GRAPHICAL ABSTRACT

Highlights

• Newly diagnosed and long-standing diabetes cases in older Koreans rose over 10 years.

• More older adults with diabetes now meet physical activity guidelines.

• By 2019, older adults with diabetes took 9.4 drugs on average, 1.8 times more than those without.

• Age-related comorbidities like dementia, HF, and CKD have increased.

• ESKD, dementia, cancer, and pneumonia were linked to a higher 3-year mortality risk.

INTRODUCTION

Diabetes is a rapidly growing global public health concern, particularly regarding its impact on the older adult population. South Korea, with one of the fastest-growing life expectancies, is projected to become a leading longevity country by 2030 [1]. This demographic shift is expected to significantly increase the burden of diabetes-related morbidity, mortality, and healthcare costs among older adults [2,3].

Older adults with diabetes often exhibit distinct clinical and metabolic profiles compared to the general older population. Managing diabetes in this group is particularly challenging due to physiological changes associated with aging, including frailty, high rates of comorbidities, polypharmacy, and varying levels of physical and cognitive function [4,5]. These complexities necessitate a tailored, older-adults-specific approach to the diagnosis, treatment, and monitoring of diabetes. Effective management of metabolic indicators such as blood glucose, blood pressure, lipid levels, and body composition is crucial. However, these factors are influenced by lifestyle habits, including physical activity, smoking, and alcohol consumption; accordingly, understanding metabolic and lifestyle management patterns in older adults with diabetes is essential for the development of effective strategies [6,7].

Over the past decade, advancements in pharmacological therapy, including the introduction of new antidiabetic agents and combination regimens, have transformed diabetes management [8,9]. However, the risks associated with polypharmacy— such as drug interactions and adverse effects—remain a significant concern, particularly in older adults with diabetes, who often require multiple medications [10]. Furthermore, older patients with diabetes frequently present with multiple chronic conditions, such as hypertension, dyslipidemia, cardiovascular disease, chronic kidney disease (CKD), and dementia. These comorbidities complicate disease management, increase the risk of complications, reduce quality of life, and escalate healthcare utilization. Despite these population-specific concerns, a comprehensive analysis of medication use trends and patterns in older adults with diabetes is still lacking. Furthermore, while the burden posed by diabetes in older patients is growing, evidence to guide optimal management strategies for this population remains limited. Current clinical guidelines often lack specificity for older patients, particularly in areas such as glycemic targets, medication selection, and the management of comorbidities and frailty [11,12].

This study examined epidemiological trends among older adults with diabetes in Korea and explored the metabolic and lifestyle characteristics, patterns of antidiabetic medication use, and trends in comorbidities. These findings offer valuable insights to inform clinical practice and public health policies.

METHODS

Study design

To analyze the prevalence of diabetes according to diabetes duration, data from the 5th (2011–2012), 6th (2013–2015), 7th (2016–2018), 8th (2019–2021), and 9th (2022) cycles of the Korea National Health and Nutrition Examination Survey (KNHANES) [13] were used. To assess the combined comorbidities and lifestyle behaviors related to diabetes, data from the 8th (2019–2021) and 9th (2022) cycles of the KNHANES were used.

To analyze trends in physical activity levels, a 60% sample cohort of adults aged 65 years and older with diabetes was extracted from the National Health Information Database (NHID) of the National Health Insurance System (NHIS) [14] between January 2009 and December 2017. We analyzed data from patients who underwent health checkups during the corresponding years. For the analysis of trends in antidiabetic medication use or comorbidities and mortality, we used a 60% sample cohort of adults aged 65 years and older with diabetes, extracted from the NHID between January 2012 and December 2022.

For analysis of trends in prescribed medication use and polypharmacy, we used NHIS-National Sample Cohort (NHISNSC), which includes one million individuals (approximately 2% of the total population). We analyzed data from adults aged 65 years and older between 2009 and 2019.

To assess adherence to antidiabetic medications within the first year following a diabetes diagnosis, as well as the continuation of insulin use after 1 year, we identified 2,616,828 diabetes patients who underwent health checkups through the NHIS between January 1, 2015 and December 31, 2016. We excluded patients younger than 65 years (n=1,699,522), those with missing key variables (n=19,948), those with a diabetes duration of more than 1 year (n=849,082), and those who died within 1 year after the health checkup (n=14,928), resulting in a total of 33,348 newly diagnosed older adults with diabetes.

To analyze factors associated with 3-year mortality, we identified 2,616,828 diabetes patients who underwent health checkups through the NHIS between January 1, 2015 and December 31, 2016. We excluded patients younger than 65 years (n=1,699,522) and those with missing key variables (n=47,309), leaving 869,997 patients. We then used a 70% sample of these 869,997 patients, resulting in a final sample of 608,998 patients.

Details of the data sources and study population used for each analysis are summarized in Supplementary Table 1.

This study was approved by the Institutional Review Board of The Catholic University of Korea, St. Vincent’s Hospital (VC24ZISI0082). The requirement for informed consent was waived. The study was conducted in accordance with the principles of the Declaration of Helsinki.

Definition of variables

In the analysis using KNHANES data, diabetes was defined as fasting plasma glucose (FPG) ≥126 mg/dL, current use of diabetes medication, a previous diagnosis of diabetes, or glycosylated hemoglobin (HbA1c) ≥6.5%. Undiagnosed diabetes was defined as FPG ≥126 mg/dL or HbA1c ≥6.5%. without a previous diagnosis of diabetes. Hypertension was defined as systolic blood pressure (SBP) ≥140 mm Hg, diastolic blood pressure (DBP) ≥90 mm Hg, or current use of antihypertensive medication. Hypercholesterolemia was defined as low-density lipoprotein cholesterol (LDL-C) ≥100 mg/dL or current use of lipid-lowering medication. Control of hypertension was defined as SBP <140 mm Hg and DBP <85 mm Hg, and control of hypercholesterolemia was defined as an LDL-C level of <100 mg/dL. Body mass index (BMI) was used to categorized individuals as underweight (<18.5 kg/m²), normal (18.5–22.9 kg/m²), pre-obesity (23–24.9 kg/m²), class 1 obesity (25–29.9 kg/m²), class 2 obesity (30–34.9 kg/m²), and class 3 obesity (≥35 kg/m²). Abdominal obesity was defined as a waist circumference ≥90 cm for men and ≥85 cm for women [15]. Current smoking was defined as smoking at least five packs (or 100 cigarettes) in a lifetime and still smoking. High-risk alcohol consumption was defined as consuming at least seven drinks twice a week for men and at least five drinks twice a week for women. Regular walking was defined as walking for at least 30 minutes per day, 5 days per week.

In the analysis using NHID, a 60% sample cohort from NHID, and NHIS-NSC, diabetes was defined as FPG ≥126 mg/dL during health checkups or having at least one annual claim for antidiabetic medication prescribed under the International Classification of Diseases, 10th Revision codes E11– E14. Physical activity levels were assessed using the NHIS selfmanagement questionnaire, with weekly physical activity calculated in metabolic equivalent of task (MET) and expressed as MET-min/week. Details of the survey content on physical activity and the calculation of METs are summarized in Supplementary Table 1. The use of antidiabetic medications across eight classes (metformin, sulfonylurea [SU], meglitinide, dipeptidyl peptidase-4 inhibitor [DPP4i], sodium-glucose cotransporter-2 inhibitor [SGLT2i], α-glucosidase inhibitor, thiazolidinedione, and insulin) was determined based on at least one prescription per year, except for insulin, which was identified if prescribed at least three times per year. Among glucagon-like peptide-1 receptor agonist (GLP-1 RA), only data for exenatide, lixisenatide, and albiglutide were available, so the use of GLP-1 RA could be significantly underestimated. Therefore, the GLP-1 RA was not included in this analysis. To analyze the number of prescribed medications, we collected the Korean general drug codes for the medications prescribed. The code consists of nine digits, including six numbers and three letters. The first four digits represent the active ingredient of the medication. We counted the number of unique active ingredients prescribed for at least 60 days per year, regardless of continuity. To analyze medication adherence, we used the medication possession ratio (MPR), because it is one of the most common measured for assessing adherence, and it is easy to use and calculate [16]. MPR was calculated by dividing the total days supplied of medication during observation period by the number of days in observation period. If the MPR ≥80%, it is considered as adherence. Information on deaths was obtained from the National Death Registry. The variables used to analyze trends in comorbidities and mortality, as well as factors associated with adherence to antidiabetic medications, continuation of insulin use (defined as at least 3 insulin prescriptions per year), and 3-year mortality risk, are summarized in Supplementary Table 1.

Statistical analysis

For the KNHANES data, sampling weights were used to obtain nationally representative prevalence estimates. All analyses were adjusted for survey year to minimize variation between years. The weighted prevalence of diabetes, combined comorbidities, and lifestyle behaviors were presented as percentages with standard error. The number of diabetes cases among older adults was compared between periods using analysis of variance (ANOVA). Combined comorbidities and lifestyle behaviors were compared between those with diabetes and those without diabetes using chi-square tests.

For the data of NHID, a 60% sample cohort from NHID, and NHIS-NSC, physical activity levels and use of antidiabetic medications were presented as percentages. Number of prescribed medications was presented as mean±standard deviation, median with interquartile range, or percentages. We used multivariable logistic regression models to analyze the factors associated with adherence to antidiabetic medications or continued insulin use, calculating adjusted odds ratio with 95% confidence interval (CI) after adjusting for all variables (age, sex, income, smoking, drinking, regular exercise, BMI, waist circumference, insulin use, number of antidiabetic medications ≥3, severe hypoglycemia, diabetic retinopathy, hypertension, dyslipidemia, myocardial infarction, stroke, kidney function, depression, dementia, Parkinson’s disease, cancer, chronic obstructive pulmonary disease, chronic liver disease, disabilities, living in a one-person household, pneumonia, heart failure, and fracture), except for the variable being examined. We also used multivariable Cox proportional hazards regression models to analyze the factors associated with 3-year mortality, calculating adjusted hazard ratio (HR) with 95% CI after adjusting for the same set of variables mentioned above. All analyses were performed using SAS software version 9.4 (SAS Institute, Cary, NC, USA). A two-sided P value of <0.05 was considered statistically significant without adjustment for multiple comparisons.

RESULTS

Trends in diabetes prevalence by duration in older adults

Table 1 demonstrates a substantial increase in the number of undiagnosed diabetes patients aged 65 years and older, rising from approximately 326,000 in 2011–2012 to 474,000 in 2019– 2022. Similarly, the number of newly diagnosed diabetes cases within 1 year of diagnosis in this population more than doubled, from 105,042 to 222,966 during the same period. While the absolute number of undiagnosed diabetes cases increased, the prevalence of undiagnosed diabetes displayed a declining trend. Notably, the proportion of long-term diabetes cases, defined as a disease duration of 10 years or more, showed a significant rise, increasing from 26.7% in 2011–2012 to 35.0% in 2019–2022.

Metabolic and lifestyle indices in older adults with diabetes

The prevalence of hypertension and concomitant hypertension and hypercholesterolemia was 72.6% and 52.0%, respectively, in older adults with diabetes, both of which were higher than in older adults without diabetes. The prevalence of hypercholesterolemia was 70.5% in older adults with diabetes, which was lower than in older adults without diabetes. The control rate for hypertension was 61.8%, while that for hypercholesterolemia was 67.5%, both higher than in older adults without diabetes (56.8% for hypertension and 42.4% for hypercholesterolemia). The respective prevalences of obesity and abdominal obesity were 43.5% and 62.9%, also significantly high compared to older adults without diabetes (33.5% for obesity and 45.5% for abdominal obesity). The rates of smoking, high-risk alcohol consumption, and regular walking did not show significant differences between older adults with and without diabetes (Table 2). According to trends in physical activity levels among older adults with diabetes, the proportion of those with minimal activity (METs=0) gradually decreased, while the proportion of those meeting the minimum recommended physical activity of 500 METs per week steadily increased over the years. Notably, the proportion of individuals achieving 1,500 METs or more per week was found to be 8.0% among those aged 65 years and older and 6.0% among those aged 75 years and older (Supplementary Table 2).

Current status of antidiabetic medication use among older adults with diabetes

Among older adults with diabetes, the use of insulin and SU has decreased, while the use of DPP4i and SGLT2i has increased from 2012 to 2022. The proportion of older adults with diabetes using combination therapy with three or more oral antidiabetic agents has also risen in the same period, comprising 34.4% as of 2022 (Supplementary Table 3, Supplementary Fig. 1). As of 2019, the average number of prescribed medications for older adults with diabetes increased to 9.4 among those aged 65 years and older, which is approximately 1.8 times higher than the average for non-diabetic individuals. Among those aged 65 years and older, 5.5% were prescribed 20 or more medications (Supplementary Table 4).

Among 33,348 newly diagnosed adults with diabetes aged 65 years and older between 2015 and 2016, 67.8% had a MPR of 80% or higher. The odds of MPR ≥80% within the first year were higher in women, those with a BMI ≥23.0 kg/m², those with dyslipidemia, those with hypertension, and those on triple oral therapy. Conversely, the odds were lower in heavy drinkers, those with a BMI <18.5 kg/m², insulin users, those with end-stage kidney disease (ESKD), those with myocardial infarction, depression, dementia, or fracture, and those living alone (Supplementary Table 5). One year after the initial diagnosis, 369 patients (1.1%) continued insulin use. The odds of continuing insulin use after 1 year were significantly higher in those who initiated insulin therapy at diagnosis, had retinopathy, were on triple antidiabetic medications, had a history of cancer or CKD, were smokers, or were male (Supplementary Table 6).

Current status of comorbidities among older adults with diabetes

An examination of comorbidities in older adults with diabetes reveals that, as of 2022, the prevalence of hypertension, stroke, and proliferative retinopathy had decreased compared to 10 years ago, while the prevalence of dyslipidemia, dementia, cancer, heart failure, atrial fibrillation, and CKD had increased. In 2022, the prevalence rates of hypertension and dyslipidemia were 77.1% and 77.1%, respectively, with dementia, cancer, and heart failure following as the most common comorbidities (Fig. 1, Supplementary Table 7). Among adults with diabetes aged 65 years and older, the comorbidity most strongly associated with 3-year mortality risk was ESKD (HR, 2.54; 95% CI, 2.33 to 2.77). Other conditions associated with increased mortality risk included dementia, cancer, pneumonia, and CKD (Fig. 2, Supplementary Table 8).

DISCUSSION

Principal findings

In this study, we identified a marked increase in the absolute number of newly diagnosed diabetes and the prevalence of long-standing diabetes over the past 10 years among older adults with diabetes in Korea. Management rates of hypertension and hypercholesterolemia were higher in older adults with diabetes compared to those without diabetes. The proportion of older adults with diabetes using combination therapy with three or more oral antidiabetic medications has increased over the years. In addition, comorbidities such as dementia, cancer, heart failure, and CKD have increased compared to 10 years before. Factors associated with poor initial medication adherence included having major comorbidities like ESKD or dementia, being an insulin user, high-risk alcohol use, and living alone. Factors associated with continuing insulin use 1 year after diagnosis of diabetes included initial insulin use at diagnosis, presence of retinopathy, use of triple oral therapy, and a history of cancer. Comorbidities associated with 3-year mortality included ESKD, dementia, cancer, pneumonia, and CKD.

Increased number of diabetes cases in older adults

In this analysis, we observed a significant increase in the absolute number of diabetes cases among individuals aged 65 years and older, irrespective of diabetes duration. According to a recent study, the estimated prevalence of diabetes among individuals aged 65 and older was 29.3% from 2019 to 2022 in Korea [17]. This prevalence was higher than that in individuals aged 30 years and older [18]. These can be attributed to a combination of aging-related physiological changes, lifestyle and environmental factors, psychological influences, and socioeconomic conditions. As aging progresses, individuals become more susceptible to the onset and progression of diabetes. Agerelated decline in pancreatic function results in decreased insulin secretion, while factors such as reduced muscle mass, increased visceral fat, mitochondrial dysfunction in muscles, and increased inflammation contribute to decreased insulin sensitivity and inhibition of insulin signaling, thereby promoting diabetes onset in older adults [19]. Additionally, decreased physical activity and increased sedentary behavior in older adults reduces energy expenditure and increases insulin resistance, heightening the risk of diabetes [20,21]. Finally, other common issues among older adults, such as depression, cognitive impairment, reduced income, and living alone, also negatively impact lifestyle management and restrict access to healthcare services [22].

The prevalence of diabetes among individuals aged 65 and older has increased globally, with an estimated rate of 18.8% in 2017, and it is projected to reach 19.6% by 2030 [23]. Compared to the global prevalence of diabetes among individuals aged 65 and older, the prevalence of diabetes in Korea for the same age group was higher. This could be explained by the increasing prevalence of diabetes with age and the growing aging population in Korea [24].

Although expanded screening programs, and heightened awareness of diabetes in Korea have contributed to a decline in undiagnosed diabetes among older adults [25], the rising number of newly diagnosed older adults with diabetes and those with long-standing diabetes due to population aging and increased life expectancy is expected to further intensify the medical, economic, and societal burden of diabetes in this population. In this context, the importance of developing integrated and sustainable management systems for older adults with diabetes has become increasingly apparent. Strengthening tailored, multidimensional approaches that consider disease progression, comorbidities, functional decline, cognitive status, and quality of life is essential for effective management of diabetes in older adults [4].

Management rates of metabolic indicators in older adults with diabetes

Although prevalence of new-onset diabetes among older adults and estimated number of older adults with any diabetes duration are high, it is encouraging that we identified control rates of hypertension and hypercholesterolemia in older adults with diabetes as favorable compared to those of the non-diabetic population. In addition, we found that the proportion of individuals meeting the minimum recommended physical activity of 500 METs per week increased over the years. These results may be attributed to the excellent healthcare accessibility in Korea, which has led to expanded diabetes screening in older adults, appropriate metabolic management, and improvements in standardized clinical guidelines, effective medication use, and management approaches [26-28]. Improvements in health literacy and education levels, and government programs such as the Community-based Hypertension and Diabetes Registry Program and the Chronic Disease Management Program may have also contributed to these positive outcomes [29,30]. From another perspective, the more favorable control rates of hypertension and hypercholesterolemia in older adults with diabetes compared to those without diabetes can be explained by the more frequent use of antihypertensive combination medications and a higher use of lipid-lowering medications in individuals with diabetes [31,32].

Medication use in older adults with diabetes

Recent pattern of diabetes medication use in older adults has not shown significant differences compared to that in the general diabetes population [33]. Although there are currently no specific guidelines for diabetes medication therapy tailored for older adults, various unique factors must be considered when prescribing medications to older patients [12]. Therefore, it is essential to develop additional, distinct guidelines based on evidence from older rather than younger adults, with personalized medication strategies tailored to the health status of older adults. Polypharmacy in older patients is associated with decreased medication adherence, an increased risk of drug-drug interactions and adverse effects, and a prescribing cascade that can perpetuate a detrimental cycle [34]. Our analysis revealed that older adults with diabetes are prescribed approximately 1.8 times more medications than those without diabetes, with this trend showing a consistent increase over time. These findings highlight the need for regular evaluation of prescribing appropriateness, deprescribing unnecessary medications, and implementing personalized treatment strategies to optimize medication management. Additionally, the importance of an integrated and systematic approach to managing complex chronic conditions in older adults cannot be overstated.

Additionally, initial medication adherence is one of the key elements in diabetes management, but only about two-thirds of patients achieve adherence rates of 80% or higher, indicating a need to identify and address risk factors that contribute to poor adherence. This study determined that among older adults with diabetes, factors associated with low medication adherence within the first year of diagnosis include the presence of severe comorbidities such as ESKD, fracture, dementia, and myocardial infarction, as well as characteristics like insulin use. Initiating insulin therapy in newly diagnosed older adults with diabetes can lead to low adherence and suboptimal management due to the complexity of administration and management, as well as fear or aversion to injections [35]. To address these challenges, standardized education programs, specialized training to enhance healthcare providers’ educational skills, certification for education, expanded financial support for insulin and supplies, and increased insurance coverage for continuous glucose monitoring could be beneficial. In addition, considering that two behavioral/educational interventions and three pharmacist interventions among 12 intervention studies improved both medication adherence and related health outcomes in older adults [36], the development of patient-centered, multidisciplinary interventions is needed in the future.

Comorbidities and mortality risk in older adults with diabetes

The pattern of comorbidities in the older adult population has changed in the past decade. With population aging and increased life expectancy, the prevalence of age-related conditions such as dementia, heart failure, and CKD appears to be rising. Among older adults with diabetes, the prevalence of major conditions such as hypertension and dyslipidemia remains high, exceeding 75%, while the prevalence of dementia, cancer, heart failure, and atrial fibrillation is also above 5%. These findings underscore the need for appropriate screening and management strategies to ensure effective prevention of and care for these comorbidities. In Korea, the comorbidity with the highest risk of mortality among older adults with diabetes is ESKD, followed by dementia and cancer. Diabetes itself is the most common cause of ESKD, and older adults with ESKD are at higher risk of complications such as cardiovascular disease and infection, as well as having a poor prognosis due to the burden of dialysis treatment and decreased quality of life [37-40]. Dementia also contributes to low treatment adherence by means of cognitive impairment and communication difficulties [41,42]. Notably, while it is crucial to strengthen the management of various comorbidities associated with diabetes for optimal treatment, limited healthcare resources necessitate prioritization. Focusing medical resources on managing comorbidities with high prevalence and significant mortality risk may be a necessary strategy.

Strengths and limitations

This study’s strength lies in its use of a large-scale nationwide dataset to investigate various aspects of older adults with diabetes. However, the study also has several limitations. First, due to constraints in the data, different datasets were used depending on the topic, which may have influenced interpretation of the results. Second, the use of operational definitions for certain variables introduces a potential for misclassification bias. Third, some parameters that are key for diabetes management, such as diabetes duration and HbA1c, were not included in the analysis. Lastly, this work did not include detailed analyses reflecting the heterogeneous characteristics of older adults with diabetes, which could limit the findings.

In conclusion, effective strategies to address diabetes in older patients are urgently needed due to the rapidly growing older population. Comprehensive management of metabolic indicators such as blood glucose, blood pressure, dyslipidemia, obesity, and frailty, along with physical activity, is essential for older adults with diabetes. Furthermore, improvements in prescribing guidelines are needed that account for the unique characteristics of older adults, particularly in managing polypharmacy. To improve adherence to antidiabetic medication in older adults, the development of patient-centered, multidisciplinary interventions is needed. Continuous monitoring and personalized management of age-related comorbidities frequently associated with diabetes in older adults are also crucial. Lastly, individualized approaches that consider the heterogeneous nature of diabetes in older patients may serve as effective management strategies. To realize these advancements, future research should focus on developing high-quality older cohorts and older-adults-specific intervention studies to establish evidence-based management for older adults with diabetes.

SUPPLEMENTARY MATERIALS

NOTES

CONFLICTS OF INTEREST

Seung-Hyun Ko has been the executive editor of the Diabetes & Metabolism Journal since 2022. Sung Hee Choi has been an associate editor of the Diabetes & Metabolism Journal since 2022. They were not involved in the review process of this article. Otherwise, there was no conflict of interest.

AUTHOR CONTRIBUTIONS

Conception or design: all authors.

Acquisition, analysis, or interpretation of data: K.K., B.K., K.L., K.H., J.S.Y.

Drafting the work or revising: K.K., K.H., J.S.Y.

Final approval of the manuscript: all authors.

FUNDING

This research was supported by the Korea National Institute of Health (KNIH) research project (project No.#2024-ER1101-00 and #2025-ER1102-00).

ACKNOWLEDGMENTS

We would like to express our gratitude to Minji Kim for her invaluable assistance with the creation of the figures and the graphical abstract.

Fig. 1.

Trends of comorbidities (excluding hypertension and dyslipidemia) among adults with diabetes aged 65 years and older, 60% sample cohort from National Health Information Database 2012 to 2022. AF, atrial fibrillation; ESKD, end-stage kidney disease; MI, myocardial infarction; PDR, proliferative diabetic retinopathy.

Fig. 2.

Mortality risk within 3 years of major comorbidities among adults with diabetes aged 65 years and older, National Health Information Database 2015 to 2016. HR, hazard ratio; CI, confidence interval; ESKD, end-stage kidney disease; CKD, chronic kidney disease; MI, myocardial infarction.

REFERENCES

• 1. Kontis V, Bennett JE, Mathers CD, Li G, Foreman K, Ezzati M. Future life expectancy in 35 industrialised countries: projections with a Bayesian model ensemble. Lancet 2017;389:1323-35.ArticlePubMedPMC
• 2. Lee SH. The growing challenge of diabetes management in an Aging Society. Diabetes Metab J 2023;47:630-1.ArticlePubMedPMCPDF
• 3. Kim CN, Jung YS, Kim YE, Ock M, Yoon SJ. Korean national burden of disease: the importance of diabetes management. Diabetes Metab J 2024;48:518-30.ArticlePubMedPMCPDF
• 4. Yun JS, Kim K, Ahn YB, Han K, Ko SH. Holistic and personalized strategies for managing in elderly type 2 diabetes patients. Diabetes Metab J 2024;48:531-45.ArticlePubMedPMCPDF
• 5. Yoon SJ, Kim KI. Frailty and disability in diabetes. Ann Geriatr Med Res 2019;23:165-9.ArticlePubMedPMCPDF
• 6. LeRoith D, Biessels GJ, Braithwaite SS, Casanueva FF, Draznin B, Halter JB, et al. Treatment of diabetes in older adults: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2019;104:1520-74.ArticlePubMedPMCPDF
• 7. Celli A, Barnouin Y, Jiang B, Blevins D, Colleluori G, Mediwala S, et al. Lifestyle intervention strategy to treat diabetes in older adults: a randomized controlled trial. Diabetes Care 2022;45:1943-52.ArticlePubMedPMCPDF
• 8. Samson SL, Vellanki P, Blonde L, Christofides EA, Galindo RJ, Hirsch IB, et al. American Association of Clinical Endocrinology consensus statement: comprehensive type 2 diabetes management algorithm: 2023 update. Endocr Pract 2023;29:305-40.ArticlePubMed
• 9. American Diabetes Association Professional Practice Committee. 9. Pharmacologic approaches to glycemic treatment: standards of care in diabetes-2024. Diabetes Care 2024;47(Suppl 1):S158-78.
• 10. Al-Musawe L, Martins AP, Raposo JF, Torre C. The association between polypharmacy and adverse health consequences in elderly type 2 diabetes mellitus patients; a systematic review and meta-analysis. Diabetes Res Clin Pract 2019;155:107804.ArticlePubMed
• 11. Choi JH, Lee KA, Moon JH, Chon S, Kim DJ, Kim HJ, et al. 2023 Clinical practice guidelines for diabetes mellitus of the Korean Diabetes Association. Diabetes Metab J 2023;47:575-94.ArticlePubMedPMCPDF
• 12. American Diabetes Association Professional Practice Committee. 13. Older adults: standards of care in diabetes-2024. Diabetes Care 2024;47(Suppl 1):S244-57.
• 13. Kweon S, Kim Y, Jang MJ, Kim Y, Kim K, Choi S, et al. Data resource profile: the Korea National Health and Nutrition Examination Survey (KNHANES). Int J Epidemiol 2014;43:69-77.ArticlePubMedPMC
• 14. Lee YH, Han K, Ko SH, Ko KS, Lee KU; Taskforce Team of Diabetes Fact Sheet of the Korean Diabetes Association. Data analytic process of a nationwide population-based study using national health information database established by national health insurance service. Diabetes Metab J 2016;40:79-82.ArticlePubMedPMCPDF
• 15. Kim KK, Haam JH, Kim BT, Kim EM, Park JH, Rhee SY, et al. Evaluation and treatment of obesity and its comorbidities: 2022 update of clinical practice guidelines for obesity by the Korean Society for the Study of Obesity. J Obes Metab Syndr 2023;32:1-24.ArticlePubMedPMC
• 16. Evans M, Engberg S, Faurby M, Fernandes JD, Hudson P, Polonsky W. Adherence to and persistence with antidiabetic medications and associations with clinical and economic outcomes in people with type 2 diabetes mellitus: a systematic literature review. Diabetes Obes Metab 2022;24:377-90.PubMed
• 17. Park SE, Ko SH, Kim JY, Kim K, Moon JH, Kim NH, et al. Diabetes fact sheets in Korea 2024. Diabetes Metab J 2025;49:24-33.ArticlePubMedPMCPDF
• 18. Ha KH, Kim DJ. Changes in the epidemiological landscape of diabetes in South Korea: trends in prevalence, incidence, and healthcare expenditures. Endocrinol Metab (Seoul) 2024;39:669-77.ArticlePubMedPMCPDF
• 19. Lee PG, Halter JB. The pathophysiology of hyperglycemia in older adults: clinical considerations. Diabetes Care 2017;40:444-52.ArticlePubMedPDF
• 20. Conn VS, Minor MA, Burks KJ, Rantz MJ, Pomeroy SH. Integrative review of physical activity intervention research with aging adults. J Am Geriatr Soc 2003;51:1159-68.ArticlePubMed
• 21. Kahn SE, Larson VG, Beard JC, Cain KC, Fellingham GW, Schwartz RS, et al. Effect of exercise on insulin action, glucose tolerance, and insulin secretion in aging. Am J Physiol 1990;258(6 Pt 1):E937-43.ArticlePubMed
• 22. Fried LP, Bandeen-Roche K, Kasper JD, Guralnik JM. Association of comorbidity with disability in older women: the Women’s health and aging study. J Clin Epidemiol 1999;52:27-37.PubMed
• 23. Sinclair A, Saeedi P, Kaundal A, Karuranga S, Malanda B, Williams R. Diabetes and global ageing among 65-99-year-old adults: findings from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract 2020;162:108078.ArticlePubMed
• 24. Koo BK. Letter: projection of diabetes prevalence in Korean adults for the year 2030 using risk factors identified from national data (Diabetes Metab J 2019;43:90-6). Diabetes Metab J 2019;43:242-3.ArticlePubMedPMCPDF
• 25. Ko SH, Han KD, Park YM, Yun JS, Kim K, Bae JH, et al. Diabetes mellitus in the elderly adults in Korea: based on data from the Korea National Health and Nutrition Examination Survey 2019 to 2020. Diabetes Metab J 2023;47:643-52.ArticlePubMedPMCPDF
• 26. Shin DW, Cho J, Park JH, Cho B. National general health screening program in Korea: history, current status, and future direction. Precis Future Med 2022;6:9-31.ArticlePDF
• 27. Lee H, Cho J, Shin DW, Lee SP, Hwang SS, Oh J, et al. Association of cardiovascular health screening with mortality, clinical outcomes, and health care cost: a nationwide cohort study. Prev Med 2015;70:19-25.ArticlePubMed
• 28. Kim HB, Lee SA, Lim W. Knowing is not half the battle: impacts of information from the National Health Screening Program in Korea. J Health Econ 2019;65:1-14.ArticlePubMed
• 29. Park EJ, Ji NJ, You CH, Lee WY. Healthcare utilization and discrepancies by income level among patients with newly diagnosed type 2 diabetes in Korea: an analysis of national health insurance sample cohort data. J Prev Med Public Health 2024;57:471-9.ArticlePubMedPMCPDF
• 30. Kim S. Effect of primary care-level chronic disease management policy on self-management of patients with hypertension and diabetes in Korea. Prim Care Diabetes 2022;16:677-83.ArticlePubMed
• 31. Kim HC, Lee H, Lee HH, Son D, Cho M, Shin S, et al. Korea hypertension fact sheet 2023: analysis of nationwide population-based data with a particular focus on hypertension in special populations. Clin Hypertens 2024;30:7.ArticlePubMedPMCPDF
• 32. Jin ES, Shim JS, Kim SE, Bae JH, Kang S, Won JC, et al. Dyslipidemia fact sheet in South Korea, 2022. Diabetes Metab J 2023;47:632-42.ArticlePubMedPMCPDF
• 33. Bae JH, Han KD, Ko SH, Yang YS, Choi JH, Choi KM, et al. Diabetes fact sheet in Korea 2021. Diabetes Metab J 2022;46:417-26.ArticlePubMedPMCPDF
• 34. Remelli F, Ceresini MG, Trevisan C, Noale M, Volpato S. Prevalence and impact of polypharmacy in older patients with type 2 diabetes. Aging Clin Exp Res 2022;34:1969-83.ArticlePubMedPMCPDF
• 35. Eliaschewitz FG, de Paula MA, Pedrosa HC, Pires AC, Salles JE, Tambascia MA, et al. Barriers to insulin initiation in elderly patients with type 2 diabetes mellitus in Brazil. Diabetes Metab Syndr 2018;12:39-44.ArticlePubMed
• 36. Marcum ZA, Hanlon JT, Murray MD. Improving medication adherence and health outcomes in older adults: an evidencebased review of randomized controlled trials. Drugs Aging 2017;34:191-201.ArticlePubMedPMCPDF
• 37. Yang DC, Lee LJ, Hsu CC, Chang YY, Wang MC, Lin WH, et al. Estimation of expected life-years saved from successful prevention of end-stage renal disease in elderly patients with diabetes: a nationwide study from Taiwan. Diabetes Care 2012;35:2279-85.PubMedPMC
• 38. Yang SC, Kuo PW, Wang JD, Lin MI, Su S. Quality of life and its determinants of hemodialysis patients in Taiwan measured with WHOQOL-BREF(TW). Am J Kidney Dis 2005;46:635-41.ArticlePubMed
• 39. Sarnak MJ, Jaber BL. Mortality caused by sepsis in patients with end-stage renal disease compared with the general population. Kidney Int 2000;58:1758-64.ArticlePubMed
• 40. Collins AJ. Cardiovascular mortality in end-stage renal disease. Am J Med Sci 2003;325:163-7.ArticlePubMed
• 41. Ostbye T, Hill G, Steenhuis R. Mortality in elderly Canadians with and without dementia: a 5-year follow-up. Neurology 1999;53:521-6.ArticlePubMed
• 42. Liang CS, Li DJ, Yang FC, Tseng PT, Carvalho AF, Stubbs B, et al. Mortality rates in Alzheimer’s disease and non-Alzheimer’s dementias: a systematic review and meta-analysis. Lancet Healthy Longev 2021;2:e479-88.ArticlePubMed

Figure & Data

References

Citations

Citations to this article as recorded by  

About this article

Kim K, Kim B, Lee K, Ahn YB, Ko SH, Choi SH, Han K, Yun JS; Committee of Public Relation of the Korean Diabetes Association. Older Adults with Diabetes in Korea: Latest Clinical and Epidemiologic Trends. Diabetes Metab J. 2025;49(2):183-193.

Received: Dec 23, 2024; Accepted: Feb 20, 2025

DOI: https://doi.org/10.4093/dmj.2024.0836.

Download citation ↓