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Systematic Review
Effective Education Methods to Improve Glycemic Control in Type 2 Diabetes Mellitus Patients: A Systematic Review
Ika Mustikaningtias, Anna Wahyuni Widayanti, Pugud Samodro, Nanang Munif Yasin
J Prev Med Public Health. 2025;58(5):453-464.   Published online June 4, 2025
DOI: https://doi.org/10.3961/jpmph.25.025
  • 2,212 View
  • 343 Download
AbstractAbstract AbstractSummary PDF
Objectives
Education for patients with type 2 diabetes mellitus (T2DM) is essential for reinforcing adherence and engagement to achieve therapeutic objectives, given the chronic nature of the treatment. Appropriate strategies for delivering education effectively are crucial. This study aimed to identify effective educational strategies for improving clinical outcomes in patients with T2DM.
Methods
The literature search included original publications from Science Direct, PubMed, and Scopus, published in English between 2015 and February 2024, for which full-text access was available. This review was performed by a team consisting of pharmacists and internist following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Results
From the initial search yielding 105 articles, 17 met the inclusion criteria. Of these 17 studies, 9 demonstrated significant improvements in clinical outcomes. Not all studies incorporated control groups for comparative analysis during the implementation of educational interventions. Most interventions were delivered via direct face-to-face methods, although there was considerable variation across studies in terms of program duration, intervention frequency, session length, education providers, and educational content.
Conclusions
Studies demonstrating improvements in clinical outcomes predominantly utilized direct face-to-face education methods, typically in sessions lasting between 30 minutes and 60 minutes, with the majority of programs extending over approximately 6 months. Pharmacists contribute significantly to the success of educational programs by providing tailored instructional information that aligns with established protocols while addressing individual patient needs.
Summary
Key Message
This systematic review identifies appropriate educational delivery patterns for patients with Type 2 Diabetes Mellitus (T2DM). This article explores the educational delivery methods, the frequency and duration of educational delivery, the length of educational programs, the providers of education, and the content of education, all of which are associated with clinical outcomes. Education must be customized to the patient's needs, necessitating a two-way conversation to investigate their difficulties or the information they need. Moreover, standardized guidelines should be established to serve as a reference for educators in patient education.
Original Articles
The Diabetogenic Effect of Statin Use May Interact With Polygenic Risk Scores for Type 2 Diabetes: Evidence From the UK Biobank
Jong Hyun Park, Kyu-Taek Lim, Jooyeon Lee, Yongjin Gil, Joohon Sung
J Prev Med Public Health. 2025;58(1):92-102.   Published online December 11, 2024
DOI: https://doi.org/10.3961/jpmph.24.671
  • 6,425 View
  • 506 Download
  • 1 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
Statins are essential in the prevention of cardiovascular disease; however, their association with type 2 diabetes mellitus (T2DM) risk is concerning. We examined whether genetic susceptibility to T2DM modifies the association between regular statin use and T2DM risk.
Methods
This study included 447 176 individuals from the UK Biobank without baseline diabetes or major cardiovascular disease. Statin use was recorded at baseline, and T2DM incidence was determined using clinical records. Polygenic risk scores (PRS) for T2DM risk were provided by the UK Biobank. Using propensity scores adjusted for age, sex, body mass index, and comorbidities, 14 831 statin users were matched with 37 060 non-users. Cox proportional hazards models were used to estimate the interaction effect of statin use and PRS on T2DM incidence, adjusting for key confounders.
Results
In the propensity-matched cohort, 3675 of 51 891 participants developed T2DM over a mean follow-up period of 13.7 years. Within the top 5% of the PRS distribution, per 1000 person-years, the incidence of T2DM was 15.42 for statin users versus 12.18 for non-users. Among the lowest 5%, the incidence was 1.90 for statin users and 1.65 for non-users. Based on the Cox proportional hazards model, regular statin use was associated with a 1.24-fold increased T2DM risk (95% confidence interval [CI], 1.15 to 1.33). Furthermore, PRS exhibited a significant multiplicative interaction with regular statin use (odds ratio, 1.10; 95% CI, 1.02 to 1.19).
Conclusions
PRS may help identify individuals particularly susceptible to the diabetogenic effects of statins, providing a potential path for personalized cardiovascular disease management.
Summary
Korean summary
스타틴은 심혈관 질환 예방에 필수적이지만, 제2형 당뇨병 발생 위험을 높인다고 알려져 있습니다. 본 연구는 영국 바이오뱅크 데이터를 활용하여, 스타틴 사용과 제2형 당뇨병 다유전자 위험 점수(Polygenic Risk Score, PRS)의 상호작용이 당뇨병 발생 위험에 미치는 영향을 분석했습니다. 연구 결과, PRS가 높은 집단에서는 스타틴 사용이 제2형 당뇨병 발생 위험을 유의하게 증가시켰으나, PRS가 낮은 집단에서는 스타틴 사용이 오히려 당뇨병 위험을 낮추는 경향을 보였습니다. 이러한 결과는 유전적 요인을 고려한 맞춤형 심혈관 질환 예방 전략의 중요성을 시사합니다.
Key Message
This study highlights that the diabetogenic effect of statins interacts significantly with genetic predisposition, as quantified by polygenic risk scores (PRS) for type 2 diabetes mellitus (T2DM). Individuals with high PRS are at a significantly increased risk of developing T2DM with statin use, while those with low PRS may experience a reduced risk. These findings underscore the potential of integrating genetic risk stratification into clinical decision-making to optimize the balance between cardiovascular benefits and T2DM risk in statin therapy.

Citations

Citations to this article as recorded by  
  • Bridging the Gap between Evidence and Practice: Nationwide Retrospective Analysis of Lipid-Modifying Therapy Prescription Patterns in 5 Million Patients with Type 2 Diabetes Mellitus
    Ahmed Hassan, Menna A. Keshk, Mohamed Reyad, Nourhan Ahmed, Omar Nassar, Aisha Siraj, Salem Badr, Sherif Eltawansy, Anoop Misra, Muhammed Amir Essibayi, Ahmed Y. Azzam, Mahmoud Nassar, Diaa Hakim
    ASIDE Internal Medicine.2025; 2(2): 6.     CrossRef
The Development of an Assessment Instrument for Behavior Toward Hypoglycemia Risk Among Type 2 Diabetes Mellitus Outpatients in Jakarta, Indonesia
Putu Rika Veryanti, Rani Sauriasari, Ratu Ayu Dewi Sartika, Berna Elya, Muhammad Ikhsan Mokoagow
J Prev Med Public Health. 2025;58(1):31-43.   Published online November 13, 2024
DOI: https://doi.org/10.3961/jpmph.24.313
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AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
The purpose of this study was to develop a valid and reliable instrument for assessing patients’ behavior toward the risk of hypoglycemia through self-assessment. Insufficient education and supervision of type 2 diabetes mellitus (DM) outpatients by healthcare providers is a significant concern, affecting their behavior during the treatment process. Additionally, inappropriate behavior typically increases the risk of hypoglycemia. To mitigate this risk, several studies have recommended evaluating patients’ behavior, necessitating the development of a new instrument.
Methods
The study procedures were conducted in 3 stages: instrument development (face and content validity, stage I), construct validity and reliability test (stage II), and criterion validity (stage III). Stage I involved 5 healthcare practitioners, including internal medicine doctors, nurses, dietitians, and pharmacists in hospitals and community health centers. Stage II included 20 respondents using a 1-shot test method. Stage III involved 237 type 2 DM outpatients at Central General Hospital (RSUP) in Jakarta, employing a cross-sectional design and consecutive sampling.
Results
The results indicated that the developed instrument was valid and reliable, comprising 9 domains (29 questions). These domains included behavior toward blood glucose monitoring, diet, physical activity, medication, assistance from healthcare providers, hypoglycemia management, self-care, family support, and insulin use. Furthermore, poor behavior was found to increase the risk of hypoglycemia by 2.36 times.
Conclusions
Based on these results, the developed instrument could be effectively used to evaluate behavior toward hypoglycemia among type 2 DM outpatients, confirming its validity and reliability.
Summary
Key Message
The development of an assessment instrument for behavior toward hypoglycemia risk among type 2 diabetes mellitus outpatients in Jakarta, Indonesia have been carried out. The instrument contains 9 domains, included behavior toward blood glucose monitoring, diet, physical activity, medication, assistance from healthcare providers, hypoglycemia management, self-care, family support, and insulin use. Poor behavior was found to increase the risk of hypoglycemia by 2.36 times. The instrument developed is valid and reliable.
Development and Validation of an Instrument to Assess the Safe Use of Antidiabetic Medication to Prevent Hypoglycemia Requiring Hospitalization Among Ambulatory Patients With Type 2 Diabetes Mellitus in Bali, Indonesia
Made Krisna Adi Jaya, Fita Rahmawati, Nanang Munif Yasin, Zullies Ikawati
J Prev Med Public Health. 2025;58(1):52-59.   Published online October 24, 2024
DOI: https://doi.org/10.3961/jpmph.24.424
  • 3,181 View
  • 554 Download
AbstractAbstract AbstractSummary PDF
Objectives
Ambulatory patients with type 2 diabetes mellitus (T2DM) require special attention when being discharged from the hospital with anti-diabetes medication. This necessity stems primarily from the risk of adverse drug reactions, particularly hypoglycemia. However, this risk is significantly influenced by the patients’ knowledge and behavior regarding their medication use. This study aimed to develop instrument to assess the risk of medication-related hypoglycemia in ambulatory T2DM patients by clinical pharmacists.
Methods
The study was conducted using an observational design that included multiple stages. These stages involved item development through focus group discussions (FGDs), content validation by clinical pharmacists, and criterion and construct validation by ambulatory T2DM patients using a cross-sectional approach.
Results
A total of 10 question items were developed for assessment by clinical pharmacists following FGDs and content validation. Criterion and construct validation identified 8 valid question items through multivariate analysis (p<0.05). The scoring system developed demonstrated a linear relationship between the score and the number of items at risk in the instrument (p<0.05, R²=0.988). Additionally, the instrument was named “Medication-related Hypoglycemia Risk Score Assessment Tools (HYPOGLYRISK).”
Conclusions
The findings of this study suggest that HYPOGLYRISK may serve as a useful tool for clinical pharmacists to evaluate the risk of medication-related hypoglycemia in ambulatory T2DM patients. Additionally, this instrument could assist clinical pharmacists in identifying priority patients and tailoring educational services to meet their specific goals and needs.
Summary
Key Message
- HYPOGLYRISK is an instrument that can be used to assess the risk of hypoglycemia requiring hospitalization in T2DM patients. This instrument met all the requirements for psychometric properties testing in this study. - Patients discharged on antidiabetic medications can be screened for risk of severe hypoglycemia using HYPOGLYRISK, specifically by pharmacists, during drug dispensing. - Patients with T2DM must be ensured to have knowledge related to the five dimensions of medication safety to avoid the risk of hypoglycemia requiring hospitalization.
Systematic Review
Effects of Physical and Mind-body Exercise on Sleep Quality in Individuals With Diabetes Mellitus: A Systematic Review and Meta‐analysis
Yohanes Andy Rias, Renny Wulan Apriliyasari, Made Satya Nugraha Gautama, Faizul Hasan, Margareta Teli, Hsiao-Yean Chiu, Ratsiri Thato
J Prev Med Public Health. 2025;58(1):1-10.   Published online October 7, 2024
DOI: https://doi.org/10.3961/jpmph.24.354
  • 15,501 View
  • 913 Download
  • 2 Web of Science
  • 3 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
Physical and mind-body exercises represent distinct intervention strategies that may improve sleep quality by influencing physiological and psychological factors. Nevertheless, their effectiveness in individuals with diabetes is not well-established. This systematic review and meta-analysis aimed to examine the impacts of physical and mind-body exercise interventions on sleep quality in patients with diabetes mellitus.
Methods
Six randomized controlled trials (RCTs) that met the inclusion criteria were identified from PubMed, CINAHL, Embase, Scopus, Web of Science, Cochrane, and Ovid-Medline Library. The effect size for sleep quality was calculated using the standardized mean difference (SMD) with a 95% confidence interval (CI), employing a random-effects model. Heterogeneity and publication bias were also examined, and subgroup, meta-regression, and sensitivity analyses were performed.
Results
Physical and mind-body exercise interventions significantly improved sleep quality, with an SMD of -1.040 (95% CI, -1.686 to -0.394). Subgroup analysis revealed significant differences with respect to the type of intervention (p=0.047), or its duration (p=0.282). Meta-regression analysis indicated that mean hemoglobin A1c level was the only factor to be significantly related to the effect size for sleep quality, demonstrating a negative association (p=0.033). The assessment of publication bias and the sensitivity analysis suggested that the findings were reliable and robust.
Conclusions
Physical and mind-body exercises may serve as effective interventions for patients with diabetes mellitus who experience poor sleep quality. However, to substantiate these findings, additional rigorous RCTs with larger sample sizes, longer follow-up periods, and standardized interventions are required.
Summary
Key Message
This systematic review and meta-analysis reviewed the impact of physical and mind-body exercise interventions on sleep quality in individuals with diabetes mellitus, examining six randomised, controlled trials. The results indicated a notable enhancement in sleep quality. A meta-analysis revealed a negative correlation between haemoglobin A1c levels and improvements in sleep quality. The findings suggest that physical and mind-body exercise are effective methods for improving sleep quality; however, additional rigorous research with larger sample sizes and standardised protocols is necessary.

Citations

Citations to this article as recorded by  
  • Assessment of Sleep Quality and Its Determinants Among Patients with Type 2 Diabetes Mellitus in Mogadishu, Somalia: A Cross-Sectional Study
    Nur Mohamed, Rahma Haji Mohamud, Fadumo Hilowle, Tigad Ali, Yusuf Abdirisak Mohamed, Adan Gabow, Hawa Mohamed, Nor Sidow, Mohamed Sheikh Hassan, Mohamud Waberi
    Diabetes, Metabolic Syndrome and Obesity.2025; Volume 18: 1949.     CrossRef
  • Sleep Quality in Patients With Type 2 Diabetes Mellitus
    Sana Khamassi, Emna Bornaz, Haifa Abdesselem, Kamilia Ounaissa, Fatma Boukhayatia, Chiraz Amrouche
    American Journal of Lifestyle Medicine.2025;[Epub]     CrossRef
  • Acute and chronic effects of inspiratory muscle training in patients with type 2 diabetes mellitus: a systematic review of randomized controlled trials
    Zoé Breuil-Marsal, Clémence Godek, Amandine Lotti, Patrick Feiereisen, Isabela Roque Marçal, Patricia Rehder-Santos, Juliana Cristina Milan-Mattos, Raphael Martins de Abreu
    Frontiers in Sports and Active Living.2024;[Epub]     CrossRef
Original Articles
Healthcare Utilization and Discrepancies by Income Level Among Patients With Newly Diagnosed Type 2 Diabetes in Korea: An Analysis of National Health Insurance Sample Cohort Data
Eun Jee Park, Nam Ju Ji, Chang Hoon You, Weon Young Lee
J Prev Med Public Health. 2024;57(5):471-479.   Published online August 20, 2024
DOI: https://doi.org/10.3961/jpmph.24.165
  • 6,516 View
  • 245 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDF
Objectives
The use of qualitative healthcare services or its discrepancy between different income levels of the type 2 diabetes (T2D) patients has seldom been studied concurrently. The present study is unique that regarding T2D patients of early stages of diagnosis. Aimed to assess the utilization of qualitative healthcare services and influence of income levels on the inequality of care among newly diagnosed patients with T2D.
Methods
A retrospective cohort study of 7590 patients was conducted by the National Health Insurance Service National Sample Cohort 2.0 from 2002 to 2015. Insured employee in 2013 with no history of T2D between 2002 and 2012 were included. The standard of diabetes care includes hemoglobin A1c (HbAlc; 4 times/y), eyes (once/y) and lipid abnormalities (once/y). Multivariate logistic regression analysis was performed to examine the difference between income levels and inequality of care.
Results
From years 1 to 3, rates of appropriate screening fell from 16.9% to 14.1% (HbA1c), 15.8% to 14.5% (eye), and 59.2% to 33.2% (lipid abnormalities). Relative to income class 5 (the highest-income group), HbA1 screening was significantly less common in class 2 (year 2: odds ratio [OR], 0.78; 95% confidence interval [CI], 0.61 to 0.99; year 3: OR, 0.79; 95% CI, 0.69 to 0.91). In year 1, lipid screening was less common in class 1 (OR, 0.84; 95% CI, 0.73 to 0.98) than in class 5, a trend that continued in year 2. Eye screening rates were consistently lower in class 1 than in class 5 (year 1: OR, 0.73; 95% CI, 0.60 to 0.89; year 2: OR, 0.63; 95% CI, 0.50 to 0.78; year 3: OR, 0.81; 95% CI, 0.67 to 0.99).
Conclusions
Newly diagnosed T2D patients have shown low rate of HbA1c and screening for diabetic-related complications and experienced inequality in relation to receiving qualitative diabetes care by income levels.
Summary
Korean summary
의료서비스 이용의 강도와 질을 측정하는 당뇨 관련 합병증 검진율은 저소득층에서 특히 낮았습니다. 보편적 건강 보장이 있는 국가에서도 신환환자 특히 낮은 경제적 계층의 치료 불균형을 해소 하기 위해서는 재정적 부담은 절감하고, 건강 문해력 증진시키고, 일차의료 기관의 기능을 최적화 하여 책임을 강화하는 것이 필요합니다.
Key Message
Diabetic-related complications screening rates that measure the intensity and quality of medical care service usage were statistically lower in low-income groups. Reducing financial burden, promoting health literacy and optimizing the function of primary care physician and reinforcing the health care provider’s accountability are necessary to address the discrepancy of care for those with low socioeconomic status people in early stage of disease, even in nations with universal health coverage.

Citations

Citations to this article as recorded by  
  • Older Adults with Diabetes in Korea: Latest Clinical and Epidemiologic Trends
    Kyuho Kim, Bongseong Kim, Kyuna Lee, Yu-Bae Ahn, Seung-Hyun Ko, Sung Hee Choi, Kyungdo Han, Jae-Seung Yun
    Diabetes & Metabolism Journal.2025; 49(2): 183.     CrossRef
  • Long-term clinical outcome and risk stratification across stages of cardiovascular-kidney-metabolic syndrome in a nationwide cohort
    Hyun-Jin Kim, Byung Sik Kim, Hasung Kim, Jungkuk Lee, Ha Hye Jo, Dong Wook Kim, Jeong-Hun Shin, Ki-Chul Sung
    The Korean Journal of Internal Medicine.2025; 40(6): 975.     CrossRef
Multilevel Analysis of the Relationship Between Prescribing Institutions and Medication Adherence Among Patients With Hypertension and Diabetes in Korea
Haryeom Ghang, Juhyang Lee
J Prev Med Public Health. 2023;56(6):504-514.   Published online October 5, 2023
DOI: https://doi.org/10.3961/jpmph.23.252
  • 5,107 View
  • 152 Download
  • 2 Web of Science
  • 3 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
This study investigated the relationship between prescribing institutions and medication adherence among patients newly diagnosed with hypertension and diabetes.
Methods
This study investigated patients with new prescriptions for hypertension and diabetes in Korea in 2019 with using data collected from general health screenings. A multilevel logistic regression model was applied to explore the relationship between patients’ first prescribing institution and their medication adherence, defined as a medication possession ratio (MPR) over 80%.
Results
The overall adherence rates were 53.7% and 56.0% among patients with hypertension and diabetes, respectively. The intraclass correlation coefficients were 13.2% for hypertension and 13.8% for diabetes (p<0.001), implying that the first prescribing institution had a significant role in medication adherence. With clinics as the reference group, all other types of hospitals showed an odds ratio (OR) less than 1.00, with the lowest for tertiary hospitals (OR, 0.30 for hypertension; 0.45 for diabetes), and the next lowest in health screening specialized clinics (OR, 0.51 for hypertension; 0.46 for diabetes). Among individual-level variables, female sex, older age, higher insurance premium level, and residing in cities were positively associated with adherence in both the hypertension and diabetes samples.
Conclusions
This study showed that the prescribing institution had a significant relationship with medication adherence. When the first prescribing institution was a clinic, newly diagnosed patients were more likely to adhere to their medication. These results highlight the important role played by primary care institutions in managing mild chronic diseases.
Summary
Korean summary
2019년 일반건강검진을 통해 발견된 고혈압과 당뇨병의 신규 환자를 대상으로 복약순응도를 분석하였다. 그 결과 검진 후 첫번째 처방기관이 의원인 경우에 비해 다른 종별 의료기관인 경우 복약순응 오즈비가 모두 감소하였는데 상급종합병원이 가장 낮았고(고혈압 0.30, 당뇨병 0.45), 그 다음은 검진전문의원인 것으로 나타났다(고혈압 0.51, 당뇨병 0.46).
Key Message
This study investigated the relationship between prescribing institutions and medication adherence among patients newly diagnosed with hypertension and diabetes using general health screening data in Korea in 2019. The results showed that with clinics as the reference group, all other types of hospitals showed an odds ratio (OR) less than 1.00, with the lowest for tertiary hospitals (OR, 0.30 for hypertension; 0.45 for diabetes), and the next lowest in health screening specialized clinics (OR, 0.51 for hypertension; 0.46 for diabetes).

Citations

Citations to this article as recorded by  
  • The Diabetogenic Effect of Statin Use May Interact With Polygenic Risk Scores for Type 2 Diabetes: Evidence From the UK Biobank
    Jong Hyun Park, Kyu-Taek Lim, Jooyeon Lee, Yongjin Gil, Joohon Sung
    Journal of Preventive Medicine and Public Health.2025; 58(1): 92.     CrossRef
  • Evidence of Overlapping Roles Between Clinics and Hospitals in Primary Care
    Boram Sim, Jihye Shin, Hyun Woo Kim, Jin Yong Lee, Min-Woo Jo
    Journal of Korean Medical Science.2025;[Epub]     CrossRef
  • Comparative Study of Preventable Hospitalizations and Underutilization for ACSCs According to Insurance Type
    Boram Sim, Hyun Joo Kim
    Journal of information and communication convergence engineering.2025; 23(3): 203.     CrossRef
Health-related Quality of Life of Patients With Diabetes Mellitus Measured With the Bahasa Indonesia Version of EQ-5D in Primary Care Settings in Indonesia
Muhammad Husen Prabowo, Ratih Puspita Febrinasari, Eti Poncorini Pamungkasari, Yodi Mahendradhata, Anni-Maria Pulkki-Brännström, Ari Probandari
J Prev Med Public Health. 2023;56(5):467-474.   Published online September 26, 2023
DOI: https://doi.org/10.3961/jpmph.23.229
  • 7,910 View
  • 251 Download
  • 8 Web of Science
  • 9 Crossref
AbstractAbstract AbstractSummary PDF
Objectives
Diabetes mellitus (DM) is a serious public health issue that places a heavy financial, social, and health-related burden on individuals, families, and healthcare systems. Self-reported health-related quality of life (HRQoL) is extensively used for monitoring the general population’s health conditions and measuring the effectiveness of interventions. Therefore, this study investigated HRQoL and associated factors among patients with type 2 DM at a primary healthcare center in Indonesia.
Methods
A cross-sectional study was conducted in Klaten District, Central Java, Indonesia, from May 2019 to July 2019. In total, 260 patients with DM registered with National Health Insurance were interviewed. HRQoL was measured with the EuroQol Group’s validated Bahasa Indonesia version of the EuroQoL 5-Dimension 5-Level (EQ-5D-5L) with the Indonesian value set. Multivariate regression models were used to identify factors influencing HRQoL.
Results
Data from 24 patients were excluded due to incomplete information. Most participants were men (60.6%), were aged above 50 years (91.5%), had less than a senior high school education (75.0%), and were unemployed (85.6%). The most frequent health problems were reported for the pain/discomfort dimension (64.0%) followed by anxiety (28.4%), mobility (17.8%), usual activities (10.6%), and self-care (6.8%). The average EuroQoL 5-Dimension (EQ-5D) index score was 0.86 (95% confidence interval [CI], 0.83 to 0.88). In the multivariate ordinal regression model, a higher education level (coefficient, 0.08; 95% CI, 0.02 to 0.14) was a significant predictor of the EQ-5D-5L utility score.
Conclusions
Patients with diabetes had poorer EQ-5D-5L utility values than the general population. DM patients experienced pain/discomfort and anxiety. There was a substantial positive relationship between education level and HRQoL.
Summary
Key Message
This study examined Health-Related Quality of Life (HRQoL) in 260 type 2 diabetes patients in Indonesia. Most were male (60.6%), over 50 (91.5%), with low education (75%) and unemployed (85.6%). Pain/discomfort was the most common issue (64%), followed by anxiety (28.4%). The average HRQoL score was 0.86. Higher education positively impacted HRQoL. Diabetes patients face lower HRQoL compared to the general population, with notable issues in pain and anxiety. Education level significantly influences HRQoL. This highlights the importance of education in improving the well-being of diabetes patients in Indonesia.

Citations

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  • Time series analysis of the impact of ambient temperature influence on healthcare service utilization by diabetes patients in the Special Capital Region of Jakarta, Indonesia: A study using Indonesian National Health Insurance data
    Helen Andriani, Chairina Suci Andhisa, Paul LC. Chua, Miftahul Arsyi
    Global Transitions.2026; 8(1): 64.     CrossRef
  • Socio-demographic disparities in health-related quality of life in hypertensive patients in Bangladesh: a comprehensive survey analysis
    Md. Mizanur Rahman, Md. Nesar Uddin Sorkar, Ryota Nakamura, Md. Monirul Islam, Md. Ashraful Alam, Syed Khurram Azmat, Motohiro Sato
    Quality of Life Research.2025; 34(5): 1457.     CrossRef
  • Research trend of functional magnetic resonance imaging in diabetes mellitus research: a visualization and bibliometric analysis
    Zongbo Sun, Yuanyuan Li, Xueli Qu, Luguang Wang, Shengyin Zhu, Xuejing Sun, Li Yang, Xiaonan Sun
    Frontiers in Neurology.2025;[Epub]     CrossRef
  • Is the pay-for-performance program associated with better quality of life among type 2 diabetes patients, including those with gastrointestinal conditions, in Taiwan? A cross-sectional survey
    Shao-Hua Kuang, Tsung-Tai Chen, Wen-Ya Ma, Szu-Tah Chen, Meng-Han Shih, Ching-Chieh Su, Wei-Chih Su, Li Ying Huang, Ya-Seng (Arthur) Hsueh, Vinchi Wang, Alexandre Morais Nunes
    PLOS One.2025; 20(8): e0328910.     CrossRef
  • Health-related quality of life and disease activity in rheumatoid arthritis: a cross-sectional study in West Java, Indonesia
    Yudisia Ausi, Rano K. Sinuraya, Sumartini Dewi, Melisa I. Barliana, Maarten J. Postma, Auliya A. Suwantika
    Frontiers in Medicine.2025;[Epub]     CrossRef
  • Effective Education Methods to Improve Glycemic Control in Type 2 Diabetes Mellitus Patients: A Systematic Review
    Ika Mustikaningtias, Anna Wahyuni Widayanti, Pugud Samodro, Nanang Munif Yasin
    Journal of Preventive Medicine and Public Health.2025; 58(5): 453.     CrossRef
  • Cost-effectiveness of community-based type 2 diabetes prevention and control in Indonesia: a health economics modelling study
    Rachmadianti Sukma Hanifa, M Rifqi Rokhman, Manuela Fritz, Vitri Widyaningsih, Ratih Puspita Febrinasari, Jaap A R Koot, Maarten J Postma, Jurjen van der Schans
    BMJ Public Health.2025; 3(2): e002161.     CrossRef
  • Quality of life and prevalence of prehypertension/hypertension among patients with diabetes mellitus: A cross-sectional study in a tertiary care hospital of Gandaki Province, Nepal
    Sushila Baral, Rajesh Kumar Yadav, Srijana Paudel, Yadunath Baral, Pawan Pandeya, Sweta Silwal, Santosh Poudel, Roshan Dhakal, Roshan Kumar Mahato
    Clinical Epidemiology and Global Health.2025; 36: 102209.     CrossRef
  • Genetic CYP2A6 Polymorphism May Worsen Glycohemoglobin Levels: Study among Javanese Indonesian Smokers
    Christine Patramurti, Dita Maria Virginia
    Borneo Journal of Pharmacy.2024; 7(1): 29.     CrossRef
Health-related Quality of Life Instrument With 8 Items for Use in Patients With Type 2 Diabetes Mellitus: A Validation Study in Korea
Juyoung Kim, Hyeon-Jeong Lee, Min-Woo Jo
J Prev Med Public Health. 2022;55(3):234-242.   Published online May 12, 2022
DOI: https://doi.org/10.3961/jpmph.22.020
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AbstractAbstract AbstractSummary PDFSupplementary Material
Objectives
This study assessed the validity and reliability of the Health-related Quality of Life Instrument with 8 Items (HINT-8) in patients with diabetes. HINT-8 is a newly-developed, generic health-related quality of life (HRQoL) instrument.
Methods
Three HRQoL instruments—HINT-8, EuroQoL 5-Dimension 5-Level (EQ-5D-5L), and Short Form Health Survey version 2.0 (SF-36v2)—were provided to 300 patients with diabetes visiting a tertiary hospital for follow-up visits in Korea. The HRQoL scores obtained using the HINT-8 were evaluated for subgroups with known differences based on demographics and diabetes-related characteristics (known-group validity). The mean scores of the instruments were compared between groups segmented by their responses to the HINT-8 (discriminatory ability). Correlation coefficients of the HINT-8 with other instruments were calculated (convergent and divergent validity). The Cohen kappa and intra-class correlation coefficient (ICC) were also evaluated (test-retest reliability).
Results
The average HINT-8 indexes were lower among women, older, and less-educated subjects. Subjects who did not list any problems on the HINT-8 had significantly higher HRQoL scores than those who did. The correlation coefficients of the HINT-8 with the EQ-5D-5L index and EuroQoL visual analogue scale were 0.715 (p<0.001) and 0.517 (p<0.001), respectively. The correlation coefficients between the HINT-8 index and the scores of 8 domains of the SF-36v2 ranged from 0.478 (p<0.001) to 0.669 (p<0.001). The Cohen kappa values for the HINT-8 ranged from 0.268 to 0.601, and the ICC of the HINT-8 index was 0.800 (95% confidence interval [CI], 0.720 to 0.860).
Conclusions
This study showed that the HINT-8 is a valid and reliable HRQoL instrument for patients with diabetes.
Summary
Korean summary
이 연구는 한국인의 사회문화적 특성을 반영하여 개발된 건강관련 삶의 질 도구인 HINT-8의 타당도 및 신뢰도를 대표적인 만성 질환인 제2형 당뇨 환자를 대상으로 검증하였다. 연구결과는 제2형 당뇨 환자에서 HINT-8의 활용 가능성을 보여주었을 뿐만 아니라 일반적 건강관련 삶의 질 도구 중 가장 널리 사용되고 있는 EQ-5D-5L보다 HINT-8이 삶의 질 상태를 더욱 정교하게 구분하고 있음을 보여주었다.

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Systematic Review
Low Social Support and Risk for Depression in People With Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis
Akhmad Azmiardi, Bhisma Murti, Ratih Puspita Febrinasari, Didik Gunawan Tamtomo
J Prev Med Public Health. 2022;55(1):37-48.   Published online January 10, 2022
DOI: https://doi.org/10.3961/jpmph.21.490
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AbstractAbstract PDF
Objectives
Depression is a frequent complication of type 2 diabetes mellitus. This study aimed to investigate the relationship between low social support and risk for depression in people with type 2 diabetes through a meta-analysis.
Methods
PubMed, ProQuest, SpringerLink, ScienceDirect, Scopus, the Cochrane Library, Embase, and Google Scholar were searched for English-language articles published up to 2021. Pooled adjusted odds ratios (aORs) were calculated using a random-effect model with 95% confidence intervals (CIs). Heterogeneity was evaluated by using the Cochrane Q test and I2 statistics. The risk of publication bias was estimated using a funnel plot, the Egger test, and the Begg test. The Joanna Briggs Institute Critical Appraisal Tools were used to assess the quality of evidence and the risk of bias.
Results
Eleven studies were included in this meta-analysis, containing a total of 3151 people with type 2 diabetes mellitus. The pooled analysis showed that people with type 2 diabetes mellitus who had low social support had twice as high a risk of depression as those with high social support (aOR, 2.02; 95% CI, 1.51 to 2.70; p<0.001). A random-effect model was used because the heterogeneity was high (I2= 87%).
Conclusions
Low social support was found to increase the risk of depression among people with type 2 diabetes mellitus. Further investigation into factors that may moderate this relationship is required.
Summary

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Original Articles
Determinants of Adherence to Diabetes Screening in Iranian Adults With a Positive Family History of Diabetes
Narges Malih, Mohammad-Reza Sohrabi, Alireza Abadi, Shahnam Arshi
J Prev Med Public Health. 2021;54(3):190-198.   Published online April 7, 2021
DOI: https://doi.org/10.3961/jpmph.20.496
  • 6,899 View
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AbstractAbstract PDFSupplementary Material
Objectives
Insufficient evidence exists regarding factors that affect screening adherence among people with a family history of diabetes, who comprise roughly half of all patients with diabetes. Therefore, we aimed to identify the determinants of diabetes screening adherence in adults with a family history of diabetes who had not yet been diagnosed with diabetes.
Methods
This cross-sectional study was conducted at selected urban primary healthcare facilities in Tehran, Iran. The study population was clinically non-diabetic adults above 20 years of age with a family history of diabetes in at least 1 first-degree relative. All eligible people identified on randomly-selected days of the month were invited to join the study.
Results
Among 408 participants, 128 (31.4%) had received a fasting blood glucose check during the last year. Using binary logistic regression, the independent predictors of screening adherence were knowledge of adverse effects of diabetes such as sexual disorders (odds ratio [OR], 3.05) and renal failure (OR, 2.73), the impact of family members’ advice on receiving diabetes screening (OR, 2.03), recommendation from a healthcare provider to have a fasting blood glucose check (OR, 2.61), and intention to have a fasting blood glucose check within the next 6 months (OR, 2.85). Other variables that predicted screening adherence were age (OR, 1.05), job (being a housekeeper; OR, 3.39), and having a college degree (OR, 3.55).
Conclusions
Knowledge of the adverse effects of diabetes, physicians’ and healthcare providers’ advice about the benefits of early disease detection, and family members’ advice were independent predictors of screening adherence.
Summary

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  • The association between sociodemographic characteristics, clinical indicators and body mass index in a population at risk of type 2 diabetes: A cross-sectional study in two Colombian cities
    Yenifer Diaz Montes, Tania Acosta Vergara, Rafael Tuesca Molina, Gillian Martinez Guerrero, Luis A. Anillo Arrieta, Pablo Aschner, Jorge Acosta-Reyes, Victor Florez-Garcia, Edgar Navarro Lechuga, Noël C. Barengo
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  • BİR ÜNİVERSİTE AKADEMİSYENLERİNİN SAĞLIK DAVRANIŞLARINA VE TARAMA PROGRAMLARINA UYUMU: KESİTSEL BİR ÇALIŞMA
    Hatice İkiışık, Sibel Sakarya
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Thirst for Information and Needs Reflections of Type 2 Diabetes Patients Receiving Insulin Treatment in North-East Ethiopia: A Qualitative Exploration
Ewunetie Mekashaw Bayked, Birhanu Demeke Workneh, Mesfin Haile Kahissay
J Prev Med Public Health. 2021;54(2):119-128.   Published online March 1, 2021
DOI: https://doi.org/10.3961/jpmph.20.510
  • 8,824 View
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  • 6 Web of Science
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AbstractAbstract PDFSupplementary Material
Objectives
Ongoing, proactive, planned, and patient-centered diabetes education is the cornerstone of care for all persons with diabetes. Thus, the aim of this study was to explore the information needs of type 2 diabetes mellitus patients receiving insulin treatment in North-East Ethiopia.
Methods
The study was conducted from July 2019 to January 2020 using a qualitative enquiry (phenomenological approach) with purposive sampling. Face-to-face in-depth interviews were used to collect data until reaching theoretical saturation. The participants were type 2 diabetes patients receiving insulin treatment. They were identified from the diabetes patients’ registration book at the diabetes clinic and interviewed at their appointment time, and were selected to include wide variations in terms of socio-demographic characteristics. Twenty-four participants (11 men and 13 women), with a median age of 57 years, were interviewed. The data were organized using QDA Miner Lite version 2.0.7 and analyzed thematically using narrative strategies.
Results
Most participants had not heard of diabetes before their diagnosis. They had limited knowledge of diabetes, but ascribed different connotations for it in the local language (Amharic). The needs reflections of patients were categorized into diabetes education and participants’ recommendations. Diabetes education was totally absent at hospitals, and patients received education primarily from the Ethiopian Diabetes Association and broadcast and digital media. Thus, the major concern of patients was the availability of diabetes education programs at health institutions.
Conclusions
Patients’ main concern was the absence of routine diabetes education, which necessitates urgent action to implement diabetes education programs, especially at health institutions.
Summary

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The Association Between Smoking Tobacco After a Diagnosis of Diabetes and the Prevalence of Diabetic Nephropathy in the Korean Male Population
Hyungseon Yeom, Jung Hyun Lee, Hyeon Chang Kim, Il Suh
J Prev Med Public Health. 2016;49(2):108-117.   Published online March 23, 2016
DOI: https://doi.org/10.3961/jpmph.15.062
  • 12,882 View
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AbstractAbstract PDFSupplementary Material
Objectives
Smoking is known to be associated with nephropathy in patients with diabetes. The distinct effects of smoking before and after diabetes has been diagnosed, however, are not well characterized. We evaluated the association of cigarette smoking before and after a diagnosis of diabetes with the presence of diabetic nephropathy.
Methods
We analyzed data from the 2011-2013 editions of the Korea National Health and Nutrition Examination Survey. A total of 629 male patients diagnosed with diabetes were classified as non-smokers (90 patients), former smokers (225 patients), or continuing smokers (314 patients). A “former smoker” was a patient who smoked only before receiving his diagnosis of diabetes. A “continuing smoker” was a patient who smoked at any time after his diabetes had been diagnosed. Diabetic nephropathy was defined as the presence of albuminuria (spot urine albumin/creatinine ratio ≥30 mg/g) or low estimated glomerular filtration rate (<60 mL/min/1.73 m2). Multiple logistic regression models were used to assess the independent association after adjusting for age, duration of diabetes, hemoglobin A1c, body mass index, systolic blood pressure, medication for hypertension, and medication for dyslipidemia. Female patients were excluded from the study due to the small proportion of females in the survey who smoked.
Results
Compared to non-smokers, continuing smokers had significantly higher odds ratio ([OR], 2.17; 95% confidence interval [CI], 1.23 to 3.83) of suffering from diabetic nephropathy. The corresponding OR (95% CI) for former smokers was 1.26 (0.70 to 2.29).
Conclusions
Smoking after diagnosis of diabetes is significantly associated with the presence of diabetic nephropathy in the Korean male population.
Summary

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Diabetes Mellitus and Site-specific Colorectal Cancer Risk in Korea: A Case-control Study
Hyeongtaek Woo, Jeeyoo Lee, Jeonghee Lee, Ji Won Park, Sungchan Park, Jeongseon Kim, Jae Hwan Oh, Aesun Shin
J Prev Med Public Health. 2016;49(1):45-52.   Published online December 22, 2015
DOI: https://doi.org/10.3961/jpmph.15.029
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AbstractAbstract PDF
Objectives
Previous large-scale cohort studies conducted in Korea have found a positive association between diabetes mellitus (DM) and colorectal cancer (CRC) in men only, in contrast to studies of other populations that have found significant associations in both men and women.
Methods
A total of 1070 CRC cases and 2775 controls were recruited from the National Cancer Center, Korea between August 2010 and June 2013. Self-reported DM history and the duration of DM were compared between cases and controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by binary and polytomous logistic regression models.
Results
DM was associated with an elevated risk of CRC in both men (OR, 1.47; 95% CI, 1.13 to 1.90) and women (OR, 1.92; 95% CI, 1.24 to 2.98). This association remained when we controlled for age, body mass index, alcohol consumption, and physical activity level. In sub-site analyses, DM was associated with distal colon cancer risk in both men (multivariate OR, 2.04; 95% CI, 1.39 to 3.00) and women (multivariate ORs, 1.99; 95% CI, 1.05 to 3.79), while DM was only associated with rectal cancer risk in women (multivariate OR, 2.05; 95% CI, 1.10 to 3.82). No significant association was found between DM and proximal colon cancer risk in either men (multivariate OR, 1.45; 95% CI, 0.88 to 2.41) or women (multivariate OR, 1.79; 95% CI, 0.78 to 4.08).
Conclusions
Overall, DM was associated with an increased risk of CRC in Koreans. However, potential over-estimation of the ORs should be considered due to potential biases from the case-control design.
Summary

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Determinants of Poor Self-rated Health in Korean Adults With Diabetes
Hwi-Won Lee, Minkyo Song, Jae Jeong Yang, Daehee Kang
J Prev Med Public Health. 2015;48(6):287-300.   Published online October 23, 2015
DOI: https://doi.org/10.3961/jpmph.15.048
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AbstractAbstract PDFSupplementary Material
Objectives
Self-rated health is a measure of perceived health widely used in epidemiological studies. Our study investigated the determinants of poor self-rated health in middle-aged Korean adults with diabetes.
Methods
A cross-sectional study was conducted based on the Health Examinees Study. A total of 9759 adults aged 40 to 69 years who reported having physician-diagnosed diabetes were analyzed with regard to a range of health determinants, including sociodemographic, lifestyle, psychosocial, and physical variables, in association with self-rated health status using multivariate logistic regression models. A p-value <0.05 was considered to indicate statistical significance.
Results
We found that negative psychosocial conditions, including frequent stress events and severe distress according to the psychosocial well-being index, were most strongly associated with poor self-rated health (odds ratio [OR]Frequent stress events, 5.40; 95% confidence interval [CI], 4.63 to 6.29; ORSevere distress, 11.08; 95% CI, 8.77 to 14.00). Moreover, younger age and being underweight or obese were shown to be associated with poor self-rated health. Physical factors relating to participants’ medical history of diabetes, such as a younger age at diagnosis, a longer duration of diabetes, insulin therapy, hemoglobin A1c levels of 6.5% or more, and comorbidities, were other correlates of poor reported health.
Conclusions
Our findings suggest that, in addition to medical variables, unfavorable socioeconomic factors, and adverse lifestyle behaviors, younger age, being underweight or obese, and psychosocial stress could be distinc factors in predicting negative perceived health status in Korean adults with diabetes.
Summary

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Associations Between the Continuity of Ambulatory Care of Adult Diabetes Patients in Korea and the Incidence of Macrovascular Complications
Young-Hoon Gong, Seok-Jun Yoon, Hyeyoung Seo, Dongwoo Kim
J Prev Med Public Health. 2015;48(4):188-194.   Published online July 23, 2015
DOI: https://doi.org/10.3961/jpmph.15.020
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  • 1 Crossref
AbstractAbstract PDF
Objectives
The goal of this study was to identify association between the continuity of ambulatory care of diabetes patients in South Korea (hereafter Korea) and the incidence of macrovascular complications of diabetes, using claims data compiled by the National Health Insurance Services of Korea.
Methods
This study was conducted retrospectively. The subjects of the study were 43 002 patients diagnosed with diabetes in 2007, who were over 30 years of age, and had insurance claim data from 2008. The macrovascular complications of diabetes mellitus were limited to ischemic heart disease and ischemic stroke. We compared the characteristics of the patients in whom macrovascular complications occurred from 2009 to 2012 to the characteristics of the patients who had no such complications. Multiple logistic regression was used to assess the effects of continuity of ambulatory care on diabetic macrovascular complications. The continuity of ambulatory diabetes care was estimated by metrics such as the medication possession ratio, the quarterly continuity of care and the number of clinics that were visited.
Results
Patients with macrovascular complications showed statistically significant differences regarding sex, age, comorbidities, hypertension, dyslipidemia and continuity of ambulatory diabetes care. Visiting a lower number of clinics reduced the odds ratio for macrovascular complications of diabetes. A medication possession ratio below 80% was associated with an increased odds ratio for macrovascular complications, but this result was of borderline statistical significance.
Conclusions
Diabetes care by regular health care providers was found to be associated with a lower occurrence of diabetic macrovascular complications. This result has policy implications for the Korean health care system, in which the delivery system does not work properly.
Summary

Citations

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  • Chasms in Achievement of Recommended Diabetes Care among Geographic Regions in Korea
    Sanghyun Cho, Ji-Yeon Shin, Hyun Joo Kim, Sang Jun Eun, Sungchan Kang, Won Mo Jang, Hyemin Jung, Yoon Kim, Jin Yong Lee
    Journal of Korean Medical Science.2019;[Epub]     CrossRef
Association of Selected Medical Conditions With Breast Cancer Risk in Korea
Sun Jae Jung, Minkyo Song, Ji-Yeob Choi, Nan Song, Sue Kyung Park, Keun-Young Yoo, Daehee Kang
J Prev Med Public Health. 2013;46(6):346-352.   Published online November 28, 2013
DOI: https://doi.org/10.3961/jpmph.2013.46.6.346
  • 12,745 View
  • 94 Download
  • 14 Crossref
AbstractAbstract PDF
Objectives

To estimate the effect of medical conditions in the population of Korea on breast cancer risk in a case-control study.

Methods

The cases were 3242 women with incident, histologically confirmed breast cancer in two major hospitals interviewed between 2001 and 2007. The controls were 1818 women each admitted to either of those two hospitals for a variety of non-neoplastic conditions. Information on each disease was obtained from a standardized questionnaire by trained personnel. Odds ratios (ORs) for each disease were derived from multiple logistic regression adjusted for age, age of menarche, pregnancy, age of first pregnancy, and family history of breast cancer.

Results

Among all of the incident breast cancer patients, pre-existing diabetes (OR, 1.33; 95% confidence interval [CI], 0.99 to 1.78), hypertension (OR, 1.46; 95% CI, 1.18 to 1.83), thyroid diseases (OR, 1.26; 95% CI, 1.00 to 1.58), and ovarian diseases (OR, 1.70; 95% CI, 1.23 to 2.35) were associated with an increased risk of breast cancer when other factors were adjusted for. In a stratified analysis by menopausal status, pre-existing hypertension (pre-menopause OR, 0.80; 95% CI, 0.48 to 1.34 vs. post-menopause OR, 1.87; 95% CI, 1.44 to 2.43; p-heterogeneity <0.01) and ovarian disease (pre-menopause OR, 4.20; 95% CI, 1.91 to 9.24 vs. post-menopause OR, 1.39; 95% CI, 1.02 to 1.91; p-heterogeneity 0.01) showed significantly different risks of breast cancer.

Conclusions

Our results suggest the possibility that medical conditions such as hypertension affect breast cancer development, and that this can differ by menopausal status. Our study also indicates a possible correlation between ovarian diseases and breast cancer risk.

Summary

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    Agnieszka Drab, Krystian Wdowiak, Wiesław Kanadys, Maria Malm, Joanna Dolar-Szczasny, Urszula Religioni
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    Shu-Chun Chuang, Guo-Jie Wu, Yen-Shen Lu, Ching-Hung Lin, Chao Agnes Hsiung, Pei-Yi Chu
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Differences in Cigarette Use Behaviors by Age at the Time of Diagnosis With Diabetes From Young Adulthood to Adulthood: Results From the National Longitudinal Study of Adolescent Health
Jisuk Bae
J Prev Med Public Health. 2013;46(5):249-260.   Published online September 30, 2013
DOI: https://doi.org/10.3961/jpmph.2013.46.5.249
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AbstractAbstract PDF
Objectives

Previous observations propose that risk-taking behaviors such as cigarette smoking are prevailing among young people with chronic conditions including diabetes. The purpose of this study was to examine whether cigarette smoking is more prevalent among diabetics than non-diabetics and whether it differs by age at the time of diagnosis with diabetes from young adulthood (YAH) to adulthood (AH).

Methods

We used US panel data from the National Longitudinal Study of Adolescent Health (Add Health Study) during the years 2001 to 2002 (Wave III, YAH) and 2007 to 2008 (Wave IV, AH). Multivariate logistic regression models were applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of cigarette use behaviors according to age at the time of diagnosis with diabetes, after adjusting for demographic and selected behavioral factors.

Results

Of 12 175 study participants, 2.6% reported having been diagnosed with diabetes up to AH. Early-onset diabetics (age at diagnosis <13 years) were more likely than non-diabetics to report frequent cigarette smoking (smoking on ≥20 days during the previous 30 days) in YAH (OR, 3.34; 95% CI, 1.27 to 8.79). On the other hand, late-onset diabetics (age at diagnosis ≥13 years) were more likely than non-diabetics to report heavy cigarette smoking (smoking ≥10 cigarettes per day during the previous 30 days) in AH (OR, 1.54; 95% CI, 1.03 to 2.30).

Conclusions

The current study indicated that diabetics are more likely than non-diabetics to smoke cigarettes frequently and heavily in YAH and AH. Effective smoking prevention and cessation programs uniquely focused on diabetics need to be designed and implemented.

Summary

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Interaction of Body Mass Index and Diabetes as Modifiers of Cardiovascular Mortality in a Cohort Study
Seung Hyun Ma, Bo-Young Park, Jae Jeong Yang, En-Joo Jung, Yohwan Yeo, Yungi Whang, Soung-Hoon Chang, Hai-Rim Shin, Daehee Kang, Keun-Young Yoo, Sue Kyung Park
J Prev Med Public Health. 2012;45(6):394-401.   Published online November 29, 2012
DOI: https://doi.org/10.3961/jpmph.2012.45.6.394
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AbstractAbstract PDF
Objectives

Diabetes and obesity each increases mortality, but recent papers have shown that lean Asian persons were at greater risk for mortality than were obese persons. The objective of this study is to determine whether an interaction exists between body mass index (BMI) and diabetes, which can modify the risk of death by cardiovascular disease (CVD).

Methods

Subjects who were over 20 years of age, and who had information regarding BMI, past history of diabetes, and fasting blood glucose levels (n=16 048), were selected from the Korea Multi-center Cancer Cohort study participants. By 2008, a total of 1290 participants had died; 251 and 155 had died of CVD and stroke, respectively. The hazard for deaths was calculated with hazard ratio (HR) and 95% confidence interval (95% CI) by Cox proportional hazard model.

Results

Compared with the normal population, patients with diabetes were at higher risk for CVD and stroke deaths (HR, 1.84; 95% CI, 1.33 to 2.56; HR, 1.82; 95% CI, 1.20 to 2.76; respectively). Relative to subjects with no diabetes and normal BMI (21 to 22.9 kg/m2), lean subjects with diabetes (BMI <21 kg/m2) had a greater risk for CVD and stroke deaths (HR, 2.83; 95% CI, 1.57 to 5.09; HR, 3.27; 95% CI, 1.58 to 6.76; respectively), while obese subjects with diabetes (BMI ≥25 kg/m2) had no increased death risk (p-interaction <0.05). This pattern was consistent in sub-populations with no incidence of hypertension.

Conclusions

This study suggests that diabetes in lean people is more critical to CVD deaths than it is in obese people.

Summary

Citations

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Smoking Is Associated With Abdominal Obesity, Not Overall Obesity, in Men With Type 2 Diabetes
Ji Eun Yun, Heejin Kimm, Young Ju Choi, Sun Ha Jee, Kap Bum Huh
J Prev Med Public Health. 2012;45(5):316-322.   Published online September 28, 2012
DOI: https://doi.org/10.3961/jpmph.2012.45.5.316
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AbstractAbstract PDF
Objectives

Abdominal obesity increases mortality and morbidity from cardiovascular disease and there is a possibility that smoking effects obesity. However, previous studies concerning the effects of smoking on obesity are inconsistent. The objective of this study was to examine whether smoking is positively related to abdominal obesity in men with type 2 diabetes.

Methods

Subjects consisted of 2197 type 2 diabetic patients who visited Huh's Diabetes Center from 2003 to 2009. Indices of abdominal obesity were defined as visceral fat thickness (VFT) measured by ultrasonography and waist circumference (WC). Overall obesity was defined as body mass index (BMI).

Results

Statistically significant differences in WC and VFT by smoking status were identified. However, there was no statistical difference in BMI according to smoking status. Means of WC and VFT were not significantly higher in heavy smokers and lower in mild smokers. Compared to nonsmokers, the BMI confounder adjusted odds ratio and 95% confidence interval for VFT in ex-smokers and current-smokers were 1.70 (1.21 to 2.39) and 1.86 (1.27 to 2.73), respectively.

Conclusions

Smoking status was positively associated with abdominal obesity in type 2 diabetic patients.

Summary

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Arterial Stiffness is Associated With Diabetic Retinopathy in Korean Type 2 Diabetic Patients
Yong-Woon Yun, Min-Ho Shin, Young-Hoon Lee, Jung-Ae Rhee, Jin-Su Choi
J Prev Med Public Health. 2011;44(6):260-266.   Published online November 14, 2011
DOI: https://doi.org/10.3961/jpmph.2011.44.6.260
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AbstractAbstract PDF
Objectives

We evaluated the association between common carotid artery intima-media thickness (CCA-IMT), brachial-ankle pulse wave velocity (baPWV), carotid plaque, and peripheral arterial disease (PAD) as indicators of macroangiopathy and diabetic retinopathy as an indicator of microangiopathy in type 2 diabetic patients.

Methods

We analyzed 605 type 2 diabetic patients registered at a public health center in Korea. Following overnight fasting, venous blood and urine samples were collected and analyzed. The CCA-IMT, levels of carotid plaque, baPWV, and ankle-brachial index (ABI) of the subjects were assessed. We used non-mydriatic fundus photography to diagnose diabetic retinopathy. Multiple logistic regression analyses were used to evaluate the association between macroangiopathy and diabetic retinopathy. CCA-IMT and baPWV were divided into tertiles: CCA-IMT, 0.39 to 0.65 mm, 0.66 to 0.78 mm, and 0.79 to 1.30 mm; baPWV, 9.9 to 15.8 m/s, 15.9 to 18.9 m/s, and 19.0 to 38.0 m/s.

Results

The association between baPWV and diabetic retinopathy remained significant after adjustment, with an increasing odds ratio (OR) in the second tertile (OR, 2.41; 95% confidence interval [CI], 1.27 to 4.55) and the third tertile (OR, 4.63; 95% CI, 2.33 to 9.21). No significant differences were observed in carotid plaque, PAD, and each tertile of CCA-IMT.

Conclusions

BaPWV was associated with diabetic retinopathy, while CCA-IMT, carotid plaque, and PAD were not. This study suggests that the association between macroangiopathy and microangiopathy may be attributable to functional processes rather than structural processes within the vascular system.

Summary

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    Diabetes Care.2013; 36(3): 715.     CrossRef
  • Author Response
    Young-Hoon Lee, Min-Ho Shin
    Journal of Preventive Medicine and Public Health.2012; 45(2): 123.     CrossRef
  • Ankle-brachial Index, Peripheral Arterial Disease, and Diabetic Retinopathy
    Hasan Kutsi Kabul, Aydogan Aydogdu, Ilker Tasci
    Journal of Preventive Medicine and Public Health.2012; 45(2): 122.     CrossRef
Intraocular Pressure and Its Determinants in Subjects With Type 2 Diabetes Mellitus in India
Sayantan Biswas, Rajiv Raman, Vaitheeswaran Koluthungan, Tarun Sharma
J Prev Med Public Health. 2011;44(4):157-166.   Published online July 29, 2010
DOI: https://doi.org/10.3961/jpmph.2011.44.4.157
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AbstractAbstract PDF
Objectives

This study was conducted to show the intraocular pressure (IOP) distribution and the factors affecting IOP in subjects with type 2 diabetes mellitus (DM) in India.

Methods

We measured the anthropometric and biochemical parameters for confirmed type 2 DM patients. A comprehensive ocular examination was performed for 1377 subjects aged > 40 years and residing in Chennai.

Results

A significant difference in IOP (mean ± standard deviation) was found between men and women (14.6±2.9 and 15.0±2.8 mmHg, p = 0.005). A significantly elevated IOP was observed among smokers, subjects with systemic hypertension and women with clinically significant macular edema (CSME). After a univariate analysis, factors associated significantly with higher IOP were elevated systolic blood pressure, elevated resting pulse rate and thicker central corneal thickness (CCT). In women, elevated glycosylated hemoglobin was associated with a higher IOP. After adjusting for all variables, the elevated resting pulse rate and CCT were found to be associated with a higher IOP.

Conclusions

Systemic hypertension, smoking, pulse rate and CCT were associated with elevated intraocular pressure in type 2 DM. Women with type 2 DM, especially those with CSME, were more prone to have an elevated IOP.

Summary

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    Siva Prasad Panda, P Hemachandra Reddy, Uma Sankar Gorla, DSNBK Prasanth
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    Kartika Chandra Tripathy, Ashish Siddharth, Ajay Bhandari
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  • Retinal Nerve Fiber Layer Loss Is Associated with Urinary Albumin Excretion in Patients with Type 2 Diabetes
    Jin A. Choi, Sun-Hee Ko, Yi Ryeung Park, Dong-Hyun Jee, Seung-Hyun Ko, Chan Kee Park
    Ophthalmology.2015; 122(5): 976.     CrossRef
  • The distribution of intraocular pressure and associated systemic factors in a Korean population: The Korea National Health and Nutrition Examination Survey
    Mi Jeung Kim, Ki Ho Park, Chan Yun Kim, Jin Wook Jeoung, Seok Hwan Kim
    Acta Ophthalmologica.2014;[Epub]     CrossRef
  • Association between Urinary Albumin Excretion and Intraocular Pressure in Type 2 Diabetic Patients without Renal Impairment
    Jin A. Choi, Kyungdo Han, Hyuk-Sang Kwon, Ariela Benigni, PhD.
    PLoS ONE.2014; 9(5): e96335.     CrossRef
Abdominal Obesity in Relation to the Incidence of Type 2 Diabetes Mellitus and Impaired Fasting Glucose among some Korean Adults: A Retrospective Cohort Study.
Seung Ho Ryu, Sung Ho Beck, Yoo Soo Chang, Dong Il Kim, Byung Seong Suh, Woon Sool Kim, Ki Chul Sung
J Prev Med Public Health. 2004;37(4):359-365.   Published online November 30, 2004
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AbstractAbstract PDF
OBJECTIVES
This study was performed to determine whether an increase in abdominal obesity is an independent risk factor for impaired fasting glucose and type 2 DM. METHODS: Among 24, 212 adults over 30 years who undertook comprehensive medical screening examinations from Jan to Dec 1999, in a university hospital in Seoul, a total of 11, 183 subjects were selected who had no DM at baseline and who were followed up more than once by Dec 2002. The average follow up period was 2.4 (+/-0.5) years. DM was defined as having a fasting glucose level > or = 126mg/dl, and impaired fasting glucose as showing a fasting glucose level between 110 and 125 mg/dl. Body weight, height and waist circumference (WC) were simultaneously measured with blood sampling. The relative risks (RRs) for DM and impaired fasting glucose by WC were calculated using Cox proportional hazard model. Ageadjusted rates were estimated by direct standardization using a reference population of 2000 from 30 to 80 years. RESULTS: The average age of the subjects was 41.7 (+/- 7.0) years; males 41.2 (+/-6.5) and females 45.6 (+/-9.2). RRs for type 2 DM by WC with the reference group of WC < 80cm were as follows: 2.66 (95%, CI 0.55~12.8) for WC of 80~89cm in men, 5.92 (95%, CI 1.08~32.3) for WC > or = 90 cm in men, and 2.64 (95%, CI 0.23~29.8) for WC of 80~89cm in females. RRs for impaired fasting glucose by WC were 3.03 (95%, CI 2.18~4.22) for WC 80~89cm in men, 6.10 (95%, CI 4.25~8.75) for WC > or = 90cm in men, and 1.56 (95%, CI 0.43~5.67) for WC 80~89cm in women, and 8.08 (95%, CI 2.22~29.4) for WC > or = 90cm in females. These results remained significant after adjustment for age, BMI and fasting glucose concentrations at baseline in both sexes. Annual increment of more than 1 cm in WC was associated with the development of DM and impaired fasting glucose independently of age, sex, BMI, or presence of abdominal obesity. CONCLUSION: In Korean adults, abdominal obesity increased the risk for the development of type 2 diabetes and impaired fasting glucose. This result supports many other prospective studies suggesting abdominal obesity as a risk factor for type 2 diabetes.
Summary
Brief Communication
A Comparison of Fasting Glucose and HbA1c for the Diagnosis of Diabetes Mellitus Among Korean Adults.
Woo Jun Yun, Min Ho Shin, Sun Seong Kweon, Kyeong Soo Park, Young Hoon Lee, Hae Sung Nam, Seul Ki Jeong, Yong Woon Yun, Jin Su Choi
J Prev Med Public Health. 2010;43(5):451-454.
DOI: https://doi.org/10.3961/jpmph.2010.43.5.451
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AbstractAbstract PDF
OBJECTIVES
The American Diabetes Association (ADA) has recently recommended the HbA1c assay as one of four options for making the diagnosis of diabetes mellitus, with a cut-point of > or =6.5%. We compared the HbA1c assay and the fasting plasma glucose level for making the diagnosis of diabetes among Korean adults. METHODS: We analyzed 8710 adults (age 45-74 years), who were not diagnosed as having diabetes mellitus, from the Namwon study population. A fasting plasma glucose level of > or =126 mg/dL and an A1c of > or =6.5% were used for the diagnosis of diabetes. The kappa index of agreement was calculated to measure the agreement between the diagnosis based on the fasting plasma glucose level and the HbA1c. RESULTS: The kappa index of agreement between the fasting plasma glucose level and HbA1c was 0.50. CONCLUSIONS: The agreement between the fasting plasma glucose and HbA1c for the diagnosis of diabetes was moderate for Korean adults.
Summary

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    Changseung Liu, Eunhye Choi, In Cheol Bae, Sang-Guk Lee, Jeong-Ho Kim
    Laboratory Medicine Online.2017; 7(2): 59.     CrossRef
  • Epidemiological ramifications of diagnosing diabetes with HbA1c levels
    Mayer B. Davidson, Deyu Pan
    Journal of Diabetes and its Complications.2014; 28(4): 464.     CrossRef
  • COMPARATIVE STUDY OF GLYCOSYLATED HAEMOGLOBIN WITH BLOOD GLUCOSE LEVELS IN THE DIAGNOSIS OF DIABETES MELLITUS
    Kavya S T, Nagaraja B S, Akila V, Chandra Mohan G, Prakash Kikker Gowdaiah
    Journal of Evolution of Medical and Dental Sciences.2014; 3(23): 6435.     CrossRef
  • An Emerging Diabetes Mellitus Diagnosis Modality: HbA1c
    Hyun-Ae Seo, In-Kyu Lee
    The Korean Journal of Internal Medicine.2012; 27(1): 39.     CrossRef
  • Evaluation of the Performance of ARKRAY ADAMS HA-8180 HbA1cAnalyzer
    Jinsook Lim, Ji-Myung Kim, Sun Hoe Koo, Kye Chul Kwon
    Laboratory Medicine Online.2012; 2(3): 126.     CrossRef
  • Discordance between HbA1c and fasting plasma glucose criteria for diabetes screening is associated with obesity and old age in Korean individuals
    Jin Hwa Kim, Ji Hye Shin, Hae Jung Lee, Sang Yong Kim, Hak Yeon Bae
    Diabetes Research and Clinical Practice.2011; 94(2): e27.     CrossRef
  • Relationship between Glycemic Control and Diabetic Retinopathy
    Woo-Jun Yun
    Journal of the Korean Geriatrics Society.2010; 14(4): 234.     CrossRef
English Abstract
The Association of Central Obesity with Type 2 Diabetes among Koreans according to the Serum Gamma-Glutamyltransferase Level: Korean Genome and Epidemiology Study.
Ji Yeon Shin, Jun Hyun Hwang, Jin Young Jeong, Sung Hi Kim, Jai Dong Moon, Sang Chul Roh, Young Wook Kim, Yangho Kim, Jong Han Leem, Young Su Ju, Young Seoub Hong, Eun Hee Ha, Yong Hwan Lee, Duk Hee Lee, Dong Hyun Kim
J Prev Med Public Health. 2009;42(6):386-391.
DOI: https://doi.org/10.3961/jpmph.2009.42.6.386
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AbstractAbstract PDF
OBJECTIVES
This cross-sectional study was performed to examine if the serum gamma-glutamyltransferase (GGT) level that is within its normal range is associated with the risk of type 2 diabetes and if the association between the waist hip ratio (WHR) and type 2 diabetes is different depending on the serum GGT levels. METHODS: The study subjects were 23,436 persons aged 40 years or older and who participated in regular health check-ups at 11 hospitals (males: 5,821, females: 17,615). The gender-specific quintiles of the serum GGT and WHR were used to examine the associations with type 2 diabetes. RESULTS: The serum GGT levels within their normal range were positively associated with type 2 diabetes only in women. The adjusted odds ratios (ORs) were 1.0, 1.0, 1.4, 2.1, and 2.5 according to the quintiles of the serum GGT (p(trend)<0.01). The WHR was more strongly associated with the prevalence of diabetes among the women with a high-normal serum GGT level as compared with those with a low-normal serum GGT level (p for interaction=0.02). For example, the adjusted ORs for women with a low normal serum GGT level were 1.0, 1.2, 1.5, 2.2, and 2.4 according to the quintiles of the WHR, while those figures were 1.0, 2.4, 3.6, 5.0, and 8.3 among the women with a high normal serum GGT level. However, in men, the serum GGT was very weakly associated with type 2 diabetes and the association between the WHR and type 2 diabetes was not different depending on the serum GGT level. CONCLUSIONS: Serum GGT within its normal range was positively associated with type 2 diabetes, and central obesity was more strongly associated with the prevalence of type 2 diabetes when the serum GGT level was high-normal. However, these associations were observed only in women, which is different from the previous findings. The stronger relation between central obesity and type 2 diabetes among women with a high-normal serum GGT level can be useful for selecting a group that is at high risk for type 2 diabetes irregardless of whatever the underlying mechanism is.
Summary

Citations

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  • Serum gamma-glutamyl transferase and risk of type 2 diabetes in the general Korean population: a Mendelian randomization study
    Youn Sue Lee, Yoonsu Cho, Stephen Burgess, George Davey Smith, Caroline L. Relton, So-Youn Shin, Min-Jeong Shin
    Human Molecular Genetics.2016; 25(17): 3877.     CrossRef
  • Different associations between obesity and impaired fasting glucose depending on serum gamma-glutamyltransferase levels within normal range: a cross-sectional study
    Nam Soo Hong, Jeong-Gook Kim, Yu-Mi Lee, Hyun-Woo Kim, Sin Kam, Keon-Yeop Kim, Ki-Su Kim, Duk-Hee Lee
    BMC Endocrine Disorders.2014;[Epub]     CrossRef
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    Jean-Claude, Lapraz, Kamyar M. Hedayat
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Evaluation Studies
An Evaluation of Sampling Design for Estimating an Epidemiologic Volume of Diabetes and for Assessing Present Status of Its Control in Korea.
Ji Sung Lee, Jaiyong Kim, Sei Hyun Baik, Ie Byung Park, Juneyoung Lee
J Prev Med Public Health. 2009;42(2):135-142.
DOI: https://doi.org/10.3961/jpmph.2009.42.2.135
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AbstractAbstract PDF
OBJECTIVES
An appropriate sampling strategy for estimating an epidemiologic volume of diabetes has been evaluated through a simulation. METHODS: We analyzed about 250 million medical insurance claims data submitted to the Health Insurance Review & Assessment Service with diabetes as principal or subsequent diagnoses, more than or equal to once per year, in 2003. The database was re-constructed to a 'patient-hospital profile' that had 3,676,164 cases, and then to a 'patient profile' that consisted of 2,412,082 observations. The patient profile data was then used to test the validity of a proposed sampling frame and methods of sampling to develop diabetic-related epidemiologic indices. RESULTS: Simulation study showed that a use of a stratified two-stage cluster sampling design with a total sample size of 4,000 will provide an estimate of 57.04% (95% prediction range, 49.83 - 64.24%) for a treatment prescription rate of diabetes. The proposed sampling design consists, at first, stratifying the area of the nation into "metropolitan/city/county" and the types of hospital into "tertiary/secondary/primary/clinic" with a proportion of 5:10:10:75. Hospitals were then randomly selected within the strata as a primary sampling unit, followed by a random selection of patients within the hospitals as a secondly sampling unit. The difference between the estimate and the parameter value was projected to be less than 0.3%. CONCLUSIONS: The sampling scheme proposed will be applied to a subsequent nationwide field survey not only for estimating the epidemiologic volume of diabetes but also for assessing the present status of nationwide diabetes control.
Summary

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  • Diabetes Epidemics in Korea: Reappraise Nationwide Survey of Diabetes "Diabetes in Korea 2007"
    Ie Byung Park, Jaiyong Kim, Dae Jung Kim, Choon Hee Chung, Jee-Young Oh, Seok Won Park, Juneyoung Lee, Kyung Mook Choi, Kyung Wan Min, Jeong Hyun Park, Hyun Shik Son, Chul Woo Ahn, Hwayoung Kim, Sunhee Lee, Im Bong Lee, Injeoung Choi, Sei Hyun Baik
    Diabetes & Metabolism Journal.2013; 37(4): 233.     CrossRef
  • Development of a Sampling Strategy and Sample Size Calculation to Estimate the Distribution of Mammographic Breast Density in Korean Women
    Jae Kwan Jun, Mi Jin Kim, Kui Son Choi, Mina Suh, Kyu-Won Jung
    Asian Pacific Journal of Cancer Prevention.2012; 13(9): 4661.     CrossRef
English Abstracts
The Effect of Smoking Status upon Occurrence of Impaired Fasting Glucose or Type 2 Diabetes in Korean Men.
Chang Hae Park, Hyuk Ga, Jong Han Leem, Seung Min Kwak, Hwan Cheol Kim, Ji Ho Choi
J Prev Med Public Health. 2008;41(4):249-254.
DOI: https://doi.org/10.3961/jpmph.2008.41.4.249
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AbstractAbstract PDF
OBJECTIVES
To investigate whether smoking and the smoking status are predictors of the incident impaired fasting glucose (IFG) or type 2 diabetes in Korean men. METHODS: A cohort of 1,717 Korean men without IFG or diabetes, who underwent annual periodic health examinations for 4 years (2002-2006), were retrospectively investigated. IFG and diabetes were defined as a serum fasting glucose concentration of 100-125 mg/dL and more than 126 mg/dL, respectively. Cox's proportional hazards model was used to evaluate the association between smoking and development of IFG or type 2 diabetes. RESULTS: A total of 558 cases (32.5%) of incident IFG and 50 cases (2.9%) of diabetes occurred. After controlling for the potential predictors of diabetes, the relative risk for IFG, compared with the never smokers, was 1.02 (95% CI=0.88 to 1.19) for the ever-smokers, 0.96 (95% CI=0.79-1.16) for those who smoked 1-9 cigarettes/d, 1.15 (95% CI=1.01 to 1.30) for those who smoked 10-19 cigarettes/d, and 1.31 (95% CI=1.10 to 1.57) for those who smoked 20 or more cigarettes/d (the P value for the current smokers was only p<0.002). The respective multivariate adjusted relative risks for type 2 diabetes, compared with the neversmokers, were 1.07 (95% CI=0.64 to 1.92), 1.47 (95% CI=0.71 to 3.04), 1.84 (95% CI=0.92-3.04), and 1.87 (95% CI=1.13-3.67), respectively (the P value for the current smokers was only p=0.004). CONCLUSIONS: The smoking status and the number of cigarettes smoked daily are associated with an increased risk for developing IFG or type 2 diabetes in Korean men.
Summary

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  • Health effects associated with smoking: a Burden of Proof study
    Xiaochen Dai, Gabriela F. Gil, Marissa B. Reitsma, Noah S. Ahmad, Jason A. Anderson, Catherine Bisignano, Sinclair Carr, Rachel Feldman, Simon I. Hay, Jiawei He, Vincent Iannucci, Hilary R. Lawlor, Matthew J. Malloy, Laurie B. Marczak, Susan A. McLaughlin
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    Peter N Lee, Katharine J Coombs
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    Benjamin Bowe, Yan Xie, Tingting Li, Yan Yan, Hong Xian, Ziyad Al-Aly
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    Mariola Śliwińska-Mossoń, Halina Milnerowicz
    Diabetes and Vascular Disease Research.2017; 14(4): 265.     CrossRef
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    Eun-Jin Lim, Mi Jeong Kim, Ji-Sook Han
    Journal of the Korean Society of Food Science and Nutrition.2014; 43(1): 141.     CrossRef
  • Associated Factors of Impaired Fasting Glucose in Some Korean Rural Adults
    Hye Eun Yun, Mi-ah Han, Ki Soon Kim, Jong Park, Myeng Guen Kang, So Yeon Ryu
    Journal of Preventive Medicine and Public Health.2010; 43(4): 309.     CrossRef
  • Association of passive and active smoking with incident type 2 diabetes mellitus in the elderly population: the KORA S4/F4 cohort study
    Bernd Kowall, Wolfgang Rathmann, Klaus Strassburger, Margit Heier, Rolf Holle, Barbara Thorand, Guido Giani, Annette Peters, Christine Meisinger
    European Journal of Epidemiology.2010; 25(6): 393.     CrossRef
  • Diabetes and impaired fasting glucose in Mongolian population, Inner Mongolia, China
    Shaoyan Zhang, Weijun Tong, Tan Xu, Burenbatu Wu, Yonghong Zhang
    Diabetes Research and Clinical Practice.2009; 86(2): 124.     CrossRef
A Prospective Cohort Study of Exercise and the Incidence of Type 2 Diabetes in Impaired Fasting Glucose Group.
Hong Dae Um, Duck Chul Lee, Sang Yi Lee, Yeon Soo Kim
J Prev Med Public Health. 2008;41(1):45-50.
DOI: https://doi.org/10.3961/jpmph.2008.41.1.45
  • 6,802 View
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AbstractAbstract PDF
OBJECTIVES
To determine the relationship between exercise and the incidence of type 2 diabetes in an impaired fasting glucose group. METHODS: This prospective cohort study was conducted in 19,440 men and 4,297 women, aged 30-69 years, with impaired fasting glucose at baseline who had undergone biennial medical evaluation through the National Health Insurance Corporation from 2000 to 2004. Impaired fasting glucose was defined as fasting glucose of 100 to 125 mg/dl and the subjects were divided into 3 groups depending on weekly exercise frequency. Multivariate logistic regression analysis was used to evaluate the association between the baseline exercise status and incidence of type 2 diabetes. RESULTS: During the 4-year follow-up, a total of 3,239 men and 283 women developed type 2 diabetes, a cumulative incidence of 16.6% for men, and 6.5% for women. Also, 1,688 men (21.2%) and 127 women (15.2%) developed type 2 diabetes in the obese group. The adjusted relative risk (RR) of developing type 2 diabetes in non-exercising men was significantly higher than exercising men regularly (RR= 1.375, 95% CI=1.236-1.529)(p<0.0001), and the RR for non-exercising women was higher than exercising women regularly (RR=1.124, 95% CI=0.711-1.778). The RR for non-exercise men/women in the obese group was 1.571 (95% CI=1.351-1.827)(p<0.0001)/1.869(95% CI=0.846-4.130). CONCLSIONS: Regular exercise is effective in preventing type 2 diabetes in people with impaired fasting glucose, and particularly in obese people. People with risk factors for diabetes should participate in a regular exercise program.
Summary

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    Yongha Seo, Seungjae Hyun, Sangshin Park
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  • Hospital-Based Korean Diabetes Prevention Study: A Prospective, Multi-Center, Randomized, Open-Label Controlled Study
    Sang Youl Rhee, Suk Chon, Kyu Jeung Ahn, Jeong-Taek Woo
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    Dae Jung Kim
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  • Adiponectin is Associated with Impaired Fasting Glucose in the Non-Diabetic Population
    Sang Yeun Kim, Sun Ju Lee, Hyoun Kyoung Park, Ji Eun Yun, Myoungsook Lee, Jidong Sung, Sun Ha Jee
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    Journal of Preventive Medicine and Public Health.2010; 43(4): 309.     CrossRef
Continuity of Care of Patient with Diabetes and Its Affecting Factors in Korea.
Chai Hyun Yoon, Sin Jae Lee, Sooyoung Choo, Ok Ryun Moon, Jae Hyun Park
J Prev Med Public Health. 2007;40(1):51-58.
DOI: https://doi.org/10.3961/jpmph.2007.40.1.51
  • 6,782 View
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AbstractAbstract PDF
OBJECTIVES
The objectives of this study were to estimate the continuity of care for all Koreans with diabetes and to identify factors affecting the continuity of care. METHODS: We obtained National Health Insurance claims data for patients with diabetes who visited health-care providers during the year 2004. A total of 1,498,327 patients were included as study subjects. Most Frequent Provider Continuity (MFPC) and Modified, Modified Continuity Index (MMCI) were used as indexes of continuity of care. A multiple linear regression analysis was used to identify factors affecting continuity of care. RESULTS: The average continuity of care in the entire population of 1,498,327 patients was 0.89+/-0.17 as calculated by MFPC and 0.92+/-0.16 by MMCI. In a multiple linear regression analysis, both MFPC and MMCI were lower for females than males, disabled than non-disabled, Medicaid beneficiaries than health insurance beneficiaries, patients with low monthly insurance contributions, patients in rural residential areas, and patients whose most frequently visited provider is the hospital. CONCLUSIONS: The continuity of care for patients with diabetes is high in Korea. However, women, the disabled and people of low socio-economic status have relatively low continuity of care. Therefore, our first priority is to promote a diabetes management program for these patients.
Summary

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Fasting Serum Glucose and Subsequent Liver Cancer Risk in a Korean Prospective Cohort.
Jin Gwack, Seung Sik Hwang, Kwang Pil Ko, Jae Kwan Jun, Sue Kyung Park, Soung Hoon Chang, Hai Rim Shin, Keun Young Yoo
J Prev Med Public Health. 2007;40(1):23-28.
DOI: https://doi.org/10.3961/jpmph.2007.40.1.23
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AbstractAbstract PDF
OBJECTIVES
Chronic infections with hepatitis B or C and alcoholic cirrhosis are three well-known major risk factors for liver cancer. Diabetes has also been suggested as a potential risk factor. However, the findings of previous studies have been controversial in terms of the causal association. Therefore, the aim of this study was to evaluate the association between serum glucose levels and liver cancer development in a Korean cohort. METHODS: Thirty-six liver cancer cases were identified in the Korean Multi-Center Cancer Cohort (KMCC). Baseline information on lifestyle characteristics was obtained via questionnaire. Serum glucose levels were measured at the study's enrollment. Relative risks (RRs) were estimated using a Cox proportional hazard regression model. The adjusting variables included age, gender, smoking history, alcohol consumption, body mass index, and hepatitis B surface antigen (HBsAg) seropositivity. RESULTS: The RRs of serum glucose for liver caner were 1.20 (95% CI=0.48-2.99) for the category of 100 to 125 mg/dL of serum glucose and 2.77 (95% CI=1.24-6.18) for the >126 mg/dL serum glucose category (both compared to the <100 mg/dL category). In a subgroup analysis, the RR of serum glucose among those who were both HBsAg seronegative and non-drinkers was 4.46 (95% CI=1.09-18.28) for those with glucose levels >100 mg/dL. CONCLUSIONS: The results of this study suggest that a high level of serum glucose can increase liver cancer risk independently of hepatitis infection and drinking history in Koreans. This study implies that glucose intolerance may be an independent risk factor for liver cancer.
Summary

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Original Articles
Short-term Glycemic Control and the Related Factors in Association with Compliance in Diabetic Patients.
Gui Young Kim, Jae Yong Park, Bo Wan Kim
Korean J Prev Med. 2000;33(3):349-363.
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AbstractAbstract PDF
OBJECTIVES
Generally, it seemed that the therapeutic result in diabetic patients was changed by compliance. This study was conducted on the basis of assumption that the therapeutic result in diabetic patients could control according to compliance. This study was conducted to analyze the related factors in association with compliance to drug, diet and exercise therapy. METHODS: 224 diabetic patients in Kyungpook National University Hospital were selected through the interviews and HbA1c values from 1 Jan. to 28 Feb. 1997. The drug compliance was tested by regularity of drug administration, the diet compliance was tested by restriction of food, exactly allocation, balance of nutrient, measuring food and the exercise compliance was tested by regularity of exercise per day. We assessed compliance by percentage, X2-test and generalized logit regression model(method:enter). RESULTS: The significant variable was the satisfaction to medical personnels in drug, the knowledge to disease in diet, the participation of the diabetic education in exercise therapy and the satisfaction to medical personnels in HbA1c. Using the generalized logit model(method : enter) in compliance change, the significant variables were the satisfaction to medical personnels and the complication in drug; the significant variables were the age at the first diagnosis, the family history, the concern of health, the knowledge of disease, the self-exertion for therapy and the complication in diet; the only significant variable was the gender in exercise therapy. CONCLUSIONS: The degree of glycemic control in diabetic patients was influenced by compliance. In order to improve patient's compliance, we must foster the knowledge on the diseases, lead participation for diabetic education. Because the satisfaction to medical personnels was the important variables, we must build up good relationship between doctors and patients.
Summary
Incidence and Risk Factors for Diabetes Mellitus in Korean Middle-aged Men: Seoul Cohort DM Follow-up Study.
Dong Hyun Kim, Yoon Ok Ahn, Sung Woo Park, Moon Gi Choi, Dae Sung Kim, Moo Song Lee, Myung Hee Shin, Jong Myon Bae
Korean J Prev Med. 1999;32(4):526-537.
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AbstractAbstract PDF
OBJECTIVES
It is known that the prevalence of diabetes mellitus(DM) appears to be rapidly increasing in recent times in Korea, presumably due to a westernized diet and change of life style followed by rapid economic growth. Based on the Seoul male cohort which was constructed in 1993, this study was conducted to estimate the annual incidence rates of DM through 4 years' follow up and to determine which factors are associated with DM risk in Korean middle-aged men. METHODS: Among 14,533 men recruited at baseline, 559 were excluded because they reported a history of diabetes or were found to be diabetes at 1992 routine health examination. During 4 years follow-up, 237 incident DM cases were ascertained through chart reviews and telephone contacts for those who have ever visited hospitals or clinics under suspicion of DM during 1993-1996 and the biennial routine health examinations in 1994 and 1996. RESULTS: In this study the annual incidence of DM among the study population was estimated to be 0.5 per 100. This study showed that fasting glucose level at initial baseline examination was a powerful predictor of risk for diabetes several years later(fasting blood glucose of > or = 110 mg/dl compared with < or = 80 mg/dl, Hazard Ratio[HR]=15.6, 95% Confidence interval[CI]=9.1-26.6) after considering potential covariates such as age, family history, smoking and alcohol history, body mass index, physical activity, total energy intake, and total fiber intake. Adjusted hazard ratios of family history of diabetes was 1.95(95% CI=1.38-2.75); of obesity as measured by BMI(BMI > or = 25.3 compared with < or = 21.3) was 7.19(95% CI=3.75-13.8); of weight change during middle life(>10kg compared with 5) was 1.77(95% CI=1.16-2.69); of smoking(current vs none) was 1.93(95% CI=1.06-3.51); and fat intake(upper tertile compared with lower tertile) was 1.88(95% CI=1.01-3.49), while fiber intake was associated with the reduced risk(HR=0.36, 95% CI=0.19-0.67). CONCLUSION: The factors identified in this study indicate that the greatest reduction in risk of diabetes might be achieved through population-based efforts that promote fiber intake and reduce obesity, smoking, and fat intake.
Summary
The Estimation of Prevalence of Diabetes Mellitus in a Rural Adult Population.
Sue Kyung Park, Joung Soon Kim
Korean J Prev Med. 1996;29(3):483-494.
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AbstractAbstract PDF
The objectives of this study are to estimate the prevalence of diabetes mellitus(DM) and to identify risk factors associated with fasting blood sugar in a rural adult population. We carried out a cross-sectional study on the residents over 30-year old. Among the 1077 eligible subjects, 725 persons responded to the study; the study consisted of interview on family and past history of DM, anthropometry, blood pressure, and blood sugar level in each subjects. Only 707 subjects of 725 participants had fasting blood sugar(FBS) examined and the rest, 18 subjects were had casual blood sugar examined due to failure of fasting over 8-hour. When subjects had FBS >or= 140mg/dl, 2 hours postprandial blood sugar level was checked after 75g oral glucose loading. The prevalence of DM was 8.9%, and age standardized prevalence rate adjusted to Korean population of 1995 was 5.8%. Mean and SD of fasting blood sugar in men was 99.8 +/- 22.6, and in women was 111.5 +/- 29.9. Mean levels of fasting blood sugar were significantly higher in women than in man and as their ages advanced the prevalencies in creased in both sexes. PP2 blood sugar levels were significantly higher in elder age and in persons with higher FBS levels than others. The risk factors associated with FBS were past history of diabetes, sex, socioeconomic status and waist-to-hip circumference ratio; the risk of diabetes was increased in female, people with past DM history, central obesity and low socioeconomic state. The low socioeconomic status associated with DM in this study, which is different from other study results, should be pursued in further studies.
Summary
Mean fasting blood glucose level and an estimated prevalence of diabetes mellitus among a representative adult Korean population.
Jung Soon Kim, Young Joon Kim, Sun Ill Park, Young Pyo Hong
Korean J Prev Med. 1993;26(3):311-320.
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AbstractAbstract PDF
This study was carried out along with the 1990 6th National Tuberculosis Prevalence Survey in order to estimated the prevalence rate of diabetes mellitus among a representative adult Korean population. Fasting blood glucose was measured by diastix(Ames) using glucometer II for seventy seven percent of the population(30 years old or above) residing in 190 enumeration districts randomly sampled from 146,944 general ED. The prevalence of diabetes mellitus of the population was estimated by projecting the ratio of > or = 200 mg/dl PP2 of fasting blood sugar level below 120 by sex to the study population. Fasting blood glucose and 2hr. postprandial blood glucose were measured on about 3000 subsampled individuals, and diabetes mellitus was defined by the WHO criteria-FBG > or = 120 mg/dl or PP2 > or = 200 mg/dl when FBG is below 120 mg/dl. The results obtained are as follows: 1. Estimated prevalence(age adjusted) of diabetes mellitus was 4.6% for male 8.1% for female. The age adjusted mean FBG was 93.9+/-26.2mg/dl for male and 102.9+/-31.5mg/dl for female. 2. The prevalence increased as age advanced with peak in 60~69 years old age group for both sexes. 3. The mean FBG and estimated prevalence rate of diabetes mellitus varied considerably among the populations of fifteen cities and provinces ; it varied from 87.0+/-17.7 to 104.6+/-34.5mg/dl and 1.2% to 8.9% for males, and from 93.3+/-25.3 to 116.7+/-38.6 mg/dl and 3.4% to 20.8% for females. 4. The mean FBG and prevalence rates were higher among the rural population than those residing in metropolitan areas. 5. The proportion of the people previously treated among the diabetics was estimated to be a little less than one fifth. 6. Factors strongly associated with FBG were age, sex, family history of D. M., BMI, area and educational level among eleven variables.
Summary
English Abstract
What will be the Proper Criteria for Impaired Fasting Glucose for Korean Men?: Based on Medical Screening Data from a General Hospital.
Seungho Ryu, Yoo Soo Chang, Dong Il Kim, Byung Seong Suh, Woon Sool Kim
J Prev Med Public Health. 2005;38(2):203-207.
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AbstractAbstract PDF
OBJECTIVES
Recently, the American Diabetes Association (ADA) redefined the criteria of prediabetes, which has lowered the diagnostic level of fasting plasma glucose (FPG) from 110 to 125 mg/dl, down to levels between 100 to 125mg/dl. The purpose of this study was to determine the predictive cutoff level of FPG as a risk for the development of diabetes mellitus in Korean men. METHODS: A retrospective cohort study was conducted on 11, 423 (64.5%) out of 17, 696 males < or =30 years of age, and who met the FPG of < or =125 mg/dl and hemoglobin A1c of < or = 6.4% criteria, without a history of diabetes, and who were enrolled at the screening center of a certain university hospital between January and December 1999. The subjects were followed from January 1999 to December 2002 (mean follow-up duration; 2.3 (+/-0.7) years). They were classified as normal (FPG < 100mg/dl), high glucose (FPG > or =100mg/dl and < 110mg/dl) and impaired fasting glucose (FPG > or =110mg/dl and < or =125mg/dl) on the basis of their fasting plasma glucose level measured in 1999. We compared the incidence of diabetes between the 3 groups by performing Cox proportional hazards model and used receiver operating characteristic analyses of the FPG level, in order to estimate the optimal cut-off values as predictors of incident diabetes. RESULTS: At the baseline, most of the study subjects were in age in their 30s to 40s (mean age, 41.8 (+/-7.1) year). The incidence of diabetes mellitus in this study was 1.19 per 1, 000 person-years (95% CI=0.68-1.79), which was much lower than the results of a community-based study that was 5.01 per 1, 000 person-years. The relative risks of incident diabetes in the high glucose and impaired fasting glucose groups, compared with the normal glucose group, were 10.3 (95% CI=2.58-41.2) and 95.2 (95% CI= 29.3-309.1), respectively. After adjustment for age, body mass index, and log triglyceride, a FPG greater than 100mg/dl remained significant predictors of incident diabetes. Using the receiver operating characteristic (ROC) curve, the optimal cutoff level of FPG as a predictor of incident diabetes was 97.5 mg/dl, with a sensitivity and a specificity of 81.0% and 86.0%, respectively. CONCLUSION: These results suggest that lowering the criteria of impaired fasting glucose is needed in Korean male adults. Future studies on community-based populations, including women, will be required to determine the optimal cutoff level of FPG as a predictor of incident diabetes.
Summary

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