DiabetesFact Sheetin Korea2016

* N Seoul Tower on Namsan Mountain Autumn View

Diabetes Fact Sheet in Korea 2016

Summary•About4.8millionKoreans(13.7%),aged30yearsorolder,haddiabetesin2014.Inaddition,nearlyaquarterofKoreanadultshadprediabetes(impairedfastingglucose).

•However,threeoutof10personswithdiabeteswerenotawareoftheircondition.Nearlyhalfpersonswithdiabeteswereobeseorhypertensive,andonethirdhadhypercholesterolemia.Nearlyone-thirdofpersonswithdiabeteshadalbuminuriaordecreasedrenalfunction.

•Althoughmostpersonswithdiabetes(89.1%)wereundermedicaltreatment-mostlybeingtreatedwithoralhypoglycemicagents(80.2%),but10.8%ofthosehadremaineduntreated.

•Withrespecttotheoverallglycemiccontrol,43.5%reachedthetargetofHbA1c<7.0%,whereas23.3%reachedthetargetwhenthestandardwassettoHbA1c<6.5%,accordingtotheKoreanDiabetesAssociation(KDA)guideline.

Data sourceTheestimatedpercentagesandthetotalnumberofpersonsovertheageof30withdiabetesandprediabetesweredeterminedfromdatafromthe2013-2014KoreaNationalHealthandNutritionalExaminationSurvey(KNHANES)conductedbytheKoreaCentersforDiseaseControlandPrevention(KCDC)andtheKoreanMinistryofHealthandWelfare,appliedtoNationalPopulationCensusin2014(34.1millionKoreanswereages30yearsorolder;16.7millionmenand17.4millionwomen).

Year 2012 2013 2015 2016

Data source KNHANES KNHANES NHIS KNHANES

2007-2010 2011 2002-2013 2013-2014

Year applied to Korean census 2010 2011 2006-2013* 2014

Co-working Institute CDC CDC NHIS CDC

Prevalence of diabetes (%, n)§ 10.1% (3.2 M) 12.4% (4.0 M) 8.0% (2.7 M) 13.7% (4.8 M)

Prevalence of IFG (%, n) 19.9% (6.2 M) 19.3% (6.1 M) 25% 24.8% (8.3 M)

Awareness of diabetes (%) 73.4% 72% • 70.7%

No treatment for diabetes (%) 14.1% 11% • 10.8%

Treatment with insulin (%) 7.4% 11% 16.4% 8.9%

Glycemic control (< 6.5%, %) 29.5% 27.9% • 23.3%

Hypertension (%)§§ • 54.6% 62.5% 54.7%

Hypertension control (%)§§ 37% 39.5% • 69.1%

Dyslipidemia (%)† • 79.6% 49.5% 31.6%

Dyslipidemia control (%)† • 17.4% • 49.8%

Albuminuria (%)‡ • 27.3% • 23.9%

Chronic kidney disease (%)‡ • 10.0% • 12.5%

Diabetes in ESRD (%)†† • • 38.8% •

Diabetic neuropathy (%)‡‡ • 33.5% • •

Diabetic retinopathy (%)∫ • 18.6% 15.9% •

Prevalence of obesity (%)∬ 74.7% 44.4% • 48.6%

SUMMARY of DIABETES FACT SHEET IN KOREA

Available at http://www.diabetes.or.kr/

NHIS,nationalhealthinsuranceservice;M,million;IFG,impairedfastingglucose;ESRD,end-stagerenaldisease.

*FromtheNationalHealthInformationDatabasefromJanuary2002throughtoDecember2013.§Diagnosticofdiabetes,basedonfastingplasmaglucose(≥126mg/dL),currenttakingofanti-diabeticmedication,orpreviousdiagnosisin2012,andadditionofHbA1c≥6.5%in2013and2016.In2015,basedonICD-10code(E11-E14)andprescriptionofantidiabeticmedications.§§Definitionandcontrolrateofhypertension(systolicanddiastolicbloodpressure,mmHg),≥140/90ortakinganti-hypertensivemedicationand<130/80in2012and2013,ICD-10codeandtakinganti-hypertensivemedicationin2015,≥140/90ortakinganti-hypertensivemedication(s)and<140/85in2016.†Definitionandcontrolrateofdyslipidemia,oneormorethanoffollowing;hypercholesterolemia(totalcholesterol≥240mg/dLormedication(s)),hypertriglyceridemia(TG)(≥150mg/dL),hyper-lowdensitylipoprotein(LDL)-cholesterolemia≥160mg/dL),hypo-highdensitylipoprotein(HDL)-cholesterolemia(<40mg/dLformen;<50mg/dLforwomen),ortakingmedication,andallofallfollowing;<100mg/dLforLDL-C,<150mg/dLforTG,and>40mg/dL(men)/50mg/dL(women)forHDL-Cin2015;hypercholesterolemia(totalcholesterol≥240mg/dL)and<100mg/dLforLDL-Cin2016.‡Thedefinitionofalbuminuriaorchronickidneydiseaseinpersonwithdiabetesareincreasedalbuminuriadeterminedbyalbumin-creatinineratio>30ug/mgofcreatinineorestimatedglomerularfiltrationrate(eGFR)<60mL/min/1.73m2.GFR(mL/min/1.73m2)=175×(SCr)

-1.154×(Age)-0.203×(0.742iffemale),respectively.††DefinitionofESRD,ICD-10codeofrenalfailure(N18,N19)ortreatedwithrenalreplacementtherapy.‡‡Diabeticneuropathy,Questionnaire(MichiganNeuropathyScreeningInstrument,score≥3)and10gmonofilamentexam.∫Diabeticretinopathy,presenceofatleastonedefiniteretinalblothemorrhageand/ormicroaneurysmwithorwithoutmoreseverelesions(hardexudates,softexudates,intraretinalmicrovascularabnormalities,venousbleeding,newretinalvessels,fibroproliferations)Basedonthediagnosisinthemoreseverelyaffectedeyein2013. ∬Bodymassindex,23.0~24.9kg/m2foroverweightand≥25.0kg/m2forobesity,overweightandobesein2012,andobesein2013and2016.

※Citation:KoSHetal,Medicine (Baltimore).2016;LeeYHetal,Diabetes Metab J.2016;JeonJYetal,Diabetes Metab J.2014;AhnJHetal,Diabetes Metab J.2014;KoSHetal,Diabetes Metab J.2014;KimCSetal,Diabetes Metab J.2014;RohEetal,Diabetes Metab J.2013;JeonJYetal,Diabetes Metab J.2013;WonJCetal,Diabet Med.2012.

Theprevalenceofdiabetesamongadults30yearsorolderis13.7%(4.8Million).

13.7%

15.7%

30.4%

11.9%

30-3

9 ye

ars

30-3

9 ye

ars

50-5

9 ye

ars

50-5

9 ye

ars

Persons (1,000)

40-4

9 ye

ars

40-4

9 ye

ars

60-6

9 ye

ars

60-6

9 ye

ars

≥ 70

yea

rs

≥ 70

yea

rs

Prevalence of Diabetes

"Nearly 1 of 7 Korean adults have diabetes"

“More than 30% of persons aged ≥ 65 years have diabetes”

"While the prevalence of diabetes get reach the highest at age of 60~69 in men, it is constantly increasing along the age in women"

"The prevalence of diabetes is 1.4 times more common in persons with the lowest quartile of family incomes compared with those with the highest quartile"

4,810,000/

2,580,000/

1,951,000/

2,230,000/

124/ 80

/

521/

239/

748/

442/

729/

574/

457/

895/33.8%

24.1%

11.1%

5.7%

3.1%

2.1%

33.1%

27.2%

18.8%

12.1%

Diabetesisdefinedbyfastingplasmaglucose≥126mg/dL,HbA1c≥6.5%,currentanti-diabetesmedication(s),orpreviousdiagnosis.

Men Women

Women

Family incomes (lowest - highest)

MenTotal

17 Diabetes

≥ 30 years ≥ 65 years Men

1 2 3 4 1 2 3 4 1 2 3 4

Women15.1%

17.7%

12.6%

12.8%

14.7%

10.6%

11.7%

13.3%

10.2%

11.2%

13.4%

9.2%

TheprevalenceofIFGamongadults30yearsorolderis24.8%(8.3Million).

Impairedfastingglucose(IFG)wasdefinedbyfastingplasmaglucosewith100~125mg/dLinpersonwithoutdiabetes.

Prevalence of IFG

“Nearly 1 of 4 Korean adults have IFG”

Threeoutof10personswithdiabetesarenotawareoftheircondition,andtwoof5personswithdiabetes(diagnosedandundiagnosed)arenottakinganytreatmentfortheircondition.Diabetesawarenessislowestatageof40~49inbothsexes.

Diabetes Awareness

30-3

9 ye

ars

30-3

9 ye

ars

Men

Tota

l

Men

Wom

en

Wom

en

50-5

9 ye

ars

50-5

9 ye

ars

≥ 65

yea

rs

50-5

9 ye

ars

50-5

9 ye

ars

40-4

9 ye

ars

40-4

9 ye

ars

≥ 30

yea

rs

40-4

9 ye

ars

40-4

9 ye

ars

60-6

9 ye

ars

60-6

9 ye

ars

60-6

9 ye

ars

60-6

9 ye

ars

≥ 70

yea

rs≥

70 y

ears

≥ 70

yea

rs≥

70 y

ears

4,786/

3,473/

796/

425/

8,259/

1,354/

708/

1,511/

1,042/

457/

642/

668/

657/

29.6%

20.0%

67.0%

70.7%

75.9%

20.1%

24.4%

26.9%

26.2%

16.9%

11.2%

24.8%

30.3%78.4%

81.5%

27.1%

82.0%

87.4%

37.9%65.5%

68.7%

31.4%46.0%

85.2%

56.9%

Persons (1,000)

“Diabetes awareness among adults 30 years or older is 70.7%”

Men

Men

Women

Women

14 IFG14 IFG

310 Unawareness

Theprevalenceofobesityandabdominalobesityinpersonswithdiabetesare48.6%and58.9%,respectively.

•BMI,bodymassindex•Obesity:BMI≥25.0kg/m2,morbidobesity:BMI≥30.0kg/m2

•Abdominalobesityisdefinedbyusingwaistcircumference≥90cmformenand≥85cmforwomen.

Obesity in Diabetes

Obesity Abdominal Obesity

Mor

bid

obes

ity

Women Women

“Nearly half of persons with diabetes are obese”

Theprevalenceandcontrolrateofhypertensioninpersonswithdiabetesare54.7%and69.1%,respectively.

Hypertensionisdefinedbysystolic/diastolicbloodpressure≥140/90mmHgand/orantihypertensivemedications,andcontrolrateisdefinedbybloodpressurelessthan140/85mmHgbasedontheKDAguideline.

Hypertension in Diabetes

“In men aged 40~49 years with diabetes, fewer than half do not reach the blood pressure goal of < 140/85 mmHg”

≥ 30 years ≥ 65 years Men Women

52.3%

63.9%

76.6%

71.7%

69.1%38.9%

9.748.6%

48.1%

49.4%

8.0

12.1

40.1%

37.3%

58.9%

61.2% 55.9%

54.7%

58.0%

76.4%

Total TotalMen Men

12

Uncontrolledhypertension

12 Obesity

Prevalence

Control rate

Mostpersonswithdiabetes(80.2%)aretreatedwithoralhypoglycemicagents,but10.8%ofthemhaveremaineduntreated.

*Inpersonswithdiagnoseddiabetes.OHA,oralhypoglycemicagent(s)

Treatment of Diabetes

OHAonly80.2%

Insulin±OHA8.9%

Notreatment10.8%

Non-pharmacologicaltherapy0.1%

Thecontrolrateofglycemiaamongthepersonswithdiagnoseddiabetesis23.3%fortargetgoalofHbA1c<6.5%or43.5%for<7.0%.However,14.6%ofpersonswithdiabeteshaveHbA1c≥9.0%.

Inpersonswithdiagnoseddiabetes

Control Rate of Diabetes

“Only one of 4 persons with diabetes gets the glycemic target”

“Only one out of 11 persons with diabetes is using insulin therapy for glycemic control”

HbA1

c <

6.5%

23.3%

HbA1

c <

7%

43.5%

HbA1

c =

7.0~

8.9%

41.9%

HbA1

c ≥

9.0%

14.6%

14 IFG

111 Insulinuser

14 HbA1c

< 6.5%

≥ 30 years ≥ 65 years Men Women

Theprevalenceandcontrolrateofhypercholesterolemiainpersonswithdiabetesare31.6%and49.8%,respectively.

Hypercholesterolemiaisdefinedbytotalcholesterol≥240mg/dLormedication(s)andcontrolrateisdefinedbylow-densitylipoproteincholesterol(LDL-C)<100mg/dLbasedonKDAguideline.

Hypercholesterolemia in Diabetes

“More than half of persons with diabetes do not reach the LDL-C goal of < 100 mg/dL”

Theprevalenceofdiabeticnephropathy(albuminuriaordecreasedeGFR)is30.3%.

Thedefinitionofnephropathyisincreasedalbuminuriadeterminedbyalbumin-creatinineratio>30ug/mgofcreatinineand/orestimatedglomerularfiltrationrate(estimatedGFR,eGFR)<60mL/min/1.73m2.GFR(mL/min/1.73m2)byMDRDequation=175×(SCr)

-1.154×(Age)-0.203×(0.742iffemale).

Nephropathy in Diabetes

“Three among 10 persons with diabetes have albuminuria or decreased renal function”

≥ 30 years

Prevalence

≥ 65 years

Control rate

Albuminuria Decreased eGFR Nephropathy

26.1%

39.0%

23.9%

30.3%

23.1%

12.5%

49.8%

31.7%

27.6%

51.0%

53.2%

37.0%

45.1%

31.6%

14 IFG12 Uncontrolled

hypercholesterolemia

310 Nephropathy

Thepercentageofcomprehensivemanagementinpersonswithdiabetesis9.4%.

Amongpersonswithdiabetes,27.4%aresmokersand21.9%arehigh-riskdrinkers.And,37.9%aretakinga30-minwalkingexerciseregularly.

Comprehensive Management of Diabetes

Health Behaviors in Diabetes

“Only one among 10 persons with diabetes gets a comprehensive management for diabetes and associated co-morbidities”

“In men aged 30 ~ 49 years with diabetes, more than half are current smoker and fewer than half are regular exercisers”

Currentsmoking(percentageofadultswhohadsmokedatleast5packsofcigarettes(100cigarettes)duringtheirlifetimeandwhoarecurrentlysmokers),high-riskdrinking(morethansevenglassesinmenorfiveglassesinwomenonthesameoccasiononeachof2ormoreaweek),regularwalkingexerciseactivity(5daysormoreperweekandfor30minutesormoreperactivity)

ThecomprehensivemanagementisdefinedbyHbA1c<6.5%or<7.0%,systolic/diastolicbloodpressure<140/85mmHg,andLDL-C<100mg/dLinpersonswithdiagnoseddiabetesbasedonKDAguidelines.

Men

Men Women≥ 30 years

Women

44.0%

23.0%

38.3%

37.3%

9.4%

16.8%

17.3%

16.2%

8.9%

9.7%

High-risk drinking

< 7.0% of HbA1c

Current smoking

< 6.5% of HbA1c

Regular walking exercise

14 IFG

110 Comprehensive

management

12 Smoking

5.2%

2.6%