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Original Articles
Steatotic Liver Disease Subtypes and Advanced Fibrosis as Independent Predictors of Ischemic Stroke in Type 2 Diabetes Mellitus
Myunghwa Jang, Gyuri Kim, Kyu-na Lee, Rosa Oh, So Hyun Cho, Ji Yoon Kim, You-Bin Lee, Sang-Man Jin, Kyu Yeon Hur, Kyungdo Han, Jae Hyeon Kim
Received November 15, 2025  Accepted February 13, 2026  Published online May 18, 2026  
DOI: https://doi.org/10.3803/EnM.2025.2792    [Epub ahead of print]
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Although type 2 diabetes mellitus (T2DM) and metabolic dysfunction-associated steatotic liver disease (MASLD) are associated with an increased risk of ischemic stroke, the extent to which steatotic liver disease (SLD) subtypes and advanced liver fibrosis confer additional risk in individuals with T2DM remains unclear. We aimed to investigate the association of SLD categories and/or advanced liver fibrosis with ischemic stroke risk among patients with T2DM.
Methods
A total of 2,220,249 patients with T2DM were classified into five groups: no steatosis, MASLD, MASLD with other combined disease, metabolic dysfunction and alcohol-related steatotic liver disease (MetALD), and alcohol-related liver disease (ALD) with metabolic dysfunction (MD). SLD was defined using a fatty liver index (FLI) of ≥30, and advanced fibrosis was defined by a BARD score of ≥2.
Results
Over a median follow-up of 11 years, 135,482 ischemic strokes (6.10%) occurred. Compared with no steatosis, adjusted hazard ratios (aHRs) for stroke were higher in MASLD (aHR, 1.10; 95% confidence interval [CI], 1.08 to 1.11), MASLD with combined disease (aHR, 1.14; 95% CI, 1.12 to 1.17), MetALD (aHR, 1.13; 95% CI, 1.11 to 1.16), and ALD with MD (aHR, 1.32; 95% CI, 1.27 to 1.37). Advanced fibrosis progressively increased stroke risk compared with non-SLD and non-fibrotic SLD. Compared with the FLI <30 group, those with FLI 30–60 and ≥60 showed increased aHRs for stroke. Very heavy drinking was associated with a further increase in risk compared with non-drinking.
Conclusion
In patients with T2DM, all SLD categories and advanced liver fibrosis were associated with an increased risk of ischemic stroke. Very heavy alcohol consumption was generally associated with a higher stroke risk across FLI categories.
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YTHDF1-Mediated m6A Modification of lncRNA OIP5-AS1 Exacerbates Macrophage Metabolic Dysfunction in Diabetes Mellitus with Coronary Artery Disease
Hongjie Wang, Luyao Li, Zhen Zhen, Zheqi Zhang, Ya Su, Bo Li
Received July 21, 2025  Accepted December 15, 2025  Published online May 7, 2026  
DOI: https://doi.org/10.3803/EnM.2025.2566    [Epub ahead of print]
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Diabetes mellitus (DM) with coronary artery disease (CAD), referred to as DM-CAD, is a prevalent endocrine-metabolic condition characterized by macrophage-driven inflammation and metabolic dysregulation. This study aims to investigate the role of YTH N6-methyladenosine RNA binding protein F1 (YTHDF1)-mediated N6-methyladenosine (m6A) modification in stabilizing the long non-coding RNA (lncRNA) Opa interacting protein 5 antisense RNA 1 (OIP5-AS1) and to determine its impact on macrophage metabolic dysfunction in DM-CAD.
Methods
Single-cell RNA sequencing and bulk RNA sequencing were performed using DM-CAD mouse models, with downstream analyses conducted using Seurat, CellChat, least absolute shrinkage and selection operator (LASSO) regression, and random forest algorithms. Experimental validation included RNA immunoprecipitation followed by quantitative polymerase chain reaction, actinomycin D-based RNA stability assays, and 2-deoxyglucose (2-DG) interventions in THP-1–derived macrophages, alongside metabolomic profiling and reactive oxygen species (ROS) measurements.
Results
Increased macrophage-endothelial cell coupling was observed in DM-CAD, with both OIP5-AS1 and YTHDF1 significantly upregulated and closely associated with glycolytic metabolic pathways. YTHDF1-mediated m6A modification stabilized OIP5-AS1, thereby promoting glycolysis, foam cell formation, ROS production, plaque development, and the upregulation of proinflammatory cytokines, collectively exacerbating atherosclerosis. Notably, treatment with 2-DG markedly reversed these pathological phenotypes.
Conclusion
This study identifies the YTHDF1–m6A–OIP5-AS1 axis as a critical regulator of macrophage metabolic dysfunction in DM-CAD, thereby providing an epigenetic framework for understanding disease progression. Targeting this regulatory pathway may attenuate metabolic inflammation and represents a promising therapeutic strategy for endocrine-related cardiovascular complications.
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Association between Prolactinoma and Incident Type 2 Diabetes Mellitus: Evidence from a Korean Nationwide Cohort
Han Na Jung, Bo Ram Yang, Min-Seon Kim, Jeong-Hwa Yoon, Se Hee Min
Received June 17, 2025  Accepted November 5, 2025  Published online May 6, 2026  
DOI: https://doi.org/10.3803/EnM.2025.2508    [Epub ahead of print]
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
The effect of prolactinoma on the development of type 2 diabetes mellitus (T2DM) has not been evaluated at the population level. We investigated the association between prolactinoma and incident T2DM in a nationwide cohort.
Methods
We analyzed data from the Korean National Health Insurance Service–National Sample Cohort, which includes 2% of the total national population selected by random sampling, covering the period from 2002 to 2019. A total of 335 patients with newly diagnosed prolactinoma and 1,562 age- and sex-matched controls were included. We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for T2DM using Cox proportional hazards regression. Time-dependent HRs were also estimated.
Results
The proportion of prolactinoma patients who developed T2DM was significantly higher than that of controls (10.1% vs. 5.5%; relative risk, 1.84; 95% CI, 1.26 to 2.69). After adjustment for age, sex, income, and comorbidities, the risk of T2DM remained significantly higher in the prolactinoma group (HR, 1.56; 95% CI, 1.01 to 2.41). Subgroup analysis showed a markedly increased risk among individuals aged ≥50 years (HR, 4.47; 95% CI, 1.66 to 12.08). The positive association between prolactinoma and T2DM decreased over time but remained significant for up to 3 years after prolactinoma diagnosis (HR, 9.28 [95% CI, 3.45 to 24.97]; HR, 3.15 [95% CI, 1.55 to 6.38]; and HR, 0.82 [95% CI, 0.44 to 1.53] for ≤1, 1–3, and >3 years, respectively).
Conclusion
Newly diagnosed prolactinoma was independently associated with a higher risk of T2DM, with the association diminishing over 3 years. These findings highlight the importance of monitoring for T2DM during the early management of prolactinoma, particularly in middle-aged patients who may have been previously overlooked.
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Sex Disparity in Suicide Mortality among Patients with Type 2 Diabetes: A Nationwide Population-Based Cohort Study
Chaiho Jeong, Bongseong Kim, Dae Jong Oh, Tae-Seo Sohn, Kyungdo Han, Hyuk-Sang Kwon
Received September 16, 2025  Accepted November 24, 2025  Published online March 19, 2026  
DOI: https://doi.org/10.3803/EnM.2025.2669    [Epub ahead of print]
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Suicide represents a major public health concern in Korea. Patients with type 2 diabetes mellitus (T2DM) are at higher risk for psychological distress and suicide. Although the male-to-female suicide mortality ratio in the general population has remained about 2.3, the specific differences in suicide mortality by sex among individuals with T2DM are not well characterized.
Methods
We performed a nationwide cohort study utilizing the Korean National Health Insurance Service database, identifying 2,526,769 adults with T2DM who underwent health screening from 2015 to 2016. Participants were monitored until the occurrence of suicide or the study endpoint.
Results
During a median follow-up of 6.0 years, 5,584 suicide deaths occurred (0.30% in men vs. 0.10% in women). Men exhibited a significantly elevated risk of suicide mortality compared to women (adjusted hazard ratio [HR], 2.88; 95% confidence interval [CI], 2.66 to 3.12). The largest disparity was observed in the ≥80 age group (HR, 3.60; 95% CI, 2.88 to 4.51). However, this sex disparity in suicide mortality was reduced among current smokers and heavy alcohol consumers. Among non-smokers, the HR comparing men to women was 3.51 (95% CI, 3.22 to 3.83), while among current smokers, it was 1.73 (95% CI, 1.40 to 2.14). Similarly, the HR among non-drinkers was 3.04 (95% CI, 2.79 to 3.31), compared with 1.36 (95% CI, 0.85 to 2.18) among heavy drinkers.
Conclusion
Men with T2DM had a significantly higher risk of suicide mortality than women, exceeding the sex disparity seen in the general population, with the gap further influenced by age and lifestyle factors.
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Review Article
Miscellaneous
Big Data Articles (National Health Insurance Service Database)
Nationwide Big Data Studies of Endocrine Diseases Using the Korean National Health Information Database: Research Trends and Standardization of Operational Definitions
Sun Wook Cho, Jung Hee Kim, Kyoung Jin Kim, Beom-Jun Kim, Mee Kyoung Kim, Eun Jung Rhee
Endocrinol Metab. 2026;41(1):86-104.   Published online February 26, 2026
DOI: https://doi.org/10.3803/EnM.2026.2953
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  • 2 Web of Science
  • 2 Crossref
AbstractAbstract PDFPubReader   ePub   
The Korean National Health Information Database (NHID) is a large-scale dataset created through linkage of National Health Insurance claims with nationwide health screening records. Because it is released in a cohort-based format, the NHID enables longitudinal follow-up and allows investigation of rare endocrine conditions with low population prevalence. Mortality data, including both dates and causes of death, are additionally obtained through linkage with Statistics Korea. Over recent years, use of the NHID has expanded rapidly, establishing it as a major resource for epidemiological research in endocrinology. Nevertheless, because the database was originally developed for administrative and screening purposes rather than for research, investigators face several methodological limitations, particularly the need to construct and validate robust operational definitions of diseases. In this review, we describe the key features of the Korean NHID, summarize operational definitions of endocrine disorders that have been applied in prior research, and provide an overview of recent endocrine studies conducted using this database.

Citations

Citations to this article as recorded by  
  • Age-specific loss of life expectancy after hip fracture in Asian adults: A nationwide population-based cohort study
    Kyoung Jin Kim, Su Jin Kwon, Seunghyun Lee, Seong Hee Ahn, So Young Park, Ha-Young Kim, Kyoung Min Kim
    Bone.2026; 208: 117896.     CrossRef
  • Diabetes progression and its association with fracture risk in type 2 diabetes
    Bongsung Kim, Kyu-Na Lee, Kyungdo Han, Mee Kyoung Kim
    Osteoporosis International.2026;[Epub]     CrossRef
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Songwon Lecture 2025
Diabetes, obesity and metabolism
Postpartum Glucose Intolerance in Women with a History of Gestational Diabetes Mellitus: An In-Depth Review
Kyung-Soo Kim, Soo-Kyung Kim, Yong-Wook Cho
Endocrinol Metab. 2026;41(1):26-33.   Published online February 3, 2026
DOI: https://doi.org/10.3803/EnM.2025.2852
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  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDFPubReader   ePub   
Gestational diabetes mellitus (GDM) is increasing in prevalence worldwide, and postpartum glucose intolerance represents one of the major complications after delivery in women with GDM. A wide range of risk factors for postpartum glucose intolerance have been identified, including ethnicity, genetic predisposition, age, obesity, pre-pregnancy body mass index, gestational weight gain, history of GDM, family history of diabetes, degree of hyperglycemia, insulin treatment, lipid profiles, and other metabolic factors. Lifestyle interventions, including weight loss, are thought to reduce the risk of postpartum glucose intolerance. Careful attention should be paid to the screening of postpartum glucose intolerance in women with GDM, and concerted efforts should be made to prevent or delay the development of diabetes and other metabolic disorders.

Citations

Citations to this article as recorded by  
  • Diabetes in Pregnancy in Korea: Prevalence, Clinical Characteristics, and Postpartum Comorbidities
    Joon Ho Moon, Han Na Jung, Bongseong Kim, Seung-Hyun Ko, Soo Heon Kwak, Kyung-Do Han, Sung Hee Choi
    Diabetes & Metabolism Journal.2026; 50(2): 280.     CrossRef
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Original Articles
Decline in Years of Life Lost Due to Diabetes in Korea, 2008–2019: A Cause-Specific Decomposition Analysis
Da Hea Seo, Kyoung Hwa Ha, Dae Jung Kim
Received August 24, 2025  Accepted November 10, 2025  Published online January 28, 2026  
DOI: https://doi.org/10.3803/EnM.2025.2622    [Epub ahead of print]
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
This study aimed to evaluate trends in years of life lost (YLL) attributable to diabetes and to identify cause-specific contributors to these changes in Korea.
Methods
We analyzed data from the Korean National Health Insurance Service-National Sample Cohort between 2008 and 2019. Standardized mortality ratios (SMRs) were calculated using indirect standardization with age-specific mortality rates of individuals without diabetes as the reference. YLL was defined as the difference in life expectancy between individuals with and without diabetes at a given age. Cause-specific contributions to changes in YLL were estimated using Arriaga’s decomposition method.
Results
From 2008 to 2019, SMRs declined from 2.19 to 1.55 in males and from 2.04 to 1.36 in females. At age 40, life expectancy among individuals with diabetes increased from 32.53 to 37.81 years in males and from 39.41 to 43.77 years in females, accompanied by a reduction in diabetes-attributable YLL from 8.36 to 5.70 years in males and from 7.51 to 5.21 years in females, representing an approximate 30% decrease. The YLL gap narrowed with increasing age. At age 40, cause-specific decomposition showed that the largest relative reductions in YLL were attributable to diabetes (–40% in males, –46% in females), cardiovascular disease (–37% in males, –52% in females), and kidney disease (–33% in both sexes).
Conclusion
Diabetes-related YLL in Korea declined substantially over the past decade, primarily driven by reductions in mortality from diabetes, cardiovascular disease, and kidney disease.

Citations

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  • Female Gender and Life Expectancy: Systematic Review with ☸️SAIMSARA

    SAIMSARA Journal.2026;[Epub]     CrossRef
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Efficacy and Safety of Stage 5 Connected Insulin Pens in Type 1 or Type 2 Diabetes: Randomized Controlled Trial Protocol (SMART-5 Study)
Ji Yoon Kim, Nam Hoon Kim, Soo Heon Kwak, Chang Hee Jung, Eun Seok Kang, Jun Sung Moon, Sun Joon Moon, So Yoon Kwon, Jee Hee Yoo, Younghoon Kim, Tae-min Lee, Chung-il Yang, Jae Hyeon Kim, Sang-Man Jin
Received July 26, 2025  Accepted October 13, 2025  Published online December 12, 2025  
DOI: https://doi.org/10.3803/EnM.2025.2579    [Epub ahead of print]
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AbstractAbstract PDFPubReader   ePub   
Background
Stage 2 or 3 connected insulin pens (CIPs) refer to tracking insulin pens that are capable of transmitting insulin dose data via cloud connectivity. Stage 4 CIPs feature a bolus calculator that determines appropriate insulin doses based on real-time continuous glucose monitoring (CGM) data, carbohydrate intake, previous dosing history, and preset parameters. Stage 5 CIPs additionally offer advanced decision-support features, such as education modules and coaching. However, the efficacy and safety of Stage 5 CIPs have not yet been established.
Methods
In this prospective, open-label, parallel-group, multicenter, randomized controlled trial, we will include adults aged ≥19 and <75 years with type 1 or type 2 diabetes receiving multiple daily insulin injections (MDI) and having glycosylated hemoglobin (HbA1c) levels of 7.5% to 12.0%. In total, 152 participants will be randomized in a 1:1 ratio to receive either Stage 5 CIPs with CGM or tracking insulin pens with CGM. Stage 5 CIPs include a Setup Wizard that recommends individualized initial settings and an algorithm that provides advanced insulin dosing guidance based on analyses of each participant’s CGM and insulin injection data. The primary outcome will be the change in HbA1c levels from baseline to week 12 (ClinicalTrials.gov, NCT07004153).
Conclusion
This trial (Stage 5 connected insulin pen for MDI with Advanced decision support in a Randomized Trial [SMART-5 Study]) will determine whether Stage 5 CIPs are superior to tracking insulin pens in improving glycemic control among adults with type 1 or type 2 diabetes treated with MDI. Overall, this study may offer a promising strategy for enhancing the management and outcomes of patients with diabetes.
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Diabetes, obesity and metabolism
Impact of Carbohydrate Intake Fluctuations on Glucose Profiles: Insights from Continuous Glucose Monitoring-Based Patient Clustering
Hyun Ah Kim, Kyung Hee Kim, Young Lee, Yoon-Ju Song, Joon Ho Moon, Sung Hee Choi, Tae Jung Oh
Endocrinol Metab. 2026;41(1):152-161.   Published online December 12, 2025
DOI: https://doi.org/10.3803/EnM.2025.2486
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AbstractAbstract PDFPubReader   ePub   
Background
Continuous glucose monitoring (CGM) is widely applied in daily glucose management. However, its potential to categorize individuals based on glucose profiles is not fully established. This study employed CGM-based patient clustering and examined nutritional factors influencing glucose patterns.
Methods
This prospective observational study enrolled 34 individuals with diabetes. Retrospective professional CGM was conducted over 7 days, during which food intake was recorded. K-means clustering was performed using CGM-derived coefficient of variation (CV) and time in range. Macronutrient intake and its fluctuations were compared across clusters.
Results
Participants were grouped into cluster 1 (well-controlled), cluster 2 (highest CV), and cluster 3 (highest mean glucose). Baseline clinical characteristics, daily energy intake (kcal), and macronutrient intake did not differ significantly among clusters. However, carbohydrate intake fluctuations were greater in cluster 3 (CV 41.0%±32.1%, standard deviation [SD] 502.1±363.4 kcal) than in cluster 1 (CV 21.9%±9.0%, SD 260.2±94.1 kcal) and cluster 2 (CV 19.2%±9.1%, SD 250.2±126.1 kcal) (P=0.123 for CV; P=0.024 for SD). The SD (kcal) of carbohydrate intake was positively correlated with mean glucose levels (rho=0.88, P=0.023).
Conclusion
CGM enables categorization of individuals based on glucose profiles, and higher carbohydrate intake fluctuations are associated with poorer glycemic control. Personalized dietary strategies, particularly stabilizing carbohydrate intake, may support better glucose management in individuals with high mean glucose and low CV.
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Diabetes, obesity and metabolism
Distinct Pituitary-Adrenal Responses to Hypoglycemia in Type 1 and Type 2 Diabetes
Yun Hu, Reng-na Yan, Ting-ting Cai, Xiao-wei Zhu, Jian-hua Ma, Bo Ding
Endocrinol Metab. 2026;41(1):162-173.   Published online December 3, 2025
DOI: https://doi.org/10.3803/EnM.2025.2479
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Hypoglycemia remains a major barrier to optimal glycemic control in diabetes. Counter-regulatory hormonal responses, particularly those involving the pituitary and adrenal systems, play a central role in mitigating hypoglycemia, yet differences between diabetes subtypes are not well characterized. We aimed to investigate pituitary-target gland responses to hypoglycemia in patients with type 2 diabetes mellitus (T2DM) and type 1 diabetes mellitus (T1DM).
Methods
We enrolled drug-naive patients with newly diagnosed T2DM or T1DM, along with controls who did not have diabetes. Participants with diabetes received insulin pump therapy until normoglycemia was achieved. Hyperinsulinemic euglycemic-hypoglycemic clamps were then performed in all participants. Hormonal profiles of the pituitary-adrenal axis and C-peptide were serially measured during the clamps.
Results
During hypoglycemic clamps, C-peptide, thyroid-stimulating hormone, estradiol, and testosterone decreased, whereas prolactin, adrenocorticotropic hormone (ACTH), cortisol, and growth hormone (GH) increased significantly according to repeatedmeasures analysis of variance (ANOVA) (P<0.05 for all). Compared to controls and T2DM, patients with T1DM exhibited elevated basal GH (P=0.002) and an exaggerated GH response to hypoglycemia (P=0.002), with earlier onset and sustained elevation. In contrast, patients with T2DM showed higher ACTH (P=0.024) and cortisol (P=0.043) levels during hypoglycemia compared to controls and T1DM. Relative to the T1DM group, the T2DM group demonstrated lower testosterone and higher estradiol levels during hypoglycemia (P<0.001 for both).
Conclusion
Distinct diabetes subtypes demonstrate divergent pituitary-adrenal counter-regulatory responses to hypoglycemia, suggesting unique pathogenic mechanisms contributing to glycemic variability. The exaggerated GH response in T1DM may aggravate glucose fluctuations, whereas elevated ACTH and cortisol in T2DM could perpetuate insulin resistance.
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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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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
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.
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Diabetes, obesity and metabolism
Big Data Articles (National Health Insurance Service Database)
Impact of Glucose Metabolism Status on the Association between Apolipoprotein A-I and Ischemic Risk in Patients with Coronary Artery Disease: A Large-Sample Cohort Study
Kailun Yan, Jiawen Li, Kexin Zhang, Menglu Liu, Pei Zhu, Xiaofang Tang, Deshan Yuan, Yuejin Yang, Runlin Gao, Jinqing Yuan, Xueyan Zhao
Endocrinol Metab. 2025;40(6):904-915.   Published online November 7, 2025
DOI: https://doi.org/10.3803/EnM.2025.2407
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Apolipoprotein A-I (ApoA-I) is a key cardioprotective lipoprotein. Nevertheless, it remains unclear how ApoA-I relates to ischemic risk across glucose metabolism statuses in patients with coronary artery disease (CAD). This study investigated whether glucose metabolism status influences the association between ApoA-I and ischemic risk in CAD patients.
Methods
This cohort study included 10,724 consecutive CAD patients undergoing percutaneous coronary intervention, who were classified into diabetes mellitus (DM), pre-DM, and normal glucose regulation (NGR) groups. The primary clinical endpoint was major adverse cardiac and cerebrovascular event (MACCE), defined as a composite of all-cause death, myocardial infarction, revascularization, and stroke.
Results
Of the 10,232 patients ultimately included, 2,139 (20.9%) experienced MACCE over 5 years. A significant interaction was observed between ApoA-I levels and glucose metabolism status (P for interaction=0.041). In the DM group, an L-shaped association between ApoA-I and MACCE was found, with lower ApoA-I levels linked to a higher risk of MACCE (P for non-linearity= 0.044). Multivariate Cox regression analysis showed that patients in the lowest quintile of ApoA-I had a 1.327-fold increased risk of MACCE compared to those at the lowest risk (hazard ratio, 1.327; 95% confidence interval, 1.097 to 1.604). However, no significant association was observed in the pre-DM or NGR groups (both P>0.05).
Conclusion
This large-scale, 5-year follow-up study is the first to demonstrate that lower ApoA-I levels are associated with increased MACCE risk in CAD patients with DM, highlighting the potential value of ApoA-I in risk stratification and as a therapeutic target.
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Brief Report
Diabetes, obesity and metabolism
Early Dose Escalation of Tirzepatide after Switching from Semaglutide in Type 2 Diabetes Mellitus
Noboru Kurinami, Masafumi Takada, Seigo Sugiyama, Akira Yoshida, Kunio Hieshima, Tomoko Suzuki, Fumio Miyamoto, Keizo Kajiwara, Katsunori Jinnouchi, Kenji Ashida, Masatoshi Nomura, Hideaki Jinnouchi
Endocrinol Metab. 2025;40(6):1012-1015.   Published online October 15, 2025
DOI: https://doi.org/10.3803/EnM.2025.2420
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  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDFPubReader   ePub   
Tirzepatide has demonstrated greater efficacy than semaglutide in improving glycemic control and reducing body weight in patients with type 2 diabetes mellitus (T2DM). However, the optimal tirzepatide dose following a switch from 1.0 mg of semaglutide remains unclear. This retrospective study included 15 T2DM patients who switched to tirzepatide due to inadequate weight loss. All patients started tirzepatide at 2.5 mg, with escalation to either 7.5 mg (n=10) or 10 mg (n=5). Changes in glycated hemoglobin (HbA1c) and body weight were assessed over a 3-month period. The 10 mg group experienced a significant reduction in HbA1c (−0.7%±0.3%, P<0.01) and a non-significant trend toward weight loss (−6.6±5.4 kg, P=0.07). In contrast, no significant changes were observed in the 7.5 mg group. There were no statistically significant differences between groups. Since 10 mg of tirzepatide significantly improved glycemic control after switching from 1.0 mg of semaglutide, early escalation to 10 mg may be beneficial for patients who respond inadequately to semaglutide.

Citations

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  • Use of Semaglutide and Tirzepatide in Rheumatic and Musculoskeletal Diseases: Insights on Initiation Patterns and Weight Loss From the Rheumatology Informatics System for Effectiveness Registry
    Nicholas P. McCormick, Cristiano S. Moura, Jingyi Zhang, Emily E. Holladay, Fenglong Xie, Tapan Mehta, Joshua F. Baker, Jeffrey R. Curtis
    ACR Open Rheumatology.2026;[Epub]     CrossRef
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Original Articles
Diabetes, obesity and metabolism
Effects of Progranulin Deficiency on Inflammation and Fibrosis in the Kidneys and Liver of Diabetic Mice Fed a High-Fat Diet
Hiroko Sakuma, Maki Murakoshi, Shinji Hagiwara, Terumi Shibata, Yusuke Suzuki, Tomohito Gohda
Endocrinol Metab. 2026;41(1):138-151.   Published online September 30, 2025
DOI: https://doi.org/10.3803/EnM.2025.2339
  • 2,485 View
  • 90 Download
  • 3 Web of Science
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Progranulin (PGRN) is an important regulator of inflammation, insulin resistance, and autophagy. However, the effects of PGRN deficiency on these processes in the kidneys and liver in diabetes remain unclear. In addition, the differential effects of PGRN deficiency and sodium-glucose co-transporter-2 (SGLT2) inhibitors on these organs are unknown.
Methods
Three diabetic mouse models were used: high-fat diet and nicotinamide/streptozotocin-induced diabetic wild-type (WT) and PGRN-knockout (KO) mice (WT-diabetes mellitus [DM] and KO-DM, respectively) and WT-DM mice treated with an SGLT2 inhibitor (tofogliflozin; WT-DM/Tofo).
Results
Despite similar glycemic control in WT-DM/Tofo and KO-DM mice, expression of inflammation- and fibrosis-related genes in the kidneys was highest in WT-DM mice, lower in KO-DM mice, and lowest in WT-DM/Tofo mice. WT-DM/Tofo mice also showed increased anti-microtubule-associated protein 1A/1B-light chain 3B and decreased p62 protein levels compared with KO-DM mice. In contrast, hepatic mRNA levels related to inflammation and fibrosis were improved in both WT-DM/Tofo and KO-DM mice. Moreover, hepatic protein levels of peroxisome proliferator-activated receptor γ (PPARγ) were elevated in both groups compared with WT-DM mice, while those of PPARα were increased in WT-DM/Tofo mice compared with both WT-DM and KO-DM mice.
Conclusion
Kidney inflammation and fibrosis were ameliorated in WT-DM/Tofo mice, but these improvements were limited by autophagy insufficiency in KO-DM mice. Additionally, both WT-DM/Tofo and KO-DM mice demonstrated improved liver inflammation and fibrosis; in the former, this was associated with enhanced fatty acid oxidation via PPARα activation, while in the latter, it appeared to result from improved insulin sensitivity and anti-inflammatory effects through PPARγ activation.

Citations

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  • Effect of Tofogliflozin on Skeletal Muscle Mitochondrial Function in Male Diabetic Mice With Muscle Atrophy
    Chiaki Kishida, Maki Murakoshi, Hiroko Sakuma, Terumi Shibata, Yusuke Suzuki, Tomohito Gohda
    Journal of the Endocrine Society.2026;[Epub]     CrossRef
  • Progranulin Deficiency Improves Metabolic Stress Yet Falls Short of Sodium-Glucose Cotransporter-2 Inhibition in Autophagy-Linked Renal Protection
    Seung-Soon Im
    Endocrinology and Metabolism.2026; 41(1): 105.     CrossRef
  • SGLT2 Inhibitors as Systemic Metabolic Modulators: Linking Glucose Excretion to Liver Function Restoration
    Seung Wan Noh, Han Sol Ryu, Yong-Ho Kim, Byung-Chul Oh
    Endocrinology and Metabolism.2025; 40(6): 851.     CrossRef
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Diabetes, obesity and metabolism
Reduced Sphingosine-1-Phosphate Levels Exacerbate Type 2 Diabetes Mellitus and Associated Complications in a High-Fat Diet Mouse Model
Shih-Chang Hsu, Ching-Lu Chen, Chung Te Liu, Hung-Chieh Lo, Ying-Kuo Liu, Pei-Song Gao, Shau-Ku Huang, Chin-Wang Hsu
Endocrinol Metab. 2026;41(1):108-120.   Published online August 5, 2025
DOI: https://doi.org/10.3803/EnM.2025.2360
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Type 2 diabetes mellitus (T2DM) is increasingly prevalent and frequently associated with obesity, insulin resistance, nonalcoholic fatty liver disease, and chronic kidney disease. Emerging evidence suggests sphingosine-1-phosphate (S1P), a bioactive sphingolipid, plays a significant role in the pathogenesis of T2DM. This study aimed to investigate how reduced S1P levels impact T2DM development.
Methods
S1P lyase knock-in (S1PLC317A KI) mice, characterized by reduced S1P levels due to impaired S1P degradation, were compared with wild-type (WT) mice. Both groups were fed a high-fat diet (HFD) to induce T2DM. Parameters including body weight, insulin resistance, blood glucose levels, hepatic fat accumulation, and kidney pathology were evaluated. Next-generation sequencing was employed to identify differentially expressed genes.
Results
S1PLC317A KI mice exhibited greater body weight, more pronounced insulin resistance, and higher blood glucose levels compared to WT mice on an HFD. Increased hepatic fat deposition and worsened diabetic kidney disease were also observed in KI mice. Sequencing analysis identified 4,656 differentially expressed genes, notably enriched in mitochondrial and bioenergetic pathways, including 133 diabetes-related genes.
Conclusion
Reduced S1P levels exacerbate T2DM symptoms, indicating that therapeutic targeting of S1P pathways may offer promising strategies for treating T2DM and its related complications.
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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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  • 81 Download
  • 1 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
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
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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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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
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

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  • 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
  • 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
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Adrenal gland
Deep Learning-Based Adrenal Gland Volumetry for the Prediction of Diabetes
Eu Jeong Ku, Soon Ho Yoon, Seung Shin Park, Ji Won Yoon, Jung Hee Kim
Endocrinol Metab. 2025;40(6):991-1001.   Published online June 18, 2025
DOI: https://doi.org/10.3803/EnM.2025.2336
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
The long-term association between adrenal gland volume (AGV) and type 2 diabetes (T2D) remains unclear. We aimed to determine the association between deep learning-based AGV and current glycemic status and incident T2D.
Methods
In this observational study, adults who underwent abdominopelvic computed tomography (CT) for health checkups (2011–2012), but had no adrenal nodules, were included. AGV was measured from CT images using a three-dimensional nnU-Net deep learning algorithm. We assessed the association between AGV and T2D using a cross-sectional and longitudinal design.
Results
We used 500 CT scans (median age, 52.3 years; 253 men) for model development and a Multi-Atlas Labeling Beyond the Cranial Vault dataset for external testing. A clinical cohort included a total of 9708 adults (median age, 52.0 years; 5,769 men). The deep learning model demonstrated a dice coefficient of 0.71±0.11 for adrenal segmentation and a mean volume difference of 0.6± 0.9 mL in the external dataset. Participants with T2D at baseline had a larger AGV than those without (7.3 cm3 vs. 6.7 cm3 and 6.3 cm3 vs. 5.5 cm3 for men and women, respectively, all P<0.05). The optimal AGV cutoff values for predicting T2D were 7.2 cm3 in men and 5.5 cm3 in women. Over a median 7.0-year follow-up, T2D developed in 938 participants. Cumulative T2D risk was accentuated with high AGV compared with low AGV (adjusted hazard ratio, 1.27; 95% confidence interval, 1.11 to 1.46).
Conclusion
AGV, measured using deep learning algorithms, is associated with current glycemic status and can significantly predict the development of T2D.
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Diabetes, obesity and metabolism
Fatty Liver Index Dynamics as a Predictor of Hepatocellular Carcinoma in Patients with Type 2 Diabetes Mellitus and Non-Cirrhotic Livers
Eun-Hee Cho, Min Gu Kang, Chang Hun Lee, Shinyoung Oh, Chen Shen, Ha Ram Oh, Young Ran Park, Hyun Lee, Jong Seung Kim, Ji Hyun Park
Endocrinol Metab. 2025;40(6):883-892.   Published online May 29, 2025
DOI: https://doi.org/10.3803/EnM.2024.2286
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  • 120 Download
  • 1 Web of Science
  • 2 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Type 2 diabetes mellitus (T2DM) is a significant risk factor for hepatocellular carcinoma (HCC) in patients with nonalcoholic fatty liver disease; however, surveillance strategies for patients with T2DM, especially without cirrhosis, are inadequate. This study examined whether the fatty liver index (FLI) and its dynamic changes can effectively identify patients with T2DM at increased risk for HCC.
Methods
Data from 92,761 individuals with T2DM aged 40 to 79 who underwent two health screenings (2012 to 2015) were analyzed. The FLI, calculated using waist circumference, body mass index, triglycerides, and gamma-glutamyl transferase, was used to stratify patients by baseline FLI and FLI changes between screenings. HCC cases were identified via International Classification of Diseases codes and reimbursement records (2016 to 2020).
Results
Patients with baseline FLI of 30 to 59.9 had a 1.90-fold higher risk (P<0.01) and those with FLI ≥60 had a 2.94-fold higher risk (P<0.01) of developing HCC compared to those with FLI <30. An increase in FLI from <30 to ≥30 resulted in a 2.10-fold higher risk of HCC (P<0.01), while a reduction in FLI from ≥30 to <30 led to a 0.64-fold lower risk (P=0.03). Protective benefits of FLI reduction took approximately 3 years to manifest.
Conclusion
Baseline and dynamic monitoring of FLI effectively identified HCC risk in T2DM patients with non-cirrhotic livers, supporting early detection and intervention.

Citations

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  • Risk Assessment and Prediction of Hepatocellular Carcinoma in Noncirrhotic Metabolic Dysfunction-Associated Steatotic Liver Disease
    Emilie K. Mitten, Piero Portincasa, György Baffy
    International Journal of Molecular Sciences.2026; 27(7): 3241.     CrossRef
  • Impact of Fatty Liver Index on Cardiovascular Disease and Mortality across Alcohol Consumption Levels in Young Adults
    Byung-Hun Han, Joonyub Lee, Hun-Sung Kim, Jae-Hyoung Cho, Kyungdo Han, Seung-Hwan Lee
    Endocrinology and Metabolism.2026;[Epub]     CrossRef
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Diabetes, obesity and metabolism
Current Status of Delay in Injectable Therapy among Type 2 Diabetes Mellitus Patients in South Korea: Multicenter Retrospective Study (2015–2021)
Jong Han Choi, Min Kyong Moon, Hae Jin Kim, Kyung Ae Lee, Hyun Jin Kim, Jung Hae Ko, Jae-Seung Yun, Seung-Hyun Ko, Suk Chon, Nam Hoon Kim
Endocrinol Metab. 2025;40(5):727-736.   Published online May 29, 2025
DOI: https://doi.org/10.3803/EnM.2024.2280
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  • 1 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
We aimed to assess the therapeutic inertia associated with injectable therapies and the factors influencing glycemic control following these therapies in patients with type 2 diabetes mellitus (T2DM) in South Korea.
Methods
This multicenter, retrospective cohort study included 2,598 T2DM patients aged 20 to 75 years from 10 referral medical centers in South Korea. These patients had been treated with three or four oral antidiabetic drugs (OADs) and were subsequently initiated on insulin (n=1,942) or glucagon-like peptide-1 receptor agonists (GLP-1RAs, n=656) between January 2015 and December 2021. We analyzed the time to initiation of injectable therapy, changes in glycated hemoglobin (HbA1c), and associations between clinical factors and glycemic control.
Results
At the time of injectable therapy initiation, the mean HbA1c was 9.54%, with insulin users having a higher HbA1c level (9.79%) than GLP-1RA users (8.70%). The mean time from starting 3 or 4 OADs to initiating injectable therapy was 3.19 years: 53.5% of patients had started injectable therapy after 2 years, and 24.2% started after 5 years. Among insulin users, older age (P= 0.004), higher body mass index (P=0.035), and lower HbA1c levels at insulin initiation (P<0.001) were associated with better glycemic control. Among GLP-1RA users, only the HbA1c level at therapy initiation (P<0.001) was a significant factor.
Conclusion
This study highlighted significant delays in initiating injectable therapies, particularly insulin, in T2DM patients in South Korea. Early initiation of injectable therapy may improve long-term glycemic control in these patients.

Citations

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  • Bridging Evidence and Practice: A Consensus Statement from the Korean Diabetes Association on Diabetes Screening, Pharmacological Treatment and Severe Diabetes
    Jong Han Choi, Shinae Kang, Soo-Kyung Kim, Won Jun Kim, Ji Min Kim, Jaehyun Bae, Jae-Seung Yun, Eonju Jeon, Young-Eun Kim, Jae Hyun Bae, Hun Jee Choe, Young Min Cho, Seung-Hyun Ko, Sang Yong Kim, Hae Jin Kim, You-Cheol Hwang, Min Kyong Moon, Suk Chon, Seo
    Diabetes & Metabolism Journal.2025; 49(6): 1155.     CrossRef
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Diabetes, obesity and metabolism
Exploring Sex Differences in Type 2 Diabetes via a Male-Dominant Beta-Cell Cluster from Single-Cell Pancreatic Sequencing of Public Datasets
Nguyen Van Anh, Hyo-Wook Gil, Samel Park, Seongho Ryu
Endocrinol Metab. 2025;40(5):706-717.   Published online May 19, 2025
DOI: https://doi.org/10.3803/EnM.2025.2297
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  • 92 Download
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AbstractAbstract PDFPubReader   ePub   
Background
Type 2 diabetes is a complex metabolic disorder characterized by insulin resistance and progressive beta-cell dysfunction. Although sex differences in type 2 diabetes prevalence, progression, and complications have been reported, the molecular mechanisms underlying these differences remain largely unknown. We aimed to utilize single-cell RNA sequencing to identify a beta-cell cluster that is more prevalent in males than in females and exhibits distinct gene expression patterns, gene set enrichment profiles, and cell-cell communication compared to other clusters.
Methods
FASTQ files from four public datasets were preprocessed, aligned to the human genome (GRCh38), and integrated into a high-quality matrix to mitigate batch effects. We focused on beta-cells from type 2 diabetes patients, performed trajectory inference to identify clusters, and conducted differential gene expression and gene set enrichment analyses. These findings were validated using bulk RNA-seq datasets. Additionally, cell-cell communication analysis was performed to identify ligand-receptor interactions, followed by a sensitivity analysis to assess sex-specific differences.
Results
We identified a male-dominant beta-cell cluster (adjusted P value=4.2×10–6) that displayed unique gene expression patterns and downregulation of pathways associated with protein metabolism and insulin synthesis. Differentially expressed genes (e.g., interleukin 24 [IL24], regulator of G protein signaling like 1 [RGSL1]) were confirmed through bulk analysis. Moreover, the cluster demonstrated distinct communication patterns with other cell types, underscoring sex-specific differences.
Conclusion
We have identified a male-dominant beta-cell cluster characterized by distinct gene expression, signaling pathways, and cell interactions. These findings provide insights into the pathophysiology of type 2 diabetes and may inform the development of more effective, sex-specific therapeutic strategies in the future.

Citations

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  • Progenitor CD8+ T cells and hyper-Treg crosstalk: a driver of immune checkpoint inhibitor resistance in esophageal squamous cell carcinoma
    Suning Huang, Jingwei Yan, Wenqi Liu, Baijun Li
    Apoptosis.2026;[Epub]     CrossRef
  • Sex differences in animal models of complex disorders: Affective disorders, type 2 diabetes mellitus and essential hypertension
    Mai Abu-Moch, Abed N. Azab, Muhammad Yousef, Galila Agam
    Biomedicine & Pharmacotherapy.2026; 198: 119356.     CrossRef
  • Biological sex affects human islet gene expression and mitochondrial function in type 2 diabetes
    Sing-Young Chen, Haoning Howard Cen, Charlotte F Chao, Andrew R Pepper, James D Johnson, Elizabeth J Rideout
    Endocrinology.2026;[Epub]     CrossRef
  • Exploring Sex-Specific Mechanisms in Type 2 Diabetes Mellitus by Single-Cell Analysis in Pancreatic Islets
    Joonyub Lee
    Endocrinology and Metabolism.2025; 40(5): 699.     CrossRef
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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
  • 6,475 View
  • 109 Download
  • 3 Web of Science
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
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

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  • 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
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Review Article
Diabetes, obesity and metabolism
Prevalence and Current Status of Cardiometabolic Risk Factors in Korean Adults Based on Fact Sheets 2024
Eun-Jung Rhee
Endocrinol Metab. 2025;40(2):174-184.   Published online April 24, 2025
DOI: https://doi.org/10.3803/EnM.2025.2398
  • 5,867 View
  • 119 Download
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AbstractAbstract PDFPubReader   ePub   
Korea has entered ‘super-aged’ society in 2025 with the proportion of people 65 years or older exceeding 20% as of the end of the year 2024. The health burden of cardiovascular diseases increases with age, and the increasing prevalence of cardiovascular risk factors, such as obesity, hypertension, diabetes mellitus, and dyslipidemia, may be linked to increased population-level cardiovascular risk. According to data from 2022, the overall prevalence of obesity reached 38.4%, marking a continued upward trend, based on National Health Insurance medical checkup data. In the combined data of 2021 to 2022, the prevalence of diabetes was 15.5% in Koreans older than 30 years according to the Diabetes Fact Sheet 2024 published by the Korean Diabetes Association, based on data from the Korean National Health and Nutrition Examination Survey. The prevalence of hypertension in the total population of Korea in 2022 was 30% according to the Korean Hypertension Fact Sheet produced by the Korean Society of Hypertension. Lastly, the prevalence of dyslipidemia in 2022 was 40.9% according to the Dyslipidemia Fact Sheet published by the Korean Society of Lipid and Atherosclerosis. In this article, I would like to review the prevalence and current management of cardiovascular risk factors in Korea according to the fact sheets released by various associations in 2024.

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  • High incidence of eating disorders in individuals with type 2 diabetes and their association with cardiovascular and mortality risks
    So Hyun Cho, Seohyun Kim, Rosa Oh, Ji Yoon Kim, Myunghwa Jang, You-Bin Lee, Sang-Man Jin, Kyu Yeon Hur, Gyuri Kim, Jae Hyeon Kim
    Diabetologia.2026; 69(3): 653.     CrossRef
  • Epidemiology and characteristics of obesity in Koreans based on the 2024 Obesity Fact Sheet
    Eun-Jung Rhee
    Journal of the Korean Medical Association.2026; 69(1): 4.     CrossRef
  • Association Between Vitamin D Deficiency and Glycemic, Lipid, and Adiposity Markers in Older Adults: A Nationally Representative Study
    Yong-Joon Kim, Kyeongmin Jang
    Metabolites.2026; 16(4): 270.     CrossRef
  • 2024 Cardio-cerebrovascular disease fact sheet in Korea
    Kyungdo Han, Jin-Hyung Jung, Sang-Suk Choi, Seung-Hyun Ko
    Cardiovascular Prevention and Pharmacotherapy.2025; 7(3): 85.     CrossRef
  • Study of diastolic dysfunction in diabetic patients and its correlation with microalbuminuria
    Rishibha Kaushik, B. P. Priyadarshi, Lalit Kumar, Yuvraj Gulati, Madhuri Priyadarshi, S. K. Sinha
    International Journal of Advances in Medicine.2025; 12(5): 462.     CrossRef
  • Relationship Between Oral Function and Social Participation Among Community-Dwelling Older Adults: An Observational Cross-Sectional Study
    Mayu Takeda, Yuhei Matsuda, Takafumi Abe, Kazumichi Tominaga, Hisaaki Saito, Jun Shimizu, Norikuni Maeda, Ryouji Matsuura, Yukio Inoue, Yuichi Ando, Shozo Yano, Minoru Isomura, Takahiro Kanno
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  • Cardiometabolic Risk Factors Among Adults in a Rural Amazonian Peruvian Population
    Miguel A. Arce-Huamani, Gustavo A. Caceres-Cuellar, Anyela Y. Guevara-Paz, Cleofe R. Lopez-Quispe, Abhely K. Barzola-Blancas, Valeria A. Cespedes-Atto, Catherine G. Acosta-Celis, Katherine Pérez-Acuña, Williams Carrascal-Astola, J. Smith Torres-Roman
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  • Longitudinal associations of serum Irisin and adiponectin with incident metabolic syndrome in middle-aged and older adults over three years
    Yejin Kim, Hong Ji Song, Dong-Hyun Kim, Jin-Young Jeong, Kyung Hee Park, Jwa-Kyung Kim, Hye-Mi Noh
    Scientific Reports.2025;[Epub]     CrossRef
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Original Article
Diabetes, obesity and metabolism
Big Data Articles (National Health Insurance Service Database)
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
Endocrinol Metab. 2025;40(4):574-582.   Published online April 15, 2025
DOI: https://doi.org/10.3803/EnM.2024.2266
  • 6,711 View
  • 172 Download
  • 6 Web of Science
  • 8 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
This study aimed to assess whether markers of diabetes severity could serve as predictors for foot amputation risk among patients with type 2 diabetes mellitus.
Methods
We analyzed data from the nationally representative Korean National Health Insurance System database, tracking 2,544,077 patients with type 2 diabetes mellitus who participated in routine health check-ups between 2009 and 2012, with followup extending through the end of 2018. The parameters used to define the diabetes severity score encompassed diabetes duration, insulin usage, the number of oral glucose-lowering medications, the presence of chronic kidney disease, diabetic retinopathy, and cardiovascular disease. Each factor was assigned one point, yielding a cumulative severity score ranging from 0 to 6.
Results
The risk of diabetic foot amputation was predominantly predicted by insulin therapy, diabetic retinopathy, and a prolonged duration of diabetes. The hazard ratios for foot amputation increased with the severity score as follows: 2.31 (95% confidence interval [CI], 2.15 to 2.47) for a score of 1, 4.73 (95% CI, 4.42 to 5.07) for a score of 2, 8.86 (95% CI, 8.24 to 9.53) for a score of 3, 16.95 (95% CI, 15.60 to 18.4) for a score of 4, 23.98 (95% CI, 21.25 to 27.05) for a score of 5, and 37.87 (95% CI, 28.93 to 49.57) for a score of 6.
Conclusion
Specific markers of advanced diabetes effectively identified patients at an elevated risk for diabetic foot amputation.

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  • Costos directos y determinantes de las amputaciones en pacientes diabéticos en un hospital de Nicaragua en el año 2024.
    Sidley Irania Hurtado Alvarado, Sheila Karina Valdivia Quiroz
    Revista Multidisciplinaria Voces de América y el Caribe.2026; 3(1): 12.     CrossRef
  • Nationwide Big Data Studies of Endocrine Diseases Using the Korean National Health Information Database: Research Trends and Standardization of Operational Definitions
    Sun Wook Cho, Jung Hee Kim, Kyoung Jin Kim, Beom-Jun Kim, Mee Kyoung Kim, Eun Jung Rhee
    Endocrinology and Metabolism.2026; 41(1): 86.     CrossRef
  • Cardiovascular outcomes with thiazolidinediones and sodium-glucose cotransporter 2 inhibitors in patients with type 2 diabetes mellitus undergoing peripheral artery revascularization
    Ji Woong Roh, Jimin Jeon, Joonsang Yoo, Minyoul Baik, Seok-Jae Heo, Deok-Kyu Cho, Jinkwon Kim
    Diabetes Research and Clinical Practice.2026; 236: 113281.     CrossRef
  • Diabetes progression and its association with fracture risk in type 2 diabetes
    Bongsung Kim, Kyu-Na Lee, Kyungdo Han, Mee Kyoung Kim
    Osteoporosis International.2026;[Epub]     CrossRef
  • Development, validation, and pilot implementation of a prognostic model to predict future foot complications among people with diabetes recently discharged from hospital
    Surain B. Roberts, Anne Löffler, Dhanesh Ramachandram, Javier Garay-Fernandez, Maia Norman, Conrad Pow, Fahad Razak, Amol A. Verma, Charles de Mestral
    Journal of Clinical Epidemiology.2026; 195: 112295.     CrossRef
  • Hemoglobin-albumin-lymphocyte-platelet score associated with diabetic foot severity, unlike modified systemic immune-inflammatory index and modified systemic inflammatory response index
    Weiyu Pan, Zhaoyuan Nie, Qizhi Tang, Ling Zhao
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    Jin Yu, Bongseong Kim, Kyungdo Han, Mee Kyoung Kim
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    Renhe Deng, Ruyi Tao, Huiyi Luo, Yueqi Gu, Mengyu Yang, Chaoqi Yin
    Diabetology & Metabolic Syndrome.2025;[Epub]     CrossRef
Close layer
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
  • 32,217 View
  • 813 Download
  • 18 Web of Science
  • 28 Crossref
AbstractAbstract PDFPubReader   ePub   
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.

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Close layer
Original Articles
Diabetes, obesity and metabolism
Discrepancies in Dapagliflozin Response in Terms of Glycemic Control and Body Weight Reduction
Ji Eun Jun, Kyoung-Ah Kim, Nan-Hee Kim, Kwan-Woo Lee, In-Kyung Jeong, on Behalf of the BEYOND Investigators
Endocrinol Metab. 2025;40(2):278-288.   Published online March 19, 2025
DOI: https://doi.org/10.3803/EnM.2024.2142
  • 5,973 View
  • 154 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Dapagliflozin, a sodium-glucose cotransporter 2 inhibitor, reduces hyperglycemia and obesity by inhibiting renal glucose reabsorption. This post hoc study evaluated clinical factors influencing patient response to dapagliflozin.
Methods
The analysis focused on patients treated with dapagliflozin (10 mg/day for 52 weeks) within the randomized, double-blind, parallel-group BEYOND trial. Adequate glycemic control (GC) was defined as a reduction in glycated hemoglobin (HbA1c) of ≥ 1.0% or the achievement of an HbA1c level <7.0% at week 52. Significant weight loss (WL) referred to a reduction in body weight of ≥3.0% at week 52. Participants were classified into four groups based on their GC and WL responses: GC+/WL+, GC+/WL−, GC−/WL+, and GC−/WL−.
Results
Among dapagliflozin recipients (n=56), at 52 weeks, HbA1c had decreased by 1.0%±0.8% from baseline, while body weight had declined by 2.4±3.1 kg. Overall, 69.6% of participants achieved GC+, and 57.1% achieved WL+. Male sex and shorter diabetes duration were significantly associated with achieving GC+. Conversely, higher estimated glomerular filtration rate was significantly linked to WL+. The only factor significantly associated with both GC+ and WL+ was shorter diabetes duration (odds ratio, 0.81; 95% confidence interval, 0.68 to 0.97; P=0.023). The GC+ and WL+ groups exhibited favorable responses beginning soon after dapagliflozin therapy was initiated. Furthermore, HbA1c decline was more strongly associated with reduction in visceral fat than with WL.
Conclusion
A short duration of diabetes and early response to treatment appear to represent key factors in maximizing the benefits of dapagliflozin for blood glucose and weight management.

Citations

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  • Sodium‐glucose cotransporter 2 inhibitor ameliorates thiazolidinedione‐induced fluid retention through vascular leakage reduction in white adipose tissue
    Ji Yoon Kim, Hye‐Min Jang, Hye‐Jin Lee, Ah Hyeon Lee, Dong‐Hoon Kim, Sin Gon Kim, Nam Hoon Kim
    Diabetes, Obesity and Metabolism.2026; 28(3): 1764.     CrossRef
  • A Pre‐Post Assessment of Blood Glucose Control Following Pharmacist‐Led Professional Continuous Glucose Monitoring in Rhode Island Primary Care Practices
    Kelley Doherty Sanzen, Natalya S. Salganik, Susanne M. Campbell, Carolyn A. Karner, Pano M. Yeracaris, Stephen J. Kogut
    JACCP: JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY.2026;[Epub]     CrossRef
  • Identification of IL18/IL18R1 signaling as a predictive biomarker of SGLT2 inhibitor efficacy in type 2 diabetes
    I-Jou Teng, Chien-Hsing Lee, Ying-Chen Chen, Sheng-Chiang Su, Chieh-Hua Lu, Peng-Fei Li, Chia-Luen Huang, Li-Ju Ho, Ming-Hsun Lin, Hsin-Ya Liu, Feng-Chih Kuo
    iScience.2025; 28(10): 113594.     CrossRef
Close layer
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
  • 7,110 View
  • 259 Download
  • 9 Web of Science
  • 10 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
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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    Yu Hua, Shaoxing Li, Yuan Jiang, Jinwang Liu
    Journal of Orthopaedic Surgery.2026;[Epub]     CrossRef
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    Hongfei Yang, Chao Sun, Ya Li, You Zhou, Rui Wang, Yingxue Li, Marwan Salih Al-Nimer
    PLOS One.2026; 21(2): e0342154.     CrossRef
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    Yu Zhou, Yuhang Wang, Jingxi Chen, Lai Jiang, Ran Chu, Weiwei Tian, Jiaxin Wang, Yin Liu, Jing Gao
    Frontiers in Nutrition.2026;[Epub]     CrossRef
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    E. Carretero-Anibarro, D. Orozco-Beltran
    Primary Care Diabetes.2026; 20(3): 292.     CrossRef
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    Ji Yoon Kim, Seohyun Kim, Jae Hyeon Kim
    Diabetologia.2026; 69(7): 1858.     CrossRef
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    Kehuang Li, Zhiwei Liu, Liang Sun, Jingjing Zhang, Xinglong Yin, Zhaokun Zhang, Changjie Cao
    Frontiers in Psychiatry.2026;[Epub]     CrossRef
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    Blessing Kenechi Myke-Mbata, Bruno Basil, Izuchukwu Nnachi Mba, Terna Gav Ambrose
    International Journal of Research in Medical Sciences.2026; 14(5): 1812.     CrossRef
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    Jang Won Son
    Endocrinology and Metabolism.2025; 40(4): 545.     CrossRef
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    Jiajun Liu, Jinhua Kang, Pengpeng Liang, Zhangxiao Song, Guiyun Li, Xueshan Jin, Hongyan Wu
    Cardiovascular Diabetology.2025;[Epub]     CrossRef
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    Nazif Yalçın, Nizameddin Koca
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Close layer
Diabetes, obesity and metabolism
Prevalence of Mortality and Vascular Complications in Older Patients with Diabetes in Korea
Kwang Joon Kim, Jeongmin Lee, Yang Sun Park, Yong-ho Lee, Kyeong Hye Park, Hee-Won Jung, Chang Oh Kim, Man Young Park, Hun-Sung Kim, Bong-Soo Cha
Endocrinol Metab. 2025;40(3):448-458.   Published online February 18, 2025
DOI: https://doi.org/10.3803/EnM.2024.2173
  • 4,988 View
  • 116 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
This study investigated the prevalence of diabetes mellitus (DM) and impaired fasting glucose, as well as their management and comorbidities among older Korean adults.
Methods
Data from 269,447 individuals aged 65 years and older from the Korean National Health Insurance Service between 2000 and 2019 were analyzed to evaluate trends in DM prevalence, healthcare utilization, mortality, and complications.
Results
Among 269,447 individuals, 18.6% (n=50,159/269,447) were diagnosed with DM and 27.0% (n=72,670/269,447) had impaired fasting glucose. The DM group had the highest body mass index, waist circumference, and prevalence of current smokers (P<0.001) but not the highest hypertension prevalence. From 2010 to 2019, the prevalence of DM and impaired fasting glucose increased from 15.5% to 21.9% and from 26.0% to 30.6%, respectively. Cancer-related mortality in DM was 1.15 times higher than in those with normal glucose tolerance (P<0.001), and cardiovascular disease-related mortality was 1.32 times higher (P<0.001); all mortalities were higher in female participants. Myocardial infarction (hazard ratio [HR], 1.34; P<0.001), stroke (HR, 1.24; P<0.001), and heart failure (HR, 1.13; P<0.001) were significantly higher in those with DM.
Conclusion
This is the first study to investigate the prevalence of DM and related complications in older individuals based on longterm representative data in Korea. These results highlight the necessity for targeted interventions to enhance management and outcomes in this population.

Citations

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  • Efficacy and safety of switching to ezetimibe 10 mg/rosuvastatin 2.5 mg in Korean patients with type 2 diabetes mellitus and dyslipidaemia: A multicentre, prospective study (EROICA study)
    Sangmo Hong, Won J. Kim, Sungrae Kim, Jung H. Park, Eun S. Kang, Min K. Moon, Jae T. Kim, Ji‐Oh Mok, Ki Y. Lee, Cheol‐Young Park, Chang B. Lee
    Diabetes, Obesity and Metabolism.2026; 28(2): 906.     CrossRef
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Diabetes, obesity and metabolism
Big Data Articles (National Health Insurance Service Database)
Time to Insulin Therapy and Severe Hypoglycemia in Korean Adults Initially Diagnosed with Type 2 Diabetes: A Nationwide Study
You-Bin Lee, Kyungdo Han, Bongsung Kim, So Hee Park, Kyu Yeon Hur, Gyuri Kim, Jae Hyeon Kim, Sang-Man Jin
Endocrinol Metab. 2025;40(3):421-433.   Published online February 4, 2025
DOI: https://doi.org/10.3803/EnM.2024.2082
  • 4,203 View
  • 99 Download
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
We examined the distribution of time to insulin therapy (TIT) post-diabetes diagnosis and the hazard of severe hypoglycemia (SH) according to TIT in Korean adults initially diagnosed with type 2 diabetes (T2D) and who progressed to insulin therapy.
Methods
Using data from the Korean National Health Insurance Service (2002 to 2018), we selected adult incident insulin users (initially diagnosed as T2D) who underwent health examinations between 2009 and 2012. The hazards of SH, recurrent SH, and problematic hypoglycemia were analyzed according to groups categorized using the TIT and clinical risk factors for SH (TIT ≥5 years with risk factors, TIT ≥5 years without risk factors, 3 ≤TIT <5 years, 1 ≤TIT <3 years, and TIT <1 year).
Results
Among 41,637 individuals, 14,840 (35.64%) and 10,587 (25.43%) initiated insulin therapy within <5 and <3 years postdiabetes diagnosis, respectively. During a median 6.53 years, 3,406 SH events occurred. Compared to individuals with TIT ≥5 years and no risk factor for SH, individuals with TIT <3 years had higher outcome hazards in a graded manner (adjusted hazard ratio [95% confidence intervals] for any SH: 1.117 [0.967 to 1.290] in those with 3 ≤TIT <5 years; 1.459 [1.284 to 1.657] in those with 1 ≤ TIT <3 years; and 1.515 [1.309 to 1.754] in those with TIT <1 year). This relationship was more pronounced in the non-obese subpopulation.
Conclusion
Among adults who progressed to insulin therapy after being diagnosed with T2D, a shorter TIT was not uncommon and may predict an increased risk of SH, particularly in non-obese patients.
Close layer
Review Article
Diabetes, obesity and metabolism
Evolving Characteristics of Type 2 Diabetes Mellitus in East Asia
Joonyub Lee, Kun-Ho Yoon
Endocrinol Metab. 2025;40(1):57-63.   Published online January 15, 2025
DOI: https://doi.org/10.3803/EnM.2024.2193
  • 8,497 View
  • 218 Download
  • 12 Web of Science
  • 13 Crossref
AbstractAbstract PDFPubReader   ePub   
In East Asians, type 2 diabetes mellitus (T2DM) is primarily characterized by significant defects in insulin secretion and comparatively low insulin resistance. Recently, the prevalence of T2DM has rapidly increased in East Asian countries, including Korea, occurring concurrently with rising obesity rates. This trend has led to an increase in the average body mass index among East Asian T2DM patients, highlighting the influence of insulin resistance in the development of T2DM within this group. Currently, the incidence of T2DM in Korea is declining, which may indicate potential adaptive changes in insulin secretory capacity. This review focuses on the changing epidemiology of T2DM in East Asia, with a particular emphasis on the characteristics of peak functional β-cell mass.

Citations

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  • Lobeglitazone improves glycaemic control as add‐on therapy to empagliflozin plus metformin in patients with type 2 diabetes mellitus: A double‐blind, randomised, placebo‐controlled trial
    Da Hea Seo, Kyung Wan Min, Ho Sang Sohn, Sang Yong Kim, In‐Kyung Jeong, Cheol‐Young Park, Kun‐Ho Yoon, So Hun Kim, Bong‐Soo Cha
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    Bohari Bohari, Rimbawan Rimbawan, Zuraidah Nasution, Ekowati Handharyani
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    Hirotaka Watada, Shiro Tanaka, Jessica Y. Matuoka, Hamza Alshannaq, Richard F. Pollock, Martin Field, Gregory J. Norman
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    Paul Kim, Minji Kang, Hyunji Sang, Sang Youl Rhee, Hyunjung Lim
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    Ji-Won Kim, Joonyub Lee, Young-Hye You, Chan-Hee Oh, Heon-Seok Park, Eun Young Lee, Seung-Hwan Lee, Seung-Hyun Ko, Ji-Ho Park, Kun-Ho Yoon
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    Joonyub Lee
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Original Articles
Diabetes, obesity and metabolism
Tirzepatide and Cancer Risk in Individuals with and without Diabetes: A Systematic Review and Meta-Analysis
A.B.M. Kamrul-Hasan, Muhammad Shah Alam, Deep Dutta, Thanikai Sasikanth, Fatema Tuz Zahura Aalpona, Lakshmi Nagendra
Endocrinol Metab. 2025;40(1):112-124.   Published online January 15, 2025
DOI: https://doi.org/10.3803/EnM.2024.2164
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  • 794 Download
  • 15 Web of Science
  • 18 Crossref
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Background
Data on the carcinogenic potential of tirzepatide from randomized controlled trials (RCTs) are limited. Furthermore, no meta-analysis has included all relevant RCTs to assess the cancer risk associated with tirzepatide.
Methods
RCTs involving patients receiving tirzepatide in the intervention arm and either a placebo or any active comparator in the control arm were searched through electronic databases. The primary outcome was the overall risk of any cancer, and secondary outcomes were the risks of specific types of cancer in the tirzepatide versus the control groups.
Results
Thirteen RCTs with 13,761 participants were analyzed. Over 26 to 72 weeks, the tirzepatide and pooled control groups had identical risks of any cancer (risk ratio, 0.78; 95% confidence interval, 0.53 to 1.16; P=0.22). The two groups had comparable cancer risks in patients with and without diabetes. In subgroup analyses, the risks were also similar in the tirzepatide versus placebo, insulin, and glucagon-like peptide-1 receptor agonist groups. The overall cancer risk was also comparable for different doses of tirzepatide compared to the control groups; only a 10-mg tirzepatide dose had a lower risk of any cancer than placebo. Furthermore, compared to the control groups (pooled or separately), tirzepatide did not increase the risk of any specific cancer types. Despite greater increments in serum calcitonin with 10- and 15-mg tirzepatide doses than with placebo, the included RCTs reported no cases of papillary thyroid carcinoma.
Conclusion
Tirzepatide use in RCTs over 26 to 72 weeks did not increase overall or specific cancer risk.

Citations

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  • The efficacy and safety of dual GIP/GLP1 receptor agonists (tirzepatide) in diabetes and obesity: a systematic review and network meta-analysis
    Karolina Hoffmann, Michał Michalak, Manfredi Rizzo, Viviana Maggio, Anna Paczkowska
    Expert Opinion on Drug Safety.2026; 25(6): 1031.     CrossRef
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    Arya Singh, Rahnuma Ahmad, Kona Chowdhury, Mahendra Narwaria, Mainul Haque
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  • Tirzepatide and Cardiovascular Outcomes: A Narrative Review of Mechanisms, Efficacy and Implications for Heart Failure Management
    Hamza A. Abdul‐Hafez, Ameer Awashra, Sosana Bdir, Sarah Saife, Qasem Salah, Mohammed Barbarawi, Thabet Swaileh, Ahmed Emara, Mohamed S. Elgendy, Abdalhakim Shubietah
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    Edoardo Mannucci, Ilaria Dicembrini
    Nature Reviews Clinical Oncology.2026; 23(6): 459.     CrossRef
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    Naseem Eisa, Omar Barood
    AACE Endocrinology and Diabetes.2026; 13(3): 400.     CrossRef
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    Sedat Arslan, Ayca Aydin
    Academia Oncology.2026;[Epub]     CrossRef
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    R. Modica, A. Liccardi, V. Zamponi, A. Gagliardi, A. Nistor, G. Veroi, A. Arecco, A. Faggiano, A. Colao
    Endocrine.2026;[Epub]     CrossRef
  • Short-term effect of tirzepatide on serum calcitonin in adults with obesity
    Nikolaos Angelopoulos, George Simeakis, Ioannis Androulakis, Andreas Rizoulis, Anastasios Boniakos, Paraskevi Mentzelopoulou, Areti Korakovouni, Dimitra Zianni, Valentina Petkova, Sarantis Livadas, Rodis Paparodis
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    Maria Lastra Cagigas, Isabella De Ciutiis, Andrius Masedunskas, Luigi Fontana
    Trends in Endocrinology & Metabolism.2025; 36(6): 521.     CrossRef
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    Isabelle R. Miousse
    American Journal of Physiology-Cell Physiology.2025; 328(6): C1822.     CrossRef
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    Jan Brož
    Vnitřní lékařství.2025; 71(3): 144.     CrossRef
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    Michaela Luconi, Giulia Cantini, Clara Crescioli
    Trends in Cancer.2025; 11(7): 691.     CrossRef
  • Impact of 1-Year Tirzepatide Use on Glycemic and Metabolic Profile in Overweight to Obese People with Type 1 Diabetes: A Systematic Review and Meta-Analysis
    Deep Dutta, Abul Bashar Mohammad Kamrul-Hasan, Ritin Mohindra, Nishant Raizada
    Diabetes Technology and Obesity Medicine.2025;[Epub]     CrossRef
  • Obesity and Pancreatic Diseases: From Inflammation to Oncogenesis and the Impact of Weight Loss Interventions
    Mariana Souto, Tiago Cúrdia Gonçalves, José Cotter
    Nutrients.2025; 17(14): 2310.     CrossRef
  • Weight loss interventions and obesity‐associated cancers in people with type 2 diabetes and overweight/obesity: A real‐world observational study
    Testimony Ipaye, Jonathan Goldney, Thomas J. Wilkinson, Francesco Zaccardi, Thomas Yates, Melanie J. Davies, Karen Brown, Dimitris Papamargaritis
    Diabetes, Obesity and Metabolism.2025; 27(12): 6914.     CrossRef
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    Estefania Valencia-Rincón, Rajani Rai, Vishal Chandra, Elizabeth A. Wellberg
    Journal of Clinical Investigation.2025;[Epub]     CrossRef
  • Precision obesity medicine: A phenotype-guided framework for pharmacologic therapy across the lifespan
    Dario Tuccinardi, Davide Masi, Mikiko Watanabe, Valeria Zanghi Buffi, Francesco De Domenico, Sabrina Berti, Valentina Cipriani, Melania Manco, Silvia Manfrini, Uberto Pagotto
    Journal of Endocrinological Investigation.2025; 48(12): 2761.     CrossRef
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    Ping-Tao Tseng, Bing-Yan Zeng, Chih-Wei Hsu, Cheuk-Kwan Sun, Mein-Woei Suen, Andre F. Carvalho, Brendon Stubbs, Yen-Wen Chen, Tien-Yu Chen, Wei-Te Lei, Po-Huang Chen, Jiann-Jy Chen, Yow-Ling Shiue, Bing-Syuan Zeng, Kuan-Pin Su, Chih-Sung Liang
    Journal of Hematology & Oncology.2025;[Epub]     CrossRef
Close layer
Diabetes, obesity and metabolism
Effectiveness and Safety of Oral Quadruple Combination Therapy in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis
Jaehyun Bae, Min Heui Yu, Minyoung Lee, Bong-Soo Cha, Byung-Wan Lee
Endocrinol Metab. 2025;40(2):258-267.   Published online January 13, 2025
DOI: https://doi.org/10.3803/EnM.2024.2120
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  • 215 Download
  • 4 Web of Science
  • 5 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Achieving optimal glucose control is essential in the management of type 2 diabetes (T2D). This study aimed to evaluate the effectiveness and safety of oral quadruple combination therapy for the treatment of T2D.
Methods
This meta-analysis reviewed original research on oral quadruple combination therapy for T2D, including both experimental and observational studies with a minimum duration of 12 weeks. The primary endpoint was the change in glycated hemoglobin (HbA1c) from baseline to follow-up. The secondary endpoint was the incidence rate of adverse events. Two investigators independently extracted data and assessed the risk of bias. Outcomes were pooled as the standardized mean difference (using Hedge’s g) and the risk ratio for adverse events in random-effects meta-analyses.
Results
The meta-analysis included 17 studies. Oral quadruple combination therapy resulted in an additional mean reduction in HbA1c levels of 1.1% in patients who did not achieve glycemic control with oral triple combination therapy. Compared with switching to injectables, such as insulin or a glucagon-like peptide-1 receptor agonist–containing regimen, this therapy was non-inferior, even demonstrating a slightly superior glucose-lowering effect. Furthermore, it was determined to be safe, with an adverse event rate of 0.25, indicating no significant difference in safety compared with adding a placebo or switching to an injectable-containing regimen.
Conclusion
Oral quadruple combination therapy is a valid option for patients with T2D who are unable to achieve glycemic targets with oral triple combination therapy, offering both effective glycemic control and a favorable safety profile.

Citations

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  • Efficacy and safety of adding a fourth oral antidiabetic drug versus metformin dose escalation in patients with type 2 diabetes inadequately controlled on triple oral combination therapy (EFFORT): A 24‐week, randomized, open‐label, multicenter trial
    So Ra Kim, Jun Hwa Hong, Sin Gon Kim, Soo‐Kyung Kim, Hyuk‐Sang Kwon, Jun Sung Moon, Jung Hwan Park, Jae Myung Yu, Bong‐Soo Cha, Byung‐Wan Lee
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    Shinae Kang, Seon Mee Kang, Jong Han Choi, Seung-Hyun Ko, Bo Kyung Koo, Hyuk-Sang Kwon, Mi Kyung Kim, Sang Yong Kim, Soo-Kyung Kim, Young-eun Kim, Eun Sook Kim, Jae Hyeon Kim, Chong Hwa Kim, Ji Min Kim, Hae Jin Kim, Min Kyong Moon, Sun Joon Moon, Jun Sung
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    Ancuța Dinu (Iacob), Luminita-Georgeta Confederat, Ionut Dragostin, Ionela Daniela Morariu, Dana Tutunaru, Oana-Maria Dragostin
    Current Issues in Molecular Biology.2025; 47(9): 709.     CrossRef
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Brief Report
Diabetes, obesity and metabolism
Metabolic Consequences of Glucagon-Like Peptide-1 Receptor Agonist Shortage: Deterioration of Glycemic Control in Type 2 Diabetes
Hun Jee Choe, Michael A. Nauck, Joon Ho Moon
Endocrinol Metab. 2025;40(1):156-160.   Published online November 25, 2024
DOI: https://doi.org/10.3803/EnM.2024.2150
  • 5,583 View
  • 116 Download
  • 5 Web of Science
  • 6 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
In the context of a global shortage of glucagon-like peptide-1 (GLP-1) receptor agonists, we assessed the impact of discontinuing dulaglutide on metabolic control in individuals with type 2 diabetes. Our analysis included data from 69 individuals and revealed a significant deterioration in glycemic control following the discontinuation. Specifically, the average hemoglobin A1c level increased from 7.0%±0.9% to 8.1%±1.4% (P<0.001), and fasting glucose levels rose from 129±31 to 156±50 mg/dL (P<0.001) within 3 months after stopping the medication. Alternative treatments such as dipeptidyl peptidase-4 inhibitors and sodium glucose cotransporter- 2 inhibitors were insufficient substitutes, highlighting the essential role of continuous GLP-1 receptor agonist therapy in maintaining metabolic health.

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  • Assessing the Impact of Glucagon-like Peptide-1 and Glucagon-like Peptide-1/glucose-dependent Insulinotropic Polypeptide Receptor Agonist Shortages on Glycemic Control: A Single Center Study
    Christian Dacon, Pramodini Kale-Pradhan, Melissa Lipari
    Journal of Pharmacy Practice.2026;[Epub]     CrossRef
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    Velimir Altabas, Zrinka Orlović, Maja Baretić
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    Alessandra T. Ayers, Cindy N. Ho, Nicole Y. Xu, Sergio D. Bergese, Ana Costa, David Kerr, David C. Klonoff
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    Afsaneh Shirani, Olaf Stuve
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Original Articles
Diabetes, obesity and metabolism
Big Data Articles (National Health Insurance Service Database)
Risk of Diabetes Mellitus in Adults with Intellectual Disabilities: A Nationwide Cohort Study
Hye Yeon Koo, In Young Cho, Yoo Jin Um, Yong-Moon Mark Park, Kyung Mee Kim, Chung Eun Lee, Kyungdo Han
Endocrinol Metab. 2025;40(1):103-111.   Published online November 20, 2024
DOI: https://doi.org/10.3803/EnM.2024.2126
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  • 123 Download
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Intellectual disability (ID) may be associated with an increased risk of diabetes mellitus (DM). However, evidence from longitudinal studies is scarce, particularly in Asian populations.
Methods
This retrospective cohort study used representative linked data from the Korea National Disability Registration System and the National Health Insurance Service database. Adults (≥20 years) who received a national health examination in 2009 (3,385 individuals with ID and 3,463,604 individuals without ID) were included and followed until 2020. ID was identified using legal registration information. Incident DM was defined by prescription records with relevant diagnostic codes. Multivariable-adjusted Cox proportional hazards regression models were used to estimate the adjusted hazard ratio (aHR) and 95% confidence interval (CI) for DM risks in individuals with ID compared to those without ID.
Results
Over a mean follow-up of 9.8 years, incident DM occurred in 302 (8.9%) individuals with ID and 299,156 (8.4%) individuals without ID. Having ID was associated with increased DM risk (aHR, 1.38; 95% CI, 1.23 to 1.55). Sensitivity analysis confirmed a higher DM risk in individuals with ID (aHR, 1.39; 95% CI, 1.24 to 1.56) than those with other disabilities (aHR, 1.11; 95% CI, 1.10 to 1.13) or no disability (reference). Stratified analysis showed higher DM risk in non-hypertensive subjects (aHR, 1.63; 95% CI, 1.43 to 1.86) compared to hypertensive subjects (aHR, 1.00; 95% CI, 0.80 to 1.26; P for interaction <0.001).
Conclusion
Adults with ID have an increased risk of developing DM, highlighting the need for targeted public health strategies to promote DM prevention in this population.
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Diabetes, obesity and metabolism
Importance of the Hemoglobin Glycation Index for Risk of Cardiovascular and Microvascular Complications and Mortality in Individuals with Type 2 Diabetes
Claudia Regina Lopes Cardoso, Nathalie Carvalho Leite, Gil Fernando Salles
Endocrinol Metab. 2024;39(5):732-747.   Published online October 15, 2024
DOI: https://doi.org/10.3803/EnM.2024.2001
  • 5,405 View
  • 97 Download
  • 14 Web of Science
  • 11 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
This study investigated the prognostic importance of the hemoglobin glycation index (HGI) for macrovascular and microvascular outcomes, mortality, and hypoglycemia occurrence in a type 2 diabetes cohort and compared it to glycated hemoglobin (HbA1c).
Methods
Baseline and mean first-year HGI and HbA1c, and the variability thereof, were assessed in 687 individuals with type 2 diabetes (median follow-up, 10.6 years). Multivariable Cox regression was conducted to evaluate the associations of HGI and HbA1c parameters with macrovascular (total and major cardiovascular events) and microvascular outcomes (microalbuminuria, advanced renal failure, retinopathy, and peripheral neuropathy), mortality (all-cause and cardiovascular), and moderate/severe hypoglycemia occurrence.
Results
During follow-up, there were 215 total cardiovascular events (176 major) and 269 all-cause deaths (131 cardiovascular). Microalbuminuria developed in 126 patients, renal failure in 104, retinopathy in 161, and neuropathy in 177. There were 90 hypoglycemia episodes. Both HGI and HbA1c predicted all adverse outcomes, except microalbuminuria and hypoglycemia. Their adjusted risks were roughly equivalent for all outcomes. For example, the adjusted hazard ratios (HRs) with 95% confidence intervals (CIs), estimated for 1 standard deviation increments, of mean first-year HGI were 1.23 (1.05 to 1.44), 1.20 (1.03 to 1.38), 1.36 (1.11 to 1.67), 1.28 (1.09 to 1.67), and 1.29 (1.09 to 1.54), respectively, for cardiovascular events, all-cause mortality, renal failure, retinopathy, and neuropathy; whereas the respective HRs (95% CIs) of mean HbA1c were 1.31 (1.12 to 1.53), 1.28 (1.11 to 1.48), 1.36 (1.11 to 1.67), 1.33 (1.14 to 1.55), and 1.29 (1.09 to 1.53).
Conclusion
HGI was no better than HbA1c as a predictor of adverse outcomes in individuals with type 2 diabetes, and its clinical use cannot be currently advised.

Citations

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Review Article
Diabetes, obesity and metabolism
Changes in the Epidemiological Landscape of Diabetes in South Korea: Trends in Prevalence, Incidence, and Healthcare Expenditures
Kyoung Hwa Ha, Dae Jung Kim
Endocrinol Metab. 2024;39(5):669-677.   Published online September 25, 2024
DOI: https://doi.org/10.3803/EnM.2024.2073
  • 17,941 View
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  • 13 Web of Science
  • 15 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Diabetes is a serious public health concern that significantly contributes to the global burden of disease. In Korea, the prevalence of diabetes is 12.5% among individuals aged 19 and older, and 14.8% among individuals aged 30 and older as of 2022. The total number of people with diabetes among those aged 19 and older is estimated to be 5.4 million. The incidence of diabetes decreased from 8.1 per 1,000 persons in 2006 to 6.3 per 1,000 persons in 2014, before rising again to 7.5 per 1,000 persons in 2019. Meanwhile, the incidence of type 1 diabetes increased significantly, from 1.1 per 100,000 persons in 1995 to 4.8 per 100,000 persons in 2016, with the prevalence reaching 41.0 per 100,000 persons in 2017. Additionally, the prevalence of gestational diabetes saw a substantial rise from 4.1% in 2007 to 22.3% in 2023. These changes have resulted in increases in the total medical costs for diabetes, covering both outpatient and inpatient services. Therefore, effective diabetes prevention strategies are urgently needed.

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Close layer
Original Article
Diabetes, obesity and metabolism
Impact of Chronic Kidney Disease and Gout on End-Stage Renal Disease in Type 2 Diabetes: Population-Based Cohort Study
Inha Jung, Da Young Lee, Seung Min Chung, So Young Park, Ji Hee Yu, Jun Sung Moon, Ji A Seo, Kyungdo Han, Nan Hee Kim
Endocrinol Metab. 2024;39(5):748-757.   Published online August 30, 2024
DOI: https://doi.org/10.3803/EnM.2024.2020
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
We examined the impact of gout on the end-stage renal disease (ESRD) risk in patients with type 2 diabetes mellitus (T2DM) and determined whether this association differs according to chronic kidney disease (CKD) status.
Methods
Using the Korean National Health Insurance Service, this nationwide cohort study enrolled 847,884 patients with T2DM who underwent health checkups in 2009. Based on the presence of CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2) and gout (two outpatient visits or one hospitalization within 5 years), patients were classified into four groups: CKDGout, CKD Gout+, CKD+Gout, and CKD+Gout+. Patients with incident ESRD were followed up until December 2018.
Results
Among 847,884 patients, 11,825 (1.4%) experienced progression to ESRD. ESRD incidence increased in the following order: 0.77 per 1,000 person-years (PY) in the CKDGout group, 1.34/1,000 PY in the CKDGout+ group, 8.20/1,000 PY in the CKD+Gout group, and 23.06/1,000 PY in the CKD+Gout+ group. The presence of gout modified the ESRD risk in a status-dependent manner. Hazard ratios (HR) were 1.49 (95% confidence interval [CI], 1.32 to 1.69) and 2.24 (95% CI, 2.09 to 2.40) in patients without and with CKD, respectively, indicating a significant interaction (P<0.0001). The CKD+Gout+ group had a markedly higher risk of developing ESRD (HR, 18.9; 95% CI, 17.58 to 20.32) than the reference group (CKDGout).
Conclusion
Gout substantially enhances the risk of ESRD, even in the absence of CKD. Concurrent CKD and gout synergistically increase the risk of ESRD. Therefore, physicians should carefully screen for hyperuricemia to prevent progression to ESRD.

Citations

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  • Undescribed phenylspirodrimane dimers with anti-gouty activity from the coral-derived fungus Stachybotrys chartarum
    Shuang Lin, Yi-Fan Geng, Hanxiao Zeng, Zixue Chai, Baolei Fan, Jun-Cheng Su, Yonghui Zhang, Zhengxi Hu
    Phytochemistry.2026; 248: 114891.     CrossRef
  • Gout in the era of multimorbidity: pathogenesis, systemic comorbidities, and evolving therapeutic strategies
    Phillip J Kim, Jihun Kang, Jesang Yu, Geun-Tae Kim, Yunkyung Kim
    Kosin Medical Journal.2026; 41(1): 26.     CrossRef
  • Acute gout attack in a peritoneal dialysis patient treated with Firsekibart: a case report
    Wenqian Wei, Lijie Gu, Hanyu Meng, Nan Zhu, Shu Rong
    Open Medicine.2026;[Epub]     CrossRef
  • Polydatin alleviates adenine-induced nephropathy in mice
    Tao Sheng, Tianhong Ma, Xin Jin, Debin Chen, Shipeng Che, Jie Wang, Jiadu Shen, Chaoqun Shi, Qiang Li, Yixin Sun, Deqing Chen, Guangtao Xu
    Renal Failure.2026;[Epub]     CrossRef
  • Heterogeneity in the development of diabetes-related complications: narrative review of the roles of ancestry and geographical determinants
    Andrea O. Y. Luk, Yingnan Fan, Baoqi Fan, Edith W. K. Chow, Tony C. K. O
    Diabetologia.2025; 68(11): 2386.     CrossRef
  • Relationship between the Chinese visceral adiposity index and gout in individuals with type 2 diabetes mellitus: a cross-sectional population-based study
    Ningyu Cai, Mengdie Chen, Ping Feng, Yiyun Wang, Xianping Zhu, Qidong Zheng
    Frontiers in Nutrition.2025;[Epub]     CrossRef
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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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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
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
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Original Articles
Diabetes, obesity and metabolism
Study Design and Protocol for a Randomized Controlled Trial to Assess Long-Term Efficacy and Safety of a Triple Combination of Ezetimibe, Fenofibrate, and Moderate-Intensity Statin in Patients with Type 2 Diabetes and Modifiable Cardiovascular Risk Factors (ENSEMBLE)
Nam Hoon Kim, Juneyoung Lee, Suk Chon, Jae Myung Yu, In-Kyung Jeong, Soo Lim, Won Jun Kim, Keeho Song, Ho Chan Cho, Hea Min Yu, Kyoung-Ah Kim, Sang Soo Kim, Soon Hee Lee, Chong Hwa Kim, Soo Heon Kwak, Yong‐ho Lee, Choon Hee Chung, Sihoon Lee, Heung Yong Jin, Jae Hyuk Lee, Gwanpyo Koh, Sang-Yong Kim, Jaetaek Kim, Ju Hee Lee, Tae Nyun Kim, Hyun Jeong Jeon, Ji Hyun Lee, Jae-Han Jeon, Hye Jin Yoo, Hee Kyung Kim, Hyeong-Kyu Park, Il Seong Nam-Goong, Seongbin Hong, Chul Woo Ahn, Ji Hee Yu, Jong Heon Park, Keun-Gyu Park, Chan Ho Park, Kyong Hye Joung, Ohk-Hyun Ryu, Keun Yong Park, Eun-Gyoung Hong, Bong-Soo Cha, Kyu Chang Won, Yoon-Sok Chung, Sin Gon Kim
Endocrinol Metab. 2024;39(5):722-731.   Published online August 22, 2024
DOI: https://doi.org/10.3803/EnM.2024.1995
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AbstractAbstract PDFPubReader   ePub   
Background
Atherogenic dyslipidemia, which is frequently associated with type 2 diabetes (T2D) and insulin resistance, contributes to the development of vascular complications. Statin therapy is the primary approach to dyslipidemia management in T2D, however, the role of non-statin therapy remains unclear. Ezetimibe reduces cholesterol burden by inhibiting intestinal cholesterol absorption. Fibrates lower triglyceride levels and increase high-density lipoprotein cholesterol (HDL-C) levels via peroxisome proliferator- activated receptor alpha agonism. Therefore, when combined, these drugs effectively lower non-HDL-C levels. Despite this, few clinical trials have specifically targeted non-HDL-C, and the efficacy of triple combination therapies, including statins, ezetimibe, and fibrates, has yet to be determined.
Methods
This is a multicenter, prospective, randomized, open-label, active-comparator controlled trial involving 3,958 eligible participants with T2D, cardiovascular risk factors, and elevated non-HDL-C (≥100 mg/dL). Participants, already on moderate-intensity statins, will be randomly assigned to either Ezefeno (ezetimibe/fenofibrate) addition or statin dose-escalation. The primary end point is the development of a composite of major adverse cardiovascular and diabetic microvascular events over 48 months.
Conclusion
This trial aims to assess whether combining statins, ezetimibe, and fenofibrate is as effective as, or possibly superior to, statin monotherapy intensification in lowering cardiovascular and microvascular disease risk for patients with T2D. This could propose a novel therapeutic approach for managing dyslipidemia in T2D.

Citations

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  • Beyond lipids: fenofibrate in diabetic retinopathy and nephropathy
    Mengying Liu, Seok Ting Lim, Weihua Song, Thomas M. Coffman, Xiaomeng Wang
    Trends in Pharmacological Sciences.2026; 47(3): 325.     CrossRef
  • Differential Pre‐ and Post‐Treatment Effects of Low‐Dose Antidyslipidemic Drugs on Gentamicin‐Induced Acute Nephrotoxicity in the Rat: A Histopathological and Biochemical Study
    Pitchai Balakumar, Sultan Alshahrani, Noohu Abdulla Khan, Rajavel Varatharajan, K. M. Sundram
    Journal of Applied Toxicology.2026; 46(6): 1879.     CrossRef
  • Ezetimibe attenuates diabetic retinopathy via NRF2-mediated suppression of inflammation and oxidative stress
    Lei Cheng, Shan Cheng, Ran Zhu, Guoxu Xu
    Journal of Diabetes and its Complications.2026; 40(2): 109250.     CrossRef
  • Current and Emerging Treatment Options for Hypertriglyceridemia: State-of-the-Art Review
    Jakub Michal Zimodro, Manfredi Rizzo, Ioanna Gouni-Berthold
    Pharmaceuticals.2025; 18(2): 147.     CrossRef
  • Fenofibrate therapy and risk of heart failure outcomes in patients with Type 2 diabetes: a propensity-matched cohort study
    Ji Yoon Kim, Nam Hoon Kim, Jiyoon Lee, Dong-Hoon Kim, Sin Gon Kim
    European Heart Journal - Cardiovascular Pharmacotherapy.2025; 11(7): 620.     CrossRef
Close layer
Diabetes, obesity and metabolism
Amelioration of Insulin Resistance after Delivery Is Associated with Reduced Risk of Postpartum Diabetes in Women with Gestational Diabetes Mellitus
Heejun Son, Joon Ho Moon, Sung Hee Choi, Nam H. Cho, Soo Heon Kwak, Hak Chul Jang
Endocrinol Metab. 2024;39(5):701-710.   Published online August 21, 2024
DOI: https://doi.org/10.3803/EnM.2024.1974
  • 6,341 View
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Identifying risk factors for postpartum type 2 diabetes in women with gestational diabetes mellitus (GDM) is crucial for effective interventions. We examined whether changes in insulin sensitivity after delivery affects the risk of type 2 diabetes in women with GDM.
Methods
This prospective cohort study included 347 women with GDM or gestational impaired glucose tolerance, who attended the follow-up visits at 2 months postpartum and annually thereafter. Changes in insulin sensitivity were calculated using the Matsuda index at GDM diagnosis and at 2 months postpartum (ΔMatsuda index). After excluding women with pregestational diabetes or those followed up only once, we analyzed the risk of postpartum type 2 diabetes based on the ΔMatsuda index tertiles.
Results
The incidence of type 2 diabetes at the two-month postpartum visit decreased with increasing ΔMatsuda index tertiles (16.4%, 9.5%, and 1.8%, P=0.001). During a 4.1-year follow-up, 26 out of 230 women who attended more than two follow-up visits (11.3%) developed type 2 diabetes. Compared to the lowest tertile, subjects in the highest ΔMatsuda index tertile showed a significantly reduced risk of type 2 diabetes (hazard ratio, 0.33; 95% confidence interval, 0.12 to 0.93; P=0.036) after adjusting for confounders.
Conclusion
Improvement in insulin sensitivity after delivery is associated with a reduced risk of postpartum type 2 diabetes in women with GDM. Postpartum changes in insulin sensitivity could be a useful prediction for future type 2 diabetes development in women with GDM.

Citations

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  • Postpartum Glucose Intolerance in Women with a History of Gestational Diabetes Mellitus: An In-Depth Review
    Kyung-Soo Kim, Soo-Kyung Kim, Yong-Wook Cho
    Endocrinology and Metabolism.2026; 41(1): 26.     CrossRef
  • Gestational Diabetes Mellitus: Mechanisms Underlying Maternal and Fetal Complications
    Jooyeop Lee, Na Keum Lee, Joon Ho Moon
    Endocrinology and Metabolism.2025; 40(1): 10.     CrossRef
  • Evaluation of Maternal Factors Affecting Postpartum Insulin Resistance Markers in Mothers with Gestational Diabetes—A Case–Control Study
    Karolina Karcz, Paulina Gaweł, Barbara Królak-Olejnik
    Nutrients.2024; 16(22): 3871.     CrossRef
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Diabetes, obesity and metabolism
Financial Benefits of Renal Dose-Adjusted Dipeptidyl Peptidase-4 Inhibitors for Patients with Type 2 Diabetes and Chronic Kidney Disease
Hun Jee Choe, Yeh-Hee Ko, Sun Joon Moon, Chang Ho Ahn, Kyoung Hwa Ha, Hyeongsuk Lee, Jae Hyun Bae, Hyung Joon Joo, Hyejin Lee, Jang Wook Son, Dae Jung Kim, Sin Gon Kim, Kwangsoo Kim, Young Min Cho
Endocrinol Metab. 2024;39(4):622-631.   Published online August 1, 2024
DOI: https://doi.org/10.3803/EnM.2024.1965
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Dipeptidyl peptidase-4 (DPP4) inhibitors are frequently prescribed for patients with type 2 diabetes; however, their cost can pose a significant barrier for those with impaired kidney function. This study aimed to estimate the economic benefits of substituting non-renal dose-adjusted (NRDA) DPP4 inhibitors with renal dose-adjusted (RDA) DPP4 inhibitors in patients with both impaired kidney function and type 2 diabetes.
Methods
This retrospective cohort study was conducted from January 1, 2012 to December 31, 2018, using data obtained from common data models of five medical centers in Korea. Model 1 applied the prescription pattern of participants with preserved kidney function to those with impaired kidney function. In contrast, model 2 replaced all NRDA DPP4 inhibitors with RDA DPP4 inhibitors, adjusting the doses of RDA DPP4 inhibitors based on individual kidney function. The primary outcome was the cost difference between the two models.
Results
In total, 67,964,996 prescription records were analyzed. NRDA DPP4 inhibitors were more frequently prescribed to patients with impaired kidney function than in those with preserved kidney function (25.7%, 51.3%, 64.3%, and 71.6% in patients with estimated glomerular filtration rates [eGFRs] of ≥60, <60, <45, and <30 mL/min/1.73 m2, respectively). When model 1 was applied, the cost savings per year were 7.6% for eGFR <60 mL/min/1.73 m2 and 30.4% for eGFR <30 mL/min/1.73 m2. According to model 2, 15.4% to 51.2% per year could be saved depending on kidney impairment severity.
Conclusion
Adjusting the doses of RDA DPP4 inhibitors based on individual kidney function could alleviate the economic burden associated with medical expenses.

Citations

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  • Nephroprotective Potential of Linagliptin and Glimepiride: a Comprehensive Review
    Sumaira Tasleem, Farogh Ahsan, Shahzadi Bano, Tarique Mahmood, Asad Ahmad, Soheir A. A. Hagras, Mohammad Sarafroz, Syed Mehdi Hasan Zaidi, Divyanshi Saxena
    Current Pharmacology Reports.2026;[Epub]     CrossRef
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Brief Report
Diabetes, obesity and metabolism
Ketonuria as an Indicator of Improvement of Renal Function in Patients with Type 2 Diabetes Receiving SGLT2 Inhibitor Treatment
Hyun Ah Kim, Han Na Jang, Sung Hye Kong, Young Lee, Sung Hee Choi, Young Min Cho, Hak Chul Jang, Tae Jung Oh
Endocrinol Metab. 2024;39(4):653-658.   Published online May 16, 2024
DOI: https://doi.org/10.3803/EnM.2024.1919
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AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
We investigated the potential association between ketonuria during treatment with sodium-glucose cotransporter-2 (SGLT2) inhibitors and its renoprotective effect in patients with type 2 diabetes. We included 192 patients who had received SGLT2 inhibitors for more than 6 months. After propensity score matching, 52 patients each were allocated into groups with or without ketonuria, respectively. The estimated glomerular filtration rate exhibited a significant improvement only in subjects with ketonuria (without ketonuria: mean difference, –0.02 mL/min/1.73 m2 [95% confidence interval (CI), –3.87 to 3.83 mL/min/1.73 m2] vs. with ketonuria: mean difference, 6.81 mL/min/1.73 m2 [95% CI, 3.16 to 10.46 mL/min/1.73 m2]; P<0.001). Improvement in estimated glomerular filtration rate at 6 months was associated with female sex and lower baseline body weight, blood pressure, and triglyceride levels in patients with ketonuria. In conclusion, the presence of ketonuria was associated with the renoprotective effect of SGLT2 inhibitors, and female sex and the absence of metabolic syndrome components may serve as additional indicators of these medications’ substantial renoprotective effects in individuals with ketonuria.

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  • Effects of a continuous remote care intervention including nutritional ketosis on kidney function and inflammation in adults with type 2 diabetes: a post-hoc latent class trajectory analysis
    Shaminie J. Athinarayanan, Caroline G. P. Roberts, Stephen D. Phinney, Thomas Weimbs, Allon N. Friedman, Jeff S. Volek
    Frontiers in Nutrition.2025;[Epub]     CrossRef
  • SGLT2 Inhibitors as Systemic Metabolic Modulators: Linking Glucose Excretion to Liver Function Restoration
    Seung Wan Noh, Han Sol Ryu, Yong-Ho Kim, Byung-Chul Oh
    Endocrinology and Metabolism.2025; 40(6): 851.     CrossRef
  • Trigger Warning: How Modern Diet, Lifestyle, and Environment Pull the Trigger on Autosomal Dominant Polycystic Kidney Disease Progression
    Melina Messing, Jacob A. Torres, Nickolas Holznecht, Thomas Weimbs
    Nutrients.2024; 16(19): 3281.     CrossRef
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Review Articles
Diabetes, obesity and metabolism
Scaling Insulin-Producing Cells by Multiple Strategies
Jinhyuk Choi, Fritz Cayabyab, Harvey Perez, Eiji Yoshihara
Endocrinol Metab. 2024;39(2):191-205.   Published online April 4, 2024
DOI: https://doi.org/10.3803/EnM.2023.1910
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  • 4 Web of Science
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AbstractAbstract PDFPubReader   ePub   
In the quest to combat insulin-dependent diabetes mellitus (IDDM), allogenic pancreatic islet cell therapy sourced from deceased donors represents a significant therapeutic advance. However, the applicability of this approach is hampered by donor scarcity and the demand for sustained immunosuppression. Human induced pluripotent stem cells are a game-changing resource for generating synthetic functional insulin-producing β cells. In addition, novel methodologies allow the direct expansion of pancreatic progenitors and mature β cells, thereby circumventing prolonged differentiation. Nevertheless, achieving practical reproducibility and scalability presents a substantial challenge for this technology. As these innovative approaches become more prominent, it is crucial to thoroughly evaluate existing expansion techniques with an emphasis on their optimization and scalability. This manuscript delineates these cutting-edge advancements, offers a critical analysis of the prevailing strategies, and underscores pivotal challenges, including cost-efficiency and logistical issues. Our insights provide a roadmap, elucidating both the promises and the imperatives in harnessing the potential of these cellular therapies for IDDM.

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  • Reconstructing the Islets: Advances in 3D Pancreatic Organoid Models for Functional β-Cell Replacement
    Muhammad Kamal Hossain, Hyung-Ryong Kim
    International Journal of Molecular Sciences.2026; 27(3): 1280.     CrossRef
  • Advances in stem cell–derived beta-cell therapy: A new frontier in type 1 diabetes treatment
    Krishnaa Shivkant Upadhye, Paritosh Tayade
    Cell Transplantation.2026;[Epub]     CrossRef
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    Lorenzo Piemonti
    Transplant International.2025;[Epub]     CrossRef
  • Insulin evolution: A holistic view of recombinant production advancements
    Ansuman Sahoo, Prabir Kumar Das, Veeranki Venkata Dasu, Sanjukta Patra
    International Journal of Biological Macromolecules.2024; 277: 133951.     CrossRef
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Diabetes, obesity and metabolism
Glucocorticoid-Induced Hyperglycemia: A Neglected Problem
Jung-Hwan Cho, Sunghwan Suh
Endocrinol Metab. 2024;39(2):222-238.   Published online March 27, 2024
DOI: https://doi.org/10.3803/EnM.2024.1951
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AbstractAbstract PDFPubReader   ePub   
Glucocorticoids provide a potent therapeutic response and are widely used to treat a variety of diseases, including coronavirus disease 2019 (COVID-19) infection. However, the issue of glucocorticoid-induced hyperglycemia (GIH), which is observed in over one-third of patients treated with glucocorticoids, is often neglected. To improve the clinical course and prognosis of diseases that necessitate glucocorticoid therapy, proper management of GIH is essential. The key pathophysiology of GIH includes systemic insulin resistance, which exacerbates hepatic steatosis and visceral obesity, as well as proteolysis and lipolysis of muscle and adipose tissue, coupled with β-cell dysfunction. For patients on glucocorticoid therapy, risk stratification should be conducted through a detailed baseline evaluation, and frequent glucose monitoring is recommended to detect the onset of GIH, particularly in high-risk individuals. Patients with confirmed GIH who require treatment should follow an insulin-centered regimen that varies depending on whether they are inpatients or outpatients, as well as the type and dosage of glucocorticoid used. The ideal strategy to maintain normoglycemia while preventing hypoglycemia is to combine basal-bolus insulin and correction doses with a continuous glucose monitoring system. This review focuses on the current understanding and latest evidence concerning GIH, incorporating insights gained from the COVID-19 pandemic.

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Close layer
Original Article
Diabetes, obesity and metabolism
Efficacy and Safety of Omarigliptin, a Novel Once-Weekly Dipeptidyl Peptidase-4 Inhibitor, in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis
A.B.M. Kamrul-Hasan, Muhammad Shah Alam, Samir Kumar Talukder, Deep Dutta, Shahjada Selim
Endocrinol Metab. 2024;39(1):109-126.   Published online January 23, 2024
DOI: https://doi.org/10.3803/EnM.2023.1839
  • 11,530 View
  • 192 Download
  • 21 Web of Science
  • 21 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
No recent meta-analysis has holistically analyzed and summarized the efficacy and safety of omarigliptin in type 2 diabetes mellitus (T2DM). We conducted a meta-analysis to address this knowledge gap.
Methods
Electronic databases were searched to identify randomized controlled trials (RCTs) that included patients with T2DM who received omarigliptin in the intervention arm. The control arm consisted of either a placebo (passive control group [PCG]) or an active comparator (active control group [ACG]). The primary outcome assessed was changes in hemoglobin A1c (HbA1c), while secondary outcomes included variations in glucose levels, achievement of glycemic targets, adverse events (AEs), and hypoglycemic events.
Results
From 332 initially screened articles, data from 16 RCTs involving 8,804 subjects were analyzed. Omarigliptin demonstrated superiority over placebo in reducing HbA1c levels (mean difference, –0.58%; 95% confidence interval, –0.75 to –0.40; P<0.00001; I2=91%). Additionally, omarigliptin outperformed placebo in lowering fasting plasma glucose, 2-hour postprandial glucose, and in the percentage of participants achieving HbA1c levels below 7.0% and 6.5%. The glycemic efficacy of omarigliptin was similar to that of the ACG across all measures. Although the omarigliptin group experienced a higher incidence of hypoglycemic events compared to the PCG, the overall AEs, serious AEs, hypoglycemia, and severe hypoglycemia were comparable between the omarigliptin and control groups (PCG and ACG).
Conclusion
Omarigliptin has a favorable glycemic efficacy and safety profile for managing T2DM.

Citations

Citations to this article as recorded by  
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    Sanobia Yousuf, Muhammad Yakoob Ahmedani
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Close layer
Review Article
Adrenal gland
The Fascinating Interplay between Growth Hormone, Insulin-Like Growth Factor-1, and Insulin
Eline C. Nijenhuis-Noort, Kirsten A. Berk, Sebastian J. C. M. M. Neggers, Aart J. van der Lely
Endocrinol Metab. 2024;39(1):83-89.   Published online January 9, 2024
DOI: https://doi.org/10.3803/EnM.2024.101
  • 156,452 View
  • 1,499 Download
  • 48 Web of Science
  • 51 Crossref
AbstractAbstract PDFPubReader   ePub   
This review intends to provide the reader with a practical overview of several (patho)physiological conditions in which knowledge of the interplay between growth hormone (GH), insulin-like growth factor-1 (IGF-1), and insulin is important. This might help treating physicians in making the right decisions on how to intervene and improve metabolism for the benefit of patients, and to understand why and how metabolism responds in their specific cases. We will specifically address the interplay between GH, IGF-1, and insulin in type 1 and 2 diabetes mellitus, liver cirrhosis, and acromegaly as examples in which this knowledge is truly necessary.

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    World Academy of Sciences Journal.2025; 7(6): 1.     CrossRef
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    Viviana Elian, Violeta Popovici, Mihnea Ioan Nicolescu, Alexandra Maria Nicolescu, Sorina Maria Aurelian, Emma Adriana Ozon
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Original Articles
Diabetes, obesity and metabolism
Effectiveness of a Social Networking Site Based Automatic Mobile Message Providing System on Glycemic Control in Patients with Type 2 Diabetes Mellitus
Kyuho Kim, Jae-Seung Yun, Joonyub Lee, Yeoree Yang, Minhan Lee, Yu-Bae Ahn, Jae Hyoung Cho, Seung-Hyun Ko
Endocrinol Metab. 2024;39(2):344-352.   Published online December 27, 2023
DOI: https://doi.org/10.3803/EnM.2023.1871
  • 6,096 View
  • 141 Download
  • 4 Web of Science
  • 4 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
This study investigated the effectiveness of a social networking site (SNS)-based automatic mobile message providing system on glycemic control in patients with type 2 diabetes mellitus (T2DM).
Methods
A 3-month, randomized, open-label, controlled, parallel-group trial was conducted. One hundred and ten participants with T2DM were randomized to a mobile message system (MMS) (n=55) or control group (n=55). The MMS group received protocolbased automated messages two times per day for 10 weeks regarding diabetes self-management through KakaoTalk SNS messenger. The primary outcome was the difference in the change in glycated hemoglobin (HbA1c) levels (%) from baseline to week 12.
Results
HbA1c levels were more markedly decreased in the MMS group (8.4%±0.7% to 8.0%±1.1%) than in the control group (8.5%±0.8% to 8.4%±0.8%), resulting in a significant between-group difference (P=0.027). No differences were observed in changes in fasting glucose levels, lipid profiles, and the number of participants who experienced hypoglycemia, or in changes in lifestyle behavior between groups. However, the self-monitoring of blood glucose frequency was significantly increased in the MMS group compared to the control group (P=0.003). In addition, sleep duration was increased in the MMS group, but was not changed in the control group.
Conclusion
An SNS-based automatic mobile message providing system was effective in improving glycemic control in patients in T2DM. Studies which based on a more individualized protocol, and investigate longer beneficial effect and sustainability will be required in the future.

Citations

Citations to this article as recorded by  
  • Effectiveness of text message-delivered health behaviour intervention on HbA1c change in adults with type 2 diabetes mellitus: a systematic review and meta-analysis of randomised controlled trials
    Qiumian Hong, Xiaoying Zhang, Mengxi Guo, Zhaoyang Wen, Qing Tang, Jiali Zhou, Peige Song, Xiaolin Wei, Ning Zhang
    Health Psychology Review.2026; 20(2): 386.     CrossRef
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    Shan Chen, Emma Mirza Wati Mohamad, Arina Anis Azlan, Xixi Zhao
    Frontiers in Public Health.2026;[Epub]     CrossRef
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    Neda Pirouzmand, Grace S Ko, Lucas C Godoy, Olivia Haldenby, Cynthia A Jackevicius, Ayman Jubran, Candace D McNaughton, Baiju R Shah, Maneesh Sud, Karen Tu, Dennis T Ko
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    Yan Zhang, Xingqi Cao, LiJuan Huang, Yue Zhu, Liying Chen
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Mineral, Bone & Muscle
Big Data Articles (National Health Insurance Service Database)
Association between Smoking Status and the Risk of Hip Fracture in Patients with Type 2 Diabetes: A Nationwide Population-Based Study
Se-Won Lee, Jun-Young Heu, Ju-Yeong Kim, Jinyoung Kim, Kyungdo Han, Hyuk-Sang Kwon
Endocrinol Metab. 2023;38(6):679-689.   Published online December 6, 2023
DOI: https://doi.org/10.3803/EnM.2023.1760
  • 7,868 View
  • 107 Download
  • 2 Web of Science
  • 4 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Limited longitudinal evidence exists regarding the potential association between smoking status and hip fracture among individuals with type 2 diabetes. We investigated this association using large-scale, nationwide cohort data for the Korean population.
Methods
This nationwide cohort study included 1,414,635 adults aged 40 and older who received Korean National Health Insurance Service health examinations between 2009 and 2012. Subjects with type 2 diabetes were categorized according to their smoking status, amount smoked (pack-years), number of cigarettes smoked per day, and duration of smoking. The results are presented as hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between smoking status parameters and risk of hip fracture in multivariable Cox proportional hazard regression analysis.
Results
Compared with never-smokers, an increased adjusted HR (aHR) for hip fracture was observed in current smokers (1.681; 95% CI, 1.578 to 1.791), and a comparable aHR for hip fracture was found in former smokers (1.065; 95% CI, 0.999 to 1.136). For former smokers who had smoked 20 pack-years or more, the risk was slightly higher than that for never-smokers (aHR, 1.107; 95% CI, 1.024 to 1.196). The hip fracture risk of female former smokers was similar to that of female current smokers, but the hip fracture risk in male former smokers was similar to that of male never-smokers.
Conclusion
Smoking is associated with an increased risk of hip fracture in patients with type 2 diabetes. Current smokers with diabetes should be encouraged to quit smoking because the risk of hip fracture is greatly reduced in former smokers.

Citations

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    Federico Hawkins Carranza, Cristina Martín-Arriscado Arroba, Arturo Corbatón-Anchuelo, Guillermo Martínez Díaz-Guerra, Félix Bermejo Pareja
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Review Articles
Diabetes, obesity and metabolism
Initial Combination Therapy in Type 2 Diabetes
Ji Yoon Kim, Nam Hoon Kim
Endocrinol Metab. 2024;39(1):23-32.   Published online November 30, 2023
DOI: https://doi.org/10.3803/EnM.2023.1816
  • 33,820 View
  • 1,294 Download
  • 13 Web of Science
  • 19 Crossref
AbstractAbstract PDFPubReader   ePub   
Type 2 diabetes (T2D) is a progressive disease in which it is challenging to achieve long-term durable glycemic control. However, intensive glycemic control is crucial for preventing diabetes-related complications. Previous studies showed that monotherapy with a stepwise add-on approach was seldom effective for long-term durable glycemic control. Combination therapy, which refers to the use of two or more drugs to control hyperglycemia, has multiple benefits, including the ability to target a variety of pathophysiological processes underlying hyperglycemia. In clinical trials, initial combination therapy showed better glycemic control than monotherapy or a stepwise approach. Emerging evidence indicates that initial combination therapy is associated with preserved β-cell function and fewer complications in T2D. However, cost-effectiveness and adverse events with combination therapy are issues that should be considered. Therefore, initial combination therapy is an important option for patients with T2D that clinicians should consider with a view toward balancing benefits and potential harms. In this review, we summarize the literature addressing initial combination therapy in T2D, and we suggest optimal strategies based on clinical situations and patient characteristics.

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Miscellaneous
Toward Systems-Level Metabolic Analysis in Endocrine Disorders and Cancer
Aliya Lakhani, Da Hyun Kang, Yea Eun Kang, Junyoung O. Park
Endocrinol Metab. 2023;38(6):619-630.   Published online November 21, 2023
DOI: https://doi.org/10.3803/EnM.2023.1814
  • 10,836 View
  • 218 Download
  • 5 Web of Science
  • 6 Crossref
AbstractAbstract PDFPubReader   ePub   
Metabolism is a dynamic network of biochemical reactions that support systemic homeostasis amidst changing nutritional, environmental, and physical activity factors. The circulatory system facilitates metabolite exchange among organs, while the endocrine system finely tunes metabolism through hormone release. Endocrine disorders like obesity, diabetes, and Cushing’s syndrome disrupt this balance, contributing to systemic inflammation and global health burdens. They accompany metabolic changes on multiple levels from molecular interactions to individual organs to the whole body. Understanding how metabolic fluxes relate to endocrine disorders illuminates the underlying dysregulation. Cancer is increasingly considered a systemic disorder because it not only affects cells in localized tumors but also the whole body, especially in metastasis. In tumorigenesis, cancer-specific mutations and nutrient availability in the tumor microenvironment reprogram cellular metabolism to meet increased energy and biosynthesis needs. Cancer cachexia results in metabolic changes to other organs like muscle, adipose tissue, and liver. This review explores the interplay between the endocrine system and systems-level metabolism in health and disease. We highlight metabolic fluxes in conditions like obesity, diabetes, Cushing’s syndrome, and cancers. Recent advances in metabolomics, fluxomics, and systems biology promise new insights into dynamic metabolism, offering potential biomarkers, therapeutic targets, and personalized medicine.

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Endocrinol Metab : Endocrinology and Metabolism
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