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1 23 rd Spring Congress of Korean Diabetes Association 08.MAY. 2010

2 % % % % Wild S, et al. Diabetes Care 2004;27: Zimmet P, et al. Nature 2001;414: % 2000: 151 million 2010: 220 million + ~50% 2025: 300 million + ~100% 2030: 366 million + ~145% %

3 그림. 당뇨병유병률추이 당뇨병유병률 : 공복혈당이 126 mg/dl 이상이거나의사진단을받았거나혈당강하제복용또는인슐린주사를투여받고있는분율, 만 30 세이상 KNHANES, 2008

4 Rapidly increasing diabetes-related mortality with socioenvironmental changes in South Korea during the last two decades Re-analyzed the annual reports on mortality in S. Korea by KNSOfrom 1983 to 2001 Age-adjusted death rate in Korea Fig. Age-adjusted death rate related to diabetes and infection in Korea ( ). Choi YJ, et al. Diabetes Res Clin Pract. 74(3): , 2006

5 Rapidly increasing diabetes-related mortality with socioenvironmental changes in South Korea during the last two decades Re-analyzed the annual reports on mortality in S. Korea by KNSOfrom 1983 to 2001 Age-adjusted diabetes-related mortality rates of South Korea, Japan, UK & USA Table. Age-adjusted diabetes-related mortality rates of South Korea, Japan, the United Kingdom and the United States ( ) Choi YJ, et al. Diabetes Res Clin Pract. 74(3): , 2006

6 Table. Risk factors for type 2 diabetes Age 45 years Overweight (BMI 25 kg/m 2 ) Family history of diabetes (i.e., parents or siblings with diabetes) Habitual physical inactivity Race/ethnicity (e.g., African-Americans, Hispanic-Americans, Native Americans, Asian-Americans, and Pacific Islanders) Previously identified IFG or IGT (A1C 5.7%) History of GDM or delivery of a baby weighing >9 lbs Hypertension ( 140/90 mmhg in adults) HDL cholesterol 35 mg/dl and/or a triglyceride level 250 mg/dl Polycystic ovary syndrome History of vascular disease American Diabetes Association. Diabetes Care. 27(S1):S11-4, 2004

7 인슐린비의존형당뇨병의위험인자분석 연천지역사회 2 개읍, 8 개면전지역을대상으로무작위집단표본조사실시 표본의크기는표본조사대상인 26,927 예중약 13% 에해당하는 3,804 예 Table. Risk factors of Diabetes Mellitus. 단변량분석 성별 ( 남 > 여 ) 남 : 8.7%, 여 : 7.2% Χ 2 =14.6, p<0.001 비만도 체질량지수증가 Χ 2 =9.6, p<0.01 도시화정도도시화 Χ 2 =6.3, p<0.05 활동도 직업상활동도증가 Χ 2 =11.4, p<0.01 가족력 당뇨병가족력 1인이상 Χ 2 =14.1, p<0.001 다변량분석 WHR 3.82 ( ) 혈청중성지방농도 2.02 ( ) 연령 3.27 ( ) 당뇨병의가족력 2.1 ( ) 수축기혈압 1.69 ( ) 도시화정도 1.56 ( ) 박용수등. 당뇨병 20(1): 14-24, 1996

8 Risk factors for type 2 diabetes mellitus in the Chinese adult population A nationally representative sample of 15,236 Chinese adults aged years Men Women Men Women Hu D, et al. Diabetes Res Clin Pract. 84(3):288-95, 2009

9 Obesity as a risk factor for non-insulin-dependent diabetes mellitus in Korea Reviewed the medical records of final cohort of 2,531 subjects. Follow-up revealed 117 cases with DM with an incident of 7.8 per 1,000 person-years. Table. Adjusted relative risk and 95% confidence interval for NIDDM among a cohort of 1,551 men and 980 women. *Using Cox proportional hazards model. All risk factors above are used as covariates Sung EJ, et al. J Korean Med Sci. 16(4):391-6, 2001

10 Cut-off point of BMI and obesity-related comorbidities and mortality in middle-aged Koreans Cohort study among 773,915 men and women from 30 to 59 years old with 8-10 year F/U. Table. BMI in 1992 and age-adjusted diabetes Risk of Diabetes incidence rates during 8-year F/U period. Fig. Multivariate RRs of diabetes occurrences during 8- year F/U period according to BMI. Age-adjusted incidence rate per 1,000 person-years. Oh SW, et al. Obes Res. 12(12): , 2004

11 Waist circumference is the key risk factor for diabetes in Korean women with history of GDM 909 women with history of GDM were enrolled. During postpartum follow-up period, mean 2.13+/-1.75 years Table. Odds ratio of diabetes by obesity parameters between the highest and the lowest quartiles a. a Odds ratio was calculated using the logistic regression analysis. The potential confounders, such as BP, lipid profiles, age, duration of follow-up, parity, F/H of DM, and working status were included in the model as an independent variable to be controlled its effect. OR in parenthesis are the values before multiple adjustment. Cho NH, Jang HC, Park HK, Cho YW. Diabetes Res Clin Pract. 71(2):177-83, 2006

12 Weight change and duration of overweight and obesity in the incidence of T2DM a prospective study of CVD in men aged years at screening. Table. Risk of diabetes by BMI at Q5 and duration of overweight and obesity. Wannamethee SG, Shaper AG. Diabetes Care. 22(8): , 1999

13 Comparison of abdominal adiposity and overall obesity in predicting risk of type 2 diabetes among men. A prospective cohort study of 27,270 men. During 13 yr of follow-up, 884 incident T2DM cases. Fig. Age-adjusted RR of T2DM by baseline WC, WHR, and BMI deciles.(n=27,270). Wang Y, et al. Am J Clin Nutr. 81(3):555-63, 2005

14 Increases in BMI, even within non-obese levels, raise the risk for T2DM A follow-up study in 16,829 men and 8,370 women who were apparently healthy at baseline (age years, BMI kg/m 2 ). Table. Incidence of DM and hazard ratio for incident DM according to deciles of BMI in Japanese men aged years Nagaya T, et al. Diabet Med. 22(8): , 2005

15 J-shaped relationship between WC and subsequent risk for T2DM 3,992 employees (2,533 men & 1,459 women, aged yrs) of a metal-products factory in Japan Table. Age-and sex-adjusted and multivariate-adjusted hazard ratios for the incidence of T2DM according to sex-specific quintile of WC. Sakurai M, et al. Diabet Med. 26(8):753-9, 2009

16 A study of WC, CVD, and DM in 168,000 primary care patients in 63 countries. Randomly chosen primary care physicians in 63 countries recruited consecutive patients aged 18 to 80 years (69,409 men and 98,750 women). Men Women Fig. Frequency of known diabetes mellitus for men and women, adjusted for age, region, and smoking status, by gender-specific WC tertiles and BMI categories. The percentage of patients in each of the 9 groups is shown. Balkau B, et al. Circulation. 116(17): , 2007

17 Impact of BMI on DM in Chinese Asians, American Whites, and American Compared the Blacks associations with BMI in Chinese Asians (n=5,980), American Whites (n=10,776), and American Blacks (n=3,582) Using prospective data from the People's Republic of China Study ( ) and the Atherosclerosis Risk in Communities Study ( ). Fig. Adjusted cumulative incidence (and 95% CI) for DM by BMI categories and ethnicity, the ARIC Study ( ) and the PRC Study ( ). Point estimates for the same BMI categories are shifted slightly in the horizontal plane so that CIs are clearly visible. Stevens J, et al. Am J Epidemiol. 167(11): , 2008

18 A study of WC, CVD, and DM in 168,000 primary care patients in 63 countries. Randomly chosen primary care physicians in 63 countries recruited consecutive patients aged 18 to 80 years (69,409 men and 98,750 women). Men Diabetes Fig. Age-standardized frequency of overweight (BMI kg/m 2 ) and obese (BMI 30 kg/m 2 ) subjects by region in men. Fig. Age-standardized frequencies of DM by region in men and women. Balkau B, et al. Circulation. 116(17): , 2007

19 Overweight and obese adults Diabetes Table. Comparison of prevalence rates of diabetes in selected countries between and Table International comparison of prevalence of adult obesity and diabetes. Yoon KH, et al. Lancet. 368(9548):1681-8, 2006

20 그림. 연령별당뇨병유병률 당뇨병유병률 : 공복혈당이 126 mg/dl 이상이거나의사진단을받았거나혈당강하제복용또는인슐린주사를투여받고있는분율, 만 30 세이상 KNHANES, 2008

21 Risk factors of type 2 diabetes among Korean adults Data of 5,132 adults aged were used from the 2001 Korean Health and Nutrition Examination Survey Table. Multivariate Logistic Regression Determinants of T2DM Status Chung HR, Pérez-Escamilla R. Nutr Res Pract. 3(4):286-94, 2009

22 Risk of DM in siblings of index cases with T2DM: implications for genetic studies Patients diagnosed at ages years (n=563) to obtain information on the occurrence of diabetes in their relatives, particularly siblings (n=1,675). Table. Estimates of the diabetes recurrence-risk ratio in siblings (λ S ) or offspring (λ O ) of index cases with diabetes in four US studies according to parental history of diabetes. Weijnen CF, et al. Diabet Med. 19(1):41-50, 2002

23 Sibling and parental history in type 2 diabetes risk among ethnic Chinese Among 2,960 participants free from baseline DM through the Chin-Shan Community Cardiovascular Cohort Study, there were 548 cases that developed DM after a median 9 yrs F/U Fig. Relative risk of diabetes during the 9-year follow-up period according to various family history status and BMI value (cutoff by median level, 23 kg/m 2 ), with adjustment for sex, alcohol intake, smoking, marital status, education, job status, and physical activity. Chien KL, et al. Eur J Cardiovasc Prev Rehabil. 15(6):657-62, 2008

24 The nutrition transition in South Korea Secondary data on economics, dietary intake, anthropometry, and causes of death, including a series of comparable nationally representative dietary surveys (the National Nutrition Survey). *GNP: gross national product Fig. Trends in GNP and the distribution of occupations, South Korea, Kim S, et al. Am J Clin Nutr. 71(1):44-53, 2000

25 Rapidly increasing diabetes-related mortality with socioenvironmental changes in South Korea during the last two decades Re-analyzed the annual reports on mortality in S. Korea by KNSOfrom 1983 to 2001 Changes of indirect measures of physical activity Fig. Trends of changes in proxies for physical activities among South Koreans. Choi YJ, et al. Diabetes Res Clin Pract. 74(3): , 2006

26 Vigorous activity Moderate activity Walking activity 격렬한신체활동실천율 : 최근 1주일동안평소보다몸이매우힘들거나숨이많이가쁜격렬한신체활동을 1회 20분이상, 주 3일이상실천한분율, 만19세이상 중등도신체활동실천율 : 최근 1주일동안평소보다몸이조금힘들거나숨이약간가쁜중등도신체활동을 1회 30분이상, 주 5일이상실천한분율, 만19세이상 최근 1주일동안걷기를 1회 30분이상, 주 5일이상실천한분율, 만19세이상 ( 01년 : 평소하루에총 30분이상걷는분율, 만19세이상 ) KNHANES, 2008

27 Physical activity and incidence of NIDDM in women Prospective cohort of 87,253 US women aged years and free of DM, CVD, and cancer. During 8 years of F/U (confirmed 1,303 cases of NIDDM) Table. Physical activity level and RR of NIDDMduring 8 years of follow-up Frequency of vigorous exercise (per week) Total personyears No. cases of NIDDM Age-adjusted RR (95% CI) Age and BMI adjusted (95% CI) 0 362, , ( ) 0.89 ( ) 2 73, ( ) 0.71 ( ) 3 62, ( ) 0.93 ( ) 4+ 94, ( ) 0.86 ( ) Total 655,195 1,267 Manson JE, et al. Lancet. 338(8770):774-8, 1991

28 A prospective study of exercise and incidence of diabetes among US male physicians. Prospective cohort study (5 years of follow-up) 21,271 US male physicians, aged years and free of diagnosed DM, MI, CVA, and cancer Fig. Age-adjusted incidence rates of NIDDM according to frequency of vigorous exercise Fig. Age-adjusted incidence rates of NIDDM according to frequency of vigorous exercise, presented separately by quartile of BMI. (Cutpointsfor the BMI quartiles are <23, , , and >26.4 kg/m 2.) Manson JE, et al. JAMA. 268(1):63-7, 1992

29 A prospective study of exercise and incidence of diabetes among US male physicians. Prospective cohort study (5 years of follow-up) 21,271 US male physicians, aged years and free of diagnosed DM, MI, CVA, and cancer Table. Physical activity, BMI, and History of HTN as independent predictors of NIDDM Manson JE, et al. JAMA. 268(1):63-7, 1992

30 Leisure-time physical activity at weekends and the risk of T2DM in Japanese men Prospective examination of 6,013 Japanese men aged years who were free of DM, IFG, or HTN at study entry Table. RR of T2DM according to overall leisure-time physical activity on both weekdays and at weekends Okada K, et al. Diabet Med. 17(1):53-8, 2000

31 Hours of work and the risk of developing T2DM in Japanese male office workers A cohort of 1,266 Japanese male office workers aged years and free of IFG, T2DM, history of DM, or medication for HTN were re-examined over 5 successive years Table. Hours of work a day and the risks of T2DM among 1266 Japanese male office workers during 5 years of follow up. Nakanishi N, et al. Occup Environ Med. 58(9):569-74, 2001

32 Daily life activity and risk of developing T2DM in middle-aged Japanese men 2,924 Japanese male office workers aged 35 to 59 years who did not have IFG, T2DM or a history of CVD, and were not receiving medication for HTN Table. Risk of developing IFG or T2DM according to levels of selected daily life activities. Nakanishi N, et al. Diabetologia. 47(10): , 2004

33 Rapidly increasing diabetes-related mortality with socioenvironmental changes in South Korea during the last two decades Re-analyzed the annual reports on mortality in S. Korea by KNSOfrom 1983 to 2001 Trends of changes in diet factors in South Korea Energy intake Energy supply Overall total energy: 2012 kcal 1976 kcal Plant food intake: 75.0% 56.0% Animal protein intake: 33.5% 47.9% Fat intake: 23.5 g/day 41.6 g/day Total energy supply: 2,622 kcal 2,994kcal Total protein & animal protein Fat supply: 47.1 g/day 84.0 g/day Choi YJ, et al. Diabetes Res Clin Pract. 74(3): , 2006

34 Fig. Trends in total energy intake in South Korea. KNHANES, 2008

35 The nutrition transition in South Korea Fig. Trends in sources of energy in South Korea. KNHANES, 2008

36 The nutrition transition in South Korea Secondary data on economics, dietary intake, anthropometry, and causes of death, including a series of comparable nationally representative dietary surveys (the National Nutrition Survey). Fig. Trends in daily intake per capita by food group in South Korea. Kim S, et al. Am J Clin Nutr. 71(1):44-53, 2000

37 The nutrition transition in South Korea Secondary data on economics, dietary intake, anthropometry, and causes of death, including a series of comparable nationally representative dietary surveys (the National Nutrition Survey). Fig. Trends in percentage of energy from fat (per capita per day) in China, Japan, and South Korea. Kim S, et al. Am J Clin Nutr. 71(1):44-53, 2000

38 Diet, lifestyle, and the risk of type 2 diabetes mellitus in women 84,941 female nurses from 1980 to 1996 (free of diagnosed CVD, DM, and cancer at baseline). Information about their diet and lifestyle was updated periodically. Fig. Multivariate RRs of T2DM according to ascending quintiles of diet intake Hu FB, et al. N Engl J Med. 345(11):790-7, 2001

39 Diet, lifestyle, and the risk of type 2 diabetes mellitus in women 84,941 female nurses from 1980 to 1996 (free of diagnosed CVD, DM, and cancer at baseline). Information about their diet and lifestyle was updated periodically. Table. Multivariate RRs of T2DM according to BMI Hu FB, et al. N Engl J Med. 345(11):790-7, 2001

40 Socio-economic, dietary, activity, nutrition and BW transitions in South Korea. Data were drawn from published government reports: the Korean National Nutrition Survey and annual reports at the national level for the years between 1969 and Fig. A system of relationships between transitions. Lee SK, Sobal J. Public Health Nutr. 6(7):665-74, 2003

41 Comprehensive association study of T2DM and related quantitative traits with 222 candidate genes 1,161 T2DMsubjects and 1,174 control Finns who are NGT Genotyped 3,531 tagsnps and annotation-based SNPs and imputed an additional 7,498 SNPs Table. Diabetes association for SNPs genotyped in FUSION stage 1 and 2 samples Gaulton KJ, et al. Diabetes. 57(11): , 2008

42 Association between polymorphisms in the NRF 1 gene and T2DM in the Korean population The NRF1 gene was sequenced to identify polymorphisms in 24 Korean DNA samples 766 patients with type 2 diabetes and 303 non-diabetic subjects Table. Association between haplotypes and the risk of type 2 diabetes Cho YM, Lee HK, et al. Diabetologia. 48(10):2033-8, 2005

43 Genetic variation and association analyses of nrf1 gene in Chinese pts with T2DM 1,027 unrelated subjects, including T2DM pts (n=596) and non-dm control subjects (n=431) Using a variation screening approach, 6 novel & 10 known SNPsin NRF1gene were identified Table. Association between the NRF1 genetic polymorphisms and type 2 diabetic patients Table. Common haplotypes of SNPs in the NRF1 gene Liu Y, et al. Diabetes. 57(3):777-82, 2008

44 Table. Replicated type 2 diabetes gene nearest to the identified marker Ramachandran A, Ma RC, Snehalatha C. Lancet. 375(9712):408-18, 2010

45 Independent risk factors for T2DM in Korean adults 5,372 non-diabetic participants (3,670 men and 1,702 women; years), 5 yrs F/U Table. Risk factors of the incident T2DM in multiple logistic regression analysis Kim CH, et al. Diabet Med. 25(4):476-81, 2008

46 Normal fasting plasma glucose levels and type 2 diabetes in young 13,163 subjects men who had baseline FPG levels <100 mg/dl(men, yrs of age) A total of 208 incident cases of T2DM occurred (during 74,309 person-years of F/U) Table. Hazard Ratios for Type 2 Diabetes among 13,163 Men According to Quintiles of Normal FPG Levels. Tirosh A, et al. N Engl J Med. 353(14): , 2005 The mul variate Cox regression model was adjusted for age, BMI, and TG levels as con nuous variables; physical activity, F/H of DM, and smoking status.

47 Lowering the criterion for IFG: impact on ds. prevalence & associated risk of DM the Singapore Impaired Glucose Tolerance (IGT) Follow-up Study (295 IGT & 292 NGT, 8 yrs F/U) Table. Risk of development of diabetes according to FPG. Odds ratios of future diabetes were estimated using logistic regression analysis and were adjusted for age, sex, and ethnic group. Data are presented for glucose tolerance determined by FPG with and without stratification by 2-h PG following a 75-g OGTT. *Glucose tolerance based on 2-h PG criteria. Tai ES, et al. Diabetes Care. 27(7): , 2004

48 IFG and risk of diabetes in Taiwan: follow-up over 3 years. A population-based cohort study was conducted among residents aged >or=40 years on the island of Penghu, Taiwan, (n=1,601) Table. Variables independently associated with DM among 600 residents of Penghu Islets, Taiwan, 1998/1999 Odds ratios calculated by age-sex-adjusted multiple logistic regression analysis. Odds of diabetes were calculated vs. odds of not having diabetes. Independent variables available to the models were age, sex, family history of diabetes, BMI, triglyceride concentration,apolipoproteinbandifg 0 (allatbaseline, ). Chen KT, et al. Diabetes Res Clin Pract. 60(3):177-82, 2003

49 Fig. Insulinogenicindex and HOMA(R) in the NFG/NGT, IFG/NGT, NFG/IGT, IFG/IGT, and diabetes groups. Kim DJ, Lee MS, Kim KW, Lee MK. Metabolism. 50(5):590-3, 2001

50 β-cell (%) Area fraction in islet (%) control diabetes control beta-cell alpha-cell diabetes Retnakaran R et al. J Clin Endocrinol Metab 2006:91;93

51 Caucacians Asians Retnakaran R et al. J Clin Endocrinol Metab 2006:91;93

52 Insulin resistant good insulin secretion 28.5 % 54% 1.5% 16% Insulin sensitive good insulin secretion Insulin sensitive low insulin secretion Insulin resistant low insulin secretion San Antonio Heart Study:baseline status for insulin resistance and insulin secretion in those converted to type 2 diabetes during 7-year follow up; n = 195 Haffner SM, et al. Circulation 101: , 2000

53 한국인남성에서 Homeostasis Model Assessment 표지자로측정한인슐린저항성및인슐린분비능과당뇨병발생위험도 15,781 명의남성수진자를대상 당뇨병이있거나공복혈당이 126 mg/dl 이상인대상자 805 명 (5.1%) 은제외 Table. RR for future DM according to different levels of HOMA-IR and HOMA β-cell. 최은숙등. 당뇨병 32: , 2008

54 Association between birth weight and insulin sensitivity in healthy young men 22 healthy young Korean adults Fig. Correlation between insulin sensitivity and birth weight. Fig. Correlation between birth weight and visceral fat area. Choi CS, et al. Diabetes Res Clin Pract. 49(1):53-9, 2000

55 Fetal and infant growth and impaired glucose tolerance at age 64 F/U study of men born during whose birth weights and weights at 1 year were known. 468 men born in east Hertfordshire and still living there. Table. Proportions of men aged 64 with IGTor DM according to birth weight. Hales CN, et al. BMJ. 303(6809): , 1991

56 Hales CN, Barker DJ. Br Med Bull. 60:5-20, 2001

57 Smoking cessation and risk of type 2 diabetes mellitus 8-year prospective study 27,635 non-diabetic men, aged years (5,701 nonsmokers, 7,477 ex-smokers and 14,457 sustained smokers) Table. Relationships between smoking status and risk for developing diabetes mellitus Hur NW, et al. Eur J Cardiovasc Prev Rehabil. 14(2):244-9, 2007

58 Cigarette smoking is an independent risk factor for type 2 diabetes 10,038 subjects were recruited from rural and urban areas. 75 g OGTT & full biochemical assessments at baseline and during 4-year F/U period. Table. Relationships between smoking status and risk for developing diabetes mellitus Data are relative risk vs. never smokers(95% CI). Adjusted of age, family history of DM, rural or urban area, waist, body fat, total pack year, exercise, alcohol drinking, income, education, WBC, HDL-C, TG, ALT, hs-crp, systolic BP, HOMA-IR, HOMA-beta. Cho NH, et al. Clin Endocrinol (Oxf). 71(5):679-85, 2009

59 A prospective study of cigarette smoking and the incidence of DM 21,068 US male physicians aged 40 to 84 years in the Physicians' Health Study who were initially free of diagnosed DM, CVD, and cancer 12 years of follow-up Table. Association between Pack-Years of Cigarette Smoking and Risk of T2DM Manson JE, et al. Am J Med. 109(7):538-42,2000

60 Smoking, smoking cessation, and risk for type 2 diabetes mellitus 10,892 middle-aged adults who initially did not have diabetes in 1987 to Fig. 9 year adjusted HR ( ) for incident DM in 10,892 middle-aged adults, by years since quitting before baseline ( ). Fig. Adjusted HR for incident self-reported DM during 12 years in 10,406 middle-aged adults without diabetes at baseline and 3-year F/U. Yeh HC, et al. Ann Intern Med. 152(1):10-7, 2010

61 Cigarette smoking and risk for IFG and T2DM in middle-aged Japanese 1,266 Japanese men male office workers 35 to 59 years of age who did not have IFG or T2DM and were not taking medication for HTN at study entry. Table. Smoking Status and Risk for IFG and T2DM in the Study Sample. Nakanishi N, et al. Ann Intern Med. 133(3):183-91, 2000

62 Heavy smoking raises risk for type 2 diabetes mellitus in obese men; but, light smoking reduces the risk in lean men a follow-up study in 16,829 apparently healthy men 30 to 59 years of age. Fig. Multivariate-adjusted (for age, drinking, exercise, education) HR for incident DM in 16 groups according to smoking and quartiles of BMI (reference: neversmokers in Q1 of BMI). *, p <0.05; **, p <0.01; ***, p < Nagaya T, et al. Ann Epidemiol. 18(2):113-8, 2008

63 Alcohol consumption and higher incidence of IFG or T2DM in obese Korean men The annual health evaluation data of 2,500 male workers from 2002 to 2006, retrospectively Table. The adjusted RR for IFGor T2DMby alcohol intake during 4 years observation by tertileof waist, BMI, and adiponectin Table. The adjusted RR for IFGor T2DMby amount of alcohol intake according to BMI during 4 years Roh WG, et al. Alcohol. 43(8):643-8, 2009

64 Alcohol consumption and risk for IFG or T2DM in middle-aged Japanese 2,953 Japanese men male office workers aged years who did not have IFG, T2DM, HTN, or a history of CVA Table. Incidence rates per 1,000 person-years for IFG and T2DM according to alcohol intake among 2,953 Japanese male office workers during 7 years of follow-up. Multivariate-adjusted RR (95% CI) (p=0.016) Nakanishi N, et al. Diabetes Care. 26(1):48-54, 2003

65 Daily alcohol consumption and the risk of type 2 diabetes in Japanese 6,362 Japanese men men aged years who did not have DM, IFG, HTN, or LC at study entry. Data on alcohol consumption were obtained from questionnaires. Table. Relative risk of type 2 diabetes according to daily alcohol consumption Tsumura K, et al. Diabetes Care. 22(9):1432-7,1999

66 Alcohol consumption for self-reported diabetes among middleaged 12,913 Japanese men & 15,980 women, aged years, followed for up to 10 years. participated in the JPHC Study Cohort I. Table. Multivariate logistic regression analysis of the 10-year incidence of T2DM in middle-aged Japanese males according to BMI. *Alcohol intake (g/day of ethanol): ALC_1: 0 < ethanol 23.0 ALC_2: 23.0 < ethanol 46.0 ALC_3: ethanol > % CI, 95% confidence interval. Adjusted for age, BMI, cigarette smoking, exercise, family history of diabetes and prevalent hypertension. Waki K, et al. Diabet Med. 22(3):323-31, 2005

67 Inconsistent results J or U-shaped manner Ajani UA, et al. Arch Intern Med. 160(7): , 2000 Carlsson S, et al. Diabet Med. 17(11):776-81, 2000 Carlsson S, et al. Diabetes Care. 26(10): , 2003 Beulens JW, et al. Diabetes Care. 28(12):2933-8, 2005 Carlsson S, et al. Diabetologia. 48(6):1051-4, 2005 No differences in RR reductions according to BMI Koppes LL, et al. Diabetes Care. 28(3):719-25, 2005 Positive linear association Sung KC, Kim SH, Reaven GM. Diabetes Care. 30(10):2690-4, 2007 No association Waki K, et al. Diabet Med. 22(3):323-31, 2005

68 The association between adiponectin and diabetes in the Korean population 4,459 healthy Koreans aged 24 to 87 years Table. Multivariable-adjusted ORs for diabetes by tertile of waist, BMI, and adiponectin Men Women Model: adjusted for WC, BMI, adiponectin, age, smoking, hypertension, alcohol drinking, exercise, and HDL-C. Yoon SJ, et al. Metabolism. 57(6):853-7, 2008

69 Adiponectin levels and risk of type 2 diabetes Systematic review and meta-analysis 13 prospective studies with a total of 14,598 participants and 2,623 incident cases of T2DM ARIC (Duncan et al) Fig. Risk of T2DM According to categories of total adiponectin levels Fig. Relative risks per 1 Log μg/ml of adiponectin level and T2DM across studies Size of squares corresponds to the weight of each study in the meta-analysis. CI indicates confidence interval. Li S, et al. JAMA. 302(2):179-88, 2009

70 Fatty liver is an independent risk factor for T2DM in Korean adults 5,372 non-diabetic participants (3,670 men and 1,702 women; years), 5 yrs F/U Table. Risk factors of the incident T2DM in multiple logistic regression analysis *Model 1: adjusted for sex, age. Model 2: adjusted for the factors in Model 1 + F/H of DM, smoking, BP, FPG. Model 3: adjusted for the factors in Model 2 + BMI, serum ALT, HDL-C, TG. Table. Relative risks according to severity of fatty infiltration in liver after excluding frequent drinkers Kim CH, et al. Diabet Med. 25(4):476-81, 2008

71 Association of chronic hepatitis C virus infection and DM in Korean patients Prospective analysis of 404 patients with chronic viral hepatitis or liver cirrhosis Table. Prevalence of DM in patients with chronic hepatitis and liver cirrhosis Fig. Prevalence of DM according to the etiology of chronic liver disease in 3 age group Ryu JK, et al. Korean J Intern Med. 16(1):18-23, 2001

72 Algae consumption and risk of type 2 diabetes Analyzed data from the Korean National Health and Nutrition Examination Survey in ,405 males and females aged yrs. Table. Algae consumption and risk of abnormal glucose metabolism. Lee HJ, et al. J Nutr Sci Vitaminol (Tokyo). 56(1):13-8, 2010

73 GDM PCOS Persistent organic pollutants (POPs) Chronic arsenic poisoning Infections Oral contraceptives Uric acid WBC count Hematocrit C-reactive protein GGTP...

74 A practical tool to predict type 2 diabetes risk Table. Logistic regression models with drug-treated DM during F/U as the dependent variable Lindström J, Tuomilehto J. Diabetes Care. 26(3):725-31, 2003

75 A risk score for predicting incident diabetes Table. Diabetes risk score based on the simple model for DM incidence in the exploratory cohort Aekplakorn W, et al. Diabetes Care. ;29(8):1872-7, 2006

76 Diverse risk factors? Ethnic differences? : 대동소이 ( 大同小異, substantial identity with negligible differences) Is Korean a high risk population for type 2 diabetes? YES!!!?