Glycemia Risk Index is Associated With Risk of Albuminuria Among Individuals With Type 1 Diabetes Ji Yoon Kim, Jee Hee Yoo, Nam Hoon Kim, Jae Hyeon Kim Journal of Diabetes Science and Technology, 2026 Background: The glycemia risk index (GRI) is a novel composite continuous glucose monitoring (CGM) metric composed of hypoglycemia and hyperglycemia components and is weighted toward extremes. This study aimed to investigate the association between GRI and the risk of albuminuria in type 1 diabetes. Methods: The 90-day CGM tracings of 330 individuals with type 1 diabetes were included in the analysis. Glycemia risk index was divided into five risk zones (A-E), and hypoglycemia and hyperglycemia components were divided into quintiles. Albuminuria was defined as a spot urine albumin-to-creatinine ratio ≥30 mg/g. Associations of albuminuria with GRI and its hypoglycemia and hyperglycemia components were estimated. Results: Mean GRI and glycated hemoglobin (HbA1c) were 40.9 ± 21.3 and 7.3 ± 1.0%, respectively, and the overall prevalence of albuminuria was 17.6%. Prevalence of albuminuria differed significantly by GRI zone ( P = .023). In logistic regression analysis, the adjusted odds ratio (OR) of albuminuria per increase in the GRI zone was 1.70 (95% confidence interval [CI]: 1.19-2.41) after adjusting for various factors affecting albuminuria. The association remained significant after adjusting for achievement of the recommended target of time in range (70-180 mg/dL; >70%) or HbA1c (<7%). The hyperglycemia component of GRI was also associated with albuminuria, and the association remained significant even after adjusting for HbA1c level itself (adjusted OR 1.44, 95% CI: 1.05-1.98). Conclusions: Glycemia risk index is significantly associated with albuminuria in individuals with type 1 diabetes.
Sodium-glucose cotransporter 2 inhibitor ameliorates thiazolidinedione-induced fluid retention through vascular leakage reduction in white adipose tissue Ji Yoon Kim, Hye‐Min Jang, Hye‐Jin Lee, Ah Hyeon Lee, Dong‐Hoon Kim, et al. Diabetes Obesity and Metabolism, 2026 Aim Thiazolidinediones (TZDs) are effective insulin sensitisers; however, their use is restricted owing to adverse effects such as fluid retention. Previous research has linked increased vascular permeability in white adipose tissue (WAT) to TZD‐induced fluid retention. We explore the potential of sodium‐glucose cotransporter 2 inhibitors (SGLT2is) to counteract this side effect and elucidate the underlying mechanisms. Materials and Methods High‐fat‐diet‐induced obese mice (C57BL/6) were assigned to three groups: (1) lobeglitazone 0.5 mg/kg (TZD monotherapy); (2) a combination of lobeglitazone 0.5 mg/kg plus empagliflozin 10 mg/kg with 0.16 mg/mL in drinking water (TZD + SGLT2i combination therapy); and (3) distilled water (control). After 6 weeks of treatment, body composition and water content in multiple tissues were measured. The expression of proteins and mRNA related to vascular permeability, renal sodium and water channels was investigated. Additionally, in vivo and in vitro experiments (the latter in human umbilical vein endothelial cells) using anti‐VEGF agents were conducted. Results TZD treatment escalated vascular leakage and fluid retention in WAT, which was associated with diminished VE‐cadherin expression and compromised vascular integrity. Co‐treatment with the SGLT2i mitigated these adverse effects, reinstating VE‐cadherin expression, reducing vascular permeability and normalizing tissue water content. Empagliflozin was found to inhibit the VEGF‐A/VEGFR2 signalling pathway, thereby reducing VE‐cadherin internalisation and degradation. In vitro studies reinforced these findings, emphasizing the interplay between VEGF and VE‐cadherin in maintaining endothelial junction stability. Conclusions Our results suggest that SGLT2is protect against TZD‐induced fluid retention by preserving vascular integrity in WAT, providing a viable therapeutic strategy to minimise TZD‐associated side effects.
Managing dyslipidemia in chronic kidney disease: a comprehensive overview of evidence and recommendations Ji Yoon Kim, Suk Min Chung, Nam Hoon Kim Korean Journal of Internal Medicine, 2025 Patients with chronic kidney disease (CKD) have a significantly increased risk of developing cardiovascular disease (CVD), making dyslipidemia management a critical component of cardiovascular risk reduction in this population. However, as the estimated glomerular filtration rate declines, distinct pathophysiological mechanisms—unlike those observed in the general population—contribute to the development and progression of CVD. Consequently, dyslipidemia management in patients with CKD requires a tailored approach that considers altered lipid profiles, comorbid conditions, and potential safety concerns associated with pharmacological therapy. This review aimed to summarize key clinical trials evaluating lipid-lowering strategies in CKD and compare current international and regional clinical practice guidelines. We assessed cardiovascular outcomes associated with various lipid-lowering agents, including statins, ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors, fibrates, and omega-3 fatty acids. In addition, we discuss optimal therapeutic strategies across distinct patient subgroups, including those not treated with dialysis or kidney transplantation, those on dialysis, and kidney transplant recipients.
Beta-Cell Function, Insulin Sensitivity, and Metabolic Characteristics in Young-Onset Type 2 Diabetes Mellitus: Findings from Anam Diabetes Observational Study Ji Yoon Kim, Jiyoon Lee, Sin Gon Kim, Nam Hoon Kim Diabetes and Metabolism Journal, 2025 Background: In this study, we aimed to determine the metabolic characteristics and changes in the early stages of young-onset type 2 diabetes mellitus (YOD) in Koreans.Methods: From the Anam Diabetes Observational Study cohort (2017–2023), the characteristics of newly diagnosed YOD (<40 years of age, <i>n</i>=39) and later-onset (≥40 years of age) type 2 diabetes mellitus (LOD, <i>n</i>=178) were compared at diagnosis and 1 year later. All participants underwent an oral glucose tolerance test at diagnosis and annually thereafter. β-Cell function was determined using the disposition index (DI), calculated as the insulinogenic index×Matsuda insulin sensitivity index (ISI). Insulin sensitivity was determined using ISI and homeostasis model assessment of insulin resistance (HOMA2-IR).Results: Mean (±standard deviation) age of individuals with YOD was 29.8±6.4 years, and 76.9% were male. YOD patients had higher body mass index (29.8 kg/m<sup>2</sup> vs. 27.2 kg/m<sup>2</sup>, <i><i>P</i></i>=0.020), fat mass (30.5 kg vs. 24.1 kg, <i><i>P</i></i>=0.011), fatty liver index (65.4 vs. 49.2, <i><i>P</i></i>=0.005), and glycosylated hemoglobin (HbA1c) level at diagnosis (9.3% vs. 7.7%, <i>P</i><0.001) compared with LOD patients. YOD patients exhibited lower insulin sensitivity (ISI: 2.79 vs. 3.26, <i><i>P</i></i>=0.008; HOMA2-IR: 2.72 vs. 1.83, <i>P</i><0.001) and β-cell function (DI) at diagnosis (0.41 vs. 0.72, <i><i>P</i></i>=0.003) than LOD patients. Following 1 year of treatment, DI improved by 94% in YOD along with improvement in HbA1c; however, it was still significantly lower than that of LOD (0.64 vs. 0.90, <i><i>P</i></i>=0.017).Conclusion: Individuals with YOD have unfavorable metabolic characteristics, substantially reduced insulin sensitivity, and decompensated β-cell function at disease onset, which persist even after treatment.
Fenofibrate therapy and risk of heart failure outcomes in patients with Type 2 diabetes: a propensity-matched cohort study Ji Yoon Kim, Nam Hoon Kim, Jiyoon Lee, Dong-Hoon Kim, Sin Gon Kim European Heart Journal Cardiovascular Pharmacotherapy, 2025 Aims This study investigated the association between fenofibrate use and outcomes of heart failure (HF) in patients with Type 2 diabetes (T2D). Methods and results In a nationwide cohort database (2008–22) in South Korea, patients with T2D (≥30 years) receiving statin therapy were 1:1 matched by propensity score into a statin plus fenofibrate group (n = 11 722) and statin only group (n = 11 722). The primary outcomes were hospitalization for HF (HHF) and a composite of HHF or cardiovascular death. A Cox proportional hazards model was used to assess the association between treatments and outcomes. During a median of 50.4 months, the incidence rate per 1000 person-years of HHF was 3.44 and 4.13 in the statin plus fenofibrate and statin only groups, respectively (adjusted hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.65–0.98). The adjusted HR for the composite outcome of HHF or cardiovascular death was 0.79 (95% CI, 0.65–0.96). Sensitivity analyses limited to individuals with ≥80% adherence showed consistent results (HHF: adjusted HR, 0.63; 95% CI, 0.43–0.92; composite outcome: adjusted HR, 0.68; 95% CI, 0.48–0.97). Conclusion In this propensity-matched cohort study, the addition of fenofibrate to statins was associated with significantly lower risks of HHF and the composite outcome of HHF or cardiovascular death in patients with T2D, suggesting a novel cardiovascular benefit of fenofibrate.
Current Status of Delay in Injectable Therapy among Type 2 Diabetes Mellitus Patients in South Korea: Multicenter Retrospective Study (2015–2021) Jong Han Choi, Min Kyong Moon, Hae Jin Kim, Kyung Ae Lee, Hyun Jin Kim, et al. Endocrinology and Metabolism, 2025 Background: We aimed to assess the therapeutic inertia associated with injectable therapies and the factors influencing glycemic control following these therapies in patients with type 2 diabetes mellitus (T2DM) in South Korea.Methods: This multicenter, retrospective cohort study included 2,598 T2DM patients aged 20 to 75 years from 10 referral medical centers in South Korea. These patients had been treated with three or four oral antidiabetic drugs (OADs) and were subsequently initiated on insulin (<i>n</i>=1,942) or glucagon-like peptide-1 receptor agonists (GLP-1RAs, <i>n</i>=656) between January 2015 and December 2021. We analyzed the time to initiation of injectable therapy, changes in glycated hemoglobin (HbA1c), and associations between clinical factors and glycemic control.Results: At the time of injectable therapy initiation, the mean HbA1c was 9.54%, with insulin users having a higher HbA1c level (9.79%) than GLP-1RA users (8.70%). The mean time from starting 3 or 4 OADs to initiating injectable therapy was 3.19 years: 53.5% of patients had started injectable therapy after 2 years, and 24.2% started after 5 years. Among insulin users, older age (<i>P</i>= 0.004), higher body mass index (<i>P</i>=0.035), and lower HbA1c levels at insulin initiation (<i>P</i><0.001) were associated with better glycemic control. Among GLP-1RA users, only the HbA1c level at therapy initiation (<i>P</i><0.001) was a significant factor.Conclusion: This study highlighted significant delays in initiating injectable therapies, particularly insulin, in T2DM patients in South Korea. Early initiation of injectable therapy may improve long-term glycemic control in these patients.
Preoperative Tyrosine Levels as Predictive Biomarkers for Excessive Fat-Free Mass Loss Following Laparoscopic Sleeve Gastrectomy in Patients with Morbid Obesity Inyoung Lee, Eunhye Seo, Yeongkeun Kwon, Chang Min Lee, Nam Hoon Kim, et al. Metabolites, 2025 Background/Objectives: Fat-free mass (FFM) loss after metabolic and bariatric surgery (MBS) is associated with adverse long-term outcomes, including osteoporosis. Identifying biomarkers that predict excessive FFM loss can improve perioperative patient management and postoperative risk stratification. This study investigated whether preoperative amino acid metabolite (AAM) levels could predict excessive FFM loss after laparoscopic sleeve gastrectomy (LSG). Methods: Forty patients with morbid obesity who underwent LSG between 2019 and 2020 were retrospectively analyzed. Based on the FFM loss to body weight loss ratio (%FFML/BWL) at 3 months postoperatively, patients were categorized into excessive (>25%) and non-excessive (≤25%) FFM loss groups. Anthropometric measurements and serum sampling were performed preoperatively and at 3, 6, and 12 months postoperatively. AAM profiles were collected before surgery. Statistical analyses, including logistic regression and receiver operating characteristic curves, were performed. Results: Twenty-five patients showed excessive FFM loss 3 months after surgery. They had significantly lower preoperative tyrosine (Tyr) levels (p = 0.025). Logistic regression revealed that higher Tyr levels were significantly associated with lower odds of being male, suggesting a potential protective effect (odds ratio (OR) =0.019, p = 0.010). Tyr profiling demonstrated acceptable predictive performance (area under the curve =0.715, p = 0.025). Despite nonsignificant p-values, trends showed lower FFM and muscle mass and higher fat mass in the excessive FFM loss group throughout follow-up. Conclusions: Preoperative Tyr profiling may help identify patients at risk for excessive FFM loss. These findings support prioritizing metabolic health alongside total weight loss in the evaluation of MBS outcomes.
