Urinary Albumin Excretion Reflects Cardiovascular Risk in Postmenopausal Women without Diabetes: The 2011 to 2013 Korean National Health and Nutrition Examination Survey

BACKGROUND: The objective of the current study was to determine whether there was an association between urinary albumin excretion and cardiovascular disease (CVD) risk by estimating the Framingham Risk Score (FRS) in postmenopausal women without diabetes. METHODS: This study was based on data from the Korea National Health and Nutrition Examination Survey, which was conducted by the Korean Ministry of Health and Welfare in 2011 to 2013. Data on 2,316 postmenopausal women from a total of 24,594 participants was included in the analysis. RESULTS: The mean FRS was significantly different in each of the urinary albumin to creatinine ratio (UACR) subgroups, and it increased with UACR. The FRS was 12.69±0.12 in the optimal group, 14.30±0.19 in the intermediate normal group, 14.62±0.26 in the high normal group, and 15.86±0.36 in the microalbuminuria group. After fully adjusting for potential confounding factors, high normal levels and microalbuminuria were significantly associated with the highest tertile of FRS ([odds ratio (OR), 1.642; 95% confidence interval (CI), 1.124 to 2.400] and [OR, 3.385; 95% CI, 2.088 to 5.488], respectively) compared with the optimal subgroup. High normal levels and microalbuminuria were also significantly associated with a ≥10% 10-year risk of CVD ([OR, 1.853; 95% CI, 1.122 to 3.060] and [OR, 2.831; 95% CI, 1.327 to 6.037], respectively) after adjusting for potential confounding covariates. CONCLUSION: Urinary albumin excretion reflects CVD risk in postmenopausal women without diabetes, and high normal levels and microalbuminuria were independently associated with a higher risk of CVD.

Comparison of Vildagliptin and Pioglitazone in Korean Patients with Type 2 Diabetes Inadequately Controlled with Metformin

BACKGROUND: We compared the efficacies of vildagliptin (50 mg twice daily) relative to pioglitazone (15 mg once daily) as an add-on treatment to metformin for reducing glycosylated hemoglobin (HbA1c) levels in Korean patients with type 2 diabetes. METHODS: The present study was a multicenter, randomized, active-controlled investigation comparing the effects of vildagliptin and pioglitazone in Korean patients receiving a stable dose of metformin but exhibiting inadequate glycemic control. Each patient underwent a 16-week treatment period with either vildagliptin or pioglitazone as an add-on treatment to metformin. RESULTS: The mean changes in HbA1c levels from baseline were -0.94% in the vildagliptin group and -0.6% in the pioglitazone group and the difference between the treatments was below the non-inferiority margin of 0.3%. The mean changes in postprandial plasma glucose (PPG) levels were -60.2 mg/dL in the vildagliptin group and -38.2 mg/dL in the pioglitazone group and these values significantly differed (P=0.040). There were significant decreases in the levels of total, low density lipoprotein, high density lipoprotein (HDL), and non-HDL cholesterol in the vildagliptin group but increases in the pioglitazone group. The mean change in body weight was -0.07 kg in the vildagliptin group and 0.69 kg in the pioglitazone group, which were also significantly different (P=0.002). CONCLUSION: As an add-on to metformin, the efficacy of vildagliptin for the improvement of glycemic control is not inferior to that of pioglitazone in Korean patients with type 2 diabetes. In addition, add-on treatment with vildagliptin had beneficial effects on PPG levels, lipid profiles, and body weight compared to pioglitazone.

Response: Clinical Marker of Platelet Hyperreactivity in Diabetes Mellitus (Diabetes Metab J 2013;37:423-8)

No abstract available.

Hemoglobin A1c Is Positively Correlated with Framingham Risk Score in Older, Apparently Healthy Nondiabetic Korean Adults

BACKGROUND: Several studies have suggested that elevated levels of hemoglobin A1c (HbA1c) are associated with cardiovascular disease (CVD) in nondiabetic individuals. However, it is unclear whether HbA1c levels can serve as a simple screening marker for increased CVD risk in nondiabetic individuals. Our objective was to evaluate the relationship between HbA1c levels and CVD risk using the Framingham risk score (FRS) in older, apparently healthy nondiabetic Korean adults. METHODS: We retrospectively studied 2,879 Korean adults between the ages of 40 and 79 who underwent voluntary health check-ups at the Health Promotion Center of our hospital from July 2009 to June 2011. Subjects were subdivided based on their HbA1c levels into four groups: tertiles within the HbA1c normal tolerance range and a group for subjects with an increased risk for diabetes (IRD). RESULTS: The mean FRS for the upper tertile (9.6+/-3.8) group was significantly higher than that of the middle tertile (8.4+/-4.0) and lower tertile (7.6+/-3.8) groups. In addition, FRS was highest in the IRD group (10.5+/-3.7). Multiple linear regression analysis demonstrated that HbA1c levels exhibited a significant positive correlation with FRS when adjusted for confounding variables in all subjects (beta+/-standard error [SE], 0.018+/-0.002; R2, 0.131), women (beta+/-SE, 0.023+/-0.003; R2, 0.170), and men (beta+/-SE, 0.016+/-0.004; R2, 0.109). CONCLUSION: HbA1c levels were positively correlated with FRS in older, apparently healthy nondiabetic Korean adults. We propose that HbA1c levels may reflect CVD risk in nondiabetic individuals.

Clinical Marker of Platelet Hyperreactivity in Diabetes Mellitus

Atherothrombotic complications are important causes of morbidity and mortality in diabetic patients. Diabetes has been considered to be a prothrombotic status. Several factors contribute to the prothrombotic condition, such as increasing coagulation, impaired fibrinolysis, endothelial dysfunction, and platelet hyperreactivity. Among the factors that contribute to the prothrombotic status in diabetes, altered platelet function plays a crucial role. Although understanding platelet function abnormalities in diabetes still remains as a challenge, more attention should be focused on platelet function for effective management and the prediction of atherothrombotic events in diabetic patients. This review will provide an overview on the current status of knowledge of platelet function abnormalities and clinical marker of platelet hyperreactivity in patients with diabetes.

Diabetic Ketoacidosis Associated with Emphysematous Gastritis: A Case Report

Diabetic ketoacidosis is a serious and demanding medical emergency for the field of endocrinology, and the identification and correction of the precipitating factors is equally important. Many patients of diabetic ketoacidosis show gastrointestinal symptoms as an initial presentation, and coincidental gastrointestinal diseases can be neglected or misdiagnosed. Emphysematous gastritis is a rare and lethal disease in which gas bubbles form in the stomach wall. The predisposing factors include ingestion of corrosive substances, alcohol abuse, diabetes, and immunosuppressive therapy. Thus, it may be difficult to detect emphysematous gastritis early, especially when it is developed in conjunction with diabetic ketoacidosis. We report a case of diabetic ketoacidosis associated with emphysematous gastritis in a young male without medical history.

Combination Therapy in Type 2 Diabetes / 대한내과학회지

Managing type 2 diabetes has become more complex as pharmacotherapy has expanded. Therapies for type 2 diabetes can be divided into drugs facilitating supply of endogenous insulin or those enhancing insulin actions. Successful treatment of type 2 diabetes combines approaches to lifestyle modification frequently in conjunction with use of pharmacologic therapy. The dual aspects of type 2 diabetes, insulin resistance and insulin deficiency, are important factors in therapy selection and the subsequent reponse to therapy. Most patients have gradually increasing needs for additional therapy. Some patients require combination pharmacologic therapy at the time of initial treatment, especially if they have a markedly elevated HbA1c. We describes combination pharmacologic therapy in type 2 diabetes, recent evidence and opinions on sequences for type 2 diabetes.

Evaluation of Fasting Plasma Glucose as a Screening for Diabetes Mellitus in Middle-aged Adults of Naju Country / 당뇨병

BACKGROUND: The criteria for the diagnosis of diabetes mellitus have been modified by the American Diabetes Association (ADA) in 1997. The ADA proposed that the diagnosis of diabetes be defined by a fasting plasma glucose (FPG) of 7.0 mmol/L. Disagreement has been reported between criteria based on FPG and postchallenge 2-h plasma glucose (2-h PG). The aim of the present study is to assess the FPG criteria as the diagnostic screening test for diabetes in Korean middle-aged adults in comparison to the 2-h PG criteria. METHODS: Randomly selected 1,731 subjects (679 men and 1,052 women) aged 40~70 years (mean age: 58.4 +/- 7.89 years) without previously diagnosed diabetes completed 75 g oral glucose tolerance test (OGTT). We assessed the prevalence of diabetes mellitus and the level of agreement (kappa statistics) according to the different diagnostic glucose categories. RESULTS: The frequency of newly diagnosed diabetes was 2.7% (n = 51) using the FPG criteria only; 6.4% (n = 120) using the 2-h PG criteria only; and 6.9% (n = 130) using concentrations of > or = 7.0 mmol/L for FPG or > or = 11.1 mmol/L for 2-h PG. Of the 120 subjects with diabetes by the 2-h PG criteria, 65.8% (n = 79) were not diagnosed with diabetes according to FPG concentration. The level of agreement between two diagnostic criteria was low (kappa = 0.268). The receiver operating characterstic (ROC) curve analysis determined FPG of 5.6 mmol/L to yield optimal sensitivity and specificity corresponding to 2-h PG 11.1 mmol/L. CONCLUSION: The findings in this study demonstrate that the discordance between the FPG and 2-h PG criteria in the diagnosis of diabetes in Korean middle-aged adults is large. We suggest that IFG group (FPG 5.6~6.9 mmol/L) were performed 75 g OGTT for diagnosing diabetes mellitus in Korean middle-aged adults.

Association of Hemoglobin A1c with Cardiovascular Disease Risk Factors and Metabolic Syndrome in Nondiabetic Adults / 당뇨병

BACKGROUND: Glycosylated hemoglobin (HbA1c) is a useful index of mean blood glucose concentrations over the preceding 2 to 3 months. Elevated HbA1c levels (> 7%) are associated with a higher incidence of microvascular and macrovascular complications in patients with diabetes mellitus. However, the relationship between HbA1c and cardiovascualr disease risk in nondiabetic adults has been unclear. The aim of this study is to estimate the association of HbA1c with cardiovascular disease risk factors and metabolic syndrome in nondiabetic adults. METHODS: The subjects of this study included 533 adults (180 males and 353 females) aged 20~70 years (mean age: 46.9 +/- 10.12 years) without previously diagnosed diabetes who lived in Kangyang country. We examined baseline HbA1c levels and cardiovascular risk factors. Metabolic syndrome was defined based on International Diabetes Federation guidelines. RESULTS: The prevalence of metabolic syndrome significantly increased as HbA1c increased. HbA1c revealed a significant correlation with age (r = 0.258, P < 0.001), BMI (r = 0.152, P < 0.001), waist circumference (r = 0.252, P < 0.001), fasting plasma glucose (r = 0.319, P < 0.001), systolic (r = 0.100, P = 0.021), diastolic (r = 0.115, P = 0.008) blood pressure, total cholesterol (r = 0.232, P < 0.001), triglyceride (r = 0.156, P < 0.001), LDL cholesterol (r = 0.216, P < 0.001), and HDL cholesterol (r = -0.167, P < 0.001). Multiple regression analysis showed that HbA1c had a association with age, fasting plasma glucose, and dyslipidemia. The receiver operating characterstics (ROC) curve analysis determined HbA1c of 5.35% to yield optimal sensitivity and specificity corresponding to the presence of metabolic syndrome. CONCLUSION: The HbA1c level is correlated with cardiovascular risk factors and prevalence of metabolic syndrome in nondiabetic adults.

The Clinical Feature of Patients with Thyroid Nodule Combined with Hashimoto's Thyroiditis

PURPOSE: This study investigated the clinical features of patients with thyroid nodule combined with Hashimoto's thyroiditis, and the latter was incidentally detected after surgery. METHODS: The authors retrospectively evaluated 43 patients who were diagnosed with Hashimoto's thyroiditis after thyroidectomy between January 2001 and December 2006 at Chosun University Hospital. RESULTS: All patients underwent ultrasonography for the diagnosis of thyroid nodules. Ultrasonography revealed 16 calcified nodules with ill-defined margins, and these nodules were suspicious for malignancy. On performing preoperative fine needle aspiration, 37 cases were suspicious for malignancy or they were diagnosed as malignancies. All the thyroid nodules were taken for frozen section examination during surgery. On the frozen sections, 19 cases that were suspicious for malignant tumors underwent near total or total thyroidectomy along with central lymph node dissection, whereas 24 cases that were diagnosed as benign tumors underwent near total thyroidectomy or thyroid lobectomy. Based on the histopathological findings, 21 cases were diagnosed as Hashimoto's thyroiditis associated with papillary cancer; the nodules of these 21 cases were on average 0.75 cm, Twenty two cases were diagnosed as Hashimoto's thyroiditis associated with benign tumors, and the nodules of these cases measured on average 1.6 cm. CONCLUSION: Hashimoto's thyroiditis may present with a variety of clinical features, atypical ultrasonographic findings and a high false positive rate on fine needle aspiration. For the cases where Hashimoto's thyroiditis is suspected before surgery, serum antibody tests, ultrasonography and fine needle aspiration should be performed for making the accurate diagnosis of Hashimoto's thyroiditis. For the cases of suspicious malignant tumors, frozen section examination should be performed during surgery to decide on the correct operative procedure.

A Case of Hashimoto's Thyroiditis Associated with Multiple Sclerosis / 대한내분비학회지

Multiple sclerosis is an autoimmune disorder, which may be associated with other rheumatologic or endocrine diseases induced by autoantibodies. Hashimoto's thyroiditis is also an organ-specific autoimmune disorder, and its association with multiple sclerosis during interferon therapy has been reported. Cases of Hashimoto's thyroiditis with multiple sclerosis are very rare. Herein is reported our experience of a 27 year-old woman who presented with general weakness, cold intolerance and progressive muscle weakness. She had been treated with levothyroxine due to subclinical hypothyroidism, which rather aggravated the symptom. In a CSF analysis, the myelin basic protein level was above 10 ng/dL and that of the IgG and the IgG index were 135 mg/dL and 7.8, respectively. In a brain MRI, demyelinating lesions in the left middle pontocerebellar junction and right subcortex were shown. She was diagnosed with multiple sclerosis, and the symptom improved after glucocorticoid and levothyroxine therapy. Herein is reported the first Korean case of Hashimoto's thyroiditis associated with multiple sclerosis

A Case of Hashimoto's Thyroiditis Associated with Multiple Sclerosis / 대한내분비학회지

Multiple sclerosis is an autoimmune disorder, which may be associated with other rheumatologic or endocrine diseases induced by autoantibodies. Hashimoto's thyroiditis is also an organ-specific autoimmune disorder, and its association with multiple sclerosis during interferon therapy has been reported. Cases of Hashimoto's thyroiditis with multiple sclerosis are very rare. Herein is reported our experience of a 27 year-old woman who presented with general weakness, cold intolerance and progressive muscle weakness. She had been treated with levothyroxine due to subclinical hypothyroidism, which rather aggravated the symptom. In a CSF analysis, the myelin basic protein level was above 10 ng/dL and that of the IgG and the IgG index were 135 mg/dL and 7.8, respectively. In a brain MRI, demyelinating lesions in the left middle pontocerebellar junction and right subcortex were shown. She was diagnosed with multiple sclerosis, and the symptom improved after glucocorticoid and levothyroxine therapy. Herein is reported the first Korean case of Hashimoto's thyroiditis associated with multiple sclerosis

The Effect of PPAR gamma2 Pro12Ala Polymorphism on Diabetic Nephropathy in Type 2 Diabetes / 대한신장학회잡지

BACKGROUND: Recently, the PPAR gamma2 Pro12Ala polymorphism has been associated with type 2 diabetes and diabetic nephropathy. In the present study, we investigated the association between Pro12Ala polymorphism and diabetic nephropathy in korean subjects. METHODS: A total of 180 patients with type 2 diabetes and 100 normal controls were enrolled in this studies. Screening for mutation at codon of PPAR gamma2 were carried out by PCR-RELP analysis. Also, we measured important covariables, such as duration of diabetes, blood pressure, renal function and serum lipids. RESULTS: In PCR-RELP, it showed that there were no difference in the PPAR gamma2 genotype frequencies between diabetic subjects (Pro/Pro: 80.5%, Pro/Ala: 19.5%) and normal controls (88%, 12%). However, it showed that there were significant difference in the PPAR gamma2 genotype frequencies between diabetic subjects with nephropathy (Pro/Pro: 74.5%, Pro/Ala: 25.5%) and diabetic subjects without nephropathy (87.8%, 12.2%) (p=0.040). In diabetic subjects, Pro/Ala genotypes were significantly different from Pro/Pro regarding serum creatinine, 24 hour proteinuria, systolic pressure, and LDL-cholesterol. In diabetic nephropathy, genotypes with Pro/Ala significantly increased serum creatinine (2.7+/-0.41 vs 1.7+/-0.68 mg/dL), 24hour urine protein (median+-SE: 1.9+/-1.02 vs 0.9+/-0.44 g/day), systolic pressure (161+/-27.8 vs 152+/-32.4 mmHg), LDL cholesterol (134+/-30.4 vs 125+/-20.0 mg/dL), and triglyceride (151+/-86.5 vs 135+/-60.9 mg/dL) than genotypes with Pro/Pro. CONCLUSION: Our results suggested that Pro12Ala Polymorphism of the PPAR gamma2 gene may be associated with diabetes with nephropathy in korean patients.

Brain Metastasis from Papillary Carcinoma of the Thyroid

Papillary thyroid carcinomas are the most common type of thyroid malignancy, and have more excellent prognosis compared to other types of thyroid malignancy, with rare occurrences of distant metastasis. The most frequent sites for distant metastases are the lungs and bones, but brain metastases are extremely rare, with a frequency of only 0.1~5% in reported series. Hence we report a patient with a papillary thyroid carcinoma metastasis to the right parietal lobe of brain, the lung, the left chest wall and right acetabulum, with a review of the literature.

Thyroid Hemiagenesis

Thyroid anomaly are rare embryological condition. The failure of the development of one lobe leading to unilateral agenesis is the rarest of all the thyroid anomalies, The cause of unilateral agenesis is unknown. Thyroid hemiagenes is common in females (3: 1) with the left lobe being absent. The common disease in the remaining lobe is a benign adenoma, a multinodular goiter, hyperthyroidism, chronic thyroiditis, and rarely carcinoma. The most common pathology involved in thyroid hemiagenesis is hyperthyroidism. This report the case of a 57-year-old woman with a right thyroid hemiagenesis.

A Case of Benign Intracranial Hypertension in Pseudopseudohypoparathyroidism

We describe a rare case of pseudopseudohypoparathyroidism (PPHP) with benign intracranial hypertension (BIH). A 16 year-old male presented with headache, vomiting, ocular pain, blurred vision, and diplopia following minor head trauma. He showed developmental delay, short stature and short metacarpals and phalanges, which suggested Albright's hereditary osteodystrophy. Neurologic examination revealed bilateral sixth cranial nerve palsy and bilateral papilledema. Lumbar puncure disclosed an elevated opening CSF pressure with normal biochemical and celluar find-ings. However, the levels of serum calcium, phosphorus and parathyroid hormone were within the normal limits and chromosomal analyses were normal. Brain MRI revealed normal ventricular size and no structural abnormality. We concluded that PPHP seemed to have a key role for the genesis of BIH in this case, although previous mild head trauma might have a precipitating effect.

A Case of Adrenal Carcinosarcoma / 대한암학회지

An adrenal carcinosarcoma is extremely rare with reported three cases. This neoplasm is extremely aggressive with distant metastasis arising from the sarcomatous component. A 48-year-old female was present with abdominal distention for 1 month. All laboratory studies were within normal reference range including urinary and serum corticosteroids. The tumor consist typical areas of adrenal carcinoma and sarcoma. Sarcomatous elements were identified and confirmed both immunohistochemically and ultrastructurally. After radical resection, the patient developed rapid local and distant metastatic recurrence and died three months after surgery. This is the first reported case of adrenal carcinosarcoma in korea.

A Study on Systolic Time Intervals during Second, Third Trimesters and Postpartum Period

Systolic time interval measurements were made sequentially during second, third trimesters and postpartum period. Recordings were made in the supine position after bed rest for at least five minutes in order to obtain a steady state. In second trimester, pre-ejection period index (PEPI) was significantly shortened and left ventricular ejection period index(LVETI) remained normal while PEP/LVET decreased. Four possible mechanisms may be involved to account for the alterations in hemodynamic changes during this period(late stage of second trimester) : (1) increased metabolic demands of pregnancy: (2) hemodynamic effects of hypervolemia: (3) circulatory adjustments secondary to an arteriovenous shunt-like effect of the placental circulation: (4) cardiovascular effect of steroid hormone. The third trimester was characterized-by a markedly shortened LVETI, a prolonged PEPI and PEP/LVET. This findings are consistent with impaired left ventricular performance and are probably due to decreased left ventricular preload resulting from diminished venous return secondary to inferior vena caval obstruction by the large gravid uterus. In the postpartum period, the PEPI and PEP/LVET remained elevated and the LVETI shortened in the supine position. It is concluded that alterations in systolic time intervals occur normally during the course of uncomplicated pregnancy and persist into the postpartum period.