It's Still Not Too Late to Make a Change: Current Status of Glycemic Control in Korea

Corresponding author: Sang Yong Kim Department of Endocrinology and Metabolism, Chosun University Hospital, Chosun University School of Medicine, 365 Pilmun-daero, Dong-gu, Gwangju 501-717, Korea E-mail: [email protected] Diabetes is an important chronic disease causing economic and social burden around the world. The prevalence of diabetes in Korea has profoundly increased from 1.5% to 12.4% over the past 40 years. Recent studies demonstrated that the prevalence of diabetes and prediabetes were 12.4% (men, 14.5%; women, 10.4%) and 38.3% (men, 41%; women, 35.7%), respectively [1,2]. This outburst of diabetes in Korea is caused by rapid economic development, dramatic changes in lifestyle, and increased aging population. Diabetes is associated with chronic diseases such as hypertension, dyslipidemia, and various other complications including macrovascular diseases as well as microvascular diseases [3]. These diseases are often the direct causes of death in patients with diabetes. Diabetes itself is the 5th leading cause of death in Korea and also influences other causes of death such as cardiovascular and cerebrovascular diseases [4]. The most serious fact is that the frequency of diabetic complications is also increasing along with the increment of prevalence of diabetes. In a Korean National Diabetes Program, 43.2% diabetic patients had hypertension, 34.8% had dyslipidemia, 10.8% had macrovascular disease, and 16.7% had microvascular diseases [5]. Recently, Korean Diabetes Association published “Diabetes Fact Sheet in Korea 2013.” According to this report, more than half of the diabetic patients have hypertension (54.6%) and dyslipidemia (79.6%) and one-third of diabetic patients also have microvascular disease such as nephropathy (27.3%), neuropathy (33.5%), or retinopathy (18.6%) [6]. Complications do not only affect the quality of life and mortality of patients with diabetes but are also associated with higher direct medical costs. Diabetic patients with microvascular complications spend up to 4.7 times as much, patients with macrovascular complications up to 10.7 times as much, and patients with both complications spend 8.8 times as much compared to those with no complications. The medical cost of diabetes mellitus covered by the national health insurance corporation is 3.2 trillion won which accounts for 19.2% of all medical costs [7]. Diabetic complications are strongly related with the degree of glycemic control. Many studies demonstrated that an adequate glycemic control is mandatory for preventing diabetic complication. The United Kingdom Prospective Diabetes Study and the Kumamoto study showed that early intensive glycemic control can delay the onset and progression of diabetic retinopathy, nephropathy, and neuropathy compared with conventional treatment [8,9]. In the Steno-2 study, the intensive therapy group had a 46% lower risk for all-cause mortality and a 57% lower risk of death from cardiovascular causes [10]. However, adequate glycemic control is not easily achieved in real clinical settings. Actually, adequate glycemic control was achieved in only 43.5% and 22.9% rate with the use of target hemoglobin A1c (HbA1c) level of <7.0% and <6.5%, respectively, according to the data from Korea National Health and Nutrition Examination Survey (KNHANES) 2005 [11]. These data means that more than half of the diabetic patients are prone to develop diabetic complications. Therefore, it is crucial to devise a plan-of-action to alleviate this situation in one way or another. Editorial Epidemiology