Hannah Seok

Refocusing Peroxisome Proliferator Activated Receptor-α: A New Insight for Therapeutic Roles in Diabetes.

Although glucose-lowering treatment shows some risk lowering effects in cardiovascular diseases, risks of macrovascular and microvascular complications have still remained, and development of new therapeutic strategies is needed. Recent data have shown that peroxisome proliferator activated receptor-α (PPAR-α) plays a pivotal role in the regulation of lipid homeostasis, fatty acid oxidation, cellular differentiation, and immune response such as inflammation or vascularization related to diabetic complication. This review will re-examine the metabolic role of PPAR-α, summarize data from clinical studies on the effect of PPAR-α agonist in diabetes, and will discuss the possible therapeutic role of PPAR-α activation.

1,5-anhydroglucitol as a useful marker for assessing short-term glycemic excursions in type 1 diabetes

Background Type 1 diabetes is associated with more severe glycemic variability and more frequent hypoglycemia than type 2 diabetes. Glycemic variability is associated with poor glycemic control and diabetic complications. In this study, we demonstrate the clinical usefulness of serum 1,5-anhydroglucitol (1,5-AG) for assessing changes in glycemic excursion in type 1 diabetes. Methods Seventeen patients with type 1 diabetes were enrolled in this study. A continuous glucose monitoring system (CGMS) was applied twice at a 2-week interval to evaluate changes in glycemic variability. The changes in serum glycemic assays, including 1,5-AG, glycated albumin and hemoglobin A1c (HbA1c), were also evaluated. Results Most subjects showed severe glycemic excursions, including hypoglycemia and hyperglycemia. The change in 1,5-AG level was significantly correlated with changes in the glycemic excursion indices of the standard deviation (SD), mean amplitude of glucose excursion (MAGE), lability index, mean postmeal maximum glucose, and area under the curve for glucose above 180 mg/dL (r=-0.576, -0.613, -0.600, -0.630, and -0.500, respectively; all P<0.05). Changes in glycated albumin were correlated with changes in SD and MAGE (r=0.495 and 0.517, respectively; all P<0.05). However, changes in HbA1c were not correlated with any changes in the CGMS variables. Conclusion 1,5-AG may be a useful marker for the assessment of short-term changes in glycemic variability. Furthermore, 1,5-AG may have clinical implications for the evaluation and treatment of glycemic excursions in type 1 diabetes.

Balsamic Vinegar Improves High Fat-Induced Beta Cell Dysfunction via Beta Cell ABCA1

Background The aim of this study was to investigate the effects of balsamic vinegar on β-cell dysfunction. Methods In this study, 28-week-old Otsuka Long-Evans Tokushima Fatty (OLETF) rats were fed a normal chow diet or a high-fat diet (HFD) and were provided with tap water or dilute balsamic vinegar for 4 weeks. Oral glucose tolerance tests and histopathological analyses were performed thereafter. Results In rats fed both the both chow diet and the HFD, the rats given balsamic vinegar showed increased insulin staining in islets compared with tap water administered rats. Balsamic vinegar administration also increased β-cell ATP-binding cassette transporter subfamily A member 1 (ABCA1) expression in islets and decreased cholesterol levels. Conclusion These findings provide the first evidence for an anti-diabetic effect of balsamic vinegar through improvement of β-cell function via increasing β-cell ABCA1 expression.

Clinical characteristics and insulin independence of Koreans with new-onset type 2 diabetes presenting with diabetic ketoacidosis.

We evaluated the incidence, characteristics and insulin independence of Koreans with new‐onset type 2 diabetes (T2D) initially presenting with diabetic ketoacidosis (DKA).

Prevalence and risk factors of periodontitis among adults with or without diabetes mellitus

Background/Aims: This study examined prevalence and risk factors of periodontitis in representative samples of Korean adults, with and without diabetes mellitus (DM). Methods: Data from the 2012 Korean National Health and Nutritional Examination Survey were analyzed. A total of 4,477 adults (≥ 30 years old) were selected from 8,057 individuals who completed a nutrition survey, a self-reported general health behavior questionnaire, an oral examination, an oral hygiene behaviors survey, and laboratory tests. DM was defined as a fasting plasma glucose ≥ 126 mg/dL, or self-reported diagnosed diabetes, or current use of oral hypoglycemic agents and/or insulin. The community periodontal index was used to assess periodontitis status and comparisons between the periodontitis and the non-periodontitis group, were performed, according to the presence of DM. Risk factors for periodontitis in adults with DM and without DM were evaluated by multiple logistic regression analysis. Results: The prevalence of periodontitis was significantly higher in adults with DM (43.7%) than in those without DM (25%, p < 0.001). In adults without DM, risk factors for periodontitis were older age, male, urban habitation, waist circumference, smoking, oral pain, and less frequent tooth brushing. Significant risk factors for periodontitis in adults with DM were the smoking, oral pain, and not-using an oral hygiene product. Conclusions: Adults with DM have an increased risk of periodontitis than those without DM. Current smoking and oral pain increase this risk. Using an oral hygiene product can reduce risk of periodontal disease in adults with DM.

High prevalence of both anti-insulin and anti-insulin receptor antibodies in Korean patients with insulin autoimmune syndrome

We performed a retrospective pooled analysis of 28 patients who had been diagnosed with insulin autoimmune syndrome and evaluated the prevalence of anti-insulin receptor antibodies. Dual positivity for anti-insulin and anti-insulin receptor antibodies was common (53.8%). However, these patients had a similar phenotype compared with insulin receptor antibody-negative patients.

A giant carotid aneurysm with intrasellar extension: a rare cause of panhypopituitarism.

A 73-year-old woman presented at our institution with a 1-day history of drowsy mental status and a 2-month history of headache and general weakness. She had not taken any medications. Laboratory investigations showed severe hyponatremia (Na, 114 mEq/L) and a potassium level of 3.2 mEq/L. A computed tomography (CT) angiogram showed an intrasellar 3.0-cm aneurysm arising from the left internal carotid artery (Fig. 1A and 1B). Basal pituitary hormone profiles showed morning cortisol, 1.43 µg/dL; adrenocorticotrophic hormone, 21.86 pg/mL; thyroid stimulating hormone, 1.36 mIU/L; free thyroxine, 0.6 ng/dL; follicle stimulating hormone, 2.46 IU/L; luteinizing hormone, 0.23 IU/L; and prolactin, 45.72 ng/mL, suggesting panhypopituitarism. A T1-weighted magnetic resonance image (MRI) revealed an aneurysm compressing the pituitary gland that was enhanced heterogeneously after injecting gadolinium (Fig. 1C).

Hyperglycemic hyperosmolar state associated with invasive rhino-orbital aspergillosis in a patient with end-stage renal disease.

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Prevalence and risk factors for reduced pulmonary function in diabetic patients: The Korea National Health and Nutrition Examination Survey

Background/Aims An association between reduced pulmonary function and diabetes has been observed. Our aim was to evaluate the prevalence and risk factors associated with reduced pulmonary function in diabetic patients. Methods We analyzed data from the Korea National Health and Nutrition Examination Survey 2011 to 2013. The study population included data from 8,784 participants (including 1,431 diabetics) aged ≥ 40 years. Reduced pulmonary function was defined as patients with restrictive (forced expiratory volume in 1 second/forced vital capacity [FEV1/FVC] ≥ 0.7 and FVC < 80% of predicted value) or obstructive (FEV1/FVC < 0.7) patterns. Results Subjects with diabetes had a higher prevalence of restrictive (18.4% vs. 9.4%, p < 0.001) and obstructive impairments (20% vs. 12.6%, p < 0.001) than those without diabetes. The adjusted odds ratios (aORs) (95% confidence interval [CI]) for obstructive and restrictive pulmonary impairment were 0.91 (0.75 to 1.11) and 1.57 (1.30 to 1.89), respectively. In the diabetes population, age (aOR, 1.04; 95% CI, 1.02 to 1.06), male sex (aOR, 1.40; 95% CI, 1.04 to 1.88), and body mass index (aOR, 1.15; 95% CI, 1.10 to 1.21) were independently associated with restrictive pulmonary impairment. Age (aOR, 1.12; 95% CI, 1.09 to 1.14), male sex (aOR, 4.24; 95% CI, 2.42 to 7.44), and smoking at any point (ever-smoker: aOR, 1.96; 95% CI, 1.16 to 3.33) were independent risk factors for obstructive pulmonary impairment in diabetics. Diabetes duration or glycated hemoglobin had no association with pulmonary impairment in diabetes. Conclusions Subjects with diabetes had a higher risk of restrictive pulmonary impairment than those without diabetes after adjusting for confounding factors. Older age, male sex, body mass index, and smoking were associated with reduced lung function in diabetes.

Dual ectopic thyroid presenting with an anterior neck mass

A 34-year-old woman presented with a 2-year history of anterior midline neck swelling. The physical examination revealed a soft, mobile, nontender, 2 × 1 cm, anterior midline neck mass. Ultrasonography showed a heterogeneously isoechoic mass (2.23 × 1.18 cm) in the subhyoid region, while a thyroid gland was not seen in the normal position (Fig. 1A). A 99mTc-pertechnetate scan demonstrated two distinct focal areas of radiotracer uptake in the sublingual and subhyoid regions, without uptake in the region of the normal thyroid gland (Fig. 1B). Neck computed tomography (CT) revealed two heterogeneous hyperdense enhancing masses, one in the sublingual region and the other in the subhyoid region (Fig. 1C). The thyroid function tests suggested subclinical hypothyroid status with a T4 level of 4.95 µg/dL (normal range, 4.7 to 12.5) and thyroid stimulating hormone level of 15.26 mIU/L (normal range, 0.17 to 4.65). Anti-microsomal antibody and anti-thyroglobulin antibody were negative. A dual ectopic thyroid was diagnosed based on the radiological findings and replacement therapy with levothyroxine was initiated. Figure 1 (A) Neck ultrasonography shows a heterogeneously isoechoic neck mass in the subhyoid region. (B) 99mTc pertechnetate thyroid scan shows two focal areas of uptake in the sublingual (upper arrow) and subhyoid regions (lower arrow)