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

Purpose@#The aims of this study were to develop a new instrument for measuring self-management with a hierarchical structure [the Diabetes Self-Management Scale (DSMS)] in patients with type 2 diabetes, and evaluate its psychometric properties. @*Methods@#The DSMS instrument was developed in three phases: (1) conceptualization and item generation; (2) content validity and pilot testing; and (3) field testing of its psychometric properties. A convenience sample of 473 participants was recruited in three university hospitals and one regional health center, South Korea. @*Results@#Exploratory and confirmatory factor analyses yielded two second-order component models explaining the common variance among six first-order factors. Principal axis factoring with a varimax rotation accounted for 60.88% of the variance. Confirmatory factor analysis of the hierarchical structure revealed the following fit indices: χ2/df = 1.373, standardized root-mean-square residual = .050, goodness-of-fit index = .935, incremental fit index = .975, comparative fit index = .974, and root-mean-square error of approximation = .039. All Cronbach' α values for internal consistency exceeded the criterion of .70. All of the intraclass correlation coefficients for test–retest reliability exceeded .70 except that for the taking-medication subscale. The components of the DSMS were moderately correlated with the comparator measures of self-efficacy and health literacy administered for convergent validity. @*Conclusion@#The DSMS is a new instrument for measuring the complex nature of self-management in patients with type 2 diabetes, comprising 17 items scored on a five-point Likert scale. The DSMS exhibits satisfactory psychometric properties for five reliability and validity metrics, and so is a suitable instrument to apply in both research and clinical practices.

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

Purpose@#The aims of this study were to develop a new instrument for measuring self-management with a hierarchical structure [the Diabetes Self-Management Scale (DSMS)] in patients with type 2 diabetes, and evaluate its psychometric properties. @*Methods@#The DSMS instrument was developed in three phases: (1) conceptualization and item generation; (2) content validity and pilot testing; and (3) field testing of its psychometric properties. A convenience sample of 473 participants was recruited in three university hospitals and one regional health center, South Korea. @*Results@#Exploratory and confirmatory factor analyses yielded two second-order component models explaining the common variance among six first-order factors. Principal axis factoring with a varimax rotation accounted for 60.88% of the variance. Confirmatory factor analysis of the hierarchical structure revealed the following fit indices: χ2/df = 1.373, standardized root-mean-square residual = .050, goodness-of-fit index = .935, incremental fit index = .975, comparative fit index = .974, and root-mean-square error of approximation = .039. All Cronbach' α values for internal consistency exceeded the criterion of .70. All of the intraclass correlation coefficients for test–retest reliability exceeded .70 except that for the taking-medication subscale. The components of the DSMS were moderately correlated with the comparator measures of self-efficacy and health literacy administered for convergent validity. @*Conclusion@#The DSMS is a new instrument for measuring the complex nature of self-management in patients with type 2 diabetes, comprising 17 items scored on a five-point Likert scale. The DSMS exhibits satisfactory psychometric properties for five reliability and validity metrics, and so is a suitable instrument to apply in both research and clinical practices.

Administration of Goji (Lycium chinense Mill.) Extracts Improves Erectile Function in Old Aged Rat Model

PURPOSE: This study investigated the effect of goji (Lycium chinense Mill.) on erectile dysfunction in old-aged rats. MATERIALS AND METHODS: Twenty-four 18-month-old male Sprague-Dawley rats (defined as old-aged rats) were used. Treatment groups contained eight rats each: a control group, goji extract of 150 mg/kg/day group, and goji extract of 300 mg/kg/day group. Treatment was by orogastric tube once daily for 6 weeks. After 6 weeks of treatment, testes weight, serum testosterone, superoxide dismutase, nitric oxide (NO)-cyclic guanosine monophosphate (cGMP)-related parameters, intracavernous pressure/mean arterial pressure, and histological changes were examined. RESULTS: Treatments with goji extracts increased serum testosterone level, increased the expression of endothelial NO synthase, neuronal NO synthase, and cGMP, improved the oxidative stress marker, and decreased corporal fibrosis. CONCLUSIONS: Our results indicate that goji extract may have a positive effect on erectile dysfunction via its antioxidant effects.

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

BACKGROUND: Regular aerobic exercise is essential for the prevention and management of type 2 diabetes mellitus and may be particularly beneficial for those treated with thiazolidinediones, since it may prevent associated weight gain. This study aimed to evaluate the effect of combined exercise and rosiglitazone treatment on body composition and glucose metabolism in obese diabetes-prone animals. METHODS: We analyzed metabolic parameters, body composition, and islet profiles in Otsuka Long Evans Tokushima Fatty rats after 28 weeks of aerobic exercise, rosiglitazone treatment, and combined exercise and rosiglitazone treatment. RESULTS: Combined exercise with rosiglitazone showed significantly less increase in weight and epididymal fat compared to rosiglitazone treatment. Aerobic exercise alone and combined rosiglitazone and exercise treatment led to similar retention of lean body mass. All experimental groups showed a decrease in fasting glucose. However, the combined exercise and rosiglitazone therapy group showed prominent improvement in glucose tolerance compared to the other groups. Rescue of islet destruction was observed in all experimental groups, but was most prominent in the combined therapy group. CONCLUSION: Regular aerobic exercise combined with rosiglitazone treatment can compensate for the adverse effect of rosiglitazone treatment and has benefit for islet preservation.

Obesity and Hyperglycemia in Korean Men with Klinefelter Syndrome: The Korean Endocrine Society Registry

BACKGROUND: The aim of this study was to investigate the prevalence of obesity in Korean men with Klinefelter syndrome (KS) and the associated risk factors for obesity and hyperglycemia. METHODS: Data were collected retrospectively from medical records from 11 university hospitals in Korea between 1994 and 2014. Subjects aged ≥18 years with newly diagnosed KS were enrolled. The following parameters were recorded at baseline before treatment: chief complaint, height, weight, fasting glucose level, lipid panel, blood pressure, testosterone, luteinizing hormone, follicle-stimulating hormone, karyotyping patterns, and history of hypertension, diabetes, and dyslipidemia. RESULTS: Data were analyzed from 376 of 544 initially enrolled patients. The rate of the 47 XXY chromosomal pattern was 94.1%. The prevalence of obesity (body mass index ≥25 kg/m²) in Korean men with KS was 42.6%. The testosterone level was an independent risk factor for obesity and hyperglycemia. CONCLUSION: Obesity is common in Korean men with KS. Hypogonadism in patients with KS was associated with obesity and hyperglycemia.

Drug-induced liver injury caused by iodine-131

Iodine-131 is a radioisotope that is routinely used for the treatment of differentiated thyroid cancer after total or near-total thyroidectomy. However, there is some evidence that iodine-131 can induce liver injury . Here we report a rare case of drug-induced liver injury (DILI) caused by iodine-131 in a patient with regional lymph node metastasis after total thyroidectomy. A 47-year-old woman was admitted with elevated liver enzymes and symptoms of general weakness and nausea. Ten weeks earlier she had undergone a total thyroidectomy for papillary thyroid carcinoma and had subsequently been prescribed levothyroxine to reduce the level of thyroid-stimulating hormone. Eight weeks after surgery she underwent iodine-131 ablative therapy at a dose of 100 millicuries, and subsequently presented with acute hepatitis after 10 days. To rule out all possible causative factors, abdominal ultrasonography, endoscopic ultrasonography (on the biliary tree and gall bladder), and a liver biopsy were performed. DILI caused by iodine-131 was suspected. Oral prednisolone was started at 30 mg/day, to which the patient responded well.

Case of concurrent Riedel's thyroiditis, acute suppurative thyroiditis, and micropapillary carcinoma

Riedel's thyroiditis (RT) is a rare chronic inflammatory disease of the thyroid gland. It is characterized by a fibroinflammatory process that partially destroys the gland and extends into adjacent neck structures. Its clinical manifestation can mask an accompanying thyroid neoplasm and can mimic invasive thyroid carcinoma. Therefore, diagnosis can be difficult prior to surgical removal of the thyroid, and histopathologic examination of the thyroid is necessary for a definite diagnosis. The concurrent presence of RT and other thyroid diseases has been reported. However, to our knowledge, the association of RT with acute suppurative thyroiditis and micropapillary carcinoma has not been reported. We report a rare case of concurrent RT, acute suppurative thyroiditis, and micropapillary carcinoma in a 48-year-old patient.

A Case of Hyperglycemic Hyperosmolar Syndrome in a Patient with Central Diabetes Insipidus and Type 2 Diabetes Mellitus / 대한내과학회지

Diabetes insipidus is a disorder caused by complete or partial deficiency or unresponsiveness to antidiuretic hormone. Both diabetes mellitus and diabetes insipidus are well-known causes of polyuria and polydipsia. Although Wolfram Syndrome, which is characterized by the concurrence of diabetes mellitus and diabetes insipidus along with optic atrophy and ataxia, is frequently reported, the concurrence of diabetes insipidus and type 2 diabetes mellitus without optic atrophy and deafness is rare. We report a 31-year-old woman presenting with hyperglycemic hyperosmolar syndrome caused by type 2 diabetes mellitus complicated with concurrent central diabetes insipidus.

Application of an Insulin Analogue in Six Hypoglycemia-Prone Hemodialysis Patients with Type 2 Diabetes / 대한내과학회지

Day-to-day insulin requirements often change due to subtle variations in insulin metabolism in patients with type 2 diabetes undergoing hemodialysis. In such cases, intra-hemodialysis hypoglycemia frequently occurs and is a main factor interfering with the delivery of dialysis. As a result, it reduces the quality of life in patients undergoing hemodialysis. The long-acting insulin analogue glargine provides peakless, continuous release over 24 h that approximates a normal basal insulin pattern. Because it has no peak, its use in patients with diabetes undergoing hemodialysis would hypothetically be useful. Specifically, patients would be able to avoid intra-hemodialysis hypoglycemia without the necessity of skipping insulin administration on the day of hemodialysis and achieving adequate glucose control on other days. We recently experienced six cases that switched from treatment with intermediate-acting insulin to a long-acting insulin analogue, which provided better glycemic control by reducing hypoglycemia risk. Limited data are available in the literature concerning insulin analogue usage in patients with diabetes undergoing hemodialysis. Our experience suggests a large-scale prospective investigation is required on this issue.

Association between Nutrient Intake and Obesity in Type 2 Diabetic Patients from the Korean National Diabetes Program: A Cross-Sectional Study

The aim of the study was to assess the association between usual dietary nutrient intake and obesity in Korean type 2 diabetic patients. We examined 2,832 type 2 diabetic patients from the Korean National Diabetes Program cohort who completed dietary assessment and clinical evaluation in this cross-sectional study. In men, higher dietary fiber intake was associated with a lower odds of being obese (Ptrend = 0.003) and in women, higher protein intake was associated with a lower odds of being obese (Ptrend = 0.03) after adjustment for age, diabetes duration, HbA1c, alcohol drinking, income, education level, and calorie intake. In men, higher fiber intake was associated with lower odds of obesity after further adjustment for diastolic blood pressure, physical activity, and possible confounding nutritional intake and medication. The multivariable adjusted odds ratio for the highest quintile of fiber intake was 0.37 (Ptrend < 0.001). In women, protein intake was not associated with obesity after further adjustment. In conclusion, higher intake of dietary fiber is associated with lower odds of being obese in type 2 diabetic men, suggesting a role for dietary fiber in the management and prevention of obesity in type 2 diabetes (ClinicalTrials.gov: NCT 01212198).

A Case of Hyperglycemic Hyperosmolar Syndrome in a Patient with Central Diabetes Insipidus and Type 2 Diabetes Mellitus / 대한내과학회지

Diabetes insipidus is a disorder caused by complete or partial deficiency or unresponsiveness to antidiuretic hormone. Both diabetes mellitus and diabetes insipidus are well-known causes of polyuria and polydipsia. Although Wolfram Syndrome, which is characterized by the concurrence of diabetes mellitus and diabetes insipidus along with optic atrophy and ataxia, is frequently reported, the concurrence of diabetes insipidus and type 2 diabetes mellitus without optic atrophy and deafness is rare. We report a 31-year-old woman presenting with hyperglycemic hyperosmolar syndrome caused by type 2 diabetes mellitus complicated with concurrent central diabetes insipidus.

A Case of Acute Esophageal Necrosis in a Patient with Diabetic Ketoacidosis / 대한내과학회지

Acute esophageal necrosis is a rare clinical entity characterized by the endoscopic finding of extensive black discoloration of the esophageal mucosa. Acute esophageal necrosis in a patient with diabetic ketoacidosis has rarely been reported. We report a case of acute esophageal necrosis in a patient with diabetic ketoacidosis. The patient had coffee ground emesis and, after an esophagogastroduodenoscopy with mucosal biopsy, acute esophageal necrosis was diagnosed. The patient was treated conservatively with an intravenous proton pump inhibitor and oral sucralfate without any complications.

R1467H Variants of Rho Guanine Nucleotide Exchange Factor 11 (ARHGEF11) are Associated with Type 2 Diabetes Mellitus in Koreans / 당뇨병

BACKGROUND: The human Rho guanine nucleotide exchange factor 11 (ARHGEF11) functions as an activator of Rho GTPases and is thought to influence insulin signaling. The R1467H variant of ARHGEF11 has been reported to be associated with susceptibility to type 2 diabetes mellitus (T2DM) in Western populations. METHODS: We investigated the effects of the R1467H variant on susceptibility to T2DM as well as related traits in a Korean population. We genotyped the R1467H (rs945508) of ARHGEF11 in 689 unrelated T2DM patients and 249 non-diabetic individuals and compared the clinical and biochemical characteristics according to different alleles. RESULTS: The H allele was significantly more frequent in T2DM cases than in controls (P = 0.037, 17.1% and 13.1%; respectively). H homozygocity was associated with a higher risk of T2DM compared to those with R/R or R/H genotype (odds ratio, 5.24; 95% confidence interval, 1.06 to 25.83; P = 0.042). The fasting plasma glucose, HbA1c, fasting insulin, HOMA2-IR and HOMA2-%beta levels did not differ significantly between different genotypes. CONCLUSION: Our study replicated associations of the ARHGEF11 polymorphism with increased risk of T2DM in a Korean population and thus supports previous data implicating a potential role of ARHGEF11 in the etiology of T2DM. Further studies revealing the underlying mechanism for this association are needed.

A case of Sheehan's syndrome with central diabetes insipidus showing hemorrhagic pituitary apoplexy / 대한내과학회지

Ischemic necrosis of the pituitary gland, known as Sheehan's syndrome, can develop after massive postpartum bleeding. This condition is rarely accompanied by diabetes insipidus. An empty sella is a constant feature of Sheehan's syndrome in the later phase, but very few observations of magnetic resonance imaging (MRI) features in the acute phase are available. We report a case of Sheehan's syndrome presenting with diabetes insipidus leading to severe hypernatremia, showing hemorrhagic postpartum pituitary apoplexy on acute MRI.

The Effect of Lowering the Threshold for Diagnosis of Impaired Fasting Glucose

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.

Insular (Poorly Differentiated) Carcinoma of Thyroid / 대한내분비외과학회지

Insular carcinoma of the thyroid is a rare thyroid malignancy, and this was named in 1984 by Carcangiu when he described its characteristic histology. Histologically, insular carcinoma is characterized by uniform cells arranged in distinct nests or an insular pattern that contain variable numbers of small follicles. Clinically and morphologically, it is considered to be in an intermediate position between well-differentiated carcinoma of the thyroid (papillary or follicular) and undifferentiated or anaplastic carcinoma of the thyroid. This thyroid malignancy is distinctive, aggressive and often lethal. However, most authors believe it to be an independent entity. The prognosis of this tumor is worse than that of classic differentiated thyroid carcinoma, and most authors advise aggressive therapy, which can achieve pro-longed survival in some cases. We describe here a patient (a 42 years-old woman) who was managed with completion thyroidectomy after unilateral lobectomy of the thyroid with confirmation of the permanent pathology as insular carcinoma. I-131 ablation (175 mCi) was performed on the remnant thyroid tissues after follow-up of I~131 whole-body scanning.

Syndrome of Inappropriate Secretion of Antidiuretic Hormone Following Adjuvant Chemotherapy with Cisplatin plus Paclitaxel in Non-Small Cell Lung Cancer Patient / 결핵및호흡기질환

We report a case of pulmonary adenocarcinoma complicated by the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) following adjuvant chemotherapy. A 51-year-old woman with stage IIIA adenocarcinoma received left lower lobe lobectomy in July, 2006. And then combination chemotherapy with paclitaxel and cisplatin was given to the patient. In five days after completion of second cycle of the chemotherapy, she visited emergency room because of general weakness and seizure. Her brain MRI was shown to be no evidence of brain metastasis. Serum sodium, urine and plasma osmolarities were 117mEq/L, 589 and 244mOsm/kg, respectively. She was improved with fluid restriction. Although occurrence of SIADH following chemotherapy is rare, physician should give an attention the potential for development of SIADH in the course of chemotherapyin non-small cell lung cancer patient.

A Case of Bilateral Macronodular Adrenocortical Hyperplasia Accompanied by Hyperresponsiveness to Vasopressin / 대한내분비학회지

Cushing's syndrome associated with nodular adrenal hyperplasia glands is divided into 4 main categories: adrenal adenoma, adrenal carcinoma, primary pigmented nodular adrenal dysplasia and macronodular adrenal hyperplasia(MAH). The mechanism of bilateral MAH, when ACTH is suppressed, was previously unknown, and referred to as being "autonomous". Recently, several reports have shown MAH to be under the control of ectopic or eutopic membrane hormone. Here, a case of Cushing's syndrome, caused by bilateral MAH, is reported. A 62-year-old woman presented with Cushingoid features, hypertension and diabetes mellitus. In her case, abnormal adrenal stimulation of cortisol secretion in response to exogenous vasopression stimulation was shown. Her urine free cortisol was 726.0microgram/dL, which was not suppressed after administration of high-dose dexamethasone. Her plasma cortisol level was elevated, but without circadian rhythm. ACTH was undetectable. An abdomen CT scan demonstrated bilaterally enlarged multinodular adrenal glands. A Sella MRI revealed no alteration of the pituitary gland. The patient underwent a laparoscopic bilateral adrenalectomy. Histological examination revealed bilateral macronodular hyperplasia. After having recovered, the patient showed progressive regression of the Cushingoid status.

A Case of Isolated Familial Somatotropinoma / 대한내분비학회지

The familial occurrence of a pituitary adenoma associated with multiple endocrine neoplasia (MEN) type 1 or Carney complex is a well-recognized entity. However, an isolated familial somatotropinoma is a rare inherited disease, which is characterized by clustering of a somatotrophic adenoma and acromegaly or gigantism in a family, but without other manifestations of MEN type 1, with only 68 cases, in 28 families, described in the literature. The mode of inheritance is autosomal dominant, with incomplete penetration, but the genetic background of these pituitary adenomas remains unknown. A family exists where both the father and son were affected. Endocrinological investigations confirmed hypersecretion of GH and IGF-1, and the pituitary adenomas were identified by magnetic resonance image in both cases. There was no symptom of MEN type 1 or other form of endocrine dysfunction. Herein is reported a case of an isolated familial somatotropinoma in Korea, with a review of the literature

A Case of Isolated Familial Somatotropinoma / 대한내분비학회지

The familial occurrence of a pituitary adenoma associated with multiple endocrine neoplasia (MEN) type 1 or Carney complex is a well-recognized entity. However, an isolated familial somatotropinoma is a rare inherited disease, which is characterized by clustering of a somatotrophic adenoma and acromegaly or gigantism in a family, but without other manifestations of MEN type 1, with only 68 cases, in 28 families, described in the literature. The mode of inheritance is autosomal dominant, with incomplete penetration, but the genetic background of these pituitary adenomas remains unknown. A family exists where both the father and son were affected. Endocrinological investigations confirmed hypersecretion of GH and IGF-1, and the pituitary adenomas were identified by magnetic resonance image in both cases. There was no symptom of MEN type 1 or other form of endocrine dysfunction. Herein is reported a case of an isolated familial somatotropinoma in Korea, with a review of the literature