AIMS:To evaluate the efficacy and safety of adding a fourth oral antidiabetic drug versus metformin uptitration in patients with type 2 diabetes inadequately controlled with oral triple therapy. MATERIALS AND METHODS:In this 24-week, randomized, open-label trial, adults with type 2 diabetes having glycated haemoglobin (HbA1C) 7.0-9.0% despite oral triple therapy with metformin plus a thiazolidinedione (TZD), sodium-glucose cotransporter 2 inhibitor (SGLT2i), or dipeptidyl peptidase 4 inhibitor (DPP-4i) were randomized to an oral quadruple add-on group or a metformin uptitration group. The quadruple group received the class not previously used (TZD, SGLT2i, or DPP-4i), whereas the metformin uptitration group increased the metformin dose by up to 500 mg per day. The primary endpoint was the change in HbA1C at week 24. Secondary endpoints included fasting glucose, metabolic parameters, and safety. RESULTS:Hundred and ninety-three were evaluable: 48 in the metformin uptitration group and 145 in the quadruple group. Compared to baseline, HbA1C at week 24 decreased by 0.70% (interquartile range [IQR] 0.40%, 1.10%) with quadruple therapy and 0.40% (IQR 0.10%, 0.80%) with metformin uptitration (p = 0.002). The rate achieving HbA1C ≤7.0% was higher in the quadruple group (69.7% vs. 47.9%, p = 0.006). Insulin resistance improved only in the quadruple group and was accompanied by reduced albuminuria. Adverse events were mild and comparable between groups. CONCLUSIONS:Oral quadruple therapy achieved greater glycaemic and metabolic improvement without compromising safety, compared with metformin uptitration, supporting its role as an intensification strategy.

Background:To evaluate the efficacy and safety of JP-2266, a novel dual sodium-glucose co-transporter 1 (SGLT1)/SGLT2 inhibitor, in patients with type 2 diabetes mellitus (T2DM) inadequately controlled with diet and exercise. Methods:In this 12-week, randomized, double-blind, placebo-controlled phase 2 trial, 156 patients with T2DM were randomly assigned (1:1:1) to receive once-daily JP-2266 5 mg (n=51), 10 mg (n=53), or placebo (n=52). The primary endpoint was the change in glycosylated hemoglobin (HbA1c) from baseline to week 12 (ClinicalTrials.gov identifier: NCT06144788). Results:JP-2266 treatment led to significant, placebo-adjusted reductions in HbA1c of -0.94% (95% confidence interval [CI], -1.24 to -0.65; P<0.0001) for the 5 mg dose and -0.97% (95% CI, -1.26 to -0.68; P<0.0001) for the 10 mg dose. Significant reductions were also observed in fasting plasma glucose (-36.22 mg/dL [95% CI, -47.62 to -24.83] with 5 mg and -39.38 mg/dL [95% CI, -50.71 to -28.05] with 10 mg), and postprandial glucose (-62.30 mg/dL [95% CI, -84.97 to -39.64] with 5 mg and -66.89 mg/dL [95% CI, -89.71 to -44.07] with 10 mg) (all P<0.0001). JP-2266 also reduced body weight of -2.0 to -2.1 kg and systolic blood pressure (-3.6 mm Hg with 10 mg). Improvements in insulin resistance and β-cell function were also observed, as assessed by homeostasis model assessment. Adverse event rates were similar to placebo. Conclusion:In patients with T2DM inadequately controlled by lifestyle alone, JP-2266 significantly improved glycemic control, reduced body weight and blood pressure, and was well tolerated over 12 weeks. These findings support further investigation of JP-2266 as a potential therapeutic option for T2DM.

BACKGROUND:While glucagon plays a role in hepatic lipid metabolism, alterations in circulating glucagon profiles and hepatic glucagon signaling in metabolic dysfunction-associated steatotic liver disease (MASLD) in humans remain unclear. We aimed to investigate the relationship between MASLD severity and plasma glucagon dynamics, and evaluate hepatic glucagon signaling using human liver tissue. METHODS:This retrospective cross-sectional study included 137 adults with prediabetes or type 2 diabetes who underwent a 75 g oral glucose tolerance test (OGTT) with fasting and 2-h plasma glucagon measurements. MASLD severity was assessed using noninvasive scores and transient liver elastography. To evaluate hepatic glucagon signaling across MASLD severity, human liver tissue transcriptome and single-nucleus RNA sequencing (snRNA-seq) were analyzed. RESULTS:Participants with moderate-to-severe hepatic steatosis or high-risk metabolic dysfunction-associated steatohepatitis exhibited a lower integrated glucagon response, assessed by glucagon AUC during the 2-h OGTT, than their respective control groups (46,500 vs. 60,480 pg·min/ml, P = 0.006; and 43,680 vs. 52,620 pg·min/ml, P = 0.014, respectively). In contrast, there was no significant association between plasma glucagon levels and fibrosis severity. Transcriptomic analyses revealed downregulation of the glucagon receptor (GCGR) and downstream signaling pathways in liver tissues from individuals with MASLD, particularly within hepatocytes from those with advanced disease. CONCLUSION:Among individuals with prediabetes or type 2 diabetes, greater hepatic steatosis and inflammation are associated with lower circulating glucagon levels and attenuated hepatic glucagon signaling. These findings may provide a basis for future investigation of glucagon-based therapeutic approaches.

Background The growing burden of obesity has profoundly influenced the epidemiology and phenotype of diabetes. This study aimed to compare the epidemiology and clinical features between obese and non-obese diabetes in Korean adults using nationwide database. Methods We analyzed data from the Korea National Health and Nutrition Examination Survey (2012–2023) to evaluate the prevalence and management of diabetes, as well as associated comorbidities. Data from the Korean National Health Insurance Service were used to assess antidiabetic medication use, metabolic surgery trends, and cancer outcomes. Results Diabetes prevalence was nearly twice as high in adults with obesity compared with those without (17.6% vs. 9.5%), with the larger difference observed in individuals aged 30 to 59 years. Obese diabetes was associated with higher rates of hypertension and dyslipidemia and lower rates of achieving glycemic, blood pressure, and lipid targets; only 21.0% achieved all three goals. Although sodium-glucose cotransporter 2 inhibitors and thiazolidinediones were more frequently prescribed in obese diabetes, overall use remained low. Metabolic surgery was less common in individuals with diabetes than in those without; sleeve gastrectomy predominated, while Roux-en-Y gastric bypass was performed more often in those with diabetes. Higher body mass index was associated with increased incidence of thyroid, breast, prostate, and kidney cancers. Conclusion Obese diabetes represents a distinct, high-risk phenotype in Korea, characterized by a greater cardiometabolic burden and suboptimal risk-factor control. Comprehensive management strategies integrating weight reduction with metabolic and cardiovascular risk control are essential to improve outcomes in this population.

Background : We aimed to investigate the influence of metabolic dysfunction-associated steatotic liver disease (MASLD) and handgrip strength (HGS) on the risk of atherosclerotic cardiovascular disease (ASCVD) in the general population. Methods : We used data from 20,611 individuals from the 2014-2019 Korea National Health and Nutrition Examination Survey. MASLD was defined as a Framingham steatosis index of ≥23. Low HGS was defined as <28 kg in men and <18 kg in women. The 10-year ASCVD risk score was assessed, and high-probability ASCVD was defined as >10%. Results : Individuals with both MASLD and low HGS had a greater risk of high-probability ASCVD (odds ratio [OR], 6.88; 95% confidence interval [CI], 6.81 to 6.97; P<0.001) than those without MASLD and with intact HGS. The association between low HGS and high-probability ASCVD was stronger when MASLD was accompanied by advanced liver fibrosis (OR, 20.94; 95% CI, 20.04 to 21.88; P<0.001). In the population with MASLD, ASCVD risk was lower in individuals with low HGS who engaged in regular exercise than in those without low HGS who did not exercise regularly (P<0.001). Conclusion : Individuals with MASLD and low HGS had a significantly higher risk of ASCVD than those without MASLD. Concurrent advanced liver fibrosis was further associated with increased ASCVD risk among individuals with MASLD.

IntroductionFinerenone reduces albuminuria and improves kidney outcomes in patients with diabetic kidney disease (DKD); however, its association with changes in non-albumin proteinuria (NAP), enriched for tubular injury-related proteins, remains unclear. We evaluated whether finerenone treatment was associated with a reduction in NAP and identified clinical phenotypes associated with a greater NAP response.MethodsWe retrospectively analyzed 477 patients treated with finerenone who had baseline urine albumin-to-creatinine ratio (uACR) and urine protein-to-creatinine ratio (uPCR) measurements from the same urine specimen. Urine non-albumin protein-to-creatinine ratio (uNAPCR) was calculated as uPCR minus uACR. Patients were stratified by baseline proteinuria severity (uPCR < 500 vs ≥ 500 mg/gCr). The primary outcome was the geometric mean percentage change in uNAPCR after 6 months of finerenone treatment, assessed using linear mixed-effects models. Subgroup interaction analyses were performed to assess differential associations and identify factors associated with greater uNAPCR reduction.ResultsAt baseline, median uPCR, uACR, and uNAPCR were 1140 [580, 2290], 716 [328, 1593], and 410 [223, 700] mg/gCr, respectively. At 6 months, uACR and uNAPCR declined by 30.3% and 17.5%, respectively. Subgroup analyses revealed differential associations: patients with higher baseline proteinuria (uPCR ≥ 500 mg/gCr) showed an 18.8% decline in uNAPCR, whereas those with uPCR < 500 mg/gCr showed a non-significant 1.3% change. Changes in uNAPCR were positively correlated with changes in urine N-acetyl-β-D-glucosaminidase-to-creatinine ratio (uNAGCR) (Spearman’s ρ = 0.53; p < 0.001).DiscussionFinerenone treatment was associated with a reduction in NAP, particularly among patients with higher baseline proteinuria, suggesting a possible effect on tubulointerstitial injury-related processes beyond albuminuria reduction. Prospective multicenter studies are needed to validate uNAPCR as a treatment-response biomarker against clinical endpoints.

Background/Objectives: Diabetic retinopathy (DR) is the most common microvascular complication of diabetes and a significant cause of severe visual impairment. Intermittent fasting (IF) has demonstrated metabolic benefits. We investigated the association between IF and DR risk in individuals with prediabetes and diabetes. Methods: This retrospective cohort study included participants of the Korean National Health and Nutrition Examination Survey 2017-2018 aged ≥40 years who were diagnosed with diabetes or prediabetes who had fundus photography and dietary pattern data. Participants were allocated to the IF (fasting for 24 h or skipping breakfast or dinner) and regular diet groups. Demographic, dietary pattern and clinical data, including DR prevalence, were compared between the groups. Multiple logistic regression assessed the association between IF and DR risk. Results: Of 922 participants, 831 followed a regular diet while 91 practiced IF. The participants in the IF group were significantly younger and more obese, had higher fat intake, and showed a lower prevalence of DR than those in the regular diet group (8.8% vs. 20.6%, p = 0.010). After adjusting for multiple covariates, including demographics, comorbidities, health behaviors, biochemical parameters, and nutritional intake profiles, IF was associated with a 70% reduced risk of DR (OR 0.30, 95% CI 0.12-0.65, p = 0.005). This association did not differ across subgroups (all p for interaction > 0.05). Conclusions: IF was significantly associated with reduced DR risk in this study. Further studies are needed to validate the effectiveness of IF as a dietary intervention for DR.

BACKGRUOUND:We evaluated epidemiologic trends and clinical characteristics in Koreans with diabetes and obesity and in those with diabetes in pregnancy. METHODS:We analyzed Korea National Health and Nutrition Examination Survey data (2012-2023) to assess obesity trends in people with diabetes and used the Korean National Health Insurance Service database (2013-2023) to evaluate diabetes in pregnancy. RESULTS:Among Korean adults with diabetes (≥19 years), 52.4% had obesity and 61.1% had abdominal obesity. Only 39.9% achieved the glycemic target (glycosylated hemoglobin <6.5%). The obesity prevalence was higher in younger age groups, and abdominal obesity showed an upward trend over the last 12 years. Diabetes in pregnancy increased despite declining total births, with gestational diabetes mellitus (GDM) rising from 7.6% to 12.4%, and pregestational diabetes from 0.9% to 2.1%, reflecting older maternal age and pre-pregnancy obesity. Women with prior GDM had a higher risk of postpartum type 2 diabetes mellitus (hazard ratio, 6.07; 95% confidence interval, 5.97 to 6.17). CONCLUSION:Obesity and abdominal obesity are highly prevalent among Korean adults with diabetes, with abdominal obesity increasing over the past decade, and obesity disproportionately affects younger adults. Diabetes in pregnancy has also increased with older maternal age and worsening pre-pregnancy metabolic health, underscoring the need for early weight-focused prevention.

BACKGROUND:New-onset diabetes (NOD) increases the risk of pancreatic cancer. Previous studies have mainly focused on the presence or absence of diabetes, with limited attention to NOD severity at diagnosis and its clinical course. OBJECTIVE:This 15-year longitudinal nationwide cohort study aimed to analyse the pancreatic cancer risk based on the initial severity and progression pattern of NOD. DESIGN:We included 402 663 individuals with or without NOD from the Korean National Health Insurance Service (2005-2019). Initial NOD severity was defined by baseline antidiabetic treatment intensity: no antidiabetics, oral antidiabetics and insulin. RESULTS:Pancreatic cancer risk increased stepwise with higher initial treatment intensity in NOD compared with individuals without diabetes (adjusted HRs (aHRs) 3.01, 4.32 and 5.60 for no antidiabetics, oral antidiabetics and insulin, respectively). Within the same baseline treatment-intensity category, individuals with rapid escalation within 6 months had a higher risk of pancreatic cancer than those with stable or decreased treatment intensity. In some comparisons between groups with different baseline treatment intensities, the risk of pancreatic cancer was higher with less intensive baseline therapy but subsequent intensification than with more intensive baseline therapy without progression. Notably, drug-naïve individuals who initiated antidiabetic treatment within 6 months had a greater risk even than those who were initially on oral medication without worsening (aHR 6.50 vs 3.67). These patterns were more prominent in pancreatic cancer cases diagnosed within 3 years after NOD. CONCLUSION:Greater initial severity of NOD and rapid early aggravation were both associated with an increased risk of pancreatic cancer.

AIMS:Finerenone is approved for the treatment of diabetic kidney disease (DKD), but real-world evidence remains limited. We evaluated the effectiveness and safety of finerenone in routine clinical practice. MATERIALS AND METHODS:This retrospective observational study included patients with DKD who were prescribed finerenone. Effectiveness was assessed by measuring changes in urine protein-to-creatinine ratio (UPCR) and urine albumin-to-creatinine ratio (UACR) over the 6-month period following initiation of finerenone. Changes in estimated glomerular filtration rate, blood pressure, potassium levels, renin, and aldosterone were also monitored. RESULTS:A total of 404 patients with DKD were analysed. After 6 months of finerenone treatment, UPCR and UACR decreased substantially, with mean within-subject changes of -820.2 ± 1528.3 and -606.4 ± 1119.6 mg/g, respectively. 59.9% of patients achieved a ≥ 30% reduction in UPCR from baseline. Patients who were older, had lower baseline potassium levels, and received a higher mean daily dose of finerenone exhibited a more favourable response to finerenone. The mean increase in potassium levels was 0.3 mEq/L at 6 months, and the treatment discontinuation rate due to hyperkalemia was 5.4%. The aldosterone-to-renin ratio showed a modest decrease at 3 months (mean within-subject change, -3.79 ± 13.76 ng/dL per ng/mL/h), with borderline statistical significance. CONCLUSIONS:Finerenone treatment was associated with a significant reduction in proteinuria in patients with DKD. The safety profile was comparable to that reported in previous studies.

Background/Aims The prevalence of diabetes mellitus (DM) is increasing worldwide owing to aging. This nationwide study aimed to investigate the prevalence of DM and its management status among elderly Koreans. Methods We analyzed data from the Korea National Health and Nutrition Examination Survey (2019–2021) to assess the prevalence of DM, awareness, treatment rates, and glycemic control status among elderly Koreans aged ≥ 65 years. Results The prevalence of DM increased significantly from 2019 to 2021, reaching 30.9% among elderly Koreans by 2021. Women were older than men (73.7 ± 5.0 vs. 72.7 ± 4.9 years, p < 0.001) and had higher BMI than men (24.5 ± 3.0 vs. 25.1 ± 3.6 kg/m2, p < 0.001). The waist circumference was 91.5 ± 8.8 cm in men and 88.8 ± 9.2 cm in women (p < 0.005). The prevalence of obesity among patients with DM was 44.5%, significantly higher in women (47.4%) than men (41.2%; p = 0.003). Women also had higher rates of hypertension and hypercholesterolemia than men (hypertension: 74.0% vs. 66.5%, p < 0.005; hypercholesterolemia: 53.0% vs. 38.5%, p < 0.001). Women exhibited higher awareness rates of DM compared to men. Awareness and treatment rates were higher in older individuals compared to those aged 30–64 years. Regarding glycemic control, the target achievement rate was 61.0% for HbA1c < 7.0% in the total age group, with nearly 27.6% achieving strict control (HbA1c < 6.5%). Conclusions Our study underscores the rising DM prevalence among elderly Koreans and emphasizes the need for age-tailored management approaches to optimize care.

We investigated the efficacy and safety of pioglitazone compared to dapagliflozin when added to metformin plus alogliptin for patients with type 2 diabetes. The patients (n = 133) were randomized to receive pioglitazone (n = 65) or dapagliflozin (n = 68) in addition to metformin and alogliptin therapy for 26 weeks. The primary endpoint was a change in HbA1c. The non-inferiority margin for HbA1c reduction was 0.4

BACKGROUND AND AIMS:There are no comprehensive studies that investigated differential effects of physical activity (PA) types on metabolic dysfunction associated steatotic liver disease (MASLD) and their associations with sarcopenia and cardiovascular disease. METHODS:A cross-sectional analysis using data from 66,021 participants from the Korean National Health and Nutrition Examination Surveys 2007-2020. Aerobic PA (A-PA) was defined as ≥ moderate-intensity 150 min/week or high-intensity 75 min/week; Muscle strengthening PA (MS-PA) was defined as ≥ 2 days/week of muscle strength training. Multicomponent PA included A-PA and MS-PA. The atherosclerotic cardiovascular disease (ASCVD) risk was determined by the pooled ASCVD risk score. RESULTS:The prevalence of MASLD was lower in all PA groups compared to physically inactive individuals. Among individuals with MASLD, multicomponent PA was associated with a lower ASCVD risk, compared with other groups (OR = 0.74, 95 % CI = 0.73-0.75 for A-PA; OR = 0.70, 95 % CI = 0.68-0.64 for MS-PA; OR = 0.62, 95 % CI = 0.61-0.64 for multicomponent PA). Sarcopenia risk was decreased among physically active individuals with MASLD (OR = 0.77, 95 % CI, 0.76-0.77 for A-PA; OR = 0.97, 95 % CI = 0.96-0.98 for MS-PA; OR = 0.57, 95 % CI = 0.57-0.58 for multicomponent PA). CONCLUSIONS:Regardless of types of exercise, physically active individuals had lower risks of MASLD, sarcopenia, and ASCVD.

BackgroundThis study investigated the prevalence of diabetes mellitus (DM) and impaired fasting glucose, as well as their management and comorbidities among older Korean adults. MethodsData 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. ResultsAmong 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. ConclusionThis 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.

AIMS:This study aimed to evaluate the efficacy and safety of triple therapy with lobeglitazone 0.5 mg as an add-on treatment compared with placebo in patients with type 2 diabetes mellitus (T2DM) inadequately controlled with metformin and empagliflozin. MATERIALS AND METHODS:In this Phase 3, multicentre, double-blind, randomised trial, patients with T2DM who had an insufficient response to metformin (≥1000 mg/day) and empagliflozin 10 mg/day (Study 1) or 25 mg/day (Study 2) were randomised to receive either lobeglitazone 0.5 mg/day, or placebo once daily for 24 weeks. Participants then entered an open-label extension phase for an additional 28 weeks, bringing the total treatment duration to 52 weeks. The primary endpoint was the change from baseline in glycated haemoglobin (HbA1c) at 24 weeks. RESULTS:At 24 weeks, the mean change in HbA1c was significantly greater with lobeglitazone than with placebo, regardless of the background empagliflozin dose (-0.71%; 95% confidence interval, -0.88 to -0.55; p < 0.001 in Study 1 and -0.62%; -0.79 to -0.45; p < 0.001 in Study 2). A higher proportion of patients achieved HbA1c levels <7% with lobeglitazone compared to placebo (48.7% vs. 13.4% in Study 1, and 44.4% vs. 13.0% in Study 2; p < 0.001). Although the incidence of adverse events was numerically different between groups, no statistically significant differences were observed, indicating a generally comparable profile for the triple combination therapy with metformin, empagliflozin, and lobeglitazone. CONCLUSIONS:Lobeglitazone as an add-on to empagliflozin and metformin significantly improved glycaemic control in patients with T2DM inadequately controlled on metformin and empagliflozin dual therapy. The treatment was well tolerated, with a low incidence of adverse events.

Background:As obesity increases, the burden of obesity-related comorbidities also rises. However, the prevalence of obesity-related comorbidities among individuals in Korea has not been evaluated. Methods:Data from the 2007 to 2022 Korean National Health and Nutrition Examination Surveys database were analyzed (n=93,761). The prevalence of hypertension, diabetes, dyslipidemia, steatotic liver disease (SLD), and chronic kidney disease (CKD) was analyzed based on the presence of obesity and central obesity. The prevalence of obesity-related comorbidities was examined according to age and sex. Results:The prevalence of obesity has steadily increased from 31.5% in 2007-2009 to 37.4% in 2020-2022, with a more pronounced rise in men and those aged 19 to 39 years. Among individuals with obesity, the prevalence of hypertension, diabetes, dyslipidemia, CKD, and SLD has also increased. The proportion of metabolic dysfunction-associated steatotic liver disease (MASLD) and MASLD with increased alcohol intake have risen. The increase in CKD prevalence was particularly prominent in the young (19 to 39 years) and middle-aged (40 to 59 years) groups. Similar trends were observed when analyzing data based on central obesity. Conclusion:With the increase in obesity, the prevalence of obesity-related comorbidities in the Korean population has risen. Young and middle-aged individuals with obesity are particularly vulnerable to these comorbidities, highlighting the need for early intervention and targeted healthcare strategies.

The close interplay between metabolic dysfunction-associated steatotic liver disease (MASLD) and type 2 diabetes supports the need to identify beneficial combination therapies of antidiabetic medications targeted for the treatment of MASLD. This study aimed to investigate the complementary effects of combination therapy with pioglitazone (PIO) and empagliflozin (EMPA) on MASLD in individuals with type 2 diabetes. In a randomized, open-label trial, 50 participants with type 2 diabetes and MASLD were assigned 1:1:1 to receive PIO 15 mg, EMPA 10 mg, or a combination (PIO 15 mg plus EMPA 10 mg) daily for 24 weeks. Liver fat fraction and stiffness were evaluated using magnetic resonance imaging-proton density fat fraction (MRI-PDFF) and magnetic resonance elastography (MRE), respectively. Combination therapy resulted in the largest reduction in liver fat and stiffness among treatment groups. Participants experiencing a relative reduction ≥ 30

β-Hydroxybutyrate (βHB), the most stable form of ketone bodies, has exhibited protective effects in metabolic and chronic diseases. This study aimed to assess the association between fasting serum βHB levels, measured at baseline in drug-naïve state, and the risk of proteinuria in patients with newly diagnosed type 2 diabetes. In this longitudinal study involving 280 patients, baseline fasting serum βHB levels, urine protein parameters, and metabolic parameters were evaluated. To monitor the development of albuminuria (spot urine albumin-to-creatinine ratio ≥ 30.0 mg/gCr) or proteinuria (spot urine protein-to-creatinine ratio > 0.15 g/gCr), patients with normal baseline levels were followed for a mean of 2.40 ± 1.40 years. Patients were classified into the highest tertile of baseline serum βHB level group and two other lower tertiles. The highest tertile group (median fasting serum βHB: 0.30 mmol/l) had a significantly lower incidence of proteinuria (6.90

Background: This study aimed to investigate the prevalence, management, and comorbidities of diabetes mellitus among Korean adults.Methods: Data from the Korea National Health and Nutrition Examination Survey (2019–2022) were analyzed to assess the prevalence, treatment, risk factors, and comorbidities of diabetes. Comparisons between young and older adults with diabetes were emphasized.Results: Among Korean adults aged ≥30 years, the prevalence of diabetes is 15.5% during 2021–2022. Of these, 74.7% were aware of their condition, 70.9% received antidiabetic treatment, and only 32.4% achieved glycosylated hemoglobin (HbA1c) <6.5%. Moreover, 15.9% met the integrated management targets, which included HbA1c <6.5%, blood pressure <140/85 mm Hg, and low-density lipoprotein cholesterol <100 mg/dL. In young adults aged 19 to 39 years, the prevalence of diabetes was 2.2%. Among them, 43.3% were aware of their condition, 34.6% received treatment, and 29.6% achieved HbA1c <6.5%. Obesity affected 87.1%, and 26.9% had both hypertension and hypercholesterolemia. Among adults aged ≥65 years, the prevalence of diabetes was 29.3%, with awareness, treatment, and control rates of 78.8%, 75.7%, and 31.2%, respectively. Integrated management targets (HbA1c <7.5%, hypertension, and lipids) were achieved by 40.1%.Conclusion: Diabetes mellitus remains highly prevalent among Korean adults, with significant gaps in integrated glycemic, blood pressure, and lipid control. Older adults with diabetes show higher awareness and treatment rates but limited integrated management outcomes. Young adults with diabetes bear a significant burden of obesity and comorbidities, alongside low awareness and treatment rates. Therefore, early intervention programs, education, and strategies tailored to younger populations are urgently required.