Diabetes & Metabolism Journal

Original Articles

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.

Citations

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Frequency of Diabetic Nephropathy among Patients of Type 2 Diabetes Mellitus
Muhammad Irfan Jamil, Yasir Hussain, Muhammad Shahid Nawaz Khan, Anjum Shahzad, Azhar Iqbal, Adeel Ahmed, Iqra Naeem
Pakistan Journal of Health Sciences.2025; : 18. CrossRef
Type 2 diabetes mellitus modifies the relationship between coronary artery calcification and adverse kidney outcome in patients with chronic kidney disease: the findings from KNOW-CKD
Hae-Ryong Yun, Young Su Joo, Hyung Woo Kim, Jung Tak Park, Nak-Hoon Son, Tae-Hyun Yoo, Shin-Wook Kang, Yaeni Kim, Soo Wan Kim, Yeong Hoon Kim, Kook-Hwan Oh, Seung Hyeok Han
Journal of Nephrology.2025; 38(9): 2755. CrossRef
Intervention effects of optimised carbohydrate diet in patients with type 2 diabetes: study protocol for a randomised controlled crossover trial
Yuwei LU, Ruiqi Zhang, Jingyi Yang, Dan Liu, Qian Wu, Xiaoxue Long, Di Cheng, Jingyi Guo, Qian Li, Ying Zhang, Piao Kang, Qinyi Wang, Xiaojing Gao, Rong Zeng, Mingliang Zhang, Qichen Fang, Weiping Jia, Yueqiong Ni, Huating Li
BMJ Open.2025; 15(10): e106756. CrossRef
Interrelationship Between Dyslipidemia and Hyperuricemia in Patients with Uncontrolled Type 2 Diabetes: Clinical Implications and a Risk Identification Algorithm
Lorena Paduraru, Cosmin Mihai Vesa, Mihaela Simona Popoviciu, Timea Claudia Ghitea, Dana Carmen Zaha
Healthcare.2025; 13(20): 2605. CrossRef
Baseline predictors of in-hospital mortality among patients with chronic kidney disease admitted to the emergency department
Arun Prabhahar, Niranjan A Vijaykumar, Harpreet Kaur, Navneet Sharma, Ashok K Pannu
World Journal of Nephrology.2025;[Epub] CrossRef
Dietary management of patients with type 2 diabetes and chronic kidney disease: A comprehensive literature review
Asmaa AlShammari, Ali AlSahow
World Journal of Nephrology.2025;[Epub] CrossRef
Unveiling the utility of artificial intelligence for prediction, diagnosis, and progression of diabetic kidney disease: an evidence-based systematic review and meta-analysis
Sagar Dholariya, Siddhartha Dutta, Amit Sonagra, Mehul Kaliya, Ragini Singh, Deepak Parchwani, Anita Motiani
Current Medical Research and Opinion.2024; 40(12): 2025. CrossRef
Non-Alcoholic Fatty Liver Disease and Its Association with Kidney and Cardiovascular Outcomes in Moderate to Advanced Chronic Kidney Disease
Cheol Ho Park, Hyunsun Lim, Youn Nam Kim, Jae Young Kim, Hyung Woo Kim, Tae Ik Chang, Seung Hyeok Han
American Journal of Nephrology.2024; : 1. CrossRef
The Beneficial Effect of Glycemic Control against Adverse Outcomes in Patients with Type 2 Diabetes Mellitus and Chronic Kidney Disease
Dong-Hwa Lee
Diabetes & Metabolism Journal.2023; 47(4): 484. CrossRef
Prevalence and predictors of chronic kidney disease among type 2 diabetic patients worldwide, systematic review and meta-analysis
Eneyew Talie Fenta, Habitu Birhan Eshetu, Natnael Kebede, Eyob Ketema Bogale, Amare Zewdie, Tadele Derbew Kassie, Tadele Fentabil Anagaw, Elyas Melaku Mazengia, Sintayehu Shiferaw Gelaw
Diabetology & Metabolic Syndrome.2023;[Epub] CrossRef
Efficacy and safety of teneligliptin in patients with type 2 diabetes mellitus: a Bayesian network meta-analysis
Miao Zhu, Ruifang Guan, Guo Ma
Frontiers in Endocrinology.2023;[Epub] CrossRef

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.

Citations

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Giulia Locatelli, Austin Matus, Chin-Yen Lin, Ercole Vellone, Barbara Riegel
Heart & Lung.2025; 70: 122. CrossRef
Editorial: Translational neuroeconomic approach: from economic decision making to neuropsychological disorders
Mrinalini Srivastava, S. Senthil Kumaran, Achal Kumar Srivastava, Sanjay Singh
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Neuroeconomically dissociable forms of mental accounting are altered in a mouse model of diabetes
Chinonso A. Nwakama, Romain Durand-de Cuttoli, Zainab M. Oketokoun, Samantha O. Brown, Jillian E. Haller, Adriana Méndez, Mohammad Jodeiri Farshbaf, Y. Zoe Cho, Sanjana Ahmed, Sophia Leng, Jessica L. Ables, Brian M. Sweis
Communications Biology.2025;[Epub] CrossRef
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
Annals of the New York Academy of Sciences.2025; 1553(1): 300. CrossRef
Glycated hemoglobin, type 2 diabetes, and poor diabetes control are positively associated with impulsivity changes in aged individuals with overweight or obesity and metabolic syndrome
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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The usefulness of an intervention with a serious video game as a complementary approach to cognitive behavioural therapy in eating disorders: A pilot randomized clinical trial for impulsivity management
Cristina Vintró‐Alcaraz, Núria Mallorquí‐Bagué, María Lozano‐Madrid, Giulia Testa, Roser Granero, Isabel Sánchez, Janet Treasure, Susana Jiménez‐Murcia, Fernando Fernández‐Aranda
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Adaptations of the balloon analog risk task for neuroimaging settings: a systematic review
Charline Compagne, Juliana Teti Mayer, Damien Gabriel, Alexandre Comte, Eloi Magnin, Djamila Bennabi, Thomas Tannou
Frontiers in Neuroscience.2023;[Epub] CrossRef
Trust-based health decision-making recruits the neural interoceptive saliency network which relates to temporal trajectories of Hemoglobin A1C in Diabetes Type 1
Helena Jorge, Isabel C. Duarte, Miguel Melo, Ana Paula Relvas, Miguel Castelo-Branco
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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Exploring biosensors: Distinctive features and emerging applications
Shweta Mishra, Ashlesha J. Chauhan, Jayaveersinh Mahida
Analytical Biochemistry.2026; 709: 115993. 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
Multilayer track‐etched membrane‐based electroosmotic pump for drug delivery
Qian Yang, Zebo Zhang, Junshu Lin, Boyu Zhu, Rongying Yu, Xinru Li, Bin Su, Bo Zhao
ELECTROPHORESIS.2024; 45(5-6): 433. CrossRef
Comparison between a tubeless, on-body automated insulin delivery system and a tubeless, on-body sensor-augmented pump in type 1 diabetes: a multicentre randomised controlled trial
Ji Yoon Kim, Sang-Man Jin, Eun Seok Kang, Soo Heon Kwak, Yeoree Yang, Jee Hee Yoo, Jae Hyun Bae, Jun Sung Moon, Chang Hee Jung, Ji Cheol Bae, Sunghwan Suh, Sun Joon Moon, Sun Ok Song, Suk Chon, Jae Hyeon Kim
Diabetologia.2024; 67(7): 1235. CrossRef
Approaches of wearable and implantable biosensor towards of developing in precision medicine
Elham Ghazizadeh, Zahra Naseri, Hans-Peter Deigner, Hossein Rahimi, Zeynep Altintas
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Advancements in Insulin Pumps: A Comprehensive Exploration of Insulin Pump Systems, Technologies, and Future Directions
Mohammad Towhidul Islam Rimon, Md Wasif Hasan, Mohammad Fuad Hassan, Sevki Cesmeci
Pharmaceutics.2024; 16(7): 944. CrossRef
A true continuous healthcare system for type 1 diabetes
Jiyong Kim, Salman Khan, Eun Kyu Kim, Hye-Jun Kil, Bo Min Kang, Hyo Geon Lee, Jin-Woo Park, Jun Young Yoon, Woochul Kim
Nano Energy.2023; 113: 108553. CrossRef

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
Diabetes, Obesity and Metabolism.2025; 27(5): 2342. CrossRef
Analysis glycemic variability in pregnant women with various type of hyperglycemia
Xuexin Zhou, Ru Zhang, Shiwei Jiang, Decui Cheng, Hao Wu
BMC Pregnancy and Childbirth.2025;[Epub] CrossRef
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
Cardiovascular Diabetology – Endocrinology Reports.2025;[Epub] CrossRef
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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Potential approaches using teneligliptin for the treatment of type 2 diabetes mellitus: current status and future prospects
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Expert Review of Clinical Pharmacology.2023; 16(1): 49. CrossRef
Mechanism of molecular interaction of sitagliptin with human DPP4 enzyme - New Insights
Michelangelo Bauwelz Gonzatti, José Edvar Monteiro Júnior, Antônio José Rocha, Jonathas Sales de Oliveira, Antônio José de Jesus Evangelista, Fátima Morgana Pio Fonseca, Vânia Marilande Ceccatto, Ariclécio Cunha de Oliveira, José Ednésio da Cruz Freire
Advances in Medical Sciences.2023; 68(2): 402. CrossRef
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)
Banshi Saboo, Suhas Erande, A.G. Unnikrishnan
Diabetes & Metabolic Syndrome: Clinical Research & Reviews.2022; 16(2): 102394. CrossRef
Association between Variability of Metabolic Risk Factors and Cardiometabolic Outcomes
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Diabetes & Metabolism Journal.2022; 46(1): 49. CrossRef

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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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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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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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
Diabetes & Metabolism Journal.2024; 48(5): 915. CrossRef
2023 Clinical Practice Guidelines for Diabetes Mellitus of the Korean Diabetes Association
Jong Han Choi, Kyung Ae Lee, Joon Ho Moon, Suk Chon, Dae Jung Kim, Hyun Jin Kim, Nan Hee Kim, Ji A Seo, Mee Kyoung Kim, Jeong Hyun Lim, YoonJu Song, Ye Seul Yang, Jae Hyeon Kim, You-Bin Lee, Junghyun Noh, Kyu Yeon Hur, Jong Suk Park, Sang Youl Rhee, Hae J
Diabetes & Metabolism Journal.2023; 47(5): 575. CrossRef
2021 Clinical Practice Guidelines for Diabetes Mellitus of the Korean Diabetes Association
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Diabetes & Metabolism Journal.2021; 45(4): 461. CrossRef

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.

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Early Glycosylated Hemoglobin Target Achievement Predicts Clinical Outcomes in Patients with Newly Diagnosed Type 2 Diabetes Mellitus
Joonyub Lee, Jae Hyoung Cho
Diabetes & Metabolism Journal.2021; 45(3): 337. CrossRef
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 (Diabetes Metab J 2021;45:368-78)
Ja Young Jeon
Diabetes & Metabolism Journal.2021; 45(4): 613. CrossRef
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 (Diabetes Metab J 2021;45:368-78)
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 & Metabolism Journal.2021; 45(4): 617. CrossRef
Plasma Nesfatin-1: Potential Predictor and Diagnostic Biomarker for Cognitive Dysfunction in T2DM Patient
Dandan Xu, Yue Yu, Yayun Xu, Jinfang Ge
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy.2021; Volume 14: 3555. CrossRef

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).

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Comprehensive Understanding for Application in Korean Patients with Type 2 Diabetes Mellitus of the Consensus Statement on Carbohydrate-Restricted Diets by Korean Diabetes Association, Korean Society for the Study of Obesity, and Korean Society of Hyperte
Jong Han Choi, Jee-Hyun Kang, Suk Chon
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Associations of Dietary Salt and Its Sources with Hemoglobin A1c in Patients with Type 2 Diabetes Not Taking Anti-Diabetic Medications: Analysis Based on 6-Month Intervention with a Moderate Low-Carbohydrate Diet
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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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Alix Covenant, Thomas Yates, Alex V. Rowlands, Paddy C. Dempsey, Charlotte L. Edwardson, Andrew P. Hall, Melanie J. Davies, Joseph Henson
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Wenquan Cheng, Hongsen Chen, Leirong Tian, Zhimin Ma, Xingran Cui
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Yoo Hyun Um, Tae-Won Kim, Jong-Hyun Jeong, Seung-Chul Hong, Ho-Jun Seo, Kyung-Do Han
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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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Seung-Hwan Lee, Kyung-Wan Min, Byung-Wan Lee, In-Kyung Jeong, Soon-Jib Yoo, Hyuk-Sang Kwon, Yoon-Hee Choi, Kun-Ho Yoon
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Angiotensin II up-regulates sodium-glucose co-transporter 2 expression and SGLT2 inhibitor attenuates Ang II-induced hypertensive renal injury in mice
Kana N. Miyata, Chao-Sheng Lo, Shuiling Zhao, Min-Chun Liao, Yuchao Pang, Shiao-Ying Chang, Junzheng Peng, Matthias Kretzler, Janos G. Filep, Julie R. Ingelfinger, Shao-Ling Zhang, John S.D. Chan
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Sodium-Glucose Cotransporter-2 Inhibitor for Renal Function Preservation in Patients with Type 2 Diabetes Mellitus: A Korean Diabetes Association and Korean Society of Nephrology Consensus Statement
Tae Jung Oh, Ju-Young Moon, Kyu Yeon Hur, Seung Hyun Ko, Hyun Jung Kim, Taehee Kim, Dong Won Lee, Min Kyong Moon
Diabetes & Metabolism Journal.2020; 44(4): 489. CrossRef
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Ildiko Lingvay, Matthew S Capehorn, Andrei-Mircea Catarig, Pierre Johansen, Jack Lawson, Anna Sandberg, Robert Shaw, Abby Paine
The Journal of Clinical Endocrinology & Metabolism.2020; 105(12): e4593. CrossRef
Letter: Predictors of the Therapeutic Efficacy and Consideration of the Best Combination Therapy of Sodium-Glucose Co-transporter 2 Inhibitors (Diabetes Metab J 2019;43:158–73)
Kyung-Soo Kim
Diabetes & Metabolism Journal.2019; 43(3): 377. CrossRef
Response: Predictors of the Therapeutic Efficacy and Consideration of the Best Combination Therapy of Sodium-Glucose Co-transporter 2 Inhibitors (Diabetes Metab J 2019;43:158–73)
Ji-Yeon Lee, Eun Seok Kang
Diabetes & Metabolism Journal.2019; 43(3): 379. CrossRef
An Age of Sodium-Glucose Cotransporter-2 Inhibitor Priority: Are We Ready?
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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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Diagnostic and therapeutic potential of PCSK9 in diabetic tubulopathy: Evidence from observational and experimental studies
JingJing Quan, Si Li, Bin Yi, Zhijun Huang
International Immunopharmacology.2026; 168: 115907. CrossRef
Albumin does not induce IL-6 release and toll-like receptor activation in vitro: Role of endotoxin contamination and biochemical modifications
Margret Paar, Vera H. Fengler, Martina Schweiger, Christine Rossmann, Christoph Nusshold, Martina Mairold, Doris Payerl, Gerhard Cvirn, Karl Oettl
BBA Advances.2025; 8: 100174. CrossRef
Glucagon-Like Peptide 1 Receptor Agonist Improves Renal Tubular Damage in Mice with Diabetic Kidney Disease
Ran Li, Dunmin She, Zhengqin Ye, Ping Fang, Guannan Zong, Yong Zhao, Kerong Hu, Liya Zhang, Sha Lei, Keqin Zhang, Ying Xue
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy.2022; Volume 15: 1331. CrossRef
Use of glycated albumin for the identification of diabetes in subjects from northeast China
Guo-Yan Li, Hao-Yu Li, Qiang Li
World Journal of Diabetes.2021; 12(2): 149. CrossRef
Diabetic Kidney Disease, Cardiovascular Disease and Non-Alcoholic Fatty Liver Disease: A New Triumvirate?
Carolina M. Perdomo, Nuria Garcia-Fernandez, Javier Escalada
Journal of Clinical Medicine.2021; 10(9): 2040. CrossRef
Empagliflozin reduces high glucose-induced oxidative stress and miR-21-dependent TRAF3IP2 induction and RECK suppression, and inhibits human renal proximal tubular epithelial cell migration and epithelial-to-mesenchymal transition
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Cellular Signalling.2020; 68: 109506. CrossRef
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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Increasing waist circumference is associated with decreased levels of glycated albumin
Yiting Xu, Xiaojing Ma, Yun Shen, Yufei Wang, Jian Zhou, Yuqian Bao
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Glucometabolic characteristics and higher vascular complication risk in Korean patients with type 2 diabetes with non-albumin proteinuria
Yongin Cho, Yong-ho Lee, Eun Seok Kang, Bong-soo Cha, Byung-wan Lee
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Association of urinary acidification function with the progression of diabetic kidney disease in patients with type 2 diabetes
Huanhuan Zhu, Xi Liu, Chengning Zhang, Qing Li, Xiaofei An, Simeng Liu, Lin Wu, Bo Zhang, Yanggang Yuan, Changying Xing
Journal of Diabetes and its Complications.2019; 33(11): 107419. CrossRef

Clinical Care/Education
Improvement of Glycosylated Hemoglobin in Patients with Type 2 Diabetes Mellitus under Insulin Treatment by Reimbursement for Self-Monitoring of Blood Glucose: Young Shin Song, Bo Kyung Koo, Sang Wan Kim, Ka Hee Yi, Kichul Shin, Min Kyong Moon; Diabetes Metab J. 2018;42(1):28-42. Published online September 28, 2017; DOI: https://doi.org/10.4093/dmj.2018.42.1.28

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Background

In Korea, the costs associated with self-monitoring of blood glucose (SMBG) for patients with type 2 diabetes mellitus (T2DM) under insulin treatment have been reimbursed since November 2015. We investigated whether this new reimbursement program for SMBG has improved the glycemic control in the beneficiaries of this policy.

Methods

Among all adult T2DM patients with ≥3 months of reimbursement (n=854), subjects without any changes in anti-hyperglycemic agents during the study period were selected. The improvement of glycosylated hemoglobin (HbA1c) was defined as an absolute reduction in HbA1c ≥0.6% or an HbA1c level at follow-up <7%.

Results

HbA1c levels significantly decreased from 8.5%±1.3% to 8.2%±1.2% during the follow-up (P<0.001) in all the study subjects (n=409). Among them, 35.5% (n=145) showed a significant improvement in HbA1c. Subjects covered under the Medical Aid system showed a higher prevalence of improvement in HbA1c than those with medical insurance (52.2% vs. 33.3%, respectively, P=0.012). In the improvement group, the baseline HbA1c (P<0.001), fasting C-peptide (P=0.016), and daily dose of insulin/body weight (P=0.024) showed significant negative correlations with the degree of HbA1c change. Multivariate analysis showed that subjects in the Medical Aid system were about 2.5-fold more likely to improve in HbA1c compared to those with medical insurance (odds ratio, 2.459; 95% confidence interval, 1.138 to 5.314; P=0.022).

Conclusion

The reimbursement for SMBG resulted in a significant improvement in HbA1c in T2DM subjects using insulin, which was more prominent in subjects with poor glucose control at baseline or covered under the Medical Aid system.

Citations

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Conundrum and chances of diabetes management in the Western Pacific Region: A narrative review
Yerin Hwang, Hyunmin Lee, Moon‐Kyu Lee
Journal of Diabetes Investigation.2025; 16(8): 1357. CrossRef
The status of blood glucose monitoring and its influencing factors in Chinese patients with type 2 diabetes initiating premixed insulin: A prospective real-world study
Si Chen, Jingyi Lu, Danfeng Peng, Fengjing Liu, Wei Lu, Wei Zhu, Yuqian Bao, Jian Zhou, Weiping Jia
Diabetes Research and Clinical Practice.2024; 218: 111895. CrossRef
Immunogenicity and Efficacy of Insulin Glargine Biosimilar Ezelin versus Originator Insulin Glargine in Patients with Type 2 Diabetes
Tri Juli Edi Tarigan, Adisti Dwijayanti, Susie Setyowati, Melva Louisa
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy.2021; Volume 14: 107. CrossRef
Insulin Glargine U100 Utilization in Patients with Type 2 Diabetes in an Italian Real-World Setting: A Retrospective Study
Luca Degli Esposti, Valentina Perrone, Stefania Saragoni, Valerio Blini, Stefano Buda, Rosella D’avella, Gina Gasperini, Fabio Lena, Francesca Fanelli, Luca Gazzi, Francesco Giorgino
Journal of Diabetes Research.2019; 2019: 1. CrossRef
Self-Monitoring of Blood Glucose in Patients with Insulin-Treated Type 2 Diabetes Mellitus
Kyung-Soo Kim
Diabetes & Metabolism Journal.2018; 42(1): 26. CrossRef

Clinical Care/Education
Physician-Directed Diabetes Education without a Medication Change and Associated Patient Outcomes: Hun-Sung Kim, Hyunah Kim, Hae-Kyung Yang, Eun Young Lee, Yoo Jin Jeong, Tong Min Kim, So Jung Yang, Seo Yeon Baik, Seung-Hwan Lee, Jae Hyoung Cho, In Young Choi, Hyeon Woo Yim, Bong-Yun Cha; Diabetes Metab J. 2017;41(3):187-194. Published online May 12, 2017; DOI: https://doi.org/10.4093/dmj.2017.41.3.187

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Background

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

Methods

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

Results

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

Conclusion

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

Citations

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Management Status of Patients with Type 2 Diabetes Mellitus at General Hospitals in Korea: A 5-Year Follow-Up Study
Jin Hee Jung, Jung Hwa Lee, Hyang Mi Jang, Young Na, Hee Sun Choi, Yeon Hee Lee, Yang Gyo Kang, Na Rae Kim, Jeong Rim Lee, Bok Rye Song, Kang Hee Sim
The Journal of Korean Diabetes.2022; 23(1): 64. CrossRef
Effect of Voluntary Participation on Mobile Health Care in Diabetes Management: Randomized Controlled Open-Label Trial
Da Young Lee, Seung-Hyun Yoo, Kyong Pil Min, Cheol-Young Park
JMIR mHealth and uHealth.2020; 8(9): e19153. CrossRef
Developing a multi-center clinical data mart of ACEI and ARB for real-world evidence (RWE)
Hun-Sung Kim, Sue Hyun Lee, Tong Min Kim, Ju Han Kim
Clinical Hypertension.2018;[Epub] CrossRef

Clinical Care/Education
Diabetes Camp as Continuing Education for Diabetes Self-Management in Middle-Aged and Elderly People with Type 2 Diabetes Mellitus: So Young Park, Sun Young Kim, Hye Mi Lee, Kyu Yeon Hur, Jae Hyeon Kim, Moon-Kyu Lee, Kang-Hee Sim, Sang-Man Jin; Diabetes Metab J. 2017;41(2):99-112. Published online March 3, 2017; DOI: https://doi.org/10.4093/dmj.2017.41.2.99

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Background

Despite the established benefits of diabetes camps for the continuing education of children with type 1 diabetes mellitus, little is known about the long-term metabolic benefits of diabetes camps for middle-aged and elderly people with type 2 diabetes mellitus (T2DM), especially in terms of glycosylated hemoglobin (HbA1c) variability.

Methods

The 1-year mean and variability of HbA1c before and after the diabetes camp was compared between the participants of the diabetes camp (n=57; median age 65 years [range, 50 to 86 years]; median diabetes duration 14 years [range, 1 to 48 years]). Additional case-control analysis compared the metabolic outcomes of the participants of the diabetes camp and their propensity score-matched controls who underwent conventional diabetes education (n=93).

Results

The levels of HbA1c during the first year after the diabetes camp were comparable to those of the matched controls (P=0.341). In an analysis of all participants of the diabetes camp, the 1-year mean±standard deviation (SD) of HbA1c decreased (P=0.010 and P=0.041) after the diabetes camp, whereas the adjusted SD and coefficient of variance (CV) of HbA1c did not decrease. The adjusted SD and CV significantly decreased after the diabetes camp in participants whose 1-year mean HbA1c was ≥6.5% before the diabetes camp (n=40) and those with a duration of diabetes less than 15 years (n=32).

Conclusion

The 1-year mean and SD of HbA1c decreased after the diabetes camp, with significant reduction in the adjusted SD and CV in those with higher baseline HbA1c and a shorter duration of diabetes.

Citations

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Camp-style lifestyle modification program (CAMP) for diabetes prevention among rural women with prior GDM: study protocol for a three-arm cluster hybrid type 2 randomized controlled trial
Yao Chen, Qinyi Zhong, Wencong Lv, Qing Long, Man Ping Wang, Jyu-Lin Chen, James Allen Willey, Robin Whittemore, Jia Guo
BMC Public Health.2024;[Epub] CrossRef
Older adults’ experiences of being at a senior summer camp—A phenomenographic study
Veronika Wallroth, Kjerstin Larsson, Agneta Schröder
Qualitative Social Work.2022; 21(5): 956. CrossRef
Pushing for miracles, pulling away from risk: An ethnographic analysis of the force dynamics at Senior Summer Camps in Sweden
Gabriella Nilsson, Lisa Ekstam, Janicke Andersson
Journal of Aging Studies.2018; 47: 96. CrossRef

Clinical Care/Education
Practical Focus on American Diabetes Association/European Association for the Study of Diabetes Consensus Algorithm in Patients with Type 2 Diabetes Mellitus: Timely Insulin Initiation and Titration (Iran-AFECT): Mohammad Ebrahim Khamseh, Gholamreza Yousefzadeh, Zahra Banazadeh, Sahar Ghareh; Diabetes Metab J. 2017;41(1):31-37. Published online October 25, 2016; DOI: https://doi.org/10.4093/dmj.2017.41.1.31

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Abstract PDF PubReader ePub: Background
The aim of this study was to evaluate the safety and effectiveness of insulin glargine in a large population from a variety of clinical care in Iranian people with type 2 diabetes mellitus (T2DM) and to measure the percentage of patients achieving glycosylated hemoglobin (HbA1c) <7% by the end of 24 weeks of treatment in routine clinical practice.
Methods
This study was a 24 week, observational study of patients with T2DM, for whom the physician had decided to initiate or to switch to insulin glargine. The safety and efficacy of glargine were assessed at baseline and at week 24.
Results
Seven hundred and twenty-five people with T2DM (63% female) including both insulin naïve and prior insulin users were recruited in this study. The mean age of the participants was 54.2±11.2 years, and the mean HbA1c level was 8.88%±0.93% at baseline. By the end of the study, 27% of the entire participants reached to HbA1c target of less than 7% and 52% had HbA1c ≤7.5%. No serious adverse event was reported in this study. Furthermore, overall hypoglycemia did not increase in prior insulin users and the entire cohort. In addition, body weight did not change in participants while lipid profile improved significantly.
Conclusion
Treatment with insulin glargine could improve glycemic control without increasing the risk of hypoglycemic events in people with T2DM. In addition, a significant clinical improvement was observed in lipid profile.

Complications
Risk Factors for the Development and Progression of Diabetic Kidney Disease in Patients with Type 2 Diabetes Mellitus and Advanced Diabetic Retinopathy: Kyung-Jin Yun, Hye Ji Kim, Mee Kyoung Kim, Hyuk-Sang Kwon, Ki-Hyun Baek, Young Jung Roh, Ki-Ho Song; Diabetes Metab J. 2016;40(6):473-481. Published online September 20, 2016; DOI: https://doi.org/10.4093/dmj.2016.40.6.473

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Background

Some patients with type 2 diabetes mellitus (T2DM) do not develop diabetic kidney disease (DKD) despite the presence of advanced diabetic retinopathy (DR). We aimed to investigate the presence of DKD and its risk factors in patients with T2DM and advanced DR.

Methods

We conducted a cross-sectional study in 317 patients with T2DM and advanced DR. The phenotypes of DKD were divided into three groups according to the urine albumin/creatinine ratio (uACR, mg/g) and estimated glomerular filtration rate (eGFR, mL/min/1.73 m²): no DKD (uACR <30 and eGFR ≥60), non-severe DKD (uACR ≥30 or eGFR <60), and severe DKD (uACR ≥30 and eGFR <60). Mean systolic and diastolic blood pressure, mean glycosylated hemoglobin (HbA1c) level, and HbA1c variability (standard deviation [SD] of serial HbA1c values or HbA1c-SD) were calculated for the preceding 2 years.

Results

The prevalence of no DKD, non-severe DKD, and severe DKD was 37.2% (n=118), 37.0% (n=117), and 25.8% (n=82), respectively. HbA1c-SD and the triglyceride/high density lipoprotein cholesterol (TG/HDL-C) ratio correlated positively with uACR and negatively with eGFR. Multiple linear regression analyses showed that the HbA1c-SD and TG/HDL-C ratio were significantly related with eGFR. Multiple logistic regression analyses after adjusting for several risk factors showed that HbA1c-SD and the TG/HDL-C ratio were significant risk factors for severe DKD.

Conclusion

The prevalence of DKD was about 60% in patients with T2DM and advanced DR. HbA1c variability and TG/HDL-C ratio may affect the development and progression of DKD in these patients.

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Brief Report

Epidemiology
Glycosylated Hemoglobin Threshold for Predicting Diabetes and Prediabetes from the Fifth Korea National Health and Nutrition Examination Survey: Sangmo Hong, Jun Goo Kang, Chul Sik Kim, Seong Jin Lee, Cheol-Young Park, Chang Beom Lee, Sung-Hee Ihm; Diabetes Metab J. 2016;40(2):167-170. Published online April 5, 2016; DOI: https://doi.org/10.4093/dmj.2016.40.2.167

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We aimed to estimate the threshold level of glycosylated hemoglobin (HbA1c) for the fasting plasma glucose of 100 and 126 mg/dL in the Korean adult population, using the 2011 Korea National Health and Nutrition Examination Survey. A total of 4,481 participants over 19 years of age without diabetic medications and conditions to influence the interpretation of HbA1c levels, such as anemia, renal insufficiency, liver cirrhosis, and cancers, were analyzed. A point-wise area under the receiver operating characteristic curve was used to estimate the optimal HbA1c cutoff value. A HbA1c threshold of 6.35% was optimal for predicting diabetes with a sensitivity of 86.9% and a specificity of 99.1%. Furthermore, the threshold of HbA1c was 5.65% for prediabetes, with a sensitivity of 69.3% and a specificity of 71%. Further prospective studies are needed to evaluate the HbA1c cutoff point for diagnosing prediabetes and diabetes in the Korean population.

Citations

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The Cutoff Value of HbA1c in Predicting Diabetes and Impaired Fasting Glucose
Seyoung Kwon, Youngak Na
The Korean Journal of Clinical Laboratory Science.2017; 49(2): 114. CrossRef
Cutoff Point of HbA1c for Diagnosis of Diabetes Mellitus in Chinese Individuals
Bing Wang, Ming-Chuan Liu, Xin-Yu Li, Xu-Han Liu, Qiu-Xia Feng, Lu Lu, Zhu Zhu, Ying-Shu Liu, Wei Zhao, Zheng-Nan Gao, Noel Christopher Barengo
PLOS ONE.2016; 11(11): e0166597. CrossRef

Original Articles

The Association of Serum Cystatin C with Glycosylated Hemoglobin in Korean Adults: Eun Hee Sim, Hye Won Lee, Hyun Ju Choi, Dong Wook Jeong, Seok Man Son, Yang Ho Kang; Diabetes Metab J. 2016;40(1):62-69. Published online November 27, 2015; DOI: https://doi.org/10.4093/dmj.2016.40.1.62

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Background

Cystatin C has been known to be associated not only with early renal impairment but also with the incidence of diabetic conditions (prediabetes plus diabetes). However, it is not clear whether cystatin C levels are associated with the prevalence of diabetic conditions in Asian populations. We evaluated this association using glycosylated hemoglobin (HbA1c) levels as the definition of diabetes in Korean adults.

Methods

We analyzed data from 1,559 Korean adults (937 men and 622 women) with available serum cystatin C and HbA1c values.

Results

The serum cystatin C levels in subjects with prediabetes and diabetes were significantly increased (0.91±0.14 mg/L in prediabetes and 0.91±0.17 mg/L in diabetes vs. 0.88±0.13 mg/L in patients with normal glucose levels, P=0.001). At increasing cystatin C levels, the prevalence of subjects with prediabetes (30.2% vs. 14.6%, P<0.001) and those with diabetes (10.6% vs. 8.0%, P<0.001) significantly increased in the group with the highest cystatin C levels. The group with the highest cystatin C levels had a significantly increased odds ratio (OR) for the presence of diabetic conditions compared to the group with the lowest values in total subjects (OR, 2.35; 95% confidence interval [CI], 1.54 to 3.58; P<0.001) and in women (OR, 4.13; 95% CI, 1.97 to 8.65; P<0.001), though there was no significant increase after adjusting for multiple variables.

Conclusions

Higher levels of serum cystatin C are associated with an increased prevalence of diabetic conditions in Korean adults. Our findings may extend the positive association of cystatin C with diabetes incidence to an Asian population.

Citations

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Relationship between serum cystatin C and diabetic retinopathy in T2DM patients
Qiuqi Gui, Kunhua Jiang, Yuxin Xu
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Prognostic significance of serum cystatin C in acute brainstem infarctions patients
H. Li, B. Zhang, Z. Huang, H. Wu, B. Qin, L. Zhou, Z. Lu, F. Qin
Revue Neurologique.2024; 180(7): 642. CrossRef
Detection of decline in estimated glomerular filtration rate in patients with type 2 diabetes by cystatin C-based equations
Tam Thai Thanh Tran, Tien Kim Ha, Nhut Minh Phan, Minh Van Le, Tin Hoang Nguyen
World Journal of Nephrology.2024;[Epub] CrossRef
Cardiovascular risk assessment in prediabetic patients in a hypertensive population: The role of cystatin C
Rafael Garcia-Carretero, Luis Vigil-Medina, Inmaculada Mora-Jimenez, Cristina Soguero-Ruiz, Rebeca Goya-Esteban, Javier Ramos-Lopez, Oscar Barquero-Perez
Diabetes & Metabolic Syndrome: Clinical Research & Reviews.2018; 12(5): 625. CrossRef
Characteristics of Dapagliflozin Responders: A Longitudinal, Prospective, Nationwide Dapagliflozin Surveillance Study in Korea
Eugene Han, Ari Kim, Sung Jae Lee, Je-Yon Kim, Jae Hyeon Kim, Woo Je Lee, Byung-Wan Lee
Diabetes Therapy.2018; 9(4): 1689. CrossRef
Cystatin C as a Predictor for Diabetes according to Glycosylated Hemoglobin Levels in Korean Patients
Eon Ju Jeon, Ji Hyun Lee
Diabetes & Metabolism Journal.2016; 40(1): 32. CrossRef
Prevalence of Reduced Kidney Function by Estimated Glomerular Filtration Rate Using an Equation Based on Creatinine and Cystatin C in Metabolic Syndrome and Its Components in Korean Adults
Yang Ho Kang, Dong Wook Jeong, Seok Man Son
Endocrinology and Metabolism.2016; 31(3): 446. CrossRef
Letter: The Association of Serum Cystatin C with Glycosylated Hemoglobin in Korean Adults (Diabetes Metab J 2016;40:62-9)
Kyung-Soo Kim
Diabetes & Metabolism Journal.2016; 40(2): 171. CrossRef
Response: The Association of Serum Cystatin C with Glycosylated Hemoglobin in Korean Adults (Diabetes Metab J 2016;40:62-9)
Yang Ho Kang
Diabetes & Metabolism Journal.2016; 40(2): 173. CrossRef

Obesity and Metabolic Syndrome
The Usefulness of the Glycosylated Hemoglobin Level for the Diagnosis of Gestational Diabetes Mellitus in the Korean Population: Ah Jeong Ryu, Hyuk Jin Moon, Joo Ok Na, Yeo Joo Kim, Sang Jin Kim, Sang Il Mo, Jeong Ran Byun; Diabetes Metab J. 2015;39(6):507-511. Published online November 23, 2015; DOI: https://doi.org/10.4093/dmj.2015.39.6.507

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Background

An oral glucose tolerance test (OGTT) is the current method used for screening and diagnosis of gestational diabetes mellitus (GDM). OGTT is a relatively complicated procedure and is expensive. Thus, new strategies that do not require fasting or more than a single blood draw may improve the diagnosis of GDM and increase the rate of GDM testing. We investigated the utility of monitoring glycosylated hemoglobin (HbA1c) levels for the diagnosis of GDM.

Methods

The data from 992 pregnant women with estimated gestational ages ranging from 24 to 28 weeks were retrospectively reviewed. There were 367 women with plasma glucose levels ≥140 mg/dL 1 hour after a 50-g OGTT. GDM was diagnosed according to the Carpenter-Coustan criteria for a 3-hour 100 g OGTT. A HbA1c assessment was performed at the same time.

Results

We enrolled 343 women in this study, and there were 109 women with GDM. The area under the curve the receiver operating characteristic curve for HbA1c detection of GDM was 0.852 (95% confidence interval, 0.808 to 0.897). A HbA1c cutoff value ≥5.35% had maximal points on the Youden index (0.581). The sensitivity was 87.2% and the specificity was 70.9% for diagnosing GDM. A threshold value ≥5.35% indicated that 163 patients had GDM and that 68 (41.7%) were false positive. The positive predictive value was 58.3% at this threshold value.

Conclusion

Despite substantial progress in methodology, HbA1c values cannot replace OGTT for the diagnosis of GDM.

Citations

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Glycaemic Variability and Risk Factors of Pregnant Women with and without Gestational Diabetes Mellitus Measured by Continuous Glucose Monitoring
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A Review on Research Progress in the Application of Glycosylated Hemoglobin and Glycated Albumin in the Screening and Monitoring of Gestational Diabetes
Xinyan Liu, Na Wu, Abdulrahman Al-Mureish
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Evaluation of the Combination of HbA1C with Hematocrit for Early Screening of Gestational Diabetes Mellitus
Ali Reza Norouzi, Mahsa Siavashi, Fatemeh Norouzi, Maryam Talayeh, Somayyeh Noei Teymoordash
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The accuracy of haemoglobin A1c as a screening and diagnostic test for gestational diabetes: a systematic review and meta-analysis of test accuracy studies
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The utility of HbA1c combined with haematocrit for early screening of gestational diabetes mellitus
Kui Wu, Yan Cheng, Tingting Li, Ziwen Ma, Junxiu Liu, Qingying Zhang, Haidong Cheng
Diabetology & Metabolic Syndrome.2018;[Epub] CrossRef
The Cutoff Value of HbA1c in Predicting Diabetes and Impaired Fasting Glucose
Seyoung Kwon, Youngak Na
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Diagnosing gestational diabetes mellitus: implications of recent changes in diagnostic criteria and role of glycated haemoglobin (HbA1c)
Fahmy W Hanna, Christopher J Duff, Ann Shelley-Hitchen, Ellen Hodgson, Anthony A Fryer
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Utility of Glycated Haemoglobin in Gestational Diabetes Mellitus: Present and Future
Rajesh Rajput, Deepak Jain
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Review

The Optimal Cutoff Value of Glycated Hemoglobin for Detection of Diabetic Retinopathy: Jung Min Kim, Dong-Jun Kim; Diabetes Metab J. 2015;39(1):16-26. Published online February 16, 2015; DOI: https://doi.org/10.4093/dmj.2015.39.1.16

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With standardization of measurement of glycated hemoglobin (A1C), the International Expert Committee Report in 2009 and the American Diabetes Association in 2010 recommended incorporating A1C ≥6.5% into the previous diagnostic criteria using fasting plasma glucose and/or 2-hour plasma glucose. Whereas the association of A1C with cardiovascular diseases and other diabetic microvascular complications was linear without evidence of a distinct threshold, several studies suggested a threshold value for A1C in diabetic retinopathy (DR). In studies about the optimal cutoff value for A1C in DR, the A1C values range from 5.2% to 7.8%. There are several possible reasons why these values for DR differ so widely (differences in the definition and/or methods for DR, variation in statistical methods, differences in study population, differences in exclusion criteria, and difference in methods for measuring A1C). With these wide variations in the study method, drawing a conclusive cutoff value for A1C in DR is impossible. In published studies, the cutoff values for moderate or severe DR were higher than those for any or mild DR (6.4% to 7.0% vs. 5.5% to 6.5%).

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Brief Report

Glycated Hemoglobin Value for Fasting Plasma Glucose of 126 mg/dL in Korean: The 2011 Korea National Health and Nutrition Examination Survey: Jung Min Kim, Jae Won Hong, Jong Chul Won, Jung Hyun Noh, Kyung Soo Ko, Byoung Doo Rhee, Dong-Jun Kim; Diabetes Metab J. 2014;38(6):480-483. Published online December 15, 2014; DOI: https://doi.org/10.4093/dmj.2014.38.6.480

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Abstract PDF PubReader ePub

We aimed to estimate the cutoff value of glycated hemoglobin (HbA1c, A1c) for fasting plasma glucose (FPG) of 126 mg/dL in the Korean adult population, using the 2011 Korea National Health and Nutrition Examination Survey. A total of 5,421 participants without a history of diabetes and over 19 years of age were included in the analysis. A point-wise area under the receiver operating characteristic curve was used to estimate the optimal A1c cutoff value. A1c threshold of 6.1% produced the highest sum of sensitivity (85.2%) and specificity (90.5%) for FPG of 126 mg/dL (area under the curve, 0.941, P<0.001). A1c of 6.5% produced a sensitivity of 67.7% and specificity of 98.0% for FPG of 126 mg/dL. Considering A1c as one of three criteria for the diagnosis of diabetes and the specificity of an A1c cutoff of 6.5%, the current diagnostic criteria of A1c≥6.5% might be acceptable in the Korean adult population.

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Glycosylated Hemoglobin Threshold for Predicting Diabetes and Prediabetes from the Fifth Korea National Health and Nutrition Examination Survey
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Comparison of the clinical characteristics of diabetes mellitus diagnosed using fasting plasma glucose and haemoglobin A1c: The 2011 Korea National Health and Nutrition Examination Survey
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Original Articles

Effectiveness of 3-Day Continuous Glucose Monitoring for Improving Glucose Control in Type 2 Diabetic Patients in Clinical Practice: Soo Kyoung Kim, Hye Jeong Kim, Taehun Kim, Kyu Yeon Hur, Sun Wook Kim, Moon-Kyu Lee, Yong-Ki Min, Kwang-Won Kim, Jae Hoon Chung, Jae Hyeon Kim; Diabetes Metab J. 2014;38(6):449-455. Published online December 15, 2014; DOI: https://doi.org/10.4093/dmj.2014.38.6.449

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Background

The aim of this study was to investigate whether adjusting diabetic treatment regimens according to the information obtained from a continuous glucose monitoring system (CGMS) might lead to improved glycemic control in patients with type 2 diabetes.

Methods

We reviewed the medical charts of 172 patients who used the CGMS for 1 year starting in December 2008 and the records of 1,500 patients who visited their regular outpatient clinics during December 2008. Of these patients, a total of 65 CGMS patients and 301 regular outpatients (control group) were enrolled in the study after propensity score matching. There were no differences in baseline glycated hemoglobin (HbA1c), age, and duration of diabetes between the CGMS and the control groups after propensity score matching. The changes in the HbA1c levels from baseline to 6 months were calculated.

Results

The CGMS group showed a significant improvement in the HbA1c level compared to the control group at 3 months (7.9%±1.6% vs. 7.4%±1.2%, P=0.001) and at 6 months (7.4%±1.2% vs. 7.9%±1.6%, P=0.010). There were significant differences in the treatment modality changes between the CGMS group and the control group.

Conclusion

Using a 3-day CGMS was advantageous for improving glucose control in patients with type 2 diabetes and may help these patients to optimize glycemic control in clinical practice.

Citations

Citations to this article as recorded by

Clinical Impact of Continuous Glucose Monitoring in Noninsulin Treated Type 2 Diabetes: A Review
Grazia Aleppo, Anders L. Carlson, Janet B. McGill, Hamza Alshannaq, Rodolfo Galindo, Davida Kruger, Carol J. Levy, Jessica Y. Matuoka, Sabrina Ilham, Guillermo Umpierrez, Gregory J. Norman
Diabetes Technology & Therapeutics.2026;[Epub] CrossRef
Advanced Hybrid Closed‐Loop Insulin Delivery Is Associated With Improved Glycemic Indicators and Normalization of Small Nerve Fibre Structure in Adults With Type 1 Diabetes
Hoda Gad, Einas Elgassim, Kawsar Mohamed Ayon Mohamud, Najlaa Sultan Al‐Naimi, Hamad Ali Al‐Sharshani, Ibrahim Mohammed, Mariam A. Al‐Malaheem, Dorothy J. Quadros, Alhanoof AlJalahma, Neila Lamine, Ahmad Yaser Alhaddad, Hussein Ahmed Hussein Zaky Aly, Joh
Journal of the Peripheral Nervous System.2025;[Epub] CrossRef
Continuous glucose monitoring in noninsulin‐treated type 2 diabetes: A critical review of reported trials with an updated systematic review and meta‐analysis of randomised controlled trials
Ronnie Aronson, Alexander Abitbol, Harpreet S. Bajaj, Alice Y. Y. Cheng, Stavroula Christopoulos, Stewart B. Harris, Akshay B. Jain, Ronald M. Goldenberg
Diabetes, Obesity and Metabolism.2025; 27(11): 6220. CrossRef
Effectiveness of continuous glucose monitoring in patient management of Type 2 Diabetes Mellitus: an umbrella review of systematic reviews from 2011 to 2024
Yong Yi Tan, Enhui Suan, Gerald Choon Huat Koh, Suhana Binte Suhairi, Shilpa Tyagi
Archives of Public Health.2024;[Epub] CrossRef
Biological and Clinical Impacts of Glucose Metabolism in Pancreatic Ductal Adenocarcinoma
Zhao Liu, Hiromitsu Hayashi, Kazuki Matsumura, Norio Uemura, Yuta Shiraishi, Hiroki Sato, Hideo Baba
Cancers.2023; 15(2): 498. CrossRef
Professional continuous glucose monitoring in patients with diabetes mellitus: A systematic review and meta‐analysis
Sergio Di Molfetta, Irene Caruso, Angelo Cignarelli, Annalisa Natalicchio, Sebastio Perrini, Luigi Laviola, Francesco Giorgino
Diabetes, Obesity and Metabolism.2023; 25(5): 1301. CrossRef
American Association of Clinical Endocrinology Clinical Practice Guideline: The Use of Advanced Technology in the Management of Persons With Diabetes Mellitus
George Grunberger, Jennifer Sherr, Myriam Allende, Thomas Blevins, Bruce Bode, Yehuda Handelsman, Richard Hellman, Rosemarie Lajara, Victor Lawrence Roberts, David Rodbard, Carla Stec, Jeff Unger
Endocrine Practice.2021; 27(6): 505. CrossRef
Lack of Acceptance of Digital Healthcare in the Medical Market: Addressing Old Problems Raised by Various Clinical Professionals and Developing Possible Solutions
Jong Il Park, Hwa Young Lee, Hyunah Kim, Jisan Lee, Jiwon Shinn, Hun-Sung Kim
Journal of Korean Medical Science.2021;[Epub] CrossRef
A head‐to‐head comparison of personal and professional continuous glucose monitoring systems in people with type 1 diabetes: Hypoglycaemia remains the weak spot
Othmar Moser, Marlene Pandis, Felix Aberer, Harald Kojzar, Daniel Hochfellner, Hesham Elsayed, Melanie Motschnig, Thomas Augustin, Philipp Kreuzer, Thomas R. Pieber, Harald Sourij, Julia K. Mader
Diabetes, Obesity and Metabolism.2019; 21(4): 1043. CrossRef
Glucose monitoring in diabetes: from clinical studies to real‐world practice
Rebecca C Sagar, Afroze Abbas, Ramzi Ajjan
Practical Diabetes.2019; 36(2): 57. CrossRef
The Effectiveness of Continuous Glucose Monitoring in Patients with Type 2 Diabetes: A Systematic Review of Literature and Meta-analysis
Cindy Park, Quang A. Le
Diabetes Technology & Therapeutics.2018; 20(9): 613. CrossRef
Effects of Dapagliflozin on 24-Hour Glycemic Control in Patients with Type 2 Diabetes: A Randomized Controlled Trial
Robert R. Henry, Poul Strange, Rong Zhou, Jeremy Pettus, Leon Shi, Sergey B. Zhuplatov, Traci Mansfield, David Klein, Arie Katz
Diabetes Technology & Therapeutics.2018; 20(11): 715. CrossRef
Clinical and economic benefits of professional CGM among people with type 2 diabetes in the United States: analysis of claims and lab data
Joseph A. Sierra, Mona Shah, Max S. Gill, Zachery Flores, Hiten Chawla, Francine R. Kaufman, Robert Vigersky
Journal of Medical Economics.2018; 21(3): 225. CrossRef
Role of continuous glucose monitoring for type 2 in diabetes management and research
Robert Vigersky, Maneesh Shrivastav
Journal of Diabetes and its Complications.2017; 31(1): 280. CrossRef
Assessing the Therapeutic Utility of Professional Continuous Glucose Monitoring in Type 2 Diabetes Across Various Therapies: A Retrospective Evaluation
Jothydev Kesavadev, Robert Vigersky, John Shin, Pradeep Babu Sadasivan Pillai, Arun Shankar, Geethu Sanal, Gopika Krishnan, Sunitha Jothydev
Advances in Therapy.2017; 34(8): 1918. CrossRef
Use of Continuous Glucose Monitoring in Youth-Onset Type 2 Diabetes
Christine L. Chan
Current Diabetes Reports.2017;[Epub] CrossRef
The efficacy and safety of adding either vildagliptin or glimepiride to ongoing metformin therapy in patients with type 2 diabetes mellitus
Gyuri Kim, Sewon Oh, Sang-Man Jin, Kyu Yeon Hur, Jae Hyeon Kim, Moon-Kyu Lee
Expert Opinion on Pharmacotherapy.2017; 18(12): 1179. CrossRef
Morning Spot Urine Glucose-to-Creatinine Ratios Predict Overnight Urinary Glucose Excretion in Patients With Type 2 Diabetes
So Ra Kim, Yong-ho Lee, Sang-Guk Lee, Sun Hee Lee, Eun Seok Kang, Bong-Soo Cha, Hyun Chul Lee, Jeong-Ho Kim, Byung-Wan Lee
Annals of Laboratory Medicine.2017; 37(1): 9. CrossRef
The Contemporary Role of Masked Continuous Glucose Monitoring in a Real-Time World
Ian Blumer
Journal of Diabetes Science and Technology.2016; 10(3): 790. CrossRef
Glycemic Variability: How Do We Measure It and Why Is It Important?
Sunghwan Suh, Jae Hyeon Kim
Diabetes & Metabolism Journal.2015; 39(4): 273. CrossRef

Assessment of the Association between Mean Hemoglobin A1c Levels for 5 Years and Coronary Artery Disease by Coronary Angiography in Nondiabetic Patients: Jae-Joon Kim, Ji-Hoon Kang, Ja-Jun Goo, Kyoung-Nyoun Kim, Ja-Young Lee, Mi-kyung Kim, Tae Ik Kim; Diabetes Metab J. 2014;38(1):58-63. Published online February 19, 2014; DOI: https://doi.org/10.4093/dmj.2014.38.1.58

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Background

The effects of glucose on cardiovascular events or mortality in nondiabetic patients has been recently reported. However, since atherosclerosis can be formed over a long period of time, it is necessary to devote several years to unveil the relationship between the two factors. Here, we attempted to find out the relationship between the mean hemoglobin A1c (HbA1c) level and HbA1c variability for 5 years and coronary artery disease (CAD) by using coronary angiography (CAG) to assess nondiabetic patients.

Methods

We reviewed patients who performed CAG who were followed up for at least 5 years after the initial diagnosis. The fasting blood test was performed annually for glucose and HbA1c level. CAD was defined as more than 50% of luminal narrowing. The severity of CAD was divided into two groups depending on whether no vessels were involved or one more vessel were involved (CAD(-) or CAD(+), respectively).

Results

The patients in CAD(+) group had higher mean HbA1c level for 5 years than CAD(-) group (5.71±0.40 vs. 5.86±0.68; P=0.04). Mean HbA1c was a significant predictor for CAD in multiple regression (odds ratio, 2.224; P=0.028). The percentage of patients with CAD was significantly higher in patients with >6.2% of mean HbA1c levels compared to patients with <6.2% of mean HbA1c levels (P<0.019).

Conclusion

When the mean HbA1c levels were above 6.2%, the risk of CAD was higher. Also this study shows that HbA1c level can be one of the predictors for CAD even if the patients do not have diabetes.

Citations

Citations to this article as recorded by

Impact of a comprehensive cardiac rehabilitation programme versus coronary revascularisation in patients with stable angina pectoris: study protocol for the PRO-FIT randomised controlled trial
Joyce M. Heutinck, Iris A. De Koning, Tom Vromen, Robert-Jan M. Van Geuns, Dick H.J. Thijssen, Hareld M.C. Kemps, Eddy M. Adang, Johanna M. Geleijnse, Pieter van Gorp, Arnoud W. J. van ‘t Hof, Veronica R. Janssen, Harald T. Jorstad, Roderik A. Kraaijenhag
BMC Cardiovascular Disorders.2023;[Epub] CrossRef
Evaluation of HbA1c as a prognostic biomarker of cardiovascular events and mortality in nondiabetic patients: Methodological considerations
Denis Monneret
Atherosclerosis.2015; 242(1): 19. CrossRef

Prevalence of Diabetes and Prediabetes according to Fasting Plasma Glucose and HbA1c: Ja Young Jeon, Seung-Hyun Ko, Hyuk-Sang Kwon, Nan Hee Kim, Jae Hyeon Kim, Chul Sik Kim, Kee-Ho Song, Jong Chul Won, Soo Lim, Sung Hee Choi, Myoung-jin Jang, Yuna Kim, Kyungwon Oh, Dae Jung Kim, Bong-Yun Cha; Diabetes Metab J. 2013;37(5):349-357. Published online October 17, 2013; DOI: https://doi.org/10.4093/dmj.2013.37.5.349

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Background

Due to the inconvenience of performing oral glucose tolerance tests and day to day variability in glucose level, glycated hemoglobin (HbA1c) has been recommended by the American Diabetes Association as a method to diagnose diabetes. In addition, the Korean Diabetes Association has also recommended the use of HbA1c as a diagnostic test for diabetes. In this study, we evaluated the prevalence of diabetes according to fasting plasma glucose (FPG) level only or the combination of FPG and HbA1c tests.

Methods

Data from the 2011 Korea National Health and Nutrition Examination Survey (KNHANES) were analyzed. Among 5,811 subjects aged 30 years or older, 5,020 were selected after excluding the data of fasting time <8 hours, missing values from fasting glucose or HbA1c level, previous diagnosis of diabetes made by physicians, or current use of antidiabetic medications. Diabetes was defined as FPG ≥126 mg/dL, previous diagnosis of diabetes made by a medical doctor, current use of antidiabetic medications, and/or HbA1c ≥6.5%. Prediabetes was defined as FPG of 100 to 125 mg/dL and/or HbA1c of 5.7% to 6.4%.

Results

When we used FPG only, the prevalence of diabetes and prediabetes were 10.5% (men, 12.6%; women, 8.5%) and 19.3% (men, 23.8%; women, 14.9%), respectively. When HbA1c was included as a diagnostic test, the prevalence of diabetes and prediabetes increased to 12.4% (men, 14.5%; women, 10.4%) and 38.3% (men, 41%; women, 35.7%), respectively. Participants with HbA1c ≥6.5% and fasting glucose level <126 mg/dL were older and had lower estimated glomerular filtration rate.

Conclusion

We concluded that using fasting glucose level only may result in an underestimation of diabetes and prediabetes. HbA1c is an acceptable complementary diagnostic test for diabetes in Korean patients. However, national standardization is needed to order to use HbA1c as a diagnostic method of diabetes and prediabetes.

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Hemoglobin A1c May Be an Inadequate Diagnostic Tool for Diabetes Mellitus in Anemic Subjects: Jung Il Son, Sang Youl Rhee, Jeong-taek Woo, Jin Kyung Hwang, Sang Ouk Chin, Suk Chon, Seungjoon Oh, Sung Woon Kim, Young Seol Kim; Diabetes Metab J. 2013;37(5):343-348. Published online October 17, 2013; DOI: https://doi.org/10.4093/dmj.2013.37.5.343

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Background

Recently, a hemoglobin A1c (HbA1c) level of 6.5% has been determined to be a criterion for diabetes mellitus (DM), and it is a widely used marker for the diagnosis of DM. However, HbA1c may be influenced by a number of factors. Anemia is one of the most prevalent diseases with an influence on HbA1c; however, its effect on HbA1c varies based on the variable pathophysiology of anemia. The aim of this study was to determine the effect of anemia on HbA1c levels.

Methods

Anemic subjects (n=112) and age- and sex-matched controls (n=217) who were drug naive and suspected of having DM were enrolled. The subjects underwent an oral glucose tolerance test and HbA1c simultaneously. We compared mean HbA1c and its sensitivity and specificity for diagnosing DM between each subgroup.

Results

Clinical characteristics were found to be similar between each subgroup. Also, when glucose levels were within the normal range, the difference in mean HbA1c was not significant (P=0.580). However, when plasma glucose levels were above the diagnostic cutoff for prediabetes and DM, the mean HbA1c of the anemic subgroup was modestly higher than in the nonanemic group. The specificity of HbA1c for diagnosis of DM was significantly lower in the anemic subgroup (P<0.05).

Conclusion

These results suggest that the diagnostic significance of HbA1c might be limited in anemic patients.

Citations

Citations to this article as recorded by

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Low Levels of Physical Activity Are Associated with Increased Metabolic Syndrome Risk Factors in Korean Adults: Dong Hoon Lee, Yoon Myung Kim, Yoonsuk Jekal, Sukyung Park, Kyong-Chol Kim, Masayo Naruse, Sun Hyun Kim, Sang-Hwan Kim, Ji-Hye Park, Mi Kyung Lee, Sang Hui Chu, Justin Y. Jeon; Diabetes Metab J. 2013;37(2):132-139. Published online April 16, 2013; DOI: https://doi.org/10.4093/dmj.2013.37.2.132

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Background

Low levels of physical activity (PA) are strongly associated with the development of metabolic syndrome (MetS) and chronic diseases. However, few studies have examined this association in Koreans. The primary purpose of this study was to examine the associations between PA and MetS risks in Korean adults.

Methods

A total of 1,016 Korean adults (494 males and 522 females) participated in this study. PA levels were assessed using the International PA Questionnaire. MetS risk factors were determined using clinically established diagnostic criteria.

Results

Compared with the highest PA group, the group with the lowest level of PA was at greater risk of high triglyceride (TG) in males (odds ratio [OR], 1.87; 95% confidence interval [CI], 1.07 to 3.24) and of hemoglobin A1c ≥5.5% in females (OR, 1.75; 95% CI, 1.00 to 3.04) after adjusting for age and body mass index. Compared with subjects who met the PA guidelines, those who did not meet the guidelines were more likely to have low high density lipoprotein cholesterol in both males (OR, 1.69; 95% CI, 1.11 to 2.58), and females (OR, 1.82; 95% CI, 1.20 to 2.77). Furthermore, those who did not meet the PA guidelines were at increased risk of high TG levels in males (OR, 1.69; 95% CI, 1.23 to 2.86) and abnormal fasting glucose (OR, 1.93; 95% CI, 1.17 to 3.20) and MetS (OR, 2.10; 95% CI, 1.15 to 3.84) in females.

Conclusion

Increased levels of PA are significantly associated with a decreased risk of abnormal MetS components.

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Review

The Roles of Glycated Albumin as Intermediate Glycation Index and Pathogenic Protein: Kwang Joon Kim, Byung-Wan Lee; Diabetes Metab J. 2012;36(2):98-107. Published online April 17, 2012; DOI: https://doi.org/10.4093/dmj.2012.36.2.98

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The conventional glycemic indices used in management of diabetic patients includes A1c, fructosamine, 1,5-anhydroglucitol, and glycated albumin (GA). Among these indices, A1c is currently used as the gold standard. However, A1c cannot reflect the glycemic change over a relatively short period of time, and its accuracy is known to decrease when abnormalities in hemoglobin metabolism, such as anemia, coexist. When considering these weaknesses, there have been needs for finding a novel glycemic index for diagnosing and managing diabetes, as well as for predicting diabetic complications properly. Recently, several studies have suggested the potential of GA as an intermediate-term glycation index in covering the short-term effect of treatment. Furthermore, its role as a pathogenic protein affecting the worsening of diabetes and occurrence of diabetic complications is receiving attention as well. Therefore, in this article, we wanted to review the recent status of GA as a glycemic index and as a pathogenic protein.

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Original Articles

Impact of HbA1c Criterion on the Detection of Subjects with Increased Risk for Diabetes among Health Check-Up Recipients in Korea: Hong-Kyu Kim, Sung-Jin Bae, Jaeone Choe; Diabetes Metab J. 2012;36(2):151-156. Published online April 17, 2012; DOI: https://doi.org/10.4093/dmj.2012.36.2.151

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Background

We performed the study to examine the impact of hemoglobin A1c (HbA1c) criterion on the screening of increased risk for diabetes among health check-up subjects in Korea.

Methods

We retrospectively analyzed clinical and laboratory data of 37,754 Korean adults (age, 20 to 89 years; 41% women) which were measured during regular health check-ups. After excluding subjects with previously diagnosed diabetes mellitus (n=1,812) and with overt anemia (n=318), 35,624 subjects (21,201 men and 14,423 women) were included in the analysis.

Results

Among the 35,624 subjects, 11,316 (31.8%) subjects were categorized as increased risk for diabetes (IRD) by fasting plasma glucose (FPG) criteria, 6,531 (18.1%) subjects by HbA1c criteria, and 13,556 (38.1%) subjects by combined criteria. Therefore, although HbA1c criteria alone identifies 42% [(11,316-6,531)/11,316] fewer subjects with IRD than does FPG criteria, about 20% [(13,556-11,316)/11,316] more subjects could be detected by including new HbA1c criteria in addition to FPG criteria. Among the 13,556 subjects with IRD, 7,025 (51.8%) met FPG criteria only, 2,240 (16.5%) met HbA1c criteria only, and 4,291 (31.7%) met both criteria. Among subjects with impaired fasting glucose, 65% were normal, 32% were IRD, and 3% were diabetes by HbA1c criterion. In receiver operating characteristic curve analysis, cutoff point of HbA1c with optimal sensitivity and specificity for identifying IRD was 5.4%.

Conclusion

Although HbA1c criteria alone identifies fewer subjects with IRD than does FPG criteria, about 20% more could be detected by addition of HbA1c criteria. Further studies are needed to define optimal cutoff point of HbA1c and to establish screening and management guidelines for IRD.

Citations

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Letter: Impact of HbA1c Criterion on the Detection of Subjects with Increased Risk for Diabetes among Health Check-Up Recipients in Korea (Diabetes Metab J 2012;36:151-6)
Sung Hee Choi
Diabetes & Metabolism Journal.2012; 36(3): 251. CrossRef

Role of HbA1c in the Screening of Diabetes Mellitus in a Korean Rural Community: Jae Hyun Kim, Gun Woo Kim, Mi Young Lee, Jang Yel Shin, Young Goo Shin, Sang Baek Koh, Choon Hee Chung; Diabetes Metab J. 2012;36(1):37-42. Published online February 17, 2012; DOI: https://doi.org/10.4093/dmj.2012.36.1.37

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Background

Recently, the measurement of glycated hemoglobin (HbA1c) was recommended as an alternative to fasting plasma glucose or oral glucose tolerance tests for diagnosing diabetes mellitus (DM). In this study, we analyzed HbA1c levels for diabetes mellitus screening in a Korean rural population.

Methods

We analyzed data from 10,111 subjects from a Korean Rural Genomic Cohort study and generated a receiver operating characteristic curve to determine an appropriate HbA1c cutoff value for diabetes.

Results

The mean age of the subjects was 56.3±8.1 years. Fasting plasma glucose and 2-hour plasma glucose after 75 g oral glucose tolerance tests were 97.5±25.6 and 138.3±67.1 mg/dL, respectively. The mean HbA1c level of the subjects was 5.7±0.9%. There were 8,809 non-DM patients (87.1%) and 1,302 DM patients (12.9%). A positive relationship between HbA1c and plasma glucose levels and between HbA1c and 2-hour plasma glucose levels after oral glucose tolerance tests was found in a scatter plot of the data. Using Youden's index, the proper cutoff level of HbA1c for diabetes mellitus screening was 5.95% (sensitivity, 77%; specificity, 89.4%).

Conclusion

Our results suggest that the optimal HbA1c level for DM screening is 5.95%.

Citations

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Seyoung Kwon, Youngak Na
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Performance of HbA1c for the prediction of diabetes in a rural community in Korea
B. M. Song, H. C. Kim, J. Y. Lee, J.‐M. Lee, D. J. Kim, Y.‐H. Lee, I. Suh
Diabetic Medicine.2015; 32(12): 1602. CrossRef
The Relationship between BMI and Glycated Albumin to Glycated Hemoglobin (GA/A1c) Ratio According to Glucose Tolerance Status
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Serum Visfatin and Fetuin-A Levels and Glycemic Control in Patients with Obese Type 2 Diabetes Mellitus: Fethiye Oztop Gunduz, Sembol Turkmen Yildirmak, Mustafa Temizel, Yilmaz Faki, Mustafa Cakmak, Mustafa Durmuscan, Funda Sezgin; Diabetes Metab J. 2011;35(5):523-528. Published online October 31, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.5.523

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Background

Visfatin is an adipokine produced by visceral adipose tissue and has insulin-mimicking effects. Fetuin-A is a hepatic secretory protein that binds the insulin receptor and inhibits insulin action both in vivo and in vitro. The authors of the present study aimed to investigate the levels of serum visfatin and fetuin-A and their correlation with hemoglobin A1c (HbA1c) and urine albumin levels in patients with type 2 diabetes mellitus (T2DM).

Methods

A total of 40 obese patients with T2DM (11 males and 29 females; age, 54.47±10.83 years and 23 obese nondiabetic controls (8 males and 15 females; age, 53.04±11.33 years) were included in the study. Age, sex, and body mass index were similar in the 2 groups. Serum visfatin and fetuin-A levels were measured by enzyme-linked immunosorbent assay. HbA1c and urine albumin levels were measured by high performance liquid chromatography and nephelometric method, respectively.

Results

Serum levels of visfatin in patients with T2DM (4.03±2.44 ng/mL) were similar to the control group (3.65±3.02 ng/mL). Serum fetuin-A levels were significantly lower in patients with T2DM than the controls (298.75±78.86 and 430.73±94.46 µg/mL, respectively). HbA1c levels were significantly higher in the T2DM group compared with controls (7.33±1.32 and 5.44±0.84%, respectively). Correlations between visfatin, fetuin-A and HbA1c levels were not observed.

Conclusion

The present study suggests fetuin-A may play a role in the pathogenesis of T2DM.

Citations

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

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Background

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

Methods

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

Results

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

Conclusion

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

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PLoS ONE.2014; 9(1): e85742. CrossRef
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Effects of 6 Weeks of Lifestyle Modification Including Combined Exercise Program on the Risk of Metabolic Parameters and Macrovascular Complications in Type 2 Diabetic Patients
Dong Hoon Lee, Seung Hwan Lee, Kiyong An, Jin Young Moon, So Hun Kim, Yoon Jin Choi, Moonsuk Nam, Justin Y. Jeon
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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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Seyoung Kwon, Youngak Na
The Korean Journal of Clinical Laboratory Science.2017; 49(2): 114. CrossRef
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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
Diabetes & Metabolism Journal.2012; 36(1): 37. CrossRef
Impact of HbA1c Criterion on the Detection of Subjects with Increased Risk for Diabetes among Health Check-Up Recipients in Korea
Hong-Kyu Kim, Sung-Jin Bae, Jaeone Choe
Diabetes & Metabolism Journal.2012; 36(2): 151. CrossRef
The Utility of HbA1c as a Diagnostic Criterion of Diabetes
Hee-Jung Kim, Eun Young Choi, Eal Whan Park, Yoo Seock Cheong, Hong-Yoen Lee, Ji Hyun Kim
Korean Journal of Family Medicine.2011; 32(7): 383. CrossRef
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
Diabetes & Metabolism Journal.2011; 35(5): 431. CrossRef
2011 Clinical Practice Guidelines for Type 2 Diabetes in Korea
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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Incidence of Diabetic Foot and Associated Risk Factors in Type 2 Diabetic Patients: A Five-year Observational Study.: Shin Ae Park, Seung Hyun Ko, Seung Hwan Lee, Jae Hyoung Cho, Sung Dae Moon, Sang A Jang, Hyun Shik Son, Ki Ho Song, Bong Yun Cha, Ho Young Son, Yu Bae Ahn; Korean Diabetes J. 2009;33(4):315-323. Published online August 1, 2009; DOI: https://doi.org/10.4093/kdj.2009.33.4.315

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BACKGROUND
The frequency of lower extremity amputation due to diabetic foot has been increasing in type 2 diabetic patients. The aim of this study was to observe the incidence, clinical aspects and associated risk factors for diabetic foot. METHODS: We evaluated the incidence of diabetic foot through a five-year observation of type 2 diabetic patients who presented to St. vincent's Hospital between January and December 2003. To identify the risk factors for diabetic foot, we evaluated mean glycosylated hemoglobin A1c (HbA1c) every six months and assessed renal function based on the existence of proteinuria and estimated glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease (MDRD) equation. Patients were also evaluated for retinopathy, peripheral neuropathy and autonomic neuropathy using Ewing's method. RESULTS: From an initial pool of 613 patients, the observational study of 508 patients (82.9%) was completed. The mean age, duration of diabetes and HbA1c were 50.3 +/- 10.6 yrs, 7.2 +/- 6.5 yrs and 8.8 +/- 2.1%, respectively. Diabetic foot occurred in 32 patients (6.3%). The incidence of diabetic foot increased when diabetic retinopathy (OR = 6.707, 2.314~19.439), peripheral neuropathy (OR = 2.949, 1.075~8.090), and autonomic neuropathy (OR = 3.967, 1.476~10.660) were present and when the MDRD GFR (OR = 5.089, 1.712~15.130) decreased. Mean HbA1c (OR = 12.013, 1.470~98.179) was found to be an independent risk factor for diabetic foot. CONCLUSION: The present study confirmed the importance of intensive glycemic control and the role of autonomic dysfunction in the development of diabetic foot. In addition, diabetic retinopathy and impaired renal function proved to be factors associated with the occurrence of diabetic foot. Therefore, intensive glycemic control, as well as periodic examination of renal function, are essential for the prevention of diabetic foot.

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The Combination of Fasting Plasma Glucose and Glycosylated Hemoglobin as a Predictor for Type 2 Diabetes in Korean Adults.: Chan Hee Lee, Woo Jin Chang, Hyun Hee Chung, Hyun Jung Kim, Sang Hyun Park, Jun Sung Moon, Ji Eun Lee, Ji Sung Yoon, Kyung Ah Chun, Kyu Chang Won, Ihn Ho Cho, Hyoung Woo Lee; Korean Diabetes J. 2009;33(4):306-314. Published online August 1, 2009; DOI: https://doi.org/10.4093/kdj.2009.33.4.306

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Abstract PDF

BACKGROUND
The oral glucose tolerance test (OGTT) for detection of diabetes is difficult to perform in clinical settings. The aim of this study is to evaluate the performance of a more practical detection test, combined fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c), as a predictor of diabetes mellitus (DM) in a Korean sample. METHODS: We examined 2,045 (M = 1,276, mean age = 47.8 +/- 9.0 yrs) medical check-up program participants between January 2002 to December 2003. FPG, HbA1c and a number of other biochemical tests were performed at baseline and four after years after initial screening. Patients who originally presented with diabetes were excluded. The characteristics of newly-diagnosed DM patients and non-diabetic patients were compared. RESULTS: The incidence of newly diagnosed diabetes was 1.6% (32/2,045) after four years of follow up. The subjects in the DM group were older, had higher levels of SBP, DBP, FPG, HbA1c, triglyceride, HDL cholesterol, GGT and LDH (P < 0.05). In multivariate logistic regression analysis, FPG (odds ratio [OR] 1.124) and HbA1c (OR 4.794) were significantly correlated with onset of diabetes (P < 0.05). The interaction parameter between FPG and HbA1c was more than 1.0, indicating that the two effects are synergistic. The predictive cut-off values of HbA1c and FPG were 5.35% (area under curve [AUC] = 0.944) and 102.5 mg/dL (AUC = 0.930), respectively. CONCLUSION: The combination of HbA1c above 5.35% and FPG above 102.5 mg/dL predicted the onset of diabetes in a Korean sample. These results suggest that the combination of FPG and HbA1c may be useful for predicting progression to type 2 diabetes in east Asians.

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Seyoung Kwon, Youngak Na
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Asian Nursing Research.2013; 7(2): 67. CrossRef
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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The Utility of HbA1c as a Diagnostic Criterion of Diabetes
Hee-Jung Kim, Eun Young Choi, Eal Whan Park, Yoo Seock Cheong, Hong-Yoen Lee, Ji Hyun Kim
Korean Journal of Family Medicine.2011; 32(7): 383. CrossRef
Predictive Clinical Parameters for the Therapeutic Efficacy of Sitagliptin in Korean Type 2 Diabetes Mellitus
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Diabetes & Metabolism Journal.2011; 35(2): 159. CrossRef
Optimal range of HbA1c for the prediction of future diabetes: A 4-year longitudinal study
Ji Cheol Bae, Eun Jung Rhee, Won Young Lee, Se Eun Park, Cheol Young Park, Ki Won Oh, Sung Woo Park, Sun Woo Kim
Diabetes Research and Clinical Practice.2011; 93(2): 255. CrossRef
The Combination of Fasting Plasma Glucose and Glycosylated Hemoglobin as a Predictor for Type 2 Diabetes in Korean Adults (Korean Diabetes J 33(4):306-314, 2009)
Soo Lim
Korean Diabetes Journal.2009; 33(5): 448. CrossRef
The Combination of Fasting Plasma Glucose and Glycosylated Hemoglobin as a Predictor for Type 2 Diabetes in Korean Adults (Korean Diabetes J 33(4):306-314, 2009)
Chan Hee Lee, Hyoung Woo Lee
Korean Diabetes Journal.2009; 33(5): 451. CrossRef

A Nationwide Survey about the Current Status of Glycemic Control and Complications in Diabetic Patients in 2006: The Committee of the Korean Diabetes Association on the Epidemiology of Diabetes Mellitus.: Soo Lim, Dae Jung Kim, In Kyung Jeong, Hyun Shik Son, Choon Hee Chung, Gwanpyo Koh, Dae Ho Lee, Kyu Chang Won, Jeong Hyun Park, Tae Sun Park, Jihyun Ahn, Jaetaek Kim, Keun Gyu Park, Seung Hyun Ko, Yu Bae Ahn, Inkyu Lee; Korean Diabetes J. 2009;33(1):48-57. Published online February 1, 2009; DOI: https://doi.org/10.4093/kdj.2009.33.1.48

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Abstract PDF

BACKGROUND
The Committee of the Korean Diabetes Association on the Epidemiology of Diabetes Mellitus performed a nationwide survey about the current status of glycemic control and diabetic complications in 2006. METHODS: The current study included 5,652 diabetic patients recruited from the rosters of endocrinology clinics of 13 tertiary hospitals in Korea. Age, gender, height, weight, waist circumference and blood pressure were investigated by standard method. Fasting and postprandial 2 hour glucose, glycosylated hemoglobin (HbA1c), lipid profiles, fasting insulin and c-peptide levels were measured. Microvascular (microalbuminuria, retinopathy and neuropathy) and macrovascular (coronary artery disease [CAD], cerebrovascular disease [CVD] and peripheral artery disease [PAD]) complications were reviewed in their medical records. RESULTS: Mean age of total subjects was 58.7 (+/- 11.6) years and duration of diabetes was 8.8 (0~50) years. Mean fasting and postprandial 2 hour glucose levels were 145.9 +/- 55.0 and 208.0 +/- 84.4 mg/dL, respectively. Their mean HbA1c was 7.9 +/- 1.9%: the percentage of patients within target goal of glycemic control (< 7% of HbA1c) was 36.7%. In this study, 30.3%, 38.3% and 44.6% of patients was found to have microalbuminuria, retinopathy and nephropathy, respectively. Prevalence of CAD, CVD and PAD was 8.7%, 6.7% and 3.0%, respectively. Diabetic complications were closely related with age, duration of diabetes and glycemic control, and this relationship was stronger in microvascular complications than macrovascular ones. CONCLUSION: Only about one third of patients with diabetes was found to reach target glycemic control in tertiary hospitals of Korea. More tight control is needed to reduce deleterious complications of diabetes in Korea.

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