Diabetes & Metabolism Journal

Response

Clinical and Preclinical Obesity in Korean Adults from 2014 to 2023 (Diabetes Metab J 2026;50:127-38): Hun Jee Choe, Soo Lim; Diabetes Metab J. 2026;50(4):821-822. Published online July 1, 2026; DOI: https://doi.org/10.4093/dmj.2026.0199

546 View
19 Download

PDF PubReader ePub

Original Article

Metabolic Risk/Epidemiology
Clinical and Preclinical Obesity in Korean Adults from 2014 to 2023: Hun Jee Choe, Jean-Pierre Després, John P. H. Wilding, Donna H. Ryan, Soo Lim; Diabetes Metab J. 2026;50(1):127-138. Published online January 1, 2026; DOI: https://doi.org/10.4093/dmj.2025.0697

4,126 View
159 Download
5 Web of Science
6 Crossref

Abstract PDF Supplementary Material PubReader ePub

Background
A new diagnostic framework for clinical obesity, proposed by the Lancet Commission, defines obesity as excess adiposity with organ dysfunction, offering a more functional assessment than traditional body mass index (BMI)-based classification. However, it has not been applied to Asian populations, where obesity-related complications arise at lower BMI thresholds.
Methods
We analyzed 57,863 Korean adults aged ≥20 years from the 2014 to 2023 Korea National Health and Nutrition Examination Survey (KNHANES), a nationally representative, cross-sectional dataset. Clinical obesity was defined as excess adiposity with ≥1 obesity-related complication or functional limitation; preclinical obesity was defined as excess adiposity without complications. Age, sex, and temporal trends were examined and compared with BMI-based classifications using complex sampling weights and age-standardization.
Results
The prevalence of clinical obesity and preclinical obesity was 31.2% and 8.1%, respectively. Among those with BMI-defined obesity (≥25.0 kg/m²), 20.1% had no complications, while 19.4% of overweight individuals (BMI 23.0–24.9 kg/m²) met clinical obesity criteria. Clinical obesity increased with age despite stable BMI, driven by metabolic and functional decline. Cancer prevalence was highest among individuals with clinical obesity (1.77%). Applying Western waist circumference cutoffs drastically reduced the estimated prevalence of clinical obesity to 13.1%. Longitudinal analyses showed a rising trend in clinical obesity over ime.
Conclusion
This is the first large-scale study to apply the clinical obesity framework in an Asian population. The framework identifies high-risk individuals missed by BMI al

Citations

Citations to this article as recorded by

Clinical Obesity Among Chinese Adults: Prevalence, Multimorbidity Burden, and Associations with Physical Activity
Zhuoren Wang, Wenwen Du, Xiaoqi Wei, Shujuan Li, Jiguo Zhang, Lahong Ju, Weiyi Gong, Qiya Guo, Xiaoli Xu, Xue Cheng, Ying Xing, Huijun Wang
Nutrients.2026; 18(6): 983. CrossRef
Does metabolically healthy obesity really exist: going toward new definitions
Christian Rodriguez, Eric Ravussin
The Journal of Clinical Endocrinology & Metabolism.2026;[Epub] CrossRef
Clinical and Preclinical Obesity in Korean Adults from 2014 to 2023 (Diabetes Metab J 2026;50:127-38)
Han Na Jung, Chang Hee Jung
Diabetes & Metabolism Journal.2026; 50(4): 816. CrossRef
Critical considerations on the study of normal-weight metabolic dysfunction-associated steatotic liver disease across diverse populations: Letter to the Editor on “Normal-weight metabolic dysfunction-associated steatotic liver disease: Reclassification, c
Qingshang Li, Xiaona Hu, Yuanwen Chen, Zhijun Bao
Clinical and Molecular Hepatology.2026; 32(3): e309. CrossRef
The lancet commission obesity categories, excess adiposity, and BMI discordance in urban Chinese adults: a cross-sectional survey in Beijing
Zhenyu Liu, Wendong Wang, Wendong Cao, Qing Yao, Qi Zhou
Frontiers in Nutrition.2026;[Epub] CrossRef
New Obesity Definition and Clinical Obesity Prevalence for Global Metabolic Bariatric Surgery
Simone Cremona, Ricardo V. Cohen, Francois Pattou, Anna Casajoana, Guilherme Sampaio Souza, Violeta Raverdy, Helene Verkindt, Beatriz T. L. Blasio, Pia Roser, Robert Caiazzo, David Benaiges, Tarissa B. Zanata Petry, Francesco Rubino
JAMA Network Open.2026; 9(8): e2628395. CrossRef

Reviews

Guideline/Statement/Fact Sheet
Bridging Evidence and Practice: A Consensus Statement from the Korean Diabetes Association on Diabetes Screening, Pharmacological Treatment and Severe Diabetes: Jong Han Choi, Shinae Kang, Soo-Kyung Kim, Won Jun Kim, Ji Min Kim, Jaehyun Bae, Jae-Seung Yun, Eonju Jeon, Young-Eun Kim, Jae Hyun Bae, Hun Jee Choe, Young Min Cho, Seung-Hyun Ko, Sang Yong Kim, Hae Jin Kim, You-Cheol Hwang, Min Kyong Moon, Suk Chon, Seon Mee Kang, Hyuk-Sang Kwon, Mi Kyung Kim, You-Bin Lee, Se Hee Min, Jung Hwan Park, Woo Je Lee, Bong-Soo Cha, Byung-Wan Lee; Diabetes Metab J. 2025;49(6):1155-1177. Published online November 1, 2025; DOI: https://doi.org/10.4093/dmj.2025.0978

12,017 View
351 Download
5 Web of Science
5 Crossref

Abstract PDF Supplementary Material PubReader ePub

This Korean Diabetes Association (KDA) consensus statement bridges global evidence with the Korean clinical context, where large randomized and real-world data remain limited. Recommendations required ≥80% agreement by the committee of clinical practice guideline and approval by the board of directors. The statement comprises three domains: diabetes screening aligned with Korean epidemiology; pharmacologic management guided by pathophysiology and comorbidities; and a severity construct of “severe diabetes mellitus” that links complication-based staging with metabolic grading to match therapeutic intensity to disease complexity. Compared with prior KDA guidelines, this statement introduces substantive advances in three areas. First, screening recommendations are streamlined to emphasize risk-aligned, practical implementation rather than prescriptive test sequences. Second, pharmacologic management applies an individualized framework for drug selection that jointly considers pathophysiology and comorbidities. It operationalizes individualized selection by dominant pathophysiology (insulin resistance vs. insulin insufficiency) and coexisting conditions, and formalizes treatment dynamics—early combination, timely initiation of injectables, avoidance of overbasalization, and structured deintensification. It also prioritizes agents with proven cardiovascular and renal protection and elevates management of obesity and metabolic dysfunction-associated steatotic liver disease as central goals; clinically, insulin should be initiated promptly in hypercatabolic states or suspected islet failure, and technology-enabled care—including continuous glucose monitoring and automated insulin delivery—are integral across all stages. Third, the newly introduced severity construct underpins treatment-intensity decisions across domains without reiterating prescriptive algorithms. Collectively, these recommendations provide a coherent, context-appropriate framework for diabetes screening and management in Korea and identify priorities for future evidence generation.

Citations

Citations to this article as recorded by

Efficacy and safety of adding a fourth oral antidiabetic drug versus metformin dose escalation in patients with type 2 diabetes inadequately controlled on triple oral combination therapy (EFFORT): A 24‐week, randomized, open‐label, multicenter trial
So Ra Kim, Jun Hwa Hong, Sin Gon Kim, Soo‐Kyung Kim, Hyuk‐Sang Kwon, Jun Sung Moon, Jung Hwan Park, Jae Myung Yu, Bong‐Soo Cha, Byung‐Wan Lee
Diabetes, Obesity and Metabolism.2026; 28(4): 3305. CrossRef
Efficacy and safety of anagliptin added to metformin and empagliflozin 25 mg in patients with type 2 diabetes: a 24-week randomized, double-blind, placebo-controlled phase 3 trial with 28-week open-label extension
Jun Sung Moon, Kyung-Ah Han, Jae Myung Yu, Jong Chul Won, Jun Goo Kang, Soojin Park, Cheol-Young Park
Diabetes Research and Clinical Practice.2026; 236: 113272. CrossRef
Cardiometabolic 2.0: Redefining Cardiovascular Prevention Through SGLT-2 Inhibitors and GLP-1 Receptor Agonists
Maria-Daniela Tanasescu, Andrei-Mihnea Rosu, Alexandru Minca, Maria-Mihaela Grigorie, Delia Timofte, Dorin Ionescu
Life.2026; 16(5): 756. CrossRef
Contemporary Type 2 Diabetes Guidelines: Converging Evidence, Diverging Strategies, and the Position of the Korean Diabetes Association Framework
Suk Kyeong Kim, Dong-Lim Kim, Keeho Song, Shinae Kang, Byung-Wan Lee, Jong Han Choi
Endocrinology and Metabolism.2026; 41(3): 351. CrossRef
The effect of rapid improvement of blood glucose level on diabetic neuropathy in Korean people with diabetes mellitus
Hun Jee Choe, Bo Kyung Koo, Yoon-Ho Hong, Nam Hoon Kim, Jun Sung Moon, Yong-ho Lee, Ho Chan Cho, Soo Heon Kwak, Soo Lim, Dong-Lim Kim, Tae Ho Kim, Sin Gon Kim, Min Kyong Moon
Diabetes Research and Clinical Practice.2026; 238: 113388. CrossRef

Guideline/Statement/Fact Sheet
Defining Severe Diabetes Mellitus: A Consensus Framework for Grading and Staging Diabetes Based on Pathophysiology and Complications: Jae Hyun Bae, Hun Jee Choe, Ye Seul Yang, Mi Hae Seo, Jong Han Choi, Gyuri Kim, Young Sang Lyu, Jeung Hun Han, Shinae Kang, Won Jun Kim, Kyung-Soo Kim, Young Min Cho, Bong Soo Cha, for the Severe Diabetes Mellitus Task Force of the Korean Diabetes Association; Diabetes Metab J. 2025;49(6):1141-1154. Published online October 28, 2025; DOI: https://doi.org/10.4093/dmj.2025.0739

16,471 View
1,021 Download
3 Web of Science
3 Crossref

Abstract PDF Supplementary Material PubReader ePub

Diabetes mellitus comprises a heterogeneous group of metabolic disorders differing in etiology, clinical course, and outcomes. Traditional classifications, such as type 1 and type 2 diabetes mellitus, fail to capture the full heterogeneity, including variation in insulin deficiency, insulin resistance, and complication burden. To address these limitations, we propose the Diabetes Grade–Stage Classification, an integrated system that combines pathophysiology-based grading with complication-based staging. Grading quantifies metabolic dysfunction through the assessment of insulin deficiency and insulin resistance. In parallel, staging assesses the extent of target organ damage, particularly in the cardiovascular, renal, ocular, and nervous systems. Together, this framework enables a comprehensive assessment of disease status, identification of vulnerable or high-risk phenotypes, and implementation of risk-adapted management strategies. Clinically, it facilitates personalized care, promotes collaborative coordination, and strengthens physician–patient communication. Furthermore, this framework provides a scalable structure for integrating disease severity into both individual- and population-level interventions. Although the current criteria for grading and staging are based on expert consensus and selected clinical indicators, such as low C-peptide levels and advanced complications, further validation and refinement are needed. In conclusion, the grading and staging system provides an operational tool for classifying the severity of diabetes mellitus and has the potential to extend life expectancy and improve quality of life for people living with diabetes mellitus.

Citations

Citations to this article as recorded by

Material-driven glucose responsiveness in insulin delivery systems: carrier selection and performance
Zhihan Li, Jingge Jiang, Ziyu Zhu, Cheng Luo, Chunyi Xu, Chuanpin Chen, Guoqin Ren, Ruofei Huang, Dongjuan He
Frontiers in Endocrinology.2026;[Epub] CrossRef
Circulating GDF15 levels reflect metabolic and inflammatory burden in early dysglycemia: findings from the ADIOS cohort
Ji Yoon Kim, Ah Hyeon Lee, Jiyoon Lee, Hye-Min Jang, Sin Gon Kim, Dong-Hoon Kim, Nam Hoon Kim
Diabetes Research and Clinical Practice.2026; 239: 113461. CrossRef
Bridging Evidence and Practice: A Consensus Statement from the Korean Diabetes Association on Diabetes Screening, Pharmacological Treatment and Severe Diabetes
Jong Han Choi, Shinae Kang, Soo-Kyung Kim, Won Jun Kim, Ji Min Kim, Jaehyun Bae, Jae-Seung Yun, Eonju Jeon, Young-Eun Kim, Jae Hyun Bae, Hun Jee Choe, Young Min Cho, Seung-Hyun Ko, Sang Yong Kim, Hae Jin Kim, You-Cheol Hwang, Min Kyong Moon, Suk Chon, Seo
Diabetes & Metabolism Journal.2025; 49(6): 1155. CrossRef

Original Article

Drug/Regimen
Comparison of Prevailing Insulin Regimens at Different Time Periods in Hospitalized Patients: A Real-World Experience from a Tertiary Hospital: Sun Joon Moon, Hun Jee Choe, Soo Heon Kwak, Hye Seung Jung, Kyong Soo Park, Young Min Cho; Diabetes Metab J. 2022;46(3):439-450. Published online October 20, 2021; DOI: https://doi.org/10.4093/dmj.2021.0065

67,056 View
345 Download
2 Web of Science
2 Crossref

Abstract PDF Supplementary Material PubReader ePub

Background
Prevailing insulin regimens for glycemic control in hospitalized patients have changed over time. We aimed to determine whether the current basal-bolus insulin (BBI) regimen is superior to the previous insulin regimen, mainly comprising split-mixed insulin therapy.
Methods
This was a single tertiary center, retrospective observational study that included non-critically ill patients with type 2 diabetes mellitus who were treated with split-mixed insulin regimens from 2004 to 2007 (period 1) and with BBI from 2008 to 2018 (period 2). Patients from each period were analyzed after propensity score matching. The mean difference in glucose levels and the achievement of fasting and preprandial glycemic targets by day 6 of admission were assessed. The total daily insulin dose, incidence of hypoglycemia, and length of hospital stay were also evaluated.
Results
Among 244 patients from each period, both fasting glucose (estimated mean±standard error, 147.4±3.1 mg/dL vs. 129.4±3.2 mg/dL, P<0.001, day 6) and preprandial glucose (177.7±2.8 mg/dL vs. 152.8±2.8 mg/dL, P<0.001, day 6) were lower in period 2 than in period 1. By day 6 of hospital admission, 42.6% and 67.2% of patients achieved a preprandial glycemic target of <140 mg/dL in periods 1 and 2, respectively (relative risk, 2.00; 95% confidence interval, 1.54 to 2.59), without an increased incidence of hypoglycemia. Length of stay was shorter in period 2 (10.23±0.26 days vs. 8.70±0.26 days, P<0.001).
Conclusion
BBI improved glycemic control in a more efficacious manner than a split-mixed insulin regimen without increasing the risk of hypoglycemia in a hospital setting.

Citations

Citations to this article as recorded by

Premixed insulin: Advantages, disadvantages, and future
Yan Xia, Yun Hu, Jian-Hua Ma
World Journal of Diabetes.2025;[Epub] CrossRef
In-Hospital Management of Hyperglycemia: The Role of Insulin Degludec
Subhash Kumar Wangnoo, Manash P. Baruah, Sailesh Lodha, Debmalya Sanyal, Ramesh Goyal, Basavaraj G. Sooragonda, Sruti Chandrasekaran, G. Vijay Kumar
Diabetes Therapy.2025; 16(4): 547. CrossRef

First
Prev
Page of 1
Next
Last

Search