Creatinine , Diabetes Complications , Diabetes Mellitus, Type 2 , Glucose , Homeostasis , Hypertension , Insulin , Insulin Resistance , Oxidative Stress , Renin-Angiotensin System , ValsartanABSTRACT
BACKGROUND/AIMS: Oxidative stress plays an important role in the pathogenesis and progression of diabetic complications and antagonists of renin-angiotensin system and amlodipine have been reported previously to reduce oxidative stress. In this study, we compared the changes in oxidative stress markers after valsartan and amlodipine treatment in type 2 diabetic patients with hypertension and compared the changes in metabolic parameters. METHODS: Type 2 diabetic subjects with hypertension 30 to 80 years of age who were not taking antihypertensive drugs were randomized into either valsartan (n = 33) or amlodipine (n = 35) groups and treated for 24 weeks. We measured serum nitrotyrosine levels as an oxidative stress marker. Metabolic parameters including serum glucose, insulin, lipid profile, and urine albumin and creatinine were also measured. RESULTS: After 24 weeks of valsartan or amlodipine treatment, systolic and diastolic blood pressure decreased, with no significant difference between the groups. Both groups showed a decrease in serum nitrotyrosine (7.74 ± 7.30 nmol/L vs. 3.95 ± 4.07 nmol/L in the valsartan group and 8.37 ± 8.75 nmol/L vs. 2.68 ± 2.23 nmol/L in the amlodipine group) with no significant difference between the groups. Other parameters including glucose, lipid profile, albumin-to-creatinine ratio, and homeostasis model assessment of insulin resistance showed no significant differences before and after treatment in either group. CONCLUSIONS: Valsartan and amlodipine reduced the oxidative stress marker in type 2 diabetic patients with hypertension.
Subject(s)
Humans , Amlodipine , Antihypertensive Agents , Blood Glucose , Blood Pressure , Creatinine , Diabetes Complications , Diabetes Mellitus, Type 2 , Glucose , Homeostasis , Hypertension , Insulin , Insulin Resistance , Oxidative Stress , Renin-Angiotensin System , ValsartanABSTRACT
An adrenal incidentaloma is an adrenal mass found in an imaging examination performed for reasons unrelated to suspected adrenal disease. The prevalence of adrenal incidentaloma increases with age; there is no gender difference, but it is often accompanied by obesity, diabetes mellitus, or hypertension. The detection of adrenal incidentaloma is expected to rise with the rapid development of imaging technology and increasing frequency of imaging studies. The Korean Endocrine Society is promoting appropriate practice guidelines to meet the rising incidence of adrenal incidentaloma, in cooperation with the Korean Adrenal Gland and Endocrine Hypertension Study Group. In this paper, we discuss important core issues for treating adrenal incidentaloma, along with the most important factors for healthcare providers who treat and manage affected patients. Initially, we identified 47 recommendations using the Delphi technique, after evaluating core propositions. We reduced these to the 20 most critical recommendations.