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This study aimed to determine the impact of dysglycemia on myocardial injury and cardiac dysfunction in acute myocardial in farctions (AMIs). From 2005 to 2016, a total of 1,593 patients with AMIs who underwent percutaneous coronary intervention were enrolled. The patients were classified into five groups according to the admission glucose level: ≤80, 81 to 140, 141 to 200, 201 to 260, and ≥261 mg/dL. The clinical and echocardiographic parameters and 30-day mortality were analyzed. The peak tro ponin I and white blood cell levels had a positive linear relationship to the admission glucose level. The left ventricular ejection fraction had an inverted U-shape trend, and the E/E’ ratio was U-shaped based on euglycemia. The 30-day mortality also in creased as the admission glucose increased, and the cut-off value for predicting the mortality was 202.5 mg/dL. Dysglycemia, es pecially hyperglycemia, appears to be associated with myocardial injury and could be another adjunctive parameter for predicting mortality in patients with AMIs.

BACKGROUND Hemorheologic indices are known to be related to vascular complications in variable clinical settings. However, little is known about the associations between hemorheologic parameters and acute myocardial infarction (AMI) in type 2 diabetes mellitus (T2DM). The purpose of this study was to demonstrate the changes of hemorheologic environment inside of blood using hemorheologic parameters, especially the elongation index (EI) and critical shear stress (CSS) in diabetics with versus without AMI. METHODS A total of 195 patients with T2DM were enrolled. Patients were divided into the study group with AMI (AMI+, n=77) and control group (AMI-, n=118) who had no history of coronary artery disease. Hemorheologic parameters such as EI and CSS were measured and compared between the two groups. RESULTS The EI was lower (30.44%±1.77% in AMI+ and 31.47%±1.48% in AMI-, P

Background: The oral glucose tolerance test (OGTT) for detection of diabetes is difficult to perform in clinical settings. The aim of this study is to evaluate the performance of a more practical detection test, combined fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c), as a predictor of diabetes mellitus (DM) in a Korean sample. Methods: We examined 2,045 (M = 1,276, mean age = 47.8 ± 9.0 yrs) medical check-up program participants between January 2002 to December 2003. FPG, HbA1c and a number of other biochemical tests were performed at baseline and four after years after initial screening. Patients who originally presented with diabetes were excluded. The characteristics of newly-diagnosed DM patients and non-diabetic patients were compared. Results: The incidence of newly diagnosed diabetes was 1.6% (32/2,045) after four years of follow up. The subjects in the DM group were older, had higher levels of SBP, DBP, FPG, HbA1c, triglyceride, HDL cholesterol, GGT and LDH (P < 0.05). In multivariate logistic regression analysis, FPG (odds ratio (OR) 1.124) and HbA1c (OR 4.794) were significantly correlated with onset of diabetes (P < 0.05). The interaction parameter between FPG and HbA1c was more than 1.0, indicating that the two effects are synergistic. The predictive cut-off values of HbA1c and FPG were 5.35% (area under curve (AUC) = 0.944) and 102.5 mg/dL (AUC = 0.930), respectively. Conclusion: The combination of HbA1c above 5.35% and FPG above 102.5 mg/dL predicted the onset of diabetes in a Korean sample. These results suggest that the combination of FPG and HbA1c may be useful for predicting progression to type 2 diabetes in east Asians. (Korean Diabetes J 33:306-314, 2009)

451 최근 당뇨병의 유병률이 증가하고 있으며, 제2형 당뇨병 환자의 약 1/3이 아직 진단되지 않은 상태로 있어, 당뇨병 을 선별하고, 조기에 진단할 수 있는 예측인자에 대한 연구 들이 많이 진행되고 있습니다. 저자들의 연구 는 제2형 당 뇨병의 예측인자로서 공복 혈장 혈당과 당화혈색소의 조합 의 유용성을 증명하는 후향적 환자 대조군 연구였습니다. 본 연구에서 4년간의 추적관찰 기간 동안 새롭게 당뇨병 으로 진단된 사람의 비율은 1.6% (32/2,045)로, 우리나라의 국민건강영양조사(Korea National Health and Nutrition Examination Survey, KNHANES) 자료 중 2007년도 당뇨 병 유병률인 10.2% (미발표 자료)에 비해 낮게 나타났습니 다. 이렇게 유병률이 낮게 나온 데에는 본 연구가 일반인이 아닌 건강검진을 받은 2,045명의 환자를 대상으로 한 점, 4 년 후의 새로운 당뇨병 진단에 있어 공복 혈장 혈당만을 사 용한 점, 또한 지적해 주신 바와 같이 중간에 당뇨병이 생겨 4년 후 추적검사를 받지 않은 환자들을 연구 대상에 포함시 키지 못했던 것 등이 원인이 될 수 있겠습니다. 당뇨병 발생을 예측하는데 있어, 공복 혈장 혈당 검사와 당화혈색소 검사의 조합은 공복 상태에서 동시에 검사할 수 있다는 장점과 함께, 전향적으로 당뇨병 발생을 예측할 수 있다는 많은 연구가 있으며 , 각각의 검사를 시행했을 때 보다 함께 검사하는 것이 더 유효하다고 하였습니다 . 449 명을 대상으로 7년간 시행한 Inoue 등의 연구에서는, 공복 혈장 혈당 10 mg/dL (0.56 mmol/L), 당화혈색소 0.5% 증 가가 당뇨병 발생에 미치는 Odds ratio [OR] (95% CI)는 각각 5.28 (3.00~9.31), 3.03 (1.73~5.32)로 나타났으며 또 한 이 두 인자의 조합이 더욱 유용함을 증명하였습니다 . 이 연구에서는 공복 혈장 혈당 100 mg/dL (5.55 mmol/L), 109.8 mg/dL (6.10 mmol/L)를 기준으로 정상 공복혈당군 (저/고)과 공복혈당장애군으로 세 군, 당화혈색소 5.8%를 기준으로 두 군으로 나누어 연구를 시행한 바 있습니다. 조 언해 주신 바와 같이, 본 연구의 회귀 분석에 있어서 공복 혈장 혈당과 당화혈색소를 단계적으로 나누어 대입하여 통 계 분석을 한다면 좋은 결과를 얻을 수 있으리라 생각됩니 다. 하지만 미국 국제 전문가 위원회에서 당뇨병의 진단기 준으로 권고한 6.5%라는 당화혈색소의 기준치와 같이 , 선 별검사에는 이와 같은 기준치가 확립되지 않아 당화혈색소 로 연구 대상을 단계화하는데 어려움이 있었습니다. 그래서 본 연구에서는 공복 혈장 혈당과 당화혈색소의 ROC curve 를 구하여 민감도가 특이도가 높은 102.5 mg/dL와 5.35% 라는 기준치를 구하였으며, 이 값을 기준으로 네 군으로 나 누어 chi-square test를 통해 두 예측인자가 높은 군이 낮은 군에 비해 당뇨병 유병률이 높다는 것과 또한 회귀 분석을 통해 공복 혈장 혈당과 당화혈색소의 교호 작용에 대한 OR 가 1 이상으로 두 가지 인자가 서로를 상승시키는 작용을 증명함으로써 두 인자의 조합이 유용함을 증명하였습니다. 당화혈색소 5.35%를 기준으로 할 경우, 환자들에게 과도한 검사나 불필요하게 당뇨병에 대한 우려를 유발할 수 있겠으 나, 당뇨병의 유병률이 폭발적으로 증가하고 있는 현시점에 서 선별 검사로서의 기준치를 마련하는 것은 중요한 역할을 할 수 있을 것으로 기대됩니다. 또한 본 연구는 단일 기관의 연구로 대상을 선정하는데 있어 여러 가지 제한점이 있었으며, 귀하의 지적대로 당뇨 병의 발생에 있어 공복 혈장 혈당이 미치는 영향보다 당화 한국 성인에서 제2형 당뇨병의 예측인자로서 공복 혈장 혈당과 당화혈색소의 조합(Korean Diabetes J 33(4):306-314, 2009)

Background: Lipid oxidation and formation of oxygen radicals have been identified to be the important factors of atherogenesis. Because bilirubin, a potent physiological antioxidant inhibits lipid oxidation, it is suggested that low serum concentrations of bilirubin is associated with atherosclerosis. The aim of this study was to evaluate the relationship between bilirubin levels and coronary atherosclerosis. Methods: The coronary calcium score (CCS) of 172 subjects (male 63, mean age 60.5 ± 1.0) with type 2 diabetes were evaluated in Yeungnam University Hospital between January 2005 and February 2007. The subjects were divided into two groups with CCS 10 as the cut off. Results: Higher CCS was significantly associated with lower bilirubin (P < 0.05), but after adjusted with age, no longer correlation were seen (P = 0.121). To determine the relationship between subclinical coronary atherosclerosis and bilirubin, the subjects with previous history of cardiovascular disease were excluded. In 138 subjects (male 54, mean age 58.4 ± 1.1), higher CCS was significantly associated with lower levels of bilirubin. After adjusted with age, duration of diabetes, and history of hypertension, CCS was also inversely related with bilirubin (P < 0.05). Conclusion: These results suggest that lower levels of bilirubin might be considered as a risk factor of coronary artery disease, especially in type 2 diabetics without cardiovascular disease. (KOREAN DIABETES J 32:338-345, 2008)

Background: Hyperglycemia is a well-recognized pathogenic factor of long term complications in diabetes mellitus and hyperglycemia also generates reactive oxygen species (ROS) in β cells when ROS accumulate in excess for prolonged periods of time, they cause chronic oxidative stress and adverse effects. Unfortunately, the islet contacts low capacity of endogenous antioxidant effects. But, γ-glutamylcysteine synthetase (γ-GCS), the rate-limiting enzyme for glutathione synthesis, is well represented in islets. Methods: This study is to evaluate the changes in the activity of γ-GCS, glutathione in β-cells exposed to high glucose, in pancreatic tissue of OLETF (Otsuka Long Evans Tokushima Fatty) and LETO (Long-Evans Tokushima Otsuka) rats, in leukocytes from patients with Korean type 2 DM (T2DM) and to disclose the effects of high blood glucose on this impairment in patients with T2DM. We divided our patients into 3 groups by HbA1c (controls: n = 20, well controls diabetes: n=24, poorly controlled diabetes: n = 36). Results: We observed that decreased glutathione level, γ-GCS expression, glucose-stimulated (GSIS) and increased intracellular peroxide level in the INS-1 cells exposed to 30 mM glucose condition. Also decreased glutathione level at erythrocytes, γ-GCS expression at leukocytes and increased oxidized LDL, MDA (malondialdehyde) level at plasma from patients with T2DM compared to controls (esp, poorly controlled patients). Conclusion: These results suggest that insufficient antioxidant defenses by the glutathione pathway may be one of the factors responsible for development of complications in T2DM. (J Kor Diabetes Assoc 31:302~309, 2007)

Background: Diabetic retinopathy is a leading cause of adult blindness. Some patients show early development and progression of diabetic retinopathy despite of apparently good glycemic control. This is suggesting the involvement of other contributing factors. Recent studies have shown that retinopathy and GAD autoantibody (GADA) show an inverse relationship immunologically. This study is designed to investigate the clinical manifes tation of diabetes who are positive for GADA and the relationship between GADA and diabetic retinopathy. Methods: Type 1 diabetic patients & LADA patients who had visited Yeungnam university Medical Center from 1988 to 2005 were involved. We reviewed the pathologic and laboratory records of these patients and investigated the development of diabetic microvascular complications. Results: Compared with patients who had GADA negative diabetes, patients with GADA positive diabetes had lower prevalence of diabetic retinopathy (GADA negative subject: 25.8% vs. GADA positive subject: 9.6%, P < 0.05). Conclusion: We confirmed that diabetic retinopathy and GADA showed an inverse relationship. It seems quite probable that GADA may contribute to the prevention of retinopathy. Further research should be needed concerning the effect of GADA on diabetic retinopathy. (J Kor Diabetes Assoc 31:429~434, 2007)