Diabetes Fact Sheets in Korea, 2018: An Appraisal of Current Status

김보연,원종철,이재혁,김헌성,박정환,하경화,원규장,김대중,박경수 대한당뇨병학회 2019 Diabetes and Metabolism Journal Vol.43 No.4

Background The objective of this study was to investigate the prevalence, management, and comorbidities of diabetes among Korean adults aged 30 years and older. Methods This study used 2013 to 2016 data from the Korea National Health and Nutrition Examination Survey, a nationally-representative survey of the Korean population. Diabetes was defined as fasting glucose ≥126 mg/dL, current use of antidiabetic medication, a previous history of diabetes, or glycosylated hemoglobin (HbA1c) ≥6.5%. Results In 2016, 14.4% (approximately 5.02 million) of Korean adults had diabetes. The prevalence of impaired fasting glucose was 25.3% (8.71 million). From 2013 to 2016, the awareness, control, and treatment rates for diabetes were 62.6%, 56.7%, and 25.1%, respectively. People with diabetes had the following comorbidities: obesity (50.4%), abdominal obesity (47.8%), hypertension (55.3%), and hypercholesterolemia (34.9%). The 25.1%, 68.4%, and 44.2% of people with diabetes achieved HbA1c <6.5%, blood pressure <140/85 mm Hg, and low density lipoprotein cholesterol <100 mg/dL. Only 8.4% of people with diabetes had good control of all three targets. Conclusion This study confirms that diabetes is as an important public health problem. Efforts should be made to increase awareness, detection, and comprehensive management of diabetes to reduce diabetes-related morbidity and mortality.

중년기 여성 당뇨병 환자의 자기관리

송자경,장수미,최정숙,김연수,정춘희 대한당뇨병학회 2002 임상당뇨병 Vol.3 No.1

연구배경 : 중년기 여성 당뇨병 환자의 자기관리를 위한 프로그램 개발의 방향을 모색하기 위한 선행연구로 자기관리능력에 대한 기초자료를 조사하는 것을 목적으로 하였다. 방법 : 당뇨병 환자의 자기관리 역량정도를 연구하기 위해 자기효능감, 사회적지지, 문제해결 능력, 그리고 당뇨병관리의 자기책임의 4부문으로 개념화하여 연구하였다. 연구대상은 내분비내과 외래를 치료받기 위해 방문한 40~60세사이의 중년기여성 당뇨병 환자 37명을 대상으로 하였다. 결과 : 중년기 여성 당뇨병 환자의 자기관리의 역량은 4.0만점 기준 평균이 2.81이었다. 자기관리역량을 구성하는 하위개념으로, 자기효능감 2.93, 사회적지지 2.54, 문제해결능력 2.56, 당뇨병관리의 자기책임 3.22의 각각 평균값으로 나타났다 (1점: 항상 그렇지 않다, 2점: 때때로 그렇지 않다, 3점: 때때로 그렇다, 4점: 항상 그렇다). 이것은 중간정도의 자기관리역량이었다. 당뇨병 환자들은 당뇨병관리의 자기책임을 인식하지만 실제적으로 자기관리를 실행해 나가는데는 능력의 한계와 어려움이 있다. 환자들이 희망하는 교육프로그램에 대한 욕구는 이미 경험한 프로그램내용보다 스트레스 관리, 심리적 어려움, 문제해결, 자신감향상, 가족의 지지 등 다양한 심리 사회적 욕구가 반영된 교육프로그램을 원하였다. 결론 : 중년기 여성 당뇨병 환자들의 자기관리 역량을 강화시키기 위해 자기효능감 증진, 가족 및 사회적 지지의 획득, 문제해결능력 강화, 그리고 당뇨병관리의 자기책임 인식과 동시에 이를 주체적으로 실행할 수 있도록 하기 위한 역량강화 교육프로그램의 개발이 필요하다. Background: The purpose of this study was to evaluate the perceived level of empowerment of self management in middle aged women with diabetes in order to develop a self management of empowerment education program for diabetes. Method: To study self management of empowerment for diabetes, we classified four concepts such as self efficacy, social support, problem solving and recognized responsibility, which were the components of empowerment. The subjects were 37 middle aged (40~60) women with diabetes who came to be treated their diseases at the endocrinology out patient clinic in a medical center at Wonju City. Results: This study found a low level of empowerment of self management in middle aged women with diabetes. The mean scores for empowerment of self management were 2.81. The sub-concept of empowerment for self efficacy was 2.93, social support, 2.54, problem solving, 2.56, and recognized responsibility of self management, 3.22 (1.0: usually not, 2.0: sometimes not, 3.0: sometimes, 4.0: usua lly). Generally, the results suggest that middle aged women with diabetes have the moderate level of empowerment in self management. Patients with diabetes recognize the responsibility of self control in diabetes, but have difficulties and stresses in managing diabetes. The patients with diabetes presented psycho-social needs which are real programs needed for treating their diabetes such as stress management, psychological difficulties, and family support, etc . Conclusion: It is needed to develop the education programs and intervention strategies to enhance self efficacy, structure family and social support, exercise problem solving for middle aged women with diabetes and obtain subjective responsibility in the performance of self management with diabetes.

Polymorphisms of the <i>Reg</i> 1α Gene and Early Onset Type 2 Diabetes in the Korean Population

Koo, Bo Kyung,Cho, Young Min,Kimm, Kuchan,Lee, Jong-Young,Oh, Bermseok,Park, Byung Lae,Cheong, Hyun Sub,Shin, Hyoung Doo,Ko, Kyung Soo,Park, Sang Gyu,Lee, Hong Kyu,Park, Kyong Soo Korean Diabetes Association 2010 Korean diabetes journal Vol.34 No.4

<P><B>Background</B></P><P>The <I>Reg</I> gene has been reported to be expressed in regenerating islets and Reg1 protein to be up-regulated at an early stage of diabetes in mice. As human <I>Reg</I>1α is homologous with murine <I>Reg</I>1, we investigated whether common variants in <I>Reg</I>1α are associated with type 2 diabetes in the Korean population.</P><P><B>Methods</B></P><P>We sequenced the <I>Reg</I>1α gene to identify common polymorphisms using 24 Korean DNA samples. Of 11 polymorphisms found, five common ones (g.-385T>C [rs10165462], g.-36T>G [rs25689789], g.209G>T [rs2070707], g.1385C>G [novel], and g.2199G>A [novel]) were genotyped in 752 type 2 diabetic patients and 642 non-diabetic subjects.</P><P><B>Results</B></P><P>No polymorphism was associated with the risk of type 2 diabetes. However, g.-385C and g.2199A lowered the risk of early-onset type 2 diabetes, defined as a diagnosis in subjects whose age at diagnosis was 25 years or more but less than 40 years (odds ratio [OR], 0.721 [0.535 to 0.971] and 0.731 [0.546 to 0.977] for g.-385C and g.2199A, respectively) and g.1385G increased the risk of early-onset diabetes (OR, 1.398 [1.055 to 1.854]). Although adjusting for errors in multiple hypotheses-testing showed no statistically significant association between the three individual polymorphisms and early-onset diabetes, the haplotype <I>H1</I>, composed of g.-385C, g.1385C, and g.2199A, was associated with a reduced risk of early-onset diabetes (OR, 0.590 [0.396 to 0.877], <I>P</I> = 0.009).</P><P><B>Conclusion</B></P><P>Polymorphisms in the <I>Reg</I>1α were not found to be associated with overall susceptibility to type 2 diabetes, though some showed modest associations with early-onset type 2 diabetes in the Korean population.</P>

Site-specific cancer risk in patients with type 2 diabetes: a nationwide population-based cohort study in Korea

Suk Kyeong Kim,Ju-Young Jang,Dong-Lim Kim,Young A Rhyu,Suh Eun Lee,Seung-Hyun Ko,Kyungdo Han,Kee-Ho Song,Korean Diabetes Association 대한내과학회 2020 The Korean Journal of Internal Medicine Vol.35 No.3

Background/Aims: We aimed to evaluate site-specific cancer risk in diabetic patients and to investigate causal and temporal relationships by analyzing organ- specific cancer risk according to the duration of diabetes. Methods: Using a database provided by the Korean National Health Insurance Service, we conducted a retrospective, population-based cohort study of adults aged ≥ 30 years from January 2005 to December 2013. To verify the possibility of detection bias or reverse causation, we compared hazard ratios (HRs) for each cancer according to the following duration of diabetes: less than 6 months, 6 months to 3 years, and more than 3 years. Results: The incidence of overall cancer per 1,000 person-years was higher in patients with diabetes than in those without diabetes (20.36 vs. 10.83). The overall cancer risk according to the duration of diabetes was the highest within the first 6 months after diagnosis (HR, 2.03; 95% confidence interval [CI], 1.99 to 2.07), and the HR decreased with the duration of diabetes, ranging from 1.19 (95% CI, 1.18 to 1.21) between 6 months and 3 years to 1.12 (95% CI, 1.11 to 1.13) after 3 years. Both overall cancer risk and HR remained significantly higher in patients with diabetes than in those without diabetes. The risk for prostate cancer was higher in men with diabetes than in those without diabetes (HR, 1.12; 95% CI, 1.10 to 1.14). In women, the risk for endometrial cancer was significantly higher in patients with diabetes than in those without diabetes throughout the duration of diabetes. Conclusions: The risk for stomach, colorectum, liver, pancreas, and kidney cancer appeared to be higher in patients with diabetes than in those without diabetes regardless of the sex or duration of diabetes.

Suicide Risk in Patients With Diabetes Varies by the Duration of Diabetes: The Korea National Health and Nutrition Examination Survey (2019)

Young-Chan Kim,Yoo Hyun Um,Sung Min Kim,Tae-Won Kim,Ho-Jun Seo,Seung Chul Hong,Jong Hyun Jeong 대한신경정신의학회 2022 PSYCHIATRY INVESTIGATION Vol.19 No.4

Objective The objectives of this study were to investigate the suicide risk in diabetes patients and evaluate the variations in suicide risk by the duration of diabetes using a large population sample in South Korea.Methods Data from 6,296 adults in the 2019 Korea National Health and Nutrition Examination Survey were included. The suicidal ideation, suicide plans, and suicidal behavior of diabetes patients were compared to the general population. After classifying the patients into ≤1 year, 2 to 9 years, and ≥10 years of diabetes duration, we evaluated the relationship between the duration of diabetes and the suicide risk.Results Diabetes patients had higher prevalences of suicidal ideation (9.1%, p<0.001) and suicide plans (3.6%, p<0.001) than the general population. After adjusting for potential confounding factors, suicide plans (adjusted odds ratio [aOR]=2.926, 95% confidence interval [CI]=1.325–6.463) were significantly associated with diabetes. In the 2 to 9 years group of diabetes patients, we found an increase in the risk of suicidal ideation (aOR=2.035, 95% CI=1.129–3.670), suicide plans (aOR=3.507, 95% CI=1.538–7.996), and suicidal behavior (aOR=7.130, 95% CI=2.035–24.978) after adjusting for the covariates. However, no increases in suicide risk were observed ≤1 year and ≥10 years after diabetes diagnosis.Conclusion In adults, diabetes is associated with an increase in suicide risk. Suicide risk in diabetes patients showed an inverted U-shaped depending upon the duration of diabetes.

Diabetes and Cancer: Is Diabetes Causally Related to Cancer?

서성환,김광원 대한당뇨병학회 2011 Diabetes and Metabolism Journal Vol.35 No.3

Diabetes mellitus is a serious and growing health problem worldwide and is associated with severe acute and chronic complications. Moreover, epidemiologic evidence suggests that people with diabetes are at significantly higher risk for many forms of cancer. Several studies indicate an association between diabetes and the risk of liver, pancreas, endometrium, colon/rectum, breast, and bladder cancer. Mortality is also moderately increased in subjects with diabetes. Common risk factors such as age, obesity, physical inactivity and smoking may contribute to increased cancer risk in diabetic patients. Hyperinsulinemia most likely favors cancer in diabetic patients as insulin is a growth factor with pre-eminent metabolic as well as mitogenic effects, and its action in malignant cells is favored by mechanisms acting at both the receptor and post-receptor level. The effect of diabetes treatment drugs, aside from metformin, on cancer is not conclusive. In order to fight the perfect storm of diabetes and cancer, strategies to promote primary prevention and early detection of these conditions are urgently needed. Diabetes mellitus is a serious and growing health problem worldwide and is associated with severe acute and chronic complications. Moreover, epidemiologic evidence suggests that people with diabetes are at significantly higher risk for many forms of cancer. Several studies indicate an association between diabetes and the risk of liver, pancreas, endometrium, colon/rectum, breast, and bladder cancer. Mortality is also moderately increased in subjects with diabetes. Common risk factors such as age, obesity, physical inactivity and smoking may contribute to increased cancer risk in diabetic patients. Hyperinsulinemia most likely favors cancer in diabetic patients as insulin is a growth factor with pre-eminent metabolic as well as mitogenic effects, and its action in malignant cells is favored by mechanisms acting at both the receptor and post-receptor level. The effect of diabetes treatment drugs, aside from metformin, on cancer is not conclusive. In order to fight the perfect storm of diabetes and cancer, strategies to promote primary prevention and early detection of these conditions are urgently needed.

Gestational Diabetes in Korea: Incidence and Risk Factors of Diabetes in Women with Previous Gestational Diabetes

장학철 대한당뇨병학회 2011 Diabetes and Metabolism Journal Vol.35 No.1

Korean women with a history of gestational diabetes mellitus (GDM) have a 3.5 times greater risk of developing postpartum diabetes than the general population. The incidence of type 2 diabetes mellitus in early postpartum is reported as 10-15% in Korean women. A prospective follow-up study on Korean women with GDM showed that approximately 40% of women with previous GDM were expected to develop diabetes within 5 years postpartum. Independent risk factors for the development of diabetes in Korean women with previous GDM are pre-pregnancy body weight, gestational age at diagnosis, antepartum hyperglycemia on oral glucose tolerance test, low insulin response to oral glucose load, and family history of diabetes. Women with postpartum diabetes have greater body mass indexes, body weight, and waist circumferences than women with normal glucose tolerance. Multiple logistic regression analysis has revealed that waist circumference is the strongest obesity index along with systolic blood pressure and that triglyceride levels are a major independent risk factor for developing diabetes. These results in Korean women with previous GDM underline the importance of postpartum testing in Korean women diagnosed with GDM, and demonstrate that impaired B-cell function, obesity, and especially visceral obesity, are associated with the development of diabetes.

Thirst for Information and Needs Reflections of Type 2 Diabetes Patients Receiving Insulin Treatment in North-East Ethiopia: A Qualitative Exploration

Bayked, Ewunetie Mekashaw,Workneh, Birhanu Demeke,Kahissay, Mesfin Haile The Korean Society for Preventive Medicine 2021 예방의학회지 Vol.54 No.2

Objectives: Ongoing, proactive, planned, and patient-centered diabetes education is the cornerstone of care for all persons with diabetes. Thus, the aim of this study was to explore the information needs of type 2 diabetes mellitus patients receiving insulin treatment in North-East Ethiopia. Methods: The study was conducted from July 2019 to January 2020 using a qualitative enquiry (phenomenological approach) with purposive sampling. Face-to-face in-depth interviews were used to collect data until reaching theoretical saturation. The participants were type 2 diabetes patients receiving insulin treatment. They were identified from the diabetes patients' registration book at the diabetes clinic and interviewed at their appointment time, and were selected to include wide variations in terms of socio-demographic characteristics. Twenty-four participants (11 men and 13 women), with a median age of 57 years, were interviewed. The data were organized using QDA Miner Lite version 2.0.7 and analyzed thematically using narrative strategies. Results: Most participants had not heard of diabetes before their diagnosis. They had limited knowledge of diabetes, but ascribed different connotations for it in the local language (Amharic). The needs reflections of patients were categorized into diabetes education and participants' recommendations. Diabetes education was totally absent at hospitals, and patients received education primarily from the Ethiopian Diabetes Association and broadcast and digital media. Thus, the major concern of patients was the availability of diabetes education programs at health institutions. Conclusions: Patients' main concern was the absence of routine diabetes education, which necessitates urgent action to implement diabetes education programs, especially at health institutions.

개인의 사회경제적 수준과 지역의 사회경제적 수준의 상호작용이 제2형 당뇨 환자에서 당뇨합병증 발생 및 당뇨와 관련된 입원에 미치는 영향: 2002-2013년 국민건강보험공단 표본 코호트 자료를 활용하여

장지은 ( Jieun Jang ),주영준 ( Yeong Jun Ju ),이두웅 ( Doo Woong Lee ),이상아 ( Sang Ah Lee ),오소연 ( Sarah Soyeon Oh ),최동우 ( Dong-woo Choi ),이현지 ( Hyeon Ji Lee ),신재용 ( Jaeyong Shin ) 한국보건행정학회 2021 보건행정학회지 Vol.31 No.1

Background: In this study, we aimed to investigate the interaction effects of individual socioeconomic status and regional deprivation on the onset of diabetes complications and diabetes-related hospitalization among type 2 diabetes patients. Methods: Korean National Health Insurance Service National Sample Cohort data from 2002 to 2013 were used. A total of 50,954 patients newly diagnosed with type 2 diabetes from 2004 to 2012 and aged 30 years or above were included. We classified patients into six groups according to individual income level and neighborhood deprivation: ‘high in advantaged,’ ‘high in disadvantaged,’ ‘middle in advantaged,’ ‘middle in disadvantaged,’ ‘low in advantaged,’ and ‘low in disadvantaged.’ We calculated hazard ratios (HR) of onset of diabetes complication and diabetes-related hospitalization using the Cox proportional hazard model, with the reference group as diabetes patients with high income in advantaged regions. Results: In terms of the interaction effects of individual income level and regional socioeconomic level, even with the same low individual income level, the group with a high regional socioeconomic level (low in advantaged) showed low HRs for the onset of diabetes complication (HR, 1.04; 95% confidence interval [CI], 1.00-1.08) compared to the ‘low in disadvantaged’ group (HR, 1.10; 95% CI, 1.05-1.16). In addition, the ‘high in advantaged’ group showed slightly higher HRs for the onset of diabetes complication (HR, 1.06; 95% CI, 1.00-1.11) compared to the ‘low in advantaged’ and it appeared to be associated with slight mitigation of the risk of diabetes complication. For the low-income level, the patients in disadvantaged regions showed the highest HRs for diabetes-related hospitalization (HR, 1.29; 95% CI, 1.19-1.41) compared to the other groups. Conclusion: Although we need to perform further investigations to reveal the mechanisms that led to our results, interaction effects individual socioeconomic status and regional deprivation might be associated with on onset of diabetes complications and diabetes-related hospitalization among type 2 diabetes patients.

Long Menstrual Cycle Is Associated with Type 2 Diabetes Mellitus in Korean Women

심은진,오지영,이혜진,홍영선,성연아 대한당뇨병학회 2011 Diabetes and Metabolism Journal Vol.35 No.4

Background: Long menstrual cycle is a risk factor for developing type 2 diabetes and cardiovascular disease in women. We aimed to evaluate the association between existing type 2 diabetes and oligomenorrhea before diagnosis of diabetes, and to observe the differences in this association among obese and non-obese Korean women. Methods: Patients with type 2 diabetes (n=118) and without any clinical evidence of abnormal glucose regulation (n=258) who attended the outpatient clinic of a university hospital and were over age 30. Patients self-reporting a menstrual cycle over 40 days during their 20s were defined as oligomenorrhea before diagnosis of diabetes. Obesity was defined as having a body mass index (BMI) over 25 kg/m^2. Results: The frequency of oligomenorrhea before diagnosis of diabetes was almost two-fold higher in women with type 2 diabetes than in the control group (16.1% vs. 8.5%, P=0.03). Oligomenorrhea was associated with type 2 diabetes after adjusting for age, BMI, systolic blood pressure, triglycerides, and high density lipoprotein cholesterol (odds ratio, 3.89; 95% confidence interval,1.37 to 11.04). Among women with oligomenorrhea before diagnosis of diabetes, the frequency of type 2 diabetes was significantly higher in obese subjects than in their non-obese counterparts (90.9% vs. 30.0%, P=0.03). Conclusion: Having a long menstrual cycle could be a risk factor for the development of type 2 diabetes, especially in obese women.