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OBJECTIVE -To investigate the long-term effectiveness of the Internet-based glucose monitoring system (IBGMS) on glucose control in patients with type 2 diabetes.RESEARCH DESIGN AND METHODS -We conducted a prospective, randomized, controlled trial in 80 patients with type 2 diabetes for 30 months. The intervention group was treated with the IBGMS, while the control group made conventional office visits only. HbA 1c (A1C) was performed at 3-month intervals. For measuring of the stability of glucose control, the SD value of A1C levels for each subject was used as the A1C fluctuation index (HFI).RESULTS -The mean A1C and HFI were significantly lower in the intervention group (n ϭ 40) than in the control group (n ϭ 40). (A1C [mean Ϯ SD] 6.9 Ϯ 0.9 vs. 7.5 Ϯ 1.0%, P ϭ 0.009; HFI 0.47 Ϯ 0.23 vs. 0.78 Ϯ 0.51, P ϭ 0.001; intervention versus control groups, respectively). Patients in the intervention group with a basal A1C Ն7% (n ϭ 27) had markedly lower A1C levels than corresponding patients in the control group during the first 3 months and maintained more stable levels throughout the study (P ϭ 0.022). Control patients with a basal A1C Ͻ7% (n ϭ 15) showed the characteristic bimodal distribution of A1C levels, whereas the A1C levels in the intervention group remained stable throughout the study with low HFI.CONCLUSIONS -Long-term use of the IBGMS has proven to be superior to conventional diabetes care systems based on office visits for controlling blood glucose and achieving glucose stability. Diabetes Care 29:2625-2631, 2006M any controlled clinical trials have shown that prolonged maintenance of the appropriate HbA 1c (A1C) level reduces the risk of developing diabetes complications in individuals with type 1 and type 2 diabetes (1-3). However, data from the National Health and Nutrition Examination Surveys in the U.S. showed that overall glycemic control did not improve between the assessment periods of 1988 -1994 and 1999 -2000 (4,5). Similar findings have been reported in other countries (6,7).Therefore, to achieve and maintain the target level of A1C, new approaches for a medical delivery system are necessary. For this purpose, different strategies using electronic technologies or educational programs have been proposed to improve the quality and efficiency of care for people with diabetes (8 -15). In our previous study (16), we introduced a new bidirectional communication tool for diabetes management referred to as the Internet-based glucose monitoring system (IBGMS) and demonstrated its short-term effects over 3 months. The IBGMS comprises an electronically organized circuit for diabetes management that includes both online and offline systems. This management system provides a close doctor-patient relationship, offers more educational opportunities, and enhances patient feedback.In this study, we demonstrated the long-term effectiveness of the IBGMS on glucose stability and A1C reduction.RESEARCH DESIGN AND METHODS -Initially, 120 individuals with type 2 diabetes were screened by a review of their medical reco...

This study was designed to investigate the relationship between adipokines in metabolic syndrome and insulin resistance. Sixty male and female subjects with or without metabolic syndrome and type 2 diabetes were included. The homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Compared with lean control subjects, patients with metabolic syndrome and type 2 diabetes had lower circulating levels of total adiponectin and high molecular weight (HMW) adiponectin, and higher levels of leptin and interleukin-6 (IL-6). Total and HMW adiponectin and the adiponectin/leptin (A/L) ratio were negatively correlated with HOMA-IR. After adjusting for age and sex, leptin, IL-6 and tumour necrosis factor-alpha (TNF-alpha) were positively correlated with HOMA-IR. After also adjusting for body mass index, HOMA-IR was found to be independently associated with leptin, A/L ratio and TNF-alpha levels. In conclusion, decreased total adiponectin and HMW adiponectin and increased leptin and IL-6 levels are characteristic of patients with metabolic syndrome and type 2 diabetes.

HRPT2, the gene associated with hyperparathyroidism-jaw tumor (HPT-JT) syndrome, was previously mapped to 1q24-q32. It was recently cloned, and several germline mutations were found to predispose to HPT-JT syndrome. We sequenced the complete HRPT2 coding sequence and splice-junctional regions in a Korean family with HPT-JT syndrome and identified a novel germline mutation, IVS2-1G>A in intron 2, that caused the autosomal dominant trait of HPT-JT syndrome in this family. RT-PCR and sequencing of the transcripts revealed that this splicing mutation generated alternative splicing errors leading to the formation of two different transcripts, one with exon 3 deleted, the other lacking the first 23 bp of exon 3 due to the use of an internal splice acceptor in exon 3. Translation of both transcripts results in premature termination. In addition, we detected two novel somatic mutations of HRPT2 in malignant parathyroid tumors from the affected individuals. One, 85delG, causes premature termination; the other, an 18 bp in-frame deletion of 13_30delCTTAGCGTCCTGCGACAG, suggests that this region may be important in the development of the parathyroid carcinomas in HPT-JT syndrome. These findings provide further evidence that mutation of HRPT2 is associated with the formation of parathyroid tumors in HPT-JT syndrome.

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The presence of abdominal obesity and lack of physical activity are both risk factors for the development of hypertension. The aim of this study was to analyze the risk of developing hypertension according to baseline waist circumference (WC). In total, 16 312 476 non‐hypertensive participants who were covered by the National Health Insurance Service (NHIS) from 2009 to 2012 in Korea were included in the study. The participants were divided into six groups according to the level of baseline WC with a 5‐cm interval starting from 80 cm in men and 75 cm in women. The risk for the future development of hypertension was assessed in 2015 using the claims data on the diagnosis of hypertension and prescription of anti‐hypertensive medications. Approximately 7.8% of the participants developed hypertension over a median follow‐up of 5.48 years. The proportion of participants who developed hypertension significantly increased from 4.2% in the WC level 1% to 17.5% in the WC level 6. After adjusting for confounding factors, level 6 of the baseline WC had a higher hazard ratio (HR) for the development of hypertension among the 6 levels of baseline with level 3 as the reference (1736; 95% confidence interval [95% CI]: 1.72‐1.753). The participants with abdominal obesity had a significantly higher HR than those without abdominal obesity regardless of whether they engage in high‐ or moderate‐intensity physical intensity (1.741; 95% CI: 1.718‐1.764). WC had a linear association with the development of hypertension based on this large nationwide population‐based cohort study, which was not influenced by physical activity.

Aims To investigate the effectiveness of sodium‐glucose co‐transporter‐2 (SGLT2) inhibitors on the risk of progression to end‐stage renal disease (ESRD) and all‐cause mortality in a broad range of patients with type 2 diabetes (T2D) using a Korean nationwide cohort. Materials and Methods Using data from the Korean National Health Insurance Service database from January 2014 to December 2017, a total of 701 674 patients were identified with T2D. We divided these patients into new users of SGLT2 inhibitors and new users of other glucose‐lowering drugs (oGLDs). Using propensity scores, patients in the two groups were matched 1:1. We assessed the risk of ESRD and all‐cause death. Results There were 45 016 patients in each group, and baseline characteristics were well balanced between the groups. The patients' mean age was 58.1 ± 10.6 years and mean estimated glomerular filtration rate (eGFR) was 89.2 ± 27.4 mL/min/1.73m2, and 8% of patients had proteinuria. We identified 167 incident ESRD cases and 1070 all‐cause deaths during follow‐up. Use of SGLT2 inhibitors versus oGLDs was associated with a lower risk of ESRD (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.34 to 0.65) and all‐cause death (HR 0.82, 95% CI 0.73 to 0.93). In a subgroup analysis by eGFR, initiation of SGLT2 inhibitor treatment, compared with oGLD treatment, was associated with lower risk of progression to ESRD among patients with eGFR 60 to 90 mL/min/1.73m2 and those with eGFR < 60 mL/min/1.73m2, and a lower risk of all‐cause death was associated with SGLT2 inhibitors versus oGLDs in patients with eGFR ≥90 and 60 to 90 mL/min/1.73m2. Conclusion In this large nationwide study of Korean patients with T2D, initiation of SGLT2 inhibitors versus oGLDs was associated with lower risk of ESRD and all‐cause death.