Graphical abstract

INTRODUCTION

Diabetes is known to be associated with cardiovascular disease (CVD) morbidity and mortality [1]. Unlike the increased prevalence of diabetes itself, the incidence of CVD and CVD-related mortality among patients with diabetes have decreased significantly over the past two decades [2].

This study was aimed to investigate the rates of cardiovascular complications and mortality among Korean adults (aged ≥30 years) with diabetes by analyzing the data of the National Health Insurance Service-National Sample Cohort (NHIS-NSC).

METHODS

Data source and study design

The NHIS-NSC enrolled 1,021,208 individuals (2.2% of the total eligible Korean population in 2006) using a systematic sampling method. Detailed information on the NHIS-NSC can be found elsewhere [3]. The protocol of this study was approved by the Institutional Review Board of Ajou University Hospital, Suwon, Korea (approval No. AJIRB-MED-EXP-19-347) and the requirement for informed consent was waived.

For each calendar year, we identified individuals with diabetes aged 30 years or older. Diabetes was defined as diagnosed with E10–E14 codes of the 10th edition of the International Classification of Diseases (ICD-10) more than twice, or when a patient had a prescription for oral glucose-lowering medications (Anatomical Therapeutic Chemical [ATC] code A10B) for more than 30 days, or (in outpatients) a prescription for insulin (ATC code A10A).

Definitions of cardiovascular complications and mortality

We identified patients hospitalized due to six diabetes-related cardiovascular complications, namely ischemic heart disease, myocardial infarction, heart failure, hemorrhagic stroke, ischemic stroke, and peripheral artery disease (PAD), based on ICD-10 and procedure codes that contributes to clinically hospitalizations regardless of the principal reason for hospitalization (Supplementary Table 1). Information on the date and underlying cause of death was obtained from the National Death Registry using unique resident registration numbers. Causes of death were identified based on ICD-10 codes. There were six mutually exclusive cause of death categories (Supplementary Table 1).

Statistical analysis

We calculated the rates of hospitalization due to cardiovascular complications separately for each year by dividing the number of patients hospitalized for cardiovascular complications by the corresponding number of patients with diabetes for that year. For each calendar year, hospitalization rates were expressed as age-standardized rates per 10,000 individuals; mortality rates were expressed as age-standardized rates per 100,000 individuals, separately for men and women. The rates were age-standardized according to the weighted distribution of the 2011 population, across sexes and 5-year age groups from 30 to 34 years up to 85 years and above. All statistical analyses were performed using SAS software version 9.4 (SAS Institute Inc., Cary, NC, USA).

RESULTS

Hospitalization rate for cardiovascular complications

In the period 2006 to 2015, the hospitalization rates due to major cardiovascular complications (ischemic heart disease, ischemic stroke, and myocardial infarction) all decreased. There was a decreasing trend in ischemic heart disease rates (from 438 to 461 and 419 to 397 per 10,000 men and women with diabetes, respectively), ischemic stroke rates (from 257 to 205 and 257 to 204 per 10,000 men and women with diabetes, respectively), and myocardial infarction rates (from 111 to 81 and 97 to 60 per 10,000 men and women with diabetes, respectively). There was a slight increase in the hemorrhagic stroke rates (from 38 to 46 and 44 to 51 per 10,000 men and women with diabetes, respectively) (Fig. 1, Supplementary Table 2).

However, increasing rates of heart failure (from 72 to 146 and 124 to 161 per 10,000 men and women with diabetes, respectively) and PAD (from 39 to 55 and 19 to 35 per 10,000 men and women with diabetes, respectively) were seen (Fig. 1, Supplementary Table 2). The hospitalization rates for revascularization slightly decreased or remained the same (percutaneous coronary intervention, from 97 to 95 and 56 to 50 per 10,000 men and women with diabetes, respectively; coronary artery bypass surgery from 11 to 7 and 4 to 4 per 10,000 men and women with diabetes, respectively) (Supplementary Table 2).

Mortality rate and cause of death in patients with diabetes

In 2007 to 2015, the mortality rate decreased in both men and women (from 2,599 to 2,010 and 1,939 to 1,662 per 100,000 adults with diabetes, respectively) (Supplementary Table 3). The mortality rates for cancer, cerebrovascular disease, diabetes, heart disease, and hypertensive disease decreased in both men and women. However, the mortality rates due to pneumonia increased in both men and women (from 22 to 93 and 34 to 79 per 100,000 adults with diabetes, respectively) (Fig. 2, Supplementary Table 3).

In 2015, the six leading causes of death accounted for 66.7% of all deaths in Korean adults with diabetes (cancer, 30.3%; diabetes, 10.5%; heart disease, 10.5%; cerebrovascular disease, 8.9%; pneumonia, 5.0%; and hypertensive disease, 1.5%) (Supplementary Fig. 1). The five most common causes of cancer deaths were lung, liver, colorectal, pancreas, and stomach cancer (Supplementary Table 4).

DISCUSSION

The rates of hospitalization due to major cardiovascular complications and deaths caused by vascular disease and cancer decreased among adult (aged ≥30 years) with diabetes in Korea. These findings are consistent with previous study in Korea [4]. In patients with diabetes, the proportion of patients with good glycemic control remains less than half of them, while the proportion of patients with extremely poor glycemic control is dramatically decreasing [5]. In addition, the overall improvement of cardiovascular risk factors management such as blood pressure, smoking, and lipid level and proper treatment of cardiovascular events and the regular national cancer screening program in Korea is related with the decrease in mortality in patients with diabetes [6–9].

The hospitalization rate for heart failure increased. Better preventive treatments of cardiovascular risk factors may also have contributed to the reduced risk of developing heart failure [10]. However, paradoxically, due to ageing and the development of treatments that allow increased survival after acute heart insults or with chronic cardiac abnormalities, number of patients with heart failure increased [11]. In Korea, appropriate treatment by the certification system for cardiovascular intervention institute/specialist since 2011, efforts to improve awareness of early symptoms, decreasing of the proportion of ST-elevation myocardial infarction led to a decrease in the case-fatality in hospitalized acute myocardial infarction patients from 2007 to 2016 [12]. Also, according to the Korean hospitalized heart failure registry, the development of cardiovascular treatment has increased the survival rate of acute coronary syndrome, as a result, ischemic heart disease is a major cause of hospitalized for heart failure [13]. In addition, the prevalence of heart failure increased with age, and the proportion of patients with diabetes has increased [13,14].

PAD also increased slightly. Recent meta-analysis reported that the prevalence of PAD increased from 2000 to 2010 in high-income countries due to an ageing population [15]. However, in this study, the outcome events were ascertained from health insurance claims data, and diagnoses were not adjudicated by medical records. In addition, using diagnoses code will tend to result in higher observed incidence and prevalence. Thus, to increase accuracy of diagnoses in claim database, we restricted patients undergoing PAD-related procedures and surgery.

Recently, the advance of new technology of peripheral angiography has led to an increase of PAD-related procedures and surgery. Thus, the increase of PAD is partly due to the diagnosis of hidden patients with PAD. In Korea, using the database of the NHIS, amputation involving diabetic foot based on vascular interventions for PAD steadily increased from 2011 to 2016, particularly in minor amputations [16]. During the study period from 2004 to 2013, endovascular revascularization including balloon angioplasty, stent placement, and percutaneous atherectomy increased, while open revascularization such as bypass with artificial graft and autologous vein decreased. This study suggested that the endovascular revascularization for PAD treatment expanded by ageing, increasing number of patients with diabetes and chronic kidney disease on hemodialysis—risk factors for the development of PAD, and repeated interventions for maintaining reasonable clinical outcomes [17].

Deaths from pneumonia also increased. The increased risk of intensive care unit hospitalization and death due to pneumonia in diabetes patients have been reported [18]. In diabetes, impaired immune response is associated with hyperglycemia, and hospitalization for hyperglycemia has been shown to increase the risk of pneumonia-related mortality [19,20].

In conclusion, the present study revealed a decrease in the rates of cardiovascular complications and mortality, among Korean adults with diabetes, which may reflect advances in diabetes care. However, the hospitalization rates for heart failure and PAD and the mortality rates for pneumonia increased. Thus, more efforts are needed to prevent diabetes complications.

SUPPLEMENTARY MATERIALS

NOTES

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

AUTHOR CONTRIBUTIONS

Conception or design: B.Y.K., J.H.L., D.J.K.

Acquisition, analysis, or interpretation of data: J.H.P., K.H.H., D.J.K.

Drafting the work or revising: J.H.P., K.H.H., B.Y.K., J.H.L., D.J.K.

Final approval of the manuscript: J.H.P., K.H.H., D.J.K.

FUNDING

None

Acknowledgements

This study used NHIS data (NHIS-2020-2-110) made by National Health Insurance Service (NHIS). The authors declare no conflict of interest with NHIS. The authors declare no conflict of interest with NHIS.

Some of the data was released in October 2019 in the form of ‘Diabetes & Complications in Korea’ from the Korean Diabetes Association. We would like to thank the Committee of Public Relation, Korean Diabetes Association for helping with the work.

Fig. 1

Rates of hospitalization due to cardiovascular complications among men (A) and women (B) with diabetes in South Korea (2006 to 2015).

Fig. 2

Mortality rates among men (A) and women (B) with diabetes in South Korea (2007 to 2015).

"Updated on 25 March 2021"

REFERENCES

• 1. Matheus AS, Tannus LR, Cobas RA, Palma CC, Negrato CA, Gomes MB. Impact of diabetes on cardiovascular disease: an update. Int J Hypertens 2013 2013:653789.ArticlePDF
• 2. Rawshani A, Rawshani A, Franzen S, Eliasson B, Svensson AM, Miftaraj M, et al. Mortality and cardiovascular disease in type 1 and type 2 diabetes. N Engl J Med 2017;376:1407-18.ArticlePubMed
• 3. Lee J, Lee JS, Park SH, Shin SA, Kim K. Cohort profile: the National Health Insurance Service-National Sample Cohort (NHIS-NSC), South Korea. Int J Epidemiol 2017;46:e15.ArticlePubMed
• 4. Jung CH, Chung JO, Han K, Ko SH, Ko KS, Park JY, et al. Improved trends in cardiovascular complications among subjects with type 2 diabetes in Korea: a nationwide study (2006–2013). Cardiovasc Diabetol 2017;16:1.ArticlePubMedPMCPDF
• 5. Ha KH, Kim DJ. Current status of managing diabetes mellitus in Korea. Korean J Intern Med 2016;31:845-50.ArticlePubMedPMCPDF
• 6. OECD. Cardiovascular disease and diabetes: policies for better health and quality of care Available from: https://www.oecd.org/publications/cardiovascular-disease-and-diabetes-policies-for-better-health-and-quality-of-care-9789264233010-en.htm(cited 2020 Oct 26).
• 7. Chang Y, Kang HY, Lim D, Cho HJ, Khang YH. Long-term trends in smoking prevalence and its socioeconomic inequalities in Korea, 1992–2016. Int J Equity Health 2019;18:148.ArticlePubMedPMCPDF
• 8. Kang SH, Kim SH, Cho JH, Yoon CH, Hwang SS, Lee HY, et al. Prevalence, awareness, treatment, and control of hypertension in Korea. Sci Rep 2019;9:10970.ArticlePubMedPMCPDF
• 9. Son M, Yun JW. Cancer mortality projections in Korea up to 2032. J Korean Med Sci 2016;31:892-901.ArticlePubMedPMCPDF
• 10. Canto JG, Kiefe CI, Rogers WJ, Peterson ED, Frederick PD, French WJ, et al. Number of coronary heart disease risk factors and mortality in patients with first myocardial infarction. JAMA 2011;306:2120-7.ArticlePubMedPMC
• 11. Chen J, Normand SL, Wang Y, Krumholz HM. National and regional trends in heart failure hospitalization and mortality rates for Medicare beneficiaries, 1998–2008. JAMA 2011;306:1669-78.ArticlePubMedPMC
• 12. Kim RB, Kim HS, Kang DR, Choi JY, Choi NC, Hwang S, et al. The trend in incidence and case-fatality of hospitalized acute myocardial infarction patients in Korea, 2007 to 2016. J Korean Med Sci 2019;34:e322.ArticlePubMedPMCPDF
• 13. Youn JC, Han S, Ryu KH. Temporal trends of hospitalized patients with heart failure in Korea. Korean Circ J 2017;47:16-24.ArticlePubMedPDF
• 14. Lee JH, Lim NK, Cho MC, Park HY. Epidemiology of heart failure in Korea: present and future. Korean Circ J 2016;46:658-64.ArticlePubMedPMCPDF
• 15. Song P, Rudan D, Zhu Y, Fowkes FJI, Rahimi K, Fowkes FGR, et al. Global, regional, and national prevalence and risk factors for peripheral artery disease in 2015: an updated systematic review and analysis. Lancet Glob Health 2019;7:e1020-30.ArticlePubMed
• 16. Kim J, Chun DI, Kim S, Yang HJ, Kim JH, Cho JH, et al. Trends in lower limb amputation in patients with diabetic foot based on vascular intervention of peripheral arterial disease in Korea: a population-based nationwide study. J Korean Med Sci 2019;34:e178.ArticlePubMedPMCPDF
• 17. Park YY, Joh JH, Han SA, Kim SH, Cho S, Park HC, et al. National trends for the treatment of peripheral arterial disease in Korea between 2004 and 2013. Ann Surg Treat Res 2015;89:319-24.ArticlePubMedPMC
• 18. Kim EJ, Ha KH, Kim DJ, Choi YH. Diabetes and the risk of infection: a national cohort study. Diabetes Metab J 2019;43:804-14.ArticlePubMedPMCPDF
• 19. Koh GC, Peacock SJ, van der Poll T, Wiersinga WJ. The impact of diabetes on the pathogenesis of sepsis. Eur J Clin Microbiol Infect Dis 2012;31:379-88.ArticlePubMedPDF
• 20. van Vught LA, Wiewel MA, Klein Klouwenberg PM, Hoogendijk AJ, Scicluna BP, Ong DS, et al. Admission hyperglycemia in critically ill sepsis patients: association with outcome and host response. Crit Care Med 2016;44:1338-46.ArticlePubMed

Figure & Data

References

Citations

Citations to this article as recorded by  

• Risk factor control and cardiovascular events in patients with type 2 diabetes mellitus
  Do Kyeong Song, Young Sun Hong, Yeon-Ah Sung, Hyejin Lee, Hidetaka Hamasaki
  PLOS ONE.2024; 19(2): e0299035.     CrossRef
• Remnant cholesterol is an independent risk factor for the incidence of chronic kidney disease in newly-diagnosed type 2 diabetes: A nationwide population-based study
  Soo Yeon Jang, Minwoong Kang, Eyun Song, Ahreum Jang, Kyung Mook Choi, Sei Hyun Baik, Hye Jin Yoo
  Diabetes Research and Clinical Practice.2024; 210: 111639.     CrossRef
• The Role of Obesity as a Cardiac Disease Risk Factor in Patients with Type 2 Diabetes
  Sushant Koirala, Michael Sunnaa, Thomas Bernier, Ahmet Afsin Oktay
  Current Cardiology Reports.2024;[Epub]     CrossRef
• Baicalin attenuates vascular inflammation and endothelial dysfunction in diabetes
  Lingchao Miao, Yifan Yang, Jinming Dai, Mei Bai, Yuehan Wang, Haiying Cui, Lin Lin, Metab Alharbi, Wai San Cheang
  Food Frontiers.2024;[Epub]     CrossRef
• Global trends in the incidence of hospital admissions for diabetes-related foot disease and amputations: a review of national rates in the 21st century
  Peter A. Lazzarini, Susanna M. Cramb, Jonathan Golledge, Jedidiah I. Morton, Dianna J. Magliano, Jaap J. Van Netten
  Diabetologia.2023; 66(2): 267.     CrossRef
• Inequalities in cancer mortality trends in people with type 2 diabetes: 20 year population-based study in England
  Suping Ling, Francesco Zaccardi, Eyad Issa, Melanie J. Davies, Kamlesh Khunti, Karen Brown
  Diabetologia.2023; 66(4): 657.     CrossRef
• Lipid Management in Korean People With Type 2 Diabetes Mellitus: Korean Diabetes Association and Korean Society of Lipid and Atherosclerosis Consensus Statement
  Ye Seul Yang, Hack-Lyoung Kim, Sang-Hyun Kim, Min Kyong Moon
  Journal of Lipid and Atherosclerosis.2023; 12(1): 12.     CrossRef
• Evaluation and Management of Patients With Diabetes and Heart Failure: A Korean Diabetes Association and Korean Society of Heart Failure Consensus Statement
  Kyu-Sun Lee, Junghyun Noh, Seong-Mi Park, Kyung Mook Choi, Seok-Min Kang, Kyu-Chang Won, Hyun-Jai Cho, Min Kyong Moon
  International Journal of Heart Failure.2023; 5(1): 1.     CrossRef
• Empagliflozin is associated with lower risk of cardiovascular events and all‐cause mortality in routine care in East Asia: Results from the EMPRISE study
  Dae Jung Kim, Wayne H‐H Sheu, Wook‐Jin Chung, Daisuke Yabe, Kyoung Hwa Ha, Masaomi Nangaku, Elise Chia‐Hui Tan, Koichi Node, Atsutaka Yasui, Weiyu Lei, Sunwoo Lee, Laura Saarelainen, Anouk Deruaz‐Luyet, Moe H Kyaw, Yutaka Seino
  Journal of Diabetes Investigation.2023; 14(3): 417.     CrossRef
• Lipid Management in Korean People with Type 2 Diabetes Mellitus: Korean Diabetes Association and Korean Society of Lipid and Atherosclerosis Consensus Statement
  Ye Seul Yang, Hack-Lyoung Kim, Sang-Hyun Kim, Min Kyong Moon
  Diabetes & Metabolism Journal.2023; 47(1): 1.     CrossRef
• Evaluation and Management of Patients with Diabetes and Heart Failure: A Korean Diabetes Association and Korean Society of Heart Failure Consensus Statement
  Kyu-Sun Lee, Junghyun Noh, Seong-Mi Park, Kyung Mook Choi, Seok-Min Kang, Kyu-Chang Won, Hyun-Jai Cho, Min Kyong Moon
  Diabetes & Metabolism Journal.2023; 47(1): 10.     CrossRef
• The effect of metabolic dysfunction-associated fatty liver disease and diabetic kidney disease on the risk of hospitalization of heart failure in type 2 diabetes: a retrospective cohort study
  Seung Eun Lee, Juhwan Yoo, Bong-Seong Kim, Han Seok Choi, Kyungdo Han, Kyoung-Ah Kim
  Diabetology & Metabolic Syndrome.2023;[Epub]     CrossRef
• Comparison of Operational Definition of Type 2 Diabetes Mellitus Based on Data from Korean National Health Insurance Service and Korea National Health and Nutrition Examination Survey
  Jong Ha Baek, Yong-Moon Park, Kyung Do Han, Min Kyong Moon, Jong Han Choi, Seung-Hyun Ko
  Diabetes & Metabolism Journal.2023; 47(2): 201.     CrossRef
• Chronic disease management program applied to type 2 diabetes patients and prevention of diabetic complications: a retrospective cohort study using nationwide data
  Min Kyung Hyun, Jang Won Lee, Seung-Hyun Ko
  BMC Public Health.2023;[Epub]     CrossRef
• The Present and Future of Artificial Intelligence-Based Medical Image in Diabetes Mellitus: Focus on Analytical Methods and Limitations of Clinical Use
  Ji-Won Chun, Hun-Sung Kim
  Journal of Korean Medical Science.2023;[Epub]     CrossRef
• The Role of Echocardiography in Evaluating Cardiovascular Diseases in Patients with Diabetes Mellitus
  Sun Hwa Lee, Jae-Hyeong Park
  Diabetes & Metabolism Journal.2023; 47(4): 470.     CrossRef
• Long-term Effectiveness of the National Diabetes Quality Assessment Program in South Korea
  Ji Hye Huh, Serim Kwon, Gui Ok Kim, Bo Yeon Kim, Kyoung Hwa Ha, Dae Jung Kim
  Diabetes Care.2023; 46(9): 1700.     CrossRef
• Management of Dyslipidemia in Patients with Diabetes Mellitus
  Kyung Ae Lee
  The Journal of Korean Diabetes.2023; 24(3): 111.     CrossRef
• 2023 Clinical Practice Guidelines for Diabetes: Management of Cardiovascular Risk Factors
  Ye Seul Yang
  The Journal of Korean Diabetes.2023; 24(3): 135.     CrossRef
• Interpreting global trends in type 2 diabetes complications and mortality
  Mohammed K. Ali, Jonathan Pearson-Stuttard, Elizabeth Selvin, Edward W. Gregg
  Diabetologia.2022; 65(1): 3.     CrossRef
• Cardiovascular disease in patients with type 2 diabetes
  Ja Young Jeon, Dae Jung Kim
  Journal of Diabetes Investigation.2022; 13(4): 614.     CrossRef
• Effects of physical activity on cardiovascular outcomes and mortality in Korean patients with diabetes: a nationwide population-based cohort study
  Inha Jung, Sun Joon Moon, Hyemi Kwon, Se Eun Park, Kyung-Do Han, Eun-Jung Rhee, Won-Young Lee
  Cardiovascular Prevention and Pharmacotherapy.2022; 4(1): 42.     CrossRef
• Editorial: Management of Diabetes and its Complications: A Focus on Endothelial Dysfunction
  Shanhu Qiu, Jianhua Ma, Tongzhi Wu
  Frontiers in Endocrinology.2022;[Epub]     CrossRef
• Smoking, Metabolic Syndrome, and Cardiovascular Disease
  Seo Young Kang
  Korean Journal of Family Practice.2022; 12(2): 59.     CrossRef
• Cardiovascular disease in type 2 diabetes mellitus: progress toward personalized management
  Cheng-Xu Ma, Xiao-Ni Ma, Cong-Hui Guan, Ying-Dong Li, Dídac Mauricio, Song-Bo Fu
  Cardiovascular Diabetology.2022;[Epub]     CrossRef
• Adherence to healthy lifestyle behaviors as a preventable risk factor for severe hypoglycemia in people with type 2 diabetes: A longitudinal nationwide cohort study
  Jae‐Seung Yun, Kyungdo Han, Yong‐Moon Park, Eugene Han, Yong‐ho Lee, Seung‐Hyun Ko
  Journal of Diabetes Investigation.2022; 13(9): 1533.     CrossRef
• Current Status of Low-Density Lipoprotein Cholesterol Target Achievement in Patients with Type 2 Diabetes Mellitus in Korea Compared with Recent Guidelines
  Soo Jin Yun, In-Kyung Jeong, Jin-Hye Cha, Juneyoung Lee, Ho Chan Cho, Sung Hee Choi, SungWan Chun, Hyun Jeong Jeon, Ho-Cheol Kang, Sang Soo Kim, Seung-Hyun Ko, Gwanpyo Koh, Su Kyoung Kwon, Jae Hyuk Lee, Min Kyong Moon, Junghyun Noh, Cheol-Young Park, Sung
  Diabetes & Metabolism Journal.2022; 46(3): 464.     CrossRef
• Diabetes Fact Sheet in Korea 2021
  Jae Hyun Bae, Kyung-Do Han, Seung-Hyun Ko, Ye Seul Yang, Jong Han Choi, Kyung Mook Choi, Hyuk-Sang Kwon, Kyu Chang Won
  Diabetes & Metabolism Journal.2022; 46(3): 417.     CrossRef
• Advanced Glycation End Products and Their Effect on Vascular Complications in Type 2 Diabetes Mellitus
  Jeongmin Lee, Jae-Seung Yun, Seung-Hyun Ko
  Nutrients.2022; 14(15): 3086.     CrossRef
• Renoprotective Mechanism of Sodium-Glucose Cotransporter 2 Inhibitors: Focusing on Renal Hemodynamics
  Nam Hoon Kim, Nan Hee Kim
  Diabetes & Metabolism Journal.2022; 46(4): 543.     CrossRef
• Association between carotid atherosclerosis and presence of intracranial atherosclerosis using three-dimensional high-resolution vessel wall magnetic resonance imaging in asymptomatic patients with type 2 diabetes
  Ji Eun Jun, You-Cheol Hwang, Kyu Jeong Ahn, Ho Yeon Chung, Geon-Ho Jahng, Soonchan Park, In-Kyung Jeong, Chang-Woo Ryu
  Diabetes Research and Clinical Practice.2022; 191: 110067.     CrossRef
• Blood Pressure Target in Type 2 Diabetes Mellitus
  Hyun-Jin Kim, Kwang-il Kim
  Diabetes & Metabolism Journal.2022; 46(5): 667.     CrossRef
• Fenofibrate add-on to statin treatment is associated with low all-cause death and cardiovascular disease in the general population with high triglyceride levels
  Kyung-Soo Kim, Sangmo Hong, Kyungdo Han, Cheol-Young Park
  Metabolism.2022; 137: 155327.     CrossRef
• Trends in diabetes-related complications in Singapore, 2013–2020: A registry-based study
  Joshua Kuan Tan, Nur Nasyitah Mohamed Salim, Gek Hsiang Lim, Sing Yi Chia, Julian Thumboo, Yong Mong Bee, Ferdinando Carlo Sasso
  PLOS ONE.2022; 17(10): e0275920.     CrossRef
• Association between the Diabetes Drug Cost and Cardiovascular Events and Death in Korea: A National Health Insurance Service Database Analysis
  Seung Min Chung, Ji-In Lee, Eugene Han, Hyun-Ae Seo, Eonju Jeon, Hye Soon Kim, Ji Sung Yoon
  Endocrinology and Metabolism.2022; 37(5): 759.     CrossRef
• Impact of hypoglycemia at the time of hospitalization for heart failure from emergency department on major adverse cardiovascular events in patients with and without type 2 diabetes
  Seon-Ah Cha, Jae-Seung Yun, Gee-Hee Kim, Yu-Bae Ahn
  Cardiovascular Diabetology.2022;[Epub]     CrossRef
• Heart Failure and Diabetes Mellitus: Dangerous Liaisons
  Hae-Young Lee
  International Journal of Heart Failure.2022; 4(4): 163.     CrossRef
• Diabetes and Stroke
  Junghyun Noh
  The Journal of Korean Diabetes.2021; 22(1): 26.     CrossRef
• Current trends in epidemiology of cardiovascular disease and cardiovascular risk management in type 2 diabetes
  Jae-Seung Yun, Seung-Hyun Ko
  Metabolism.2021; 123: 154838.     CrossRef

About this article

Park JH, Ha KH, Kim BY, Lee JH, Kim DJ. Trends in Cardiovascular Complications and Mortality among Patients with Diabetes in South Korea. Diabetes Metab J. 2021;45(1):120-124.

Received: Jul 21, 2020; Accepted: Sep 06, 2020

DOI: https://doi.org/10.4093/dmj.2020.0175.

Download citation ↓