Diabetes & Metabolism Journal

Original Articles

Guideline/Statement/Fact Sheet
Diabetes Fact Sheet 2025: Special Edition on Diabetes with Obesity and in Pregnancy: Se Eun Park, Se Hee Min, Jin Hwa Kim, Seung-Hwan Lee, Han Na Jung, Joon Ho Moon, Kyungdo Han, Seung-Hyun Ko, Bong Soo Cha, Sung Hee Choi; Diabetes Metab J. 2026;50(2):255-266. Published online March 1, 2026; DOI: https://doi.org/10.4093/dmj.2025.1162

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Background
We evaluated epidemiologic trends and clinical characteristics in Koreans with diabetes and obesity and in those with diabetes in pregnancy.
Methods
We analyzed Korea National Health and Nutrition Examination Survey data (2012–2023) to assess obesity trends in people with diabetes and used the Korean National Health Insurance Service database (2013–2023) to evaluate diabetes in pregnancy.
Results
Among Korean adults with diabetes (≥19 years), 52.4% had obesity and 61.1% had abdominal obesity. Only 39.9% achieved the glycemic target (glycosylated hemoglobin <6.5%). The obesity prevalence was higher in younger age groups, and abdominal obesity showed an upward trend over the last 12 years. Diabetes in pregnancy increased despite declining total births, with gestational diabetes mellitus (GDM) rising from 7.6% to 12.4%, and pregestational diabetes from 0.9% to 2.1%, reflecting older maternal age and pre-pregnancy obesity. Women with prior GDM had a higher risk of postpartum type 2 diabetes mellitus (hazard ratio, 6.07; 95% confidence interval, 5.97 to 6.17).
Conclusion
Obesity and abdominal obesity are highly prevalent among Korean adults with diabetes, with abdominal obesity increasing over the past decade, and obesity disproportionately affects younger adults. Diabetes in pregnancy has also increased with older maternal age and worsening pre-pregnancy metabolic health, underscoring the need for early weight-focused prevention.

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Diabetes Fact Sheet 2025: Comparative Epidemiology and Clinical Features of Obese and Non-Obese Diabetes in Korea
Jin Hwa Kim, Bongseong Kim, Se Eun Park, Seung-Hyun Ko, Sung Hee Choi, Bong Soo Cha, Kyungdo Han, Seung-Hwan Lee
Diabetes & Metabolism Journal.2026; 50(2): 267. CrossRef
Diabetes in Pregnancy in Korea: Prevalence, Clinical Characteristics, and Postpartum Comorbidities
Joon Ho Moon, Han Na Jung, Bongseong Kim, Seung-Hyun Ko, Soo Heon Kwak, Kyung-Do Han, Sung Hee Choi
Diabetes & Metabolism Journal.2026; 50(2): 280. CrossRef

Guideline/Statement/Fact Sheet
Diabetes Fact Sheet 2025: Comparative Epidemiology and Clinical Features of Obese and Non-Obese Diabetes in Korea: Jin Hwa Kim, Bongseong Kim, Se Eun Park, Seung-Hyun Ko, Sung Hee Choi, Bong Soo Cha, Kyungdo Han, Seung-Hwan Lee, on Behalf of the Committee of Public Relation and Obese Diabetes Task Force Team of the Korean Diabetes Association; Diabetes Metab J. 2026;50(2):267-279. Published online March 1, 2026; DOI: https://doi.org/10.4093/dmj.2025.1160

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Abstract PDF Supplementary Material PubReader ePub: Background
The growing burden of obesity has profoundly influenced the epidemiology and phenotype of diabetes. This study aimed to compare the epidemiology and clinical features between obese and non-obese diabetes in Korean adults using nationwide database.
Methods
We analyzed data from the Korea National Health and Nutrition Examination Survey (2012–2023) to evaluate the prevalence and management of diabetes, as well as associated comorbidities. Data from the Korean National Health Insurance Service were used to assess antidiabetic medication use, metabolic surgery trends, and cancer outcomes.
Results
Diabetes prevalence was nearly twice as high in adults with obesity compared with those without (17.6% vs. 9.5%), with the larger difference observed in individuals aged 30 to 59 years. Obese diabetes was associated with higher rates of hypertension and dyslipidemia and lower rates of achieving glycemic, blood pressure, and lipid targets; only 21.0% achieved all three goals. Although sodium-glucose cotransporter 2 inhibitors and thiazolidinediones were more frequently prescribed in obese diabetes, overall use remained low. Metabolic surgery was less common in individuals with diabetes than in those without; sleeve gastrectomy predominated, while Roux-en-Y gastric bypass was performed more often in those with diabetes. Higher body mass index was associated with increased incidence of thyroid, breast, prostate, and kidney cancers.
Conclusion
Obese diabetes represents a distinct, high-risk phenotype in Korea, characterized by a greater cardiometabolic burden and suboptimal risk-factor control. Comprehensive management strategies integrating weight reduction with metabolic and cardiovascular risk control are essential to improve outcomes in this population.

Basic and Translational Research
Targeting PGC-1α by miRNA-374 Simultaneously Improve β-Cell Dysfunction and Suppress Hepatic Glucose Overproduction: Ji-Won Kim, Joonyub Lee, Young-Hye You, Chan-Hee Oh, Heon-Seok Park, Eun Young Lee, Seung-Hwan Lee, Seung-Hyun Ko, Ji-Ho Park, Kun-Ho Yoon; Diabetes Metab J. 2026;50(3):535-551. Published online November 3, 2025; DOI: https://doi.org/10.4093/dmj.2025.0287

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Background
In this study, we aimed to validate the potential of miR-374 in ameliorating hyperglycemia by regulating peroxisome proliferator-activated receptor γ coactivator-1 (PGC-1α) expression in pancreatic islets and liver.
Methods
To identify miRNAs targeting PGC-1α, we performed miRNA chip analysis in rat islets under hyperglycemic and euglycemic conditions. Luciferase reporter assay was performed to identify miR binding sites in the 3’-untranslated region (3’ UTR) of PGC-1α. In db/db mice, miRNA-encapsulated adenoviruses were administered and intraperitoneal glucose tolerance test and glucose stimulated insulin secretion tests were performed. For enhanced delivery to β-cells, we developed exendin-4 (Ex-4) coated cationic lipoparticles (CCLs) encapsulating miRNAs. The therapeutic potential of Ex-4-CCL-miRNA was further evaluated in insulin-producing cells derived from induced pluripotent stem cells.
Results
By analyzing miRNA expression in primary rat islets exposed under hyperglycemic environment, we identified miR-374 as a potential target. In vitro experiments confirmed that miR-374 significantly suppressed PGC-1α expression in β-cells and hepatocytes by binding to its 3’-UTR. In vivo experiments using adenovirus-mediated miR-374 (Ad-miR-374) delivering directly to the pancreas and liver of db/db mice demonstrated improved glycemic control, enhanced insulin secretion, and downregulated hepatic gluconeogenesis-related genes (G6Pase, Pepck, PC). To enhance the clinical applicability of miR-374, we developed Ex-4-CCLs. Ex-4-CCL-miR-374 successfully alleviated hyperglycemia, restored pancreatic islet function, and decreased gluconeogenesis gene expression in db/db mice. Furthermore, Ex-4-CCL-miR-374 improved insulin secretory function in glucotoxicity-exposed human induced pluripotent stem cell-derived insulin producing cells.
Conclusion
Based on these findings, we propose that Ex-4-CCL-miR-374 as a promising therapeutic approach to reverse β-cell dysfunction and improve hepatic insulin resistance in type 2 diabetes mellitus.

Citations

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β‐cell recovery revisited: Is prediabetes remission driven by insulin sensitivity or β‐cell function?
Joonyub Lee, Kun‐Ho Yoon
Journal of Diabetes Investigation.2026; 17(5): 716. CrossRef

Editorial

A New Era in Islet Transplantation: Stem Cell-Derived and Gene-Edited Islet Therapies: Joonyub Lee, Seung-Hwan Lee; Diabetes Metab J. 2025;49(6):1201-1203. Published online November 1, 2025; DOI: https://doi.org/10.4093/dmj.2025.0999

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Review

Basic and Translational Research
Extracellular Vesicle-Mediated Network in the Pathogenesis of Obesity, Diabetes, Steatotic Liver Disease, and Cardiovascular Disease: Joonyub Lee, Won Gun Choi, Marie Rhee, Seung-Hwan Lee; Diabetes Metab J. 2025;49(3):348-367. Published online May 1, 2025; DOI: https://doi.org/10.4093/dmj.2025.0184

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Extracellular vesicles (EVs) are lipid bilayer-enclosed particles carrying bioactive cargo, including nucleic acids, proteins, and lipids, facilitating intercellular and interorgan communication. In addition to traditional mediators such as hormones, metabolites, and cytokines, increasing evidence suggests that EVs are key modulators in various physiological and pathological processes, particularly influencing metabolic homeostasis and contributing to the progression of cardiometabolic diseases. This review provides an overview of the most recent insights into EV-mediated mechanisms involved in the pathogenesis of obesity, insulin resistance, diabetes mellitus, steatotic liver disease, atherosclerosis, and cardiovascular disease. EVs play a critical role in modulating insulin sensitivity, glucose homeostasis, systemic inflammation, and vascular health by transferring functional molecules to target cells. Understanding the EV-mediated network offers potential for identifying novel biomarkers and therapeutic targets, providing opportunities for EV-based interventions in cardiometabolic disease management. Although many challenges remain, this evolving field highlights the need for further research into EV biology and its translational applications in cardiovascular and metabolic health.

Citations

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Postbiotics in Functional Foods: Microbial Derivatives Shaping Health, Immunity and Next‐Generation Nutrition
Alice Njolke Mafe, Javad Sharifi‐Rad, Daniela Calina, Ayobami Joshua Ogunyemi, Abiola O. Tubi
Food Frontiers.2026;[Epub] CrossRef
Decoding the Endocrine Code of Skeletal Muscle: Myokines, Exerkines, and Inter-Organ Crosstalk in Metabolic Health and Disease
Young-Sool Hah, Jeongyun Hwang, Seung-Jun Lee, Seung-Jin Kwag
Cells.2026; 15(4): 318. CrossRef
Extracellular Vesicles: Biology, Intercellular Communication and Therapeutic Potential in Diabetes
Swayam Prakash Srivastava, Lydia Herrmann, Eden Ozkan, Abhiram Kunamneni, Vinamra Swaroop, Geetika Nehra, Rohit Srivastava, Pratima Tripathi, Ken Inoki, Julie E. Goodwin
Advanced Therapeutics.2026;[Epub] CrossRef
Extracellular vesicles in cardiovascular disease: Biomarkers, therapeutic applications, and drug delivery strategies
Qamar Abuhassan, Amirali Salajegheh, Faris Anad Muhammad, Ali Fawzi Al-Hussainy, Tushar B. Gajjar, Malathi Hanumanthayya, Sandeep Kumar Shukla, Rajashree Panigrahi, Neeraj Bainsal, Djamila Polatova, Hayder Naji Sameer, Rasim M. Salih, Mohaned Adil
Clinica Chimica Acta.2026; 588: 120972. CrossRef
β‐cell recovery revisited: Is prediabetes remission driven by insulin sensitivity or β‐cell function?
Joonyub Lee, Kun‐Ho Yoon
Journal of Diabetes Investigation.2026; 17(5): 716. CrossRef
Extracellular Vesicles in Obesity: From Pathophysiological Mediators to Therapeutic Tools
Nikola Pavlović, Petar Todorović, Mirko Maglica, Andrea Kopilaš, Roko Šantić, Marko Kumrić, Marino Lukenda, Joško Božić
International Journal of Molecular Sciences.2026; 27(7): 3137. CrossRef
Urinary extracellular vesicle miRNA signature reflects pancreatic islet stress in type 2 diabetes
Md. Zubbair Malik, Mohammed Dashti, Anwar Mohammad, Mohamed Al‐Sayegh, Mohammed Al‐Onaizi, Rasheeba Nizam, Khadija M Dashti, Mohamed Abu‐Farha, Jehad Abubaker, Fahd Al‐Mulla, Hamad Ali
Journal of Diabetes Investigation.2026;[Epub] CrossRef
Impact of Fatty Liver Index on Cardiovascular Disease and Mortality across Alcohol Consumption Levels in Young Adults
Byung-Hun Han, Joonyub Lee, Hun-Sung Kim, Jae-Hyoung Cho, Kyungdo Han, Seung-Hwan Lee
Endocrinology and Metabolism.2026;[Epub] CrossRef
Single-Cell Immune Atlases to Map Small Extracellular Vesicle Cargo in Tuberculosis–Diabetes Comorbidity: A Narrative Review and Conceptual Roadmap
Ramona Cioboata, Silviu Gabriel Vlasceanu, Denisa Maria Mitroi, Anca Lelia Riza, Mara Amalia Balteanu, Oana Maria Catana, Mihai Olteanu
International Journal of Molecular Sciences.2026; 27(8): 3437. CrossRef
Metabolic dysfunction–associated steatotic liver disease and cardiovascular disease: Emerging insights into the liver–heart axis
Seung‐Hwan Lee
Journal of Diabetes Investigation.2026;[Epub] CrossRef
Association between dyslipidemia and elevated liver enzymes: A cross-sectional study from the PERSIAN Guilan cohort study
Milad Shahdkar, Mahdi Orang Goorabzarmakhi, Mahdi Shafizadeh, Farahnaz Joukar, Saman Maroufizadeh, Niloofar Faraji, Tahereh Zeinali, Fariborz Mansour-Ghanaei
Endocrine and Metabolic Science.2025; 19: 100272. CrossRef
Molecular Signatures of Obesity-Associated Infertility in Polycystic Ovary Syndrome: The Emerging Role of Exosomal microRNAs and Non-Coding RNAs
Charalampos Voros, Georgios Papadimas, Despoina Mavrogianni, Aristotelis-Marios Koulakmanidis, Diamantis Athanasiou, Kyriakos Bananis, Antonia Athanasiou, Aikaterini Athanasiou, Ioannis Papapanagiotou, Dimitrios Vaitsis, Charalampos Tsimpoukelis, Maria An
Genes.2025; 16(9): 1101. CrossRef
Molecular mechanisms linking adipose tissue-derived small extracellular vesicles/exosomes to the development or amelioration of obesity, insulin resistance, and diabetes-related complications
Linfeng Chen, Fatemeh Amraee, Sahar Sadegh-Nejadi, Mostafa Saberian, Seyed Arsalan Ghahari, Xiaolei Miao, Giuseppe Lisco, Reza Afrisham
European Journal of Medical Research.2025;[Epub] CrossRef
Mitochondria-Enriched Extracellular Vesicles (EVs) for Cardiac Bioenergetics Restoration: A Scoping Review of Preclinical Mechanisms and Source-Specific Strategies
Dhienda C. Shahannaz, Tadahisa Sugiura, Taizo Yoshida
International Journal of Molecular Sciences.2025; 26(22): 11052. CrossRef
A Comprehensive Insight Into the Roles of Exosomal circRNAs in Metabolic Syndrome
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BioFactors.2025;[Epub] CrossRef

Original Article

Complications
Risk of End-Stage Kidney Disease in Individuals with Diabetes Living Alone: A Large-Scale Population-Based Study: Kyunghun Sung, Jae-Seung Yun, Bongseong Kim, Hun-Sung Kim, Jae-Hyoung Cho, Yong-Moon Mark Park, Kyungdo Han, Seung-Hwan Lee; Diabetes Metab J. 2025;49(4):862-872. Published online April 5, 2025; DOI: https://doi.org/10.4093/dmj.2024.0578

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Background
Previous research has linked solitary living to various adverse health outcomes, but its association with diabetic complications among individuals with type 2 diabetes mellitus (T2DM) remains underexplored. We examined the risk of endstage kidney disease (ESKD) in individuals with diabetes living alone (IDLA).
Methods
This population-based cohort study used the National Health Information Database of Korea, which included 2,432,613 adults with T2DM. Household status was determined based on the number of registered family members. IDLA was defined as continuously living alone for 5 years or more. A multivariable Cox proportional hazards model was used to evaluate the association between living alone and the risk of developing ESKD.
Results
During a median follow-up of 6.0 years, 26,691 participants developed ESKD, with a higher incidence observed in the IDLA group than in the non-IDLA group. After adjusting for confounding variables, the hazard ratio for ESKD in the IDLA group was 1.10 (95% confidence interval, 1.06 to 1.14). The risk of ESKD was particularly elevated in younger individuals, those without underlying chronic kidney disease, with longer durations of living alone, and with low household income. Adherence to favorable lifestyle behaviors (no smoking, no alcohol consumption, and engaging in regular exercise) was associated with a significantly lower risk of ESKD, with a more pronounced effect in the IDLA group.
Conclusion
Living alone was associated with a higher risk of ESKD in individuals with T2DM. Tailored medical interventions and social support for IDLA are crucial for the prevention of diabetic complications.

Citations

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Elevated triglyceride‐glucose index is associated with increased risk of chronic kidney disease and end‐stage renal disease in type 1 diabetes: Nationwide cohort study
Rosa Oh, Seohyun Kim, So Hyun Cho, Ji Yoon Kim, Myunghwa Jang, Sang Ho Park, You‐Bin Lee, Sang‐Man Jin, Kyu Yeon Hur, Gyuri Kim, Jae Hyeon Kim
Diabetes, Obesity and Metabolism.2026; 28(4): 2784. CrossRef

Editorial

Beyond Body Mass Index: New Criteria for a Holistic Approach to Clinical Obesity: Kyunghun Sung, Seung-Hwan Lee, Soo Lim; Diabetes Metab J. 2025;49(2):165-168. Published online March 1, 2025; DOI: https://doi.org/10.4093/dmj.2025.0097

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Inflammatory and neuroendocrine biomarkers associated with mental health symptoms across body mass index categories: a cross-sectional machine learning analysis
Joice M. A. Rodolpho, Krissia F. Godoy, Bruna D. L. Fragelli, Jaqueline Bianchi, Fernanda O. Duarte, Luciana Camillo, Gustavo B. Silva, Paulo Henrique Marques de Andrade, Juliana A. Prado, Evelyn Tenan Ribeiro, Francisco José Nardi Filho, Mateus Pereira A
Frontiers in Immunology.2026;[Epub] CrossRef
Development and Validation of an Integrated Metabolism‐Obesity Index for Screening Renal Impairment in Patients With Newly Diagnosed Type 2 Diabetes Mellitus
Xiangying Zhu, Xinyuan Li, Zhenhua Wang, Meixia Ji, Xiaoxiao Ji, Lihong Jin, Chunlai Zeng, Yuanliang Gu, Beini Lyu
Journal of Diabetes Research.2026;[Epub] CrossRef
Rethinking obesity metrics in Southeast Asia: Evidence from Haiphong highlights urgent gaps
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Original Article

Cardiovascular Risk/Epidemiology
Different Associations between Lipid Levels and Risk for Heart Failure according to Diabetes Progression: Seung-Hwan Lee, Kyu Na Lee, Jong-Chan Youn, Hun Sung Kim, Kyungdo Han, Mee Kyoung Kim; Diabetes Metab J. 2025;49(1):105-116. Published online August 28, 2024; DOI: https://doi.org/10.4093/dmj.2024.0066

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Background
The relationship between circulating lipid levels and the risk for heart failure (HF) is controversial. We aimed to examine this association, and whether it is modified by the duration of diabetes or treatment regimens in people with type 2 diabetes mellitus.
Methods
Individuals (n=2,439,978) who underwent health examinations in 2015 to 2016 were identified from the Korean National Health Information Database. Subjects were categorized according to the duration of diabetes (new-onset, <5, 5–10, or ≥10 years) and number of antidiabetic medications. Incident HF was defined according to the International Classification of Diseases, 10th Revision (ICD-10) code I50 as the primary diagnosis during hospitalization. The risk for HF was estimated using multivariate Cox proportional hazard analysis.
Results
During a median follow-up of 4.0 years, 151,624 cases of HF occurred. An inverse association between low-density lipoprotein cholesterol (LDL-C) levels and incident HF was observed in the new-onset diabetes group, with an approximately 25% lower risk in those with LDL-C levels of 100–129, 130–159, and ≥160 mg/dL, compared to those with levels <70 mg/dL. However, J-shaped associations were noted in the long-standing diabetes group, with a 16% higher risk in those with LDL-C level ≥160 mg/dL, compared to those with levels <70 mg/dL. Similar patterns were observed in the relationship between total cholesterol or non-high-density lipoprotein cholesterol and the risk for HF, and when subjects were grouped according to the number of antidiabetic medications instead of diabetes duration.
Conclusion
Different associations between lipid levels and the risk for HF were noted according to disease progression status among individuals with diabetes.

Citations

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J-shaped association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and heart failure: a cross-sectional study
Ping Lv, Chenze Zhao, Yu Shan
European Journal of Medical Research.2026;[Epub] CrossRef
The Central Role of Lipid Metabolism Disorders in Diabetes Mellitus: Mechanisms, Clinical Manifestations, and Emerging Therapeutic Strategies
Qiang Yang, Xueting Liu, Tianyi Zhang, Xu Zhao, Xiaohe Xiao
Diabetes, Metabolic Syndrome and Obesity.2026; Volume 19: 1. CrossRef
Analysis of pathogen distribution and association with lipid levels in patients with diabetic foot
Yan Chen, Weihong Chen, Yinxia Zhuo
Frontiers in Medicine.2026;[Epub] CrossRef
Remnant cholesterol inflammatory index, calculated from residual cholesterol to C-reactive protein ratio, and stroke outcomes: a retrospective study using the National institutes of health stroke scale and modified Rankin scale
Yanmei Yu, Yiming Zhang, Chunyan Zhu, Tingting Duan, Zichen Rao
Lipids in Health and Disease.2025;[Epub] CrossRef
Association of outcome with non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio in hospitalized patients with congestive heart failure: a retrospective analysis
Lina Yu, Lianhong Xie
Journal of Cardiothoracic Surgery.2025;[Epub] CrossRef

Brief Report

Complications
Diabetic Ketoacidosis as an Effect of Sodium-Glucose Cotransporter 2 Inhibitor: Real World Insights: Han-Sang Baek, Chaiho Jeong, Yeoree Yang, Joonyub Lee, Jeongmin Lee, Seung-Hwan Lee, Jae Hyoung Cho, Tae-Seo Sohn, Hyun-Shik Son, Kun-Ho Yoon, Eun Young Lee; Diabetes Metab J. 2024;48(6):1169-1175. Published online June 10, 2024; DOI: https://doi.org/10.4093/dmj.2024.0036

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One of the notable adverse effects of sodium-glucose cotransporter 2 (SGLT2) inhibitor is diabetic ketoacidosis (DKA) often characterized by euglycemia. In this retrospective review of patients with DKA from 2015 to 2023, 21 cases of SGLT2 inhibitorassociated DKA were identified. Twelve (57.1%) exhibited euglycemic DKA (euDKA) while nine (42.9%) had hyperglycemic DKA (hyDKA). More than 90% of these cases were patients with type 2 diabetes mellitus. Despite similar age, sex, body mass index, and diabetes duration, individuals with hyDKA showed poorer glycemic control and lower C-peptide levels compared with euDKA. Renal impairment and acidosis were worse in the hyDKA group, requiring hemodialysis in two patients. Approximately one-half of hyDKA patients had concurrent hyperosmolar hyperglycemic state. Common symptoms included nausea, vomiting, general weakness, and dyspnea. Seizure was the initial manifestation of DKA in two cases. Infection and volume depletion were major contributors, while carbohydrate restriction and inadequate insulin treatment also contributed to SGLT2 inhibitor-associated DKA. Despite their beneficial effects, clinicians should be vigilant for SGLT2 inhibitor risk associated with DKA.

Citations

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Fallbericht einer Euglykämischen Diabetischen Ketoacidose unter SGLT-2-Inhibition bei einer geriatrischen Patientin: „Sick-Day-Off Drug“
Laura Wassermann, Michael Denkinger
Zeitschrift für Gerontologie und Geriatrie.2026; 59(1): 74. CrossRef
The evolution of C-peptide's role in diabetes care
Laura Briggs, Alexander Read, Sarah Darch, Emma L. Williams, Wann Jia Loh, Julia S. Kenkre
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Diabetic ketoacidosis is not a simple consequence of hyperglycemia, it is biochemical event driven by PDK4-mediated inhibition of PDC
Ayah Al-Qasrawi
Medical Hypotheses.2026; 208: 111898. CrossRef
Diabetic ketoacidosis in patients with type 2 diabetes: Risk factors for mortality and adverse outcomes
Vishnu Chandrabalan, Timothy Howcroft, Mohammed Khalid Alkhalifah, Noorulanne Younis, Ebrahim Aldhafiri, Joseph M Pappachan
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Diabetes mellitus im Alter
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Die Diabetologie.2026;[Epub] CrossRef
The Diabetes–Viral Respiratory Syndemic: Pathophysiological Insights and Precision Management: A Scoping Review
Ana Maria Mihai, Monica Marc, Florina Lucaciu, Alexandra Sima
Medicina.2026; 62(4): 770. CrossRef
Metabolic Impact of Sodium-Glucose Cotransporter 2 Inhibitor-Induced Ketogenesis in Type 2 Diabetes Mellitus
Hee Woo Park, Hun Jee Choe, Ho Jun Lim, Sung Hye Kong, Tae Jung Oh, Min Joo Kim, Jae Hoon Moon, Sung Hee Choi, Soo Lim, Joon Ho Moon
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Dapagliflozin/Empagliflozin/Ertugliflozin

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Diabetes Mellitus at an Elderly Age
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SGLT2 Inhibitors and GLP-1 Receptor Agonists in Diabetic Kidney Disease: Evolving Evidence and Clinical Application
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Cardiorenal outcomes and safety of SGLT2 inhibitors in patients with diabetes secondary to disorders of the exocrine pancreas: a nationwide population-based study
Kyoung Hwa Ha, Minae Park, Yujin Lee, Dae Jung Kim, Seung Jin Han
Diabetes & Metabolism.2025; 51(5): 101668. CrossRef
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Rui Hu, Congchao Lu, Yifan Liu, Mengli Yang, Hongya Xing, Kerui Dai, Jiyin Li, Hui Zheng, Xi Chen, Nai-Jun Tang
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Severe euglycemic ketoacidosis following combined therapy with GLP-1 receptor agonist and SGLT-2 inhibitor, refractory to standard treatment: a case report
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Andrej Zeyfang, Jürgen Wernecke, Anke Bahrmann
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Diabetes mellitus im Alter
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Original Articles

Drug/Regimen
Efficacy and Safety of Metformin and Atorvastatin Combination Therapy vs. Monotherapy with Either Drug in Type 2 Diabetes Mellitus and Dyslipidemia Patients (ATOMIC): Double-Blinded Randomized Controlled Trial: Jie-Eun Lee, Seung Hee Yu, Sung Rae Kim, Kyu Jeung Ahn, Kee-Ho Song, In-Kyu Lee, Ho-Sang Shon, In Joo Kim, Soo Lim, Doo-Man Kim, Choon Hee Chung, Won-Young Lee, Soon Hee Lee, Dong Joon Kim, Sung-Rae Cho, Chang Hee Jung, Hyun Jeong Jeon, Seung-Hwan Lee, Keun-Young Park, Sang Youl Rhee, Sin Gon Kim, Seok O Park, Dae Jung Kim, Byung Joon Kim, Sang Ah Lee, Yong-Hyun Kim, Kyung-Soo Kim, Ji A Seo, Il Seong Nam-Goong, Chang Won Lee, Duk Kyu Kim, Sang Wook Kim, Chung Gu Cho, Jung Han Kim, Yeo-Joo Kim, Jae-Myung Yoo, Kyung Wan Min, Moon-Kyu Lee; Diabetes Metab J. 2024;48(4):730-739. Published online May 20, 2024; DOI: https://doi.org/10.4093/dmj.2023.0077

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Background
It is well known that a large number of patients with diabetes also have dyslipidemia, which significantly increases the risk of cardiovascular disease (CVD). This study aimed to evaluate the efficacy and safety of combination drugs consisting of metformin and atorvastatin, widely used as therapeutic agents for diabetes and dyslipidemia.
Methods
This randomized, double-blind, placebo-controlled, parallel-group and phase III multicenter study included adults with glycosylated hemoglobin (HbA1c) levels >7.0% and <10.0%, low-density lipoprotein cholesterol (LDL-C) >100 and <250 mg/dL. One hundred eighty-five eligible subjects were randomized to the combination group (metformin+atorvastatin), metformin group (metformin+atorvastatin placebo), and atorvastatin group (atorvastatin+metformin placebo). The primary efficacy endpoints were the percent changes in HbA1c and LDL-C levels from baseline at the end of the treatment.
Results
After 16 weeks of treatment compared to baseline, HbA1c showed a significant difference of 0.94% compared to the atorvastatin group in the combination group (0.35% vs. −0.58%, respectively; P<0.0001), whereas the proportion of patients with increased HbA1c was also 62% and 15%, respectively, showing a significant difference (P<0.001). The combination group also showed a significant decrease in LDL-C levels compared to the metformin group (−55.20% vs. −7.69%, P<0.001) without previously unknown adverse drug events.
Conclusion
The addition of atorvastatin to metformin improved HbA1c and LDL-C levels to a significant extent compared to metformin or atorvastatin alone in diabetes and dyslipidemia patients. This study also suggested metformin’s preventive effect on the glucose-elevating potential of atorvastatin in patients with type 2 diabetes mellitus and dyslipidemia, insufficiently controlled with exercise and diet. Metformin and atorvastatin combination might be an effective treatment in reducing the CVD risk in patients with both diabetes and dyslipidemia because of its lowering effect on LDL-C and glucose.

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Cardiovascular risk/Epidemiology
Real-World Treatment Patterns according to Clinical Practice Guidelines in Patients with Type 2 Diabetes Mellitus and Established Cardiovascular Disease in Korea: Multicenter, Retrospective, Observational Study: Ye Seul Yang, Nam Hoon Kim, Jong Ha Baek, Seung-Hyun Ko, Jang Won Son, Seung-Hwan Lee, Sang Youl Rhee, Soo-Kyung Kim, Tae Seo Sohn, Ji Eun Jun, In-Kyung Jeong, Chong Hwa Kim, Keeho Song, Eun-Jung Rhee, Junghyun Noh, Kyu Yeon Hur, Committee of Clinical Practice Guidelines, Korean Diabetes Association; Diabetes Metab J. 2024;48(2):279-289. Published online January 26, 2024; DOI: https://doi.org/10.4093/dmj.2023.0225

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Background
Recent diabetes management guidelines recommend that sodium-glucose cotransporter 2 inhibitors (SGLT2is) or glucagon-like peptide 1 receptor agonists (GLP-1RAs) with proven cardiovascular benefits should be prioritized for combination therapy in patients with type 2 diabetes mellitus (T2DM) and established cardiovascular disease (CVD). This study was aimed at evaluating SGLT2i or GLP-1RA usage rates and various related factors in patients with T2DM and established CVD.
Methods
We enrolled adults with T2DM aged ≥30 years who were hospitalized due to established CVD from January 2019 to May 2020 at 13 secondary and tertiary hospitals in Korea in this retrospective observational study.
Results
Overall, 2,050 patients were eligible for analysis among 2,107 enrolled patients. The mean patient age, diabetes duration, and glycosylated hemoglobin level were 70.0 years, 12.0 years, and 7.5%, respectively. During the mean follow-up duration of 9.7 months, 25.7% of the patients were prescribed SGLT2is after CVD events. However, only 1.8% were prescribed GLP-1RAs. Compared with SGLT2i non-users, SGLT2i users were more frequently male and obese. Furthermore, they had a shorter diabetes duration but showed worse glycemic control and better renal function at the time of the event. GLP-1RA users had a longer duration of diabetes and worse glycemic control at the time of the event than GLP-1RA non-users.
Conclusion
The SGLT2i or GLP-1RA prescription rates were suboptimal in patients with T2DM and established CVD. Sex, body mass index, diabetes duration, glycemic control, and renal function were associated with the use of these agents.

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Editorial

The Growing Challenge of Diabetes Management in an Aging Society: Seung-Hwan Lee; Diabetes Metab J. 2023;47(5):630-631. Published online September 26, 2023; DOI: https://doi.org/10.4093/dmj.2023.0279

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Reviews

Others
Current Trends of Big Data Research Using the Korean National Health Information Database: Mee Kyoung Kim, Kyungdo Han, Seung-Hwan Lee; Diabetes Metab J. 2022;46(4):552-563. Published online July 27, 2022; DOI: https://doi.org/10.4093/dmj.2022.0193

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Recently, medical research using big data has become very popular, and its value has become increasingly recognized. The Korean National Health Information Database (NHID) is representative of big data that combines information obtained from the National Health Insurance Service collected for claims and reimbursement of health care services and results obtained from general health examinations provided to all Korean adults. This database has several strengths and limitations. Given the large size, various laboratory data, and questionnaires obtained from medical check-ups, their longitudinal nature, and long-term accumulation of data since 2002, carefully designed studies may provide valuable information that is difficult to obtain from other forms of research. However, consideration of possible bias and careful interpretation when defining causal relationships is also important because the data were not collected for research purposes. After the NHID became publicly available, research and publications based on this database have increased explosively, especially in the field of diabetes and metabolism. This article reviews the history, structure, and characteristics of the Korean NHID. Recent trends in big data research using this database, commonly used operational diagnosis, and representative studies have been introduced. We expect further progress and expansion of big data research using the Korean NHID.

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Drug/Regimen
A Century of Progress in Diabetes Care with Insulin: A History of Innovations and Foundation for the Future: Seung-Hwan Lee, Kun-Ho Yoon; Diabetes Metab J. 2021;45(5):629-640. Published online September 30, 2021; DOI: https://doi.org/10.4093/dmj.2021.0163

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The year 2021 marks the 100th anniversary of the discovery of insulin, which has greatly changed the lives of people with diabetes and become a cornerstone of advances in medical science. A rapid bench-to-bedside application of the lifesaving pancreatic extract and its immediate commercialization was the result of a promising idea, positive drive, perseverance, and collaboration of Banting and colleagues. As one of the very few proteins isolated in a pure form at that time, insulin also played a key role in the development of important methodologies and in the beginning of various fields of modern science. Since its discovery, insulin has evolved continuously to optimize the care of people with diabetes. Since the 1980s, recombinant DNA technology has been employed to engineer insulin analogs by modifying their amino acid sequence, which has resulted in the production of insulins with various profiles that are currently used. However, unmet needs in insulin treatment still exist, and several forms of future insulins are under development. In this review, we discuss the past, present, and future of insulin, including a history of ceaseless innovations and collective intelligence. We believe that this story will be a solid foundation and an unerring guide for the future.

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Guideline/Fact Sheet
2021 Clinical Practice Guidelines for Diabetes Mellitus in Korea: Kyu Yeon Hur, Min Kyong Moon, Jong Suk Park, Soo-Kyung Kim, Seung-Hwan Lee, Jae-Seung Yun, Jong Ha Baek, Junghyun Noh, Byung-Wan Lee, Tae Jung Oh, Suk Chon, Ye Seul Yang, Jang Won Son, Jong Han Choi, Kee Ho Song, Nam Hoon Kim, Sang Yong Kim, Jin Wha Kim, Sang Youl Rhee, You-Bin Lee, Sang-Man Jin, Jae Hyeon Kim, Chong Hwa Kim, Dae Jung Kim, SungWan Chun, Eun-Jung Rhee, Hyun Min Kim, Hyun Jung Kim, Donghyun Jee, Jae Hyun Kim, Won Seok Choi, Eun-Young Lee, Kun-Ho Yoon, Seung-Hyun Ko, Committee of Clinical Practice Guidelines, Korean Diabetes Association; Diabetes Metab J. 2021;45(4):461-481. Published online July 30, 2021; DOI: https://doi.org/10.4093/dmj.2021.0156

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The Committee of Clinical Practice Guidelines of the Korean Diabetes Association (KDA) updated the previous clinical practice guidelines for Korean adults with diabetes and prediabetes and published the seventh edition in May 2021. We performed a comprehensive systematic review of recent clinical trials and evidence that could be applicable in real-world practice and suitable for the Korean population. The guideline is provided for all healthcare providers including physicians, diabetes experts, and certified diabetes educators across the country who manage patients with diabetes or the individuals at the risk of developing diabetes mellitus. The recommendations for screening diabetes and glucose-lowering agents have been revised and updated. New sections for continuous glucose monitoring, insulin pump use, and non-alcoholic fatty liver disease in patients with diabetes mellitus have been added. The KDA recommends active vaccination for coronavirus disease 2019 in patients with diabetes during the pandemic. An abridgement that contains practical information for patient education and systematic management in the clinic was published separately.

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Topic Modeling Analysis of Diabetes-Related Health Information during the Coronavirus Disease Pandemic
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Risk of Pancreatic Cancer and Use of Dipeptidyl Peptidase 4 Inhibitors in Patients with Type 2 Diabetes: A Propensity Score-Matching Analysis
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Coleus forskohlii Root Extract (ForcslimTM) as a Prospective Antidiabetic Agent: In vitro Glucose Uptake Stimulation and α-Amylase Inhibitory Effects
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Effectiveness and safety of teneligliptin added to patients with type 2 diabetes inadequately controlled by oral triple combination therapy: A multicentre, randomized, double‐blind, and placebo‐controlled study
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Novel Glycemic Index Based on Continuous Glucose Monitoring to Predict Poor Clinical Outcomes in Critically Ill Patients: A Pilot Study
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Original Articles

Drug/Regimen
Effect of Dapagliflozin as an Add-on Therapy to Insulin on the Glycemic Variability in Subjects with Type 2 Diabetes Mellitus (DIVE): A Multicenter, Placebo-Controlled, Double-Blind, Randomized Study: Seung-Hwan Lee, Kyung-Wan Min, Byung-Wan Lee, In-Kyung Jeong, Soon-Jib Yoo, Hyuk-Sang Kwon, Yoon-Hee Choi, Kun-Ho Yoon; Diabetes Metab J. 2021;45(3):339-348. Published online May 28, 2020; DOI: https://doi.org/10.4093/dmj.2019.0203

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Background

Glycemic variability is associated with the development of diabetic complications and hypoglycemia. However, the effect of sodium-glucose transporter 2 (SGLT2) inhibitors on glycemic variability is controversial. We aimed to examine the effect of dapagliflozin as an add-on therapy to insulin on the glycemic variability assessed using continuous glucose monitoring (CGM) in subjects with type 2 diabetes mellitus.

Methods

In this multicenter, placebo-controlled, double-blind, randomized study, 84 subjects received 10 mg of dapagliflozin (n=41) or the placebo (n=43) for 12 weeks. CGM was performed before and after treatment to compare the changes in glycemic variability measures (standard deviation [SD], mean amplitude of glycemic excursions [MAGEs]).

Results

At week 12, significant reductions in glycosylated hemoglobin (−0.74%±0.66% vs. 0.01%±0.65%, P<0.001), glycated albumin (−3.94%±2.55% vs. −0.67%±2.48%, P<0.001), and CGM-derived mean glucose (−41.6±39.2 mg/dL vs. 1.1±46.2 mg/dL, P<0.001) levels were observed in the dapagliflozin group compared with the placebo group. SD and MAGE were significantly decreased in the dapagliflozin group, but not in the placebo group. However, the difference in ΔSD and ΔMAGE failed to reach statistical significance between two groups. No significant differences in the incidence of safety endpoints were observed between the two groups.

Conclusion

Dapagliflozin effectively decreased glucose levels, but not glucose variability, after 12 weeks of treatment in participants with type 2 diabetes mellitus receiving insulin treatment. The role of SGLT2 inhibitors in glycemic variability warrants further investigations.

Citations

Citations to this article as recorded by

Empagliflozin versus metformin for glucose variability and metabolic outcomes in drug-naïve type 2 diabetes: The EMPA-FIT study
Soo Lim, Cheol Young Park, In Kyung Jeong, Ji Sung Yoon, Sang Yong Kim, Eun Seok Kang, Junghyun Noh, Kyu Yeon Hur, Sungrae Kim
Journal of Diabetes and its Complications.2026; 40(1): 109214. CrossRef
Comparative Study of Efficacy and Safety of Dapagliflozin vs Basal Insulin in Stabilizing Glycemic Variability in Patients with Type 2 Diabetes Mellitus Inadequately Controlled on Triple Drug Combination Therapy
Deepak S Bhosle, Bhakti Chandekar, Satish Shelke
Journal of The Association of Physicians of India.2025; 73(4): 29. CrossRef
Serum uric acid reduction through SGLT2 inhibitors: evidence from a systematic review and meta-analysis
Shiwen Yang, Qiaozhi Hu, Kexin Liu, Binjie Xiao, Bofei Zhang, Na Su
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Glycemic variability and iatrogenic hypoglycemia: how to resolve
Louis Monnier, Claude Colette, Eric Renard, Pierre-Yves Benhamou, Safa Aouinti, Nicolas Molinari, David Owens
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Effects of sodium-glucose cotransporter-2 inhibitors on serum urate levels and gout in patients with and without type 2 diabetes: a systematic review and network meta-analysis
Qiaozhi Hu, Shiwen Yang, Bofei Zhang, Na Su
International Journal of Clinical Pharmacy.2025; 47(5): 1162. CrossRef
Proteomic Signatures and Blood Adenosine Triphosphate Levels as Markers of Empagliflozin Efficacy in Type 2 Diabetes Mellitus and Heart Failure
Uulkan Omurzakova, Matthias Breidert, Markus Donner, Nurgul Toktogulova, Maria Moldobaeva, Angélique Quartier, Pierre Eftekhari
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Donald C Simonson, Marcia A Testa, Ella Ekholm, Maxwell Su, Tina Vilsbøll, Serge A Jabbour, Marcus Lind
The Journal of Clinical Endocrinology & Metabolism.2024; 109(12): e2261. CrossRef
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SuA Oh, Sujata Purja, Hocheol Shin, Minji Kim, Eunyoung Kim
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The Clinical Effect of Dapagliflozin in Patients with Angiographically Confirmed Coronary Artery Disease and Concomitant Type 2 Diabetes Mellitus
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Effect of Dapagliflozin on Glycemic Variability in Patients with Type 2 Diabetes under Insulin Glargine Combined with Other Oral Hypoglycemic Drugs
Menghui Luo, Xiaocen Kong, Huiying Wang, Xiaofang Zhai, Tingting Cai, Bo Ding, Yun Hu, Ting Jing, Xiaofei Su, Huiqin Li, Jianhua Ma, Yoshifumi Saisho
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Complications
Differences in Clinical Outcomes between Patients with and without Hypoglycemia during Hospitalization: A Retrospective Study Using Real-World Evidence: Jeongmin Lee, Tong Min Kim, Hyunah Kim, Seung-Hwan Lee, Jae Hyoung Cho, Hyunyong Lee, Hyeon Woo Yim, Kun-Ho Yoon, Hun-Sung Kim; Diabetes Metab J. 2020;44(4):555-565. Published online May 8, 2020; DOI: https://doi.org/10.4093/dmj.2019.0064

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Background

Some patients admitted to hospitals for glycemic control experience hypoglycemia despite regular meals and despite adhering to standard blood glucose control protocols. Different factors can have a negative impact on blood glucose control and prognosis after discharge. This study investigated risk factors for hypoglycemia and its effects on glycemic control during the hospitalization of patients in the general ward.

Methods

This retrospective study included patients who were admitted between 2009 and 2018. Patients were provided regular meals at fixed times according to ideal body weights during hospitalization. We categorized the patients into two groups: those with and those without hypoglycemia during hospitalization.

Results

Of the 3,031 patients, 379 experienced at least one episode of hypoglycemia during hospitalization (HYPO group). Hypoglycemia occurred more frequently particularly in cases of premixed insulin therapy. Compared with the control group, the HYPO group was older (61.0±16.8 years vs. 59.1±16.5 years, P=0.035), with more females (60.4% vs. 49.6%, P<0.001), lower body mass index (BMI) (23.5±4.2 kg/m² vs. 25.1±4.4 kg/m², P<0.001), and higher prevalence of type 1 diabetes mellitus (6.1% vs. 2.6%, P<0.001), They had longer hospital stay (11.1±13.5 days vs. 7.6±4.6 days, P<0.001). After discharge the HYPO group had lower glycosylated hemoglobin reduction rate (−2.0%±0.2% vs. −2.5%±0.1%, P=0.003) and tended to have more frequent cases of cardiovascular disease.

Conclusion

Hypoglycemia occurred more frequently in older female patients with lower BMI and was associated with longer hospital stay and poorer glycemic control after discharge. Therefore, clinicians must carefully ensure that patients do not experience hypoglycemia during hospitalization.

Citations

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A Nomogram Prediction Model and Validation of Hypoglycemia Risk in Patients With Decompensated Cirrhosis and Type 2 Diabetes
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Incidence and factors associated with hypoglycemia in newly diagnosed hospitalized children and adolescents with type 1 diabetes mellitus in China
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Adherence to healthy lifestyle behaviors as a preventable risk factor for severe hypoglycemia in people with type 2 diabetes: A longitudinal nationwide cohort study
Jae‐Seung Yun, Kyungdo Han, Yong‐Moon Park, Eugene Han, Yong‐ho Lee, Seung‐Hyun Ko
Journal of Diabetes Investigation.2022; 13(9): 1533. CrossRef
Predicting hypoglycemia in hospitalized patients with diabetes: A derivation and validation study
Michal Elbaz, Jeries Nashashibi, Shiri Kushnir, Leonard Leibovici
Diabetes Research and Clinical Practice.2021; 171: 108611. CrossRef
Hospital care: improving outcomes in type 1 diabetes
Schafer Boeder, Kristen Kulasa
Current Opinion in Endocrinology, Diabetes & Obesity.2021; 28(1): 14. CrossRef
Data Pseudonymization in a Range That Does Not Affect Data Quality: Correlation with the Degree of Participation of Clinicians
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Letter: Differences in Clinical Outcomes between Patients with and without Hypoglycemia during Hospitalization: A Retrospective Study Using Real-World Evidence (Diabetes Metab J 2020;44:555-65)
Sung-Woo Kim
Diabetes & Metabolism Journal.2020; 44(5): 775. CrossRef
Response: Differences in Clinical Outcomes between Patients with and without Hypoglycemia during Hospitalization: A Retrospective Study Using Real-World Evidence (Diabetes Metab J 2020;44:555-65)
Jeongmin Lee, Hun-Sung Kim
Diabetes & Metabolism Journal.2020; 44(5): 779. CrossRef
Hypoglycaemia and Cardiovascular Disease Risk in Patients with Diabetes
Niki Katsiki, Kalliopi Kotsa, Anca P. Stoian, Dimitri P. Mikhailidis
Current Pharmaceutical Design.2020; 26(43): 5637. CrossRef

Editorial

Obesity and Metabolic Syndrome
Changes in Metabolic Profile Over Time: Impact on the Risk of Diabetes: Yunjung Cho, Seung-Hwan Lee; Diabetes Metab J. 2019;43(4):407-409. Published online August 20, 2019; DOI: https://doi.org/10.4093/dmj.2019.0141

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Original Articles

Clinical Diabetes & Therapeutics
Effectiveness and Safety of Adding Basal Insulin Glargine in Patients with Type 2 Diabetes Mellitus Exhibiting Inadequate Response to Metformin and DPP-4 Inhibitors with or without Sulfonylurea: Yu Mi Kang, Chang Hee Jung, Seung-Hwan Lee, Sang-Wook Kim, Kee-Ho Song, Sin Gon Kim, Jae Hyeon Kim, Young Min Cho, Tae Sun Park, Bon Jeong Ku, Gwanpyo Koh, Dol Mi Kim, Byung-Wan Lee, Joong-Yeol Park; Diabetes Metab J. 2019;43(4):432-446. Published online June 19, 2019; DOI: https://doi.org/10.4093/dmj.2018.0092

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Background

We aimed to investigate the effectiveness and safety of adding basal insulin to initiating dipeptidyl peptidase-4 (DPP-4) inhibitor and metformin and/or sulfonylurea (SU) in achieving the target glycosylated hemoglobin (HbA1c) in patients with type 2 diabetes mellitus (T2DM).

Methods

This was a single-arm, multicenter, 24-week, open-label, phase 4 study in patients with inadequately controlled (HbA1c ≥7.5%) T2DM despite the use of DPP-4 inhibitor and metformin. A total of 108 patients received insulin glargine while continuing oral antidiabetic drugs (OADs). The primary efficacy endpoint was the percentage of subjects achieving HbA1c ≤7.0%. Other glycemic profiles were also evaluated, and the safety endpoints were adverse events (AEs) and hypoglycemia.

Results

The median HbA1c at baseline (8.9%; range, 7.5% to 11.1%) decreased to 7.6% (5.5% to 11.7%) at 24 weeks. Overall, 31.7% subjects (n=33) achieved the target HbA1c level of ≤7.0%. The mean differences in body weight and fasting plasma glucose were 1.2±3.4 kg and 56.0±49.8 mg/dL, respectively. Hypoglycemia was reported in 36 subjects (33.3%, 112 episodes), all of which were fully recovered. There was no serious AE attributed to insulin glargine. Body weight change was significantly different between SU users and nonusers (1.5±2.5 kg vs. −0.9±6.0 kg, P=0.011).

Conclusion

The combination add-on therapy of insulin glargine, on metformin and DPP-4 inhibitors with or without SU was safe and efficient in reducing HbA1c levels and thus, is a preferable option in managing T2DM patients exhibiting dysglycemia despite the use of OADs.

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Clinical Diabetes & Therapeutics
Acarbose Add-on Therapy in Patients with Type 2 Diabetes Mellitus with Metformin and Sitagliptin Failure: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Study: Hae Kyung Yang, Seung-Hwan Lee, Juyoung Shin, Yoon-Hee Choi, Yu-Bae Ahn, Byung-Wan Lee, Eun Jung Rhee, Kyung Wan Min, Kun-Ho Yoon; Diabetes Metab J. 2019;43(3):287-301. Published online December 20, 2018; DOI: https://doi.org/10.4093/dmj.2018.0054

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Background

We evaluated the efficacy and safety of acarbose add-on therapy in Korean patients with type 2 diabetes mellitus (T2DM) who are inadequately controlled with metformin and sitagliptin.

Methods

A total of 165 subjects were randomized to metformin and sitagliptin (Met+Sita, n=65), metformin, sitagliptin, and acarbose (Met+Sita+Acarb, n=66) and sitagliptin and acarbose (Sita+Acarb, exploratory assessment, n=34) therapy in five institutions in Korea. After 16 weeks of acarbose add-on or metformin-switch therapy, a triple combination therapy was maintained from week 16 to 24.

Results

The add-on of acarbose (Met+Sita+Acarb group) demonstrated a 0.44%±0.08% (P<0.001 vs. baseline) decrease in glycosylated hemoglobin (HbA1c) at week 16, while changes in HbA1c were insignificant in the Met+Sita group (−0.09%±0.10%, P=0.113). After 8 weeks of triple combination therapy, HbA1c levels were comparable between Met+Sita and Met+Sita+Acarb group (7.66%±0.13% vs. 7.47%±0.12%, P=0.321). Acarbose add-on therapy demonstrated suppressed glucagon secretion (area under the curve of glucagon, 4,726.17±415.80 ng·min/L vs. 3,314.38±191.63 ng·min/L, P=0.004) in the absence of excess insulin secretion during the meal tolerance tests at week 16 versus baseline. The incidence of adverse or serious adverse events was similar between two groups.

Conclusion

In conclusion, a 16-week acarbose add-on therapy to metformin and sitagliptin, effectively lowered HbA1c without significant adverse events. Acarbose might be a good choice as a third-line therapy in addition to metformin and sitagliptin in Korean subjects with T2DM who have predominant postprandial hyperglycemia and a high carbohydrate intake.

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Complications
Cardiovascular Autonomic Neuropathy Predicts Higher HbA1c Variability in Subjects with Type 2 Diabetes Mellitus: Yeoree Yang, Eun-Young Lee, Jae-Hyoung Cho, Yong-Moon Park, Seung-Hyun Ko, Kun-Ho Yoon, Moo-Il Kang, Bong-Yun Cha, Seung-Hwan Lee; Diabetes Metab J. 2018;42(6):496-512. Published online September 28, 2018; DOI: https://doi.org/10.4093/dmj.2018.0026

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Background

This study aimed to investigate the association between the presence and severity of cardiovascular autonomic neuropathy (CAN) and development of long-term glucose fluctuation in subjects with type 2 diabetes mellitus.

Methods

In this retrospective cohort study, subjects with type 2 diabetes mellitus who received cardiovascular autonomic reflex tests (CARTs) at baseline and at least 4-year of follow-up with ≥6 measures of glycosylated hemoglobin (HbA1c) were included. The severity of CAN was categorized as normal, early, or severe CAN according to the CARTs score. HbA1c variability was measured as the standard deviation (SD), coefficient of variation, and adjusted SD of serial HbA1c measurements.

Results

A total of 681 subjects were analyzed (294 normal, 318 early, and 69 severe CAN). The HbA1c variability index values showed a positive relationship with the severity of CAN. Multivariable logistic regression analysis showed that CAN was significantly associated with the risk of developing higher HbA1c variability (SD) after adjusting for age, sex, body mass index, diabetes duration, mean HbA1c, heart rate, glomerular filtration rate, diabetic retinopathy, coronary artery disease, insulin use, and anti-hypertensive medication (early CAN: odds ratio [OR], 1.65; 95% confidence interval [CI], 1.12 to 2.43) (severe CAN: OR, 2.86; 95% CI, 1.47 to 5.56). This association was more prominent in subjects who had a longer duration of diabetes (>10 years) and lower mean HbA1c (<7%).

Conclusion

CAN is an independent risk factor for future higher HbA1c variability in subjects with type 2 diabetes mellitus. Tailored therapy for stabilizing glucose fluctuation should be emphasized in subjects with CAN.

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Long-Term Risk of Cardiovascular Disease Among Type 2 Diabetes Patients According to Average and Visit-to-Visit Variations of HbA1c Levels During the First 3 Years of Diabetes Diagnosis
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Journal of Korean Medical Science.2023;[Epub] CrossRef
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Editorial

Epidemiology
Hidden Risks behind Normal Fasting Glucose: Is It Significant?: Seung-Hwan Lee; Diabetes Metab J. 2018;42(3):196-197. Published online June 19, 2018; DOI: https://doi.org/10.4093/dmj.2018.0083

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Original Articles

Epidemiology
Serum Betatrophin Concentrations and the Risk of Incident Diabetes: A Nested Case-Control Study from Chungju Metabolic Disease Cohort: Seung-Hwan Lee, Marie Rhee, Hyuk-Sang Kwon, Yong-Moon Park, Kun-Ho Yoon; Diabetes Metab J. 2018;42(1):53-62. Published online November 3, 2017; DOI: https://doi.org/10.4093/dmj.2018.42.1.53

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Background

Betatrophin is a newly identified hormone derived from the liver and adipose tissue, which has been suggested to regulate glucose and lipid metabolism. Circulating levels of betatrophin are altered in various metabolic diseases, although the results are inconsistent. We aimed to examine whether betatrophin is a useful biomarker in predicting the development of diabetes.

Methods

A nested case-control study was performed using a prospective Chungju Metabolic disease Cohort Study. During a 4-year follow-up period, we analyzed 167 individuals who converted to diabetes and 167 non-converters, who were matched by age, sex, and body mass index. Serum betatrophin levels were measured by an ELISA (enzyme-linked immunosorbent assay).

Results

Baseline serum betatrophin levels were significantly higher in the converter group compared to the non-converter group (1,315±598 pg/mL vs. 1,072±446 pg/mL, P<0.001). After adjusting for age, sex, body mass index, fasting plasma glucose, systolic blood pressure, total cholesterol, and family history of diabetes, the risk of developing diabetes showed a stepwise increase across the betatrophin quartile groups. Subjects in the highest baseline quartile of betatrophin levels had more than a threefold higher risk of incident diabetes than the subjects in the lowest quartile (relative risk, 3.275; 95% confidence interval, 1.574 to 6.814; P=0.010). However, no significant relationships were observed between serum betatrophin levels and indices of insulin resistance or β-cell function.

Conclusion

Circulating levels of betatrophin could be a potential biomarker for predicting new-onset diabetes. Further studies are needed to understand the underlying mechanism of this association.

Citations

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Probiotics and exercise modulate hepatic asprosin, betatrophin, Leap-2, and ORM2 gene expression in a high fat diet rat model
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Diabetes/Metabolism Research and Reviews.2023;[Epub] CrossRef
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Cureus.2023;[Epub] CrossRef
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Hassan Tavassoli, Ali Heidarianpour
The American Journal of the Medical Sciences.2021; 362(5): 496. CrossRef
Evidences for Expression and Location of ANGPTL8 in Human Adipose Tissue
Leonardo Catalano-Iniesta, Virginia Sánchez Robledo, María Carmen Iglesias-Osma, Amparo Galán Albiñana, Sixto Carrero, Enrique J. Blanco, Marta Carretero-Hernández, José Carretero, María José García-Barrado
Journal of Clinical Medicine.2020; 9(2): 512. CrossRef
Higher circulating levels of ANGPTL8 are associated with body mass index, triglycerides, and endothelial dysfunction in patients with coronary artery disease
Reza Fadaei, Hossein Shateri, Johanna K. DiStefano, Nariman Moradi, Mohammad Mohammadi, Farzad Emami, Hassan Aghajani, Nasrin Ziamajidi
Molecular and Cellular Biochemistry.2020; 469(1-2): 29. CrossRef
Effects of a diet with or without physical activity on angiopoietin-like protein 8 concentrations in overweight/obese patients with newly diagnosed type 2 diabetes: a randomized controlled trial
Hao Hu, Guoyue Yuan, Xinchen Wang, Jin Sun, Zhaohua Gao, Tingting Zhou, Wenwen Yin, Ruonan Cai, Xing Ye, Zhaoling Wang
Endocrine Journal.2019; 66(1): 89. CrossRef
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Clinical Care/Education
Physician-Directed Diabetes Education without a Medication Change and Associated Patient Outcomes: Hun-Sung Kim, Hyunah Kim, Hae-Kyung Yang, Eun Young Lee, Yoo Jin Jeong, Tong Min Kim, So Jung Yang, Seo Yeon Baik, Seung-Hwan Lee, Jae Hyoung Cho, In Young Choi, Hyeon Woo Yim, Bong-Yun Cha; Diabetes Metab J. 2017;41(3):187-194. Published online May 12, 2017; DOI: https://doi.org/10.4093/dmj.2017.41.3.187

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Background

When patients with diabetes mellitus (DM) are first referred to a hospital from primary health care clinics, physicians have to decide whether to administer an oral hypoglycemic agent (OHA) immediately or postpone a medication change in favor of diabetes education regarding diet or exercise. The aim of this study was to determine the effect of diabetes education alone (without alterations in diabetes medication) on blood glucose levels.

Methods

The study was conducted between January 2009 and December 2013 and included patients with DM. The glycosylated hemoglobin (HbA1c) levels were evaluated at the first visit and after 3 months. During the first medical examination, a designated doctor also conducted a diabetes education session that mainly covered dietary management.

Results

Patients were divided into those who received no diabetic medications (n=66) and those who received an OHA (n=124). Education resulted in a marked decrease in HbA1c levels in the OHA group among patients who had DM for <1 year (from 7.0%±1.3% to 6.6%±0.9%, P=0.0092) and for 1 to 5 years (from 7.5%±1.8% to 6.9%±1.1%, P=0.0091). Those with DM >10 years showed a slightly lower HbA1c target achievement rate of <6.5% (odds ratio, 0.089; P=0.0024).

Conclusion

For patients who had DM for more than 5 years, higher doses or changes in medication were more effective than intensive active education. Therefore, individualized and customized education are needed for these patients. For patients with a shorter duration of DM, it may be more effective to provide initial intensive education for diabetes before prescribing medicines, such as OHAs.

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Jin Hee Jung, Jung Hwa Lee, Hyang Mi Jang, Young Na, Hee Sun Choi, Yeon Hee Lee, Yang Gyo Kang, Na Rae Kim, Jeong Rim Lee, Bok Rye Song, Kang Hee Sim
The Journal of Korean Diabetes.2022; 23(1): 64. CrossRef
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Clinical Care/Education
Reduction of Sulfonylurea with the Initiation of Basal Insulin in Patients with Inadequately Controlled Type 2 Diabetes Mellitus Undergoing Long-Term Sulfonylurea-Based Treatment: Yeoree Yang, Jeong-Ah Shin, Hae Kyung Yang, Seung-Hwan Lee, Seung-Hyun Ko, Yu-Bae Ahn, Kun-Ho Yoon, Jae-Hyoung Cho; Diabetes Metab J. 2016;40(6):454-462. Published online October 11, 2016; DOI: https://doi.org/10.4093/dmj.2016.40.6.454

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Background

There were a limited number of studies about β-cell function after insulin initiation in patients exposed to long durations of sulfonylurea treatment. In this study, we aimed to evaluate the recovery of β-cell function and the efficacy of concurrent sulfonylurea use after the start of long-acting insulin.

Methods

In this randomized controlled study, patients with type 2 diabetes mellitus (T2DM), receiving sulfonylurea for at least 2 years with glycosylated hemoglobin (HbA1c) >7%, were randomly assigned to two groups: sulfonylurea maintenance (SM) and sulfonylurea reduction (SR). Following a 75-g oral glucose tolerance test (OGTT), we administered long-acting basal insulin to the two groups. After a 6-month follow-up, we repeated the OGTT.

Results

Among 69 enrolled patients, 57 completed the study and were analyzed: 31 in the SM and 26 in the SR group. At baseline, there was no significant difference except for the longer duration of diabetes and lower triglycerides in the SR group. After 6 months, the HbA1c was similarly reduced in both groups, but there was little difference in the insulin dose. In addition, insulin secretion during OGTT was significantly increased by 20% to 30% in both groups. A significant weight gain was observed in the SM group only. The insulinogenic index was more significantly improved in the SR group.

Conclusion

Long-acting basal insulin replacement could improve the glycemic status and restore β-cell function in the T2DM patients undergoing sulfonylurea-based treatment, irrespective of the sulfonylurea dose reduction. The dose reduction of the concurrent sulfonylurea might be beneficial with regard to weight grain.

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Background

This study aimed to evaluate the effect of sitagliptin, an oral dipeptidyl peptidase-4 inhibitor, on insulin secretion and glucagon suppression in Korean subjects with type 2 diabetes mellitus.

Methods

Twenty-four subjects underwent a 75-g oral glucose tolerance test (OGTT) before and after 6 months of sitagliptin treatment. Sitagliptin, insulin, and sulfonylurea were withdrawn for 3 days before OGTT to eliminate any acute effects on β-cell insulin or α-cell glucagon secretion. Venous samples were drawn five times during each OGTT to measure plasma glucose, insulin, and glucagon. Indices on insulin secretion and resistance were calculated.

Results

Early phase insulin secretion, measured by the insulinogenic index significantly increased after 6 months of sitagliptin treatment, especially in the higher baseline body mass index group and higher baseline glycosylated hemoglobin (HbA1c) group. There were no significant differences in the insulin resistance indices before and after sitagliptin treatment. Although no significant differences were observed in the absolute levels of glucagon and the glucagon-to-insulin ratio, there was a significant reduction in the percentile change of glucagon-to-insulin ratio at 30- and 120-minute during the OGTT.

Conclusion

Although the HbA1c level did not decrease significantly after 6 months of sitagliptin treatment, an increase in insulin secretion and reduction in early phase postprandial plasma glucagon-to-insulin ratio excursion was confirmed in Korean subjects with type 2 diabetes.

Citations

Citations to this article as recorded by

A genetic variant in GLP1R is associated with response to DPP-4 inhibitors in patients with type 2 diabetes
Eugene Han, Hye Sun Park, Obin Kwon, Eun Yeong Choe, Hye Jin Wang, Yong-ho Lee, Sang-Hak Lee, Chul Hoon Kim, Lee-Kyung Kim, Soo Heon Kwak, Kyong Soo Park, Chul Sik Kim, Eun Seok Kang
Medicine.2016; 95(44): e5155. CrossRef
Effects of sitagliptin on circulating zinc-α2-glycoprotein levels in newly diagnosed type 2 diabetes patients: a randomized trial
Mingyuan Tian, Zerong Liang, Rui Liu, Ke Li, Xinrong Tan, Yong Luo, Mengliu Yang, Harvest F Gu, Hua Liu, Ling Li, Gangyi Yang
European Journal of Endocrinology.2016; 174(2): 147. CrossRef
Effects of Sitagliptin on Insulin and Glucagon Levels in Type 2 Diabetes Mellitus
Ji Hyun Kim
Diabetes & Metabolism Journal.2015; 39(4): 304. CrossRef

The Insulin Resistance but Not the Insulin Secretion Parameters Have Changed in the Korean Population during the Last Decade: Hae Kyung Yang, Jin Hee Lee, In-Young Choi, Hyuk Sang Kwon, Jeong Ah Shin, Seung Hee Jeong, Seung-Hwan Lee, Jae Hyoung Cho, Ho Young Son, Kun Ho Yoon; Diabetes Metab J. 2015;39(2):117-125. Published online April 20, 2015; DOI: https://doi.org/10.4093/dmj.2015.39.2.117

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Background

This study aimed to compare the patterns of insulin secretion and resistance between Korean subjects in the 1990s and 2000s.

Methods

Insulin secretion and resistance indices were calculated from subjects who underwent 75-g oral glucose tolerance tests in the year 1997 to 1999 and 2007 to 2011 at the Seoul St. Mary's Hospital, Korea.

Results

A total of 578 subjects from the 1990s (mean age, 48.5 years) and 504 subjects from the 2000s (mean age, 50.2 years) were enrolled. Compared with the subjects from the 1990s, those from the 2000s exhibited increased insulin resistance (increased homeostatic model assessment for insulin resistance), and reduced insulin sensitivity (reduced Matsuda index and quantitative insulin sensitivity check index), regardless of their glucose tolerance status. However, insulinogenic index did not reveal significant differences between the 2 decades in subjects with or without diabetes. A distinct relationship was confirmed between Matsuda index and total area under the curve (insulin/glucose) in each glucose tolerance group. The mean product of the Matsuda index and the total area under the curve (insulin/glucose) as well as the oral disposition index, was lower in subjects with normal glucose tolerance from the 2000s than in those from the 1990s.

Conclusion

After rapid economic growth and changes in lifestyle patterns, insulin resistance has worsened across the glucose tolerance status; however, the insulin secretory function remained unchanged, which resulted in an increase in the susceptibility to the development of type 2 diabetes mellitus among Korean subjects without diabetes. We could not rule out the potential selection bias and therefore, further studies in general Korean population are needed.

Citations

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Joonyub Lee, Kun-Ho Yoon
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Inha Jung, Dae-Jeong Koo, Won-Young Lee
Diabetes & Metabolism Journal.2024; 48(3): 327. CrossRef
A Randomized Crossover Study Comparing the Effects of Diabetes-Specific Formula with Common Asian Breakfasts on Glycemic Control and Satiety in Adults with Type 2 Diabetes Mellitus
Sing Teang Kong, Dieu Thi Thu Huynh, Weerachai Srivanichakorn, Weerapan Khovidhunkit, Chaiwat Washirasaksiri, Tullaya Sitasuwan, Chengrong Huang, Swapnil Paunikar, Menaka Yalawar, Siew Ling Tey
Diabetology.2024; 5(4): 447. CrossRef
Longitudinal Changes in Insulin Resistance, Beta-Cell Function and Glucose Regulation Status in Prediabetes
Chul-Hee Kim, Hong-Kyu Kim, Eun-Hee Kim, Sung-Jin Bae, Jaewon Choe, Joong-Yeol Park
The American Journal of the Medical Sciences.2018; 355(1): 54. CrossRef
Association of serum 25-hydroxyvitamin D and diabetes-related factors in Korean adults without diabetes: The Fifth Korea National Health and Nutrition Examination Survey 2010–2012
Hyunah Kim, Hyunyong Lee, Hyeon Woo Yim, Hun-Sung Kim
Primary Care Diabetes.2018; 12(1): 59. CrossRef
Long‐term effects on glycaemic control and β‐cell preservation of early intensive treatment in patients with newly diagnosed type 2 diabetes: A multicentre randomized trial
Suk Chon, Sang Youl Rhee, Kyu Jeung Ahn, Sei Hyun Baik, Yongsoo Park, Moon Suk Nam, Kwan Woo Lee, Soon Jib Yoo, Gwanpyo Koh, Dae Ho Lee, Young Seol Kim, Jeong‐Taek Woo
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Four Plasma Glucose and Insulin Responses to a 75 g OGTT in Healthy Young Japanese Women
Kei Takahashi, Hidetaka Nakamura, Hiroshi Sato, Hideto Matsuda, Kazuo Takada, Tomiko Tsuji
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Comparison of insulin intensification strategies with insulin lispro low mixture twice daily versus basal insulin glargine and prandial insulin lispro once daily in East Asian and Caucasian patients with type 2 diabetes mellitus
In‐Kyung Jeong, Choon Hee Chung, Zhiguang Zhou, Jeong Hee Han, Ran Duan, Diana M. Edralin, Angel Rodriguez
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Insulin Secretory Capacity and Insulin Resistance in Korean Type 2 Diabetes Mellitus Patients
Jong-Dai Kim, Won-Young Lee
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Antisenescence activity of G9a inhibitor BIX01294 on human bone marrow mesenchymal stromal cells
Min-Ji AHN, Sin-Gu JEONG, Goang-Won CHO
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Urinary N-acetyl-β-D-glucosaminidase, an early marker of diabetic kidney disease, might reflect glucose excursion in patients with type 2 diabetes
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Letter

Letter: The Effect of DPP-4 Inhibitors on Metabolic Parameters in Patients with Type 2 Diabetes (Diabetes Metab J 2014;38:211-9): Seung-Hwan Lee; Diabetes Metab J. 2014;38(4):317-318. Published online August 20, 2014; DOI: https://doi.org/10.4093/dmj.2014.38.4.317

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Original Articles

Statin Discontinuation after Achieving a Target Low Density Lipoprotein Cholesterol Level in Type 2 Diabetic Patients without Cardiovascular Disease: A Randomized Controlled Study: Seung-Hwan Lee, Hyuk-Sang Kwon, Yong-Moon Park, Seung-Hyun Ko, Yoon-Hee Choi, Kun-Ho Yoon, Yu-Bae Ahn; Diabetes Metab J. 2014;38(1):64-73. Published online February 19, 2014; DOI: https://doi.org/10.4093/dmj.2014.38.1.64

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Background

This study investigated the rate of relapse of dyslipidemia and the factors which could predict relapse following a short-term statin discontinuation after achieving a target low density lipoprotein cholesterol (LDL-C) level in type 2 diabetic patients without cardiovascular disease (CVD).

Methods

Ninety-nine subjects on rosuvastatin treatment and whose LDL-C level was lower than 100 mg/dL were randomly assigned to discontinue or maintain statin treatment at a 2:1 ratio. The subjects were followed-up after 10 weeks. A relapse of dyslipidemia was defined as a reascent of LDL-C level to greater than 100 mg/dL.

Results

The statin discontinuation group had a significant rate of relapse compared to the maintenance group (79% vs. 3%, respectively). Pretreatment and baseline lipid levels, their ratios, and hemoglobin A1c level were significantly different between the relapse and nonrelapse groups. The pretreatment and baseline lipid profiles and their ratios were independently associated with relapse. The pretreatment LDL-C level was the most useful parameter for predicting a relapse, with a cutoff of 123 mg/dL. During the follow-up period, no CVD event was noted.

Conclusion

The relapse rate of dyslipidemia was high when statins were discontinued in type 2 diabetic patients without CVD. Statin discontinuation should be considered carefully based on the pretreatment lipid profiles of patients.

Citations

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Longitudinal exposure to non‐HDL‐C and cardiovascular events, all‐cause mortality in type 2 diabetes: A post hoc analysis of the ACCORD trial
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Diabetes, Obesity and Metabolism.2026; 28(4): 3095. CrossRef
Trials evaluating drug discontinuation: a scoping review sub-analysis focusing on outcomes and research questions
Nele Kornder, Norbert Donner-Banzhoff, Ina Staudt, Nina Grede, Annette Becker, Annika Viniol
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Postmarketing Reports of Incomplete Dosing-Related Complications with Self-Injected PCSK9 Inhibitors: A Descriptive Study and Disproportionality Analysis
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Cardiovascular Outcomes and Mortality Associated With Discontinuing Statins in Older Patients Receiving Polypharmacy
Federico Rea, Annalisa Biffi, Raffaella Ronco, Matteo Franchi, Simona Cammarota, Anna Citarella, Valeria Conti, Amelia Filippelli, Carmine Sellitto, Giovanni Corrao
JAMA Network Open.2021; 4(6): e2113186. CrossRef
Visit-to-visit variability of lipid measurements and the risk of myocardial infarction and all-cause mortality: A prospective cohort study
Xiaoxue Liu, Shouling Wu, Qiaofeng Song, Xizhu Wang
Atherosclerosis.2020; 312: 110. CrossRef
2018 Guidelines for the management of dyslipidemia
Eun-Jung Rhee, Hyeon Chang Kim, Jae Hyeon Kim, Eun Young Lee, Byung Jin Kim, Eun Mi Kim, YoonJu Song, Jeong Hyun Lim, Hae Jin Kim, Seonghoon Choi, Min Kyong Moon, Jin Oh Na, Kwang-Yeol Park, Mi Sun Oh, Sang Youb Han, Junghyun Noh, Kyung Hee Yi, Sang-Hak L
The Korean Journal of Internal Medicine.2019; 34(4): 723. CrossRef
2018 Guidelines for the Management of Dyslipidemia in Korea
Eun-Jung Rhee, Hyeon Chang Kim, Jae Hyeon Kim, Eun Young Lee, Byung Jin Kim, Eun Mi Kim, YoonJu Song, Jeong Hyun Lim, Hae Jin Kim, Seonghoon Choi, Min Kyong Moon, Jin Oh Na, Kwang-Yeol Park, Mi Sun Oh, Sang Youb Han, Junghyun Noh, Kyung Hee Yi, Sang-Hak L
Journal of Lipid and Atherosclerosis.2019; 8(2): 78. CrossRef
Patterns of statin use and long‐term adherence and persistence among older adults with diabetes
Richard Ofori‐Asenso, Jenni Ilomäki, Mark Tacey, Ella Zomer, Andrea J. Curtis, J. Simon Bell, Sophia Zoungas, Danny Liew
Journal of Diabetes.2018; 10(9): 699. CrossRef
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Eun Young Lee, Yeoree Yang, Hun-Sung Kim, Jae-Hyoung Cho, Kun-Ho Yoon, Wook Sung Chung, Seung-Hwan Lee, Kiyuk Chang
Atherosclerosis.2018; 279: 1. CrossRef
Change in ALT levels after administration of HMG‐CoA reductase inhibitors to subjects with pretreatment levels three times the upper normal limit in clinical practice
Hyunah Kim, Hyeseon Lee, Tong Min Kim, So Jung Yang, Seo Yeon Baik, Seung‐Hwan Lee, Jae‐Hyoung Cho, Hyunyong Lee, Hyeon Woo Yim, In Young Choi, Kun‐Ho Yoon, Hun‐Sung Kim
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Theocharis Koufakis, Spyridon N Karras, Pantelis Zebekakis, Kalliopi Kotsa
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Jingyun Choi, Yejin Kim, Hun-Sung Kim, In Young Choi, Hwanjo Yu, Katriina Aalto-Setala
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Influence of the Duration of Diabetes on the Outcome of a Diabetes Self-Management Education Program: Seung-Hyun Ko, Sin-Ae Park, Jae-Hyoung Cho, Sun-Hye Ko, Kyung-Mi Shin, Seung-Hwan Lee, Ki-Ho Song, Yong-Moon Park, Yu-Bae Ahn; Diabetes Metab J. 2012;36(3):222-229. Published online June 14, 2012; DOI: https://doi.org/10.4093/dmj.2012.36.3.222

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Abstract PDF PubReader ePub

Background

Diabetes education and lifestyle modification are critical components in controlling blood glucose levels of people with type 2 diabetes. Until now, available data on the effectiveness of education with respect to the duration of diabetes are limited. We investigated whether adherence to lifestyle behavior modification prompted by diabetes education was influenced by the duration of diabetes.

Methods

Two hundred and twenty-five people with type 2 diabetes were recruited for an intensive, collaborative, group-based diabetes education program with annual reinforcement. We divided the patients into two groups based on the duration of their diabetes prior to the education program (≤1 year [≤1Y] vs. ≥3 years [≥3Y]). Dietary habits, physical activity, and the frequency of blood glucose self-monitoring were evaluated with a questionnaire prior to education and at the follow-up endpoint.

Results

The mean follow-up period was 32.2 months. The mean hemoglobin A1c (A1C) value was significantly lower in the ≤1Y group. Self-care behaviors, measured by scores for dietary habits (P=0.004) and physical activity (P<0.001), were higher at the endpoint in the ≤1Y group than in the ≥3Y group. Logistic regression analysis revealed that a longer diabetes duration before education was significantly associated with mean A1C levels greater than or equal to 7.0% (53 mmol/mol).

Conclusion

Diabetes duration influenced the effectiveness of diabetes education on lifestyle behavior modification and glycemic control. More-intense, regular, and sustained reinforcement with encouragement may be required for individuals with longstanding type 2 diabetes.

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Association between Obesity and Physical Fitness, and Hemoglobin A1c Level and Metabolic Syndrome in Korean Adults: Yoonsuk Jekal, Mi-Kyung Lee, Sukyung Park, Seung-Hwan Lee, Jun-Young Kim, Jung-Ui Kang, Masayo Naruse, Sang-Hwan Kim, Sun-Hyeon Kim, Sang Hui Chu, Sang-Hoon Suh, Justin Y Jeon; Korean Diabetes J. 2010;34(3):182-190. Published online June 30, 2010; DOI: https://doi.org/10.4093/kdj.2010.34.3.182

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Background

The purpose of the current study was to investigate the association of obesity level, physical fitness level, hemoglobin A1c (HbA1c) level and metabolic syndrome (MetS) risk factors among Korean adults.

Methods

A total of 557 adults (272 males and 285 females) who underwent medical check-up at local hospital were recruited. In addition to regular health check-up, cardiopulmonary fitness, muscular endurance were measured and their association were analyzed.

Results

The prevalence of MetS was 31.7% for males and 23.7% for females. Females with the higher muscular endurance had lower waist circumference, triglyceride level, and HbA1c level than those with the lower muscular endurance. Males with the higher level of cardiopulmonary fitness had lower diastolic blood pressure, lower high-sensitivity C-reactive protein level and higher high density lipoprotein cholesterol level than males with the lower level of cardiopulmonary fitness. Females with the higher level of cardiopulmonary fitness had lower body weight, body mass index, systolic blood pressure, and fasting blood glucose level than females with the lower level of cardiopulmonary fitness. Participants with the higher level of adiposity and the lower level of physical fitness were 5.26 times (95% confidence interval [CI], 2.19 to 12.62), 5.71 times (95% CI, 2.23 to 14.60) more likely to have MetS, respectively, in male and female compared to participants who were neither obese nor have the lower level of fitness.

Conclusion

This study suggests that maintaining a healthy body weight as well as a certain level of fitness is important for the prevention of MetS.

Citations

Citations to this article as recorded by

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