Diabetes & Metabolism Journal

Review

Guideline/Fact Sheet
Metabolic Dysfunction-Associated Steatotic Liver Disease in Type 2 Diabetes Mellitus: A Review and Position Statement of the Fatty Liver Research Group of the Korean Diabetes Association: Jaehyun Bae, Eugene Han, Hye Won Lee, Cheol-Young Park, Choon Hee Chung, Dae Ho Lee, Eun-Hee Cho, Eun-Jung Rhee, Ji Hee Yu, Ji Hyun Park, Ji-Cheol Bae, Jung Hwan Park, Kyung Mook Choi, Kyung-Soo Kim, Mi Hae Seo, Minyoung Lee, Nan-Hee Kim, So Hun Kim, Won-Young Lee, Woo Je Lee, Yeon-Kyung Choi, Yong-ho Lee, You-Cheol Hwang, Young Sang Lyu, Byung-Wan Lee, Bong-Soo Cha, on Behalf of the Fatty Liver Research Group of the Korean Diabetes Association; Diabetes Metab J. 2024;48(6):1015-1028. Published online November 21, 2024; DOI: https://doi.org/10.4093/dmj.2024.0541

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Abstract PDF PubReader ePub: Since the role of the liver in metabolic dysfunction, including type 2 diabetes mellitus, was demonstrated, studies on non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated fatty liver disease (MAFLD) have shown associations between fatty liver disease and other metabolic diseases. Unlike the exclusionary diagnostic criteria of NAFLD, MAFLD diagnosis is based on the presence of metabolic dysregulation in fatty liver disease. Renaming NAFLD as MAFLD also introduced simpler diagnostic criteria. In 2023, a new nomenclature, steatotic liver disease (SLD), was proposed. Similar to MAFLD, SLD diagnosis is based on the presence of hepatic steatosis with at least one cardiometabolic dysfunction. SLD is categorized into metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction and alcohol-related/-associated liver disease, alcoholrelated liver disease, specific etiology SLD, and cryptogenic SLD. The term MASLD has been adopted by a number of leading national and international societies due to its concise diagnostic criteria, exclusion of other concomitant liver diseases, and lack of stigmatizing terms. This article reviews the diagnostic criteria, clinical relevance, and differences among NAFLD, MAFLD, and MASLD from a diabetologist’s perspective and provides a rationale for adopting SLD/MASLD in the Fatty Liver Research Group of the Korean Diabetes Association.

Original Articles

Metabolic Risk/Epidemiology
Dose-Dependent Effect of Smoking on Risk of Diabetes Remains after Smoking Cessation: A Nationwide Population-Based Cohort Study in Korea: Se Eun Park, Mi Hae Seo, Jung-Hwan Cho, Hyemi Kwon, Yang-Hyun Kim, Kyung-Do Han, Jin-Hyung Jung, Yong-Gyu Park, Eun-Jung Rhee, Won-Young Lee; Diabetes Metab J. 2021;45(4):539-546. Published online March 4, 2021; DOI: https://doi.org/10.4093/dmj.2020.0061

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Graphical Abstract Abstract PDF Supplementary Material PubReader ePub

Background
This study aimed to evaluate the dose-dependent effects of smoking on risk of diabetes among those quitting smoking.
Methods
We analyzed clinical data from a total of 5,198,792 individuals age 20 years or older who received health care check-up arranged by the national insurance program of Korea between 2009 and 2016 using the Korean National Health Insurance Service database. Cumulative smoking was estimated by pack-years. Smokers were classified into four categories according to the amount of smoking: light smokers (0.025 to 5 smoking pack-years), medium smokers (5 to 14 smoking pack-years), heavy smokers (14 to 26 smoking pack-years), and extreme smokers (more than 26 smoking pack-years).
Results
During the study period, 164,335 individuals (3.2% of the total population) developed diabetes. Compared to sustained smokers, the risk of diabetes was significantly reduced in both quitters (hazard ratio [HR], 0.858; 95% confidence interval [CI], 0.838 to 0.878) and nonsmokers (HR, 0.616; 95% CI, 0.606 to 0.625) after adjustment for multiple risk factors. The risk of diabetes gradually increased with amount of smoking in both quitters and current smokers. The risk of diabetes in heavy (HR, 1.119; 95% CI, 1.057 to 1.185) and extreme smokers (HR, 1.348; 95% CI, 1.275 to 1.425) among quitters was much higher compared to light smokers among current smokers.
Conclusion
Smoking cessation was effective in reducing the risk of diabetes regardless of weight change. However, there was a potential dose-dependent association between smoking amount and the development of diabetes. Diabetes risk still remained in heavy and extreme smokers even after smoking cessation.

Citations

Citations to this article as recorded by

Dietary and other lifestyle factors and their influence on non-communicable diseases in the Western Pacific region
Xiaomin Sun, Dong Keon Yon, Tuan Thanh Nguyen, Kumpei Tanisawa, Kumhee Son, Ling Zhang, Jing Shu, Wen Peng, Yuexin Yang, Francesco Branca, Mark L. Wahlqvist, Hyunjung Lim, Youfa Wang
The Lancet Regional Health - Western Pacific.2024; 43: 100842. CrossRef
The Concentrations of Interleukin-6, Insulin, and Glucagon in the Context of Obesity and Type 2 Diabetes and Single Nucleotide Polymorphisms in IL6 and INS Genes
Magdalena Król-Kulikowska, Iwona Urbanowicz, Marta Kepinska, Mayank Choubey
Journal of Obesity.2024; 2024: 1. CrossRef
Prevalence, cessation, and geographical variation of smoking among middle-aged and elderly adults in China: A population-based study
Qingjia Zeng, Chongyang Zhang, Feiyu Su, Yanli Wan, Wen-jun Tu, Hongpu Hu
Tobacco Induced Diseases.2024; 22(July): 1. CrossRef
Chronic cigarette smoking is associated with increased arterial stiffness in men and women: evidence from a large population-based cohort
Omar Hahad, Volker H. Schmitt, Natalie Arnold, Karsten Keller, Jürgen H. Prochaska, Philipp S. Wild, Andreas Schulz, Karl J. Lackner, Norbert Pfeiffer, Irene Schmidtmann, Matthias Michal, Jörn M. Schattenberg, Oliver Tüscher, Andreas Daiber, Thomas Münzel
Clinical Research in Cardiology.2023; 112(2): 270. CrossRef
Association between Meal Frequency and Type 2 Diabetes Mellitus in Rural Adults: A Large-Scale Cross-Sectional Study
Bota Baheti, Xiaotian Liu, Mu Wang, Caiyun Zhang, Xiaokang Dong, Ning Kang, Linlin Li, Xing Li, Songcheng Yu, Jian Hou, Zhenxing Mao, Chongjian Wang
Nutrients.2023; 15(6): 1348. CrossRef
Impaired Lung Function and Lung Cancer Incidence: A Nationwide Population-Based Cohort Study
Hye Seon Kang, Yong-Moon Park, Seung-Hyun Ko, Seung Hoon Kim, Shin Young Kim, Chi Hong Kim, Kyungdo Han, Sung Kyoung Kim
Journal of Clinical Medicine.2022; 11(4): 1077. CrossRef
Smoking cessation and risk of type 2 diabetes
Jana Malinovská, Jana Urbanová, Veronika Vejtasová, Alexandra Romanová, Sabina Pálová, Syed Taha Naeem, Jan Brož
Vnitřní lékařství.2022; 68(1): E04. CrossRef
Association between lung function and the risk of atrial fibrillation in a nationwide population cohort study
Su Nam Lee, Seung-Hyun Ko, Sung-Ho Her, Kyungdo Han, Donggyu Moon, Sung Kyoung Kim, Ki-Dong Yoo, Yu-Bae Ahn
Scientific Reports.2022;[Epub] CrossRef
Sex differences in factors associated with prediabetes in Korean adults
Jin Suk Ra
Osong Public Health and Research Perspectives.2022; 13(2): 142. CrossRef
Smoking and diabetes interplay: A comprehensive review and joint statement
Vincent Durlach, Bruno Vergès, Abdallah Al-Salameh, Thibault Bahougne, Farid Benzerouk, Ivan Berlin, Carole Clair, Jacques Mansourati, Alexia Rouland, Daniel Thomas, Philippe Thuillier, Blandine Tramunt, Anne-Laurence Le Faou
Diabetes & Metabolism.2022; 48(6): 101370. CrossRef
Impact of healthy lifestyle on the risk of type 2 diabetes mellitus in southwest China: A prospective cohort study
Yanli Wu, Xi He, Jie Zhou, Yiying Wang, Lisha Yu, Xuejiao Li, Tao Liu, Jianhua Luo
Journal of Diabetes Investigation.2022; 13(12): 2091. CrossRef
Current status of health promotion in Korea
Soo Young Kim
Journal of the Korean Medical Association.2022; 65(12): 776. CrossRef
Smoking Cessation after Diagnosis of New-Onset Atrial Fibrillation and the Risk of Stroke and Death
So-Ryoung Lee, Eue-Keun Choi, Jin-Hyung Jung, Kyung-Do Han, Seil Oh, Gregory Y. H. Lip
Journal of Clinical Medicine.2021; 10(11): 2238. CrossRef

Clinical Care/Education
Patient Understanding of Hypoglycemia in Tertiary Referral Centers: Nan Hee Cho, Nam Kyung Kim, Eugene Han, Jun Hwa Hong, Eon Ju Jeon, Jun Sung Moon, Mi Hae Seo, Ji Eun Lee, Hyun-Ae Seo, Mi-Kyung Kim, Hye Soon Kim; Diabetes Metab J. 2018;42(1):43-52. Published online February 23, 2018; DOI: https://doi.org/10.4093/dmj.2018.42.1.43

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Abstract PDF PubReader

Background

Hypoglycemia is an important complication in the treatment of patients with diabetes. We surveyed the insight by patients with diabetes into hypoglycemia, their hypoglycemia avoidance behavior, and their level of worry regarding hypoglycemia.

Methods

A survey of patients with diabetes, who had visited seven tertiary referral centers in Daegu or Gyeongsangbuk-do, Korea, between June 2014 and June 2015, was conducted. The survey contained questions about personal history, symptoms, educational experience, self-management, and attitudes about hypoglycemia.

Results

Of 758 participants, 471 (62.1%) had experienced hypoglycemia, and 250 (32.9%) had experienced hypoglycemia at least once in the month immediately preceding the study. Two hundred and forty-two (31.8%) of the participants had received hypoglycemia education at least once, but only 148 (19.4%) knew the exact definition of hypoglycemia. Hypoglycemic symptoms identified by the participants were dizziness (55.0%), sweating (53.8%), and tremor (40.8%). They mostly chose candy (62.1%), chocolate (37.7%), or juice (36.8%) as food for recovering hypoglycemia. Participants who had experienced hypoglycemia had longer duration of diabetes and a higher proportion of insulin usage. The mean scores for hypoglycemia avoidance behavior and worry about hypoglycemia were 21.2±10.71 and 23.38±13.19, respectively. These scores tended to be higher for participants with higher than 8% of glycosylated hemoglobin, insulin use, and experience of emergency room visits.

Conclusion

Many patients had experienced hypoglycemia and worried about it. We recommend identifying patients that are anxious about hypoglycemia and educating them about what to do when they develop hypoglycemic symptoms, especially those who have a high risk of hypoglycemia.

Citations

Citations to this article as recorded by

Severe Hypoglycemia Increases Dementia Risk and Related Mortality: A Nationwide, Population-based Cohort Study
Eugene Han, Kyung-do Han, Byung-Wan Lee, Eun Seok Kang, Bong-Soo Cha, Seung-Hyun Ko, Yong-ho Lee
The Journal of Clinical Endocrinology & Metabolism.2022; 107(5): e1976. CrossRef
Severe hypoglycemia as a preventable risk factor for cardiovascular disease in patients with type 2 diabetes mellitus
Soo-Yeon Choi, Seung-Hyun Ko
The Korean Journal of Internal Medicine.2021; 36(2): 263. CrossRef
Severe hypoglycemia and the risk of end stage renal disease in type 2 diabetes
Jae-Seung Yun, Yong-Moon Park, Kyungdo Han, Hyung-Wook Kim, Seon-Ah Cha, Yu-Bae Ahn, Seung-Hyun Ko
Scientific Reports.2021;[Epub] CrossRef
Response: Patient Understanding of Hypoglycemia in Tertiary Referral Centers (Diabetes Metab J 2018;42:43-52)
Nan Hee Cho, Hye Soon Kim
Diabetes & Metabolism Journal.2018; 42(2): 175. CrossRef
Letter: Patient Understanding of Hypoglycemia in Tertiary Referral Centers (Diabetes Metab J 2018;42:43-52)
Jae-Han Jeon
Diabetes & Metabolism Journal.2018; 42(2): 173. CrossRef

Management of Blood Pressure in Patients with Type 2 Diabetes Mellitus: A Nationwide Survey in Korean: Mi Hae Seo, Woo Je Lee, Cheol Young Park, Sung Rae Kim, Joong Yeol Park, Kun-Ho Yoon, Moon Kyu Lee, Sung Woo Park; Diabetes Metab J. 2011;35(4):348-353. Published online August 31, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.4.348

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Abstract PDF PubReader

Background

Hypertension is common in patients with type 2 diabetes, affecting up to 60% of patients. The Korean Diabetes Association performed a nationwide survey about prevalence, awareness and control of hypertension among diabetic Koreans.

Methods

The current survey included 3,859 diabetic patients recruited from 43 hospitals in Korea. Age, gender, height, weight and blood pressure (BP) were measured by standard methods. Data on fasting plasma glucose, glycosylated hemoglobin (HbA1c), awareness of hypertension, and compliance of antihypertensive medication were collected via interview and reviewed using patient medical records.

Results

A total of 57.5% of all patients were >60 years old. Their mean HbA1c was 7.6±1.5%. Among antihypertensive medication users, 39.9% had <130 mm Hg and <80 mm Hg, whereas 60.1% had ≥130 mm Hg or ≥80 mm Hg. The answer "BP is under good control" was given by 75.1% of the antihypertensive medication users. Out of these patients, 26.4% had <130 mm Hg and <80 mm Hg, whereas 73.6% had ≥130 mm Hg or ≥80 mm Hg. A total of 75.5% of antihypertensive medication users answered that they had taken their antihypertensive medication every day for the past 2 weeks. "Forgetfulness" was most frequently the reason of non-compliance for patients that did not take their antihypertensive medication regularly.

Conclusion

Approximately one third of the patients with diabetes were found to reach target blood pressure control in the 43 hospitals across Korea. Stricter control is needed to reduce severe complications of diabetes in Korea.

Citations

Citations to this article as recorded by

Value of ambulatory blood pressure measurement in diagnosing hypotension in hypertensive diabetic patients with medication-controlled BP
Kamal Alghalayini
JRSM Cardiovascular Disease.2020;[Epub] CrossRef
Association between blood pressure and target organ damage in patients with chronic kidney disease and hypertension: results of the APrODiTe study
Ran-hui Cha, Sejoong Kim, Sun Ae Yoon, Dong-Ryeol Ryu, Ji Eun Oh, Sang-Youb Han, Eun Young Lee, Dong Ki Kim, Yon Su Kim
Hypertension Research.2014; 37(2): 172. CrossRef
Blood Pressure Control According to the Prevalence of Diabetes in Renal Transplant Recipients
E. Zbroch, J. Malyszko, I. Glowinska, D. Maciorkowska, G. Kobus, M. Mysliwiec
Transplantation Proceedings.2013; 45(1): 200. CrossRef
Prevalence, awareness, treatment and control of hypertension in adults with diagnosed diabetes: The Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV)
H-S Lee, S-S Lee, I-Y Hwang, Y-J Park, S-H Yoon, K Han, J-W Son, S-H Ko, Y G Park, H W Yim, W-C Lee, Y-M Park
Journal of Human Hypertension.2013; 27(6): 381. CrossRef
Multi-Institutional Analysis of Localized Renal Cell Carcinoma that Demonstrates the Impact of Diabetic Status on Prognosis After Nephrectomy
Yun-Sok Ha, Won Tae Kim, Seok-Joong Yun, Sang-Cheol Lee, Wun-Jae Kim, Yong Hyun Park, Seok Ho Kang, Sung-Hoo Hong, Seok-Soo Byun, Yong-June Kim
Annals of Surgical Oncology.2013; 20(11): 3662. CrossRef

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