- Guideline/Fact Sheet
- Metabolic Dysfunction-Associated Steatotic Liver Disease in Type 2 Diabetes Mellitus: A Review and Position Statement of the Fatty Liver Research Group of the Korean Diabetes Association
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Jaehyun Bae, Eugene Han, Hye Won Lee, Cheol-Young Park, Choon Hee Chung, Dae Ho Lee, Eun-Hee Cho, Eun-Jung Rhee, Ji Hee Yu, Ji Hyun Park, Ji-Cheol Bae, Jung Hwan Park, Kyung Mook Choi, Kyung-Soo Kim, Mi Hae Seo, Minyoung Lee, Nan-Hee Kim, So Hun Kim, Won-Young Lee, Woo Je Lee, Yeon-Kyung Choi, Yong-ho Lee, You-Cheol Hwang, Young Sang Lyu, Byung-Wan Lee, Bong-Soo Cha, on Behalf of the Fatty Liver Research Group of the Korean Diabetes Association
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Diabetes Metab J. 2024;48(6):1015-1028. Published online November 21, 2024
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DOI: https://doi.org/10.4093/dmj.2024.0541
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- Since the role of the liver in metabolic dysfunction, including type 2 diabetes mellitus, was demonstrated, studies on non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated fatty liver disease (MAFLD) have shown associations between fatty liver disease and other metabolic diseases. Unlike the exclusionary diagnostic criteria of NAFLD, MAFLD diagnosis is based on the presence of metabolic dysregulation in fatty liver disease. Renaming NAFLD as MAFLD also introduced simpler diagnostic criteria. In 2023, a new nomenclature, steatotic liver disease (SLD), was proposed. Similar to MAFLD, SLD diagnosis is based on the presence of hepatic steatosis with at least one cardiometabolic dysfunction. SLD is categorized into metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction and alcohol-related/-associated liver disease, alcoholrelated liver disease, specific etiology SLD, and cryptogenic SLD. The term MASLD has been adopted by a number of leading national and international societies due to its concise diagnostic criteria, exclusion of other concomitant liver diseases, and lack of stigmatizing terms. This article reviews the diagnostic criteria, clinical relevance, and differences among NAFLD, MAFLD, and MASLD from a diabetologist’s perspective and provides a rationale for adopting SLD/MASLD in the Fatty Liver Research Group of the Korean Diabetes Association.
- Guideline/Fact Sheet
- Diabetes Mellitus in the Elderly Adults in Korea: Based on Data from the Korea National Health and Nutrition Examination Survey 2019 to 2020
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Seung-Hyun Ko, Kyung Do Han, Yong-Moon Park, Jae-Seung Yun, Kyuho Kim, Jae-Hyun Bae, Hyuk-Sang Kwon, Nan-Hee Kim
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Diabetes Metab J. 2023;47(5):643-652. Published online August 7, 2023
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DOI: https://doi.org/10.4093/dmj.2023.0041
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- Background
We evaluated the prevalence and management of diabetes mellitus (DM) in elderly Korean patients based on data from the Korea National Health and Nutrition Examination Survey (KNHANES).
Methods
A total of 3,068 adults aged 65 years and older (19.8% of total population) were analyzed using KNHANES from 2019 to 2020. Prevalence, awareness, treatment, and control rates, and comorbidities were analyzed. Lifestyle behaviors and energy intake were also measured.
Results
The prevalence of DM and prediabetes was 29.6% and 50.5%, respectively. The awareness, treatment and control rates were 76.4%, 73.3%, and 28.3%, respectively. The control rate was 77.0% if A1C <7.5% criteria was used. The mean A1C value of individuals with known DM was 7.1%, and 14.5% of the known DM patients had A1C ≥8.0%. Abdominal obesity, hypertension, and hypercholesterolemia were combined with DM in 63.9%, 71.7%, and 70.7%, respectively, and the rate of integrated management was 36.0% (A1C <7.5% criteria). A total of 40.1% of those with DM walked regularly. The percentage of energy intake from carbohydrates was higher in those with DM than in those without DM (P=0.044), while those of fat (P=0.003) and protein (P=0.025) were lower in those with DM than in those without DM in women.
Conclusion
In 2019 to 2020, three of 10 adults aged 65 years and older in Korea had DM, and approximately 70% of them had comorbidities. A strategy for more individualized comprehensive care for the elderly patients with DM is urgently needed.
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- Non-Alcoholic Fatty Liver Disease in Patients with Type 2 Diabetes Mellitus: A Position Statement of the Fatty Liver Research Group of the Korean Diabetes Association
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Byung-Wan Lee, Yong-ho Lee, Cheol-Young Park, Eun-Jung Rhee, Won-Young Lee, Nan-Hee Kim, Kyung Mook Choi, Keun-Gyu Park, Yeon-Kyung Choi, Bong-Soo Cha, Dae Ho Lee, Korean Diabetes Association (KDA) Fatty Liver Research Group
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DOI: https://doi.org/10.4093/dmj.2020.0010
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This clinical practice position statement, a product of the Fatty Liver Research Group of the Korean Diabetes Association, proposes recommendations for the diagnosis, progression and/or severity assessment, management, and follow-up of non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (T2DM). Patients with both T2DM and NAFLD have an increased risk of non-alcoholic steatohepatitis (NASH) and fibrosis and a higher risk of cardiovascular diseases and diabetic complications compared to those without NAFLD. With regards to the evaluation of patients with T2DM and NAFLD, ultrasonography-based stepwise approaches using noninvasive biomarker models such as fibrosis-4 or the NAFLD fibrosis score as well as imaging studies such as vibration-controlled transient elastography with controlled attenuation parameter or magnetic resonance imaging-proton density fat fraction are recommended. After the diagnosis of NAFLD, the stage of fibrosis needs to be assessed appropriately. For management, weight reduction achieved by lifestyle modification has proven beneficial and is recommended in combination with antidiabetic agent(s). Evidence that some antidiabetic agents improve NAFLD/NASH with fibrosis in patients with T2DM is emerging. However, there are currently no definite pharmacologic treatments for NAFLD in patients with T2DM. For specific cases, bariatric surgery may be an option if indicated. -
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- 2019 Clinical Practice Guidelines for Type 2 Diabetes Mellitus in Korea
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Mee Kyoung Kim, Seung-Hyun Ko, Bo-Yeon Kim, Eun Seok Kang, Junghyun Noh, Soo-Kyung Kim, Seok-O Park, Kyu Yeon Hur, Suk Chon, Min Kyong Moon, Nan-Hee Kim, Sang Yong Kim, Sang Youl Rhee, Kang-Woo Lee, Jae Hyeon Kim, Eun-Jung Rhee, SungWan Chun, Sung Hoon Yu, Dae Jung Kim, Hyuk-Sang Kwon, Kyong Soo Park
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Diabetes Metab J. 2019;43(4):398-406. Published online August 20, 2019
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DOI: https://doi.org/10.4093/dmj.2019.0137
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The Committee of Clinical Practice Guidelines of the Korean Diabetes Association revised and updated the 6th Clinical Practice Guidelines in 2019. Targets of glycemic, blood pressure, and lipid control in type 2 diabetes mellitus (T2DM) were updated. The obese and overweight population is increasing steadily in Korea, and half of the Koreans with diabetes are obese. Evidence-based recommendations for weight-loss therapy for obesity management as treatment for hyperglycemia in T2DM were provided. In addition, evidence from large clinical studies assessing cardiovascular outcomes following the use of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide 1 receptor agonists in patients with T2DM were incorporated into the recommendations. -
Citations
Citations to this article as recorded by
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Hyun Jin Kim, Seok O Park, Seung-Hyun Ko, Sang Youl Rhee, Kyu-Yeon Hur, Nan-Hee Kim, Min Kyong Moon, Byung-Wan Lee, Jin Hwa Kim, Kyung Mook Choi
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Diabetes Metab J. 2017;41(6):423-429. Published online December 19, 2017
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DOI: https://doi.org/10.4093/dmj.2017.41.6.423
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The glucagon-like peptide-1 receptor agonists (GLP-1RAs) were recommended as a monotherapy or combination therapy with oral hypoglycemic agents or basal insulin in the position statement of the Korean Diabetes Association 2017 for pharmacological therapy. Many randomized clinical trials and systematic reviews report that GLP-1RAs have considerable glucose-lowering effect and lead to weight reduction and low risk of hypoglycemia when used as a monotherapy or combination therapy. The cardiovascular safety of GLP-1RAs has been assessed in several randomized clinical trials and systematic reviews. The results of cardiovascular outcome trials of long-acting GLP-1RAs (liraglutide, semaglutide) demonstrated cardiovascular benefits in subjects with type 2 diabetes mellitus and a high risk of cardiovascular disease. The GLP-1RA may be a choice of therapy when weight control and avoidance of hypoglycemia are important, and patients with high risk of cardiovascular disease might also favor choosing GLP-1RA. -
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Seung-Hyun Ko, Kyu-Yeon Hur, Sang Youl Rhee, Nan-Hee Kim, Min Kyong Moon, Seok-O Park, Byung-Wan Lee, Hyun Jin Kim, Kyung Mook Choi, Jin Hwa Kim
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Diabetes Metab J. 2017;41(5):337-348. Published online October 17, 2017
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DOI: https://doi.org/10.4093/dmj.2017.41.5.337
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Abstract
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In 2017, the Korean Diabetes Association (KDA) published a position statement on the use of antihyperglycemic agents for patients with type 2 diabetes mellitus (T2DM). The KDA regularly updates its Clinical Practice Guidelines, but since the last update in 2015, many results from clinical trials have been introduced, and domestic data from studies performed in Korean patients with T2DM have been published. Recently, evidence from large clinical studies assessing cardiovascular outcomes following the use of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists in patients with T2DM were incorporated into the recommendations. Additionally, new data from clinical trials using dipeptidyl peptidase 4 inhibitors and thiazolidinediones in Korean patients with T2DM were added. Following a systematic review and assessment of recent evidence, the KDA updated and modified its clinical practice recommendations regarding the use of antihyperglycemic agents and revised the treatment algorithm for Korean adult patients with T2DM. -
Citations
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- Clinical Diabetes & Therapeutics
- Monotherapy in Patients with Type 2 Diabetes Mellitus
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Sang Youl Rhee, Hyun Jin Kim, Seung-Hyun Ko, Kyu-Yeon Hur, Nan-Hee Kim, Min Kyong Moon, Seok-O Park, Byung-Wan Lee, Kyung Mook Choi, Jin Hwa Kim
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Diabetes Metab J. 2017;41(5):349-356. Published online October 19, 2017
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DOI: https://doi.org/10.4093/dmj.2017.41.5.349
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In order to improve the quality of life and to prevent chronic complications related to diabetes mellitus, intensive lifestyle modification and proper medication are needed from the early stage of diagnosis of type 2 diabetes mellitus (T2DM). When using the first medication for diabetic patients, the appropriate treatment should be selected considering the clinical characteristics of the patient, efficacy of the drug, side effects, and cost. In general, the use of metformin as the first treatment for oral hypoglycemic monotherapy is recommended because of its excellent blood glucose-lowering effect, relatively low side effects, long-term proven safety, low risk of hypoglycemia, and low weight gain. If metformin is difficult to use as a first-line treatment, other appropriate medications should be selected in view of the clinical situation. If the goal of achieving glycemic control is not achieved by monotherapy, a combination therapy with different mechanisms of action should be initiated promptly. -
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Min Kyong Moon, Kyu-Yeon Hur, Seung-Hyun Ko, Seok-O Park, Byung-Wan Lee, Jin Hwa Kim, Sang Youl Rhee, Hyun Jin Kim, Kyung Mook Choi, Nan-Hee Kim
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Diabetes Metab J. 2017;41(5):357-366. Published online October 24, 2017
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DOI: https://doi.org/10.4093/dmj.2017.41.5.357
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Abstract
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The Korean Diabetes Association (KDA) recently updated the Clinical Practice Guidelines on antihyperglycemic agent therapy for adult patients with type 2 diabetes mellitus (T2DM). In combination therapy of oral hypoglycemic agents (OHAs), general recommendations were not changed from those of the 2015 KDA guidelines. The Committee on Clinical Practice Guidelines of the KDA has extensively reviewed and discussed the results of meta-analyses and systematic reviews of effectiveness and safety of OHAs and many clinical trials on Korean patients with T2DM for the update of guidelines. All OHAs were effective when added to metformin or metformin and sulfonylurea, although the effects of each agent on body weight and hypoglycemia were different. Therefore, selection of a second agent as a metformin add-on therapy or third agent as a metformin and sulfonylurea add-on therapy should be based on the patient's clinical characteristics and the efficacy, side effects, mechanism of action, risk of hypoglycemia, effect on body weight, patient preference, and combined comorbidity. In this review, we address the results of meta-analyses and systematic reviews, comparing the effectiveness and safety among OHAs. It will help to choose the appropriate drug for an individual patient with T2DM. -
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Byung-Wan Lee, Jin Hwa Kim, Seung-Hyun Ko, Kyu-Yeon Hur, Nan-Hee Kim, Sang Youl Rhee, Hyun Jin Kim, Min Kyong Moon, Seok-O Park, Kyung Mook Choi
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Diabetes Metab J. 2017;41(5):367-373. Published online October 24, 2017
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DOI: https://doi.org/10.4093/dmj.2017.41.5.367
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Abstract
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The Korean Diabetes Association (KDA) has regularly updated its Clinical Practice Guidelines. In 2017, the KDA published a position statement on the use of antihyperglycemic agents for patients with type 2 diabetes mellitus (T2DM). Growing evidence from new multinational clinical trials using novel and traditional insulin analogues has also been accumulated. Following global trends, many results of clinical trials, especially concerning the clinical efficacy and safety of insulin therapy, have been published about Korean patients with T2DM. After a systematic search of recent evidence, the KDA updated and modified its clinical practice recommendations regarding the initiation, choice, and intensification of insulin and created an insulin treatment algorithm for the first time to guide physicians caring for adult Korean patients with T2DM. -
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Seung-Hyun Ko, Sung-Rea Kim, Dong-Joon Kim, Seung-Joon Oh, Hye-Jin Lee, Kang-Hee Shim, Mi-Hye Woo, Jun-Young Kim, Nan-Hee Kim, Jae-Taik Kim, Chong Hwa Kim, Hae Jin Kim, In-Kyung Jeong, Eun-Kyung Hong, Jae-Hyoung Cho, Ji-Oh Mok, Kun-Ho Yoon
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Diabetes Metab J. 2011;35(5):431-436. Published online October 31, 2011
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DOI: https://doi.org/10.4093/dmj.2011.35.5.431
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58,870
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As in other countries, type 2 diabetes is major health concern in Korea. A dramatic increase in the prevalence of type 2 diabetes and its chronic complications has led to an increase in health costs and economic burdens. Early detection of high risk individuals, hidden diabetic patients, and improvement in the quality of care for the disease are the first steps to mitigate the increase in prevalence. The Committee of Clinical Practice Guidelines of the Korean Diabetes Association revised and updated the '3rd Clinical Practice Guidelines' at the end of 2010. In the guidelines, the committee recommended active screening of high risk individuals for early detection and added the hemoglobin A1c level to the diagnostic criteria for type 2 diabetes based on clinical studies performed in Korea. Furthermore, the committee members emphasized that integrating patient education and self-management is an essential part of care. The drug treatment algorithm based on the degree of hyperglycemia and patient characteristics were also updated. -
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Diabetes & Metabolism Journal.2019; 43(2): 174. CrossRef - 2019 Clinical Practice Guidelines for Type 2 Diabetes Mellitus in Korea
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Nutrients.2019; 11(8): 1874. CrossRef - Does Korean diet based on brown rice really have the effect on treating chronic diseases and on suspending drug use?
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The Korean Journal of Clinical Laboratory Science.2017; 49(2): 114. CrossRef - Changes in HbA 1c levels and body mass index after successful decompression surgery in patients with type 2 diabetes mellitus and lumbar spinal stenosis: results of a 2-year follow-up study
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Diabetes & Metabolism Journal.2016; 40(3): 192. CrossRef - Effectiveness of Web-Based Interventions for Managing Diabetes in Korea
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Seon-Ah Cha, Jae-Seung Yun, Tae-Seok Lim, Seawon Hwang, Eun-Jung Yim, Ki-Ho Song, Ki-Dong Yoo, Yong-Moon Park, Yu-Bae Ahn, Seung-Hyun Ko
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Diabetes & Metabolism Journal.2016; 40(5): 414. CrossRef - Experiences of Diabetes Education among Educators of Diabetes : a content analysis approach
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The Korean Journal of Internal Medicine.2016; 31(3): 457. CrossRef - Uncontrolled diabetes mellitus: Prevalence and risk factors among people with type 2 diabetes mellitus in an Urban District of Karachi, Pakistan
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Journal of Diabetes Investigation.2015; 6(3): 317. CrossRef - Avoiding or coping with severe hypoglycemia in patients with type 2 diabetes
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The Korean Journal of Internal Medicine.2015; 30(1): 6. CrossRef - The Correlation between Hemoglobin A1c and Common Carotid Artery Intima Medial Thickness of Both Genders with Less Than 6.5% HbA1c Based on Ultrasound Measurement
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PLOS ONE.2015; 10(4): e0125338. CrossRef - Efficacy of a New Medical Information system, Ubiquitous Healthcare Service with Voice Inception Technique in Elderly Diabetic Patients
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Scientific Reports.2015;[Epub] CrossRef - Intensive Individualized Reinforcement Education Is Important for the Prevention of Hypoglycemia in Patients with Type 2 Diabetes
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Diabetes & Metabolism Journal.2015; 39(6): 498. CrossRef - Association between flavonoid intake and diabetes risk among the Koreans
Jee-Young Yeon, Yun Jung Bae, Eun-Young Kim, Eun-Ju Lee
Clinica Chimica Acta.2015; 439: 225. CrossRef - Association between Self-Reported Smoking and Hemoglobin A1c in a Korean Population without Diabetes: The 2011–2012 Korean National Health and Nutrition Examination Survey
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PLOS ONE.2015; 10(5): e0126746. CrossRef - Relationship between metabolic syndrome and thyroid nodules in healthy Koreans
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The Diabetes Educator.2015; 41(2): 203. CrossRef - Current Status of Management in Type 2 Diabetes Mellitus at General Hospitals in South Korea
Jin-Hee Jung, Jung-Hwa Lee, Jin-Won Noh, Jeong-Eun Park, Hee-Sook Kim, Joo-Wha Yoo, Bok-Rye Song, Jeong-rim Lee, Myeong-Hee Hong, Hyang-Mi Jang, Young Na, Hyun-Joo Lee, Jeong-Mi Lee, Yang-Gyo Kang, Sun-Young Kim, Kang-Hee Sim
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Nutrition, Metabolism and Cardiovascular Diseases.2014; 24(3): 277. CrossRef - Internet-Based Mentoring Program for Patients with Type 1 Diabetes
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Diabetes & Metabolism Journal.2014; 38(2): 107. CrossRef - Association of Vitamin B12Deficiency and Metformin Use in Patients with Type 2 Diabetes
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Journal of Korean Medical Science.2014; 29(7): 965. CrossRef - Plasma Glucose Regulation and Mortality in Korea: A Pooled Analysis of Three Community-Based Cohort Studies
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International Journal of Clinical Practice.2014; 68(11): 1338. CrossRef - 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 & Metabolism Journal.2014; 38(1): 51. CrossRef - Comparison between the Therapeutic Effect of Metformin, Glimepiride and Their Combination as an Add-On Treatment to Insulin Glargine in Uncontrolled Patients with Type 2 Diabetes
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PLoS ONE.2014; 9(3): e87799. CrossRef - Glycaemic and haemoglobin A1c thresholds for detecting diabetic retinopathy: The fifth Korea National Health and Nutrition Examination Survey (2011)
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Diabetes Research and Clinical Practice.2014; 104(3): 435. CrossRef - Development of an HbA1c-Based Conversion Equation for Estimating Glycated Albumin in a Korean Population with a Wide Range of Glucose Intolerance
Chang Hee Jung, You-Cheol Hwang, Kwang Joon Kim, Bong Soo Cha, Cheol-Young Park, Won Seon Jeon, Jae Hyeon Kim, Sang-Man Jin, Sang Youl Rhee, Jeong-taek Woo, Byung-Wan Lee, Sompop Bencharit
PLoS ONE.2014; 9(4): e95729. CrossRef - Risk of suicidal ideation in diabetes varies by diabetes regimen, diabetes duration, and HbA1c level
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Journal of Psychosomatic Research.2014; 76(4): 275. CrossRef - Non-HDL cholesterol is an independent risk factor for aspirin resistance in obese patients with type 2 diabetes
Jong Dai Kim, Cheol-Young Park, Kue Jeong Ahn, Jae Hyoung Cho, Kyung Mook Choi, Jun Goo Kang, Jae Hyeon Kim, Ki Young Lee, Byung Wan Lee, Ji Oh Mok, Min Kyong Moon, Joong Yeol Park, Sung Woo Park
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You-Cheol Hwang, Chang Hee Jung, Hong-Yup Ahn, Won Seon Jeon, Sang-Man Jin, Jeong-taek Woo, Bong Soo Cha, Jae Hyeon Kim, Cheol-Young Park, Byung-Wan Lee
Clinica Chimica Acta.2014; 437: 1. CrossRef - Higher Prevalence of Metformin-Induced Vitamin B12 Deficiency in Sulfonylurea Combination Compared with Insulin Combination in Patients with Type 2 Diabetes: A Cross-Sectional Study
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Diabetes & Metabolism Journal.2013; 37(5): 349. CrossRef - Metformin Based Dual-Combination Therapies in Drug Naïve Type 2 Diabetic Patients
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Diabetes & Metabolism Journal.2013; 37(6): 465. CrossRef - Long-term changes of the prevalence and control rate of hypertension among Korean adults with diagnosed diabetes: 1998–2008 Korean National Health and Nutrition Examination Survey
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Diabetes Research and Clinical Practice.2012; 97(1): 151. CrossRef - Smoking and Type 2 Diabetes Mellitus
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Rieko Okada, Kenji Wakai, Mariko Naito, Emi Morita, Sayo Kawai, Guang Yin, Noriyo Ozawa, Masatoshi Furuta, Erina Koyama, Rumi Tsuchiya, Noriko Kouno, Nobuyuki Hamajima
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Diabetes Technology & Therapeutics.2012; 14(6): 508. CrossRef - The Risk of Bladder Cancer in Korean Diabetic Subjects Treated with Pioglitazone
Sun Ok Song, Kwang Joon Kim, Byung-Wan Lee, Eun Seok Kang, Bong Soo Cha, Hyun Chul Lee
Diabetes & Metabolism Journal.2012; 36(5): 371. CrossRef - Low Density Lipoprotein Cholesterol Target Goal Attainment Rate and Physician Perceptions about Target Goal Achievement in Korean Patients with Diabetes
Jenie Yoonoo Hwang, Chang Hee Jung, Woo Je Lee, Cheol Young Park, Sung Rae Kim, Kun-Ho Yoon, Moon Kyu Lee, Sung Woo Park, Joong-Yeol Park
Diabetes & Metabolism Journal.2011; 35(6): 628. CrossRef - Letter: Diabetic Polyneuropathy and Cardiovascular Complications in Type 2 Diabetic Patients (Diabetes Metab J 2011;35:390-6)
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