Diabetes & Metabolism Journal

Original Articles

Cardiovascular Risk/Epidemiology
High Waist-to-Height Ratio Increases the Risk of Cardiovascular Outcomes in Adults with Type 1 Diabetes Mellitus: A Nationwide Cohort Study: Kyeong-Jin Kim, Seohyun Kim, Rosa Oh, So Hyun Cho, Myunghwa Jang, You-Bin Lee, Gyuri Kim, Sang-Man Jin, Kyu Yeon Hur, Ji Yoon Kim, Jae Hyeon Kim; Received March 4, 2025 Accepted June 21, 2025 Published online September 4, 2025; DOI: https://doi.org/10.4093/dmj.2025.0179 [Epub ahead of print]

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Abstract PDF Supplementary Material PubReader ePub: Background
Central obesity contributes to an increased risk of cardiovascular disease (CVD) and mortality. The waist-to-height ratio (WHtR) is a practical marker of central obesity across sexes, ages, and ethnicities. However, its association with comprehensive cardiovascular (CV) outcomes in patients with type 1 diabetes mellitus (T1DM) remains unclear.
Methods
From a nationwide cohort database (2006–2020), 16,928 Korean adults with T1DM were included. Participants were categorized by their WHtR values using three criteria: a three-group classification (<0.5, 0.5 to <0.6, and ≥0.6) and two binary classifications (≥0.5 vs. <0.5; ≥0.6 vs. <0.6). The primary outcomes were composite CV events, including heart failure (HF), myocardial infarction (MI), ischemic stroke, and CVD-related deaths, with each component analyzed as a secondary outcome.
Results
During a median follow-up of 6.7 years (interquartile range, 5.2 to 8.8), 4,293 composite CV events occurred. Compared to the WHtR <0.5 group, the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for the composite CV outcome were 1.14 (1.05 to 1.24) in the WHtR 0.5 to <0.6 group and 1.62 (1.38 to 1.90) in the WHtR ≥0.6 group (P for trend <0.001). Increasing trends in aHRs were noted with rising WHtR values for each component of the composite outcome. Compared to the WHtR <0.6 group, the aHRs for the WHtR ≥0.6 group were as follows: HF, 1.49 (95% CI, 1.28 to 1.73); MI, 1.31 (95% CI, 1.02 to 1.68); ischemic stroke, 1.24 (95% CI, 1.02 to 1.51); and CVD-related death, 2.09 (95% CI, 1.49 to 2.92).
Conclusion
High WHtR is associated with an increased risk of CV events in adults with T1DM.

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

Metabolic Risk/Epidemiology
Metabolic Dysfunction-Associated Steatotic Liver Disease and All-Cause and Cause-Specific Mortality: Rosa Oh, Seohyun Kim, So Hyun Cho, Jiyoon Kim, You-Bin Lee, Sang-Man Jin, Kyu Yeon Hur, Gyuri Kim, Jae Hyeon Kim; Diabetes Metab J. 2025;49(1):80-91. Published online August 28, 2024; DOI: https://doi.org/10.4093/dmj.2024.0042

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Background
Given the association between nonalcoholic fatty liver disease and metabolic risks, a new term, metabolic dysfunction- associated steatotic liver disease (MASLD) has been proposed. We aimed to explore the association between MASLD and all-cause, cause-specific mortalities.
Methods
We included individuals with steatotic liver disease (SLD) from the Korean National Health Insurance Service. Moreover, SLD was defined as a fatty liver index ≥30. Furthermore, MASLD, metabolic alcohol-associated liver disease (MetALD), and alcoholic liver disease (ALD) with metabolic dysfunction (MD) were categorized based on alcohol consumption and MD. We also analyzed all-cause, liver-, cancer-, hepatocellular carcinoma (HCC)- and cardiovascular (CV)-related mortalities.
Results
This retrospective nationwide cohort study included 1,298,993 individuals aged 40 to 79 years for a mean follow-up duration of 9.04 years. The prevalence of MASLD, MetALD, and ALD with MD was 33.11%, 3.93%, and 1.00%, respectively. Relative to the “no SLD” group, multivariable analysis identified that MASLD (adjusted hazard ratio [aHR], 1.28; 95% confidence interval [CI], 1.26 to 1.31), MetALD (aHR, 1.38; 95% CI, 1.32 to 1.44), and ALD with MD group (aHR, 1.80; 95% CI, 1.68 to 1.93) have a significantly higher risk of all-cause mortality. Furthermore, MASLD, MetALD, ALD with MD groups showed higher liver-, cancer-, and HCC-related mortality than “no SLD” group. While all-cause specific mortalities increase from MASLD to MetALD to ALD with MD, the MetALD group shows a lower risk of CV-related mortality compared to MASLD. However, ALD with MD group still have a higher risk of CV-related mortality compared to MASLD.
Conclusion
SLD is associated with an increased risk of all-cause, liver-, cancer-, HCC-, and CV-related mortalities.

Citations

Citations to this article as recorded by

Treatment approaches for alcohol use disorder with metabolic dysfunction
Alexandra C. Wagner, Jeesun Jung, Pal Pacher, Falk.W. Lohoff
Pharmacology & Therapeutics.2026; 277: 108957. CrossRef
Agentes antidiabéticos de nueva generación en cirugía cardíaca: beneficios cardiovasculares y renales más allá del control glucémico

Cirugía Cardiaca en México.2026; 11(1): 13. CrossRef
Clinical outcomes in MetALD compared with ALD in patients referred for liver transplant evaluation
Mohamad Ali Ibrahim, Nagham Ramadan, Islam B. Mohamed, Caroline Ankoma-Sey, Sherry Fares, Mazen Elsheikh, Megha B. Bhongade, Eric Hoang Nguyen, Youseph Karouni, Ximena Ramirez-Morales, Karim Adhem, Manal Hassan, Prasun K. Jalal
Hepatology Communications.2026;[Epub] CrossRef
Distinct Laboratory and Clinical Features of Metabolic and Alcohol-Related Liver Disease (MetALD): A Systematic Review and Meta-Analysis
Maria Tampaki, Vasileios Lekakis, Christos Chologkitas, Stergios Α. Polyzos, Evangelos Cholongitas
Current Obesity Reports.2026;[Epub] CrossRef
Special Population
Winston Dunn, Aleksander Krag, Patrick Kamath, Ashwani K. Singal
Clinics in Liver Disease.2026; 30(2): 449. CrossRef
Prebiotic xylooligosaccharides ameliorate metabolic dysfunction-associated steatotic liver disease via modulating gut microbiota and metabolites
Li Chen, Ti-Dong Shan
Scientific Reports.2026;[Epub] CrossRef
Hesperidin Attenuates Experimental MASH by Modulating the Liver–Immune–Brain Axis: Integrated Evidence from Network Pharmacology and In Vivo Analysis
Seung-Hoon Yoo, Ji-Han Kim, Yeon-Joo Yoo, Byung-Cheol Lee
Nutrients.2026; 18(9): 1402. CrossRef
KASL clinical practice guidelines for the management of metabolic dysfunction-associated steatotic liver disease 2025
Won Sohn, Young-Sun Lee, Soon Sun Kim, Jung Hee Kim, Young-Joo Jin, Gi-Ae Kim, Pil Soo Sung, Jeong-Ju Yoo, Young Chang, Eun Joo Lee, Hye Won Lee, Miyoung Choi, Su Jong Yu, Young Kul Jung, Byoung Kuk Jang
Clinical and Molecular Hepatology.2025; 31(Suppl): S1. CrossRef
Diagnosis and Management of Early Stages of ALD
Jordi Gratacós-Ginès, Edilmar Alvarado-Tapias, David Martí-Aguado, Hugo López-Pelayo, Ramón Bataller, Elisa Pose
Seminars in Liver Disease.2025; 45(02): 195. CrossRef
Refining Risk Estimates of Colorectal Cancer in Steatotic Liver Disease: Insights on Methodological Challenges
Wei-Chun Cheng, Ching-Nung Wu, Pin-Nan Cheng
Clinical Gastroenterology and Hepatology.2025; 23(13): 2637. CrossRef
Synergistic benefit of thiazolidinedione and sodium-glucose cotransporter 2 inhibitor for metabolic dysfunction-associated steatotic liver disease in type 2 diabetes: a 24-week, open-label, randomized controlled trial
Minyoung Lee, Sukchul Hong, Yongin Cho, Hyungjin Rhee, Min Heui Yu, Jaehyun Bae, Yong-ho Lee, Byung-Wan Lee, Eun Seok Kang, Bong-Soo Cha
BMC Medicine.2025;[Epub] CrossRef
Reply
Takefumi Kimura, Nobuharu Tamaki, Masayuki Kurosaki
Clinical Gastroenterology and Hepatology.2025; 23(13): 2638. CrossRef
Pan-immune-inflammation value and mortality in the US adult MASLD: a nonlinear NHANES analysis
Qing Zhou, Jisu Xue, Lu Hao
BMC Gastroenterology.2025;[Epub] CrossRef
MASLD and CMRFs: Combination or Separation? An Open Exploration From the Perspective of All‐Cause Mortality
Zheng Li, Ting Luo, Dan Zheng, Zhiping Li, Dan Cao, Yue Hu
Liver International.2025;[Epub] CrossRef
Metabolic Impact of Alcohol Consumption in MASLD: Understanding MetALD and Beyond
Eva Juárez-Hernández, Montserrat Berrospe-Alfaro, Misael Uribe, Iván López-Mendez
Journal of Clinical and Experimental Hepatology.2025; 15(6): 103114. CrossRef
MetALD: new insights and unraveling therapeutic potential
Yue Feng, PanShiLi Han, Tao Liu, YanHang Gao
Metabolism and Target Organ Damage.2025;[Epub] CrossRef
Impact of smoking and physical activity on cardiovascular outcomes in type 2 diabetes across steatotic liver disease categories
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
Scientific Reports.2025;[Epub] CrossRef
Metabolic Divergence Between MASLD and Metabolic Syndrome: Distinct Clinical Phenotypes and Risk Stratification Implications
Mariana M. Ramírez‐Mejía, Sandra M. Barbalho, Guadalupe Ponciano‐Rodríguez, Mohammed Eslam, Jacob George, Ming‐Hua Zheng, Nahum Méndez‐Sánchez
Liver International.2025;[Epub] CrossRef
Association between dietary patterns and cardiovascular mortality in patients with metabolic dysfunction-associated steatotic liver disease
Yu-Jin Kwon, Hye Sun Lee, Ji-Won Lee
Endocrine.2025; 90(2): 558. CrossRef
High-Sensitivity C-Reactive Protein Levels in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), Metabolic Alcohol-Associated Liver Disease (MetALD), and Alcoholic Liver Disease (ALD) with Metabolic Dysfunction
Seong-Uk Baek, Jin-Ha Yoon
Biomolecules.2024; 14(11): 1468. 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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Abstract PDF Supplementary Material PubReader ePub

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

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