Chun-Chin Sun

Association of Glycemic Control with Risk of Erectile Dysfunction in Men with Type 2 Diabetes

INTRODUCTION Improvement in glycemic control is likely to reduce the risk of diabetic complication, while its effect on erectile dysfunction (ED) remains unclear. AIM The aim of this study was to evaluate the association of glycemic control with risk of ED in type 2 diabetics. METHODS A self-administered questionnaire containing Sexual Health Inventory for Men was obtained from 792 subjects with type 2 diabetes at our institution. Clinical data were obtained through chart review. MAIN OUTCOME MEASURES The contribution of glycemic control assessed by glycated hemoglobin (HbA(1c)) level as well as age, duration of diabetes, hypertension (HT), dyslipidemia, and cigarette smoking to risk of ED was evaluated. RESULTS Of 792 subjects, 83.6% reported having ED and 43.2% had severe ED. HbA(1c) level (%) adjusted for age and duration of diabetes was significantly associated with ED (OR 1.12, 95% CI: 1.01-1.25). None of HT, dyslipidemia, and cigarette smoking was a significant risk factor for ED after adjusted for age and duration of diabetes. HbA(1c) level, age, and duration of diabetes were significant independent risk factors for ED among the younger group (age < or = 60 years), and only age and duration of diabetes were independent risk factors among the older group (age > 60 years). For the risk of severe ED, compared with no and mild to moderate ED, HbA(1c) level, duration of diabetes, and HT were independent risk factors among the younger group, and only age was an independent factor among the older group. CONCLUSIONS Better glycemic control probably would reduce the prevalence of ED and its severity among the younger men with type 2 diabetes. For the older group, aging was the major determinant for ED risk among this population with type 2 diabetes.

The effects of different doses of atorvastatin on plasma endothelin-1 levels in type 2 diabetic patients with dyslipidemia

We investigated the effects of three different daily doses (10 mg, 20 mg, and 40 mg) of atorvastatin, a relatively new and potent statin, on plasma endothelin (ET)-1 and highly sensitive C-reactive protein (CRP) levels in type 2 diabetic subjects. Twenty-nine type 2 diabetic patients with dyslipidemia were enrolled and randomly assigned to receive atorvastatin orally at 10 mg (A10; n = 10), 20 mg (A20; n = 10), or 40 mg (A40; n = 9) daily for 12 weeks. Levels of plasma total cholesterol and low-density lipoprotein (LDL)-cholesterol (C) in all three studied groups were significantly decreased after treatment with atorvastatin for 12 weeks (all groups, P < 0.001). However, the greatest LDL-C lowering effect and the highest percentage of subjects achieving the National Cholesterol Education Program’s Adult Treatment Panel III (NCEP-ATP III) LDL-C goal were observed in the A20 group. All diabetic subjects had a higher plasma ET-1 concentration (A10, 1.02 ± 0.37 pg/ml, mean ± SD; A20, 1.17 ± 0.55 pg/ml; and A40, 0.87 ± 0.45 pg/ml) than that of age- and sex-matched normal control subjects (0.64 ± 0.15 pg/ml; all groups, P < 0.001). Plasma ET-1 levels showed a borderline significant decrease at the end of study, by 22% in diabetic subjects treated with 10 mg atorvastatin (P=0.05 compared with baseline), and by 30% in subjects treated with 20 mg atorvastatin (P = 0.06, compared with baseline). Paradoxically, the 40-mg dose of atorvastatin provided an increase of 2% in plasma ET-1 levels at the end of study, which is significantly different (P < 0.05) and marginally significant (P = 0.057) from the levels of the 10- and 20-mg doses, respectively. Similarly, although insignificantly, plasma concentrations of CRP also tended to decrease by 12% and 48%, and paradoxically increased by 18% in diabetic patients treated with 10 mg, 20 mg, and 40 mg atorvastatin, respectively. The clinical significance of these biphasic lipid-independent statin effects is unknown and the present study suggests that 20 mg atorvastatin may have the best benefits in treating diabetic patients with dyslipidemia.

Change of visfatin, C-reactive protein concentrations, and insulin sensitivity in patients with hyperthyroidism

The present study was undertaken to evaluate the change of circulating visfatin, C-reactive protein (CRP) concentrations, and insulin sensitivity in patients with hyperthyroidism. We studied 19 adult patients (14 women and 5 men aged 32.6 +/- 1.8 years) with hyperthyroidism due to Graves disease and 19 age- and sex-matched euthyroid controls (17 women and 2 men aged 36.7 +/- 2.7 years). All hyperthyroid patients were treated with 1 of 2 antithyroid drugs and were reevaluated after thyroid function normalized. Before antithyroid treatment, the hyperthyroid group had significantly higher visfatin plasma concentration (mean +/- standard error of the mean, 20.7 +/- 1.8 ng/mL) than the control group (16.2 +/- 1.3 ng/mL, P = .044); but the visfatin level dropped significantly after treatment (12.0 +/- 1.4 ng/mL, P < .001). The reciprocal index of homeostasis model assessment of insulin resistance (HOMA-IR) in the hyperthyroid group was higher before treatment (2.06 +/- 0.26 mmol mU/L*L) than after treatment (1.21 +/- 0.16 mmol mU/L*L, P = .027). There was no significant difference in serum glucose, high-sensitivity CRP, and insulin levels between hyperthyroid and control groups and in the hyperthyroid group before and after treatment. Body mass index-adjusted visfatin levels were significantly elevated in the hyperthyroid group. Pearson correlation revealed that visfatin, glucose, insulin, and HOMA-IR values positively correlated with triiodothyronine and free thyroxine levels. However, visfatin did not correlate with insulin and HOMA-IR levels. The results indicated that plasma visfatin concentration was elevated in hyperthyroidism due to Graves disease, but serum CRP levels were not. Plasma visfatin levels were not associated with indicators of insulin resistance in hyperthyroid patients.

Patterns and Their Correlates of Seeking Treatment for Erectile Dysfunction in Type 2 Diabetic Patients

INTRODUCTION Diabetic patients are at high risk of having erectile dysfunction (ED), but their doctors rarely pay attention to this association. AIM To evaluate the treatment-seeking patterns and their correlates for ED in type 2 diabetic patients. METHODS A questionnaire containing Sexual Health Inventory for Men and questions inquiring treatment-seeking patterns was mailed or given to 4,040 subjects who had visited our endocrinology outpatient department for diabetes during January 2004 to May 2006. MAIN OUTCOME MEASURES The prevalence of being bothered and having interest in treatment, and the percentage having sought treatment in regard to ED and their correlates with age and ED severity. RESULTS Of the subjects with questionnaire completed, 83.9% (708/844) had ED. Among the subjects with different severity of ED, the moderate group had the highest percentages regarding prevalence of being bothered (89.4%), having interest in treatment (78.5%), and having sought treatment (46.2%). Of all the subjects, only 14.2% had ever visited Western physicians, whereas embarrassment and misinformation about ED treatment were the leading reasons for never doing so. Over half (56.6%) of those with ED wished to discuss ED problem with their doctors, and of them 90.4% wished the doctors to initiate to broach this issue. CONCLUSIONS The prevalence of ED and the concerns about it were high in these diabetic patients. ED severity was the major determinant of their treatment-seeking decision, whereas only few of them had ever sought professional help. Routine screening of ED in diabetic patients is recommended.

Salivary immunoreactive endothelin in patients with upper gastrointestinal diseases.

Endothelins have been implicated in gastric mucosal damage in a variety of animal models. Furthermore, clinical reports also show elevated gastric mucosal endothelin-1 levels in patients suffering from peptic ulcer diseases. We have demonstrated, first, the presence of immunoreactive endothelin (IR-ET) in human saliva. We also show that endothelins are rather stable in human saliva. The present study was undertaken to determine whether patients with endoscopically proven upper gastrointestinal diseases have a salivary excess of IR-ET, compared with patients with a normal esophagogastroduodenoscopy. Saliva was collected from fasting subjects prior to esophagogastroduodenoscopy. The levels of IR-ET were measured by the radioimmunoassay method. The salivary concentrations of IR-ET in the studied subjects were as follows: 8.9 ± 1.0 fmol/mL (mean ± standard error of the mean) for patients with gastric ulcers (n = 18); 7.3 ± 1.0 fmol/mL for patients with duodenal ulcers (n = 22); and 6.8 ± 0.6 fmol/mL for patients with gastritis (n = 28). These values are all higher than that of normal subjects (4.4 ± 0.5 fmol/mL, n = 20; P < 0.001, P < 0.01, and P < 0.05, respectively). No significant differences in salivary IR-ET were noted between patients with a normal esophagogastroduodenoscopy and patients with esophagitis (3.8 ± 0.7 fmol/mL, n = 4) or gastric cancer (5.3 ± 1.4 fmol/mL, n = 4). There were no significant differences in the salivary IR-ET levels between males and females. However, the salivary IR-ET levels in the smokers (8.0 ± 0.6 fmol/mL, n = 38) were significantly higher (P < 0.01) than those of the non-smokers (6.0 ± 0.4 fmol/mL, n = 58). There was no correlation of IR-ET levels with age. Our findings suggest that salivary endothelin may have a contributing role in certain gastroduodenal diseases.

Hyperthyroidism Is Associated with Higher Plasma Endothelin-1 Concentrations

The objective of this study was to determine the change of plasma endothelin (ET)-1 concentrations and insulin resistance index after therapy for hyperthyroidism. We studied 20 patients with hyperthyroidism (15 women and 5 men; age, 34.0 ± 2.8 years), and 31 patients with euthyroid goiters as controls (27 women, 4 men; age, 37.0 ± 2.4 years). All hyperthyroid patients were treated with antithyroid drugs. The patients received evaluations before and after normalization of thyroid function. The evaluations included body mass index (BMI), body fat, and measurement of circulating concentrations of thyroid hormones, glucose, insulin, and ET-1. Hyperthyroid subjects had higher plasma ET-1 concentrations than the control group (P < 0.001). No significant differences in serum glucose and insulin concentrations or insulin resistance index estimated by the R value of the homeostasis model assessment (HOMA-R) were noted between the groups. Plasma ET-1 concentrations decreased after correction of hyperthyroidism compared with pretreatment (P = 0.006). Serum glucose concentrations decreased after correction of hyperthyroidism (P = 0.005). Moreover, both body weight–adjusted insulin concentrations and the HOMA-R index were also decreased after correction of hyperthyroidism compared with pretreatment (P = 0.026 and P = 0.019, respectively). Pearson’s correlation revealed that plasma ET-1 levels positively correlated with serum triiodothyronine (T3) and free thyroxine (FT4) levels. Serum insulin levels and the HOMA-R index positively correlated with BMI and body fat. The HOMA-R index also positively correlated with serum T3 and FT4 levels. Neither insulin levels nor the HOMA-R index correlated with ET-1 levels. Hyperthyroidism is associated with higher plasma ET-1 concentrations. In addition, correction of hyperthyroidism is also associated with a decrease of plasma ET-1 levels as well as the insulin resistance index calculated by HOMA-R.

Common Hemoglobin Variants in Southern Taiwan and Their Effect on the Determination of HbA1c by Ion-exchange High-performance Liquid Chromatography

Background: Patients with hemoglobin (Hb) variants may produce false HbA1c measurement. This study aimed to detect the common Hb variants in southern Taiwan and to evaluate their effect on the determination of HbA1c. Methods: A total of 1,434 samples collected for HbA1c measurement at Kaohsiung Veterans General Hospital in southern Taiwan in March 2008 were submitted for Hb variant analysis by Primus CLC‐385. HbA1c measurements were obtained using ion‐exchange high‐performance liquid chromatography (HPLC) (Tosoh HLC‐723 G7) for routine analysis. Patients identified with Hb variants were recalled for boronate‐affinity HPLC analysis. The values of estimated average glucose (eAG) were converted from HbA1c. Values of eAG‐FPG, calculated by eAG minus fasting plasma glucose (FPG), were compared to estimate the accuracy of HbA1c measurement in patients with Hb variants. Results: Among the 1,434 patients, the mean ± standard deviation of FPG was 162.8 ± 60.5 mg/dL, HbA1c was 8.28 ± 1.97%, and eAG was 190.9 ± 56.6 mg/dL. Five Hb variants were detected in 11 patients, the incidence being 0.76%. Hb J was identified in 4 patients, Hb G in 2 patients, Hb E in 1 patient, Hb owari in 3 patients, and high fetal hemoglobin (HbF) in 1 patient. Abnormal HPLC chromatograms were seen among the patients with Hb J, E, G and HbF, but not in the patients with Hb owari. In patients with Hb variants, FPG was 149.5 ± 39.9 mg/dL, HbA1c was 7.29 ± 2.01%, and eAG was 162.5 ± 57.7 mg/dL. Lower values of eAG‐FPG may have occurred in the patients with Hb J and E, and in those with high HbF. On scattergrams of the relationship between HbA1c and FPG, the plots of Hb J, E and high HbF lay below the regression line of non‐Hb variants. Inconsistent Hb values between both methods were only observed among some samples of patients with Hb variants. Conclusion: The existence of Hb variants may result in false HbA1c measurement. The possible presence of spuriously low HbA1c levels or abnormal HPLC chromatograms by using ion‐exchange methods should be kept in mind.

Color Doppler Sonography of the Neck in a Patient with Bilateral Carotid Body Tumors

Paragangliomas are rare cases. Carotid body tumor (CBT) is the most common paragan-glioma of the head and neck. Embryologically derived from neural crest cells, paragan-glioma and pheochromocytoma are similar in histology. But unlike pheochromocytoma, almost all paragangliomas are nonfunctional. Duplex sonography is increasingly used as the first noninvasive diagnostic tool for neck mass. However, for more detail of soft tissue nearby, magnetic resonance imaging (MRI) and computed tomography (CT) with 3D reconstruction are preferred. Herein we report a patient having bilateral CBT concomitant with bilateral pheochromocytomas. Duplex sonography clearly demonstrates the tumor and surrounding carotid arteries. Compared with CT, duplex sonography is a more rapid, convenient, safe, and economic measurement for the first diagnostic step.

Immunoreactive endothelin in Taiwanese thyroid cystic fluid

Endothelin-1 is a major vasoconstrictor peptide, first found in endothelial cells and later in many other tissues, including the thyroid gland. It is well known that endothelins can act as autocrine and/or paracrine regulators of thyroid homeostasis and growth. Previously we have demonstrated that immunoreactive endothelins (IR-ET) are present in various human body fluids, and IR-ET has also been detected in pathologic breast and thyroid cystic fluids. In this study, the IR-ET in Taiwanese thyroid cystic fluid was measured by radioimmunoassay and characterized by chromatography. Human thyroid cystic fluid was obtained by fine needle aspiration, was centrifuged, and the supernatant was stored at −20°C until IR-ET assay. IR-ET has been detected in 25 of 33 samples of thyroid cystic fluid [25 cases, 4.11 ± 0.31 fmol/mL (mean ± standard error of the mean); other eight cases, undetectable]. Gel permeation chromatography of the extract of pooled cystic fluid showed only one major peak at the elution position of human endothelin-1 standard. No difference in cystic IR-ET levels was found in our patients with cystic nodules in relation to differences in thyroid function. It is probable that endothelin-1 is produced by the epithelial cells lining the thyroid cysts, and the increased levels of IR-ET in cystic fluid found in our patients could either be secondary to cystic nodule development or have a role in goiter formation.

Thyrotoxic Periodic Paralysis in Southern Taiwan

Purpose: To see the differences of the patients with TPP between different races in clinical and biochemical characteristics. Methods: From 1993 to 2003, twenty one adult in-patients with acute limb weakness, plasma potassium ≦ 3.5 mmol/L and thyrotoxicosis confirmed by laboratory investigation were reviewed retrospectively in a medical center in southern Taiwan. Results: All but one were male (mean age 31±2.2 years). In 15 patients (71%), the attacks occurred between 9 pm and 9 am. No seasonal variation was noted in the incidence of TPP. The mean plasma potassium concentration on admission was 2.15 ± 0.13 mmol/L (range 1.1 to 3.2 mmol/L). Most of the patients (63%) developed sinus tachycardia. The mean heart rate of the patients was 106 ± 4 beats per minute, mean PR intervals was 236 ± 10 ms, mean QTc was 378±24 ms, and the mean QRS voltage was 29.1±1.8 mv. Conclusions: Thyroid function tests should be performed for young patients presenting with paralysis, when thyroid function tests are not available immediately, electrocardiogram (ECG) may be an useful tool to identify the diagnosis of TPP in the emergency unit.