Endocrinol Metab.  2016 Sep;31(3):354-360. 10.3803/EnM.2016.31.3.354.

Insulin Secretory Capacity and Insulin Resistance in Korean Type 2 Diabetes Mellitus Patients

• Kim JD
• Lee WY

• KMID: 2352972
• DOI: http://doi.org/10.3803/EnM.2016.31.3.354

Abstract

It is well known that many Korean patients with type 2 diabetes mellitus (T2DM) were non-obese and had decreased insulin secretion in past. However, during the past three decades, lifestyles in Korea have been westernized. As a result, the prevalence of obesity, the main cause of diabetes has increased. Thus, there is still a question as to whether the main pathophysiology of current Korean T2DM is insulin resistance or an insulin secretion defect. Because various anti-diabetes medications having different mechanisms of action are currently used as therapeutics, it is important to understand which of these factors is the main physiology in the development of diabetes in Koreans. In this review, we review changes in obesity prevalence, insulin resistance and insulin secretion defects in Korean T2DM during three decades.

Keyword

Insulin resistance; Diabetes mellitus, type 2; Asian continental ancestry group

MeSH Terms

Asian Continental Ancestry Group
Diabetes Mellitus, Type 2*
Humans
Insulin Resistance*
Insulin*
Korea
Life Style
Obesity
Physiology
Prevalence
Insulin

Figure

• 

  Fig. 1 Insulinogenic index during past 2 decades in Koreans. NGT, normal glucose tolerance.

Reference

1. Defronzo RA. Banting lecture. From the triumvirate to the ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus. Diabetes. 2009; 58:773–795.

2. Warram JH, Martin BC, Krolewski AS, Soeldner JS, Kahn CR. Slow glucose removal rate and hyperinsulinemia precede the development of type II diabetes in the offspring of diabetic parents. Ann Intern Med. 1990; 113:909–915.

3. Park SW, Yun YS, Song YD, Lee HC, Huh KB. Pathogenetic heterogeneity of type 2 diabetes mellitus in Korea. J Korean Diabetes Assoc. 1999; 23:62–69.

4. Yoon KH. Pathogenesis of type 2 diabetes in Korea. J Korean Diabetes Assoc. 2000; 24:397–403.

5. Min HK. Clinical characteristics of diabetes in Korea. J Korean Diabetes Assoc. 1992; 16:163–174.

6. Son JW, Park CY, Kim S, Lee HK, Lee YS. Insulin Resistance as Primary Pathogenesis in Newly Diagnosed, Drug Naive Type 2 Diabetes Patients in Korea (SURPRISE) Study Group. Changing clinical characteristics according to insulin resistance and insulin secretion in newly diagnosed type 2 diabetic patients in Korea. Diabetes Metab J. 2015; 39:387–394.

7. Kim KS, Choi CH, Lee DY, Jin KE. Epidemiological study on diabetes mellitus among rural Korean. J Korean Diabetes Assoc. 1972; 1:17–24.

8. Lee KW, Son HY, Kang SK, Bang BK, Park DH, Song HH, et al. Prevalence of diabetes mellitus and associated diseases among Korean subjects as studied with AMHTS. J Korean Diabetes Assoc. 1984; 8:5–14.

9. Park Y, Lee H, Koh CS, Min H, Yoo K, Kim Y, et al. Prevalence of diabetes and IGT in Yonchon County, South Korea. Diabetes Care. 1995; 18:545–548.

10. Kim YI, Choi CS, Kim SW, Lee JS, Kim HH, Lee MS, et al. Prevalence of diabetes mellitus and impaired glucose tolerance in Korean adults living in Jungup District, South Korea. J Korean Diabetes Assoc. 1998; 22:363–371.

11. Cho NH, Chan JC, Jang HC, Lim S, Kim HL, Choi SH. Cigarette smoking is an independent risk factor for type 2 diabetes: a four-year community-based prospective study. Clin Endocrinol (Oxf). 2009; 71:679–685.

12. Kim DJ. The epidemiology of diabetes in Korea. Diabetes Metab J. 2011; 35:303–308.

13. Korea Centers for Disease Control and Prevention (KCDC) and the Korean Ministry of Health and Welfare. Diabetes fact sheet in Korea 2012 [Internet]. Seoul: Korean Diabetes Association;2016. cited 2016 Jul 4. Available from: http://www.diabetes.or.kr/bbs/index.html?sub_menu=&code=e_resource&category=1&gubun=&page=1&number=215&mode=view&order=&sort=&keyfield=&key=BMI.

14. Park JY, Kim HK, Kim MS, Park KS, Kim SY, Cho BY, et al. Body weight changes of non-insulin dependent diabetic patients in Korea. J Korean Diabetes Assoc. 1993; 17:51–58.

15. Cho JK, Kim HM, Lim SK, Whang Y, Lee HC, Huh KB. A study on change of body weight non-insulin dependent diabetes mellitus. J Korean Diabetes Assoc. 1986; 10:89–93.

16. Shin CS, Park YS, Kim YS, Kim SY, Cho BY, Lee HK, et al. The etiologic heterogeneity of diabetes mellitus in Korean adults. Korean J Med. 1991; 40:91–104.

17. Song TH, Choi BR, Tak SM, Kang JW, Kim CE, Moon FC, et al. A retrospective study on body weight of diabetes in Korea. J Korean Diabetes Assoc. 1990; 14:229–233.

18. Lee KU, Ryu JS, Kim YT, Shong YK, Kim GS, Lee M, et al. Clinical characteristics of Korean diabetic patients classified by fasting plasma C-peptide level and degree of obesity. Korean J Med. 1992; 42:315–322.

19. Shin CS, Lee HK, Koh CS, Kim YI, Shin YS, Yoo KY, et al. Risk factors for the development of NIDDM in Yonchon County, Korea. Diabetes Care. 1997; 20:1842–1846.

20. Lee TH. Prevalence of obesity in Korean non-insulin-dependent diabetic patients. Diabetes Res Clin Pract. 1996; 32:71–80.

21. Park JY, Lee KU, Kim CH, Kim HK, Hong SK, Park KS, et al. Past and current obesity in Koreans with non-insulin-dependent diabetes mellitus. Diabetes Res Clin Pract. 1997; 35:49–56.

22. Yang HK, Lee JH, Choi IY, Kwon HS, Shin JA, Jeong SH, et al. The insulin resistance but not the insulin secretion parameters have changed in the Korean population during the last decade. Diabetes Metab J. 2015; 39:117–125.

23. Kim DJ, Hahm JR, Jeong IK, Yang TY, Oh EY, Choi YH, et al. Insulin secretion and insulin sensitivity in Korean subjects with impaired glucose intolerance. J Korean Diabetes Assoc. 2000; 24:356–364.

24. Kim DJ, Song KE, Park JW, Cho HK, Lee KW, Huh KB. Clinical characteristics of Korean type 2 diabetic patients in 2005. Diabetes Res Clin Pract. 2007; 77:Suppl 1. S252–S257.

25. Yoon KH, Shin JA, Kwon HS, Lee SH, Min KW, Ahn YB, et al. Comparison of the efficacy of glimepiride, metformin, and rosiglitazone monotherapy in Korean drug-naive type 2 diabetic patients: the practical evidence of antidiabetic monotherapy study. Diabetes Metab J. 2011; 35:26–33.

26. Lee SY, Shim YH, Park HK, Kim YS, Kim JH. Insulin response during oral glucose tolerance test in normal and diabetic subjects. Korean J Med. 1972; 15:27–34.

27. Woo JT, Lee BW, Kim SW, Yang IM, Kim JW, Kim YS, et al. Analysis of type 2 non-insulin dependent diabetes mellitus by insulin secretory capacity. J Kyung Hee Univ. 1987; 3:50–56.

28. Kim HK, Park KS, Shin CS, Kim SY, Cho BY, Lee HK, et al. Measurement of insulin sensitivity in patients with non-insulin-dependent diabetes mellitus. J Korean Diabetes Assoc. 1995; 19:374–383.

29. Park SW, Yun YS, Song YD, Lee HC, Huh KB. Pathogenetic heterogeneity of type 2 diabetes mellitus in Korea. J Korean Diabetes Assoc. 1999; 23:62–69.

30. Yoon KH. Insulin secretion and insulin resistance in Korean diabetics. J Korean Diabetes Assoc. 1995; 19:Suppl 3. 25–36.

31. Rhee SY, Kim JY, Chon S, Hwang YC, Jeong IK, Oh S, et al. The changes in early phase insulin secretion in newly diagnosed, drug naive Korean prediabetes subjects. Korean Diabetes J. 2010; 34:157–165.

32. Lee JH, Sung YA, Kyung NH, Jang YJ. Insulin secretion, insulin sensitivity and body fat distribution patterns in patients with impaired glucose tolerance. J Korean Diabetes Assoc. 1999; 23:647–660.

33. Kim SH, Kim DJ, Lee BW, Seo IA, Chung JH, Min YK, et al. Insulin secretory dysfunction in the pathogenesis of type 2 diabetes in Koreans: a minimal model analysis. J Korean Diabetes Assoc. 2003; 27:414–419.

34. Kim JD, Kang SJ, Lee MK, Park SE, Rhee EJ, Park CY, et al. C-peptide-based index is more related to incident type 2 diabetes in non-diabetic subjects than insulin-based index. Endocrinol Metab (Seoul). 2016; 31:320–327.

35. Ohn JH, Kwak SH, Cho YM, Lim S, Jang HC, Park KS, et al. 10-Year trajectory of β-cell function and insulin sensitivity in the development of type 2 diabetes: a community-based prospective cohort study. Lancet Diabetes Endocrinol. 2016; 4:27–34.

36. Rhee SY, Kwon MK, Park BJ, Chon S, Jeong IK, Oh S, et al. Differences in insulin sensitivity and secretory capacity based on OGTT in subjects with impaired glucose regulation. Korean J Intern Med. 2007; 22:270–274.

37. Rhee SY, Chon S, Oh S, Kim SW, Kim JW, Kim YS, et al. Insulin secretion and insulin resistance in newly diagnosed, drug naive prediabetes and type 2 diabetes patients with/without metabolic syndrome. Diabetes Res Clin Pract. 2007; 76:397–403.