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Pharmacotherapy
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Initial Pharmacological Strategies in People with Early Type 2 Diabetes Mellitus: A Systematic Review and Network Meta-Analysis
Jong Han Choi, Bo Kyung Koo, Ye Seul Yang, Se Hee Min, Jong Suk Park, Sang Youl Rhee, Hyun Jung Kim, Min Kyong Moon
Received October 24, 2024  Accepted January 16, 2025  Published online April 29, 2025  
DOI: https://doi.org/10.4093/dmj.2024.0660    [Epub ahead of print]
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AbstractAbstract PDF
Background
Type 2 diabetes mellitus (T2DM) requires stringent glycemic control from an early stage to prevent complications. The most effective treatment regimen for early T2DM remains unclear. The study aimed to compare the efficacy and safety of monotherapies and combination therapies for early T2DM.
Methods
A systematic review and network meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized controlled trials focused on glycemic control, body weight, and adverse events were included. The primary outcomes were changes in glycosylated hemoglobin (HbA1c) and odds of achieving the target HbA1c after 6 months.
Results
All combination therapies were more effective than monotherapy. Metformin+glucagon-like peptide-1 receptor agonists (GLP-1RA) (weighted mean difference [WMD] –1.50%; 95% confidence interval [CI] –2.04 to –0.96) and metformin+dipeptidyl peptidase-4 inhibitors (WMD –1.46%; 95% CI, –1.96 to –0.95) were the most effective for change in HbA1c. GLP-1RA and sodium- glucose cotransporter-2 inhibitors led to weight reduction. Apart from the increased risk of hypoglycemia with sulfonylureas, no significant differences in adverse events were observed across regimens.
Conclusion
Early combination therapy effectively improved glycemic control in patients with early T2DM without significantly increasing adverse risks. Future studies should explore new combinations, including potent GLP-1RA.
Basic Research
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Macrophage-Specific Progranulin Deficiency Prevents Diet-Induced Obesity through the Inhibition of Hypothalamic and Adipose Tissue Inflammation
Chan Hee Lee, Chae Beom Park, Hyun-Kyong Kim, Won Hee Jang, Se Hee Min, Jae Bum Kim, Min-Seon Kim
Received August 17, 2024  Accepted October 23, 2024  Published online March 11, 2025  
DOI: https://doi.org/10.4093/dmj.2024.0486    [Epub ahead of print]
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Chronic low-grade inflammation in multiple metabolic organs contributes to the development of insulin resistance induced by obesity. Progranulin (PGRN) is an evolutionarily-conserved secretory protein implicated in immune modulation. The generalized deletion of the PGRN-encoded Grn gene improves insulin resistance and glucose intolerance in obese mice fed a high-fat diet (HFD). However, it remains unclear which cells or organs are responsible for the beneficial metabolic effect of Grn depletion.
Methods
Considering the critical role of macrophages in HFD-induced obesity and inflammation, we generated mice with a macrophage-specific Grn depletion (Grn-MΦKO mice) by mating lysozyme M (LysM)-Cre and Grn-floxed mice. Body weight, food intake, energy expenditure, and glucose and insulin tolerance were compared between Grn-MΦKO mice and their wildtype (WT) controls under normal chow diet (NCD)- or HFD-fed conditions. We also examined macrophage activation and inflammation- related gene expression in the visceral adipose tissue and hypothalamus along with insulin and leptin signaling.
Results
Grn-MΦKO mice showed no alteration in metabolic phenotypes under NCD-fed conditions. However, upon HFD feeding, these mice exhibited less weight gain and improved glucose and insulin tolerance compared to WT mice. Moreover, HFD-induced macrophage activation and proinflammatory cytokine expression were significantly reduced in both the adipose tissue and hypothalamus of Grn-MΦKO mice, while HFD-induced impairments in leptin and insulin signaling showed improvement.
Conclusion
Macrophage-derived PGRN and possibly other Grn products play a critical role in the development of HFD-induced obesity, tissue inflammation, and impaired hormonal signaling in both central and peripheral metabolic organs.
Guideline/Statement/Fact Sheet
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Older Adults with Diabetes in Korea: Latest Clinical and Epidemiologic Trends
Kyuho Kim, Bongseong Kim, Kyuna Lee, Yu-Bae Ahn, Seung-Hyun Ko, Sung Hee Choi, Kyungdo Han, Jae-Seung Yun, on Behalf of the Committee of Public Relation of the Korean Diabetes Association
Diabetes Metab J. 2025;49(2):183-193.   Published online March 1, 2025
DOI: https://doi.org/10.4093/dmj.2024.0836
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Diabetes in older adults is becoming a significant public burden to South Korea. However, a comprehensive understanding of epidemiologic trends and the detailed clinical characteristics of older adults with diabetes is lacking. Therefore, we evaluated epidemiologic trends and the metabolic and lifestyle characteristics of diabetes in Korean older adults.
Methods
We analyzed data from the Korea National Health and Nutrition Examination Survey to assess diabetes prevalence according to diabetes duration and lifestyle behaviors. In addition, we drew upon the National Health Information Database of the National Health Insurance System to assess physical activity levels, antidiabetic medication use, polypharmacy, medication adherence, and major comorbidities.
Results
The absolute number of newly diagnosed cases of diabetes among older adults doubled over the past decade. Management rates of metabolic indicators were higher in older adults with diabetes compared to those without diabetes. The proportion of older adults with diabetes meeting the minimum recommended physical activity increased over the years. Compared to 10 years before, the use of dipeptidyl peptidase-4 inhibitor or sodium-glucose cotransporter-2 inhibitor had increased, as had comorbidities such as dyslipidemia, dementia, cancer, heart failure, atrial fibrillation, and chronic kidney disease. Initial medication adherence was significantly lower in those with end-stage kidney disease or dementia, insulin use, high-risk alcohol use, and living alone. Continuing insulin use 1 year after diagnosis of diabetes was significantly higher in those who initiated insulin therapy at diagnosis, had retinopathy, were on triple antidiabetic medications, and had a history of cancer.
Conclusion
Comprehensive management of metabolic indicators and physical activity is essential for older adults with diabetes. Improvements in prescribing guidelines, personalized management of age-related comorbidities, and individualized approaches that consider the heterogeneous nature of older adults with diabetes are desirable. Further research, such as high-quality cohort and intervention studies specific to older adults, is needed to establish evidence-based management for older adults with diabetes.
Guideline/Statement/Fact Sheet
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Prevalence, Incidence, and Metabolic Characteristics of Young Adults with Type 2 Diabetes Mellitus in South Korea (2010–2020)
Ji Yoon Kim, Jiyoon Lee, Joon Ho Moon, Se Eun Park, Seung-Hyun Ko, Sung Hee Choi, Nam Hoon Kim
Diabetes Metab J. 2025;49(2):172-182.   Published online March 1, 2025
DOI: https://doi.org/10.4093/dmj.2024.0826
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
This study aimed to examine trends in the prevalence, incidence, metabolic characteristics, and management of type 2 diabetes mellitus (T2DM) among young adults in South Korea.
Methods
Young adults with T2DM were defined as individuals aged 19 to 39 years who met the diagnostic criteria for T2DM. Data from the Korean National Health Insurance Service-Customized Database (2010–2020, n=225,497–372,726) were analyzed to evaluate trends in T2DM prevalence, incidence, metabolic profiles, comorbidities, and antidiabetic drug prescription. Additional analyses were performed using the Korea National Health and Nutrition Examination Survey.
Results
The prevalence of T2DM in young adults significantly increased from 1.02% in 2010 to 2.02% in 2020 (P<0.001), corresponding to 372,726 patients in 2020. Over the same period, the incidence rate remained stable within the range of 0.36% to 0.45%. Prediabetes prevalence steadily increased from 15.53% to 20.92%, affecting 3.87 million individuals in 2020. The proportion of young adults with T2DM who were obese also increased, with 67.8% having a body mass index (BMI) ≥25 kg/m² and 31.6% having a BMI ≥30 kg/m² in 2020. The prevalence of hypertension, dyslipidemia, and fatty liver disease also increased, reaching 34.2%, 79.8%, and 78.9%, respectively, in 2020. Although the overall pharmacological treatment rate remained low, the prescription of antidiabetic medications with weight-reducing properties increased over the study period.
Conclusion
The prevalence of T2DM among young adults in South Korea nearly doubled over the past decade. The strong association with obesity and metabolic comorbidities emphasizes the urgent need for targeted prevention and management strategies tailored to this population.
Guideline/Statement/Fact Sheet
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Diabetes Fact Sheets in Korea 2024
Se Eun Park, Seung-Hyun Ko, Ji Yoon Kim, Kyuho Kim, Joon Ho Moon, Nam Hoon Kim, Kyung Do Han, Sung Hee Choi, Bong Soo Cha
Diabetes Metab J. 2025;49(1):24-33.   Published online January 1, 2025
DOI: https://doi.org/10.4093/dmj.2024.0818
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  • 517 Download
  • 4 Web of Science
  • 9 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
This study aimed to investigate the prevalence, management, and comorbidities of diabetes mellitus among Korean adults.
Methods
Data from the Korea National Health and Nutrition Examination Survey (2019–2022) were analyzed to assess the prevalence, treatment, risk factors, and comorbidities of diabetes. Comparisons between young and older adults with diabetes were emphasized.
Results
Among Korean adults aged ≥30 years, the prevalence of diabetes is 15.5% during 2021–2022. Of these, 74.7% were aware of their condition, 70.9% received antidiabetic treatment, and only 32.4% achieved glycosylated hemoglobin (HbA1c) <6.5%. Moreover, 15.9% met the integrated management targets, which included HbA1c <6.5%, blood pressure <140/85 mm Hg, and low-density lipoprotein cholesterol <100 mg/dL. In young adults aged 19 to 39 years, the prevalence of diabetes was 2.2%. Among them, 43.3% were aware of their condition, 34.6% received treatment, and 29.6% achieved HbA1c <6.5%. Obesity affected 87.1%, and 26.9% had both hypertension and hypercholesterolemia. Among adults aged ≥65 years, the prevalence of diabetes was 29.3%, with awareness, treatment, and control rates of 78.8%, 75.7%, and 31.2%, respectively. Integrated management targets (HbA1c <7.5%, hypertension, and lipids) were achieved by 40.1%.
Conclusion
Diabetes mellitus remains highly prevalent among Korean adults, with significant gaps in integrated glycemic, blood pressure, and lipid control. Older adults with diabetes show higher awareness and treatment rates but limited integrated management outcomes. Young adults with diabetes bear a significant burden of obesity and comorbidities, alongside low awareness and treatment rates. Therefore, early intervention programs, education, and strategies tailored to younger populations are urgently required.

Citations

Citations to this article as recorded by  
  • Diabetes in Korean Adults: Prevalence, Management, and Comorbidities
    Sung Hoon Yu
    Diabetes & Metabolism Journal.2025; 49(1): 22.     CrossRef
  • Effectiveness of adding glucagon-like peptide-1 receptor agonist on diabetes complications and mortality among basal insulin-treated people with type 2 diabetes: A real-world Korean study
    Kyoung Hwa Ha, Won Kim, Dong Han Kim, Dae Jung Kim
    Journal of Diabetes and its Complications.2025; 39(5): 108983.     CrossRef
  • A Machine Learning-Based Prediction Model for Diabetic Kidney Disease in Korean Patients with Type 2 Diabetes Mellitus
    Kyung Ae Lee, Jong Seung Kim, Yu Ji Kim, In Sun Goak, Heung Yong Jin, Seungyong Park, Hyejin Kang, Tae Sun Park
    Journal of Clinical Medicine.2025; 14(6): 2065.     CrossRef
  • Glucagon-Like Peptide-1 Receptor Agonists: What’s the Optimizing Policies for Obesity-Related Metabolic Diseases?
    Tae Sun Park
    Diabetes & Metabolism Journal.2025; 49(2): 169.     CrossRef
  • Older Adults with Diabetes in Korea: Latest Clinical and Epidemiologic Trends
    Kyuho Kim, Bongseong Kim, Kyuna Lee, Yu-Bae Ahn, Seung-Hyun Ko, Sung Hee Choi, Kyungdo Han, Jae-Seung Yun
    Diabetes & Metabolism Journal.2025; 49(2): 183.     CrossRef
  • How Do We Diagnose Diabetes in Primary Care?
    Hyeong Jin Kim
    The Journal of Korean Diabetes.2025; 26(1): 10.     CrossRef
  • Prevention and Management of Prediabetes
    Jae Min Lee
    The Journal of Korean Diabetes.2025; 26(1): 18.     CrossRef
  • Feasibility of a Structured Calorie-Restricted Dietary Intervention in Korean Adults with Early Type 2 Diabetes and Obesity: A Pilot Study
    Su-Jeong Park, Mee Kyung Kim, Jinyoung Kim, Ji-Yeon Choi, YoonJu Song, Hyuk-Sang Kwon
    Nutrients.2025; 17(9): 1530.     CrossRef
  • Prevalence and Current Status of Cardiometabolic Risk Factors in Korean Adults Based on Fact Sheets 2024
    Eun-Jung Rhee
    Endocrinology and Metabolism.2025; 40(2): 174.     CrossRef
Reviews
Drug/Regimen
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Benefit and Safety of Sodium-Glucose Co-Transporter 2 Inhibitors in Older Patients with Type 2 Diabetes Mellitus
Ja Young Jeon, Dae Jung Kim
Diabetes Metab J. 2024;48(5):837-846.   Published online September 1, 2024
DOI: https://doi.org/10.4093/dmj.2024.0317
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  • 521 Download
  • 2 Web of Science
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AbstractAbstract PDFPubReader   ePub   
People with type 2 diabetes mellitus (T2DM) are at higher risk of developing cardiovascular disease, heart failure, chronic kidney disease, and premature death than people without diabetes. Therefore, treatment of diabetes aims to reduce these complications. Sodium-glucose co-transporter 2 (SGLT2) inhibitors have shown beneficial effects on cardiorenal and metabolic health beyond glucose control, making them a promising class of drugs for achieving the ultimate goals of diabetes treatment. However, despite their proven benefits, the use of SGLT2 inhibitors in eligible patients with T2DM remains suboptimal due to reports of adverse events. The use of SGLT2 inhibitors is particularly limited in older patients with T2DM because of the lack of treatment experience and insufficient long-term safety data. This article comprehensively reviews the risk-benefit profile of SGLT2 inhibitors in older patients with T2DM, drawing on data from prospective randomized controlled trials of cardiorenal outcomes, original studies, subgroup analyses across different age groups, and observational cohort studies.

Citations

Citations to this article as recorded by  
  • Trends in prescribing sodium‐glucose cotransporter 2 inhibitors for individuals with type 2 diabetes with and without cardiovascular‐renal disease in South Korea, 2015–2021
    Kyoung Hwa Ha, Soyoung Shin, EunJi Na, Dae Jung Kim
    Journal of Diabetes Investigation.2025; 16(2): 215.     CrossRef
  • Pharmacological management of diabetes in older adults
    Junghyun Noh
    Cardiovascular Prevention and Pharmacotherapy.2025; 7(1): 13.     CrossRef
  • Challenges, current innovations, and opportunities for managing type 2 diabetes in frail older adults: a position paper of the European Geriatric Medicine Society (EuGMS)—Special Interest Group in Diabetes
    Virginia Boccardi, Gülistan Bahat, Cafer Balci, Isabelle Bourdel-Marchasson, Antoine Christiaens, Lorenzo Maria Donini, Sibel Cavdar, Stefania Maggi, Serdar Özkök, Tajana Pavic, Stany Perkisas, Stefano Volpato, Muhammad Shoaib Zaidi, Andrej Zeyfang, Alan
    European Geriatric Medicine.2025;[Epub]     CrossRef
Others
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Holistic and Personalized Strategies for Managing in Elderly Type 2 Diabetes Patients
Jae-Seung Yun, Kyuho Kim, Yu-Bae Ahn, Kyungdo Han, Seung-Hyun Ko
Diabetes Metab J. 2024;48(4):531-545.   Published online July 26, 2024
DOI: https://doi.org/10.4093/dmj.2024.0310
  • 9,634 View
  • 432 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract PDFPubReader   ePub   
Due to increased life expectancy and lifestyle changes, the prevalence of diabetes among the elderly in Korea is continuously rising, as is the associated public health burden. Diabetes management in elderly patients is complicated by age-related physiological changes, sarcopenia characterized by loss of muscle mass and function, comorbidities, and varying levels of functional, cognitive, and mobility abilities that lead to frailty. Moreover, elderly patients with diabetes frequently face multiple chronic conditions that elevate their risk of cardiovascular diseases, cancer, and mortality; they are also prone to complications such as hyperglycemic hyperosmolar state, diabetic ketoacidosis, and severe hypoglycemia. This review examines the characteristics of and management approaches for diabetes in the elderly, and advocates for a comprehensive yet personalized strategy.

Citations

Citations to this article as recorded by  
  • Diabetes Fact Sheets in Korea 2024
    Se Eun Park, Seung-Hyun Ko, Ji Yoon Kim, Kyuho Kim, Joon Ho Moon, Nam Hoon Kim, Kyung Do Han, Sung Hee Choi, Bong Soo Cha
    Diabetes & Metabolism Journal.2025; 49(1): 24.     CrossRef
  • The effect of multidisciplinary team and experience-based co-design on the care of older adult patients with type 2 diabetes: A randomized controlled trial
    Yujun Zhuang, Hongjiang Ye, Xiaoyan Yang, Lifang Zheng, Zhizhen Chen, Jianjia Jiang, Lunpan Mou, Pingping Li, Jiawei Qin, Yaduan Dai, Yanling Mao
    Diabetes Research and Clinical Practice.2025; 221: 112028.     CrossRef
  • Older Adults with Diabetes in Korea: Latest Clinical and Epidemiologic Trends
    Kyuho Kim, Bongseong Kim, Kyuna Lee, Yu-Bae Ahn, Seung-Hyun Ko, Sung Hee Choi, Kyungdo Han, Jae-Seung Yun
    Diabetes & Metabolism Journal.2025; 49(2): 183.     CrossRef
Original Articles
Basic Research
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Single-Cell Landscape and a Macrophage Subset Enhancing Brown Adipocyte Function in Diabetes
Junfei Gu, Jiajia Jin, Xiaoyu Ren, Xinjie Zhang, Jiaxuan Li, Xiaowei Wang, Shucui Zhang, Xianlun Yin, Qunye Zhang, Zhe Wang
Diabetes Metab J. 2024;48(5):885-900.   Published online May 29, 2024
DOI: https://doi.org/10.4093/dmj.2023.0278
  • 4,498 View
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  • 3 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Metabolic dysregulation is a hallmark of type 2 diabetes mellitus (T2DM), in which the abnormalities in brown adipose tissue (BAT) play important roles. However, the cellular composition and function of BAT as well as its pathological significance in diabetes remain incompletely understood. Our objective is to delineate the single-cell landscape of BAT-derived stromal vascular fraction (SVF) and their characteristic alterations in T2DM rats.
Methods
T2DM was induced in rats by intraperitoneal injection of low-dose streptozotocin and high-fat diet feeding. Single-cell mRNA sequencing was then performed on BAT samples and compared to normal rats to characterize changes in T2DM rats. Subsequently, the importance of key cell subsets in T2DM was elucidated using various functional studies.
Results
Almost all cell types in the BAT-derived SVF of T2DM rats exhibited enhanced inflammatory responses, increased angiogenesis, and disordered glucose and lipid metabolism. The multidirectional differentiation potential of adipose tissue-derived stem cells was also reduced. Moreover, macrophages played a pivotal role in intercellular crosstalk of BAT-derived SVF. A novel Rarres2+macrophage subset promoted the differentiation and metabolic function of brown adipocytes via adipose-immune crosstalk.
Conclusion
BAT SVF exhibited strong heterogeneity in cellular composition and function and contributed to T2DM as a significant inflammation source, in which a novel macrophage subset was identified that can promote brown adipocyte function.

Citations

Citations to this article as recorded by  
  • Single-Cell Landscape and a Macrophage Subset Enhancing Brown Adipocyte Function in Diabetes (Diabetes Metab J 2024;48:885-900)
    Yea Eun Kang, Ju Hee Lee
    Diabetes & Metabolism Journal.2025; 49(1): 160.     CrossRef
  • Single-Cell Landscape and a Macrophage Subset Enhancing Brown Adipocyte Function in Diabetes (Diabetes Metab J 2024;48:885-900)
    Junfei Gu, Xinjie Zhang, Qunye Zhang, Zhe Wang
    Diabetes & Metabolism Journal.2025; 49(1): 162.     CrossRef
  • Engineered stromal vascular fraction for tissue regeneration
    Jianfeng Liu, Yiwei Li, Yanan Zhang, Zhiwei Zhao, Bin Liu
    Frontiers in Pharmacology.2025;[Epub]     CrossRef
Drug/Regimen
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Efficacy and Safety of Alogliptin-Pioglitazone Combination for Type 2 Diabetes Mellitus Poorly Controlled with Metformin: A Multicenter, Double-Blind Randomized Trial
Ji-Yeon Park, Joonyub Lee, Yoon-Hee Choi, Kyung Wan Min, Kyung Ah Han, Kyu Jeung Ahn, Soo Lim, Young-Hyun Kim, Chul Woo Ahn, Kyung Mook Choi, Kun-Ho Yoon, the Practical Evidence of Antidiabetic Combination Therapy in Korea (PEAK) study investigators
Diabetes Metab J. 2024;48(5):915-928.   Published online April 23, 2024
DOI: https://doi.org/10.4093/dmj.2023.0259
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Guidelines for switching to triple combination therapy directly after monotherapy failure are limited. This study investigated the efficacy, long-term sustainability, and safety of either mono or dual add-on therapy using alogliptin and pioglitazone for patients with type 2 diabetes mellitus (T2DM) who did not achieve their target glycemic range with metformin monotherapy.
Methods
The Practical Evidence of Antidiabetic Combination Therapy in Korea (PEAK) was a multicenter, placebo-controlled, double-blind, randomized trial. A total of 214 participants were randomized to receive alogliptin+pioglitazone (Alo+Pio group, n=70), alogliptin (Alo group, n=75), or pioglitazone (Pio group, n=69). The primary outcome was the difference in glycosylated hemoglobin (HbA1c) levels between the three groups at baseline to 24 weeks. For durability, the achievement of HbA1c levels <7% and <6.5% was compared in each group. The number of adverse events was investigated for safety.
Results
After 24 weeks of treatment, the change of HbA1c in the Alo+Pio, Alo, and Pio groups were –1.38%±0.08%, –1.03%±0.08%, and –0.84%±0.08%, respectively. The Alo+Pio group had significantly lower HbA1c levels than the other groups (P=0.0063, P<0.0001) and had a higher proportion of patients with target HbA1c achievement. In addition, insulin sensitivity and β-cell function, lipid profiles, and other metabolic indicators were also improved. There were no significant safety issues in patients treated with triple combination therapy.
Conclusion
Early combination triple therapy showed better efficacy and durability than the single add-on (dual) therapy. Therefore, combination therapy with metformin, alogliptin, and pioglitazone is a valuable early treatment option for T2DM poorly controlled with metformin monotherapy.
Metabolic Risk/Epidemiology
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Harnessing Metabolic Indices as a Predictive Tool for Cardiovascular Disease in a Korean Population without Known Major Cardiovascular Event
Hyun-Jin Kim, Byung Sik Kim, Yonggu Lee, Sang Bong Ahn, Dong Wook Kim, Jeong-Hun Shin
Diabetes Metab J. 2024;48(3):449-462.   Published online February 1, 2024
DOI: https://doi.org/10.4093/dmj.2023.0197
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  • 2 Web of Science
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
This study evaluated the usefulness of indices for metabolic syndrome, non-alcoholic fatty liver disease (NAFLD), and insulin resistance (IR), as predictive tools for cardiovascular disease in middle-aged Korean adults.
Methods
The prospective data obtained from the Ansan-Ansung cohort database, excluding patients with major adverse cardiac and cerebrovascular events (MACCE). The primary outcome was the incidence of MACCE during the follow-up period.
Results
A total of 9,337 patients were included in the analysis, of whom 1,130 (12.1%) experienced MACCE during a median follow-up period of 15.5 years. The metabolic syndrome severity Z-score, metabolic syndrome severity score, hepatic steatosis index, and NAFLD liver fat score were found to significantly predict MACCE at values above the cut-off point and in the second and third tertiles. Among these indices, the hazard ratios of the metabolic syndrome severity score and metabolic syndrome severity Z-score were the highest after adjusting for confounding factors. The area under the receiver operating characteristic curve (AUC) of the 10-year atherosclerotic cardiovascular disease (ASCVD) score for predicting MACCE was 0.716, and the metabolic syndrome severity Z-score had an AUC of 0.619.
Conclusion
The metabolic syndrome severity score is a highly reliable indicator and was closely associated with the 10-year ASCVD risk score in predicting MACCE in the general population. Given the specific characteristics and limitations of metabolic syndrome severity scores as well as the indices of NAFLD and IR, a more practical scoring system that considers these factors is essential to achieve greater accuracy in forecasting cardiovascular outcomes.

Citations

Citations to this article as recorded by  
  • Comparing non-alcoholic fatty liver disease indices in predicting the prevalence and incidence of metabolic syndrome in middle-aged adults
    Byung Sik Kim, Hyun-Jin Kim, Seong Won Jeon, Kyung Hwan Kim, Dong Wook Kim, Jeong-Hun Shin
    Heliyon.2025; 11(7): e43073.     CrossRef
  • Association between mixed exposure to per- and polyfluoroalkyl substances and metabolic syndrome in Korean adults: Data from the Korean National environmental health survey cycle 4
    Seung Min Chung, Kyun Hoo Kim, Jun Sung Moon, Kyu Chang Won
    International Journal of Hygiene and Environmental Health.2024; 261: 114427.     CrossRef
  • Estimated pulse wave velocity as a forefront indicator of developing metabolic syndrome in Korean adults
    Hyun-Jin Kim, Byung Sik Kim, Dong Wook Kim, Jeong-Hun Shin
    The Korean Journal of Internal Medicine.2024; 39(4): 612.     CrossRef
Others
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Comparative Effect of Glucose-Lowering Drugs for Type 2 Diabetes Mellitus on Stroke Prevention: A Systematic Review and Network Meta-Analysis
Ji Soo Kim, Gyeongsil Lee, Kyung-Il Park, Seung-Won Oh
Diabetes Metab J. 2024;48(2):312-320.   Published online January 26, 2024
DOI: https://doi.org/10.4093/dmj.2022.0421
  • 6,714 View
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  • 6 Web of Science
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
There is still a lack of research on which diabetic drugs are more effective in preventing stroke. Our network metaanalysis aimed to compare cerebrovascular benefits among glucose-lowering treatments.
Methods
We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the ClinicalTrials.gov registry for clinical trials from inception through May 25, 2021. We included both prespecified cerebrovascular outcomes and cerebrovascular events reported as severe adverse events. Subgroup analyses were conducted by stroke subtype, publication type, age of patients, baseline glycosylated hemoglobin (HbA1c), duration of type 2 diabetes mellitus, and cardiovascular risks.
Results
Of 2,861 reports and 1,779 trials screened, 79 randomized controlled trials comprising 206,387 patients fulfilled the inclusion criteria. In the pairwise meta-analysis, the use of glucagon-like peptide-1 (GLP-1) agonist was associated with a lower risk of total stroke compared with placebo (relative risk [RR], –0.17; 95% confidence interval [CI], –0.27 to –0.07). In the network meta- analysis, only the use of sodium-glucose cotransporter-2 (SGLT-2) inhibitor was associated with a reduction of total stroke, compared with placebo (RR, 0.81; 95% CI, 0.67 to 0.98). In the subgroup analyses, the use of SGLT-2 inhibitor and GLP-1 agonist was associated with a lower risk of stroke in those with high HbA1c (≥8.0) and low-risk of cardiovascular disease, respectively.
Conclusion
SGLT-2 inhibitors and GLP-1 agonists were shown to be beneficial for stroke prevention in patients with type 2 diabetes mellitus.

Citations

Citations to this article as recorded by  
  • Sodium-glucose cotransporter protein 2 inhibition, plasma proteins, and ischemic stroke: A mediation Mendelian randomization and colocalization study
    Zhiqing Chen, Hongmei Meng, Yujin Guo, Huaiyu Sun, Wuqiong Zhang, Yu Guo, Shuai Hou
    Journal of Stroke and Cerebrovascular Diseases.2025; 34(1): 108136.     CrossRef
  • Secondary stroke prevention beyond antiplatelets: The role of colchicine and GLP-1RA – an ounce of prevention is worth a pound of cure
    Milija D. Mijajlović, Natan M. Bornstein, Vuk Aleksić
    Therapeutic Advances in Neurological Disorders.2025;[Epub]     CrossRef
  • SGLT2 Inhibitors and GLP-1 Agonists: A Beacon of Hope for Stroke Prevention in Diabetes
    Jae-Han Jeon
    Diabetes & Metabolism Journal.2024; 48(2): 213.     CrossRef
  • Reply to comment on: Association of glucose-lowering drugs with incident stroke and transient ischaemic attacks in primary care patients with type 2 diabetes: disease analyser database
    Wolfgang Rathmann, Karel Kostev
    Acta Diabetologica.2024; 61(8): 1081.     CrossRef
  • Empagliflozin: Primus Inter Pares Among Sodium–Glucose Cotransporter-2 Inhibitors?
    Giuseppe Biondi-Zoccai, Giacomo Frati, Mariangela Peruzzi, George W. Booz
    Journal of Cardiovascular Pharmacology.2024; 84(3): 271.     CrossRef
  • Impact of GLP-1 Receptor Agonists on Psoriasis and Cardiovascular Comorbidities: A Narrative Review
    Kathryn Haran, Chandler Johnson, Payton Smith, Zoë Venable, Allison Kranyak, Tina Bhutani, Caleb Jeon, Wilson Liao
    Psoriasis: Targets and Therapy.2024; Volume 14: 143.     CrossRef
Basic Research
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A New Concept in Antidiabetic Therapeutics: A Concerted Removal of Labile Iron and Intracellular Deposition of Zinc
Vladimir Vinokur, Eduard Berenshtein, Mordechai Chevion, Dror Chevion
Diabetes Metab J. 2024;48(1):59-71.   Published online January 3, 2024
DOI: https://doi.org/10.4093/dmj.2022.0292
Retraction in: Diabetes Metab J 2024;48(2):325
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  • 178 Download
  • 2 Web of Science
  • 1 Crossref
Guideline/Fact Sheet
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Dyslipidemia Fact Sheet in South Korea, 2022
Eun-Sun Jin, Jee-Seon Shim, Sung Eun Kim, Jae Hyun Bae, Shinae Kang, Jong Chul Won, Min-Jeong Shin, Heung Yong Jin, Jenny Moon, Hokyou Lee, Hyeon Chang Kim, In-Kyung Jeong, on Behalf of the Committee of Public Relation of the Korean Society of Lipid and Atherosclerosis
Diabetes Metab J. 2023;47(5):632-642.   Published online August 2, 2023
DOI: https://doi.org/10.4093/dmj.2023.0135
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Background
This study aimed to investigate the prevalence and status of dyslipidemia management among South Korean adults, as performed by the Korean Society of Lipid and Atherosclerosis under the name Dyslipidemia Fact Sheet 2022.
Methods
We analyzed the lipid profiles, age-standardized and crude prevalence, management status of hypercholesterolemia and dyslipidemia, and health behaviors among Korean adults aged ≥20 years, using the Korea National Health and Nutrition Examination Survey data between 2007 and 2020.
Results
In South Korea, the crude prevalence of hypercholesterolemia (total cholesterol ≥240 mg/dL or use of a lipid-lowering drug) in 2020 was 24%, and the age-standardized prevalence of hypercholesterolemia more than doubled from 2007 to 2020. The crude treatment rate was 55.2%, and the control rate was 47.7%. The crude prevalence of dyslipidemia—more than one out of three conditions (low-density lipoprotein cholesterol ≥160 or the use of a lipid-lowering drug, triglycerides ≥200, or high-density lipoprotein cholesterol [HDL-C] [men and women] <40 mg/dL)—was 40.2% between 2016 and 2020. However, it increased to 48.2% when the definition of hypo-HDL-cholesterolemia in women changed from <40 to <50 mg/dL.
Conclusion
Although the prevalence of hypercholesterolemia and dyslipidemia has steadily increased in South Korea, the treatment rate remains low. Therefore, continuous efforts are needed to manage dyslipidemia through cooperation between the national healthcare system, patients, and healthcare providers.

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Drug Regimen
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Efficacy and Safety of Enavogliflozin versus Dapagliflozin as Add-on to Metformin in Patients with Type 2 Diabetes Mellitus: A 24-Week, Double-Blind, Randomized Trial
Kyung Ah Han, Yong Hyun Kim, Doo Man Kim, Byung Wan Lee, Suk Chon, Tae Seo Sohn, In Kyung Jeong, Eun-Gyoung Hong, Jang Won Son, Jae Jin Nah, Hwa Rang Song, Seong In Cho, Seung-Ah Cho, Kun Ho Yoon
Diabetes Metab J. 2023;47(6):796-807.   Published online February 9, 2023
DOI: https://doi.org/10.4093/dmj.2022.0315
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  • 9 Web of Science
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Background
Enavogliflozin is a novel sodium-glucose cotransporter-2 inhibitor currently under clinical development. This study evaluated the efficacy and safety of enavogliflozin as an add-on to metformin in Korean patients with type 2 diabetes mellitus (T2DM) against dapagliflozin.
Methods
In this multicenter, double-blind, randomized, phase 3 study, 200 patients were randomized to receive enavogliflozin 0.3 mg/day (n=101) or dapagliflozin 10 mg/day (n=99) in addition to ongoing metformin therapy for 24 weeks. The primary objective of the study was to prove the non-inferiority of enavogliflozin to dapagliflozin in glycosylated hemoglobin (HbA1c) change at week 24 (non-inferiority margin of 0.35%) (Clinical trial registration number: NCT04634500).
Results
Adjusted mean change of HbA1c at week 24 was –0.80% with enavogliflozin and –0.75% with dapagliflozin (difference, –0.04%; 95% confidence interval, –0.21% to 0.12%). Percentages of patients achieving HbA1c <7.0% were 61% and 62%, respectively. Adjusted mean change of fasting plasma glucose at week 24 was –32.53 and –29.14 mg/dL. An increase in urine glucose-creatinine ratio (60.48 vs. 44.94, P<0.0001) and decrease in homeostasis model assessment of insulin resistance (–1.85 vs. –1.31, P=0.0041) were significantly greater with enavogliflozin than dapagliflozin at week 24. Beneficial effects of enavogliflozin on body weight (–3.77 kg vs. –3.58 kg) and blood pressure (systolic/diastolic, –5.93/–5.41 mm Hg vs. –6.57/–4.26 mm Hg) were comparable with those of dapagliflozin, and both drugs were safe and well-tolerated.
Conclusion
Enavogliflozin added to metformin significantly improved glycemic control in patients with T2DM and was non-inferior to dapagliflozin 10 mg, suggesting enavogliflozin as a viable treatment option for patients with inadequate glycemic control on metformin alone.

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Guideline/Fact Sheet
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Insulin Fact Sheet in Type 1 and 2 Diabetes Mellitus and Trends of Antidiabetic Medication Use in Insulin Users with Type 2 Diabetes Mellitus: 2002 to 2019
Jiyun Park, Gyuri Kim, Bong-Sung Kim, Kyung-Do Han, So Yoon Kwon, So Hee Park, You-Bin Lee, Sang-Man Jin, Jae Hyeon Kim
Diabetes Metab J. 2023;47(2):211-219.   Published online February 7, 2023
DOI: https://doi.org/10.4093/dmj.2022.0346
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Background
This study investigated the trends of insulin use among Korean patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). Changes in prescription of antidiabetic medications in T2DM patients taking insulin therapy were evaluated.
Methods
We analyzed data from the National Health Insurance Service database in Korea to evaluate the prevalence of insulin users and trends of insulin use in T1DM and T2DM patients from January 2002 to December 2019. We also investigated numbers and types of antidiabetic medications in insulin users with T2DM.
Results
The overall total number of insulin users increased from 2002 to 2019, reaching 348,254 for T2DM and 20,287 for T1DM in 2019 compared with 109,974 for T2DM and 34,972 for T1DM in 2002. The proportion of patients using basal analogs and short acting analogs have increased and those using human insulin, premixed insulin, or biphasic human insulin have decreased (rapid acting analogs: 71.85% and 24.12% in T1DM and T2DM, respectively, in 2019; basal analogs: 76.75% and 75.09% in T1DM and T2DM, respectively, in 2019). The use of other antidiabetic medication in addition to insulin increased for T2DM, especially in dual therapy, reaching up to 52.35% in 2019 compared with 16.72% in 2002.
Conclusion
The proportion of the patients using basal or rapid acting analogs increased among all insulin users in both T1DM and T2DM patients. Among patients with T2DM, the proportion of patients using antidiabetic medications in addition to insulin was significantly increased compared to those who used insulin alone.

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