Diabetes & Metabolism Journal

Original Articles

Metabolic Risk/Epidemiology
Prevalence of Type 2 Diabetes Mellitus among Korean Children, Adolescents, and Adults Younger than 30 Years: Changes from 2002 to 2016: Yong Hee Hong, In-Hyuk Chung, Kyungdo Han, Sochung Chung, on Behalf of the Taskforce Team of the Obesity Fact Sheet of the Korean Society for the Study of Obesity; Diabetes Metab J. 2022;46(2):297-306. Published online October 26, 2021; DOI: https://doi.org/10.4093/dmj.2021.0038

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Background
Despite the importance of and social concern regarding prevention of diabetes at younger ages, limited data are available. This study sought to analyze changes in the prevalence of type 2 diabetes mellitus (T2DM) in Koreans younger than 30 years according to sex, age, and level of income.
Methods
The dataset analyzed in this study was derived from health insurance claims recorded in the National Health Insurance Service (NHIS) database. Participants’ level of income was categorized as low (quintile 1, <20% of insurance premium) or others (quintile 2–5).
Results
In males and females, the prevalence of T2DM per 10,000 people steadily increased from 2.57 in 2002 to 11.41 in 2016, and from 1.96 in 2002 to 8.63 in 2016. The prevalence of T2DM in girls was higher in the age group of 5 to 14 years. Even though the prevalence was higher among those older than 20 years, the increase had started earlier, in the early 2000s, in younger age group. Adolescents aged 10 to 19 years in low-income families showed a remarkable increase in prevalence of T2DM, especially in boys.
Conclusion
The prevalence of T2DM in young Koreans increased more than 4.4-fold from 2002 to 2016, and the increase started in the early 2000s in younger age groups and in low-income families. This is the first study to examine the trend in prevalence of T2DM in children, adolescents, and young adults in Korea. Future studies and collaborations with social support systems to prevent T2DM at an early age group should be performed.

Citations

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Diabetes & Metabolism Journal.2024; 48(3): 418. CrossRef
Do Type 1 and Type 2 Diabetes Have the Same Vascular Complications?
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The Journal of Korean Diabetes.2024; 25(2): 62. CrossRef
2023 Clinical Practice Guidelines for Diabetes Management in Korea: Full Version Recommendation of the Korean Diabetes Association
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Trends and Risk Factors of Metabolic Syndrome among Korean Adolescents, 2007 to 2018 (Diabetes Metab J 2021;45:880-9)
Dae Jung Kim
Diabetes & Metabolism Journal.2022; 46(2): 349. CrossRef
Prevalence trends of type 1 and type 2 diabetes in children and adolescents in North Rhine-Westphalia, the most populous federal state in Germany, 2002-2020
C. Baechle, A. Stahl-Pehe, N. Prinz, T. Meissner, C. Kamrath, R.W. Holl, J. Rosenbauer
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Diagnostic and Therapeutic Strategies of Type 2 Diabetes Mellitus in Youth
Hwa Young Kim, Jae Hyun Kim
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Factors Affecting High-Risk for Diabetes among Korean Adolescents: An Analysis Using the Eighth Korea National Health and Nutrition Examination Survey (2020)
Kyung-Sook Bang, Sang-Youn Jang, Ji-Hye Choe
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Han-sang Baek, Ji-Yeon Park, Jin Yu, Joonyub Lee, Yeoree Yang, Jeonghoon Ha, Seung Hwan Lee, Jae Hyoung Cho, Dong-Jun Lim, Hun-Sung Kim
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Metabolic Risk/Epidemiology
Trends and Risk Factors of Metabolic Syndrome among Korean Adolescents, 2007 to 2018: Jiun Chae, Moon Young Seo, Shin-Hye Kim, Mi Jung Park; Diabetes Metab J. 2021;45(6):880-889. Published online July 6, 2021; DOI: https://doi.org/10.4093/dmj.2020.0185

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Background
There is a lack of recent research on the changes in risk factors for metabolic syndrome (MetS) in the Asian pediatric population. We aimed to determine the 12-year trends in the prevalence of MetS and relevant lifestyle factors such as smoking, exercise, and calorie intake among Korean adolescents.
Methods
We investigated trends in MetS and lifestyle factors among 6,308 adolescents aged 12 to 18 years from the Korea National Health and Nutrition Examination Survey, 2007 to 2018.
Results
The prevalence of MetS was stable from 2007 to 2018 (1.7% to 2.2%). There were significant increases in the prevalence of central obesity (from 8.1% to 11.2%, P=0.012) and hyperglycemia (from 5.3% to 10.4%, P<0.001) and decreases in hypo-high-density lipoprotein (HDL)-cholesterolemia (from 22.4% to 14.8%, P<0.001). Total calorie intake and calorie intake from fat significantly increased (P<0.001), whereas calorie intake from carbohydrates significantly decreased (P<0.001) during the study period. The proportions of tobacco smokers and regular walkers significantly decreased from 2007 to 2018. After controlling for all covariates, total calorie intake was positively correlated with waist circumference (P<0.05). HDL-cholesterol was negatively associated with carbohydrate consumption (P<0.01) and positively associated with fat consumption (P<0.001). Regular walking and regular strength training were associated with lower waist circumference (P<0.05). Smoking was associated with lower fasting glucose levels (P<0.01).
Conclusion
Although the prevalence rate of MetS is stable among Korean adolescents, the prevalence of central obesity and hyperglycemia has increased greatly in the recent decade. Public education on proper dietary intake and lifestyle modification is required.

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Epidemiology
Association of Bisphenol A and Its Substitutes, Bisphenol F and Bisphenol S, with Obesity in United States Children and Adolescents: Buyun Liu, Hans-Joachim Lehmler, Yangbo Sun, Guifeng Xu, Qi Sun, Linda G. Snetselaar, Robert B. Wallace, Wei Bao; Diabetes Metab J. 2019;43(1):59-75. Published online February 19, 2019; DOI: https://doi.org/10.4093/dmj.2018.0045

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Abstract PDF Supplementary Material PubReader

Background

Bisphenol F (BPF) and bisphenol S (BPS) are increasingly used as substitutes for bisphenol A (BPA), an environmental obesogen. However, health effects of BPF and BPS remain unclear. In this study, we evaluated the associations of BPA, BPF, and BPS with obesity in children and adolescents.

Methods

We used data from the U.S. National Health and Nutrition Examination Survey 2013 to 2014, a nationally representative study. We included 745 participants aged 6 to 17 years old. General obesity was defined based on the 2000 Centers for Disease Control and Prevention body mass index-for-age growth charts for the United States. Abdominal obesity was defined as waist-to-height ratio ≥0.5.

Results

After adjustment for demographic, socioeconomic and lifestyle factors, and urinary creatinine levels, the odds ratio of general obesity comparing the highest with lowest quartile of urinary bisphenol levels was 1.74 (95% confidence interval [CI], 0.92 to 3.31) for BPA, 1.54 (95% CI, 1.02 to 2.32) for BPF, and 1.36 (95% CI, 0.53 to 3.51) for BPS. Moreover, the associations were stronger in boys than in girls for BPA and BPF. Similar results were observed for abdominal obesity.

Conclusion

This study for the first time showed that exposure to BPF, a commonly used substitute for BPA, was positively associated with higher risk of obesity in children and adolescents. The association of BPA and BPF with general and abdominal obesity was primarily observed in boys, suggesting a possible sex difference. Further investigations on the underlying mechanisms are needed.

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Epidemiology
Association between Changes in Anthropometric Indices and in Fasting Insulin Levels among Healthy Korean Adolescents: The JS High School Study: Ji Hye Park, Seyeon Mun, Dong Phil Choi, Joo Young Lee, Hyeon Chang Kim; Diabetes Metab J. 2019;43(2):183-191. Published online January 22, 2019; DOI: https://doi.org/10.4093/dmj.2018.0034; Correction in: Diabetes Metab J 2022;46(1):164

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Abstract PDF Supplementary Material PubReader

Background

This study investigated the association between changes in anthropometric indices and fasting insulin levels among healthy adolescents and whether the association differed by baseline obesity status.

Methods

This analysis was based on data collected for the JS High School study; 884 healthy adolescents aged 15 to 16 years followed up for 24 to 30 months were included. Changes in anthropometric indices and fasting insulin levels were computed as the difference between baseline and follow-up values. Multivariate linear regression models were used to determine the association between changes in anthropometric indices and fasting insulin levels. Based on body mass index (BMI)-for-age and waist circumference (WC)-for-age percentiles, participants were classified as normal weight (<85th percentile), overweight (85th percentile to <95th percentile), or obese (≥95th percentile).

Results

Changes in BMI, WC, waist-hip ratio, and waist-height ratio were significantly associated with changes in fasting insulin levels in both sexes (P<0.05). In analyses stratified by baseline obesity status, the association between change in BMI and change in fasting insulin was significantly stronger in overweight (males: standardized β=1.136; females: standardized β=1.262) and obese (males: standardized β=1.817; females: standardized β=2.290) participants than in those with normal weight (males: standardized β=0.957; females: standardized β=0.976) at baseline. Results were similar for changes in WC.

Conclusion

Changes in anthropometric indices were positively associated with fasting insulin level increases. Moreover, those who were overweight or obese at baseline had a higher absolute increase in fasting insulin levels per one standard deviation unit increase in anthropometric indices than adolescents with normal weight.

Citations

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Rice-based breakfast improves fasting glucose and HOMA-IR in Korean adolescents who skip breakfast, but breakfast skipping increases aromatic amino acids associated with diabetes prediction in Korean adolescents who skip breakfast: a randomized, parallel-
Hyun Suk Kim, Su-Jin Jung, Soyoung Jang, Min Jung Kim, Youn-Soo Cha
Nutrition Research and Practice.2022; 16(4): 450. CrossRef

Epidemiology
Discrepancies between Glycosylated Hemoglobin and Fasting Plasma Glucose for Diagnosing Impaired Fasting Glucose and Diabetes Mellitus in Korean Youth and Young Adults: Jieun Lee, Young Ah Lee, Jae Hyun Kim, Seong Yong Lee, Choong Ho Shin, Sei Won Yang; Diabetes Metab J. 2019;43(2):174-182. Published online November 2, 2018; DOI: https://doi.org/10.4093/dmj.2018.0046

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Abstract PDF Supplementary Material PubReader

Background

Glycosylated hemoglobin (HbA1c) has been recommended as a diagnostic test for prediabetes and diabetes. Here, we evaluated the level of agreement between diagnoses based on fasting plasma glucose (FPG) versus HbA1c levels and determined optimal HbA1c cutoff values for these diseases in youth and young adults.

Methods

The study included 7,332 subjects (n=4,129, aged 10 to 19 years in youth group; and n=3,203 aged 20 to 29 years in young adult group) from the 2011 to 2016 Korea National Health and Nutrition Examination Survey. Prediabetes and diabetes were defined as 100 to 125 mg/dL (impaired fasting glucose [IFG]) and ≥126 mg/dL for FPG (diabetes mellitus [DM] by FPG [DM_FPG]), and 5.7% to 6.4% and ≥6.5% for HbA1c, respectively.

Results

In the youth group, 32.5% with IFG had an HbA1c level of 5.7% to 6.4%, and 72.2% with DM_FPG had an HbA1c ≥6.5%. In the young adult group, 27.5% with IFG had an HbA1c level of 5.7% to 6.4%, and 66.6% with DM_FPG had an HbA1c ≥6.5%. Kappa coefficients for agreement between the FPG and HbA1c results were 0.12 for the youth group and 0.19 for the young adult group. In receiver operating characteristic curve analysis, the optimal HbA1c cutoff for IFG and DM_FPG were 5.6% and 5.9% in youths and 5.5% and 5.8% in young adults, respectively.

Conclusion

Usefulness of HbA1c for diagnosis of IFG and DM_FPG in Koreans aged <30 years remains to be determined due to discrepancies between the results of glucose- and HbA1c-based tests. Additional testing might be warranted at lower HbA1c levels to detect IFG and DM_FPG in this age group.

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Clinical Care/Education
Frequency of Self-Monitoring of Blood Glucose during the School Day Is Associated with the Optimal Glycemic Control among Korean Adolescents with Type 1 Diabetes: Eun Young Joo, Ji-Eun Lee, Hee Sook Kang, Shin Goo Park, Yong Hee Hong, Young-Lim Shin, Min Sohn; Diabetes Metab J. 2018;42(6):480-487. Published online June 29, 2018; DOI: https://doi.org/10.4093/dmj.2018.0018

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Background

This study aimed to evaluate the relationship between the frequency of self-monitoring of blood glucose (SMBG) and glycosylated hemoglobin (HbA1c) levels among Korean adolescents with type 1 diabetes mellitus (T1DM). Factors affecting the SMBG frequency were analyzed in order to improve their glycemic control.

Methods

Sixty-one adolescents aged 13 to 18 years with T1DM were included from one tertiary center. Clinical and biochemical variables were recorded. Factors associated with SMBG frequency were assessed using structured self-reported questionnaires.

Results

Average total daily SMBG frequency was 3.8±2.1 and frequency during the school day was 1.3±1.2. The mean HbA1c level was 8.6%±1.4%. As the daily SMBG frequency increased, HbA1c levels declined (P=0.001). The adjusted odds of achieving the target HbA1c in participants who performed daily SMBG ≥5 significantly increased 9.87 folds (95% confidence interval [CI], 1.58 to 61.70) compared with those performed SMBG four times a day. In the subjects whose SMBG frequency <1/day during the school day, an 80% reduction in the adjusted odds ratio 0.2 (95% CI, 0.05 to 0.86) showed compared to the group with performing two SMBG measurements in the school setting. The number of SMBG testing performed at school was significantly high for individuals assisted by their friends (P=0.031) and for those who did SMBG in the classrooms (P=0.039).

Conclusion

Higher SMBG frequency was significantly associated with lower HbA1c in Korean adolescents with T1DM. It would be necessary to establish the school environments that can facilitate adequate glycemic control, including frequent SMBG.

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Ayman A Al Hayek, Asirvatham A Robert, Mohamed A Al Dawish
Clinical Medicine Insights: Endocrinology and Diabetes.2019; 12: 117955141986110. CrossRef

Associations between Fatness, Fitness, IGF and IMT among Obese Korean Male Adolescents: Eun Sung Kim, Ji-Hye Park, Mi Kyung Lee, Dong Hoon Lee, Eun Seok Kang, Hyun Chul Lee, Yoonsuk Jekal, Justin Y. Jeon; Diabetes Metab J. 2011;35(6):610-618. Published online December 26, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.6.610

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Background

The purpose of this study was to investigate the association between obesity, fitness levels and cardiovascular (CVD) risk factors, and to identify the correlation between of insulin-like growth factor (IGF)-1, IGF binding protein-3 (IGFBP-3), and carotid intima media thickness (IMT) in Korean adolescents.

Methods

A total of 225 high school males with a mean age of 16.96±0.23 years participated in this study, and their fatness and fitness levels, fasting glucose, fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), blood lipids, IGF-1, IGFBP-3, and IMT were measured.

Results

The results showed that total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), fasting insulin, HOMA-IR, IGF-1, and IGFBP-3 levels were significantly higher in the most obese group than in the other two groups (tertiles). Muscular and cardiopulmonary fitness were negatively associated with weight, body mass index (BMI), fat mass, body fat, waist circumference (WC), fasting insulin, HOMA-IR, and IMT. IGF-1 and IGFBP-3 levels were correlated with WC, hip circumference (HC), fasting glucose, TG, HDL-C, fasting insulin, and HOMA-IR. IMT levels were significantly associated with weight, BMI, muscle mass, fat mass, percent body fat, WC, HC, systolic blood pressure, diastolic blood pressure and high-sensitivity C-reactive protein.

Conclusion

There was a significant association between increased obesity and decreased fitness and HOMA-IR, IGF, and IMT among adolescents.

Citations

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Effects of Resistance Training and Aerobic Exercise on Insulin Sensitivity in Overweight Korean Adolescents: A Controlled Randomized Trial: Sunghwan Suh, In-Kyong Jeong, Mi Yeon Kim, Yeon Soo Kim, Sue Shin, Sun Sin Kim, Jae Hyeon Kim; Diabetes Metab J. 2011;35(4):418-426. Published online August 31, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.4.418

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Background

Data on the impact of resistance training on insulin resistance in overweight or obese children are inconclusive.

Methods

Thirty overweight South Korean adolescents (mean age of 13.10 years) were divided by sex, and then randomly assigned to one of three treatment groups, which were the diet only (DO), diet with aerobic exercise (AE), or diet with resistance training (RT) group. Physiologic and metabolic parameters were assessed at baseline and after 12 weeks of exercise training and diet modification.

Results

Both exercise groups (aerobic and resistance) showed significant improvements in their insulin area under the curve and insulin sensitivity index values when compared to their baseline values while the DO group showed no significant changes in these variables. Age-, sex-, and body mass index (BMI)-adjusted intergroup comparison analyses showed a marked reduction in BMI and a significant reduction in muscle mass in the AE group when compared to the RT group and the DO group, respectively.

Conclusion

A 12-week exercise training program of either resistance or aerobic activity improved insulin sensitivity in overweight adolescents, although it failed to show superiority over a DO program. Aerobic exercise decreased both body weight and BMI, and it was noted that this group also had a significant reduction in muscle mass when compared to the DO group.

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The Relationship between the Level of Fatness and Fitness during Adolescence and the Risk Factors of Metabolic Disorders in Adulthood: Yoonsuk Jekal, Ji Eun Yun, Sang Wook Park, Sun Ha Jee, Justin Y Jeon; Korean Diabetes J. 2010;34(2):126-134. Published online April 30, 2010; DOI: https://doi.org/10.4093/kdj.2010.34.2.126

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Abstract PDF PubReader

Background

The purpose of the current study was to investigate the association between the level of obesity and physical fitness (PF) during adolescence and the risk factors of metabolic disorders during adulthood.

Methods

In the current analysis, 3,993 Korean adults (mean age, 38.70 ± 1.69 years) were recruited. The level of body index (BI) and PF were examined during adolescence through high school record, and their health examination data, including systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting glucose (FG), total cholesterol (TC), and current body mass index (BMI) were obtained from National Health Insurance Corporation Data. Gender-specific analyses were administered to compare health exam data across the level of BI, the level of PF, and a mixed level of BI and PF.

Results

Most obese males during high school had statistically higher SBP, DBP, FG, and BMI in adulthood, and most obese females had higher BMI, as compared to most lean males or females. Least fit males during high school had statistically higher BMI in adulthood, and least fit females had statistically higher SBP, DBP, FG, TC, and BMI, as compared to most fit males or females. There was a significant relationship between the mixed level of BI and PF and SBP, DBP, TC and current BMI in both genders.

Conclusion

Maintaining a healthy level of body weight and PF during adolescence is recommended to prevent the development of metabolic diseases in adulthood.

Citations

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Yoonsuk Jekal, Justin Y Jeon
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Self-Management and Health-Related Quality of Life in Adolescent and Adulthood Diabetic Patients.: Bong Suk Park, Gi Nam Jin, Youn Chung Choi, Ji Hee Chung, Kyoung Hoe Kim, Mi Young Lee, Jang Hyun Koh, Choon Hee Chung; Korean Diabetes J. 2005;29(3):254-261. Published online May 1, 2005

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Abstract PDF: BACKGROUND
The purposes of this study are to analyze the factors that influence selfmanagement and health-related QOL, and to provide useful informations to improve the QOL in adolescent and adult diabetic patients. METHODS: For this study, we interviewed 126 adolescent and adult diabetic patients who visited the Yonsei University Wonju Christian Hospital from March 4th, 2004 to April 5th, 2004. RESULTS: We examined the relationship between the socio-demographic characteristics and the health-related quality of life(QOL). There were statistically significant relationships between the QOL-and employment, years of education, income level and marriage status, but not between the health-related QOL and age and gender. Furthermore, there were no statistically significant relationships between the health-related QOL and smoking or drinking, nor between type 1 and 2 diabetic patients. The health-related QOL was significantly higher for an increased diabetes duration and for a greater number of symptoms, but the QOL was significantly lower in the presence of complications and hospital admission. The health-related QOL was lower when the preprandial blood glucose levels and HbA1c concentrations were higher, but it was higher when the hemoglobin and hematocrit levels were higher. Regarding the treatment methods, the health-related QOL was significantly lower for those patients who took insulin injection. The QOL was higher when the general self-management and diet therapy were well-controlled. Meanwhile, those subjects who had obtained medical informations from doctors, the media(including the internet and TV) and nurses in that order, they selected diet therapy as the hardest factor in the management of their diabetes. CONCLUSION: Adolescent and adult diabetic patients need continuous education and assistance to improve their health-related QOL and to keep from developing complications

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