Diabetes & Metabolism Journal

Original Articles

Metabolic Risk/Epidemiology
Metabolic Dysfunction-Associated Steatotic Liver Disease and Risk of Hepatocellular Carcinoma in Type 2 Diabetes Mellitus: So Hyun Cho, Gyuri Kim, Kyu-na Lee, Rosa Oh, Ji Yoon Kim, Myunghwa Jang, You-Bin Lee, Sang-Man Jin, Kyu Yeon Hur, Kyungdo Han, Jae Hyeon Kim; Diabetes Metab J. 2025;49(6):1298-1307. Published online July 22, 2025; DOI: https://doi.org/10.4093/dmj.2024.0641

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Background
We investigated the incidence rates of hepatocellular carcinoma (HCC) in metabolic dysfunction-associated steatotic liver disease (MASLD) categories, focusing on its association with alcohol consumption in patients with type 2 diabetes mellitus (T2DM).
Methods
This study included 2,418,858 patients with T2DM aged 20 years and older who underwent a health examination between 2009 and 2012. Participants were categorized into five groups according to hepatic steatosis, cardiometabolic risk factors, other liver diseases, and alcohol consumption. Hepatic steatosis was defined as the fatty liver index ≥30. Cox regression analysis was used to analyze the association between steatotic liver disease and development of HCC.
Results
The MASLD group showed a higher risk of HCC development regardless of alcohol consumption or presence of other liver diseases (adjusted hazard ratio [aHR], 1.38; 95% confidence interval [CI], 1.33 to 1.44). The MASLD with other combined group expressed the highest risk (aHR, 5.02; 95% CI, 4.79 to 5.27). In the metabolic dysfunction and alcohol-related steatotic liver disease and alcohol-related liver disease groups, heavy to excessive alcohol consumption increased the risk of HCC development, with a higher risk associated with greater alcohol intake (aHR, 2.40; 95% CI, 2.27 to 2.53 and aHR, 3.16; 95% CI, 2.93 to 3.41). Fine and Gray analysis also exhibited a consistent trend.
Conclusion
MASLD in patients with T2DM was associated with an increased risk of developing HCC, particularly when accompanied by other liver diseases. Moreover, alcohol consumption proportionally increased the risk of HCC with the amount of alcohol consumed.

Citations

Citations to this article as recorded by

Telomere length and metabolic dysfunction-associated steatotic liver disease risk and progression: A systematic review and meta-analysis
Chunfeng Sun, Ping Qiu, Shuo Huang, Qihan Luo, Qing Ma, Piao Hu, Fangming Chen, Hongyan Wu, Chunxiao Chen
Experimental Gerontology.2026; 214: 113036. CrossRef
Cancer-Specific Disproportionality Signals Associated with Metformin Versus Other Antidiabetic Agents: A Real-World Pharmacovigilance Analysis of FAERS
Daniel Obinna Eke, Jessica Awingosit Ayamyiya, Katabaazi Lillian Mirembe, Anthony Kosisochukwu Anyabuoke, Jacqueline , Azodoh, Gloria Oluwabukunmi Oladapo
Oncology, Nuclear Medicine and Transplantology.2026; 2(2): onmt018. CrossRef

Complications
Connection between Impaired Fasting Glucose or Type 2 Diabetes Mellitus and Sepsis: A 10-Year Observational Data from the National Health Screening Cohort: Eun Hwa Lee, Kyoung Hwa Lee, Kyu-na Lee, Yebin Park, Kyung Do Han, Sang Hoon Han; Diabetes Metab J. 2025;49(3):485-497. Published online February 17, 2025; DOI: https://doi.org/10.4093/dmj.2024.0387

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Background
The mortality of sepsis without direct drugs is high. The association between prediabetes, based on a single fasting glucose (FG), or long-term type 2 diabetes mellitus (T2DM) and sepsis remains unclear.
Methods
Of the adults aged ≥20 years who were included in the National Health Screening Program (NHSP) in 2009, 40% were randomly sampled. After excluding patients with type 1 diabetes mellitus, with missing information, and who were diagnosed with sepsis during the wash-out (between 2001 and the NHSP) or 1-year lag period, a cohort comprised of 3,863,323 examinees. Body mass index (BMI) measurements, FG tests, and self-reported questionnaires on health-related behaviors were conducted. Individual information was followed up until 2020 and censored upon the first occurrence of sepsis or death. The incidence of sepsis was compared using a multivariable regression adjusted for age, sex, income, BMI, smoking, drinking, physical activity levels, and chronic diseases.
Results
The cohort was divided into those with normal FG (n=2,675,476), impaired fasting glucose (IFG) (n=890,402, 23.0%), T2DM <5 years (n=212,391, 5.5%), or T2DM for ≥5 years (n=85,054, 2.2%). The groups with IFG (adjusted hazard ratio [aHR], 1.03; 95% confidence interval [CI], 1.01 to 1.05), T2DM <5 years (aHR, 1.43; 95% CI, 1.40 to 1.47), and T2DM for ≥5 years (aHR, 1.82; 95% CI, 1.77 to 1.87) exhibited significantly higher incidence of sepsis (P<0.001), with the greatest risk in patients with T2DM aged <40 years (aHR, 1.96; 95% CI, 1.71 to 2.25).
Conclusion
Patients with long-standing and young-onset T2DM show a substantially high risk of sepsis, emphasizing the need for infection prevention and vaccination.

Citations

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Association Between Blood Glucose Variability and Clinical Outcomes in Patients With Sepsis: A Systematic Review and Meta‐Analysis
Gelan Miao, Rui Lu, Tanyong Pipanmekaporn, Srisuluk Kacha, Atirut Supphapipat, Natsuda Phothikun, Phut Jewprasertpan, Kaweesak Chittawatanarat
Diabetes/Metabolism Research and Reviews.2026;[Epub] CrossRef
Simultaneous assessment of stress hyperglycemia ratio and glucose variability to predict all-cause mortality in sepsis patients across different glucose metabolic states: an observational cohort study with interpretable machine learning approach
Fuxu Wang, Yu Guo, Chucheng Jiao, Shuangmei Zhao, Liutao Sui, Zhi Mao, Ruogu Lu, Rongyao Hou, Xiaoyan Zhu
International Journal of Surgery.2026; 112(1): 1219. CrossRef
Forecasting diabetes and sepsis mortality trends using advanced time-series models in United States from 1999 to 2030
Gabriele Volucke, Brandon Xian Ch’ng, Moaz Ahmad, Syed Muhammad Ali Hassnain, Toqeer Ahmed, Khadija Khizar Khan, Obaid Ur Rahman, Rowena Rachel George, Mustafa Elhaj, Syed Anjum Gardezi, Muhammad Azhar Waheed Khan, Abdulqadir J. Nashwan, Eeshal Zulfiqar,
Journal of Diabetes & Metabolic Disorders.2026;[Epub] CrossRef
Prevalence and incidence of infections among people with type 2 diabetes: a systematic review and meta-analysis
Xue-Lei Fu, Wen-Jun Chen, Hui-Mei Zhao, Meng-Di Li, Meng-Yi Zhuang, Yang Xiao, Bei Wu, Jia Guo
Journal of Global Health.2026;[Epub] CrossRef
Prognostic nutritional index, Naples prognostic score and Osaka prognostic score as predictors of acute respiratory distress syndrome in non-diabetes mellitus patients with sepsis: a loss of predictive efficacy of NPS and OPS in diabetes mellitus cohorts
Jie Wu, Wenfeng Qiu, Xiuwen Lin, Jinrun Wu, Renyuan Li
Frontiers in Endocrinology.2026;[Epub] CrossRef
Development and Validation of a Nomogram for Predicting Sepsis Risk in Patients with Non-Ventilator Hospital-Acquired Pneumonia
Han Zhou, Zhenchao Wu, Beibei Liu, Yipeng Du, Rui Wu, Ning Shen
Biomedicines.2026; 14(5): 987. CrossRef
Plant-Based Diet and Risk of Sepsis: A 16-Year Follow-Up Study
Shaokang Xu, Ziqiao Fang, Xiaoke Kong, Jian Shi, Yiting Tang, Bin Zhao, Fang Fang, Jiaqi Huang, Ben Lu
Critical Care Medicine.2026;[Epub] CrossRef
Association between a Single-time Measurement of Fatty Liver Index and Occurrence of Sepsis among Individuals without Excessive Alcohol Consumption
Dayeong Kim, Sang Hoon Han, Eun Hwa Lee, Hye Seong, Kyu-na Lee, Yebin Park, Kyung-Do Han
Infection & Chemotherapy.2025; 57(3): 389. CrossRef
Impact of Diabetes on Clinical Characteristics and Prognosis in Sepsis: A Retrospective Study
Wen-Wen Han, Jian-Jiang Fang
Journal of Inflammation Research.2025; Volume 18: 13823. CrossRef

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.

Citations

Citations to this article as recorded by

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
The impact of blood pressure and its variability on suicide mortality: a nationwide population-based study
Jeongmin Lee, Jeongeun Kwak, Jin-Hyung Jung, Dong Woo Kang, Mee Kyoung Kim, Dong-Jun Lim, Hyuk-Sang Kwon, Jung Min Lee, Sang-Ah Chang, Kyungdo Han, Seung-Hwan Lee
Hypertension Research.2025; 48(8): 2173. CrossRef
Socioeconomic gradients and inequalities in all-cause mortality and cardiovascular diseases: A retrospective cohort study using Korean NHANES-mortality linkage data
Chaiho Jeong, Kyu-Na Lee, Jin-Hyung Jung, Tae-Seo Sohn, Hyuk-Sang Kwon, Kyungdo Han, Seung-Hwan Lee
Public Health.2025; 244: 105767. CrossRef
Association between smoking status and suicide mortality in patients with type 2 diabetes: A nationwide population-based cohort study
Chaiho Jeong, Bongseong Kim, Dae Jong Oh, Tae-Seo Sohn, Kyungdo Han, Hyuk-Sang Kwon
Diabetes & Metabolism.2025; 51(6): 101692. CrossRef
Beyond glycemic control: a holistic perspective on psychosocial support in outpatient diabetes management
Lin-na Hao, Xiao-wei Ma, Li-na Kang, Yu-ying Wang, Hong Shi
Frontiers in Endocrinology.2025;[Epub] 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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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.

Citations

Citations to this article as recorded by

Income and risk of type 2 diabetes incidence varied associations according to obesity status: a nationwide study
Jee Hee Yoo, You-Bin Lee, Ji Eun Jun, Kyu-Na Lee, Kyungdo Han
BMC Public Health.2026;[Epub] CrossRef
Social determinants of health and type 2 diabetes in Asia
Kyunghun Sung, Seung‐Hwan Lee
Journal of Diabetes Investigation.2025; 16(6): 971. CrossRef
Socioeconomic gradients and inequalities in all-cause mortality and cardiovascular diseases: A retrospective cohort study using Korean NHANES-mortality linkage data
Chaiho Jeong, Kyu-Na Lee, Jin-Hyung Jung, Tae-Seo Sohn, Hyuk-Sang Kwon, Kyungdo Han, Seung-Hwan Lee
Public Health.2025; 244: 105767. CrossRef
Time to Insulin Therapy and Severe Hypoglycemia in Korean Adults Initially Diagnosed with Type 2 Diabetes: A Nationwide Study
You-Bin Lee, Kyungdo Han, Bongsung Kim, So Hee Park, Kyu Yeon Hur, Gyuri Kim, Jae Hyeon Kim, Sang-Man Jin
Endocrinology and Metabolism.2025; 40(3): 421. CrossRef
Income-Related Disparities in Mortality Among Young Adults With Type 2 Diabetes
Ji Yoon Kim, Sojeong Park, Minae Park, Nam Hoon Kim, Sin Gon Kim
JAMA Network Open.2024; 7(11): e2443918. CrossRef

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