Diabetes & Metabolism Journal

Review

Guideline/Statement/Fact Sheet
Bridging Evidence and Practice: A Consensus Statement from the Korean Diabetes Association on Diabetes Screening, Pharmacological Treatment and Severe Diabetes: Jong Han Choi, Shinae Kang, Soo-Kyung Kim, Won Jun Kim, Ji Min Kim, Jaehyun Bae, Jae-Seung Yun, Eonju Jeon, Young-Eun Kim, Jae Hyun Bae, Hun Jee Choe, Young Min Cho, Seung-Hyun Ko, Sang Yong Kim, Hae Jin Kim, You-Cheol Hwang, Min Kyong Moon, Suk Chon, Seon Mee Kang, Hyuk-Sang Kwon, Mi Kyung Kim, You-Bin Lee, Se Hee Min, Jung Hwan Park, Woo Je Lee, Bong-Soo Cha, Byung-Wan Lee; Diabetes Metab J. 2025;49(6):1155-1177. Published online November 1, 2025; DOI: https://doi.org/10.4093/dmj.2025.0978

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Abstract PDF Supplementary Material PubReader ePub: This Korean Diabetes Association (KDA) consensus statement bridges global evidence with the Korean clinical context, where large randomized and real-world data remain limited. Recommendations required ≥80% agreement by the committee of clinical practice guideline and approval by the board of directors. The statement comprises three domains: diabetes screening aligned with Korean epidemiology; pharmacologic management guided by pathophysiology and comorbidities; and a severity construct of “severe diabetes mellitus” that links complication-based staging with metabolic grading to match therapeutic intensity to disease complexity. Compared with prior KDA guidelines, this statement introduces substantive advances in three areas. First, screening recommendations are streamlined to emphasize risk-aligned, practical implementation rather than prescriptive test sequences. Second, pharmacologic management applies an individualized framework for drug selection that jointly considers pathophysiology and comorbidities. It operationalizes individualized selection by dominant pathophysiology (insulin resistance vs. insulin insufficiency) and coexisting conditions, and formalizes treatment dynamics—early combination, timely initiation of injectables, avoidance of overbasalization, and structured deintensification. It also prioritizes agents with proven cardiovascular and renal protection and elevates management of obesity and metabolic dysfunction-associated steatotic liver disease as central goals; clinically, insulin should be initiated promptly in hypercatabolic states or suspected islet failure, and technology-enabled care—including continuous glucose monitoring and automated insulin delivery—are integral across all stages. Third, the newly introduced severity construct underpins treatment-intensity decisions across domains without reiterating prescriptive algorithms. Collectively, these recommendations provide a coherent, context-appropriate framework for diabetes screening and management in Korea and identify priorities for future evidence generation.

Original Article

Guideline/Statement/Fact Sheet
2025 Clinical Practice Guidelines for Diabetes Management in Korea: Recommendation of the Korean Diabetes Association: Shinae Kang, Seon Mee Kang, Jong Han Choi, Seung-Hyun Ko, Bo Kyung Koo, Hyuk-Sang Kwon, Mi Kyung Kim, Sang Yong Kim, Soo-Kyung Kim, Young-eun Kim, Eun Sook Kim, Jae Hyeon Kim, Chong Hwa Kim, Ji Min Kim, Hae Jin Kim, Min Kyong Moon, Sun Joon Moon, Jun Sung Moon, Joon Ho Moon, Se Hee Min, Jung Hwan Park, Jaehyun Bae, Keeho Song, Ji Yoon Ahn, Jae-Seung Yun, Woo Je Lee, You-Bin Lee, Suk Chon, Eonju Jeon, Sang-Man Jin, Eugene Han, You-Cheol Hwang, Jae Hyun Bae, YoonJu Song, Jeong Hyun Lim, Jae Won Cho, Ji Yeon Choi, Yong Hee Hong, Jieun Lee, Sung Eun Kim, Ji Yun Noh, Bong-Soo Cha, Byung-Wan Lee; Diabetes Metab J. 2025;49(4):582-783. Published online July 1, 2025; DOI: https://doi.org/10.4093/dmj.2025.0469

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Citations

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Impact of smart watch mobile application on the risk treatment of type 2 diabetes mellitus (iSMART-DM)
Min Kyoung Jang, Yun Kyung Cho, Jung Yoon Moon, Se Hee Min, Ju Hee Hwang, Chang Hee Jung
Primary Care Diabetes.2026; 20(1): 47. CrossRef
Efficacy and safety of adding a fourth oral antidiabetic drug versus metformin dose escalation in patients with type 2 diabetes inadequately controlled on triple oral combination therapy (EFFORT): A 24‐week, randomized, open‐label, multicenter trial
So Ra Kim, Jun Hwa Hong, Sin Gon Kim, Soo‐Kyung Kim, Hyuk‐Sang Kwon, Jun Sung Moon, Jung Hwan Park, Jae Myung Yu, Bong‐Soo Cha, Byung‐Wan Lee
Diabetes, Obesity and Metabolism.2026;[Epub] CrossRef
Glucagon-like Peptide-1 Receptor Agonists and Gastrointestinal Neoplasms
Yu Jin Kim, Jaehyun Bae
Journal of Digestive Cancer Research.2025; 13(2): 99. CrossRef
Is the next STEP on the BPROAD to intensive blood pressure lowering for all type 2 diabetic patients?: consensus statements from the Korean Society of Hypertension
Eun Mi Lee, In-Jeong Cho, Hae Jin Kim, Dae-Hee Kim, Hae-Young Lee, Sungha Park, Sang-Hyun Ihm
Clinical Hypertension.2025;[Epub] CrossRef
Lifestyle prescriptions for diabetes management in primary care: a narrative review
Hye Jun Lee, Jung-Ha Kim
Ewha Medical Journal.2025; 48(4): e55. CrossRef
Continuous Glucose Monitoring for Pancreatogenic Diabetes After Total Pancreatectomy
Young Jae Cho, Inhyuck Lee, Yoon Soo Chae, Go‐Won Choi, Younsoo Seo, Youngmin Han, Hye‐sol Jung, Wooil Kwon, Joon Seong Park, Jin‐Young Jang
Journal of Hepato-Biliary-Pancreatic Sciences.2025;[Epub] CrossRef
Real‐World Evidence of Long‐Term Dulaglutide Use: Sustained Glycemic and Weight Improvements Beyond Three Years
Hwi Seung Kim, Myung Jin Kim, Hee Sung Kim, Yun Kyung Cho, Chang Hee Jung, Woo Je Lee
Clinical Endocrinology.2025;[Epub] CrossRef
Obesity Pharmacotherapy: A Practical Approach to Patient-Centered Medication Selection
Jungha Park
Korean Journal of Family Practice.2025; 15(4): 194. CrossRef
Efficacy and safety of combining empagliflozin in people with type 2 diabetes mellitus uncontrolled with metformin and sitagliptin: A randomised, double‐blind, multicentre, therapeutic confirmatory phase 3 clinical trial
Seung‐Hwan Lee, Kyung Ah Han, Eun‐Gyoung Hong, Jun Goo Kang, Choon Hee Chung, Jong Chul Won, Eon Ju Jeon, Jung‐Hwan Cho, Ho Chan Cho, Sin Gon Kim, Eun Seok Kang, So Hun Kim, Hae Jin Kim, In‐Kyung Jeong, Sung Wan Chun, Young Min Cho
Diabetes, Obesity and Metabolism.2025;[Epub] CrossRef
Genetic Variants in HTR3B Locus Influence Glycemic Control and Type 2 Diabetes Susceptibility in Koreans
Sangwook Park
Biomedical Science Letters.2025; 31(4): 364. CrossRef

Response

Effects of Pancreatitis and Type 2 Diabetes Mellitus on the Development of Pancreatic Cancer: A Nationwide Nested Case-Control Study (Diabetes Metab J 2025;49:252-63): Young-eun Kim, Min Heui Yu, Chung Mo Nam, Eun Seok Kang; Diabetes Metab J. 2025;49(3):522-523. Published online May 1, 2025; DOI: https://doi.org/10.4093/dmj.2025.0314

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Original Article

Metabolic Risk/Epidemiology
Effects of Pancreatitis and Type 2 Diabetes Mellitus on the Development of Pancreatic Cancer: A Nationwide Nested Case-Control Study: Young-eun Kim, Min Heui Yu, Chung Mo Nam, Eun Seok Kang; Diabetes Metab J. 2025;49(2):252-263. Published online March 1, 2025; DOI: https://doi.org/10.4093/dmj.2024.0277

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Background
Despite diabetes mellitus (DM) and pancreatitis being known risk factors for pancreatic cancer, patients with these conditions are not included in pancreatic cancer screening due to the low incidence of pancreatic cancer in these populations. This study aimed to determine the high-risk subgroup of patients with diabetes and pancreatitis that would benefit from pancreatic cancer screening.
Methods
A nested case-control study was conducted using data from the National Health Information Database of the Korean National Health Insurance Service. Patients were categorized into the following groups: type 2 diabetes mellitus only (T2DM-only), pancreatitis-only (PAN-only), T2DM followed by pancreatitis (T2DM-PAN), post-pancreatitis diabetes mellitus (PPDM), and no diabetes and no pancreatitis (NDNP). Conditional logistic regression was used to determine significant associations of each group with pancreatic cancer development risk.
Results
The risk of pancreatic cancer was significantly higher in the T2DM-PAN (adjusted odds ratio [AOR], 4.96; 95% confidence interval [CI], 4.48 to 5.49) and PPDM (AOR, 4.71; 95% CI, 4.12 to 5.37) groups than in the NDNP group. Compared to patients in the NDNP group, those with PPDM using insulin had a 17-fold increased risk (AOR, 16.72; 95% CI, 9.50 to 29.43), and individuals with PPDM who had diabetes for less than 3 years had a more than 8-fold increased risk of pancreatic cancer (AOR, 8.83; 95% CI, 5.99 to 13.01).
Conclusion
In patients with post-pancreatitis diabetes, insulin use or shorter duration of diabetes was associated with a higher risk of pancreatic cancer, suggesting that patients in these subgroups may require close monitoring for pancreatic cancer development.

Citations

Citations to this article as recorded by

Effects of Pancreatitis and Type 2 Diabetes Mellitus on the Development of Pancreatic Cancer: A Nationwide Nested Case-Control Study (Diabetes Metab J 2025;49:252-63)
Young-eun Kim, Min Heui Yu, Chung Mo Nam, Eun Seok Kang
Diabetes & Metabolism Journal.2025; 49(3): 522. CrossRef
Pancreatitis, Type 2 Diabetes Mellitus, and Pancreatic Cancer (Diabetes Metab J 2025;49:252-63)
Shih-Wei Lai, Kuan-Fu Liao
Diabetes & Metabolism Journal.2025; 49(3): 518. CrossRef

Review

Others
Korean National Burden of Disease: The Importance of Diabetes Management: Chung-Nyun Kim, Yoon-Sun Jung, Young-Eun Kim, Minsu Ock, Seok-Jun Yoon; Diabetes Metab J. 2024;48(4):518-530. Published online July 26, 2024; DOI: https://doi.org/10.4093/dmj.2024.0087

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300 Download
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Abstract PDF PubReader ePub

Diagnosing the current health status and disease burden in a population is crucial for public health interventions. The ability to compare the burden of different diseases through a single measure, such as disability-adjusted life years has become feasible and continues to be produced and updated through the Global Burden of Diseases (GBD) study. However, the disease burden values of the GBD study do not accurately reflect the unique situation in a specific country with various circumstances. In response, the Korean National Burden of Disease (KNBD) study was conducted to estimate the disease burden in Koreans by considering Korea’s cultural context and utilizing the available data sources at the national level. Both studies identified non-communicable diseases, such as diabetes mellitus (DM), as the primary cause of disease burden among Koreans. However, the extent of public health interventions currently being conducted by the central and local governments does not align with the severity of the disease burden. This review suggests that despite the high burden of DM in South Korea, the current policies may not fully address its impact, underscoring the need for expanded chronic disease management programs and a shift towards prevention-focused healthcare paradigms.

Citations

Citations to this article as recorded by

One cancer, two stories: divergent estimates of gastric cancer burden in Korea
Chul Hyun, Yun Seo Kim, Sarah Soyeon Oh, Sung Hwi Hong, Jae Il Shin
Archives of Public Health.2026;[Epub] CrossRef
Measuring Trends in Disability-adjusted Life Years and Life Expectancy in Korea: 2008 to 2021
Chung-Nyun Kim, Dawit Urgi Gurmu, Young-Eun Kim, Yoon-Sun Jung, Yongseok Choi, Minsu Ock, Seok-Jun Yoon
Journal of Preventive Medicine and Public Health.2026; 59(1): 25. CrossRef
Diabetes Fact Sheets in Korea 2024
Se Eun Park, Seung-Hyun Ko, Ji Yoon Kim, Kyuho Kim, Joon Ho Moon, Nam Hoon Kim, Kyung Do Han, Sung Hee Choi, Bong Soo Cha
Diabetes & Metabolism Journal.2025; 49(1): 24. CrossRef
Reinforcing Primary Care in Korea: Policy Implications, Data Sources, and Research Methods
Chung-Nyun Kim, Seok-Jun Yoon
Journal of Korean Medical Science.2025;[Epub] CrossRef
Older Adults with Diabetes in Korea: Latest Clinical and Epidemiologic Trends
Kyuho Kim, Bongseong Kim, Kyuna Lee, Yu-Bae Ahn, Seung-Hyun Ko, Sung Hee Choi, Kyungdo Han, Jae-Seung Yun
Diabetes & Metabolism Journal.2025; 49(2): 183. 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
Continuity of care and medication adherence in patients with angina: a retrospective cohort study using Korea’s National Health Insurance data
Dayea Kim, Jaewoo Cha
BMJ Open.2025; 15(6): e098903. CrossRef
Effect of smoking cessation on new-onset diabetes mellitus in dyslipidemic individuals: A population-based cohort study
Wooin Seo, Se Young Jung, KeeHyuck Lee, Woo Kyung Bae, Jong Soo Han, Hyejin Lee, Ji Soo Kim, Hye Yeon Koo, Seung Yeon Lee, Kiheon Lee
Tobacco Induced Diseases.2025; 23(June): 1. 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
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The Journal of Internal Korean Medicine.2025; 46(3): 511. CrossRef
Start Early, Do It Well: Implications of a National Diabetes Care Quality Assessment Program for Life Expectancy
Kyoung Hwa Ha, Dae Jung Kim
Diabetes & Metabolism Journal.2025; 49(5): 987. CrossRef
Two decades of diabetes prevention: Sustained benefits, heterogeneous effects, and implications for precision prevention
Seung‐Hwan Lee
Journal of Diabetes Investigation.2025; 16(10): 1779. CrossRef
Is the next STEP on the BPROAD to intensive blood pressure lowering for all type 2 diabetic patients?: consensus statements from the Korean Society of Hypertension
Eun Mi Lee, In-Jeong Cho, Hae Jin Kim, Dae-Hee Kim, Hae-Young Lee, Sungha Park, Sang-Hyun Ihm
Clinical Hypertension.2025;[Epub] CrossRef
Effect of smoking cessation and post-cessation weight change on suicide mortality in type 2 diabetes: A nationwide cohort study
Chaiho Jeong, Bongseong Kim, Dae Jong Oh, Tae-Seo Sohn, Kyungdo Han, Hyuk-Sang Kwon
Diabetes Research and Clinical Practice.2025; 230: 112967. CrossRef
Pharmacoacupuncture for Lowering HbA1c in Korean Adult Patients With Hyperglycemia: A Retrospective Study
Ju-young Lee, Youngeun Yoo, Sanghun Lee
Acupuncture & Electro-Therapeutics Research: International Journal of Integrated Medicine.2025; 49(4): 230. CrossRef
From 1990 to 2021, the burden of diabetes among the elderly in the Western Pacific Region (WPR) and projections for 2040 prevalence: A systematic analysis of the 2021 Global Burden of Disease study
Yve Han, Huaxing Lou, Peng Zhao, Hui Li, Congyi Zhang, Hongru Sun
Diabetes & Metabolic Syndrome: Clinical Research & Reviews.2025; 19(10): 103324. CrossRef

Original Articles

Complications
Association of Muscle Mass Loss with Diabetes Development in Liver Transplantation Recipients: Sejeong Lee, Minyoung Lee, Young-Eun Kim, Hae Kyung Kim, Sook Jung Lee, Jiwon Kim, Yurim Yang, Chul Hoon Kim, Hyangkyu Lee, Dong Jin Joo, Myoung Soo Kim, Eun Seok Kang; Diabetes Metab J. 2024;48(1):146-156. Published online January 3, 2024; DOI: https://doi.org/10.4093/dmj.2022.0100

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Abstract PDF Supplementary Material PubReader ePub: Background
Post-transplant diabetes mellitus (PTDM) is one of the most significant complications after transplantation. Patients with end-stage liver diseases requiring transplantation are prone to sarcopenia, but the association between sarcopenia and PTDM remains to be elucidated. We aimed to investigate the effect of postoperative muscle mass loss on PTDM development.
Methods
A total of 500 patients who underwent liver transplantation at a tertiary care hospital between 2005 and 2020 were included. Skeletal muscle area at the level of the L3–L5 vertebrae was measured using computed tomography scans performed before and 1 year after the transplantation. The associations between the change in the muscle area after the transplantation and the incidence of PTDM was investigated using a Cox proportional hazard model.
Results
During the follow-up period (median, 4.9 years), PTDM occurred in 165 patients (33%). The muscle mass loss was greater in patients who developed PTDM than in those without PTDM. Muscle depletion significantly increased risk of developing PTDM after adjustment for other confounding factors (hazard ratio, 1.50; 95% confidence interval, 1.23 to 1.84; P=0.001). Of the 357 subjects who had muscle mass loss, 124 (34.7%) developed PTDM, whereas of the 143 patients in the muscle mass maintenance group, 41 (28.7%) developed PTDM. The cumulative incidence of PTDM was significantly higher in patients with muscle loss than in patients without muscle loss (P=0.034).
Conclusion
Muscle depletion after liver transplantation is associated with increased risk of PTDM development.

Others
Satisfaction Survey on Information Technology-Based Glucose Monitoring System Targeting Diabetes Mellitus in Private Local Clinics in Korea: Hun-Sung Kim, So Jung Yang, Yoo Jin Jeong, Young-Eun Kim, Seok-Won Hong, Jae Hyoung Cho; Diabetes Metab J. 2017;41(3):213-222. Published online June 21, 2017; DOI: https://doi.org/10.4093/dmj.2017.41.3.213

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Background

Private local clinics in Korea have little experience with information technology (IT)-based glucose monitoring (ITGM). Our aim is to examine user satisfaction and the possibility of using ITGM service practically.

Methods

Patients sent their blood glucose levels to physicians in local clinics. The physicians reviewed the blood glucose values online and provided personal consultations through text messaging or phone calls. Thereafter, a satisfaction survey on the ITGM service, the modified Morisky scale, and patient assessment of chronic illness care were administered.

Results

One hundred and seventy patients from seven private local clinics used the ITGM. Overall satisfaction, including that about the ITGM service, the device, and its usefulness, was rated higher than “mostly satisfied” (score 4.2±0.8 out of 5.0) and even higher among the elderly. Satisfaction was positively associated with age, especially in those older than 60 years. The main reason for intent for future use of the service was the time/place flexibility. Highly motivated patients tended to answer positively regarding information satisfaction (P=0.0377).

Conclusion

Our study is the first to investigate ITGM satisfaction in private local clinics. The feasibility of users utilizing ITGM should be clarified, and future clinical research on the service's clinical effects and cost-benefit analysis is needed.

Citations

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Evaluation of mobile health applications using the RE-AIM model: systematic review and meta-analysis
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Exploring Quantitative Methodologies for Assessing the Environmental, Social, and Economic Impacts of Telemedicine: A Literature Review
Anna Savoldelli, Daniele Landi, Caterina Rizzi
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Mobile solution and chronic diseases: development and implementation of a mobile application and digital platform for collecting, analyzing data, monitoring and managing health care
Emily de Souza Ferreira, Ary Henrique Morais de Oliveira, Mateus Araújo Dias, Glauce Dias da Costa, José Pedro Toledo Januário, Glenda Michele Botelho, Rosângela Minardi Mitre Cotta
BMC Health Services Research.2024;[Epub] CrossRef
Telemedicine for Diabetes Mellitus Management in Older Adults: A Systematic Review
Luca Schiliró Tristão, Guilherme Tavares, Francisco Tustumi, Wanderley Marques Bernardo, Márcio Luis Duarte, Maria Stella Peccin, Lucas Ribeiro dos Santos
Current Diabetes Reviews.2023;[Epub] CrossRef
The effectiveness of mobile application for monitoring diabetes mellitus and hypertension in the adult and elderly population: systematic review and meta-analysis
Emily de Souza Ferreira, Fernanda de Aguiar Franco, Marina Marilac dos Santos Lara, André Amaral Levcovitz, Mateus Araújo Dias, Tiago Ricardo Moreira, Ary Henrique Morais de Oliveira, Rosângela Minardi Mitre Cotta
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Effects of the Physician–Primary-Healthcare Nurse Telemedicine Model (P-NTM) on Medication Adherence and Health-Related Quality of Life (HRQoL) of Patients with Chronic Disease at Remote Rural Areas
Mi Young Kwak, Eun Jeong Hwang, Tae Ho Lee
International Journal of Environmental Research and Public Health.2021; 18(5): 2502. CrossRef
Lessons from Use of Continuous Glucose Monitoring Systems in Digital Healthcare
Hun-Sung Kim, Kun-Ho Yoon
Endocrinology and Metabolism.2020; 35(3): 541. CrossRef
Apprehensions about Excessive Belief in Digital Therapeutics: Points of Concern Excluding Merits
Hun-Sung Kim
Journal of Korean Medical Science.2020;[Epub] CrossRef
Peripartum Management of Gestational Diabetes Using a Digital Health Care Service: A Pilot, Randomized Controlled Study
Ji-Hee Sung, Da Young Lee, Kyoung Pil Min, Cheol-Young Park
Clinical Therapeutics.2019; 41(11): 2426. CrossRef
Mobile Phone–Based Telemedicine Practice in Older Chinese Patients with Type 2 Diabetes Mellitus: Randomized Controlled Trial
Chenglin Sun, Lin Sun, Shugang Xi, Hong Zhang, Huan Wang, Yakun Feng, Yufeng Deng, Haimin Wang, Xianchao Xiao, Gang Wang, Yuan Gao, Guixia Wang
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