Diabetes & Metabolism Journal

Original Articles

Cardiovascular Risk/Epidemiology
Association of Systolic and Diastolic Blood Pressure with the Risk of End-Stage Renal Disease in Older Type 2 Diabetes Mellitus Patients without Cardiovascular Disease: A Nationwide Population-Based Study: Sangmo Hong, Kyungdo Han, Kye-Yeung Park, Chang Beom Lee, Dong Sun Kim, Jung Hwan Park, Sung Hoon Yu; Diabetes Metab J. 2025;49(6):1308-1317. Published online September 25, 2025; DOI: https://doi.org/10.4093/dmj.2023.0364

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Background
There is insufficient evidence to determine a precise blood pressure target in older adults with diabetes mellitus. In this study, we evaluated the potential relationship between blood pressure levels and end-stage renal disease (ESRD) in older type 2 diabetes mellitus (T2DM) patients without ESRD using a nationwide longitudinal population dataset.
Methods
We performed a retrospective, observational, cohort study including 267,156 older (≥65 years old) patients with T2DM and without ESRD from 2009 to 2018 based on the National Health Information Database. We divided the participants into eight groups based on their systolic blood pressure (SBP) and diastolic blood pressure (DBP). The primary outcome was ESRD. All outcomes were analyzed using Cox proportional hazards regression analysis while controlling for baseline covariates.
Results
During a median follow-up of 7.26 years, the incidence rate of ESRD was 2.03 per 1,000 person-years. In multivariable Cox proportional hazard modeling, the risk of the primary outcome was the lowest in groups with an SBP of 100–119 mm Hg and DBP of <80 mm Hg. In subgroup analysis according to the use of hypertension medication, there was a significant difference in DBP (P for interaction=0.026) but no difference in SBP (P for interaction=0.247). The risk of ESRD was the lowest in patients with an SBP of 110–129 mm Hg taking hypertension medication and the highest in the group with an SBP of ≥160 mm Hg.
Conclusion
Maintaining blood pressure at less than 120/80 mm Hg might prevent progression to ESRD in older T2DM patients without cardiovascular disease.

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Association of Systolic and Diastolic Blood Pressure with the Risk of End-Stage Renal Disease in Older Type 2 Diabetes Mellitus Patients without Cardiovascular Disease: A Nationwide Population-Based Study (Diabetes Metab J 2025;49:1308-17)
Sangmo Hong, Kyungdo Han, Kye-Yeung Park, Chang Beom Lee, Dong Sun Kim, Jung Hwan Park, Sung Hoon Yu
Diabetes & Metabolism Journal.2026; 50(2): 430. CrossRef
Association of Systolic and Diastolic Blood Pressure with the Risk of End-Stage Renal Disease in Older Type 2 Diabetes Mellitus Patients without Cardiovascular Disease: A Nationwide Population-Based Study (Diabetes Metab J 2025;49:1308-17)
Zhi Wang, Leping Shao
Diabetes & Metabolism Journal.2026; 50(2): 416. CrossRef
Preventing End-Stage Kidney Disease in Older Adults with Type 2 Diabetes Mellitus: Optimal Blood Pressure Targets
Jae-Seung Yun, Seung-Hyun Ko
Diabetes & Metabolism Journal.2025; 49(6): 1198. CrossRef

Complications
Impact of Remnant Cholesterol on the Risk for End-Stage Renal Disease in Type 2 Diabetes Mellitus: A Nationwide Population-Based Cohort Study: Eun Roh, Ji Hye Heo, Han Na Jung, Kyung-Do Han, Jun Goo Kang, Seong Jin Lee, Sung-Hee Ihm; Diabetes Metab J. 2025;49(5):1106-1115. Published online May 21, 2025; DOI: https://doi.org/10.4093/dmj.2024.0406

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Background
Remnant cholesterol (remnant-C) has been linked to the risk of various vascular diseases, but the association between remnant-C and end-stage renal disease (ESRD) in patients with type 2 diabetes mellitus (T2DM) remains unclear.
Methods
Using a nationwide cohort, a total of 2,537,149 patients with T2DM without ESRD, who had participated in the national health screening in 2009, were enrolled and followed up until 2020. Low-density lipoprotein cholesterol (LDL-C) levels were assessed by the Martin-Hopkins method, and remnant-C was calculated as total cholesterol–LDL-C–high-density lipoprotein cholesterol.
Results
During a median follow-up period of 10.3 years, 26,246 patients with T2DM (1.03%) developed ESRD. Participants in the upper quartile of remnant-C had a higher risk of ESRD, with hazard ratios of 1.12 (95% confidence interval [CI], 1.08 to 1.17), 1.20 (95% CI, 1.15 to 1.24), and 1.33 (95% CI, 1.26 to 1.41) in the second, third, and fourth quartile, compared with the lowest quartile, in multivariable-adjusted analyses. The positive association between remnant-C and ESRD remained consistent, irrespective of age, sex, presence of pre-existing comorbidities, and use of anti-dyslipidemic medications. The increased risk of ESRD was more pronounced in high-risk subgroups, including those with hypertension, chronic kidney disease, obesity, and a longer duration of diabetes.
Conclusion
These findings suggest that remnant-C profiles in T2DM have a predictive role for future progression of ESRD, independent of traditional risk factors for renal dysfunction.

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Impact of Remnant Cholesterol on the Risk for End-Stage Renal Disease in Type 2 Diabetes Mellitus: A Nationwide Population-Based Cohort Study (Diabetes Metab J 2025;49:1106-15)
Jun Hwa Hong
Diabetes & Metabolism Journal.2026; 50(1): 190. CrossRef
A Narrative Review of Remnant Cholesterol as an Independent Atherogenic Lipoprotein in Type 2 Diabetes: Pathophysiology and Clinical Implications
Ramdhani Natsir, Eli Halimah, Ajeng Diantini, Jutti Levita
Therapeutics and Clinical Risk Management.2026; Volume 22: 1. CrossRef

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

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

Citations

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

Complications
Burden of End-Stage Kidney Disease by Type 2 Diabetes Mellitus Status in South Korea: A Nationwide Epidemiologic Study: Jwa-Kyung Kim, Han Na Jung, Bum Jun Kim, Boram Han, Ji Hye Huh, Eun Roh, Joo-Hee Kim, Kyung-Do Han, Jun Goo Kang; Diabetes Metab J. 2025;49(3):498-506. Published online March 6, 2025; DOI: https://doi.org/10.4093/dmj.2024.0443

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Background
Patients with diabetes are known to be at high risk for end-stage kidney disease (ESKD), but the accurate annual risk data for new-onset ESKD is still limited. In South Korea, the prevalence and incidence of ESKD are increasing more rapidly compared to the global average. This study aimed to determine the incidence rate (IR) of ESKD by diabetes status from 2012 to 2022.
Methods
Using data from the Korean National Health Insurance Service, we calculated the IR and hazard ratio (HR) for newonset ESKD in the general population. Individuals were categorized based on diabetes status into nondiabetes, impaired fasting glucose (IFG), diabetes duration <5 and ≥5 years.
Results
Among the participants, 67.6% were nondiabetic, 22.3% had IFG, and 10% had diabetes. In Korea, the IRs of ESKD were 139 per million population (pmp) for nondiabetes, 188 pmp for IFG, 632 pmp for diabetes <5 years, and 3,403 pmp for diabetes ≥5 years. An advanced estimated glomerular filtration rate (eGFR) category was the strongest risk factor for ESKD development. However, even in patients with normal renal function, those with long-standing diabetes had a 14-fold higher risk of ESKD compared to nondiabetic individuals. The risk of ESKD associated with diabetes increased exponentially with declining renal function. Notably, IFG showed an increasing tendency for ESKD in younger patients (<65 years) with early-stage chronic kidney disease (CKD; eGFR ≥60 mL/min/1.73 m²).
Conclusion
Longer diabetes duration amplifies ESKD risk, particularly as renal function declines. Even in patients with normal renal function, long-standing diabetes significantly increases ESKD risk, while IFG is associated with elevated risk only in younger individuals with early-stage CKD.

Citations

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Development and validation of a machine learning model to predict comorbid hypertension in patients with type 2 diabetes
Hailu Yang, Changfeng Fan, Chunyan Liu
Frontiers in Medicine.2026;[Epub] CrossRef

Review

Others
Risk Prediction and Management of Chronic Kidney Disease in People Living with Type 2 Diabetes Mellitus: Ying-Guat Ooi, Tharsini Sarvanandan, Nicholas Ken Yoong Hee, Quan-Hziung Lim, Sharmila S. Paramasivam, Jeyakantha Ratnasingam, Shireene R. Vethakkan, Soo-Kun Lim, Lee-Ling Lim; Diabetes Metab J. 2024;48(2):196-207. Published online January 26, 2024; DOI: https://doi.org/10.4093/dmj.2023.0244

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People with type 2 diabetes mellitus have increased risk of chronic kidney disease and atherosclerotic cardiovascular disease. Improved care delivery and implementation of guideline-directed medical therapy have contributed to the declining incidence of atherosclerotic cardiovascular disease in high-income countries. By contrast, the global incidence of chronic kidney disease and associated mortality is either plateaued or increased, leading to escalating direct and indirect medical costs. Given limited resources, better risk stratification approaches to identify people at risk of rapid progression to end-stage kidney disease can reduce therapeutic inertia, facilitate timely interventions and identify the need for early nephrologist referral. Among people with chronic kidney disease G3a and beyond, the kidney failure risk equations (KFRE) have been externally validated and outperformed other risk prediction models. The KFRE can also guide the timing of preparation for kidney replacement therapy with improved healthcare resources planning and may prevent multiple complications and premature mortality among people with chronic kidney disease with and without type 2 diabetes mellitus. The present review summarizes the evidence of KFRE to date and call for future research to validate and evaluate its impact on cardiovascular and mortality outcomes, as well as healthcare resource utilization in multiethnic populations and different healthcare settings.

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Kidney failure risk equation (KFRE), A risk-based triage for nephrology referrals: A mixed-methods study at pre-implementation phase among healthcare providers
Nur Raziana Rozi, Christine Shamala Selvaraj, Jia-Kai Tan, Zhan-Foong Lim, Noor Wahidah Nordin, Nuqman Hakimi Mazhar, Haris Hafizal, Hooi-Chin Beh, Quan-Hziung Lim, Ying-Guat Ooi, Adina Abdullah, Wan Ahmad Hafiz Wan Md Adnan, Pavai Sthaneswar, Soo-Kun Lim
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External validation, recalibration, and clinical utility of the kidney failure risk equation in patients with advanced CKD: a nationwide retrospective cohort analysis in Peru
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BMC Nephrology.2025;[Epub] CrossRef
Reprint of: Chronic Kidney Disease in Diabetes: A Clinical Practice Guideline
Sheldon W. Tobe, Harpreet S. Bajaj, Navdeep Tangri, Rahul Jain, Thuy Pham, Valerie Beaudin, Phil McFarlane
Canadian Journal of Diabetes.2025; 49: 7. CrossRef
Prevalence of diabetes and its associated factors in Cape Verde: an analysis of the 2020 WHO STEPS survey on non-communicable diseases risk factors
Joshua Okyere, Castro Ayebeng, Kwamena Sekyi Dickson
BMC Endocrine Disorders.2024;[Epub] CrossRef

Brief Reports

Complications
Trends in the Incidence, Prevalence, and Mortality of End-Stage Kidney Disease in South Korea: Min-Jeong Lee, Kyoung Hwa Ha, Dae Jung Kim, Inwhee Park; Diabetes Metab J. 2020;44(6):933-937. Published online December 23, 2020; DOI: https://doi.org/10.4093/dmj.2020.0156

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Knowledge of the epidemiologic characteristics of end-stage kidney disease (ESKD) patients is essential. The trends in the prevalence, incidence, and mortality rates of ESKD were analyzed retrospectively using the Korean National Health Insurance ServiceNational Sample Cohort database between 2006 and 2015. From 2006 to 2015, the incidence of ESKD decreased from 28.6 to 24.0 per 100,000 people and showed a decreasing pattern with or without diabetes mellitus. However, the incidence of those aged ≥75 years increased, as did the mean age at the onset of ESKD. From 2007 to 2015, the prevalence of ESKD increased in all age groups, but particularly in those aged ≥75 years. The prevalence of ESKD differed by sex and diabetes mellitus status and this gap widened over time. Mortality rates in ESKD patients remained relatively constant throughout the study period. However, mortality rates in ESKD without diabetes decreased over the same period.

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Burden of End-Stage Kidney Disease by Type 2 Diabetes Mellitus Status in South Korea: A Nationwide Epidemiologic Study
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Diabetes & Metabolism Journal.2025; 49(3): 498. CrossRef
Burden of End-Stage Kidney Disease by Type 2 Diabetes Mellitus Status in South Korea: A Nationwide Epidemiologic Study (Diabetes Metab J 2025;49:498-506)
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Diabetes & Metabolism Journal.2025; 49(5): 1139. CrossRef
Burden of End-Stage Kidney Disease by Type 2 Diabetes Mellitus Status in South Korea: A Nationwide Epidemiologic Study (Diabetes Metab J 2025;49:498-506)
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Impact of Remnant Cholesterol on the Risk for End-Stage Renal Disease in Type 2 Diabetes Mellitus: A Nationwide Population-Based Cohort Study
Eun Roh, Ji Hye Heo, Han Na Jung, Kyung-Do Han, Jun Goo Kang, Seong Jin Lee, Sung-Hee Ihm
Diabetes & Metabolism Journal.2025; 49(5): 1106. CrossRef
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Drug/Regimen
Evogliptin, a Dipeptidyl Peptidase-4 Inhibitor, Attenuates Renal Fibrosis Caused by Unilateral Ureteral Obstruction in Mice: Mi-Jin Kim, Na-young Kim, Yun-A Jung, Seunghyeong Lee, Gwon-Soo Jung, Jung-Guk Kim, In-Kyu Lee, Sungwoo Lee, Yeon-Kyung Choi, Keun-Gyu Park; Diabetes Metab J. 2020;44(1):186-192. Published online October 31, 2019; DOI: https://doi.org/10.4093/dmj.2018.0271

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Renal fibrosis is considered to be the final common outcome of chronic kidney disease. Dipeptidyl peptidase-4 (DPP-4) inhibitors have demonstrated protective effects against diabetic kidney disease. However, the anti-fibrotic effect of evogliptin, a DPP-4 inhibitor, has not been studied. Here, we report the beneficial effects of evogliptin on unilateral ureteral obstruction (UUO)-induced renal fibrosis in mice. Evogliptin attenuated UUO-induced renal atrophy and tubulointerstitial fibrosis. Immunohistochemistry and Western blotting demonstrated that evogliptin treatment inhibits pro-fibrotic gene expressions and extracellular matrix production. In vitro findings showed that the beneficial effects of evogliptin on renal fibrosis are mediated by inhibition of the transforming growth factor-β/Smad3 signaling pathway. The present study demonstrates that evogliptin is protective against UUO-induced renal fibrosis, suggesting that its clinical applications could extend to the treatment of kidney disease of non-diabetic origin.

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