Diabetes & Metabolism Journal

Original Articles

Technology/Device
Current Status of Continuous Glucose Monitoring Use in South Korean Type 1 Diabetes Mellitus Population–Pronounced Age-Related Disparities: Nationwide Cohort Study: Ji Yoon Kim, Seohyun Kim, Jae Hyeon Kim; Diabetes Metab J. 2025;49(5):1040-1050. Published online April 28, 2025; DOI: https://doi.org/10.4093/dmj.2024.0804

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Background
This study aims to identify the status of continuous glucose monitoring (CGM) use among individuals with type 1 diabetes mellitus (T1DM) in South Korea and to investigate whether age-related disparities exist.
Methods
Individuals with T1DM receiving intensive insulin therapy were identified from the Korean National Health Insurance Cohort (2019–2022). Characteristics of CGM users and non-users were compared, and the prescription rates of CGM and sensor- augmented pump (SAP) or automated insulin delivery (AID) systems according to age groups (<19, 19–39, 40–59, and ≥60 years) were analyzed using chi-square tests. Glycosylated hemoglobin (HbA1c) levels and coefficients of variation (CV) among CGM users were also examined.
Results
Among the 56,908 individuals with T1DM, 10,822 (19.0%) used CGM at least once, and 6,073 (10.7%) used CGM continuously. Only 241 (0.4%) individuals utilized either SAP or AID systems. CGM users were younger than non-users. The continuous prescription rate of CGM was highest among individuals aged <19 years (37.0%), followed by those aged 19–39 years (15.8%), 40–59 years (10.7%), and ≥60 years (3.9%) (P<0.001 for between-group differences). Among CGM users, HbA1c levels decreased from 8.7%±2.4% at baseline to 7.2%±1.2% at 24 months, and CV decreased from 36.6%±11.9% at 3 months to 34.1%±12.7% at 24 months.
Conclusion
Despite national reimbursement for CGM devices, the prescription rates of CGM remain low, particularly among older adults. Given the improvements in HbA1c and CV following CGM initiation, more efforts are needed to increase CGM utilization and reduce age-related disparities.

Citations

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Association of perceived diabetes stigma with time below range <3.0 mmol/L and anxiety in adults with type 1 diabetes using continuous glucose monitoring
Seohyun Kim, Soojin Park, Sang‐Man Jin, Jae Hyeon Kim, Gyuri Kim
Diabetic Medicine.2026;[Epub] CrossRef
Suboptimal adoption of diabetes technology despite coverage and the impact on glycemic outcomes in children and adolescents with type 1 diabetes in Hong Kong
Sarah Wing-yiu Poon, Kwong-tat Chan, Betty Wai-man But, Shirley Man-yee Wong, Wing-in Yam, Pik-to Cheung, Wing-shan See, Suk-yan Chan, Ho-chung Yau, Eunice Wai Yu Wong, Lap Ming Wong, Antony Chun-cheung Fu, Elaine Yin-wah Kwan, Janez Heung-ching Tsui, Sin
Journal of Pediatric Endocrinology and Metabolism.2026; 39(3): 251. CrossRef
Preliminary clinical outcomes and adoption of continuous glucose monitoring following reimbursement implementation in patients with type 1 diabetes in Thailand
Nichapa Yordsudueam, Nattakarn Numsriskulrat, Worapimon Lerdrassameethad, Pattayarporn Paleekul, Jutipond jitchana, Nitchakarn Laichuthai, Taninee Sahakitrungruang
Annals of Pediatric Endocrinology & Metabolism.2026; 31(1): 66. CrossRef
Challenges and Opportunities for Improving Care for Type 1 Diabetes in Older Adulthood
Anna R. Kahkoska, Joshua J. Neumiller, Anastasia-Stefania Alexopoulos, Amlan Barik, Elbert S. Huang, Lori M. Laffel, Naushira Pandya, Christine Slyne, Elena Toschi, Ruth S. Weinstock, Medha Munshi
Diabetes Care.2026; 49(4): 559. CrossRef
Continuous glucose monitoring and risks of acute and chronic diabetes-related complications and mortality in adults with type 1 diabetes: a nationwide cohort study
Ji Yoon Kim, Seohyun Kim, Jae Hyeon Kim
Diabetologia.2026;[Epub] CrossRef
Integrating Pharmacists into CGM-Enabled Digital Diabetes Care: Advancing Personalized and Data-Driven Management
Xiaoxiao Chen, Gyeong Eon Kim, Nam Ah Kim, Kwang Joon Kim
Healthcare.2026; 14(8): 1019. CrossRef
Sequential use of continuous glucose monitoring, with or without exercise trackers, significantly improves glycemic control in patients with type 2 diabetes
Anushka Lahiri, Suan Tee Lim, Htike Kyu, Yock Young Dan, Chin Meng Khoo
Diabetology & Metabolic Syndrome.2025;[Epub] CrossRef
Efficacy and Safety of Stage 5 Connected Insulin Pens in Type 1 or Type 2 Diabetes: Randomized Controlled Trial Protocol
Ji Yoon Kim, Nam Hoon Kim, Soo Heon Kwak, Chang Hee Jung, Eun Seok Kang, Jun Sung Moon, Sun Joon Moon, So Yoon Kwon, Jee Hee Yoo, Younghoon Kim, Tae-min Lee, Chung-il Yang, Jae Hyeon Kim, Sang-Man Jin
Endocrinology and Metabolism.2025;[Epub] CrossRef

Technology/Device
Comparison of Real-Time and Intermittently-Scanned Continuous Glucose Monitoring for Glycemic Control in Type 1 Diabetes Mellitus: Nationwide Cohort Study: Ji Yoon Kim, Seohyun Kim, Jae Hyeon Kim; Diabetes Metab J. 2025;49(3):436-447. Published online February 27, 2025; DOI: https://doi.org/10.4093/dmj.2024.0160

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Background
This study compares the association between real-time continuous glucose monitoring (rtCGM) and intermittently- scanned CGM (isCGM) and glycemic control in individuals with type 1 diabetes mellitus (T1DM) in a real-world setting.
Methods
Using data from the Korean National Health Insurance Service Cohort, individuals with T1DM managed by intensive insulin therapy were followed at 3-month intervals for 2 years after the initiation of CGM. The glycosylated hemoglobin (HbA1c) levels and coefficients of variation (CVs) of rtCGM and isCGM users were compared using independent two-sample t-test and a linear mixed model.
Results
The analyses considered 7,786 individuals (5,875 adults aged ≥19 years and 1,911 children and adolescents aged <19 years). Overall, a significant reduction in HbA1c level was observed after 3 months of CGM, and the effect was sustained for 2 years. The mean HbA1c level at baseline was higher in rtCGM users than in isCGM users (8.9%±2.7% vs. 8.6%±2.2%, P<0.001). However, from 3 to 24 months, rtCGM users had lower HbA1c levels than isCGM users at every time point (7.1%±1.2% vs. 7.5%±1.3% at 24 months, P<0.001 for all time points). In both adults and children, the greater reduction in HbA1c with rtCGM remained significant after adjusting for the baseline characteristics of the users. The CV also showed greater decrease with rtCGM than with isCGM.
Conclusion
In this large nationwide cohort study, the use of rtCGM was associated with a greater improvement in glycemic control, including HbA1c reduction, than the use of isCGM in both adults and children with T1DM.

Citations

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EMERGING DIGITAL TECHNOLOGIES IN MONITORING ENDOCRINE DISORDERS: CONTINUOUS GLUCOSE MONITORING SYSTEMS AND ARTIFICIAL INTELLIGENCE IN THE DIAGNOSIS OF POLYCYSTIC OVARY SYNDROME
Aleksandra Ćwirko-Godycka, Nikola Murawska, Michalina Chodór, Aleksandra Tomaszewska, Kinga Karczewska, Sonia Mojzyk, Maciej Kokoszka, Aleksandra Mierniczek, Natalia Dymel, Ryszard Feret
International Journal of Innovative Technologies in Social Science.2026;[Epub] CrossRef
Dementia Risk in Type 1 and 2 Diabetes: A Nationwide Population‐Based Comparison
Ji Eun Jun, Seohyun Kim, In‐Kyung Jeong, Jae Hyeon Kim
Diabetes, Obesity and Metabolism.2026; 28(6): 4915. CrossRef
Continuous glucose monitoring and risks of acute and chronic diabetes-related complications and mortality in adults with type 1 diabetes: a nationwide cohort study
Ji Yoon Kim, Seohyun Kim, Jae Hyeon Kim
Diabetologia.2026; 69(7): 1858. CrossRef
Consensus-Based Recommendations on an Optimal Educational Pathway for Diabetes Educators for Training People With Diabetes on Continuous Glucose Monitoring in Saudi Arabia
Ayman Al Hayek, Abeer Ali Yahya Aljabir, Abdulrahim Alsufyani, Alhanouf Alharthi, Amani Aldhewaila, Fatima Alawami, Hanan Kaki, Khulud Ali Alatawi, Mashael Mohammad Alfotais, Naglaa Helmy
Journal of Diabetes Science and Technology.2026;[Epub] CrossRef
Beneficial Analysis for Glucose Variability by Continuous Glucose Monitoring (CGM)
Sanae Mima, Hiroshi Bando, Akemi Tamura, Yukari Okino, Takumi Yamada, Yoshiyuki Abe
Asploro Journal of Biomedical and Clinical Case Reports.2025; 8(2): 193. CrossRef
Islet Tissue Macrophages in Immunity Homeostasis and Type 1 Diabetes
Yan Wang, Zhaoran Wang, Wenya Diao, Tong Shi, Jiahe Xu, Tiantian Deng, Chaoying Wen, Jienan Gu, Tingting Deng, Sixuan Wang, Cheng Xiao
Clinical Reviews in Allergy & Immunology.2025;[Epub] CrossRef
Continuous glucose monitoring in Korean pediatric patients with type 1 diabetes: current landscape and clinical implications
Hwa Young Kim, Jaehyun Kim
Clinical and Experimental Pediatrics.2025; 68(11): 842. CrossRef
Dispositivi indossabili per la gestione del diabete
Filippo CARLUCCI, Antonella TABUCCHI, Marcello FIORINI, Lucrezia GALASSO, Alessandro TERRENI
Biochimica Clinica.2025;[Epub] CrossRef
Efficacy and Safety of Stage 5 Connected Insulin Pens in Type 1 or Type 2 Diabetes: Randomized Controlled Trial Protocol
Ji Yoon Kim, Nam Hoon Kim, Soo Heon Kwak, Chang Hee Jung, Eun Seok Kang, Jun Sung Moon, Sun Joon Moon, So Yoon Kwon, Jee Hee Yoo, Younghoon Kim, Tae-min Lee, Chung-il Yang, Jae Hyeon Kim, Sang-Man Jin
Endocrinology and Metabolism.2025;[Epub] CrossRef

Drug/Regimen
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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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.

Citations

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Lipid metabolism in homeostasis and disease
Zhenghao Li, Wende Deng, Lanxuan Yang, Changheng Tang, Jian-Min Yue, Olivia Monteiro, Daniel T. Baptista-Hon, Ting Li
Signal Transduction and Targeted Therapy.2026;[Epub] CrossRef
Fixed-dose combinations of hypoglycemic drugs: potential of alogliptin/pioglitazone in type 2 diabetes mellitus: a review
Olga I. Butranova, Sergey K. Zyryanov, Anna R. Melnikova, Anastasia E. Matsepuro
Terapevticheskii arkhiv.2025; 97(8): 735. CrossRef
Triple oral therapy with metformin, DPP‐4 inhibitor, and SGLT2 inhibitor for adults with type 2 diabetes: Consensus recommendations of a Chinese expert panel (version 2025)
Miao Yu, Tong Wang, Chun Xu, Yan Bi, Ling Gao, Guang Wang, Guangda Xiang, Yaoming Xue, Tao Yang, Deying Kang, Zhiguang Zhou, Lixin Guo, Xinhua Xiao
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Thiazolidinediones for people with chronic kidney disease and diabetes
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Targeting adipose remodeling: Synergistic mechanisms of drugs and adipose-derived stem cells in obese type 2 diabetes mellitus
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Nuclear receptors as therapeutic targets in metabolic and cardiovascular disorders
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Complications
Glycemic Control and Retinal Microvascular Changes in Type 2 Diabetes Mellitus Patients without Clinical Retinopathy: Kangmin Lee, Ga Hye Lee, Seung Eun Lee, Jee Myung Yang, Kunho Bae; Diabetes Metab J. 2024;48(5):983-992. Published online March 13, 2024; DOI: https://doi.org/10.4093/dmj.2023.0149

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Background
To investigate the association of glycemic control and retinal microvascular changes in patients with type 2 diabetes mellitus (T2DM) without diabetic retinopathy (DR).
Methods
This retrospective, observational, cohort study included patients with T2DM without DR. The patients were categorized into intensive control (IC; mean glycosylated hemoglobin [HbA1c] ≤7.0%) and moderate control (MC; mean HbA1c >7.0%) groups. Optical coherence tomography (OCT) and swept-source OCT angiography (OCTA) image parameters were compared between three groups, including healthy controls.
Results
In total, 259 eyes of 259 participants (88 IC, 81 MC, and 90 controls) were included. The foveal avascular zone area was significantly larger in the MC group than IC and control groups (all P<0.05). The IC group had lower vessel density in the superficial retinal layer and deep retinal layer than the controls (all P<0.05). The choriocapillaris (CC) flow deficit (FD) was significantly greater in the MC group than in the IC and control groups (18.2%, 16.7%, and 14.2%, respectively; all P<0.01). In multivariate regression analysis, CC-FD was associated with the mean HbA1c level (P=0.008). There were no significant differences in OCT parameters among the groups.
Conclusion
OCTA revealed that early CC impairment is associated with HbA1c levels; the CC changes precede clinically apparent DR. The OCTA parameters differed among the groups according to the degree of glycemic control. Our results suggest that microvascular changes precede DR and are closely related to glycemic control.

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Correlation of Glycemic Risk Index with Retinal Structure and Blood Flow in Patients without Diabetic Retinopathy
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Metabolic Risk/Epidemiology
Glycemic Control Is Associated with Histological Findings of Nonalcoholic Fatty Liver Disease: Teruki Miyake, Shinya Furukawa, Bunzo Matsuura, Osamu Yoshida, Masumi Miyazaki, Akihito Shiomi, Ayumi Kanamoto, Hironobu Nakaguchi, Yoshiko Nakamura, Yusuke Imai, Mitsuhito Koizumi, Takao Watanabe, Yasunori Yamamoto, Yohei Koizumi, Yoshio Tokumoto, Masashi Hirooka, Teru Kumagi, Eiji Takesita, Yoshio Ikeda, Masanori Abe, Yoichi Hiasa; Diabetes Metab J. 2024;48(3):440-448. Published online February 2, 2024; DOI: https://doi.org/10.4093/dmj.2023.0200

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Background
Poor lifestyle habits may worsen nonalcoholic fatty liver disease (NAFLD), with progression to nonalcoholic steatohepatitis (NASH) and cirrhosis. This study investigated the association between glycemic control status and hepatic histological findings to elucidate the effect of glycemic control on NAFLD.
Methods
This observational study included 331 patients diagnosed with NAFLD by liver biopsy. Effects of the glycemic control status on histological findings of NAFLD were evaluated by comparing the following four glycemic status groups defined by the glycosylated hemoglobin (HbA1c) level at the time of NAFLD diagnosis: ≤5.4%, 5.5%–6.4%, 6.5%–7.4%, and ≥7.5%.
Results
Compared with the lowest HbA1c group (≤5.4%), the higher HbA1c groups (5.5%–6.4%, 6.5%–7.4%, and ≥7.5%) were associated with advanced liver fibrosis and high NAFLD activity score (NAS). On multivariate analysis, an HbA1c level of 6.5%– 7.4% group was significantly associated with advanced fibrosis compared with the lowest HbA1c group after adjusting for age, sex, hemoglobin, alanine aminotransferase, and creatinine levels. When further controlling for body mass index and uric acid, total cholesterol, and triglyceride levels, the higher HbA1c groups were significantly associated with advanced fibrosis compared with the lowest HbA1c group. On the other hand, compared with the lowest HbA1c group, the higher HbA1c groups were also associated with a high NAS in both multivariate analyses.
Conclusion
Glycemic control is associated with NAFLD exacerbation, with even a mild deterioration in glycemic control, especially a HbA1c level of 6.5%–7.4%, contributing to NAFLD progression.

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Drug/Regimen
Two-Year Therapeutic Efficacy and Safety of Initial Triple Combination of Metformin, Sitagliptin, and Empagliflozin in Drug-Naïve Type 2 Diabetes Mellitus Patients: Young-Hwan Park, Minji Sohn, So Yeon Lee, Soo Lim; Diabetes Metab J. 2024;48(2):253-264. Published online January 26, 2024; DOI: https://doi.org/10.4093/dmj.2023.0128

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Background
We investigated the long-term efficacy and safety of initial triple therapy using metformin, a dipeptidyl peptidase-4 inhibitor, and a sodium-glucose cotransporter-2 inhibitor, in patients with type 2 diabetes mellitus.
Methods
We enrolled 170 drug-naïve patients with glycosylated hemoglobin (HbA1c) level >7.5% who had started triple therapy (metformin, sitagliptin, and empagliflozin). Glycemic, metabolic, and urinary parameters were measured for 24 months.
Results
After 24 months, HbA1c level decreased significantly from 11.0%±1.8% to 7.0%±1.7%. At 12 and 24 months, the rates of achievement of the glycemic target goal (HbA1c <7.0%) were 72.5% and 61.7%, respectively, and homeostasis model assessment of β-cell function and insulin resistance indices improved. Whole-body fat percentage decreased by 1.08%, and whole-body muscle percentage increased by 0.97% after 24 months. Fatty liver indices and albuminuria improved significantly. The concentration of ketone bodies was elevated at the baseline but decreased after 24 months. There were no serious adverse events, including ketoacidosis.
Conclusion
Initial triple combination therapy with metformin, sitagliptin, and empagliflozin led to achievement of the glycemic target goal, which was maintained for 24 months without severe hypoglycemia but with improved metabolic function and albuminuria. This combination therapy may be a good strategy for drug-naïve patients with type 2 diabetes mellitus.

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Metabolic Risk/Epidemiology
Association of Measures of Glucose Metabolism with Colorectal Cancer Risk in Older Chinese: A 13-Year Follow-up of the Guangzhou Biobank Cohort Study-Cardiovascular Disease Substudy and Meta-Analysis: Shu Yi Wang, Wei Sen Zhang, Chao Qiang Jiang, Ya Li Jin, Tong Zhu, Feng Zhu, Lin Xu; Diabetes Metab J. 2024;48(1):134-145. Published online January 3, 2024; DOI: https://doi.org/10.4093/dmj.2022.0383

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Background
Abnormal glucose metabolism is a risk factor for colorectal cancer (CRC). However, association of glycosylated hemoglobin (HbA1c) with CRC risk remains under-reported. We examined the association between glycemic indicators (HbA1c, fasting plasma glucose, fasting insulin, 2-hour glucose, 2-hour insulin, and homeostasis model of risk assessment-insulin resistance index) and CRC risk using prospective analysis and meta-analysis.
Methods
Participants (n=1,915) from the Guangzhou Biobank Cohort Study-Cardiovascular Disease Substudy were included. CRC events were identified through record linkage. Cox regression was used to assess the associations of glycemic indicators with CRC risk. A meta-analysis was performed to investigate the association between HbA1c and CRC risk.
Results
During an average of 12.9 years follow-up (standard deviation, 2.8), 42 incident CRC cases occurred. After adjusting for potential confounders, the hazard ratio (95% confidence interval [CI]) of CRC for per % increment in HbA1c was 1.28 (95% CI, 1.01 to 1.63) in overall population, 1.51 (95% CI, 1.13 to 2.02) in women and 1.06 (95% CI, 0.68 to 1.68) in men. No significant association of other measures of glycemic indicators and baseline diabetes with CRC risk was found. Meta-analyses of 523,857 participants including our results showed that per % increment of HbA1c was associated with 13% higher risk of CRC, with the pooled risk ratio being 1.13 (95% CI, 1.01 to 1.27). Subgroupanalyses found stronger associations in women, colon cancer, Asians, and case-control studies.
Conclusion
Higher HbA1c was a significant predictor of CRC in the general population. Our findings shed light on the pathology of glucose metabolism and CRC, which warrants more in-depth investigation.

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The intersection of colorectal cancer and cardiovascular disease: shared mechanisms and clinical implications
Shuzhen Wu, Luyao Yu, Meitong Liu, Bo Dong
Clinical and Translational Oncology.2026;[Epub] CrossRef
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Aiping Zhang, Xia Zhu, Zhe Li, Yaoyao Li, Meng Zhu, Caiwang Yan, Guangfu Jin, Pengpeng Cai, Min Zhang, Yanbing Ding
Cancer Medicine.2026;[Epub] CrossRef
Glycemic Control as a Predictor of Advanced Colorectal Neoplasia
P Wehbe, A Kahwagi, L Abi Khalil, K Honein, J Amara, E Mahfouz, R Slim, C Yaghi
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Increased colorectal cancer risk in prediabetes: A meta-analysis
Na Wang, Tian-Yi Zhao, Xiao Ma
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Felipe Ignacio Santos Santos , Camila Andrea Guajardo Cantillanez , Esteban Rodolfo Acevedo Araya, Camila Jose Carrasco Bravo, Camilo Patricio Cáceres Espinoza, Javiera Andrea Sandoval Pino
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Associations between blood glucose and early- and late-onset colorectal cancer: evidence from two prospective cohorts and Mendelian randomization analyses
Chenyu Luo, Jiahui Luo, Yuhan Zhang, Bin Lu, Na Li, Yueyang Zhou, Shuohua Chen, Shouling Wu, Qingsong Zhang, Min Dai, Hongda Chen
Journal of the National Cancer Center.2024; 4(3): 241. CrossRef

Cardiovascular Risk/Epidemiology
Glycemic Control and Adverse Clinical Outcomes in Patients with Chronic Kidney Disease and Type 2 Diabetes Mellitus: Results from KNOW-CKD: Ga Young Heo, Hee Byung Koh, Hyung Woo Kim, Jung Tak Park, Tae-Hyun Yoo, Shin-Wook Kang, Jayoun Kim, Soo Wan Kim, Yeong Hoon Kim, Su Ah Sung, Kook-Hwan Oh, Seung Hyeok Han; Diabetes Metab J. 2023;47(4):535-546. Published online April 25, 2023; DOI: https://doi.org/10.4093/dmj.2022.0112

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Background
The optimal level of glycosylated hemoglobin (HbA1c) to prevent adverse clinical outcomes is unknown in patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM).
Methods
We analyzed 707 patients with CKD G1-G5 without kidney replacement therapy and T2DM from the KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD), a nationwide prospective cohort study. The main predictor was time-varying HbA1c level at each visit. The primary outcome was a composite of development of major adverse cardiovascular events (MACEs) or all-cause mortality. Secondary outcomes included the individual endpoint of MACEs, all-cause mortality, and CKD progression. CKD progression was defined as a ≥50% decline in the estimated glomerular filtration rate from baseline or the onset of end-stage kidney disease.
Results
During a median follow-up of 4.8 years, the primary outcome occurred in 129 (18.2%) patients. In time-varying Cox model, the adjusted hazard ratios (aHRs) for the primary outcome were 1.59 (95% confidence interval [CI], 1.01 to 2.49) and 1.99 (95% CI, 1.24 to 3.19) for HbA1c levels of 7.0%–7.9% and ≥8.0%, respectively, compared with <7.0%. Additional analysis of baseline HbA1c levels yielded a similar graded association. In secondary outcome analyses, the aHRs for the corresponding HbA1c categories were 2.17 (95% CI, 1.20 to 3.95) and 2.26 (95% CI, 1.17 to 4.37) for MACE, and 1.36 (95% CI, 0.68 to 2.72) and 2.08 (95% CI, 1.06 to 4.05) for all-cause mortality. However, the risk of CKD progression did not differ between the three groups.
Conclusion
This study showed that higher HbA1c levels were associated with an increased risk of MACE and mortality in patients with CKD and T2DM.

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Arun Prabhahar, Niranjan A Vijaykumar, Harpreet Kaur, Navneet Sharma, Ashok K Pannu
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Asmaa AlShammari, Ali AlSahow
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The Association between Glomerular Filtration Rate, Cardiometabolic Risk, and HbA1c Levels among Outpatients with Type 2 Diabetes Mellitus in Mopti
Modibo Coulibaly, Djibril Mamadou Coulibaly, Moctar Bah, Djeneba Djiguiba, Klétigui Casimir Dembélé, Dramane Samaké, Lamine Sidibé, Adama Kondé, Aboubacar Sidiki Traoré, Moussa Diawara, Valentin Sagara, Soumaïla Touré, Boubacar Coulibaly, Boubacar Sidiki
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Dong-Hwa Lee
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Type 1 Diabetes
Abnormal Responses in Cognitive Impulsivity Circuits Are Associated with Glycosylated Hemoglobin Trajectories in Type 1 Diabetes Mellitus and Impaired Metabolic Control: Helena Jorge, Isabel C. Duarte, Sandra Paiva, Ana Paula Relvas, Miguel Castelo-Branco; Diabetes Metab J. 2022;46(6):866-878. Published online March 22, 2022; DOI: https://doi.org/10.4093/dmj.2021.0307

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Background
Risky health decisions and impulse control profiles may impact on metabolic control in type 1 diabetes mellitus (T1DM). We hypothesize that the neural correlates of cognitive impulsivity and decision-making in T1DM relate to metabolic control trajectories.
Methods
We combined functional magnetic resonance imaging (fMRI), measures of metabolic trajectories (glycosylated hemoglobin [HbA1c] over multiple time points) and behavioral assessment using a cognitive impulsivity paradigm, the Balloon Analogue Risk Task (BART), in 50 participants (25 T1DM and 25 controls).
Results
Behavioral results showed that T1DM participants followed a rigid conservative risk strategy along the iterative game. Imaging group comparisons showed that patients showed larger activation of reward related, limbic regions (nucleus accumbens, amygdala) and insula (interoceptive saliency network) in initial game stages. Upon game completion differences emerged in relation to error monitoring (anterior cingulate cortex [ACC]) and inhibitory control (inferior frontal gyrus). Importantly, activity in the saliency network (ACC and insula), which monitors interoceptive states, was related with metabolic trajectories, which was also found for limbic/reward networks. Parietal and posterior cingulate regions activated both in controls and patients with adaptive decision-making, and positively associated with metabolic trajectories.
Conclusion
We found triple converging evidence when comparing metabolic trajectories, patients versus controls or risk averse (non-learners) versus patients who learned by trial and error. Dopaminergic reward and saliency (interoceptive and error monitoring) circuits show a tight link with impaired metabolic trajectories and cognitive impulsivity in T1DM. Activity in parietal and posterior cingulate are associated with adaptive trajectories. This link between reward-saliency-inhibition circuits suggests novel strategies for patient management.

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Giulia Locatelli, Austin Matus, Chin-Yen Lin, Ercole Vellone, Barbara Riegel
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Trust‐Based Decision‐Making in the Health and Economic Domains Shows Similar Neural Correlates
Isabel Catarina Duarte, Bruno Ribeiro, Helena Jorge, Bruno Direito, Miguel Castelo‐Branco
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Carlos Gómez‐Martínez, Nancy Babio, Lucía Camacho‐Barcia, Jordi Júlvez, Stephanie K. Nishi, Zenaida Vázquez, Laura Forcano, Andrea Álvarez‐Sala, Aida Cuenca‐Royo, Rafael de la Torre, Marta Fanlo‐Maresma, Susanna Tello, Dolores Corella, Alejandro Arias Vás
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Trust-based health decision-making recruits the neural interoceptive saliency network which relates to temporal trajectories of Hemoglobin A1C in Diabetes Type 1
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Brain Imaging and Behavior.2023; 18(1): 171. CrossRef

Short Communication

Technology/Device
A 4-Week, Two-Center, Open-Label, Single-Arm Study to Evaluate the Safety and Efficacy of EOPatch in Well-Controlled Type 1 Diabetes Mellitus: Jiyun Park, Nammi Park, Sangjin Han, You-Bin Lee, Gyuri Kim, Sang-Man Jin, Woo Je Lee, Jae Hyeon Kim; Diabetes Metab J. 2022;46(6):941-947. Published online March 8, 2022; DOI: https://doi.org/10.4093/dmj.2021.0299

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This study evaluated the safety and efficacy of tubeless patch pump called EOPatch in patients with well-controlled type 1 diabetes mellitus (T1DM). This 4-week, two-center, open-label, single-arm study enrolled 10 adult patients diagnosed with T1DM with glycosylated hemoglobin less than 7.5%. The co-primary end points were patch pump usage time for one attachment and number of serious adverse events related to the patch pump. The secondary end points were total amount of insulin injected per patch and changes in glycemic parameters including continuous glucose monitoring data compared to those at study entry. The median usage time per patch was 84.00 hours (interquartile range, 64.50 to 92.50). Serious adverse events did not occur during the trial. Four weeks later, time in range 70 to 180 mg/dL was significantly improved (70.71%±17.14 % vs. 82.96%±9.14%, P=0.01). The times spent below range (<54 mg/dL) and above range (>180 mg/dL) also improved (All P<0.05). Four-week treatment with a tubeless patch pump was safe and led to clinical improvement in glycemic control.

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Original Articles

Drug/Regimen
Effects of Teneligliptin on HbA1c levels, Continuous Glucose Monitoring-Derived Time in Range and Glycemic Variability in Elderly Patients with T2DM (TEDDY Study): Ji Cheol Bae, Soo Heon Kwak, Hyun Jin Kim, Sang-Yong Kim, You-Cheol Hwang, Sunghwan Suh, Bok Jin Hyun, Ji Eun Cha, Jong Chul Won, Jae Hyeon Kim; Diabetes Metab J. 2022;46(1):81-92. Published online June 16, 2021; DOI: https://doi.org/10.4093/dmj.2021.0016

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Background
To evaluate the effects of teneligliptin on glycosylated hemoglobin (HbA1c) levels, continuous glucose monitoring (CGM)-derived time in range, and glycemic variability in elderly type 2 diabetes mellitus patients.
Methods
This randomized, double-blinded, placebo-controlled study was conducted in eight centers in Korea (clinical trial registration number: NCT03508323). Sixty-five participants aged ≥65 years, who were treatment-naïve or had been treated with stable doses of metformin, were randomized at a 1:1 ratio to receive 20 mg of teneligliptin (n=35) or placebo (n=30) for 12 weeks. The main endpoints were the changes in HbA1c levels from baseline to week 12, CGM metrics-derived time in range, and glycemic variability.
Results
After 12 weeks, a significant reduction (by 0.84%) in HbA1c levels was observed in the teneligliptin group compared to that in the placebo group (by 0.08%), with a between-group least squares mean difference of –0.76% (95% confidence interval [CI], –1.08 to –0.44). The coefficient of variation, standard deviation, and mean amplitude of glycemic excursion significantly decreased in participants treated with teneligliptin as compared to those in the placebo group. Teneligliptin treatment significantly decreased the time spent above 180 or 250 mg/dL, respectively, without increasing the time spent below 70 mg/dL. The mean percentage of time for which glucose levels remained in the 70 to 180 mg/dL time in range (TIR70–180) at week 12 was 82.0%±16.0% in the teneligliptin group, and placebo-adjusted change in TIR70–180 from baseline was 13.3% (95% CI, 6.0 to 20.6).
Conclusion
Teneligliptin effectively reduced HbA1c levels, time spent above the target range, and glycemic variability, without increasing hypoglycemia in our study population.

Citations

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Time in range—A new gold standard in type 2 diabetes research?
Ashni Goshrani, Rose Lin, David O'Neal, Elif I. Ekinci
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Xuexin Zhou, Ru Zhang, Shiwei Jiang, Decui Cheng, Hao Wu
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Triple arm, prospective, real-world study comparing the efficacy of FDC teneligliptin + dapagliflozin to FDC sitagliptin + dapagliflozin, and FDC linagliptin + empagliflozin in Indian type 2 diabetes mellitus patients using CGM device: the Amplify-TIR stu
Suhas Erande, Mayur Agrawal, Sanjeev Gulati, Namdev Jagtap, N. S. Praveen Kumar, Vinod Kumar Kapoor, Sumit Bhushan, Rujuta Gadkari, Mayur Jadhav, Sanjay Choudhari, Saiprasad Patil, Hanmant Barkate
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Comparison of teneligliptin and other gliptin-based regimens in addressing insulin resistance and glycemic control in type 2 diabetic patients: a cross-sectional study
Harmanjit Singh, Ravi Rohilla, Shivani Jaswal, Mandeep Singla
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A prospective multicentre open label study to assess effect of Teneligliptin on glycemic control through parameters of time in range (TIR) Metric using continuous glucose monitoring (TOP-TIR study)
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Drug/Regimen
Increasing Age Associated with Higher Dipeptidyl Peptidase-4 Inhibition Rate Is a Predictive Factor for Efficacy of Dipeptidyl Peptidase-4 Inhibitors: Sangmo Hong, Chang Hee Jung, Song Han, Cheol-Young Park; Diabetes Metab J. 2022;46(1):63-70. Published online April 19, 2021; DOI: https://doi.org/10.4093/dmj.2020.0253

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Background
It is not known which type 2 diabetes mellitus (T2DM) patients would most benefit from dipeptidyl peptidase-4 (DPP-4) inhibitor treatment. We aimed to investigate the predictors of response to DPP-4 inhibitors considering degree of DPP-4 inhibition.
Methods
This study is a post hoc analysis of a 24-week, randomized, double-blind, phase III trial that compared the efficacy and safety of a DPP-4 inhibitor (gemigliptin vs. sitagliptin) in patients with T2DM. Subjects were classified into tertiles of T1 <65.26%, T2=65.26%–76.35%, and T3 ≥76.35% by DPP-4 inhibition. We analyzed the change from baseline in glycosylated hemoglobin (HbA1c) according to DPP-4 inhibition with multiple linear regression adjusting for age, ethnicity, body mass index, baseline HbA1c, and DPP-4 activity at baseline.
Results
The mean age was greater in the high tertile group compared with the low tertile group (T1: 49.8±8.3 vs. T2: 53.1±10.5 vs. T3: 55.3±9.5, P<0.001) of DPP-4 inhibition. Although HbA1c at baseline was not different among tertiles of DPP-4 inhibition (P=0.398), HbA1c after 24-week treatment was lower in the higher tertile compares to the lower tertile (T1: 7.30%±0.88% vs. T2: 7.12%±0.78% vs. T3: 7.00%±0.78%, P=0.021). In multiple regression analysis, DPP-4 enzyme inhibition rate was not a significant determent for HbA1c reduction due to age. In subgroup analysis by tertile of DPP-4 inhibition, age was the only significant predictor and only in the highest tertile (R²=0.281, B=–0.014, P=0.024).
Conclusion
This study showed that HbA1c reduction by DPP-4 inhibitor was associated with increasing age, and this association was linked with higher DPP-4 inhibition.

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Review

Type 1 Diabetes
Time in Range from Continuous Glucose Monitoring: A Novel Metric for Glycemic Control: Jee Hee Yoo, Jae Hyeon Kim; Diabetes Metab J. 2020;44(6):828-839. Published online December 23, 2020; DOI: https://doi.org/10.4093/dmj.2020.0257; Correction in: Diabetes Metab J 2021;45(5):795

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Abstract PDF PubReader ePub

Glycosylated hemoglobin (HbA1c) has been the sole surrogate marker for assessing diabetic complications. However, consistently reported limitations of HbA1c are that it lacks detailed information on short-term glycemic control and can be easily interfered with by various clinical conditions such as anemia, pregnancy, or liver disease. Thus, HbA1c alone may not represent the real glycemic status of a patient. The advancement of continuous glucose monitoring (CGM) has enabled both patients and healthcare providers to monitor glucose trends for a whole single day, which is not possible with HbA1c. This has allowed for the development of core metrics such as time spent in time in range (TIR), hyperglycemia, or hypoglycemia, and glycemic variability. Among the 10 core metrics, TIR is reported to represent overall glycemic control better than HbA1c alone. Moreover, various evidence supports TIR as a predictive marker of diabetes complications as well as HbA1c, as the inverse relationship between HbA1c and TIR reveals. However, there are more complex relationships between HbA1c, TIR, and other CGM metrics. This article provides information about 10 core metrics with particular focus on TIR and the relationships between the CGM metrics for comprehensive understanding of glycemic status using CGM.

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Short Communication

COVID-19
Impact of Social Distancing Due to Coronavirus Disease 2019 on the Changes in Glycosylated Hemoglobin Level in People with Type 2 Diabetes Mellitus: Sung-Don Park, Sung-Woo Kim, Jun Sung Moon, Yin Young Lee, Nan Hee Cho, Ji-Hyun Lee, Jae-Han Jeon, Yeon-Kyung Choi, Mi Kyung Kim, Keun-Gyu Park; Diabetes Metab J. 2021;45(1):109-114. Published online December 4, 2020; DOI: https://doi.org/10.4093/dmj.2020.0226

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This study investigated the impact of social distancing due to coronavirus disease 2019 (COVID-19) on glycemic control in people with type 2 diabetes mellitus (T2DM). We retrospectively analyzed the change in glycosylated hemoglobin level (ΔHbA1c) in people with T2DM who undertook social distancing because of COVID-19. We compared the ΔHbA1c between COVID-19 and non-COVID-19 cohorts that were enrolled at the same time of year. The ΔHbA1c of the COVID-19 cohort was significantly higher than that of two non-COVID-19 cohorts. Subgroup analysis according to age and baseline HbA1c level showed that social distancing significantly increased the mean HbA1c level of participants of <50 years. The ΔHbA1c of participants of <50 years and with HbA1c <7.0% in the COVID-19 cohort showed larger changes than other subgroups. In adjusted model, adjusted ΔHbA1c levels in the COVID-19 cohort remained significantly higher than those in the two other cohorts. Social distancing negatively impacts blood glucose control in people with T2DM, especially those who are younger and have good blood glucose control.

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Brief Report

Drug/Regimen
Long-Term Glycaemic Durability of Early Combination Therapy Strategy versus Metformin Monotherapy in Korean Patients with Newly Diagnosed Type 2 Diabetes Mellitus: Soon-Jib Yoo, Sang-Ah Chang, Tae Seo Sohn, Hyuk-Sang Kwon, Jong Min Lee, Sungdae Moon, Pieter Proot, Päivi M Paldánius, Kun Ho Yoon; Diabetes Metab J. 2021;45(6):954-959. Published online November 12, 2020; DOI: https://doi.org/10.4093/dmj.2020.0173

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We assessed the glycaemic durability with early combination (EC; vildagliptin+metformin [MET], n=22) versus MET monotherapy (n=17), among newly-diagnosed type 2 diabetes mellitus (T2DM) enrolled (between 2012 and 2014) in the VERIFY study from Korea (n=39). Primary endpoint was time to initial treatment failure (TF) (glycosylated hemoglobin [HbA1c] ≥7.0% at two consecutive scheduled visits after randomization [end of period 1]). Time to second TF was assessed when both groups were receiving and failing on the combination (end of period 2). With EC the risk of initial TF significantly reduced by 78% compared to MET (n=3 [15%] vs. n=10 [58.7%], P=0.0228). No secondary TF occurred in EC group versus five patients (29.4%) in MET. Patients receiving EC treatment achieved consistently lower HbA1c levels. Both treatment approaches were well tolerated with no hypoglycaemic events. In Korean patients with newly diagnosed T2DM, EC treatment significantly and consistently improved the long-term glycaemic durability as compared with MET.

Citations

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Original Articles

Complications
Time to Reach Target Glycosylated Hemoglobin Is Associated with Long-Term Durable Glycemic Control and Risk of Diabetic Complications in Patients with Newly Diagnosed Type 2 Diabetes Mellitus: A 6-Year Observational Study: Kyoung Jin Kim, Jimi Choi, Jae Hyun Bae, Kyeong Jin Kim, Hye Jin Yoo, Ji A Seo, Nan Hee Kim, Kyung Mook Choi, Sei Hyun Baik, Sin Gon Kim, Nam Hoon Kim; Diabetes Metab J. 2021;45(3):368-378. Published online October 20, 2020; DOI: https://doi.org/10.4093/dmj.2020.0046

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Background
To evaluate the association of time to reach the target glycosylated hemoglobin (HbA1c) level with long-term durable glycemic control and risk of diabetic complications in patients with newly diagnosed type 2 diabetes mellitus (T2DM).
Methods
In a longitudinal observational cohort, 194 patients with T2DM newly diagnosed between January 2011 and March 2013 were followed up over 6 years. Patients were classified according to the time needed to reach the target HbA1c (<7.0%): <3, 3 to 6 (early achievement group), and ≥6 months (late achievement group). Risks of microvascular complications including diabetic retinopathy, nephropathy, and neuropathy as well as macrovascular events including ischemic heart disease, ischemic stroke, and peripheral arterial disease were assessed by multivariable Cox proportional hazards analysis.
Results
During a median follow-up of 6.53 years, 66 microvascular and 14 macrovascular events occurred. Maintenance of durable glycemic control over 6 years was more likely in the early achievement groups than in the late achievement group (34.5%, 30.0%, and 16.1% in <3, 3 to 6, and ≥6 months, respectively, P=0.039). Early target HbA1c achievement was associated with lower risk of composite diabetic complications (adjusted hazard ratio [HR, 0.47; 95% confidence interval [CI], 0.26 to 0.86 in <3 months group) (adjusted HR, 0.50; 95% CI, 0.23 to 1.10 in 3 to 6 months group, in reference to ≥6 months group). Similar trends were maintained for risks of microvascular and macrovascular complications, although statistical significance was not reached for macrovascular complications.
Conclusion
Early target HbA1c achievement was associated with long-term durable glycemic control and reduced risk of diabetic complications in newly diagnosed T2DM.

Citations

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Lifestyle
Reducing Carbohydrate from Individual Sources Has Differential Effects on Glycosylated Hemoglobin in Type 2 Diabetes Mellitus Patients on Moderate Low-Carbohydrate Diets: Hajime Haimoto, Shiho Watanabe, Keiko Maeda, Takashi Murase, Kenji Wakai; Diabetes Metab J. 2021;45(3):390-403. Published online July 21, 2020; DOI: https://doi.org/10.4093/dmj.2020.0033

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Background

We evaluated decreases in glycosylated hemoglobin (HbA1c) achieved by reducing carbohydrate from various sources in type 2 diabetes mellitus patients.

Methods

We followed up 138 male and 107 female outpatients on a moderate low-carbohydrate diet without diabetic medication for 6 months. Changes in carbohydrate sources (Δcarbohydrate) were assessed from 3-day dietary records at baseline and 6 months, and associations with changes in HbA1c (ΔHbA1c) were examined with Spearman's correlation coefficients (r_s) and multiple regression analysis.

Results

ΔHbA1c was −1.5%±1.6% in men and −0.9%±1.3% in women, while Δtotal carbohydrate was −115.3±103.7 g/day in men and −63.6±71.1 g/day in women. Positive associations with ΔHbA1c were found for Δtotal carbohydrate (r_s=0.584), Δcarbohydrate from soft drinks (0.368), confectionery (0.361), rice (0.325), bread (0.221), Chinese soup noodles (0.199) in men, and Δtotal carbohydrate (0.547) and Δcarbohydrate from rice (0.376) and confectionery (0.195) in women. Reducing carbohydrate sources by 50 g achieved decreases in HbA1c of 0.43% for total carbohydrate, 1.33% for soft drinks, 0.88% for confectionery, 0.63% for bread, 0.82% for Chinese soup noodles and 0.34% for rice in men and 0.45% for total carbohydrate, 0.67% for confectionery and 0.34% for rice in women, although mean reductions in carbohydrate from these sources were much smaller than that from rice.

Conclusion

Decreases in HbA1c achieved by reducing carbohydrate from soft drinks, confectionery, bread and Chinese soup noodles were 2- to 4-fold greater than that for rice. Our results will enable patients to decrease HbA1c efficiently (UMIN000009866).

Citations

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Complications
Deterioration of Sleep Quality According to Glycemic Status: Myung Haeng Hur, Mi-Kyoung Lee, Kayeon Seong, Jun Hwa Hong; Diabetes Metab J. 2020;44(5):679-686. Published online April 17, 2020; DOI: https://doi.org/10.4093/dmj.2019.0125

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Background

Type 2 diabetes mellitus (T2DM) is a progressive disease with multiple complications. The present study aimed to determine the effects of glycemic status on sleep quality in individuals with T2DM, prediabetes, and normal glucose tolerance (NGT).

Methods

A total of 90 participants were categorized into three groups, T2DM (n=30), prediabetes (n=30), and NGT (n=30). Objective sleep quality was measured with the actigraph wrist-worn device over 3 nights and subjective sleep quality was evaluated with a questionnaire.

Results

The duration of diabetes in the T2DM group was 2.23 years and the glycosylated hemoglobin (HbA1c) levels in the T2DM, prediabetes, and NGT groups were 7.83%, 5.80%, and 5.31%, respectively. Sleep efficiency decreased across the T2DM, prediabetes, and NGT groups (86.25%, 87.99%, and 90.22%, respectively; P=0.047). Additionally, HbA1c levels revealed a significant negative correlation with sleep efficiency (r=−0.348, P=0.001). The sleep quality questionnaire results were similar among the three groups.

Conclusion

Although the participants in the present study were not necessarily conscious of their sleep disturbances, deterioration in sleep quality progressed according to glycemic status.

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Short Communication

Epidemiology
Low-Normal Free Thyroxine Levels in Euthyroid Male Are Associated with Prediabetes: Sung Woo Kim, Jae-Han Jeon, Jun Sung Moon, Eon Ju Jeon, Mi-Kyung Kim, In-Kyu Lee, Jung Beom Seo, Keun-Gyu Park; Diabetes Metab J. 2019;43(5):718-726. Published online March 19, 2019; DOI: https://doi.org/10.4093/dmj.2018.0222

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Abnormal thyroid function is associated with impaired glucose homeostasis. This study aimed to determine whether free thyroxine (FT4) influences the prevalence of prediabetes in euthyroid subjects using a cross-sectional survey derived from the Korea National Health and Nutrition Examination Survey, conducted between 2013 and 2015. We studied 2,399 male participants of >20 years of age who were euthyroid and non-diabetic. Prediabetic participants had lower FT4 concentrations than those without prediabetes, but their thyrotropin concentrations were similar. We stratified the population into tertiles according to FT4 concentration. After adjusting for multiple confounding factors, glycosylated hemoglobin (HbA1c) levels significantly decreased with increasing FT4 tertile, whereas fasting plasma glucose (FPG) levels were not associated with FT4 tertiles (HbA1c, P<0.01 in T3 vs. T1; FPG, P=0.489 in T3 vs. T1). The prevalence of prediabetes was significantly higher in T1 (odds ratio, 1.426; 95% confidence interval, 1.126 to 1.806; P<0.01) than in T3. In conclusion, subjects with low-normal serum FT4 had high HbA1c and were more likely to have prediabetes. These results suggest that low FT4 concentration is a risk factor for prediabetes in male, even when thyroid function is within the normal range.

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Original Article

Clinical Diabetes & Therapeutics
Predictors of the Therapeutic Efficacy and Consideration of the Best Combination Therapy of Sodium-Glucose Co-transporter 2 Inhibitors: Ji-Yeon Lee, Yongin Cho, Minyoung Lee, You Jin Kim, Yong-ho Lee, Byung-Wan Lee, Bong-Soo Cha, Eun Seok Kang; Diabetes Metab J. 2019;43(2):158-173. Published online January 25, 2019; DOI: https://doi.org/10.4093/dmj.2018.0057

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Background

We investigated the predictive markers for the therapeutic efficacy and the best combination of sodium-glucose co-transporter 2 (SGLT2) inhibitors (empagliflozin, dapagliflozin, and ipragliflozin) therapy in patients with type 2 diabetes mellitus (T2DM).

Methods

A total of 804 patients with T2DM who had taken SGLT2 inhibitor as monotherapy or an add-on therapy were analyzed. Multivariate regression analyses were performed to identify the predictors of SGLT2 inhibitor response including the classes of baseline anti-diabetic medications.

Results

After adjusting for age, sex, baseline body mass index (BMI), diabetes duration, duration of SGLT2 inhibitor use, initial glycosylated hemoglobin (HbA1c) level, estimated glomerular filtration rate (eGFR), and other anti-diabetic agent usage, multivariate analysis revealed that shorter diabetes duration, higher initial HbA1c and eGFR were associated with better glycemic response. However, baseline BMI was inversely correlated with glycemic status; lean subjects with well-controlled diabetes and obese subjects with inadequately controlled diabetes received more benefit from SGLT2 inhibitor treatment. In addition, dipeptidyl peptidase 4 (DPP4) inhibitor use was related to a greater reduction in HbA1c in patients with higher baseline HbA1c ≥7%. Sulfonylurea users experienced a larger change from baseline HbA1c but the significance was lost after adjustment for covariates and metformin and thiazolidinedione use did not affect the glycemic outcome.

Conclusion

A better response to SGLT2 inhibitors is expected in Korean T2DM patients who have higher baseline HbA1c and eGFR with a shorter diabetes duration. Moreover, the add-on of an SGLT2 inhibitor to a DPP4 inhibitor is likely to show the greatest glycemic response.

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Short Communication

Complications
Glycosylated Hemoglobin in Subjects Affected by Iron-Deficiency Anemia: Jari Intra, Giuseppe Limonta, Fabrizio Cappellini, Maria Bertona, Paolo Brambilla; Diabetes Metab J. 2019;43(4):539-544. Published online November 28, 2018; DOI: https://doi.org/10.4093/dmj.2018.0072

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Previous studies have suggested that iron-deficiency anemia affects glycosylated hemoglobin (HbA1c) measurements, but the results were contradictory. We conducted a retrospective case-control study to determine the effects of iron deficiency on HbA1c levels. Starting with the large computerized database of the Italian Hospital of Desio, including data from 2000 to 2016, all non-pregnant individuals older than 12 years of age with at least one measurement of HbA1c, cell blood count, ferritin, and fasting blood glucose on the same date of blood collection were enrolled. A total of 2,831 patients met the study criteria. Eighty-six individuals were diagnosed with iron-deficiency anemia, while 2,745 had a normal iron state. The adjusted means of HbA1c were significantly higher in anemic subjects (5.59% [37.37 mmol/mol]), than those measured in individuals without anemia (5.34% [34.81 mmol/mol]) (P<0.0001). These results suggest that clinicians should be cautious about diagnosing prediabetes and diabetes in individuals with anemia.

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Original Articles

Clinical Diabetes & Therapeutics
Effectiveness of Exercise Intervention in Reducing Body Weight and Glycosylated Hemoglobin Levels in Patients with Type 2 Diabetes Mellitus in Korea: A Systematic Review and Meta-Analysis: Ji-Eun Jang, Yongin Cho, Byung Wan Lee, Ein-Soon Shin, Sun Hee Lee; Diabetes Metab J. 2019;43(3):302-318. Published online November 19, 2018; DOI: https://doi.org/10.4093/dmj.2018.0062

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Background

This study aimed to assess the effectiveness of exercise intervention in reducing body weight and glycosylated hemoglobin (HbA1c) level in patients with type 2 diabetes mellitus (T2DM) in Korea.

Methods

Cochrane, PubMed, Embase, KoreaMed, KMbase, NDSL, KCI, RISS, and DBpia databases were used to search randomized controlled trials and controlled clinical trials that compared exercise with non-exercise intervention among patients with non-insulin-treated T2DM in Korea. The effectiveness of exercise intervention was estimated by the mean difference in body weight changes and HbA1c level. Weighted mean difference (WMD) with its corresponding 95% confidence interval (CI) was used as the effect size. The pooled mean differences of outcomes were calculated using a random-effects model.

Results

We identified 7,692 studies through literature search and selected 23 articles (723 participants). Compared with the control group, exercise intervention (17 studies) was associated with a significant decline in HbA1c level (WMD, −0.58%; 95% CI, −0.89 to −0.27; I²=73%). Although no significant effectiveness on body weight was observed, eight aerobic training studies showed a significant reduction in body weight (WMD, −2.25 kg; 95% CI, −4.36 to −0.13; I²=17%) in the subgroup analysis.

Conclusion

Exercise significantly improves glycemic control; however, it does not significantly reduce body weight. Aerobic training can be beneficial for patients with non-insulin-treated T2DM in Korea.

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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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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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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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Epidemiology
Diabetes Fact Sheet in Korea, 2016: An Appraisal of Current Status: Jong Chul Won, Jae Hyuk Lee, Jae Hyeon Kim, Eun Seok Kang, Kyu Chang Won, Dae Jung Kim, Moon-Kyu Lee; Diabetes Metab J. 2018;42(5):415-424. Published online August 9, 2018; DOI: https://doi.org/10.4093/dmj.2018.0017

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Background

This report presents the recent prevalence and comorbidities related to diabetes in Korea by analyzing the nationally representative data.

Methods

Using data from the Korea National Health and Nutrition Examination Survey for 2013 to 2014, the percentages and the total number of subjects over the age of 30 years with diabetes and prediabetes were estimated and applied to the National Population Census in 2014. Diagnosis of diabetes was based on fasting plasma glucose (≥126 mg/dL), current taking of antidiabetic medication, history of previous diabetes, or glycosylated hemoglobin (HbA1c) ≥6.5%. Impaired fasting glucose (IFG) was defined by fasting plasma glucose in the range of 100 to 125 mg/dL among those without diabetes.

Results

About 4.8 million (13.7%) Korean adults (≥30 years old) had diabetes, and about 8.3 million (24.8%) Korean adults had IFG. However, 29.3% of the subjects with diabetes are not aware of their condition. Of the subjects with diabetes, 48.6% and 54.7% were obese and hypertensive, respectively, and 31.6% had hypercholesterolemia. Although most subjects with diabetes (89.1%) were under medical treatment, and mostly being treated with oral hypoglycemic agents (80.2%), 10.8% have remained untreated. With respect to overall glycemic control, 43.5% reached the target of HbA1c <7%, whereas 23.3% reached the target when the standard was set to HbA1c <6.5%, according to the Korean Diabetes Association guideline.

Conclusion

Diabetes is a major public health threat in Korea, but a significant proportion of adults were not controlling their illness. We need comprehensive approaches to overcome the upcoming diabetes-related disease burden in Korea.

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Complications
Glycated Albumin Is a More Useful Glycation Index than HbA1c for Reflecting Renal Tubulopathy in Subjects with Early Diabetic Kidney Disease: Ji Hye Huh, Minyoung Lee, So Young Park, Jae Hyeon Kim, Byung-Wan Lee; Diabetes Metab J. 2018;42(3):215-223. Published online May 2, 2018; DOI: https://doi.org/10.4093/dmj.2017.0091

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Background

The aim of this study was to investigate which glycemic parameters better reflect urinary N-acetyl-β-D-glucosaminidase (uNAG) abnormality, a marker for renal tubulopathy, in subjects with type 2 diabetes mellitus (T2DM) subjects with normoalbuminuria and a normal estimated glomerular filtration rate (eGFR).

Methods

We classified 1,061 participants with T2DM into two groups according to uNAG level—normal vs. high (>5.8 U/g creatinine)—and measured their biochemical parameters.

Results

Subjects with high uNAG level had significantly higher levels of fasting and stimulated glucose, glycated albumin (GA), and glycosylated hemoglobin (HbA1c) and lower levels of homeostasis model assessment of β-cell compared with subjects with normal uNAG level. Multiple linear regression analyses showed that uNAG was significantly associated with GA (standardized β coefficient [β]=0.213, P=0.016), but not with HbA1c (β=−0.137, P=0.096) or stimulated glucose (β=0.095, P=0.140) after adjusting confounding factors. In receiver operating characteristic analysis, the value of the area under the curve (AUC) for renal tubular injury of GA was significantly higher (AUC=0.634; 95% confidence interval [CI], 0.646 to 0.899) than those for HbA1c (AUC=0.598; 95% CI, 0.553 to 0.640), stimulated glucose (AUC=0.594; 95% CI, 0.552 to 0.636), or fasting glucose (AUC=0.558; 95% CI, 0.515 to 0.600). The optimal GA cutoff point for renal tubular damage was 17.55% (sensitivity 59%, specificity 62%).

Conclusion

GA is a more useful glycation index than HbA1c for reflecting renal tubulopathy in subjects with T2DM with normoalbuminuria and normal eGFR.

Citations

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Mayura Apte, Girish Kumthekar, Rashmi Santosh Tupe
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Use of glycated albumin for the identification of diabetes in subjects from northeast China
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Glycated Plasma Proteins as More Sensitive Markers for Glycemic Control in Type 1 Diabetes
Lina Zhang, Qibin Zhang
PROTEOMICS – Clinical Applications.2020;[Epub] CrossRef
Glycated albumin and its variability: Clinical significance, research progress and overall review
Dongjun Dai, Yifei Mo, Jian Zhou
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Hepatic fibrosis is associated with total proteinuria in Korean patients with type 2 diabetes
Eugene Han, Yongin Cho, Kyung-won Kim, Yong-ho Lee, Eun Seok Kang, Bong-Soo Cha, Byung-wan Lee
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Yiting Xu, Xiaojing Ma, Yun Shen, Yufei Wang, Jian Zhou, Yuqian Bao
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Yongin Cho, Yong-ho Lee, Eun Seok Kang, Bong-soo Cha, Byung-wan Lee
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Huanhuan Zhu, Xi Liu, Chengning Zhang, Qing Li, Xiaofei An, Simeng Liu, Lin Wu, Bo Zhang, Yanggang Yuan, Changying Xing
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The Glycated Albumin to Glycated Hemoglobin Ratio Might Not Be Associated with Carotid Atherosclerosis in Patients with Type 1 Diabetes: Wonjin Kim, Kwang Joon Kim, Byung-Wan Lee, Eun Seok Kang, Bong Soo Cha, Hyun Chul Lee; Diabetes Metab J. 2014;38(6):456-463. Published online December 15, 2014; DOI: https://doi.org/10.4093/dmj.2014.38.6.456

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Background

The ratio of glycated albumin to glycated hemoglobin (GA/A1c) is known to be elevated in subjects with type 2 diabetes mellitus (T2DM) who had decreased insulin secretion. Additionally, the carotid intima media thickness (IMT) is greater in T2DM patients with higher GA/A1c ratios. We investigated whether increased GA/A1c ratio and IMT are also associated in type 1 diabetes mellitus (T1DM), which is characterized by lack of insulin secretory capacity.

Methods

In this cross-sectional study, we recruited 81 T1DM patients (33 men, 48 women; mean age 44.1±13.0 years) who underwent carotid IMT, GA, and HbA1c measurements.

Results

The mean GA/A1c ratio was 2.90. Based on these results, we classified the subjects into two groups: group I (GA/A1c ratio <2.90, n=36) and group II (GA/A1c ratio ≥2.90, n=45). Compared with group I, the body mass indexes (BMIs), waist circumferences, and IMTs were lower in group II. GA/A1c ratio was negatively correlated with BMI, urine albumin to creatinine ratio (P<0.001 for both), and both the mean and maximal IMT (P=0.001, both). However, after adjusting the confounding factors, we observed that IMT was no longer associated with GA/A1c ratio.

Conclusion

In contrast to T2DM, IMT was not significantly related to GA/A1c ratio in the subjects with T1DM. This suggests that the correlations between GA/A1c ratio and the parameters known to be associated with atherosclerosis in T2DM could be manifested differently in T1DM. Further studies are needed to investigate these relationships in T1DM.

Citations

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High glycated albumin is associated with early neurological deterioration in patients with acute ischemic stroke
Ki-Woong Nam, Jung Hoon Han, Chi Kyung Kim, Hyung-Min Kwon, Yong-Seok Lee, Kyungmi Oh, Keon-Joo Lee, Byeongsu Park
BMC Neurology.2024;[Epub] CrossRef
Glycated Albumin and Glycated Albumin/HbA1c Predict the Progression of Coronavirus Disease 2019 from Mild to Severe Disease in Korean Patients with Type 2 Diabetes
Jeongseon Yoo, Youngah Choi, Shin Ae Park, Ji Yeon Seo, Chul Woo Ahn, Jaehyun Han
Journal of Clinical Medicine.2022; 11(9): 2327. CrossRef
Variability in glycated albumin levels predicts the progression of diabetic nephropathy
Su Bin Park, Sang Soo Kim, In Joo Kim, Yoon Jeong Nam, Kang Hee Ahn, Jong Ho Kim, Yun Kyung Jeon, Bo Hyun Kim, Sang Heon Song, Ihm Soo Kwak, Eun Kyung Lee, Yong Ki Kim
Journal of Diabetes and its Complications.2017; 31(6): 1041. CrossRef
Significant liver fibrosis assessed using liver transient elastography is independently associated with low bone mineral density in patients with non-alcoholic fatty liver disease
Gyuri Kim, Kwang Joon Kim, Yumie Rhee, Sung-Kil Lim, Salvatore Petta
PLOS ONE.2017; 12(7): e0182202. CrossRef
Determinants of Preclinical Atherosclerosis Are Different in Type 1 and Type 2 Diabetic Women
P. PIŤHOVÁ, K. ŠTECHOVÁ, J. PIŤHA, V. LÁNSKÁ, M. KVAPIL
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Gyuri Kim, Yong-ho Lee, Eun Seok Kang, Bong-Soo Cha, Hyun Chul Lee, Byung-Wan Lee
Yonsei Medical Journal.2016; 57(6): 1395. CrossRef
Visceral adiposity is associated with altered myocardial glucose uptake measured by 18FDG-PET in 346 subjects with normal glucose tolerance, prediabetes, and type 2 diabetes
Gyuri Kim, Kwanhyeong Jo, Kwang Joon Kim, Yong-ho Lee, Eugene Han, Hye-jin Yoon, Hye Jin Wang, Eun Seok Kang, Mijin Yun
Cardiovascular Diabetology.2015;[Epub] CrossRef
Glycated albumin and the risk of micro- and macrovascular complications in subjects with Type 1 Diabetes
Hye-jin Yoon, Yong-ho Lee, So Ra Kim, Tyler Hyungtaek Rim, Eun Young Lee, Eun Seok Kang, Bong-Soo Cha, Hyun Chul Lee, Byung-Wan Lee
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Hongbo Liu, Mei Yuan, Xiaolan Yang, Xiaolei Hu, Juan Liao, Jizheng Dang, Yanling Xie, Jun Pu, Yuanli Li, Chang-Guo Zhan, Fei Liao
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Glycated Albumin Levels in Patients with Type 2 Diabetes Increase Relative to HbA1cwith Time
Hye-jin Yoon, Yong-ho Lee, Kwang Joon Kim, So Ra Kim, Eun Seok Kang, Bong-Soo Cha, Hyun Chul Lee, Byung-Wan Lee
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Total Energy Intake May Be More Associated with Glycemic Control Compared to Each Proportion of Macronutrients in the Korean Diabetic Population: Hye Mi Kang, Dong-Jun Kim; Diabetes Metab J. 2012;36(4):300-306. Published online August 20, 2012; DOI: https://doi.org/10.4093/dmj.2012.36.4.300

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Background

Major macronutrients for energy intake vary among countries and cultures. Carbohydrates, including rice, are the major component of daily energy intake in Korea. The aim of this study was to examine the association of daily energy intake or each proportion of macronutrients, especially carbohydrates, with glycemic control in diabetic Koreans.

Methods

A total of 334 individuals with diabetes (175 men, age 57.4±0.8 years; 159 women, age 60.9±0.9 years) who participated in the 2005 Korean National Health and Nutrition Examination Survey were examined. Glycemic control was categorized based on concentration of glycated hemoglobin (HbA1c; HbA1c ≤6.5%; 6.6% to 8.0%; ≥8.1%). Dietary intake was assessed by using a 24-recall item questionnaire.

Results

High total energy intake was associated with poor glycemic control (HbA1c ≤6.5%, 1,824±75 kcal; 6.6% to 8.0%, 1,990±57 kcal; ≥8.1%, 2,144±73 kcal; P value for trend=0.002). Each proportion of protein, fat, or carbohydrate was not associated with glycemic control. Even after adjusting for several parameters, the association of daily energy intake with glycemic control still persisted.

Conclusion

Total energy intake may be more closely related to glycemic control than each proportionof macronutrients in Korean diabetics.

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Higher Glycated Hemoglobin Level Is Associated with Increased Risk for Ischemic Stroke in Non-Diabetic Korean Male Adults: Hyung Geun Oh, Eun-Jung Rhee, Tae-Woong Kim, Kyung Bok Lee, Jeong-Ho Park, Kwang-Ik Yang, Dushin Jeong, Hyung-Kook Park; Diabetes Metab J. 2011;35(5):551-557. Published online October 31, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.5.551

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Background

The role of glycated hemoglobin (HbA1c) in the prediction of ischemic stroke in non-diabetic subjects is not clear. We performed a study to analyze the role of HbA1c in the risk prediction of ischemic stroke in non-diabetic Korean males adult.

Methods

A total of 307 non-diabetic male patients with ischemic stroke were enrolled, and 253 age-matched control subjects without a history of diabetes, hypertension, or cardiovascular disease were selected from a Health Check-up database. Anthropometric measurement data, fasting glucose level, lipid profile, and HbA1c level were available for all subjects. Associations of the variables and the presence or absence of ischemic stroke were analyzed.

Results

The ischemic stroke patient group had significantly higher HbA1c levels (5.8±0.5% vs. 5.5±0.5%, P<0.01) and mean systolic and diastolic blood pressure compared with the control group. Among the variables, smoking, low high density lipoprotein cholesterol, systolic blood pressure, and HbA1c were the significant determinants for ischemic stroke. The highest quartile of HbA1c showed a 9.6-fold increased odds ratio for ischemic stroke compared with the lowest quartile of HbA1c (odds ratio, 9.596; 95% confidence interval, 3.859 to 23.863, P<0.01). The proportion of ischemic stroke patients showed a significant trend for increment as the deciles of HbA1c increased (P for trend <0.01).

Conclusion

Higher HbA1c indicated a significantly increased risk for ischemic stroke after adjusting for other confounding variables in non-diabetic Korean adult males. HbA1c might have significance in predicting the risk for ischemic stroke even in the non-diabetic range.

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The Cutoff Value of HbA1c in Predicting Diabetes in Korean Adults in a University Hospital in Seoul.: Ji Cheol Bae, Eun Jung Rhee, Eun Suk Choi, Ji Hoon Kim, Won Jun Kim, Seung Hyun Yoo, Se Eun Park, Cheol Young Park, Won Young Lee, Ki Won Oh, Sung Woo Park, Sun Woo Kim; Korean Diabetes J. 2009;33(6):503-510. Published online December 1, 2009; DOI: https://doi.org/10.4093/kdj.2009.33.6.503

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Abstract PDF

BACKGROUND
Glycated hemoglobin (HbA1c) levels represent a 2~3 month average of blood glucose concentration. The use of HbA1c as a diagnostic tool for diabetes is gaining interest. Therefore, we determined the cutoff point of HbA1c for predicting abnormal glucose tolerance status in non-diabetic Korean subjects. METHODS: We analyzed the data from 1,482 subjects without diabetes mellitus in whom a 75-g oral glucose tolerance test (OGTT) was performed due to suspected abnormal glucose tolerance. We obtained an HbA1c cutoff point for predicting diabetes using Receiver Operating Characteristic (ROC) curve analysis. RESULTS: A cut-off point of 5.95% HbA1c yielded sensitivity of 60.8% and specificity of 85.6%, respectively, for predicting diabetes. There was a difference in HbA1c cut-off value between men and women, 5.85% and 6.05%, respectively. CONCLUSION: To use the cut-off point of 5.95% HbA1c for predicting undiagnosed diabetes in Koreans may be reliable. However, studies of different ethnic groups have reported disparate HbA1c cut-off points. Thus, ethnicity, age, gender, and population prevalence of diabetes are important factors to consider in using elevated HbA1c value as a tool to diagnose diabetes.

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The Cutoff Value of HbA1c in Predicting Diabetes and Impaired Fasting Glucose
Seyoung Kwon, Youngak Na
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Jae Hyun Kim, Gun Woo Kim, Mi Young Lee, Jang Yel Shin, Young Goo Shin, Sang Baek Koh, Choon Hee Chung
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Impact of HbA1c Criterion on the Detection of Subjects with Increased Risk for Diabetes among Health Check-Up Recipients in Korea
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2011 Clinical Practice Guidelines for Type 2 Diabetes in Korea
Seung-Hyun Ko, Sung-Rea Kim, Dong-Joon Kim, Seung-Joon Oh, Hye-Jin Lee, Kang-Hee Shim, Mi-Hye Woo, Jun-Young Kim, Nan-Hee Kim, Jae-Taik Kim, Chong Hwa Kim, Hae Jin Kim, In-Kyung Jeong, Eun-Kyung Hong, Jae-Hyoung Cho, Ji-Oh Mok, Kun-Ho Yoon
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Seung-Hyun Ko, Dong-Joon Kim, Seung-Joon Oh, Hye-Jin Lee, Kang-Hee Shim, Mi-Hye Woo, Jun-Young Kim, Nan-Hee Kim, Jae-Taik Kim, Chong Hwa Kim, Hye Jin Kim, In-Kyung Jeong, Eun-Gyoung Hong, Jae-Hyoung Cho, Ji-Oh Mok, Kun-Ho Yoon, Sung-Rea Kim
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The Long-term Effect of a Structured Diabetes Education Program for Uncontrolled Type 2 Diabetes Mellitus Patients-a 4-Year Follow-up.: Min Sun Song, Ki Ho Song, Seung Hyun Ko, Yu Bai Ahn, Joon Sung Kim, Jin Hee Shin, Yang Kyung Cho, Kun Ho Yoon, Bong Youn Cha, Ho Young Son, Dong Han Lee; Korean Diabetes J. 2005;29(2):140-150. Published online March 1, 2005

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Abstract PDF: BACKGROUND
Diabetes mellitus is a chronic illness with many metabolic complications. The prevalence of diabetes mellitus has markedly increased. Until now, however, little data have been presented for the long-term evaluation of a structured diabetes education program (SDEP) for patients with type 2 diabetes mellitus. The aim of this study was to examine the effects of the SDEP on glycemic control, lipid profiles, and self-care behavior over a four-year follow-up period. METHODS: A total of 248 diabetic patients completed the SDEP from December 1999 to September 2000. Ninety-eight patients were followed-up for more than four years and 75 of them were selected for the study, after those subjects having a baseline glycated hemoglobin(HbA1c) levels below 7.9% were excluded. The laboratory data included the glycemic control status(fasting blood sugar and HbA1c), serum creatinine, and lipid profiles. Compliance with their diet, self monitoring of blood glucose, and their exercise frequency were monitored with a questionnaire that was completed by the patients when they visited the hospital. The data were analyzed by using repeated ANOVA measures and chi2 testing for detecting trends. RESULTS: There were no significant decreases in the fasting blood glucose, creatinine, total cholesterol, triglycerides or low density lipoprotein cholesterol for the SDEP group compared with the control group. The self-care behavior of the SDEP group was much better than that of the control group and it was well maintained. Although the self-care behavior tended to deteriorate with time in the SDEP group, the exercise frequency did not change. The HbA1c level was much improved in the SDEP group(HbA1c: SDEP, 7.9+/-1.2% vs. 8.9+/-1.6% for the control; P =0.009). High density lipoprotein(HDL) cholesterol was also relatively improved in the SDEP group(HDL cholesterol: SDEP, 1.1+/-0.2 mmol/L vs. 1.0+/-0.3mmol/L for the control; P=0.006). CONCLUSIONS: The glycemic control status of diabetic patients who undertook the SDEP was satisfactory for one year after the program, although all the habitual compliance measures decreased gradually with time over the total four years. These results demonstrate that the SDEP for patients with diabetes is useful in improving their long-term glycemic control and self-care behavior. Regular and sustained reinforcement with encouragement will be required for the diabetic patients to maintain their self-care

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