Hyun Shik Son

First insulinization with basal insulin in patients with Type 2 diabetes in a real-world setting in Asia

Background:  The First Basal Insulin Evaluation (FINE) Asia study is a multinational, prospective, observational study of insulin‐naïve Type 2 diabetes mellitus (T2DM) patients in Asia, uncontrolled (A1c ≥ 8%) on oral hypoglycemic agents, designed to evaluate the impact of basal insulin initiation.

Thyrotoxic Periodic Paralysis Presenting as Polymorphic Ventricular Tachycardia Induced by Painless Thyroiditis

Thyrotoxic periodic paralysis (TPP) can occur with any form of thyrotoxicosis. The most common cause of TPP in thyrotoxicosis is the Graves’ disease (1). Only one patient with TPP due to a painless thyroiditis (PT) has been reported (2). Here we describe an additional patient with TTP due to PT who had polymorphic ventricular tachycardia. This is an extremely unusual presentation of TTP. A 38-year-old Korean man was admitted to the emergency room for flaccid paralysis of the lower limbs for 6 hours duration. His past medical history was unremarkable. He had not taken any prescribed medications, and he did not have a history of drug abuse. There was no family history of Graves’ disease. On arrival at the emergency room, his blood pressure was 150=100 mmHg, and the heart rate was 96 beats=minutes. He was alert with a respiratory rate of 20 breaths=minutes and a body temperature of 368C. There was no proptosis. Palpation of the thyroid showed slight enlargement of the right lobe without tenderness or palpable nodule. Auscultation of the thyroid revealed no bruit. The lower limbs had flaccid paralysis with intact sensory function. Baseline laboratory data indicated normal serum sodium, magnesium, and calcium levels. The potassium level was 2.5 mEq=L (normal range 3.5–5.1 mEq=L), free thyroxine was 2.4 ng=dL (0.9–1.8 ng=dL), thyroid-stimulating hormone was 0.02 mIU=mL (0.17–4.65 mIU=mL), triiodothyronine was 179.41 ng=dL (78–200 ng=dL), thyroid-binding inhibitory immunoglobulins was 4% (normal rage <15%), and the antimicrosomal antibody was 1:6400. The initial electrocardiogram showed normal sinus rhythm (Fig. 1A). Twenty minutes after admission, he had polymorphic ventricular tachycardia with loss of consciousness (Fig. 1B). He was successfully resuscitated with 250 J cardioversion. He regained consciousness and his cardiac rhythm converted to atrial fibrillation (Fig. 1C). Cardiac enzyme measurements were as follows: creatine phosphokinase 626 U=L; creatine phosphokinase-MB 2.55 ng=mL; and troponin T< 0.010 mg=dL. A repeat electrocardiogram showed normal sinus rhythm (heart rate: 100 beats=minutes) and normal corrected QT interval. An echocardiogram performed 2 days later showed normal cardiac function without structural heart disease. Twenty-four hour holter monitoring did not show arrhythmias. A thyroid scan with Tc-99m revealed little or no uptake in the thyroid area compatible with thyroiditis (Fig. 2A). Therefore, no antithyroid drugs were administered. He was discharged from the hospital without further untoward events. The serum potassium and thyroid function was normal for 3 months (free thyroxine 1.07 ng=dL, thyroid-stimulating hormone 1.07 mIU=mL, potassium 4.1 mEq=L), and there were no symptoms of hypokalemia and muscle paralysis. A repeat thyroid scan with Tc-99m performed 3 months after the initial test revealed normal uptake in the thyroid area (Fig. 2B). Although PT is a self-limited disease associated with transient mild thyrotoxicosis and hypothyroidism, our patient not only had TPP but also a near-fatal ventricular arrhythmia.

The Effect of an Angiotensin Receptor Blocker on Arterial Stiffness in Type 2 Diabetes Mellitus Patients with Hypertension

Background Hypertension and type 2 diabetes mellitus are major risk factors for cardiovascular disease. This study analyzed the changes in central aortic waveforms and pulse wave velocity as well as related parameters after treatment with valsartan, an angiotensin II type 1 receptor blocker, in patients with type 2 diabetes and hypertension. Methods We used pulse wave analysis to measure central aortic waveform in a total of 98 subjects. In 47 of these patients, pulse wave velocity measurements were obtained before and after 12 weeks of treatment with valsartan. Results In the central aortic waveform analysis, the aortic pulse pressure and augmentation index were significantly decreased after valsartan treatment, as was the aortic pulse wave velocity. Factors contributing to the improvement in pulse wave velocity were the fasting blood glucose and haemoglobin A1c levels. Conclusion Short-term treatment with valsartan improves arterial stiffness in patients with type 2 diabetes and hypertension, and the glucose status at baseline was associated with this effect.

Differentially up-regulated genes in proliferating porcine neonatal pancreas cells caused by epidermal growth factor

Pancreatic duct cells are considered to be a major source for β‐cell regeneration or neogenesis. Although epidermal growth factor (EGF) is a well‐known important growth factor for pancreas development, the control of pancreatic duct cell growth and differentiation by EGF is poorly understood. In this study, we focused on identifying the genes that were differentially up‐regulated in response to EGF stimulation using monolayer cultured porcine neonatal pancreas cells. Cells were obtained from 1 to 3 day old pigs, dispersed and cultured for 8 days. Monolayer cultured porcine pancreas cells were comprised of duct cells and some endocrine and mesenchymal cells (75.2 ± 15.1, 19.6 ± 4.9, and 9.5 ± 3.1%, respectively). After 16 h in serum free media, cells were treated with 100 μg/L EGF for 24 h. Differentially expressed genes were screened by subtractive hybridization. 3H‐thymidine uptake was significantly increased by EGF with time (untreated vs. 24 h treated, untreated vs. 48 h treated: 305.5 ± 3.5 cpm vs. 380.3 ± 17.3 cpm (P < 0.05), 309.2 ± 4.51 vs. 929 ± 9.19 cpm, (P < 0.005), respectively). Three hundred and fify cDNA clones were obtained by subtractive hybridization and the inserts were confirmed in 161 colonies and then sequenced. Finally, we found increased mRNA expression of five unknown and five known genes, including cytochrome c oxidase subunit I (COI), cyclooxygenase‐2 (COX‐2), matrix metalloproteinase‐13 (MMP‐13), Wiskott–Aldrich syndrome protein interacting protein (WASPIP), and hyaluronan synthase‐2 (HAS‐2). We confirmed the up‐regulation of these genes by Northern blot and semi‐quantitative RT‐PCR at various time points. The present findings opened new targets for the research on the mechanisms of pancreatic duct cell proliferation by EGF.

Effect of the combination of mitiglinide and metformin on glycemic control in patients with type 2 diabetes mellitus

Aims/Introduction:  Mitiglinide is the newest drug in the meglitinide family. It increases the early‐phase insulin release through rapid association‐dissociation kinetics in the pancreatic β cells. The efficacy and safety of adding meglitinide to metformin monotherapy in patients with type 2 diabetes are unknown.

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).

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)

Regulation of Glucose Control in People with Type 2 Diabetes: A Review and Consensus

A conference was convened by the Korean Diabetes Association and the Korean Endocrine Society on September 7, 2009 to discuss and organize the results of research on intensive glucose control for the prevention of cardiovascular disease in patients with type 2 diabetes. Professor Kyung Soo Park led the conference, and Professors Kwang Won Kim and Ho Young Son acted as chairmen. Professors Doo Man Kim, Tae Sun Park, and Bong Soo Cha reported on intensive glucose control and diabetic complications, including the UK Prospective Diabetes Study (UKPDS), Diabetes Control and Complication Trial (DCCT) research results, the recently published Action to Control Cardiovascular Risk in Diabetes (ACCORD), Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE), and Veterans Affairs Diabetes Trial (VADT) research, as well as meta-analyses. Professor Jeong-Taek Woo reported on the manuscript written by the committee for the Korean Diabetes Association which dealt with the treatment of diabetes mellitus. Professors Kyung Soo Ko, Joong Yeol Park, Hyun Shik Son, Moon-Kyu Lee, Dong-Won Byun, and Yoon-Sok Chung participated in the discussion and collected information for the manuscript from all of the participants. The aim of the debate was to determine how to establish target goals for intensive glucose control and how to individualize those goals. The participants concluded that there was no need to modify the recommendation of maintaining an HbA1c under 6.5%, the current blood glucose treatment goal that is recommended by the Korean Diabetes Association. In addition, individual target goals for glucose control were recommended depending on the situation of each patient. We report on the consensus statement from the meeting.