The Korean journal of internal medicine

  • 제27권3호
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  • Pages.285-292
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  • 2012
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  • 1226-3303(pISSN)
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  • 2005-6648(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
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Associations between Hemoglobin Concentrations and the Clinical Characteristics of Patients with Type 2 Diabetes

  • Chung, Jin-Ook (Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School) ;
  • Cho, Dong-Hyeok (Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School) ;
  • Chung, Dong-Jin (Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School) ;
  • Chung, Min-Young (Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School)
  • 발행 : 2012.09.01
⟨ 이전 논문 다음 논문 ⟩

초록

Background/Aims: Many studies have demonstrated an association between hemoglobin levels and cardiovascular disease in diabetic patients. The aim of this study was to determine whether there is an association between hemoglobin concentrations and various clinical parameters, including metabolic factors, plasma C-peptide response after a meal tolerance test, and microvascular complications, in Korean patients with type 2 diabetes. Methods: In total, 337 male patients with type 2 diabetes were recruited. All subjects were subjected to a meal tolerance test and underwent assessment of hemoglobin levels, fasting and postprandial ${\beta}$-cell responsiveness, and microvascular complications. Results: Patients with lower hemoglobin concentrations had a longer duration of diabetes, a lower body mass index, and lower concentrations of total cholesterol, triglycerides, and low-density lipoprotein cholesterol. They also had lower levels of postprandial C-peptide, ${\Delta}$ C-peptide, and postprandial ${\beta}$-cell responsiveness. They had a higher prevalence of retinopathy and nephropathy. In multivariate analyses, there was a significant association between nephropathy and hemoglobin concentration. Also, hemoglobin concentrations were independently associated with ${\Delta}$ C-peptide levels and postprandial ${\beta}$-cell responsiveness. Conclusions: Hemoglobin concentrations are associated with postprandial C-peptide responses and diabetic nephropathy in patients with type 2 diabetes.

키워드

참고문헌

  1. Thomas MC, MacIsaac RJ, Tsalamandris C, Power D, Jerums G. Unrecognized anemia in patients with diabetes: a crosssectional survey. Diabetes Care 2003;26:1164-1169. https://doi.org/10.2337/diacare.26.4.1164
  2. McFarlane SI, Salifu MO, Makaryus J, Sowers JR. Anemia and cardiovascular disease in diabetic nephropathy. Curr Diab Rep 2006;6:213-218. https://doi.org/10.1007/s11892-006-0037-4
  3. Vlagopoulos PT, Tighiouart H, Weiner DE, et al. Anemia as a risk factor for cardiovascular disease and all-cause mortality in diabetes: the impact of chronic kidney disease. J Am Soc Nephrol 2005;16:3403-3410. https://doi.org/10.1681/ASN.2005030226
  4. Astor BC, Arnett DK, Brown A, Coresh J. Association of kidney function and hemoglobin with left ventricular morphology among African Americans: the Atherosclerosis Risk in Communities (ARIC) study. Am J Kidney Dis 2004;43:836-845. https://doi.org/10.1053/j.ajkd.2003.12.047
  5. Joss N, Patel R, Paterson K, Simpson K, Perry C, Stirling C. Anaemia is common and predicts mortality in diabetic nephropathy. QJM 2007;100:641-647. https://doi.org/10.1093/qjmed/hcm080
  6. Srivastava PM, Thomas MC, Calafiore P, MacIsaac RJ, Jerums G, Burrell LM. Diastolic dysfunction is associated with anaemia in patients with type II diabetes. Clin Sci (Lond) 2006;110:109-116. https://doi.org/10.1042/CS20050184
  7. Ranil PK, Raman R, Rachepalli SR, et al. Anemia and diabetic retinopathy in type 2 diabetes mellitus. J Assoc Physicians India 2010;58:91-94.
  8. Ueda H, Ishimura E, Shoji T, et al. Factors affecting progression of renal failure in patients with type 2 diabetes. Diabetes Care 2003;26:1530-1534. https://doi.org/10.2337/diacare.26.5.1530
  9. Marchetti P, Dotta F, Lauro D, Purrello F. An overview of pancreatic beta-cell defects in human type 2 diabetes: implications for treatment. Regul Pept 2008;146:4-11. https://doi.org/10.1016/j.regpep.2007.08.017
  10. Bo S, Cavallo-Perin P, Gentile L, Repetti E, Pagano G. Relationship of residual beta-cell function, metabolic control and chronic complications in type 2 diabetes mellitus. Acta Diabetol 2000;37:125-129. https://doi.org/10.1007/s005920070014
  11. Hovorka R, Chassin L, Luzio SD, Playle R, Owens DR. Pancreatic beta-cell responsiveness during meal tolerance test: model assessment in normal subjects and subjects with newly diagnosed noninsulin-dependent diabetes mellitus. J Clin Endocrinol Metab 1998;83:744-750. https://doi.org/10.1210/jc.83.3.744
  12. Tal MG. Type 2 diabetes: microvascular ischemia of pancreatic islets? Med Hypotheses 2009;73:357-358. https://doi.org/10.1016/j.mehy.2009.03.034
  13. Dynyak AK, Dynyak AA, Popova FV. Diabetes mellitus: hypoxia of the islets of Langerhans resulting from the systematic rest prone on the back after a meal? Med Hypotheses 2010;74:1002-1005. https://doi.org/10.1016/j.mehy.2010.01.016
  14. Larsen JJ, Dela F, Kjaer M, Galbo H. The effect of moderate exercise on postprandial glucose homeostasis in NIDDM patients. Diabetologia 1997;40:447-453. https://doi.org/10.1007/s001250050699
  15. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39(2 Suppl 1):S1-S266.
  16. Claus D, Mustafa C, Vogel W, Herz M, Neundorfer B. Assessment of diabetic neuropathy: definition of norm and discrimination of abnormal nerve function. Muscle Nerve 1993;16:757-768. https://doi.org/10.1002/mus.880160711
  17. Ishimura E, Nishizawa Y, Okuno S, et al. Diabetes mellitus increases the severity of anemia in non-dialyzed patients with renal failure. J Nephrol 1998;11:83-86.
  18. Redondo-Bermejo B, Pascual-Figal DA, Hurtado-Martinez JA, et al. Clinical determinants and prognostic value of hemoglobin in hospitalized patients with systolic heart failure. Rev Esp Cardiol 2007;60:597-606. https://doi.org/10.1157/13107116
  19. Craig KJ, Williams JD, Riley SG, et al. Anemia and diabetes in the absence of nephropathy. Diabetes Care 2005;28:1118-1123. https://doi.org/10.2337/diacare.28.5.1118
  20. Harusato I, Fukui M, Tanaka M, et al. Hemoglobin concentration in men with type 2 diabetes mellitus. Metabolism 2010;59:808-813. https://doi.org/10.1016/j.metabol.2009.09.028
  21. Astor BC, Muntner P, Levin A, Eustace JA, Coresh J. Association of kidney function with anemia: the third National Health and Nutrition Examination Survey (1988-1994). Arch Intern Med 2002;162:1401-1408. https://doi.org/10.1001/archinte.162.12.1401
  22. Adetunji OR, Mani H, Olujohungbe A, Abraham KA, Gill GV. 'Microalbuminuric anaemia': the relationship between haemoglobin levels and albuminuria in diabetes. Diabetes Res Clin Pract 2009;85:179-182. https://doi.org/10.1016/j.diabres.2009.04.028
  23. Rossing K, Christensen PK, Hovind P, Tarnow L, Rossing P, Parving HH. Progression of nephropathy in type 2 diabetic patients. Kidney Int 2004;66:1596-1605. https://doi.org/10.1111/j.1523-1755.2004.00925.x
  24. Cusick M, Chew EY, Hoogwerf B, et al. Risk factors for renal replacement therapy in the Early Treatment Diabetic Retinopathy Study (ETDRS), Early Treatment Diabetic Retinopathy Study Report No. 26. Kidney Int 2004;66:1173-1179. https://doi.org/10.1111/j.1523-1755.2004.00869.x
  25. Qiao Q, Keinanen-Kiukaanniemi S, Laara E. The relationship between hemoglobin levels and diabetic retinopathy. J Clin Epidemiol 1997;50:153-158. https://doi.org/10.1016/S0895-4356(96)00335-6
  26. Davis MD, Fisher MR, Gangnon RE, et al. Risk factors for high-risk proliferative diabetic retinopathy and severe visual loss: Early Treatment Diabetic Retinopathy Study Report #18. Invest Ophthalmol Vis Sci 1998;39:233-252.
  27. Shorb SR. Anemia and diabetic retinopathy. Am J Ophthalmol 1985;100:434-436. https://doi.org/10.1016/0002-9394(85)90508-2
  28. Friedman EA, Brown CD, Berman DH. Erythropoietin in diabetic macular edema and renal insufficiency. Am J Kidney Dis 1995;26:202-208. https://doi.org/10.1016/0272-6386(95)90175-2
  29. Deray G, Heurtier A, Grimaldi A, Laun ay Vacher V, Isnard Bagnis C. Anemia and diabetes. Am J Nephrol 2004;24:522-526. https://doi.org/10.1159/000081058
  30. Funakoshi S, Fujimoto S, Hamasaki A, et al. Analysis of factors inf luencing pancreatic beta-cell function in Japanese patients with type 2 diabetes: association with body mass index and duration of diabetic exposure. Diabetes Res Clin Pract 2008;82:353-358. https://doi.org/10.1016/j.diabres.2008.09.010
  31. Haupt E, Haupt A, Herrmann R, Benecke-Timp A, Vogel H, Walter C. The KID Study V: the natural history of type 2 diabetes in younger patients still practising a profession. Heterogeneity of basal and reactive C-peptide levels in relation to BMI, duration of disease, age and HbA1. Exp Clin Endocrinol Diabetes 1999;107:236-243. https://doi.org/10.1055/s-0029-1212106
  32. Dionne KE, Colton CK, Yarmush ML. Effect of hypoxia on insulin secretion by isolated rat and canine islets of Langerhans. Diabetes 1993;42:12-21. https://doi.org/10.2337/diabetes.42.1.12
  33. Moritz W, Meier F, Stroka DM, et al. Apoptosis in hypoxic human pancreatic islets correlates with HIF-1alpha expression. FASEB J 2002;16:745-747. https://doi.org/10.1096/fj.01-0403fje
  34. Gunton JE, Kulkarni RN, Yim S, et al. Loss of ARNT/HIF-1beta mediates altered gene expression and pancreatic-islet dysfunction in human type 2 diabetes. Cell 2005;122:337-349. https://doi.org/10.1016/j.cell.2005.05.027
  35. McMillan DE, Utterback NG, La Puma J. Reduced erythrocyte deformability in diabetes. Diabetes 1978;27:895-901. https://doi.org/10.2337/diab.27.9.895
  36. Ditzel J. Changes in red cell oxygen release capacity in diabetes mellitus. Fed Proc 1979;38:2484-2488.

피인용 문헌

  1. Anemia is inversely associated with serum C-peptide concentrations in individuals with type 2 diabetes vol.97, pp.32, 2012, https://doi.org/10.1097/md.0000000000011783