Endocrinology and Metabolism

Review Article

Diabetes, obesity and metabolism
Advances in Continuous Glucose Monitoring: Clinical Applications: So Yoon Kwon, Jun Sung Moon; Endocrinol Metab. 2025;40(2):161-173. Published online April 8, 2025; DOI: https://doi.org/10.3803/EnM.2025.2370

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Continuous glucose monitoring (CGM) has revolutionized diabetes management, significantly enhancing glycemic control across diverse patient populations. Recent evidence supports its effectiveness in both type 1 and type 2 diabetes management, with benefits extending beyond traditional glucose monitoring approaches. CGM has demonstrated substantial improvements in glycemic control across multiple metrics. Studies report consistent glycosylated hemoglobin reductions of 0.25%–3.0% and notable time in range improvements of 15%–34%. CGM effectively reduces hypoglycemic events, with studies reporting significant reductions in time spent in hypoglycemia. CGM also serves as an educational tool for lifestyle modification, providing real-time feedback that helps patients understand how diet and physical activity affect glucose levels. While skin-related complications remain a concern, technological advancements have addressed many initial concerns. High satisfaction rates and long-term use suggest that device-related issues are manageable with proper education and support. Despite high initial costs, CGM’s prevention of complications and hospitalizations ultimately reduces healthcare expenditures. With appropriate training and support, CGM represents a transformative technology for comprehensive diabetes care.

Citations

Citations to this article as recorded by

Associations of time in tight range, time in range, and glycated hemoglobin with albuminuria in type 1 diabetes: A cross-sectional study
Ji Yoon Kim, Seohyun Kim, Sang Ho Park, Jin A Lee, So Hyun Cho, Rosa Oh, Myunghwa Jang, You-Bin Lee, Gyuri Kim, Kyu Yeon Hur, Jae Hyeon Kim, Sang-Man Jin
Diabetes Research and Clinical Practice.2025; 226: 112325. CrossRef

Original Article

Diabetes, obesity and metabolism
Plasma C-Peptide Levels and the Continuous Glucose Monitoring-Defined Coefficient of Variation in Risk Prediction for Hypoglycemia in Korean People with Diabetes Having Normal and Impaired Kidney Function: So Yoon Kwon, Jiyun Park, So Hee Park, You-Bin Lee, Gyuri Kim, Kyu Yeon Hur, Jae Hyeon Kim, Sang-Man Jin; Endocrinol Metab. 2025;40(2):268-277. Published online February 27, 2025; DOI: https://doi.org/10.3803/EnM.2024.2083

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Abstract PDF Supplementary Material PubReader ePub

Background
We aimed to investigate the predictive values of plasma C-peptide levels and the continuous glucose monitoring (CGM)-defined coefficient of variation (CV) in risk prediction for hypoglycemia in Korean people with diabetes with normal and impaired kidney function.
Methods
We analyzed data from 1,185 participants diagnosed with type 1 and type 2 diabetes who underwent blinded professional CGM between January 2009 and May 2021 at outpatient clinics. We explored correlations among CGM-defined CV, plasma C-peptide levels, and time below range at <70 and 54 mg/dL across different kidney function categories.
Results
In patients with chronic kidney disease (CKD) stages 1–2 (n=934), 89.3% who had a random plasma C-peptide level higher than 600 pmol/L exhibited a CV of ≤36%. Among those in CKD stage 3 (n=161) with a random plasma C-peptide level exceeding 600 pmol/L, 66.7% showed a CV of ≤36%. In stages 4–5 of CKD (n=90), the correlation between random C-peptide levels and CV was not significant (r=–0.05, P=0.640), including cases with a CV greater than 36% despite very high random plasma C-peptide levels. Random plasma C-peptide levels and CGM-assessed CV significantly predicted hypoglycemia in CKD stages 1–2 and 1–5, respectively.
Conclusion
The established C-peptide criteria in Western populations are applicable to Korean people with diabetes for hypoglycemic risk prediction, unless kidney function is impaired equivalent to CKD stage 3–5. The CGM-defined CV is informative for hypoglycemic risk prediction regardless of kidney function.

Citations

Citations to this article as recorded by

Plasma C-Peptide Level and Continuous Glucose Monitoring-Derived Coefficient of Variation as a Predictable Risk Factor for Hypoglycemia in Koreans with Diabetes
Seung-Hyun Ko
Endocrinology and Metabolism.2025; 40(2): 198. CrossRef
Beneficial Role of Increased Glucose Infusion in Decompensated Type 2 Diabetes Patient
Marie Ticha, Ondrej Sobotka, Pavel Skorepa, Lubos Sobotka
Diabetology.2025; 6(6): 47. CrossRef

Review Article

Stepwise Approach to Problematic Hypoglycemia in Korea: Educational, Technological, and Transplant Interventions: Sang-Man Jin; Endocrinol Metab. 2017;32(2):190-194. Published online June 23, 2017; DOI: https://doi.org/10.3803/EnM.2017.32.2.190

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Abstract PDF PubReader

Impaired awareness of hypoglycemia has been found to be prevalent in 20% to 40% of people with type 1 diabetes. If a similar prevalence exists in Koreans with type 1 diabetes, at a minimum, thousands of people with type 1 diabetes suffer at least one unpredicted episode of severe hypoglycemia per year in Korea. For patients with problematic hypoglycemia, an evidence-based stepwise approach was suggested in 2015. The first step is structured education regarding multiple daily injections of an insulin analog, and the second step is adding a technological intervention, such as continuous subcutaneous insulin infusion or real-time continuous glucose monitoring. The next step is a sensor-augmented pump, preferably with a low glucose suspension feature or very frequent contact, and the final step is islet or pancreas transplantation. In Korea, however, none of these treatments are reimbursed by the National Health Insurance, and thus have not been widely implemented. The low prevalence of type 1 diabetes means that Korean physicians are relatively unfamiliar with the new technologies in this field. Therefore, the roles of new technologies and pancreas or islet transplantation in the treatment of problematic hypoglycemia need to be defined in the current clinical setting of Korea.

Citations

Citations to this article as recorded by

Protective and risk factors of impaired awareness of hypoglycemia in patients with type 1 diabetes: a cross-sectional analysis of baseline data from the PR-IAH study
Naoki Sakane, Ken Kato, Sonyun Hata, Erika Nishimura, Rika Araki, Kunichi kouyama, Masako Hatao, Yuka Matoba, Yuichi Matsushita, Masayuki Domichi, Akiko Suganuma, Seiko Sakane, Takashi Murata, Fei Ling Wu
Diabetology & Metabolic Syndrome.2023;[Epub] CrossRef
A 4-Week, Two-Center, Open-Label, Single-Arm Study to Evaluate the Safety and Efficacy of EOPatch in Well-Controlled Type 1 Diabetes Mellitus
Jiyun Park, Nammi Park, Sangjin Han, You-Bin Lee, Gyuri Kim, Sang-Man Jin, Woo Je Lee, Jae Hyeon Kim
Diabetes & Metabolism Journal.2022; 46(6): 941. CrossRef
Impaired hypoglycemia awareness in diabetes: epidemiology, mechanisms and therapeutic approaches
Vadim V. Klimontov
Diabetes mellitus.2019; 21(6): 513. CrossRef

Original Article

Clinical Study
1,5-Anhydro-D-Glucitol Could Reflect Hypoglycemia Risk in Patients with Type 2 Diabetes Receiving Insulin Therapy: Min Kyeong Kim, Hye Seung Jung, Soo Heon Kwak, Young Min Cho, Kyong Soo Park, Seong Yeon Kim; Endocrinol Metab. 2016;31(2):284-291. Published online May 27, 2016; DOI: https://doi.org/10.3803/EnM.2016.31.2.284

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Abstract PDF PubReader

Background

The identification of a marker for hypoglycemia could help patients achieve strict glucose control with a lower risk of hypoglycemia. 1,5-Anhydro-D-glucitol (1,5-AG) reflects postprandial hyperglycemia in patients with well-controlled diabetes, which contributes to glycemic variability. Because glycemic variability is related to hypoglycemia, we aimed to evaluate the value of 1,5-AG as a marker of hypoglycemia.

Methods

We enrolled 18 adults with type 2 diabetes mellitus (T2DM) receiving insulin therapy and assessed the occurrence of hypoglycemia within a 3-month period. We measured 1,5-AG level, performed a survey to score the severity of hypoglycemia, and applied a continuous glucose monitoring system (CGMS).

Results

1,5-AG was significantly lower in the high hypoglycemia-score group compared to the low-score group. Additionally, the duration of insulin treatment was significantly longer in the high-score group. Subsequent analyses were adjusted by the duration of insulin treatment and mean blood glucose, which was closely associated with both 1,5-AG level and hypoglycemia risk. In adjusted correlation analyses, 1,5-AG was negatively correlated with hypoglycemia score, area under the curve at 80 mg/dL, and low blood glucose index during CGMS (P=0.068, P=0.033, and P=0.060, respectively).

Conclusion

1,5-AG level was negatively associated with hypoglycemia score determined by recall and with documented hypoglycemia after adjusting for mean glucose and duration of insulin treatment. As a result, this level could be a marker of the risk of hypoglycemia in patients with well-controlled T2DM receiving insulin therapy.

Citations

Citations to this article as recorded by

Neurological dysfunction screening in a cohort of adolescents with type 1 diabetes: a six-year follow-up
Davide Tinti, Carlotta Canavese, Cecilia Nobili, Daniele Marcotulli, Erika Daniele, Ivana Rabbone, Luisa de Sanctis
Frontiers in Medicine.2024;[Epub] CrossRef
The progress of clinical research on the detection of 1,5-anhydroglucitol in diabetes and its complications
Huijuan Xu, Junhua Pan, Qiu Chen
Frontiers in Endocrinology.2024;[Epub] CrossRef
Mobile Healthcare System Provided by Primary Care Physicians Improves Quality of Diabetes Care
Tae Jung Oh, Jie-Eun Lee, Seok Kim, Sooyoung Yoo, Hak Chul Jang
CardioMetabolic Syndrome Journal.2021; 1(1): 88. CrossRef
Effects of mobile phone application combined with or without self‐monitoring of blood glucose on glycemic control in patients with diabetes: A randomized controlled trial
Yuan Yu, Qun Yan, Huizhi Li, Hongmei Li, Lin Wang, Hua Wang, Yiyun Zhang, Lei Xu, Zhaosheng Tang, Xinfeng Yan, Yinghua Chen, Huili He, Jie Chen, Bo Feng
Journal of Diabetes Investigation.2019; 10(5): 1365. CrossRef
Articles inEndocrinology and Metabolismin 2016
Won-Young Lee
Endocrinology and Metabolism.2017; 32(1): 62. CrossRef
A Diet Diverse in Bamboo Parts is Important for Giant Panda (Ailuropoda melanoleuca) Metabolism and Health
Hairui Wang, Heju Zhong, Rong Hou, James Ayala, Guangmang Liu, Shibin Yuan, Zheng Yan, Wenping Zhang, Yuliang Liu, Kailai Cai, Zhigang Cai, He Huang, Zhihe Zhang, De Wu
Scientific Reports.2017;[Epub] CrossRef
Low and exacerbated levels of 1,5-anhydroglucitol are associated with cardiovascular events in patients after first-time elective percutaneous coronary intervention
Shuhei Takahashi, Kazunori Shimada, Katsumi Miyauchi, Tetsuro Miyazaki, Eiryu Sai, Manabu Ogita, Shuta Tsuboi, Hiroshi Tamura, Shinya Okazaki, Tomoyuki Shiozawa, Shohei Ouchi, Tatsuro Aikawa, Tomoyasu Kadoguchi, Hamad Al Shahi, Takuma Yoshihara, Makoto Hi
Cardiovascular Diabetology.2016;[Epub] CrossRef

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