Diabetes & Metabolism Journal

Kyungdo Han (Han K)

24 Articles

Others
Holistic and Personalized Strategies for Managing in Elderly Type 2 Diabetes Patients: Jae-Seung Yun, Kyuho Kim, Yu-Bae Ahn, Kyungdo Han, Seung-Hyun Ko; Diabetes Metab J. 2024;48(4):531-545. Published online July 26, 2024; DOI: https://doi.org/10.4093/dmj.2024.0310

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Abstract PDF PubReader ePub: Due to increased life expectancy and lifestyle changes, the prevalence of diabetes among the elderly in Korea is continuously rising, as is the associated public health burden. Diabetes management in elderly patients is complicated by age-related physiological changes, sarcopenia characterized by loss of muscle mass and function, comorbidities, and varying levels of functional, cognitive, and mobility abilities that lead to frailty. Moreover, elderly patients with diabetes frequently face multiple chronic conditions that elevate their risk of cardiovascular diseases, cancer, and mortality; they are also prone to complications such as hyperglycemic hyperosmolar state, diabetic ketoacidosis, and severe hypoglycemia. This review examines the characteristics of and management approaches for diabetes in the elderly, and advocates for a comprehensive yet personalized strategy.

Complications
Risk of Depression according to Cumulative Exposure to a Low-Household Income Status in Individuals with Type 2 Diabetes Mellitus: A Nationwide Population- Based Study: So Hee Park, You-Bin Lee, Kyu-na Lee, Bongsung Kim, So Hyun Cho, So Yoon Kwon, Jiyun Park, Gyuri Kim, Sang-Man Jin, Kyu Yeon Hur, Kyungdo Han, Jae Hyeon Kim; Diabetes Metab J. 2024;48(2):290-301. Published online January 3, 2024; DOI: https://doi.org/10.4093/dmj.2022.0299

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Background
We aimed to identify the risk of incident depression according to cumulative exposure to a low-household income status in individuals with type 2 diabetes mellitus (T2DM).
Methods
For this retrospective longitudinal population-based cohort study, we used Korean National Health Insurance Service data from 2002 to 2018. Risk of depression was assessed according to cumulative exposure to low-household income status (defined as Medical Aid registration) during the previous 5 years among adults (aged ≥20 years) with T2DM and without baseline depression who underwent health examinations from 2009 to 2012 (n=2,027,317).
Results
During an average 6.23 years of follow-up, 401,175 incident depression cases occurred. Advance in cumulative number of years registered for medical aid during the previous 5 years from baseline was associated with an increased risk of depression in a dose-dependent manner (hazard ratio [HR], 1.44 [95% confidence interval (CI), 1.38 to 1.50]; HR, 1.40 [95% CI, 1.35 to 1.46]; HR, 1.42, [95% CI, 1.37 to 1.48]; HR, 1.46, [95% CI, 1.40 to 1.53]; HR, 1.69, [95% CI, 1.63 to 1.74] in groups with 1 to 5 exposed years, respectively). Insulin users exposed for 5 years to a low-household income state had the highest risk of depression among groups categorized by insulin use and duration of low-household income status.
Conclusion
Cumulative duration of low-household income status, defined as medical aid registration, was associated with an increased risk of depression in a dose-response manner in individuals with T2DM.

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Type 2 diabetes mellitus modifies and mediates the association between the visceral adiposity index and depression: A cross-sectional study using NHANES 2005–2018 data
Yujun Zhang, Jingjing Song, Benjie Li, Xinmeng Lv, Jiahao Liu, Wei Si, Xin Huang, Jiazhen Tang, Xiaorong Yang, Fang Liu
Journal of Affective Disorders.2025; 368: 749. CrossRef

Metabolic Risk/Epidemiology
Low Household Income Status and Death from Pneumonia in People with Type 2 Diabetes Mellitus: A Nationwide Study: You-Bin Lee, So Hee Park, Kyu-na Lee, Bongsung Kim, So Yoon Kwon, Jiyun Park, Gyuri Kim, Sang-Man Jin, Kyu Yeon Hur, Kyungdo Han, Jae Hyeon Kim; Diabetes Metab J. 2023;47(5):682-692. Published online June 22, 2023; DOI: https://doi.org/10.4093/dmj.2022.0184

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Abstract PDF Supplementary Material PubReader ePub: Background
We explored the risk of death from pneumonia according to cumulative duration in low household income state (LHIS) among adults with type 2 diabetes mellitus (T2DM).
Methods
Using Korean National Health Insurance Service data (2002 to 2018), the hazards of mortality from pneumonia were analyzed according to duration in LHIS (being registered to Medical Aid) during the 5 years before baseline (0, 1–4, and 5 years) among adults with T2DM who underwent health examinations between 2009 and 2012 (n=2,503,581). Hazards of outcomes were also compared in six groups categorized by insulin use and duration in LHIS.
Results
During a median 7.18 years, 12,245 deaths from pneumonia occurred. Individuals who had been exposed to LHIS had higher hazards of death from pneumonia in a dose-response manner (hazard ratio [HR], 1.726; 95% confidence interval [CI], 1.568 to 1.899 and HR, 4.686; 95% CI, 3.948 to 5.562 in those exposed for 1–4 and 5 years, respectively) compared to the non-exposed reference. Insulin users exposed for 5 years to LHIS exhibited the highest outcome hazard among six groups categorized by insulin use and duration in LHIS.
Conclusion
Among adults with T2DM, cumulative duration in LHIS may predict increased risks of mortality from pneumonia in a graded dose-response manner. Insulin users with the longest duration in LHIS might be the group most vulnerable to death from pneumonia among adults with T2DM.

Cardiovascular Risk/Epidemiology
Two-Year Changes in Diabetic Kidney Disease Phenotype and the Risk of Heart Failure: A Nationwide Population-Based Study in Korea: Seung Eun Lee, Juhwan Yoo, Han Seok Choi, Kyungdo Han, Kyoung-Ah Kim; Diabetes Metab J. 2023;47(4):523-534. Published online April 25, 2023; DOI: https://doi.org/10.4093/dmj.2022.0096

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Abstract PDF Supplementary Material PubReader ePub: Background
Diabetic kidney disease (DKD) is a risk factor for hospitalization for heart failure (HHF). DKD could be classified into four phenotypes by estimated glomerular filtration rate (eGFR, normal vs. low) and proteinuria (PU, negative vs. positive). Also, the phenotype often changes dynamically. This study examined HHF risk according to the DKD phenotype changes across 2-year assessments.
Methods
The study included 1,343,116 patients with type 2 diabetes mellitus (T2DM) from the Korean National Health Insurance Service database after excluding a very high-risk phenotype (eGFR <30 mL/min/1.73 m2) at baseline, who underwent two cycles of medical checkups between 2009 and 2014. From the baseline and 2-year eGFR and PU results, participants were divided into 10 DKD phenotypic change categories.
Results
During an average of 6.5 years of follow-up, 7,874 subjects developed HHF. The cumulative incidence of HHF from index date was highest in the eGFR^lowPU– phenotype, followed by eGFR^norPU⁺ and eGFR^norPU^–. Changes in DKD phenotype differently affect HHF risk. When the persistent eGFR^norPU^– category was the reference, hazard ratios for HHF were 3.10 (95% confidence interval [CI], 2.73 to 3.52) in persistent eGFR^norPU⁺ and 1.86 (95% CI, 1.73 to 1.99) in persistent eGFR^lowPU^–. Among altered phenotypes, the category converted to eGFR^lowPU⁺ showed the highest risk. In the normal eGFR category at the second examination, those who converted from PU^– to PU⁺ showed a higher risk of HHF than those who converted from PU⁺ to PU^–.
Conclusion
Changes in DKD phenotype, particularly with the presence of PU, are more likely to reflect the risk of HHF, compared with DKD phenotype based on a single time point in patients with T2DM.

Association of Body Mass Index and Fracture Risk Varied by Affected Bones in Patients with Diabetes: A Nationwide Cohort Study (Diabetes Metab J 2023;47:242-54): Se-Won Lee, Kyungdo Han, Hyuk-Sang Kwon; Diabetes Metab J. 2023;47(3):439-440. Published online May 26, 2023; DOI: https://doi.org/10.4093/dmj.2023.0104; [Original]

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Complications
Association of Body Mass Index and Fracture Risk Varied by Affected Bones in Patients with Diabetes: A Nationwide Cohort Study: Se-Won Lee, Kyungdo Han, Hyuk-Sang Kwon; Diabetes Metab J. 2023;47(2):242-254. Published online January 19, 2023; DOI: https://doi.org/10.4093/dmj.2022.0001

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Background
Body mass index (BMI) is a risk factor for the type 2 diabetes (T2DM), and T2DM accompanies various complications, such as fractures. We investigated the effects of BMI and T2DM on fracture risk and analyzed whether the association varied with fracture locations.
Methods
This study is a nationwide population-based cohort study that included all people with T2DM (n=2,746,078) who received the National Screening Program during 2009–2012. According to the anatomical location of the fracture, the incidence rate and hazard ratio (HR) were analyzed by dividing it into four categories: vertebra, hip, limbs, and total fracture.
Results
The total fracture had higher HR in the underweight group (HR, 1.268; 95% CI, 1.228 to 1.309) and lower HR in the obese group (HR, 0.891; 95% CI, 0.882 to 0.901) and the morbidly obese group (HR, 0.873; 95% CI, 0.857 to 0.89), compared to reference (normal BMI group). Similar trends were observed for HR of vertebra fracture. The risk of hip fracture was most prominent, the risk of hip fracture increased in the underweight group (HR, 1.896; 95% CI, 1.178 to 2.021) and decreased in the obesity (HR, 0.643; 95% CI, 0.624 to 0.663) and morbidly obesity group (HR, 0.627; 95% CI, 0.591 to 0.665). Lastly, fracture risk was least affected by BMI for limbs.
Conclusion
In T2DM patients, underweight tends to increase fracture risk, and overweight tends to lower fracture risk, but association between BMI and fracture risk varied depending on the affected bone lesions.

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Dysuricemia—A New Concept Encompassing Hyperuricemia and Hypouricemia
Naoyuki Otani, Motoshi Ouchi, Einosuke Mizuta, Asuka Morita, Tomoe Fujita, Naohiko Anzai, Ichiro Hisatome
Biomedicines.2023; 11(5): 1255. CrossRef
Association of Body Mass Index and Fracture Risk Varied by Affected Bones in Patients with Diabetes: A Nationwide Cohort Study (Diabetes Metab J 2023;47:242-54)
Se-Won Lee, Kyungdo Han, Hyuk-Sang Kwon
Diabetes & Metabolism Journal.2023; 47(3): 439. CrossRef
Association of Body Mass Index and Fracture Risk Varied by Affected Bones in Patients with Diabetes: A Nationwide Cohort Study (Diabetes Metab J 2023;47:242-54)
So Young Park
Diabetes & Metabolism Journal.2023; 47(3): 437. CrossRef
Effect of SGLT2 inhibitors on fractures, BMD, and bone metabolism markers in patients with type 2 diabetes mellitus: a systematic review and meta-analysis
Xin Wang, Fengyi Zhang, Yufeng Zhang, Jiayi Zhang, Yingli Sheng, Wenbo Wang, Yujie Li
Osteoporosis International.2023; 34(12): 2013. CrossRef

Others
Fasting Glucose Variability and the Risk of Dementia in Individuals with Diabetes: A Nationwide Cohort Study: Da Young Lee, Jaeyoung Kim, Sanghyun Park, So Young Park, Ji Hee Yu, Ji A Seo, Nam Hoon Kim, Hye Jin Yoo, Sin Gon Kim, Kyung Mook Choi, Sei Hyun Baik, Kyungdo Han, Nan Hee Kim; Diabetes Metab J. 2022;46(6):923-935. Published online May 24, 2022; DOI: https://doi.org/10.4093/dmj.2021.0346

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Background
We investigated whether fasting glucose (FG) variability could predict the risk of dementia.
Methods
This cohort study analyzed data from Koreans with diabetes after at least three health examinations by the Korean National Health Insurance Corporation between 2005 and 2010, which included at least one examination between 2009 and 2010. A total of 769,554 individuals were included, excluding those aged <40 years and those with dementia. FG variability was measured using the variability independent of the mean (FG-VIM). The incidence of dementia was defined by the International Classification of Diseases 10th Revision codes and prescription of anti-dementia medication and was subdivided into Alzheimer’s disease (AD) and vascular dementia (VD).
Results
During the 6.9-year follow-up, 54,837, 41,032, and 6,892 cases of all-cause dementia, AD, and VD, respectively, were identified. Cox proportional regression analyses showed that as the FG-VIM quartile increased, the risk of dementia serially increased after adjustment for metabolic factors, income status, and diabetes-related characteristics, including the mean FG. Participants in FG-VIM quartile 4 showed a 18%, 19%, and 17% higher risk for all-cause dementia, AD, and VD, respectively, than those in quartile 1; this particularly included non-obese patients with a longer duration of diabetes, high FG levels, dyslipidemia, and those taking glucose-lowering medications. Conversely, the baseline FG status and dementia showed a U-shaped association.
Conclusion
Increased FG variability over 5 years can predict the risk of dementia in individuals with diabetes in Korea. This finding was more pronounced in patients with less favorable metabolic profiles.

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Fasting glucose variability and risk of dementia in Parkinson’s disease: a 9-year longitudinal follow-up study of a nationwide cohort
Sung Hoon Kang, Yunjin Choi, Su Jin Chung, Seok-Joo Moon, Chi Kyung Kim, Ji Hyun Kim, Kyungmi Oh, Joon Shik Yoon, Sang Won Seo, Geum Joon Cho, Seong-Beom Koh
Frontiers in Aging Neuroscience.2024;[Epub] CrossRef
Effects of a Diabetic Microenvironment on Neurodegeneration: Special Focus on Neurological Cells
Vishal Chavda, Dhananjay Yadav, Snehal Patel, Minseok Song
Brain Sciences.2024; 14(3): 284. CrossRef
The relationship between diabetes and the dementia risk: a meta-analysis
Fang Cao, Fushuang Yang, Jian Li, Wei Guo, Chongheng Zhang, Fa Gao, Xinxin Sun, Yi Zhou, Wenfeng Zhang
Diabetology & Metabolic Syndrome.2024;[Epub] CrossRef
Effect of glucose variability on the mortality of adults aged 75 years and over during the first year of the COVID-19 pandemic
Miguel A. Salinero-Fort, F. Javier San Andrés-Rebollo, Juan Cárdenas-Valladolid, José Mostaza, Carlos Lahoz, Fernando Rodriguez-Artalejo, Paloma Gómez-Campelo, Pilar Vich-Pérez, Rodrigo Jiménez-García, José M. de-Miguel-Yanes, Javier Maroto-Rodriguez, Bel
BMC Geriatrics.2024;[Epub] CrossRef
Association of remnant cholesterol with risk of dementia: a nationwide population-based cohort study in South Korea
Ji Hye Heo, Han Na Jung, Eun Roh, Kyung-do Han, Jun Goo Kang, Seong Jin Lee, Sung-Hee Ihm
The Lancet Healthy Longevity.2024; 5(8): e524. CrossRef
Glycated Hemoglobin A1c Time in Range and Dementia in Older Adults With Diabetes
Patricia C. Underwood, Libin Zhang, David C. Mohr, Julia C. Prentice, Richard E. Nelson, Andrew E. Budson, Paul R. Conlin
JAMA Network Open.2024; 7(8): e2425354. CrossRef
The Association of Glucose Variability and Dementia Incidence in Latinx Adults with Type 2 Diabetes: A Retrospective Study
Heather Cuevas, Elizabeth Muñoz, Divya Nagireddy, Jeeyeon Kim, Grace Ganucheau, Fathia Alomoush
Clinical Nursing Research.2023; 32(2): 249. CrossRef
The effects of long-term cumulative HbA1c exposure on the development and onset time of dementia in the patients with type 2 diabetes mellitus: Hospital based retrospective study (2005–2021)
Sunyoung Cho, Choon Ok Kim, Bong-soo Cha, Eosu Kim, Chung Mo Nam, Min-Gul Kim, Min Soo Park
Diabetes Research and Clinical Practice.2023; 201: 110721. CrossRef
Physiological Mechanisms Inherent to Diabetes Involved in the Development of Dementia: Alzheimer’s Disease
Himan Mohamed-Mohamed, Victoria García-Morales, Encarnación María Sánchez Lara, Anabel González-Acedo, Teresa Pardo-Moreno, María Isabel Tovar-Gálvez, Lucía Melguizo-Rodríguez, Juan José Ramos-Rodríguez
Neurology International.2023; 15(4): 1253. CrossRef
Cumulative effect of impaired fasting glucose on the risk of dementia in middle-aged and elderly people: a nationwide cohort study
Jin Yu, Kyu-Na Lee, Hun-Sung Kim, Kyungdo Han, Seung-Hwan Lee
Scientific Reports.2023;[Epub] CrossRef

Guideline/Fact Sheet
Screening for Prediabetes and Diabetes in Korean Nonpregnant Adults: A Position Statement of the Korean Diabetes Association, 2022: Kyung Ae Lee, Dae Jung Kim, Kyungdo Han, Suk Chon, Min Kyong Moon, on Behalf of the Committee of Clinical Practice Guideline of Korean Diabetes Association; Diabetes Metab J. 2022;46(6):819-826. Published online November 24, 2022; DOI: https://doi.org/10.4093/dmj.2022.0364

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Diabetes screening serves to identify individuals at high-risk for diabetes who have not yet developed symptoms and to diagnose diabetes at an early stage. Globally, the prevalence of diabetes is rapidly increasing. Furthermore, obesity and/or abdominal obesity, which are major risk factors for type 2 diabetes mellitus (T2DM), are progressively increasing, particularly among young adults. Many patients with T2DM are asymptomatic and can accompany various complications at the time of diagnosis, as well as chronic complications develop as the duration of diabetes increases. Thus, proper screening and early diagnosis are essential for diabetes care. Based on reports on the changing epidemiology of diabetes and obesity in Korea, as well as growing evidence from new national cohort studies on diabetes screening, the Korean Diabetes Association has updated its clinical practice recommendations regarding T2DM screening. Diabetes screening is now recommended in adults aged ≥35 years regardless of the presence of risk factors, and in all adults (aged ≥19) with any of the risk factors. Abdominal obesity based on waist circumference (men ≥90 cm, women ≥85 cm) was added to the list of risk factors.

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Oxidative Balance Score and New-Onset Type 2 Diabetes Mellitus in Korean Adults without Non-Alcoholic Fatty Liver Disease: Korean Genome and Epidemiology Study-Health Examinees (KoGES-HEXA) Cohort
Mid-Eum Moon, Dong Hyuk Jung, Seok-Jae Heo, Byoungjin Park, Yong Jae Lee
Antioxidants.2024; 13(1): 107. CrossRef
Efficacy and Safety of Once-Weekly Semaglutide Versus Once-Daily Sitagliptin as Metformin Add-on in a Korean Population with Type 2 Diabetes
Byung-Wan Lee, Young Min Cho, Sin Gon Kim, Seung-Hyun Ko, Soo Lim, Amine Dahaoui, Jin Sook Jeong, Hyo Jin Lim, Jae Myung Yu
Diabetes Therapy.2024;[Epub] CrossRef
Triglyceride-glucose index predicts type 2 diabetes mellitus more effectively than oral glucose tolerance test-derived insulin sensitivity and secretion markers
Min Jin Lee, Ji Hyun Bae, Ah Reum Khang, Dongwon Yi, Mi Sook Yun, Yang Ho Kang
Diabetes Research and Clinical Practice.2024; 210: 111640. CrossRef
Association of sleep fragmentation with general and abdominal obesity: a population-based longitudinal study
Yu-xiang Xu, Shan-shan Wang, Yu-hui Wan, Pu-yu Su, Fang-biao Tao, Ying Sun
International Journal of Obesity.2024; 48(9): 1258. CrossRef
Oxidative balance score as a useful predictive marker for new-onset type 2 diabetes mellitus in Korean adults aged 60 years or older: The Korean Genome and Epidemiologic Study–Health Examination (KoGES-HEXA) cohort
Mid-Eum Moon, Dong Hyuk Jung, Seok-Jae Heo, Byoungjin Park, Yong Jae Lee
Experimental Gerontology.2024; 193: 112475. CrossRef
The optimal dose of metformin to control conversion to diabetes in patients with prediabetes: A meta-analysis
Xiaoyan Yi, Yongliang Pan, Huan Peng, Mengru Ren, Qin Jia, Bing Wang
Journal of Diabetes and its Complications.2024; 38(10): 108846. CrossRef
Cumulative muscle strength and risk of diabetes: A prospective cohort study with mediation analysis
Shanhu Qiu, Xue Cai, Yan Liang, Wenji Chen, Duolao Wang, Zilin Sun, Bo Xie, Tongzhi Wu
Diabetes Research and Clinical Practice.2023; 197: 110562. CrossRef
Revisiting the Diabetes Crisis in Korea: Call for Urgent Action
Jun Sung Moon
The Journal of Korean Diabetes.2023; 24(1): 1. 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
2023 Clinical Practice Guidelines for Diabetes
Min Kyong Moon
The Journal of Korean Diabetes.2023; 24(3): 120. CrossRef

Metabolic Risk/Epidemiology
Reproductive Life Span and Severe Hypoglycemia Risk in Postmenopausal Women with Type 2 Diabetes Mellitus: Soyeon Kang, Yong-Moon Park, Dong Jin Kwon, Youn-Jee Chung, Jeong Namkung, Kyungdo Han, Seung-Hyun Ko; Diabetes Metab J. 2022;46(4):578-591. Published online January 24, 2022; DOI: https://doi.org/10.4093/dmj.2021.0135

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Background
Estrogen promotes glucose homeostasis, enhances insulin sensitivity, and maintains counterregulatory responses in recurrent hypoglycemia in women of reproductive age. Postmenopausal women with type 2 diabetes mellitus (T2DM) might be more vulnerable to severe hypoglycemia (SH) events. However, the relationship between reproductive factors and SH occurrence in T2DM remains unelucidated.
Methods
This study included data on 181,263 women with postmenopausal T2DM who participated in a national health screening program from January 1 to December 31, 2009, obtained using the Korean National Health Insurance System database. Outcome data were obtained until December 31, 2018. Associations between reproductive factors and SH incidence were assessed using Cox proportional hazards models.
Results
During the mean follow-up of 7.9 years, 11,279 (6.22%) postmenopausal women with T2DM experienced SH episodes. A longer reproductive life span (RLS) (≥40 years) was associated with a lower SH risk compared to a shorter RLS (<30 years) (adjusted hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.69 to 0.80; P for trend <0.001) after multivariable adjustment. SH risk decreased with every 5-year increment of RLS (with <30 years as a reference [adjusted HR, 0.91; 95% CI, 0.86 to 0.95; P=0.0001 for 30−34 years], [adjusted HR, 0.80; 95% CI, 0.76 to 0.84; P<0.001 for 35−39 years], [adjusted HR, 0.74; 95% CI, 0.68 to 0.81; P<0.001 for ≥40 years]). The use of hormone replacement therapy (HRT) was associated with a lower SH risk than HRT nonuse.
Conclusion
Extended exposure to endogenous ovarian hormone during lifetime may decrease the number of SH events in women with T2DM after menopause.

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Others
Current Trends of Big Data Research Using the Korean National Health Information Database: Mee Kyoung Kim, Kyungdo Han, Seung-Hwan Lee; Diabetes Metab J. 2022;46(4):552-563. Published online July 27, 2022; DOI: https://doi.org/10.4093/dmj.2022.0193

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Recently, medical research using big data has become very popular, and its value has become increasingly recognized. The Korean National Health Information Database (NHID) is representative of big data that combines information obtained from the National Health Insurance Service collected for claims and reimbursement of health care services and results obtained from general health examinations provided to all Korean adults. This database has several strengths and limitations. Given the large size, various laboratory data, and questionnaires obtained from medical check-ups, their longitudinal nature, and long-term accumulation of data since 2002, carefully designed studies may provide valuable information that is difficult to obtain from other forms of research. However, consideration of possible bias and careful interpretation when defining causal relationships is also important because the data were not collected for research purposes. After the NHID became publicly available, research and publications based on this database have increased explosively, especially in the field of diabetes and metabolism. This article reviews the history, structure, and characteristics of the Korean NHID. Recent trends in big data research using this database, commonly used operational diagnosis, and representative studies have been introduced. We expect further progress and expansion of big data research using the Korean NHID.

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Weight change in patients with new‐onset type 2 diabetes mellitus and its association with remission: Comprehensive real‐world data
Jinyoung Kim, Bongseong Kim, Mee Kyoung Kim, Ki‐Hyun Baek, Ki‐Ho Song, Kyungdo Han, Hyuk‐Sang Kwon
Diabetes, Obesity and Metabolism.2024; 26(2): 567. CrossRef
Repeated detection of non‐alcoholic fatty liver disease increases the incidence risk of type 2 diabetes in young adults
Jin Hwa Kim, Young Sang Lyu, Mee Kyoung Kim, Sang Yong Kim, Ki‐Hyun Baek, Ki‐Ho Song, Kyungdo Han, Hyuk‐Sang Kwon
Diabetes, Obesity and Metabolism.2024; 26(1): 180. CrossRef
Diabetes severity and the risk of depression: A nationwide population-based study
Yunjung Cho, Bongsung Kim, Hyuk-Sang Kwon, Kyungdo Han, Mee Kyoung Kim
Journal of Affective Disorders.2024; 351: 694. CrossRef
Diabetes Duration, Cholesterol Levels, and Risk of Cardiovascular Diseases in Individuals With Type 2 Diabetes
Mee Kyoung Kim, Kyu Na Lee, Kyungdo Han, Seung-Hwan Lee
The Journal of Clinical Endocrinology & Metabolism.2024;[Epub] 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
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Soo‐Young Yoon, Ji Yoon Kong, Su Jin Jeong, Jin Sug Kim, Hyeon Seok Hwang, Kyunghwan Jeong
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Risk of Depression according to Cumulative Exposure to a Low-Household Income Status in Individuals with Type 2 Diabetes Mellitus: A Nationwide Population- Based Study
So Hee Park, You-Bin Lee, Kyu-na Lee, Bongsung Kim, So Hyun Cho, So Yoon Kwon, Jiyun Park, Gyuri Kim, Sang-Man Jin, Kyu Yeon Hur, Kyungdo Han, Jae Hyeon Kim
Diabetes & Metabolism Journal.2024; 48(2): 290. CrossRef
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Depression and Anxiety.2024; 2024: 1. CrossRef
Effect of body mass index on gastric cancer risk according to sex in Korea: a nationwide cohort study and literature review
Yonghoon Choi, Jieun Jang, Nayoung Kim
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Association between exercise habits and incident type 2 diabetes mellitus in patients with thyroid cancer: nationwide population-based study
Jiyun Park, Jin-Hyung Jung, Hyunju Park, Young Shin Song, Soo-Kyung Kim, Yong-Wook Cho, Kyungdo Han, Kyung-Soo Kim
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Association between Body Weight Variability and Mortality in Young Adults: A Nationwide Cohort Study
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Association between the length of stay in rehabilitation and mortality among the adults with Parkinson’s disease: 2009–2019 Korean National Health Insurance Service Databases
Suyeong Bae, Ickpyo Hong, Min Seok Baek
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Metabolic Risk/Epidemiology
Prevalence of Type 2 Diabetes Mellitus among Korean Children, Adolescents, and Adults Younger than 30 Years: Changes from 2002 to 2016: Yong Hee Hong, In-Hyuk Chung, Kyungdo Han, Sochung Chung, on Behalf of the Taskforce Team of the Obesity Fact Sheet of the Korean Society for the Study of Obesity; Diabetes Metab J. 2022;46(2):297-306. Published online October 26, 2021; DOI: https://doi.org/10.4093/dmj.2021.0038

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Background
Despite the importance of and social concern regarding prevention of diabetes at younger ages, limited data are available. This study sought to analyze changes in the prevalence of type 2 diabetes mellitus (T2DM) in Koreans younger than 30 years according to sex, age, and level of income.
Methods
The dataset analyzed in this study was derived from health insurance claims recorded in the National Health Insurance Service (NHIS) database. Participants’ level of income was categorized as low (quintile 1, <20% of insurance premium) or others (quintile 2–5).
Results
In males and females, the prevalence of T2DM per 10,000 people steadily increased from 2.57 in 2002 to 11.41 in 2016, and from 1.96 in 2002 to 8.63 in 2016. The prevalence of T2DM in girls was higher in the age group of 5 to 14 years. Even though the prevalence was higher among those older than 20 years, the increase had started earlier, in the early 2000s, in younger age group. Adolescents aged 10 to 19 years in low-income families showed a remarkable increase in prevalence of T2DM, especially in boys.
Conclusion
The prevalence of T2DM in young Koreans increased more than 4.4-fold from 2002 to 2016, and the increase started in the early 2000s in younger age groups and in low-income families. This is the first study to examine the trend in prevalence of T2DM in children, adolescents, and young adults in Korea. Future studies and collaborations with social support systems to prevent T2DM at an early age group should be performed.

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Metabolic Risk/Epidemiology
Insulin Resistance Increases Serum Immunoglobulin E Sensitization in Premenopausal Women: Seung Eun Lee, Ji Yeon Baek, Kyungdo Han, Eun Hee Koh; Diabetes Metab J. 2021;45(2):175-182. Published online April 14, 2020; DOI: https://doi.org/10.4093/dmj.2019.0150

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Background

Although studies have shown that obesity is associated with aeroallergen sensitization (atopy), controversy still exists. We aimed to investigate the association between metabolic status, obesity, and atopy stratified by sex and menopausal status.

Methods

A total of 1,700 adults from the 2010 Korean National Health and Nutrition Examination Survey were classified into metabolically healthy nonobese (MHNO), metabolically unhealthy nonobese (MUNO), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO) by body mass index and insulin resistance. Atopy was defined as a positive response to at least one aeroallergen. Multiple regression analysis was used to evaluate the risk of immunoglobulin E (IgE) elevation or atopy in relation to the degree of metabolic abnormality and obesity.

Results

In premenopausal women, total IgE was positively correlated with obesity and insulin resistance. MUNO participants had a higher risk of having elevated total IgE compared to MHNO participants (odds ratio [OR], 2.271; 95% confidence interval [CI], 1.201 to 4.294), while MHO participants did not show a significant difference (OR, 1.435; 95% CI, 0.656 to 3.137) in premenopausal women. MUNO, but not MHO was also associated with atopy (OR, 2.157; 95% CI, 1.284 to 3.625). In men and postmenopausal women, there was no significant difference between metabolic status, obesity, and atopy among groups.

Conclusion

Increased insulin resistance is associated with total IgE and atopy in premenopausal women but not in postmenopausal women or men.

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Metabolic Risk/Epidemiology
Metabolic Health, Obesity, and the Risk of Developing Open-Angle Glaucoma: Metabolically Healthy Obese Patients versus Metabolically Unhealthy but Normal Weight Patients: Younhea Jung, Kyungdo Han, Hae-Young L. Park, Seung Hoon Lee, Chan Kee Park; Diabetes Metab J. 2020;44(3):414-425. Published online December 23, 2019; DOI: https://doi.org/10.4093/dmj.2019.0048

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Abstract PDF PubReader

Background

This study sought to investigate the associations between metabolic health status, obesity, and incidence of primary open-angle glaucoma (POAG).

Methods

In this nationwide, population-based, longitudinal prospective cohort study conducted using the Korean National Health Insurance System, we categorized all subjects based on presence and severity of metabolic syndrome and obesity. Insurance claims data were used to identify POAG development. Then, Cox regression was applied to calculate the hazard of developing POAG in people with various components of metabolic syndrome, obesity, or their combination.

Results

Of the total 287,553 subjects, 4,970 (1.3%) developed POAG. High fasting glucose, blood pressure, and total cholesterol levels were all associated with increased risk of developing POAG. Regarding obesity level, people with body mass index (BMI) greater than 30 kg/m² were more likely to develop POAG than those with normal BMI. Also, people with greater number of metabolic syndrome components showed a greater POAG incidence. People who are metabolically unhealthy and obese (adjusted hazard ratio [HR], 1.574; 95% confidence interval [CI], 1.449 to 1.711) and those who are metabolically unhealthy nonobese (MUNO: adjusted HR, 1.521; 95% CI, 1.405 to 1.645) but not those who are metabolically healthy obese (MHO: adjusted HR, 1.019; 95% CI, 0.907 to 1.144) had an increased hazard of developing POAG compared with metabolically healthy nonobese (MHNO) subjects.

Conclusion

Metabolic health status and obesity were significantly associated with increased risk of POAG incidence. MUNO subjects but not MHO subjects showed a higher risk of POAG development than did MHNO subjects, suggesting that metabolic status is more important than obesity in POAG.

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Clinical Complications
Incidence and Risk Factors for Dementia in Type 2 Diabetes Mellitus: A Nationwide Population-Based Study in Korea: Ji Hee Yu, Kyungdo Han, Sanghyun Park, Hanna Cho, Da Young Lee, Jin-Wook Kim, Ji A Seo, Sin Gon Kim, Sei Hyun Baik, Yong Gyu Park, Kyung Mook Choi, Seon Mee Kim, Nan Hee Kim; Diabetes Metab J. 2020;44(1):113-124. Published online November 12, 2019; DOI: https://doi.org/10.4093/dmj.2018.0216

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Background

Diabetes mellitus is associated with an increased risk of dementia. We aimed to comprehensively analyze the incidence and risk factors for dementia and young-onset dementia (YOD) in diabetic patients in Korea using the National Health Insurance Service data.

Methods

Between January 1, 2009 and December 31, 2012, a total of 1,917,702 participants with diabetes were included and followed until the date of dementia diagnosis or until December 31, 2015. We evaluated the incidence and risk factors for all dementia, Alzheimer's disease (AD), and vascular dementia (VaD) by Cox proportional hazards analyses. We also compared the impact of risk factors on the occurrence of YOD and late-onset dementia (LOD).

Results

During an average of 5.1 years of follow-up, the incidence of all types of dementia, AD, or VaD was 9.5, 6.8, and 1.3/1,000 person-years, respectively, in participants with diabetes. YOD comprised 4.8% of all dementia occurrence, and the ratio of AD/VaD was 2.1 for YOD compared with 5.5 for LOD. Current smokers and subjects with lower income, plasma glucose levels, body mass index (BMI), and subjects with hypertension, dyslipidemia, vascular complications, depression, and insulin treatment developed dementia more frequently. Vascular risk factors such as smoking, hypertension, and previous cardiovascular diseases were more strongly associated with the development of VaD than AD. Low BMI and a history of stroke or depression had a stronger influence on the development of YOD than LOD.

Conclusion

The optimal management of modifiable risk factors may be important for preventing dementia in subjects with diabetes mellitus.

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Epidemiology
Associations between Breastfeeding and Type 2 Diabetes Mellitus and Glycemic Control in Parous Women: A Nationwide, Population-Based Study: Ga Eun Nam, Kyungdo Han, Do-Hoon Kim, Youn Huh, Byoungduck Han, Sung Jung Cho, Yong Gyu Park, Yong-Moon Park; Diabetes Metab J. 2019;43(2):236-241. Published online December 21, 2018; DOI: https://doi.org/10.4093/dmj.2018.0044

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We investigated associations between breastfeeding duration and number of children breastfed and type 2 diabetes mellitus (T2DM) and glycemic control among parous women. We performed a cross-sectional analysis of data for 9,960 parous women from the Korea National Health and Nutritional Examination Survey (2010 to 2013). Having ever breastfed was inversely associated with prevalent T2DM (adjusted odds ratio [OR], 0.60; 95% confidence interval [CI], 0.42 to 0.87). All ranges of total and average breastfeeding duration showed inverse associations with T2DM. Even short periods of breastfeeding were inversely associated with T2DM (adjusted OR, 0.61; 95% CI, 0.38 to 0.99 for a total breastfeeding duration ≤12 months; adjusted OR, 0.65; 95% CI, 0.42 to 0.99 for an average breastfeeding duration per child ≤6 months). A longer duration of breastfeeding was associated with better glycemic control in parous women with T2DM (P trend=0.004 for total breastfeeding duration; P trend <0.001 for average breastfeeding duration per child). Breastfeeding may be associated with a lower risk of T2DM and good glycemic control in parous women with T2DM. Breastfeeding may be a feasible method to prevent T2DM and improve glycemic control.

Citations

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Association of Childbirth and Breastfeeding with Diabetes Mellitus in Korean Women
Seulkee Kim, So Yeon Ryu
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Integration of nutrigenomics, melatonin, serotonin and inflammatory cytokines in the pathophysiology of pregnancy-specific urinary incontinence in women with gestational diabetes mellitus
Danielle Cristina Honorio França, Eduardo Luzía França, Luis Sobrevia, Angélica Mércia Pascon Barbosa, Adenilda Cristina Honorio-França, Marilza Vieira Cunha Rudge
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Epidemiology
High Proportion of Adult Cases and Prevalence of Metabolic Syndrome in Type 1 Diabetes Mellitus Population in Korea: A Nationwide Study: You-Bin Lee, Kyungdo Han, Bongsung Kim, Sang-Man Jin, Seung-Eun Lee, Ji Eun Jun, Jiyeon Ahn, Gyuri Kim, Jae Hyeon Kim; Diabetes Metab J. 2019;43(1):76-89. Published online August 22, 2018; DOI: https://doi.org/10.4093/dmj.2018.0048

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Background

The prevalence and incidence of type 1 diabetes mellitus (T1DM) in all age groups and the prevalence of metabolic syndrome in patients with T1DM in Korea were estimated.

Methods

The incidence and prevalence of T1DM between 2007 and 2013 were calculated using the Korean National Health Insurance Service (NHIS) datasets of claims. Clinical characteristics and prevalence of metabolic syndrome in individuals with T1DM between 2009 and 2013 were determined using the database of NHIS preventive health checkups.

Results

The prevalence of T1DM in Korea between 2007 and 2013 was 0.041% to 0.047%. The annual incidence rate of T1DM in Korea in 2007 to 2013 was 2.73 to 5.02/100,000 people. Although the incidence rate of typical T1DM was highest in teenagers, it remained steady in adults over 30 years of age. In contrast, the incidence rate of atypical T1DM in 2013 was higher in people aged 40 years or older than in younger age groups. Age- and sex-adjusted prevalence of metabolic syndrome in patients with T1DM was 51.65% to 55.06% between 2009 and 2013.

Conclusion

T1DM may be more common in Korean adults than previously believed. Metabolic syndrome may be a frequent finding in individuals with T1DM in Korea.

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Clinical Diabetes & Therapeutics
Past and Current Status of Adult Type 2 Diabetes Mellitus Management in Korea: A National Health Insurance Service Database Analysis: Seung-Hyun Ko, Kyungdo Han, Yong-ho Lee, Junghyun Noh, Cheol-Young Park, Dae-Jung Kim, Chang Hee Jung, Ki-Up Lee, Kyung-Soo Ko; Diabetes Metab J. 2018;42(2):93-100. Published online April 19, 2018; DOI: https://doi.org/10.4093/dmj.2018.42.2.93

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Korea's National Healthcare Program, the National Health Insurance Service (NHIS), a government-affiliated agency under the Korean Ministry of Health and Welfare, covers the entire Korean population. The NHIS supervises all medical services in Korea and establishes a systematic National Health Information database (DB). A health information DB system including all of the claims, medications, death information, and health check-ups, both in the general population and in patients with various diseases, is not common worldwide. On June 9, 2014, the NHIS signed a memorandum of understanding with the Korean Diabetes Association (KDA) to provide limited open access to its DB. By October 31, 2017, seven papers had been published through this collaborative research project. These studies were conducted to investigate the past and current status of type 2 diabetes mellitus and its complications and management in Korea. This review is a brief summary of the collaborative projects between the KDA and the NHIS over the last 3 years. According to the analysis, the national health check-up DB or claim DB were used, and the age category or study period were differentially applied.

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Epidemiology
Depression and Mortality in People with Type 2 Diabetes Mellitus, 2003 to 2013: A Nationwide Population-Based Cohort Study: Jong-Hyun Jeong, Yoo Hyun Um, Seung-Hyun Ko, Jong-Heon Park, Joong-Yeol Park, Kyungdo Han, Kyung-Soo Ko; Diabetes Metab J. 2017;41(4):296-302. Published online August 3, 2017; DOI: https://doi.org/10.4093/dmj.2017.41.4.296

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Abstract PDF PubReader

Background

Previous reports have demonstrated a bidirectional relationship between depression and diabetes mellitus (DM), accentuating a need for more intensive depression screening in DM patients. There is a relative paucity of data on the mortality of depressed DM patients in Korea.

Methods

Retrospective data from January 2003 to December 2013 were collected for adult type 2 diabetes mellitus (T2DM) patients older than 30 years using the National Health Information database maintained by the Korean National Health Insurance Service (NHIS). Demographic characteristics were analyzed with descriptive statistics, and the annual prevalence of depression was estimated. Mortality rates and hazard ratios for each age group (stratified into six age groups) of patients diagnosed with T2DM in 2003 were estimated using a Cox proportional hazard method, with the Kaplan-Meier cumulative survival curve showing the overall survival rates according to the T2DM status until the given year of 2013.

Results

The annual prevalence of depression was consistently higher in T2DM group from 2003 to 2013. The mortality hazard ratio was higher in the depressed in all age groups, and the risk was higher in male groups and in younger-aged groups.

Conclusion

Depression was significantly associated with a high mortality risk in T2DM patients; hence, a more systematic surveillance of T2DM patients to identify risk factors for depression might contribute significantly to reducing mortality risk in this group of patients.

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Epidemiology
Data Analytic Process of a Nationwide Population-Based Study Using National Health Information Database Established by National Health Insurance Service: Yong-ho Lee, Kyungdo Han, Seung-Hyun Ko, Kyung Soo Ko, Ki-Up Lee; Diabetes Metab J. 2016;40(1):79-82. Published online February 19, 2016; DOI: https://doi.org/10.4093/dmj.2016.40.1.79

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Abstract PDF PubReader

In 2014, the National Health Insurance Service (NHIS) signed a memorandum of understanding with the Korean Diabetes Association to provide limited open access to its databases for investigating the past and current status of diabetes and its management. NHIS databases include the entire Korean population; therefore, it can be used as a population-based nationwide study for various diseases, including diabetes and its complications. This report presents how we established the analytic system of nation-wide population-based studies using the NHIS database as follows: the selection of database study population and its distribution and operational definition of diabetes and patients of currently ongoing collaboration projects.

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Changes in Physical Activity and the Risk of Dementia in Patients With New-Onset Type 2 Diabetes: A Nationwide Cohort Study
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Understanding and Utilizing Claim Data from the Korean National Health Insurance Service (NHIS) and Health Insurance Review & Assessment (HIRA) Database for Research
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Annual Trends in the Incidence and Prevalence of Alzheimer's Disease in South Korea: A Nationwide Cohort Study
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Light-to-Moderate Alcohol Consumption Increases the Risk of Biliary Tract Cancer in Prediabetes and Diabetes, but Not in Normoglycemic Status: A Nationwide Cohort Study
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Colonoscopy decreases mortality in colorectal cancer patients compared with fecal immunochemical test
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Factors Affecting the Occurrence of Mental Health Problems in Female Cancer Survivors: A Nationwide Cohort Study
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Risk for Behçet’s disease gauged via high-density lipoprotein cholesterol: a nationwide population-based study in Korea
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Current Trends of Big Data Research Using the Korean National Health Information Database
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Recent Increases in Influenza-Related Hospitalizations, Critical Care Resource Use, and In-Hospital Mortality: A 10-Year Population-Based Study in South Korea
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Association between Age-Related Macular Degeneration and the Risk of Diabetes Mellitus: A Nationwide Cohort Study
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The Dose-Response Association between Smoking and the Risk of Gallbladder Cancer Differs by Glycemic Status: A Nationwide Cohort Study
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Threshold Dose-Response Association between Smoking Pack-Years and the Risk of Gallbladder Cancer: A Nationwide Cohort Study
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Cardiovascular and renal effectiveness of empagliflozin in routine care in East Asia: Results from the EMPRISE East Asia study
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Both cardiovascular and cerebrovascular events are decreased following long‐term narrowband ultraviolet B phototherapy in patients with vitiligo: a propensity score matching analysis
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The risk of hip fractures in individuals over 50 years old with prediabetes and type 2 diabetes – A longitudinal nationwide population-based study
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Changes in Smoking, Alcohol Consumption, and the Risk of Thyroid Cancer: A Population-Based Korean Cohort Study
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Association between Relative Preference for Vegetables and Meat and Cancer Incidence in Korean Adults: A Nationwide Population-based Retrospective Cohort Study
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Comparison of fracture risk between type 1 and type 2 diabetes: a comprehensive real-world data
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Patient-Level Cancer Prediction Models From a Nationwide Patient Cohort: Model Development and Validation
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A Study on Metabolic Health Status as a Risk Factor for Female Bladder Cancer Incidence: Analysis From the National Health Checkups Database of Korea
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Fasting Glucose Variability as a Risk Indicator for End-Stage Kidney Disease in Patients with Diabetes: A Nationwide Population-Based Study
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Female Reproductive Factors and Risk of Bronchiectasis: A Nationwide Population-Based Longitudinal Study
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Changes in Direct Healthcare Costs before and after the Diagnosis of Inflammatory Bowel Disease: A Nationwide Population-Based Study
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Non‐melanoma skin cancer as a clinical marker for internal malignancies: a nationwide population‐based cohort study
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The prognoses and postoperative outcomes of patients with both colorectal cancer and liver cirrhosis based on a nationwide cohort in Korea
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Label Adherence of Direct Oral Anticoagulants Dosing and Clinical Outcomes in Patients With Atrial Fibrillation
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Female reproductive factors and the risk of Parkinson’s disease: a nationwide cohort study
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The association between nonalcoholic fatty liver disease and esophageal, stomach, or colorectal cancer: National population-based cohort study
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Body Weight Variability and the Risk of Cardiovascular Outcomes and Mortality in Patients With Type 2 Diabetes: A Nationwide Cohort Study
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Female reproductive factors and the risk of lung cancer in postmenopausal women: a nationwide cohort study
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Gamma-Glutamyl Transferase Variability and Risk of Dementia in Diabetes Mellitus: A Nationwide Population-Based Study
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The Journal of Clinical Endocrinology & Metabolism.2020; 105(3): e119. CrossRef
Variability in body weight precedes diagnosis in dementia: A nationwide cohort study
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Anti-diabetic medications and the risk for colorectal cancer: A population-based nested case-control study
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Longitudinal Study of Diabetic Differences between International Migrants and Natives among the Asian Population
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Dose-response relationship between gamma-glutamyltransferase and the risk of atherosclerotic cardiovascular diseases in Korean adults
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Dipstick proteinuria and cancer incidence: a nationwide population-based study
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Association Between Glycemic Status and the Risk of Parkinson Disease: A Nationwide Population-Based Study
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Gamma glutamyltransferase and risk of dementia in prediabetes and diabetes
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European Journal of Neurology.2020; 27(8): 1448. CrossRef
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Diabetes Research and Clinical Practice.2020; 163: 108157. CrossRef
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Annual Prevalence, Health Expenditures, and Co-Morbidities Trend of Iron Deficiency Anemia in Korea: National Health Insurance Service Data from 2002 to 2013
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Hypertension.2020; 75(4): 982. CrossRef
Gliclazide monotherapy increases risks of all-cause mortality and has similar risk of acute myocardial infarction and stroke with glimepiride monotherapy in Korean type 2 diabetes mellitus
Eun-Hee Cho, Kyungdo Han, Bongseong Kim, Dae Ho Lee
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Risk of Cardiovascular Disease and Chronic Kidney Disease According to 2017 Blood Pressure Categories in Diabetes Mellitus
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Hypertension.2020; 76(3): 766. CrossRef
The Burden of Cervical Cancer in Korea: A Population-Based Study
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International Journal of Environmental Research and Public Health.2020; 17(17): 6308. CrossRef
Underweight increases the risk of primary open-angle glaucoma in diabetes patients
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Increased risk of idiopathic pulmonary fibrosis in inflammatory bowel disease: A nationwide study
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Impact of the timing of Helicobacter pylori eradication on the risk of development of metachronous lesions after treatment of early gastric cancer: a population-based cohort study
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Site-specific cancer risk in patients with type 2 diabetes: a nationwide population-based cohort study in Korea
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The Korean Journal of Internal Medicine.2020; 35(3): 641. CrossRef
Cardiovascular Research Using the Korean National Health Information Database
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Korean Circulation Journal.2020; 50(9): 754. CrossRef
Gamma‐glutamyl transferase variability and risk of dementia: A nationwide study
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International Journal of Geriatric Psychiatry.2020; 35(10): 1105. CrossRef
Gamma-glutamyl transferase variability can predict the development of end-stage of renal disease: a nationwide population-based study
Da Young Lee, Kyungdo Han, Ji Hee Yu, Sanghyun Park, Jee-In Heo, Ji A. Seo, Nam Hoon Kim, Hye Jin Yoo, Sin Gon Kim, Seon Mee Kim, Kyung Mook Choi, Sei Hyun Baik, Yong Gyu Park, Nan Hee Kim
Scientific Reports.2020;[Epub] CrossRef
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Sex Differences in Cardiovascular Disease Risk by Socioeconomic Status (SES) of Workers Using National Health Information Database
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International Journal of Environmental Research and Public Health.2020; 17(6): 2047. CrossRef
Impact of Mean and Variability of High‐Density Lipoprotein‐Cholesterol on the Risk of Myocardial Infarction, Stroke, and Mortality in the General Population
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Asian Journal of Psychiatry.2020; 53: 102194. CrossRef
Social Inequalities of Oral Anticoagulation after the Introduction of Non-Vitamin K Antagonists in Patients with Atrial Fibrillation
Hee Tae Yu, Pil-Sung Yang, Jinseub Hwang, Soorack Ryu, Eunsun Jang, Tae-Hoon Kim, Jae-Sun Uhm, Jong-Youn Kim, Hui-Nam Pak, Moon-Hyoung Lee, Gregory Y.H. Lip, Boyoung Joung
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Increased incidence of bladder cancer with metabolically unhealthy status: analysis from the National Health Checkup database in Korea
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Endocrinology and Metabolism.2020; 35(1): 85. CrossRef
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Journal of Diabetes Investigation.2020; 11(6): 1583. CrossRef
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The Journal of Clinical Hypertension.2020; 22(9): 1638. CrossRef
Fasting plasma glucose level and the risk of open angle glaucoma: Nationwide population-based cohort study in Korea
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Prognostic value of long-term gamma-glutamyl transferase variability in individuals with diabetes: a nationwide population-based study
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Predicting the Development of Myocardial Infarction in Middle-Aged Adults with Type 2 Diabetes: A Risk Model Generated from a Nationwide Population-Based Cohort Study in Korea
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Endocrinology and Metabolism.2020; 35(3): 636. CrossRef
Exposure-weighted scoring for metabolic syndrome and the risk of myocardial infarction and stroke: a nationwide population-based study
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Clinical Outcomes of COVID-19 Patients with Type 2 Diabetes: A Population-Based Study in Korea
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Variability in estimated glomerular filtration rate and the incidence of type 2 diabetes: a nationwide population-based study
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Appropriate Medical Technology in the Era of the 4th Industrial Revolution
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The Korean Journal of Medicine.2019; 94(5): 387. CrossRef
Validation of diagnostic codes of major clinical outcomes in a National Health Insurance database
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The Korean Journal of Medicine.2019; 94(6): 463. CrossRef
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Ga Eun Nam, Yang-Hyun Kim, Kyungdo Han, Jin-Hyung Jung, Yong Gyu Park, Kwan-Woo Lee, Eun-Jung Rhee, Jang Won Son, Seong-Su Lee, Hyuk-Sang Kwon, Won-Young Lee, Soon Jib Yoo
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The American Journal of Cardiology.2019; 123(12): 1921. CrossRef
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The protective effect of klotho against contrast-associated acute kidney injury via the antioxidative effect
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American Journal of Physiology-Renal Physiology.2019; 317(4): F881. CrossRef
Ankylosing spondylitis: A novel risk factor for atrial fibrillation — A nationwide population-based study
Inki Moon, Eue-Keun Choi, Jin-Hyung Jung, Kyung-Do Han, You-Jung Choi, Jiesuck Park, Jun Hwan Cho, Euijae Lee, Wonseok Choe, So-Ryoung Lee, Myung-Jin Cha, Woo-Hyun Lim, Seil Oh
International Journal of Cardiology.2019; 275: 77. CrossRef
Impact of Cytomegalovirus Disease on New-Onset Type 2 Diabetes Mellitus: Population-Based Matched Case-Control Cohort Study
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Diabetes & Metabolism Journal.2019; 43(6): 815. CrossRef
Body Mass Index Variability and Long-term Risk of New-Onset Atrial Fibrillation in the General Population: A Korean Nationwide Cohort Study
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Effect of hypertension duration and blood pressure level on ischaemic stroke risk in atrial fibrillation: nationwide data covering the entire Korean population
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European Heart Journal.2019; 40(10): 809. CrossRef
Increased Risk of Diabetes in Inflammatory Bowel Disease Patients: A Nationwide Population-Based Study in Korea
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Journal of Clinical Medicine.2019; 8(3): 343. CrossRef
High Proportion of Adult Cases and Prevalence of Metabolic Syndrome in Type 1 Diabetes Mellitus Population in Korea: A Nationwide Study
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Diabetes & Metabolism Journal.2019; 43(1): 76. CrossRef
Long-term evolution of direct healthcare costs for inflammatory bowel diseases: a population-based study (2006–2015)
Jung-Wook Kim, Chang Kyun Lee, Jung Kuk Lee, Su Jin Jeong, Shin Ju Oh, Jung Rock Moon, Hyun-Soo Kim, Hyo Jong Kim
Scandinavian Journal of Gastroenterology.2019; 54(4): 419. CrossRef
Association Between Systolic and Diastolic Blood Pressure Variability and the Risk of End-Stage Renal Disease
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Effect of Dipeptidyl Peptidase-4 Inhibitors on the Risk of Bone Fractures in a Korean Population
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Jiesuck Park, Eue-Keun Choi, Kyung-Do Han, You-jung Choi, Euijae Lee, Wonseok Choe, So-Ryoung Lee, Myung-Jin Cha, Woo-Hyun Lim, Jeehoon Kang, Kyung Woo Park, Seil Oh, Gregory Y. H. Lip, Chiara Lazzeri
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Association of Exposure to Diagnostic Low-Dose Ionizing Radiation With Risk of Cancer Among Youths in South Korea
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JAMA Network Open.2019; 2(9): e1910584. CrossRef
Cholesterol levels and development of cardiovascular disease in Koreans with type 2 diabetes mellitus and without pre-existing cardiovascular disease
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Cost Effectiveness of Quadrivalent Influenza Vaccines Compared with Trivalent Influenza Vaccines in Young Children and Older Adults in Korea
Yun-Kyung Kim, Joon Young Song, Hyeongap Jang, Tae Hyun Kim, Heejo Koo, Lijoy Varghese, Euna Han
PharmacoEconomics.2018; 36(12): 1475. CrossRef
Trends in the prevalence of metabolic syndrome and its components in South Korea: Findings from the Korean National Health Insurance Service Database (2009–2013)
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Appropriate Amount of Regular Exercise Is Associated with a Reduced Mortality Risk
DA YOUNG LEE, EUN-JUNG RHEE, JUNG HWAN CHO, HYEMI KWON, SE EUN PARK, YANG-HYUN KIM, KYUNGDO HAN, YONG-KYU PARK, SOON JIB YOO, WON-YOUNG LEE
Medicine & Science in Sports & Exercise.2018; 50(12): 2451. CrossRef
Association of blood pressure components with mortality and cardiovascular events in prehypertensive individuals: a nationwide population-based cohort study
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Annals of Medicine.2018; 50(5): 443. CrossRef
Trends in diabetic retinopathy and related medical practices among type 2 diabetes patients: Results from the National Insurance Service Survey 2006–2013
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Journal of Diabetes Investigation.2018; 9(1): 173. CrossRef
Optimal Blood Pressure in Elderly Hypertensive Subjects: A Korean National Health Insurance Service Health Examinee Cohort Study
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American Journal of Hypertension.2018; 31(9): 1033. CrossRef
Association between diabetes and asthma
Ji Yeon Baek, Seung Eun Lee, Kyungdo Han, Eun Hee Koh
Annals of Allergy, Asthma & Immunology.2018; 121(6): 699. CrossRef
Increased risk of open‐angle glaucoma among patients with diabetes mellitus: a 10‐year follow‐up nationwide cohort study
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Acta Ophthalmologica.2018;[Epub] CrossRef
Age Threshold for Ischemic Stroke Risk in Atrial Fibrillation
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Stroke.2018; 49(8): 1872. CrossRef
Impact of Renal Function on Outcomes With Edoxaban in Real-World Patients With Atrial Fibrillation
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Dipstick proteinuria predicts all-cause mortality in general population: A study of 17 million Korean adults
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Past and Current Status of Adult Type 2 Diabetes Mellitus Management in Korea: A National Health Insurance Service Database Analysis
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Diabetes & Metabolism Journal.2018; 42(2): 93. CrossRef
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Circulation.2018; 138(23): 2627. CrossRef
Effects of smoking habit change on all-cause mortality and cardiovascular diseases among patients with newly diagnosed diabetes in Korea
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Scientific Reports.2018;[Epub] CrossRef
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Journal of Diabetes and its Complications.2018; 32(2): 157. CrossRef
Association Between Diabetic Retinopathy and Parkinson Disease: The Korean National Health Insurance Service Database
Seung Eun Lee, Kyungdo Han, Ji Yeon Baek, Kyung Soo Ko, Ki-Up Lee, Eun Hee Koh
The Journal of Clinical Endocrinology & Metabolism.2018; 103(9): 3231. CrossRef
Variability in metabolic parameters and risk of dementia: a nationwide population-based study
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Alzheimer's Research & Therapy.2018;[Epub] CrossRef
Factors associated with continued smoking after the diagnosis of type 2 diabetes: a retrospective study in the Korean cohort
Mi Hee Cho, Sung Min Kim, Kiheon Lee, Sang Min Park, Jooyoung Chang, Seulggie Choi, Kyuwoong Kim, Hye-Yeon Koo, Ji-Hye Jun
BMJ Open.2018; 8(6): e020160. CrossRef
Impact of diabetes mellitus and chronic liver disease on the incidence of dementia and all-cause mortality among patients with dementia
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Trends in the incidence and prevalence of atrial fibrillation and estimated thromboembolic risk using the CHA2DS2-VASc score in the entire Korean population
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International Journal of Cardiology.2017; 236: 226. CrossRef
Increased risk for diabetes development in subjects with large variation in total cholesterol levels in 2,827,950 Koreans: A nationwide population-based study
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Prevalence and Determinants of Diabetic Nephropathy in Korea: Korea National Health and Nutrition Examination Survey: Jae Hee Ahn, Ji Hee Yu, Seung-Hyun Ko, Hyuk-Sang Kwon, Dae Jung Kim, Jae Hyeon Kim, Chul Sik Kim, Kee-Ho Song, Jong Chul Won, Soo Lim, Sung Hee Choi, Kyungdo Han, Bong-Yun Cha, Nan Hee Kim; Diabetes Metab J. 2014;38(2):109-119. Published online April 18, 2014; DOI: https://doi.org/10.4093/dmj.2014.38.2.109

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Background

Diabetic nephropathy is a leading cause of end stage renal disease and is associated with an increased risk of cardiovascular mortality. It manifests as albuminuria or impaired glomerular filtration rate (GFR), and the prevalence of diabetic nephropathy varies with ethnicity. The prevalence of diabetic nephropathy and its determinants in Korean adults have not previously been studied at the national level. This cross-sectional study was undertaken to ascertain the prevalence and determinants of albuminuria and chronic kidney disease (CKD) in Korean patients with diabetes.

Methods

The Korea National Health and Nutrition Examination Survey (KNHANES) V, conducted in 2011, was used to define albuminuria (n=4,652), and the dataset of KNHANES IV-V (2008-2011) was used to define CKD (n=21,521). Selected samples were weighted to represent the entire civilian population in Korea. Albuminuria was defined as a spot urine albumin/creatinine ratio >30 mg/g. CKD was defined as a GFR <60 mL/min/1.73 m².

Results

Among subjects with diabetes, 26.7% had albuminuria, and 8.6% had CKD. Diabetes was associated with an approximate 2.5-fold increased risk of albuminuria, with virtually no difference between new-onset and previously diagnosed diabetes. Only systolic blood pressure was significantly associated with albuminuria, and old age, high serum triglyceride levels, and previous cardiovascular disease (CVD) were related with CKD in subjects with diabetes.

Conclusion

Korean subjects with diabetes had a higher prevalence of albuminuria and CKD than those without diabetes. Blood pressure was associated with albuminuria, and age, triglyceride level, and previous CVD were independent determinants of CKD in subjects with diabetes.

Citations

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Higher Prevalence and Awareness, but Lower Control Rate of Hypertension in Patients with Diabetes than General Population: The Fifth Korean National Health and Nutrition Examination Survey in 2011: Seung-Hyun Ko, Hyuk-Sang Kwon, Dae Jung Kim, Jae Hyeon Kim, Nan Hee Kim, Chul Sik Kim, Kee-Ho Song, Jong Chul Won, Soo Lim, Sung Hee Choi, Kyungdo Han, Yong-Moon Park, Bong-Yun Cha; Diabetes Metab J. 2014;38(1):51-57. Published online February 19, 2014; DOI: https://doi.org/10.4093/dmj.2014.38.1.51

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Abstract PDF PubReader

Background

We investigated the prevalence, awareness, treatment, and control rate of hypertension in Korean adults with diabetes using nationally representative data.

Methods

Using data of 5,105 adults from the fifth Korea National Health and Nutrition Examination Survey in 2011 (4,389 nondiabetes mellitus [non-DM]), 242 newly diagnosed with DM (new-DM), and 474 previously diagnosed with DM (known-DM), we analyzed the prevalence of hypertension (mean systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or use of antihypertensive medication) and control rate of hypertension (blood pressure [BP] <130/80 mm Hg).

Results

The prevalence of hypertension in diabetic adults was 54.6% (44.4% in new-DM and 62.6% in known-DM, P<0.0001 and P<0.0001, respectively) compared with non-DM adults (26.2%). Compared to non-DM, awareness (85.7%, P<0.001) and treatment (97.0%, P=0.020) rates were higher in known-DM, whereas no differences were found between new-DM and non-DM. Control rate among all hypertensive subjects was lower in new-DM (14.9%), compared to non-DM (35.1%, P<0.001) and known-DM (33.3%, P=0.004). Control rate among treated subjects was also lower in new-DM (25.2%), compared to non-DM (68.4%, P<0.0001) and known-DM (39.9%, P<0.0001).

Conclusion

Higher prevalence and low control rate of hypertension in adults with diabetes suggest that stringent efforts are needed to control BP in patients with diabetes, particularly in newly diagnosed diabetic patients.

Citations

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Tae-Seok Lim, Jae-Seung Yun, Seon-Ah Cha, Ki-Ho Song, Ki-Dong Yoo, Yu-Bae Ahn, Yong-Moon Park, Seung-Hyun Ko
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The association of incident hypertension with metabolic health and obesity status: definition of metabolic health does not matter
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Metabolic Risk/Epidemiology
Association of Uterine Leiomyoma with Type 2 Diabetes Mellitus in Young Women: A Population-Based Cohort Study: Ji-Hee Sung, Kyung-Soo Kim, Kyungdo Han, Cheol-Young Park; Received December 8, 2023 Accepted June 17, 2024 Published online August 19, 2024; DOI: https://doi.org/10.4093/dmj.2023.0444 [Epub ahead of print]

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Abstract PDF Supplementary Material PubReader ePub: Background
We investigated the association between uterine leiomyoma (UL) and incident type 2 diabetes mellitus (T2DM) in young women.
Methods
A nationwide population-based cohort study of 2,541,550 women aged between 20 and 40 years was performed using the National Health Information Database. Cox proportional hazards models were used to analyze the risk of incident T2DM according to the presence of UL and myomectomy.
Results
The mean age was 29.70 years, and mean body mass index was 21.31 kg/m2. Among 2,541,550 participants, 18,375 (0.72%) women had UL. During a median 7.45 years of follow-up, 23,829 women (0.94%) were diagnosed with T2DM. The incidence of T2DM in women with UL (1.805/1,000 person-years) was higher than in those without UL (1.289/1,000 person-years). Compared with women without UL, women with UL had a higher risk of incident T2DM (hazard ratio, 1.216; 95% confidence interval [CI], 1.071 to 1.382). Women with UL who did not undergo myomectomy had a 1.505 times (95% CI, 1.297 to 1.748) higher risk for incident T2DM than women without UL. However, women with UL who underwent myomectomy did not have increased risk for incident T2DM.
Conclusion
Young women with UL were associated with a high risk of incident T2DM. In addition, myomectomy seemed to attenuate the risk for incident T2DM in young women with UL.

Cardiovascular Risk/Epidemiology
Different Associations between Lipid Levels and Risk for Heart Failure according to Diabetes Progression: Seung-Hwan Lee, Kyu Na Lee, Jong-Chan Youn, Hun Sung Kim, Kyungdo Han, Mee Kyoung Kim; Received February 10, 2024 Accepted May 13, 2024 Published online August 28, 2024; DOI: https://doi.org/10.4093/dmj.2024.0066 [Epub ahead of print]

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Abstract PDF Supplementary Material PubReader ePub: Background
The relationship between circulating lipid levels and the risk for heart failure (HF) is controversial. We aimed to examine this association, and whether it is modified by the duration of diabetes or treatment regimens in people with type 2 diabetes mellitus.
Methods
Individuals (n=2,439,978) who underwent health examinations in 2015 to 2016 were identified from the Korean National Health Information Database. Subjects were categorized according to the duration of diabetes (new-onset, <5, 5–10, or ≥10 years) and number of antidiabetic medications. Incident HF was defined according to the International Classification of Diseases, 10th Revision (ICD-10) code I50 as the primary diagnosis during hospitalization. The risk for HF was estimated using multivariate Cox proportional hazard analysis.
Results
During a median follow-up of 4.0 years, 151,624 cases of HF occurred. An inverse association between low-density lipoprotein cholesterol (LDL-C) levels and incident HF was observed in the new-onset diabetes group, with an approximately 25% lower risk in those with LDL-C levels of 100–129, 130–159, and ≥160 mg/dL, compared to those with levels <70 mg/dL. However, J-shaped associations were noted in the long-standing diabetes group, with a 16% higher risk in those with LDL-C level ≥160 mg/dL, compared to those with levels <70 mg/dL. Similar patterns were observed in the relationship between total cholesterol or non-high-density lipoprotein cholesterol and the risk for HF, and when subjects were grouped according to the number of antidiabetic medications instead of diabetes duration.
Conclusion
Different associations between lipid levels and the risk for HF were noted according to disease progression status among individuals with diabetes.

Cardiovascular Risk/Epidemiology
Impact of New-Onset Diabetes after Transplantation on Cardiovascular Risk and Mortality in Korea: A Nationwide Population-Based Study: Seung Shin Park, Bo Kyung Koo, Sanghyun Park, Kyungdo Han, Min Kyong Moon; Received February 18, 2024 Accepted June 17, 2024 Published online September 12, 2024; DOI: https://doi.org/10.4093/dmj.2024.0078 [Epub ahead of print]

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Abstract PDF Supplementary Material PubReader ePub: Background
Limited data are available on the adverse effects of new-onset diabetes after transplantation (NODAT) in solid organ transplantation (TPL) other than kidney. This study aimed to identify the risk of complications associated with NODAT in recipients of kidney, liver, or heart TPL.
Methods
Using the Korean National Health Insurance Service database, recipients of kidney, liver, or heart TPL between 2009 and 2015 were identified. The incidence of coronary artery disease (CAD), cerebrovascular accident (CVA), and malignancy was compared across groups with NODAT, pretransplant diabetes mellitus (DM), and without DM using Cox regression analysis.
Results
A total of 9,632 kidney, liver, or heart TPL recipients were included. During the median follow-up of 5.9 years, NODAT independently increased the incidence of CAD (hazard ratio [HR], 2.46; 95% confidence interval [CI], 1.39 to 4.30) and overall mortality (HR, 1.48; 95% CI, 1.14 to 1.95) compared to the reference group even after adjustment for confounders; this was more prominent in kidney TPL than in liver TPL. The risk of CVA was significantly increased by pretransplant DM but not by NODAT in both kidney and liver TPL (HR, 2.47; 95% CI, 1.68 to 3.65; and HR, 3.18; 95% CI, 1.07 to 9.48, respectively). NODAT increased the risk of malignancy in the crude model, which lost its statistical significance after confounder adjustment.
Conclusion
NODAT independently increases the risk of CAD and mortality after TPL, which is more evident in kidney recipients. There was no additional increased risk of CVA or malignancy with NODAT in solid organ TPL.

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