Endocrinology and Metabolism

Original Article

Diabetes
High Brachial Ankle Pulse Wave Velocity as a Marker for Predicting Coronary Artery Stenosis in Patients with Type 2 Diabetes: Bo Hyun Kim, Jae Sik Jang, Yong Seop Kwon, June Hyung Kim, In Joo Kim, Chang Won Lee; Endocrinol Metab. 2018;33(1):88-96. Published online March 21, 2018; DOI: https://doi.org/10.3803/EnM.2018.33.1.88

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Background

We evaluated the ability of brachial ankle pulse wave velocity (baPWV) to predict coronary artery stenosis (CAS) in patients with type 2 diabetes, and compared the predictive power of baPWV to that of well-known cardiovascular disease (CVD) risk calculators.

Methods

The study group included 83 consecutive patients over 30 years old with type 2 diabetes who complained of vague chest discomfort. An automatic pulse waveform analyzer was used to measure baPWV. CAS was measured using multi-slice computed tomographic (MSCT) angiography.

Results

Age, maximal baPWV, duration of diabetes, current smoking, the UK Prospective Diabetes Study (UKPDS) Risk Engine score, American College of Cardiology/American Heart Association (ACC/AHA) risk estimator score, the Framingham risk calculator score, and coronary artery calcium score were greater in patients with CAS than in those without CAS. An area under the curve (AUC) indicative of a predictive value for CAS (≥20%) was found for several parameters. The AUC of maximal baPWV, the UKPDS Risk Engine, the ACC/AHA ASCVD risk estimator, and the Framingham risk calculator were 0.672 (95% confidence interval [CI], 0.554 to 0.785; P=0.010), 0.777 (95% CI, 0.675 to 0.878; P<0.001), 0.763 (95% CI, 0.660 to 0.866; P<0.001), and 0.736 (95% CI, 0.629 to 0.843; P<0.001), respectively. The optimal cutoff value of baPWV for the detection of CAS was 1,650 cm/sec (sensitivity, 68.9%; specificity, 63.2%).

Conclusion

Maximal baPWV was closely related with CAS detected by MSCT coronary angiography in patients with type 2 diabetes. baPWV has the potential to be a useful, noninvasive screening tool for the prediction of occult CAS in patients with type 2 diabetes.

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Comment

Response: The Association between Type 2 Diabetes Mellitus and Colorectal Cancer.: Byeong Do Yi, Young Pil Bae, Bong Gun Kim, Jong Wha Park, Dong Hyun Kim, Ja Young Park, Seong Ho Choi, Hee Seung Park, Jae Seung Lee, Chang Won Lee, Sang Soo Kim, Bo Hyun Kim, Moon Ki Choi, In Joo Kim; Endocrinol Metab. 2011;26(4):365. Published online December 1, 2011; DOI: https://doi.org/10.3803/EnM.2011.26.4.365

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Abstract PDF: No abstract available.

Original Articles

The Association between Type 2 Diabetes Mellitus and Colorectal Cancer.: Byeong Do Yi, Young Pil Bae, Bong Gun Kim, Jong Wha Park, Dong Hyun Kim, Ja Young Park, Seong Ho Choi, Hee Seung Park, Jae Seung Lee, Chang Won Lee, Sang Soo Kim, Bo Hyun Kim, Moon Ki Choi, In Joo Kim; Endocrinol Metab. 2011;26(2):126-132. Published online June 1, 2011; DOI: https://doi.org/10.3803/EnM.2011.26.2.126

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Abstract PDF

BACKGROUND
There is a close connection between type 2 diabetes mellitus and the risk of cancers and related mortality. The principal objective of the present study was to explore the association between type 2 diabetes and colorectal cancer. METHODS: We retrospectively compared 1111 subjects (age > or = 30 years) who were subjected to colonoscopies between June 2006 and June 2009. We evaluated the anthropometric data, presenting symptoms and signs, history of diabetes, laboratory data, colonoscopy findings and biopsy results. We analyzed the correlation between colorectal cancer and influencing factors, and compared the incidence rates of colorectal cancer in the type 2 diabetes and control groups. RESULTS: Four hundreds and seven of the subjects had diabetes mellitus. The incidence of colorectal cancer was increased significantly in type 2 diabetes relative to the control group (7.4% vs. 3.4%, P < 0.05). Colorectal cancer was correlated significantly with age, type 2 diabetes, constipation, anemia, and gastrointestinal symptoms. Following logistic regression analysis, age and constipation were associated significantly with colorectal cancer. In the age below 65 years subgroup, the incidence of colorectal cancer was increased significantly in the type 2 diabetes group relative to the control group. CONCLUSION: Type 2 diabetes was associated with increased colorectal cancer risk. This association was more definite in the subjects younger than 65 years.

Citations

Citations to this article as recorded by

Clinical Characteristics and Prevalence of Comorbidities according to Metformin Use in Korean Patients with Type 2 Diabetes
Sang Ouk Chin, In Gyoon Ha, Sang Youl Rhee, Su Jin Jeong, Suk Chon, Sung Hoon Kim, Kyu Jeung Ahn, Sei Hyun Baik, Yongsoo Park, Moon Suk Nam, Kwan Woo Lee, Jeong Taek Woo
International Journal of Endocrinology.2020; 2020: 1. CrossRef
Management of long-term thyroid cancer survivors in Korea
Ji Eun Lee, Aejin Goo, Kyu Eun Lee, Do Joon Park, Belong Cho
Journal of the Korean Medical Association.2016; 59(4): 287. CrossRef
Analysis of the Prevalence of Diabetes Mellitus and Related Factors for the Local Seniors
Min-Jee Sung, Eun-Jung Kim, Hyun-Joo Lee, Jin-Won Noh
The Journal of the Korea Contents Association.2014; 14(5): 244. CrossRef
Does Diabetes Mellitus Influence Standardized Uptake Values of Fluorodeoxyglucose Positron Emission Tomography in Colorectal Cancer?
Da Yeon Oh, Ji Won Kim, Seong-Joon Koh, Mingoo Kim, Ji Hoon Park, Su Yeon Cho, Byeong Gwan Kim, Kook Lae Lee, Jong Pil Im
Intestinal Research.2014; 12(2): 146. CrossRef

Relationships between Cardiac Autonomic Neuropathy and the Brachial-ankle Pulse Wave Velocity in Patients with Type 2 Diabetes.: Young Pil Bae, Byeong Do Yi, Bong Gun Kim, Jong Hwa Park, Yong Seop Kwon, Ja Young Park, Chang Won Lee, Bo Hyun Kim, Jae Sik Jang; Endocrinol Metab. 2011;26(1):44-52. Published online March 1, 2011; DOI: https://doi.org/10.3803/EnM.2011.26.1.44

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Abstract PDF

BACKGROUND
Cardiovascular disease is the leading cause of death in patients with type 2 diabetes. Clinically, evaluating cardiovascular autonomic neuropathy (CAN) is important to predict cardiovascular mortality because it is correlated with cardiovascular death. The pulse wave velocity (PWV) correlates well with arterial distensibility and stiffness. It is also a useful approach for evaluating the severity of systemic atherosclerosis in adults. So, we evaluated that the relationship between cardiac autonomic neuropathy and the brachial-ankle pulse wave velocity (baPWV) in patients with type 2 diabetes. METHODS: We retrospectively analyzed 465 patients (209 men and 256 women) with type 2 diabetes. We checked the clinical characteristics and the laboratory tests and we assessed the diabetic complications. Standard tests for CAN were performed by DiCAN (Medicore, Seoul, Korea): 1) heart rate variability during deep breathing (the E/I ratio), 2) a Valsalva maneuver, 3) 30:15 ratio of R-R interval the blood pressure response to standing, and 5) the blood pressure response to handgrip. The CAN score was determined according to the results of the test as following: 0 = normal, 0.5 = borderline, 1 = abnormal. We also measured the baPWV by using a VP 1000 (Colin, Japan) and all the analyses were performed with the SPSS version 14.0. P values < 0.05 were considered significant. RESULTS: The CAN score is associated with the maximal baPWV, age, systolic blood pressure, microalbuminuria, the duration of diabetes, angiotensin II receptor blocker treatment, calcium channel blocker treatment, beta-blocker treatment and nephropathy. After adjusting for age, the baPWV is a independent predictor of the risk for CAN (beta = 0.108, P = 0.021). CONCLUSION: The CAN is associated with the baPWV in patient with type 2 diabetes.

Citations

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Prevalence and Risk Factors of Gastroesophageal Reflux Disease in Patients with Type 2 Diabetes Mellitus
Jun Ouk Ha, Tae Hee Lee, Chang Won Lee, Ja Young Park, Seong Ho Choi, Hee Seung Park, Jae Seung Lee, Seung Heon Lee, Eun Hee Seo, Young Hwan Kim, Young Woo Kang
Diabetes & Metabolism Journal.2016; 40(4): 297. CrossRef
Relationship between Cardiac Autonomic Neuropathy and Brachial-ankle Pulse Wave Velocity in Type 2 Diabetics
Sin Gon Kim
Endocrinology and Metabolism.2011; 26(1): 33. CrossRef
Determinants for Heart Rate Variability in a Normal Korean Population
Gyung-Mee Kim, Jong-Min Woo
Journal of Korean Medical Science.2011; 26(10): 1293. CrossRef

Determinants of the Brachial-Ankle Pulse Wave Velocity (baPWV) in Patients with Type 2 Diabetes Mellitus.: Seong Woo Lee, Kyung Won Yun, Yun Sik Yu, Hong Kyu Lim, Yung Pil Bae, Byung Do Lee, Bo Hyun Kim, Chang Won Lee; J Korean Endocr Soc. 2008;23(4):253-259. Published online August 1, 2008; DOI: https://doi.org/10.3803/jkes.2008.23.4.253

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Abstract PDF

BACKGROUND
Pulse wave velocity (PWV) correlates with arterial distensibility and stiffness and is a useful method for evaluating the severity of systemic atherosclerosis in adults. Brachial-ankle PWV (baPWV) is affected by many different factors such as age, systolic blood pressure (SBP), sex, body mass index, waist to hip ratio, and HbA1c. We evaluated the determinants of baPWV in patients with type 2 diabetes mellitus. METHODS: The study included 803 type 2 diabetic patients over age 30 who had their ankle brachial pressure index (ABI) and baPWV measured at Busan St. Mary's Medical Center, Busan, Korea. Anthropometric parameters, blood pressure, pulse pressure, fasting plasma glucose, fasting insulin, HbA1c, lipid profile, high sensitivity C-reactive protein (hs-CRP), and microalbuminuria were checked concurrently. We also investigated tobacco and alcohol use by means of questionnaire. We then retrospectively analyzed the relationships between baPWV and various risk factors. RESULTS: Differences between men and women were measured using the independence sample probate. Pearson correlation analysis confirmed the factors affecting the baPWV as follows: SBP, diastolic blood pressure, pulse pressure, age, waist circumference, gender, and duration of diabetes mellitus were positively correlated, and height and weight were negatively correlated. On aged-adjusted partial correlation, HbA1c, SBP, diastolic blood pressure, and pulse pressure were correlated. By multiple linear regression analysis, SBP, age, HbA1c, and weight were independent predictors of baPWV. CONCLUSION: The baPWV is principally affected by SBP and age in patients with type 2 diabetes mellitus.

Citations

Citations to this article as recorded by

High Brachial Ankle Pulse Wave Velocity as a Marker for Predicting Coronary Artery Stenosis in Patients with Type 2 Diabetes
Bo Hyun Kim, Jae Sik Jang, Yong Seop Kwon, June Hyung Kim, In Joo Kim, Chang Won Lee
Endocrinology and Metabolism.2018; 33(1): 88. CrossRef
Relationships between Brachial-Ankle Pulse Wave Velocity and Peripheral Neuropathy in Type 2 Diabetes
Byung Kil Ha, Bong Gun Kim, Dong Hyun Kim, Soon Il Lee, Soon Myung Jung, Ja Young Park, Chang Won Lee, Sang Soo Kim, Bo Hyun Kim, In Ju Kim
Diabetes & Metabolism Journal.2012; 36(6): 443. CrossRef
Relationships between Cardiac Autonomic Neuropathy and the Brachial-ankle Pulse Wave Velocity in Patients with Type 2 Diabetes
Young Pil Bae, Byeong Do Yi, Bong-Gun Kim, Jong-Hwa Park, Yong Seop Kwon, Ja Young Park, Chang Won Lee, Bo Hyun Kim, Jae-Sik Jang
Endocrinology and Metabolism.2011; 26(1): 44. CrossRef
Type 2 Diabetes Mellitus and Arterial Stiffness
Sung Hee Choi
Journal of Korean Endocrine Society.2008; 23(4): 234. CrossRef

Association between Cigarette Smoking and Thyroid Function in Adults without Previous History of Thyroid Disease.: Bo Hyun Kim, Won Bae Kim, Tae Yong Kim, Hong Kyu Kim, Seong Hoon Jeon, Chang Won Lee, Young Kee Shong; J Korean Endocr Soc. 2008;23(2):123-128. Published online April 1, 2008; DOI: https://doi.org/10.3803/jkes.2008.23.2.123

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Abstract PDF

BACKGROUND
Cigarette smoking has a significant impact on thyroid function. However, the association between smoking and thyroid function is incompletely understood. METHODS: We conducted a cross-sectional study that included 90,970 adults (age range: 20 to 79) who had visited the health promotion center at Asan Medical Center between January 1, 2001, and December 31, 2003. Those subjects with previous known thyroid disease, a history of thyroid operation, a history of thyroid function altering medication (herb, estrogen or digestive) or a family history of thyroid disease were excluded. Finally, 47,577 subjects (males: 30,726, females: 16,851) were included in this study. We calculated the age-adjusted geometric mean of the serum TSH and the age-adjusted mean of the serum free T4 among the current, former and never smokers. We also analyzed the age-adjusted prevalence of hypothyroidism and hyperthyroidism among each group. RESULTS: Among men, the geometric mean TSH level was significantly low in the current (1.40 mIU/L, 95% confidence interval [CI]: 1.38-1.41) and former smokers (1.59 mIU/L, 95% CI: 1.57-1.61) compared with the never smokers (1.65 mIU/L, 95% CI: 1.63-1.68). The mean free T4 level was high in the current smokers (1.236 ng/dL, 95% CI: 1.234-1.239) compared with the never smokers (1.234 ng/dL, 95% CI: 1.230-1.238). Similarly, among women, the geometric mean TSH level was low in the current smokers (1.75 mIU/L, 95% CI: 1.67-1.87) compared with the never smokers (1.85 mIU/L, 95% CI: 1.83-1.87). The mean free T4 level was high in the current smokers (1.149 ng/dL, 95% CI: 1.139-1.159) compared with the never smokers (1.138 ng/dL, 95% CI: 1.135-1.140). Among the current male smokers, heavy daily smoking (over 2 packs per day) was more associated with low TSH levels than moderate smoking (less than 1 pack per day). In men, the prevalence of subclinical hypothyroidism was low in the current smokers compared with the never smokers (odds ratio: 0.53, 95% CI: 0.43-0.66). CONCLUSION: We found that current smokers had lower TSH levels and higher free T4 levels than never smokers in both men and women and smoking was associated with a low prevalence of subclinical hypothyroidism in men, which may be of importance when evaluating subjects with subclinical hypothyroidism in Korea.

Citations

Citations to this article as recorded by

Reference interval for thyrotropin in a ultrasonography screened Korean population
Mijin Kim, Tae Yong Kim, Soo Han Kim, Yunkyoung Lee, Su-yeon Park, Hyung-don Kim, Hyemi Kwon, Yun Mi Choi, Eun Kyung Jang, Min Ji Jeon, Won Gu Kim, Young Kee Shong, Won Bae Kim
The Korean Journal of Internal Medicine.2015; 30(3): 335. CrossRef
Clinical Review of Thyroid Dysfunction in the Subjects for Health Check-up
Ji Eun Park, Ho Chan Cho
Journal of Korean Thyroid Association.2012; 5(1): 52. CrossRef
Thyroid Dysfunction of North Korean Women Living in South Korea, Focusing on Subclinical Hypothyroidism
Joo Hyung Kim, Sol Ah Park, Nam Hoon Kim, Jae Hee Ahn, Yoon Jung Kim, Myongjin Cho, Yoon Jung Lee, Hye Jin Yoo, Hee Young Kim, Ji A Seo, Nan Hee Kim, Kyung Mook Choi, Sei Hyun Baik, Dong Seop Choi, Sin Gon Kim
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Case Report

A Case of Adrenocortical Carcinoma with Concurrent Cushing's Syndrome and Primary Aldosteronism.: Chang Won Lee, Hyun Ju Yoon, Won Min Hwang, Jung Kyu Kim, Hoon Sup Koo, Dong Mee Lim, Eu Gene Choi, Moon Jun Na, Do Yeun Cho, Bum Kyeong Kim, In Seok Choi, Keun Young Park; J Korean Endocr Soc. 2004;19(4):446-451. Published online August 1, 2004

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Abstract PDF: An adrenocortical carcinoma is a rare malignancy, which is associated with a poor prognosis. Eighty percent of adrenal tumors are functional, and commonly secrete glucocorticoids alone (45%), glucocorticoids and androgens (45%) or androgen alone (10%). Less than 1% of all cases secrete aldosterone. A case of a 75 year old female patient was experienced, presenting with anadrenocortical carcinoma and associated concurrent Cushing's syndrome and primary aldosteronism. She had complained of left flank pain for 5 months, and also showed clinical features of Cushing's syndrome, hypertension, hypokalemia and a left abdominal mass. An abdominal CT* demonstrated a large left adrenal mass, with necrosis, and a hemorrhage in the left upper abdomen. The plasma renin activity was 0.51 ng/ml/hr, and the serum aldosterone level was increased by 46.4 ng/dL. A low and high dose dexamethasone suppression test revealed no suppression. Histologically, the tumor was diagnosed as a adrenocortical carcinoma. After complete removal of the mass, she received mitotan and prednisolone as adjuvant therapies. Liver and bone metastasis occurred after 6 months of treatment, so was treated with palliative radiotherapy for the bone metastasis

Original Articles

Relationship between The Expressions of Sodium/Iodide Symporter and The Findings of Thallium-201 Scan in Thyroid Nodules.: Joon Hyop An, Min Ah Na, Sang Soo Kim, Ok Nyu Kong, Ju Won Seok, Chang Hun Lee, Chang Won Lee, In Joo Kim, Yong Ki Kim; J Korean Endocr Soc. 2004;19(2):165-174. Published online April 1, 2004

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Abstract PDF: BACKGROUND
The sodium/iodide symporter (NIS) has an important role in the diagnosis and treatment of well differentiated thyroid carcinoma. The relationship between the uptake of thallium- 201 scan (201Tl scan) and the expression of sodium/iodide symporter (hNIS) was studied in thyroid nodules. METHODS: Patients that had undergone operations for thyroid nodules, and who received a 201Tl scan before their operations, were investigated. Anti-NIS antibodies were used to analyze the presence and distribution of the hNIS protein by immunohistochemical staining of their thyroid tissues. RESULTS: Forty-four patients (papillary carcinoma; 18, follicular adenoma; 11, adenomatous goiter; 14, nonspecific thyroiditis; 1) 30 with no immunoreactivity and 14 with a positive reaction to the anti-NIS antibody, were included. The NIS negative patients (12/30) had no 201Tl uptake, but all others were positive on 201Tl scan, and the NIS-positive patients (13/14) had positive 201Tl uptake, with 1 negative on 201Tl scan, with significant difference (p=0.035). Of the 18 patients with a papillary thyroid carcinoma, the NIS negative patients (2/10) had no 201Tl uptake and the others were positive on 201Tl scan, but without significant difference. NIS positive patients (1/8) with a papillary thyroid carcinoma had no 201Tl uptake, and the others were positive on 201Tl scan, but without significant difference. Whether the results of NIS staining and 201Tl scan were positive or not did not affect the responses of radioactive iodine therapy in our study. CONCLUSION: These results suggest that thallium-201 uptake may be correlated with hNIS expression in thyroid nodules

Usefulness of Thallium-201 Scintigraphy for Differentiating Benign and Malignant Thyroid Nodules in Inconclusive Cases with Fine Needle Aspiration.: Young Sil Lee, Chang Won Lee, Mi Hwa Jang, Ju Won Seok, Seok Man Son, Seok Dong Yoo, In Joo Kim, Yong Ki Kim; J Korean Endocr Soc. 2001;16(4-5):447-456. Published online October 1, 2001

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Abstract PDF: BACKGROUND
Although fine needle aspiration(FNA) is recognized as the most accurate procedure in the differential diagnosis of thyroid nodules, about 20~30% of nodules remain inconclusive in FNA. Therefore, we assessed the usefulness of Thallium-201 scintigraphy in differentiating benign from malignant thyroid nodules in patients with inconclusive diagnosis by FNA. METHODS: We studied 43 patients with inconclusive diagnosis(29 of follicular neoplasm, 11 of cystic change and 3 of inadequate) by FNA, with the results being confirmed histopathologically by operation. Thallium-201 scintigraphy was performed at 15 minutes(early scan) and 2-3 hours(late scan) after the intravenous administration of 37 MBq of thallium-201. Malignant nodules were defined by the retention of Thallium-201 on delayed images. RESULTS: In the 43 patients with inconclusive FNA diagnosis, Thallium-201 scan had a sensitivity of 75.0%, specificity of 62.9% and accuracy of 65.1%. The positive and negative predictive values were 31.6% and 91.7%, respectively. In the 29 patients with follicular neoplasm by FNA, Thallium-201 scan had a sensitivity of 83.3%, specificity of 60.9% and accuracy of 65.5%. The positive and negative predictive values were 35.7% and 93.3%, respectively. CONCLUSION: In particular, Thallium-201 scintigraphy demonstrated a high negative predictive value, Therefore, for patients with inconclusive FNA findings, Thallium-201 scintigraphy might be useful in differentiating between benign and malignant thyroid nodules, and has the potential to reduce the rate of unnecessary operations in benign nodules.

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