Endocrinology and Metabolism

Original Articles

Impact of Health Behaviors on Cardiovascular Risk in Thyroid Cancer Survivors according to Metastasis: A Nationwide Cohort Study: Jeongmin Lee, Jaekyung Lee, Joonseon Park, Kwangsoon Kim, Ja Seong Bae, Kyung-Do Han, Dong-Jun Lim; Received November 3, 2025 Accepted March 12, 2026 Published online June 17, 2026; DOI: https://doi.org/10.3803/EnM.2025.2767 [Epub ahead of print]

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Abstract PDF Supplementary Material PubReader ePub: Background
Patients with thyroid cancer receive thyroid-stimulating hormone suppressive therapy and radioactive iodine therapy, which can alter metabolism and affect the association between lifestyle factors and cardiovascular disease (CVD) outcomes. However, it remains unclear how changes in lifestyle relate to CVD risk, particularly according to metastatic status. We investigated the impact of baseline and changing lifestyle behaviors on CVD risk among thyroid cancer patients by metastasis status.
Methods
This study was a nationwide cohort study using data from the Korean National Health Insurance Service claims database with the Cancer Clinical Library Database from the Korea Clinical Data Utilization Network for Research Excellence project. Over a mean follow-up of 5.7 years, 99,742 thyroid cancer patients were analyzed.
Results
Current smoking increased CVD risk in both no metastasis (NM) group (hazard ratio [HR], 1.77; 95% confidence interval [CI], 1.33 to 2.35) and the local metastasis (LM) group (HR, 1.30; 95% CI, 1.00 to 1.68), but not in those with distant metastasis. Regular activity reduced the risk in the NM group (HR, 0.84; 95% CI, 0.79 to 0.96). Alcohol consumption was not significantly associated with the CVD risk. Sustained smoking showed an increased CVD risk in both NM (HR, 1.95; 95% CI, 1.31 to 2.90) and LM (HR, 1.88; 95% CI, 1.28 to 2.77). Sustained regular physical activity was associated with a lower risk of CVD only in NM (HR, 0.68; 95% CI, 0.53 to 0.87).
Conclusion
Sustained smoking increased CVD risk, while regular physical activity was associated with a lower risk of CVD, particularly in those without distant metastasis.

All-Cause Mortality and Secondary Malignancy in Patients with Pheochromocytoma/Paraganglioma: Hyemi Kwon, Bong-Sung Kim, Kyung-Do Han, Cheol-Young Park; Received August 26, 2025 Accepted January 2, 2026 Published online May 14, 2026; DOI: https://doi.org/10.3803/EnM.2025.2628 [Epub ahead of print]

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Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumors that can be fatal if not diagnosed early or adequately managed. This study investigated the risk of all-cause mortality and secondary malignancies in patients with PPGL compared to age- and sex-matched controls without PPGL.
Methods
This nationwide population-based cohort study included 1,672 patients with PPGL and 16,790 controls with a median follow-up of approximately 7.1 years. A Cox proportional hazard model was used to estimate the adjusted hazard ratio (HR) and 95% confidence intervals (CI).
Results
The mean age was 46.5 years and 50.5% were male. All-cause mortality was identified in 118 patients with PPGL (7.06%) and 749 controls (4.46%) during the follow-up period. The incidence of all-cause mortality in patients with PPGL was significantly higher than that in controls (9.92 per 1,000 person-years vs. 6.49 per 1,000 person-years, P=0.0003). The risk of all-cause mortality was significantly higher in patients with PPGL than in the controls (HR, 1.372; 95% CI, 1.124 to 1.675). The risk of secondary malignancies was significantly higher in patients with PPGL than in controls (HR, 1.612; 95% CI, 1.33 to 1.954) after adjusting. Among the various cancer subtypes, thyroid and prostate cancers were observed more frequently in PPGL patients, and these findings should be interpreted as descriptive trends.
Conclusion
Patients with PPGL exhibited significantly increased risks of all-cause mortality and secondary malignancies compared with controls, highlighting the importance of appropriate assessment and follow-up.

Diabetes, obesity and metabolism Big Data Articles (National Health Insurance Service Database)
A Nomogram for End-Stage Renal Disease Prediction in Patients with Type 2 Diabetes Mellitus: A Nationwide Cohort Study in Korea: Inha Jung, Bong-Seong Kim, So Young Park, Da Young Lee, Ji Hee Yu, Ji A Seo, Kyung-Do Han, Nan Hee Kim; Endocrinol Metab. 2026;41(2):245-255. Published online November 12, 2025; DOI: https://doi.org/10.3803/EnM.2025.2570

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Despite the rising incidence of end-stage renal disease (ESRD) among individuals with type 2 diabetes mellitus (T2DM) in Korea, no predictive model or nomogram has been developed using a nationwide cohort. In this study, we developed a nomogram to predict the long-term risk of ESRD in patients with T2DM using a large-scale, population-based Korean database.
Methods
Using the Korean National Health Insurance Database, patients with T2DM who underwent health examinations between 2015 and 2016 were assigned as development (n=1,744,277) and validation (n=747,407) cohorts. New ESRD cases were identified using codes for renal replacement therapy. A Cox proportional hazards regression model was used to derive a risk-scoring system, and 13 variables were selected. A risk score nomogram was then created to estimate the risk of ESRD.
Results
In the development cohort, 8,631 patients with T2DM developed ESRD during a follow-up period of 4.8±0.9 years. After multivariable adjustment, significant predictors of ESRD included male sex, current smoking, physical inactivity, low income, low body mass index, hypertension, low-density lipoprotein cholesterol ≥160 mg/dL, chronic kidney disease, insulin use, and longer duration of T2DM. A final nomogram incorporating 13 variables was developed to estimate the individual probability of ESRD. The concordance index for ESRD prediction in the validation cohort was 0.906 (95% confidence interval, 0.9 to 0.912).
Conclusion
This 13-variable nomogram provides a simple tool for identifying patients with T2DM at high risk of ESRD and may aid in early intervention.

Diabetes, obesity and metabolism Big Data Articles (National Health Insurance Service Database)
Early-Onset Dementia Risk Escalates with Diabetes Duration: Insights from a Nationwide Cohort Study: Ji-Hong Park, Sun-Joon Moon, Da Yeon Lee, Ji-Hee Ko, Han Na Jang, Hye-Mi Kwon, Se-Eun Park, Kyung-Do Han, Eun-Jung Rhee, Won-Young Lee; Endocrinol Metab. 2026;41(2):235-244. Published online July 17, 2025; DOI: https://doi.org/10.3803/EnM.2024.2287

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Background
The prevalence of diabetes mellitus and early-onset dementia (EOD), defined as dementia diagnosed at an age <65 years, is increasing worldwide, with significant socioeconomic implications. We investigated the association between diabetes, prediabetes, and EOD, focusing on the influence of diabetes duration on EOD risk.
Methods
Using the Korean National Health Insurance Service database, we analyzed data from 1,979,509 patients aged 40–60 years who underwent health checkups in 2009. Patients were categorized into five groups: normal, impaired fasting glucose (IFG), newly diagnosed diabetes, diabetes duration <5 years, and diabetes duration ≥5 years. Cox proportional hazard models were used to estimate the adjusted hazard ratios (aHRs) for EOD after adjusting for demographic and clinical covariates.
Results
During the observation period (mean 7.75 years), 8,921 patients with EOD were identified. The diabetes group demonstrated a significantly higher incidence of EOD compared to the normal group (aHR, 1.334; 95% confidence interval [CI], 1.226 to 1.451). EOD risk increased with longer diabetes duration, with the highest risk observed in patients with diabetes ≥5 years (aHR, 1.543; 95% CI, 1.368 to 1.741). No significant difference was observed between the IFG and normal groups (aHR, 0.989; 95% CI, 0.938 to 1.043). Additionally, the hypertension group exhibited a significantly higher incidence of EOD compared to the non-hypertension group (aHR, 1.364; 95% CI, 1.291 to 1.442).
Conclusion
Diabetes is independently associated with increased risk of EOD, and this risk increases with longer diabetes duration. This association remained significant regardless of the presence and duration of hypertension.

Citations

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Research Progress on Time in Range as a Predictor of Chronic Complications in Type 2 Diabetes Mellitus
晓雨李
Advances in Clinical Medicine.2026; 16(05): 2100. CrossRef

Diabetes, obesity and metabolism Big Data Articles (National Health Insurance Service Database)
Associations of Alcohol Consumption with All-Cause and Cancer Mortalities in Patients with Type 2 Diabetes Mellitus: A Nationwide Population Cohort Study: Da Yeon Lee, Sun-Joon Moon, Kyung-Do Han, Ji-Hee Ko, Han-na Jang, Hye-Mi Kwon, Se-Eun Park, Eun-Jung Rhee, Won-Young Lee; Endocrinol Metab. 2025;40(6):893-903. Published online July 14, 2025; DOI: https://doi.org/10.3803/EnM.2024.2275

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Background
To investigate the impact of alcohol consumption on all-cause and cancer mortalities in patients with type 2 diabetes (T2D).
Methods
This nationwide cohort study included Korean patients with T2D aged >20 years from a national health exams cohort (2009 to 2012). Participants were categorized based on alcohol consumption: non, mild (<30 g/day), and heavy drinkers (≥30 g/day). Primary outcomes were all-cause and cancer mortality rates. Cox proportional hazard regression analyses were used to calculate adjusted hazard ratios (aHRs) with a 95% confidence interval (CI) with adjustments for age, sex, body mass index, smoking, exercise, comorbidities, diabetes duration, and medications.
Results
Among 2,642,359 participants (median follow-up, 7.8 years), 57.2%, 32.7%, and 10.1% were non, mild, and heavy drinkers, respectively. Compared to non-drinkers, mild alcohol consumption was associated with reduced all-cause mortality (aHR, 0.81; 95% CI, 0.80 to 0.82) and cancer mortality (aHR, 0.88; 95% CI, 0.86 to 0.89), while heavy drinking increased both all-cause (aHR, 1.06; 95% CI, 1.04 to 1.07) and cancer mortalities (aHR, 1.09; 95% CI, 1.06 to 1.11). Subgroup analyses revealed variations: in chronic kidney disease and older age groups, heavy drinkers showed lower risk of all-cause mortality compared to non-drinkers. Regarding cancer mortality, younger and middle-aged groups showed protective effects of alcohol even for heavy drinkers, while females showed linear association between alcohol consumption and cancer mortality.
Conclusion
This study indicates a J-shaped relationship between alcohol consumption and all-cause and cancer mortality risk in patients with T2D, with variations across subgroups. These findings suggest the need for personalized recommendations considering individual risk factors.

Citations

Citations to this article as recorded by

Alcohol and the endocrine system: A critical review of disruptions, potential mechanisms, and health implications
Patricia E. Molina, Liz Simon
Alcohol, Clinical and Experimental Research.2026;[Epub] CrossRef
Impact of Moderate Wine Consumption on Type 2 Diabetes
Attilio Giacosa, Josep Masip, Ursula Fradera, Ramon Estruch, Mariangela Rondanelli
Nutrients.2026; 18(12): 2006. CrossRef
High BMI-attributable female-specific cancers: a comprehensive analysis of the global disease burden and trends from 1990 to 2021 and projections to 2040
Guangming Sun, Junmei Tang, Hao Chen, Yue Zhu, Pan Ren, Hanyue Gan, Wenbin Wu
Frontiers in Oncology.2025;[Epub] CrossRef

Diabetes, obesity and metabolism Big Data Articles (National Health Insurance Service Database)
The Triglyceride-Glucose Index and Risk of End-Stage Renal Disease across Different Durations of Type 2 Diabetes Mellitus: A Longitudinal Cohort Study: Mi-sook Kim, Kyu-Na Lee, Jeongmin Lee, Jeongeun Kwak, Seung-Hwan Lee, Hyuk-Sang Kwon, Jing Hughes, Kyung-Do Han, Eun Young Lee; Endocrinol Metab. 2025;40(5):718-726. Published online May 19, 2025; DOI: https://doi.org/10.3803/EnM.2024.2271

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Background
This study investigated the association between the triglyceride-glucose (TyG) index, a marker of insulin resistance, and the risk of end-stage renal disease (ESRD) in individuals with type 2 diabetes mellitus (T2DM), focusing on variations by diabetes duration.
Methods
We analyzed 1,219,148 Korean adults with T2DM from National Health Insurance Service data who underwent biennial health evaluations (2015 to 2016). ESRD was defined using specific procedural codes (V codes), and Cox proportional hazard models were employed to estimate hazard ratios (HRs) for ESRD across TyG index quartiles and diabetes duration categories, adjusting for various confounders.
Results
Over 6,967,381 person-years of follow-up, 7,548 participants developed ESRD. Higher TyG index quartiles were independently associated with increased risk of ESRD, which was more pronounced with longer diabetes duration. The adjusted HR for ESRD in the highest TyG quartile (Q4) compared to the lowest quartile (Q1) was 1.235 (95% confidence interval [CI], 0.995 to 1.533) in new-onset diabetes, and 1.592 (95% CI, 1.465 to 1.730) in those with diabetes for ≥10 years. Compared to the lowest TyG quartile in new-onset diabetes, the adjusted HR for ESRD in the highest quartile with diabetes duration ≥10 years increased to 10.239 (95% CI, 8.440 to 12.422). Subgroup analysis revealed that a higher TyG index consistently increased the risk of ESRD, with stronger associations observed in younger individuals and those without comorbidities.
Conclusion
The TyG index is a significant predictor of ESRD in T2DM, particularly in those with prolonged diabetes duration. Targeting insulin resistance early may mitigate the risk of ESRD in this population.

Citations

Citations to this article as recorded by

Association between TYG-BMI index and asthma in adults over 45 years of age: analysis of Global Burden of Disease 2021, China Health and Retirement Longitudinal Study, and National Health and Nutrition Examination Survey data
Zhuolin Qin, Longqian Li, Cheng Wang
Journal of Asthma.2026; 63(2): 214. CrossRef
The Association Between the Triglyceride–Glucose Index and the Risk of Diabetic Kidney Disease in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study
Munther S. Momani, Raneem Dalaeen, Dia Sarhan, Zaid Sarhan, Suhib Awamleh, Yazan M. Momani, Omar Abu Farsakh
Life.2026; 16(2): 345. CrossRef
Continuous glucose monitoring and risks of acute and chronic diabetes-related complications and mortality in adults with type 1 diabetes: a nationwide cohort study
Ji Yoon Kim, Seohyun Kim, Jae Hyeon Kim
Diabetologia.2026; 69(7): 1858. CrossRef
Longitudinal trajectories of the triglyceride-glucose index and risk of incident type 2 diabetes in adults undergoing repeated health examinations
Nanping Mao, Ruoli Wang, Yi Wang, Lingna Jin, Yanyun He, Wenbin Wu
Frontiers in Endocrinology.2026;[Epub] CrossRef

Diabetes, obesity and metabolism Big Data Articles (National Health Insurance Service Database)
Association between the Triglyceride-Glucose Index and Cardiovascular Risk and Mortality across Different Diabetes Durations: A Nationwide Cohort Study: Jeongeun Kwak, Kyung-Do Han, Eun Young Lee, Seung-Hwan Lee, Dong-Jun Lim, Hyuk-Sang Kwon, Jeongmin Lee; Endocrinol Metab. 2025;40(4):548-560. Published online March 5, 2025; DOI: https://doi.org/10.3803/EnM.2024.2205

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Background
We aimed to assess the association between triglyceride-glucose (TyG) index and cardiovascular disease (CVD) risk and mortality in a large cohort of diabetes patients.
Methods
A retrospective cohort study of 1,090,485 participants from the Korean National Health Insurance Service database was conducted. Participants were stratified into TyG quartiles.
Results
Higher TyG index quartiles were significantly associated with an increased CVD risk and mortality risk. In fully adjusted models, participants in the highest TyG quartile (Q4) had an 18% higher risk of CVD (hazard ratio [HR], 1.18; 95% confidence interval [CI], 1.13 to 1.23) and a 16% higher risk of mortality (HR, 1.16; 95% CI, 1.11 to 1.23) compared to those in the lowest quartile (Q1). The association was particularly pronounced in patients with fasting glucose ≥126 mg/dL (CVD [HR, 1.33; 95% CI, 1.29 to 1.37], mortality [HR, 1.23; 95% CI, 1.20 to 1.26]; P for interaction <0.001). Patients with a diabetes duration of ≥10 years showed the strongest association between the TyG index and CVD risk (HR, 1.44; 95% CI, 1.38 to 1.50), while the mortality risk was particularly elevated in those with a diabetes duration of less than 5 years (HR, 1.23; 95% CI, 1.18 to 1.30). Subgroup analyses revealed stronger associations between TyG index and CVD risk in younger participants, non-obese individuals, and non-smokers.
Conclusion
The TyG index is a significant predictor of CVD and mortality in diabetic patients, particularly in those with poor glycemic control or longer disease duration.

Citations

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Preoperative triglyceride–glucose index as a metabolic predictor of surgical site infection after posterior lumbar fusion
Yu Hua, Shaoxing Li, Yuan Jiang, Jinwang Liu
Journal of Orthopaedic Surgery.2026;[Epub] CrossRef
Combined effect of triglyceride-glucose index and glucose disposal rate on cardio-cerebrovascular disease
Hongfei Yang, Chao Sun, Ya Li, You Zhou, Rui Wang, Yingxue Li, Marwan Salih Al-Nimer
PLOS One.2026; 21(2): e0342154. CrossRef
The association between insulin resistance indices and the occurrence of major adverse cardiovascular events in patients with premature myocardial infarction: a prospective cohort study
Yu Zhou, Yuhang Wang, Jingxi Chen, Lai Jiang, Ran Chu, Weiwei Tian, Jiaxin Wang, Yin Liu, Jing Gao
Frontiers in Nutrition.2026;[Epub] CrossRef
Current evidence on lipid ratios for cardiovascular risk assessment in diabetes: A review
E. Carretero-Anibarro, D. Orozco-Beltran
Primary Care Diabetes.2026; 20(3): 292. CrossRef
Continuous glucose monitoring and risks of acute and chronic diabetes-related complications and mortality in adults with type 1 diabetes: a nationwide cohort study
Ji Yoon Kim, Seohyun Kim, Jae Hyeon Kim
Diabetologia.2026; 69(7): 1858. CrossRef
Analysis of the prevalence of dyslipidemia in early-onset schizophrenia patients and its correlation with clinical characteristics
Kehuang Li, Zhiwei Liu, Liang Sun, Jingjing Zhang, Xinglong Yin, Zhaokun Zhang, Changjie Cao
Frontiers in Psychiatry.2026;[Epub] CrossRef
Exploring the relationship between triglyceride-glucose index and peripheral neuropathy in Nigerian patients with type 2 diabetes: a comparison with other metabolic markers
Blessing Kenechi Myke-Mbata, Bruno Basil, Izuchukwu Nnachi Mba, Terna Gav Ambrose
International Journal of Research in Medical Sciences.2026; 14(5): 1812. CrossRef
Reassessing of the incremental predictive value of triglyceride-glucose index beyond traditional cardiovascular risk factors: a cohort study based on the China health and nutrition survey and meta-analysis
Fang Liu, Zhipeng Zhao, Haidan Zhao
Frontiers in Cardiovascular Medicine.2026;[Epub] CrossRef
The Triglyceride-Glucose Index: A Practical Tool for Enhanced Cardiovascular Risk Stratification in Type 2 Diabetes
Jang Won Son
Endocrinology and Metabolism.2025; 40(4): 545. CrossRef
The association between triglyceride-glucose index and all-cause/cardiovascular mortality in patients with different glucose metabolism statuses
Jiajun Liu, Jinhua Kang, Pengpeng Liang, Zhangxiao Song, Guiyun Li, Xueshan Jin, Hongyan Wu
Cardiovascular Diabetology.2025;[Epub] CrossRef
Standardized Triglyceride-Glucose and Plasma Atherogenic Indices as Predictors of Diabetic Nephropathy and Coronary Artery Disease in Patients with Type 1 Diabetes Mellitus
Nazif Yalçın, Nizameddin Koca
European Journal of Therapeutics.2025; 32(1): 1. CrossRef

Brief Report

Diabetes, obesity and metabolism
Impact of Diabetes on COVID-19 Susceptibility: A Nationwide Propensity Score Matching Study: Han Na Jang, Sun Joon Moon, Jin Hyung Jung, Kyung-Do Han, Eun-Jung Rhee, Won-Young Lee; Endocrinol Metab. 2024;39(5):813-818. Published online August 28, 2024; DOI: https://doi.org/10.3803/EnM.2024.2014

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Prior research has highlighted poor clinical outcomes in coronavirus disease 2019 (COVID-19)-infected patients with diabetes; however, susceptibility to COVID-19 infection in patients with diabetes has not been extensively studied. Participants aged ≥30 years who underwent COVID-19 testing from December 2019 to April 2020 were analyzed using the National Health Insurance Service data in South Korea. In a cohort comprising 29,433 1:1 propensity score-matched participants, COVID-19 positivity was significantly higher in participants with diabetes than in those without diabetes (512 [3.5%] vs. 395 [2.7%], P<0.001). Logistic regression analysis indicated that diabetes significantly increased the risk of COVID-19 test positivity (odds ratio, 1.307; 95% confidence interval, 1.144 to 1.493; P<0.001). Patients with diabetes exhibited heightened COVID-19 infection rates compared to individuals without diabetes, and diabetes increased the susceptibility to COVID-19, reinforcing the need for heightened preventive measures, particularly considering the poor clinical outcomes in this group.

Citations

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The silent epidemic within the pandemic: pathophysiology and prediction of post-COVID-19 diabetes
Hongjuan Fang, Qiang Wang
Journal of Translational Medicine.2026;[Epub] CrossRef
Underweight Status Amplifies Respiratory Infection Mortality in Diabetes: Findings From a Nationwide Cohort Study
Hun Jee Choe, Kyong Do Han, Ji‐Hong Park, Jiwoo Lee, Mi Kyung Kwak, Yun Mi Choi, Sun‐Joon Moon, Eun‐Gyoung Hong
Journal of Cachexia, Sarcopenia and Muscle.2026;[Epub] CrossRef

Original Articles

Diabetes, obesity and metabolism
Impact of Antidiabetic Drugs on Clinical Outcomes of COVID-19: A Nationwide Population-Based Study: Han Na Jang, Sun Joon Moon, Jin Hyung Jung, Kyung-Do Han, Eun-Jung Rhee, Won-Young Lee; Endocrinol Metab. 2024;39(3):479-488. Published online January 29, 2024; DOI: https://doi.org/10.3803/EnM.2023.1857

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Background
Inconsistent results have been reported regarding the association between the use of antidiabetic drugs and the clinical outcomes of coronavirus disease 2019 (COVID-19). This study aimed to investigate the effect of antidiabetic drugs on COVID-19 outcomes in patients with diabetes using data from the National Health Insurance Service (NHIS) in South Korea.
Methods
We analyzed the NHIS data of patients aged ≥20 years who tested positive for COVID-19 and were taking antidiabetic drugs between December 2019 and June 2020. Multiple logistic regression analysis was performed to analyze the clinical outcomes of COVID-19 based on the use of antidiabetic drugs.
Results
A total of 556 patients taking antidiabetic drugs tested positive for COVID-19, including 271 male (48.7%), most of whom were in their sixties. Of all patients, 433 (77.9%) were hospitalized, 119 (21.4%) received oxygen treatment, 87 (15.6%) were admitted to the intensive care unit, 31 (5.6%) required mechanical ventilation, and 61 (11.0%) died. Metformin was significantly associated with the lower risks of mechanical ventilation (odds ratio [OR], 0.281; 95% confidence interval [CI], 0.109 to 0.720; P=0.008), and death (OR, 0.395; 95% CI, 0.182 to 0.854; P=0.018). Dipeptidylpeptidase-4 inhibitor (DPP-4i) were significantly associated with the lower risks of oxygen treatment (OR, 0.565; 95% CI, 0.356 to 0.895; P=0.015) and death (OR, 0.454; 95% CI, 0.217 to 0.949; P=0.036). Sulfonylurea was significantly associated with the higher risk of mechanical ventilation (OR, 2.579; 95% CI, 1.004 to 6.626; P=0.049).
Conclusion
In patients with diabetes and COVID-19, metformin exhibited reduced risks of mechanical ventilation and death, DPP- 4i was linked with lower risks of oxygen treatment and death, while sulfonylurea was related to the increased risk of mechanical ventilation.

Citations

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Clinical Outcomes with the Use of Dipeptidyl Peptidase-4 (DPP-4) Inhibitor Among Patients with Diabetes Mellitus and COVID-19: A Systematic Review of Observational Studies
Shaden A. Alkhalifah, Walaa A. Alshahrani, Abdulmajeed M. Alshehri, Majed S. Al Yami
Journal of Clinical Medicine.2026; 15(6): 2117. CrossRef
Innovative Lipid-Lowering Strategies: RNA-Based, Small Molecule, and Protein-Based Therapies
Youngwoo Jang, Eun-Jung Rhee, Sung Hee Choi
Endocrinology and Metabolism.2025; 40(5): 668. CrossRef

Diabetes, Obesity and Metabolism Big Data Articles (National Health Insurance Service Database)
Association among Current Smoking, Alcohol Consumption, Regular Exercise, and Lower Extremity Amputation in Patients with Diabetic Foot: Nationwide Population-Based Study: Yoon Jae Lee, Kyung-Do Han, Jun Hyeok Kim; Endocrinol Metab. 2022;37(5):770-780. Published online October 12, 2022; DOI: https://doi.org/10.3803/EnM.2022.1519

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Background
The present study investigates whether modifiable behavioral factors of current cigarette smoking, heavy alcohol consumption, and regular exercise are associated with risk of lower extremity amputation (LEA) in diabetic patients.
Methods
A total of 2,644,440 diabetic patients (aged ≥20 years) was analyzed using the database of the Korean National Health Insurance Service. Cox proportional hazard regression was used to assess adjusted hazard ratios (HRs) for the behavioral factors with risk of LEA under adjustment for potential confounders.
Results
The risk of LEA was significantly increased by current cigarette smoking and heavy alcohol consumption (HR, 1.436; 95% confidence interval [CI], 1.367 to 1.508 and HR, 1.082; 95% CI, 1.011 to 1.158) but significantly decreased with regular exercise (HR, 0.745; 95% CI, 0.706 to 0.786) after adjusting for age, sex, smoking, alcohol consumption, exercise, low income, hypertension, dyslipidemia, body mass index, using insulin or oral antidiabetic drugs, and diabetic duration. A synergistically increased risk of LEA was observed with larger number of risky behaviors.
Conclusion
Modification of behaviors of current smoking, heavy alcohol intake, and exercise prevents LEA and can improve physical, emotional, and social quality of life in diabetic patients.

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Association Between Diabetic Foot Lesions and Diabetic Foot Ulcers: A Cross-Sectional Study
Moe Murai, Yoshitaka Hashimoto, Haruka Utsuyama, Takashi Ogasawara, Akifumi Shiota, Nozomi Yoshioka, Yusuke Hamazawa, Michiaki Fukui
Journal of Clinical Medicine.2026; 15(10): 3754. CrossRef
International consensus recommendations for smoking cessation in type 2 diabetes from the DiaSmokeFree Working group
Magdalena Walicka, Cristina Russo, Antonio Ceriello, Jacob George, Davide Campagna, Anoop Misra, Giusy Rita Maria La Rosa, Roberta Sammut, Riccardo Polosa
Diabetes Research and Clinical Practice.2026; : 113528. CrossRef
Fatores associados à amputação de membros inferiores em pacientes diabéticos: uma abordagem epidemiológica
Edimar Chaves Junior, Ana Clara Paulino Queiroz, Arthur Felipe Vieira Bastos, Isadora Borges Toledo, Jessica Coelho Costa, Julien Barbosa, Lilian Nunes de Assis Lacerda, Marcos Bruno Couto Garcia, Maria Eduarda Avelina Bontempo, Maria Eduarda Mendes Reis,
Caderno Pedagógico.2025; 22(1): e13493. CrossRef
Are There Sex Differences in the Association of Alcohol Consumption With the Risk of Soft Tissue Sarcoma? A Nationwide Population-based Study in Korea
Min Wook Joo, Kyungdo Han, Yoon Joo Cho, Nicholas Matthew Bernthal, Ye Bin Park
Clinical Orthopaedics & Related Research.2025; 483(9): 1583. CrossRef
Knowledge, attitudes, and practices among patients with diabetic foot ulcers towards disease management
Liangxiao Xie, Changshun Wei, Liqun Chen, Huaqiang Zheng, Jiajia Dong, Jinzhi Wu
Scientific Reports.2025;[Epub] CrossRef
Diabetes‐Associated Major Limb Amputation in Solomon Islands: A National, 5‐Year Retrospective Study
Dylan M. Bush, Adrian Garcia Hernandez, Anita Pickard, Thomas H. Fitzpatrick, Rooney Jagilly, Micky Olangi, Michael Buin, Johanna Roth, Hendrick Kaniki, Jones Ghabu, Tony Quity, Alexandra L. Martiniuk
World Journal of Surgery.2025; 49(8): 2266. CrossRef
The Severity of Diabetes and the Risk of Diabetic Foot Amputation: A National Cohort Study
Jin Yu, Ji-Hyun Kim, Bongseong Kim, Kyungdo Han, Seung Hwan Lee, Mee Kyoung Kim
Endocrinology and Metabolism.2025; 40(4): 574. CrossRef
Nationwide study of income-based disparities in diabetic limb preservation in South Korea
Yoon Jae Lee, Kyung-Do Han, Jun Hyeok Kim
Scientific Reports.2025;[Epub] CrossRef
Adjuvant effect of antimicrobial photodynamic therapy (aPDT) in the treatment of diabetic foot ulcers: A case series
Rita de Cassia Ferreira, Rebeca Boltes Cecatto, Silvana Torres Perez, Raquel Agnelli Mesquita‐Ferrari, Sandra Kalil Bussadori, Cinthya Cosme Duran, Anna Carolina Tempestini Horliana, Kristianne Porta Santos Fernandes
Journal of Biophotonics.2024;[Epub] CrossRef
Factors associated with diabetic foot ulcers and lower limb amputations in type 1 and type 2 diabetes supported by real‐world data from the German/Austrian DPV registry
Alexander J. Eckert, Stefan Zimny, Marcus Altmeier, Ana Dugic, Anton Gillessen, Latife Bozkurt, Gabriele Götz, Wolfram Karges, Frank J. Wosch, Stephan Kress, Reinhard W. Holl
Journal of Diabetes.2024;[Epub] CrossRef
Patients with diabetic foot ulcers: A qualitative study of patient knowledge, experience, and encountered obstacles
Vahide Semerci Çakmak, Serap Çetinkaya Özdemir
Journal of Tissue Viability.2024; 33(4): 571. CrossRef
A randomized controlled trial of an app-based intervention on physical activity and glycemic control in people with type 2 diabetes
Gyuri Kim, Seohyun Kim, You-Bin Lee, Sang-Man Jin, Kyu Yeon Hur, Jae Hyeon Kim
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Diabetes, Obesity and Metabolism Big Data Articles (National Health Insurance Service Database)
The Effects of Glucose Lowering Agents on the Secondary Prevention of Coronary Artery Disease in Patients with Type 2 Diabetes: Inha Jung, Hyemi Kwon, Se Eun Park, Kyung-Do Han, Yong-Gyu Park, Eun-Jung Rhee, Won-Young Lee; Endocrinol Metab. 2021;36(5):977-987. Published online October 14, 2021; DOI: https://doi.org/10.3803/EnM.2021.1046

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Background
Patients with diabetes have a higher risk of requiring repeated percutaneous coronary intervention (PCI) than non-diabetic patients. We aimed to evaluate and compare the effects of anti-diabetic drugs on the secondary prevention of myocardial infarction among type 2 diabetes mellitus patients.
Methods
We analyzed the general health check-up dataset and claims data of the Korean National Health Insurance Service of 199,714 participants (age ≥30 years) who underwent PCIs between 2010 and 2013. Those who underwent additional PCI within 1 year of their first PCI (n=3,325) and those who died within 1 year (n=1,312) were excluded. Patients were classified according to their prescription records for glucose-lowering agents. The primary endpoint was the incidence rate of coronary revascularization.
Results
A total of 35,348 patients were included in the study. Metformin significantly decreased the risk of requiring repeat PCI in all patients (adjusted hazard ratio [aHR], 0.77). In obese patients with body mass index (BMI) ≥25 kg/m², patients treated with thiazolidinedione (TZD) exhibited a decreased risk of requiring repeat revascularization than those who were not treated with TZD (aHR, 0.77; 95% confidence interval, 0.63 to 0.95). Patients treated with metformin showed a decreased risk of requiring revascularization regardless of their BMI. Insulin, meglitinide, and alpha-glucosidase inhibitor were associated with increased risk of repeated PCI.
Conclusion
The risk of requiring repeat revascularization was lower in diabetic patients treated with metformin and in obese patients treated with TZD. These results suggest that physicians should choose appropriate glucose-lowering agents for the secondary prevention of coronary artery disease.

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Cardiovascular preventive role of thiazolidinedione in patients with type 2 diabetes mellitus undergoing percutaneous coronary intervention
Jinkwon Kim, Jimin Jeon, Joonsang Yoo, Minyoul Baik, Seok‐Jae Heo, Ji Woong Roh
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Innovative Lipid-Lowering Strategies: RNA-Based, Small Molecule, and Protein-Based Therapies
Youngwoo Jang, Eun-Jung Rhee, Sung Hee Choi
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Preadmission metformin use increased the incidence of hyperlactatemia at admission and 30-day in-hospital mortality among T2D patients with heart disease at high risk of hypoxia
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Establishment of a Predictive Model for Poor Prognosis of Incomplete Revascularization in Patients with Coronary Heart Disease and Multivessel Disease
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Clinical and Applied Thrombosis/Hemostasis.2022;[Epub] CrossRef

Clinical Study
The Prevalence and Risk of Type 2 Diabetes in Adults with Disabilities in Korea: Inha Jung, Hyemi Kwon, Se Eun Park, Kyung-Do Han, Yong-Gyu Park, Eun-Jung Rhee, Won-Young Lee; Endocrinol Metab. 2020;35(3):552-561. Published online July 22, 2020; DOI: https://doi.org/10.3803/EnM.2020.653

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Background
People with disabilities are at risk of secondary conditions such as diabetes. The aim of this study was to evaluate the prevalence and risk of type 2 diabetes in South Korea, especially among people with all types of disabilities.
Methods
We conducted a cross-sectional study using data from the Korean National Health Insurance Service, with two disabilityfree controls matched for each participant with disabilities by age and sex. Information regarding the type, severity and grade of disabilities was obtained based on the National Disability Registry. Diagnosis of type 2 diabetes was defined according to the following criteria: presence of International Classification of Diseases, Tenth Revision, Clinical Modification codes E11, E12, E13, or E14 and claims for at least one oral anti-diabetic agent or insulin at baseline, or fasting glucose level ≥126 mg/dL.
Results
We included 1,297,806 participants with disabilities and 2,943,719 control. Out of 4,241,525 participants, 841,990 (19.9%) were diagnosed with diabetes. The prevalence of diabetes was higher in the disability group compared with individuals without disabilities (23.1% vs. 18.4%). The odds of having diabetes was higher in the disability group compared with the control group (adjusted odds ratio, 1.34; 95% confidence interval, 1.33 to 1.34). The results showed higher prevalence of diabetes in the mildly disabled group (23.2%) than in the severely disabled group (22.7%).
Conclusion
The prevalence and risk of diabetes were higher in people with disabilities compared with the general population. Physicians and public health authorities should focus on people with disabilities for proper diabetes management.

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Association of disability with cardiovascular mortality in the community-dwelling Spanish adult population
Roberto Pastor-Barriuso, Alicia Padrón-Monedero, Fernando J. García López, Javier Almazán-Isla, Jesús de Pedro-Cuesta, Javier Damián
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Roberto Pastor-Barriuso, Alicia Padrón-Monedero, Fernando J. García López, Javier Almazán-Isla, Jesús de Pedro-Cuesta, Javier Damián
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Intellectual disabilities and risk of cardiovascular diseases: A population-based cohort study
In Young Cho, Hye Yeon Koo, Yoo Jin Um, Yong-Moon Mark Park, Kyung Mee Kim, Chung Eun Lee, Kyungdo Han
Disability and Health Journal.2025; 18(2): 101754. CrossRef
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Hyungsun Jun, Dasol Park, Jae-Uk Sul, Moon Joo Cheong, Haerim Kim, Inae Youn, Jungtae Leem
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Risk of Diabetes Mellitus in Adults with Intellectual Disabilities: A Nationwide Cohort Study
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Endocrinology and Metabolism.2025; 40(1): 103. CrossRef
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Thyroid
Prevalence and Annual Incidence of Thyroid Disease in Korea from 2006 to 2015: A Nationwide Population-Based Cohort Study: Hyemi Kwon, Jin-hyung Jung, Kyung-Do Han, Yong-Gyu Park, Jung-Hwan Cho, Da Young Lee, Ji Min Han, Se Eun Park, Eun-Jung Rhee, Won-Young Lee; Endocrinol Metab. 2018;33(2):260-267. Published online June 21, 2018; DOI: https://doi.org/10.3803/EnM.2018.33.2.260

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Background

The incidence of thyroid nodules has increased worldwide in recent years. Thyroid dysfunction is a potential risk factor for hypercholesterolemia, cardiovascular disease, osteoporosis, arrhythmia, and neuropsychiatric disease. This study investigated the prevalence and annual incidence of thyroid nodules, hypothyroidism, and hyperthyroidism in Koreans.

Methods

In this nationwide population-based cohort study, 51,834,660 subjects were included using the National Health Information database from 2006 to 2015, after the exclusion of subjects with thyroid cancer.

Results

The prevalence in Korea in 2015 of thyroid nodules, hypothyroidism in patients taking thyroid hormone, and hyperthyroidism in patients undergoing treatment was 15.82/1,000 population, 15.94/1,000 population, and 2.76/1,000 population, respectively. All these diseases were more prevalent among women than among men. The number of incident cases of these three thyroid diseases steadily increased from 2006 to 2012, and then decreased through 2015. The incidence of thyroid nodules, hypothyroidism treated with thyroid hormone, and treated hyperthyroidism was 6.79/1,000 population, 1.76/1,000 population, and 0.55/1,000 population, respectively, in Korea in 2015. The use of methimazole continuously increased, from 33% of total antithyroid drug prescriptions in 2006 to 74.4% in 2015, and it became the most frequently prescribed antithyroid drug in Korea. In contrast, the use of propylthiouracil continuously decreased.

Conclusion

This was the first nationwide study of the prevalence and annual incidence of thyroid nodules, hypothyroidism, and hyperthyroidism to take into account recent changes and to include the current status of patients receiving treatment.

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