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Diabetes and Obesity

Fact Sheet in Korea

Diabetes is a major health problem and leads to multiple complications in almost all parts of the body. It causes significant morbidity and mortality in Korea. According to the Diabetes Fact Sheet in Korea, the prevalence of diabetes was 13.7% in those aged 30 years or older in 2016, indicating that approximately 1 out of 7 adults have diabetes. In addition, nearly 1 out of 4 adults are diagnosed as prediabetes. In particular, those aged over 50 years belong to the fastest growing segment of the population diagnosed with type 2 diabetes (T2D). Korea shows a low prevalence (48.6%) of obese diabetic individuals (based on a BMI ≥ 25) when compared with Western countries (about 85%).

Nonetheless, the number of obese diabetic individuals is rapidly increasing. Additionally, other factors are assumed to be involved in this growing epidemic, such as a remarkable increase in unhealthy lifestyles, excessive alcohol consumption, smoking, and physical inactivity.

Obesity is recognized as a strong risk factor of chronic diseases including diabetes and CVDs.
According to the Korea National Health and Nutrition Examination Survey and the National Health Insurance Service, the prevalence of obesity in those aged 19 or older in 2013 was 31.8%, and medical costs exceeded USD 6.77 billion. The consequent burden of chronic diseases is increasing markedly and is expected to increase further in the future. Therefore, the government needs to prepare and provide scientific evidence-based standard guidelines or protocols to effectively control and manage obesity.

The multi-omics and functional studies on obese and diabetes

Through epidemiological and multi-omics studies, which are based on combined analyses of targeted genotypes, metabolites, and metagenome profiles, we have attempted to identify some specific biomarkers for “early” detection of obesity and related metabolic diseases. Because childhood obesity is strongly related to future insulin resistance and the metabolic syndrome, identification of early detection biomarkers of obesity-related disorders is essential to control future metabolic diseases.

We have worked to provide scientific evidence for the prevention and management of diabetes through multi-omics and functional studies on obese and high-risk groups of diabetes. To unravel metabolic determinants of insulin resistance, we performed a targeted metabolomics analysis in the Korean Children-Adolescent Cohort Study (KoCAS, n = 430). Sixty-seven metabolites were associated with insulin resistance in adolescents, and the association was also found in an adult population (KoGES, n = 2,485). Asymmetric dimethylarginine (ADMA) levels showed a higher association with adolescent obesity (P < 0.001) and adult diabetes (P = 0.007) and, consistently, these levels decreased after obesity intervention (Table)

Table. Association of the asymmetric dimethylarginine (ADMA) level with obesity and diabetes

Study sample Cases,N OR (95% CI) P-value
KoCAS Weight status
Normal weight 171 1
Overweight or Obesity 98 1.67 (0.64–4.33) 0.293
Severe Obesity 161 6.48 (2.44–17.24) <0.001
KoGES Diabetes status
Normal 989 1
Prediabetes 975 1.27 (0.99–1.62) 0.058
Diabetes 517 1.56 (1.13–2.16) 0.007
Functional studies in cellular and mouse models demonstrated that an accumulation of ADMA is associated with the regulation of obesity-induced insulin resistance in skeletal muscle (Fig. 4). This study raises the possibility of ADMA as a new therapeutic target for functional and clinical control of energy and metabolic homeostasis in humans.