Background: The aim of this study was to evaluate clinical outcomes in coronavirus disease 2019 (COVID-19) positive patients with type 2 diabetes compared to those without diabetes in Korea.Methods: We extracted claims data for patients diagnosed with COVID-19 from the National Health Insurance Service database in Korea from January 20, 2020 to March 31, 2020. We followed up this cohort until death from COVID-19 or discharge from hospital.Results: A total of 5,473 patients diagnosed with COVID-19 were analyzed, including 495 with type 2 diabetes and 4,978 without diabetes. Patients with type 2 diabetes were more likely to be treated in the intensive care unit (ICU) (P<0.0001). The incidence of inhospital mortality was higher in patients with type 2 diabetes (P<0.0001). After adjustment for age, sex, insurance status, and comorbidities, odds of ICU admission (adjusted odds ratio [OR], 1.59; 95% confidence interval [CI], 1.02 to 2.49; P=0.0416) and in-hospital mortality (adjusted OR, 1.90; 95% CI, 1.13 to 3.21; P=0.0161) among patients with COVID-19 infection were significantly higher in those with type 2 diabetes. However, there was no significant difference between patients with and without type 2 diabetes in ventilator, oxygen therapy, antibiotics, antiviral drugs, antipyretics, and the incidence of pneumonia after adjustment.Conclusion: COVID-19 positive patients with type 2 diabetes had poorer clinical outcomes with higher risk of ICU admission and in-hospital mortality than those without diabetes. Therefore, medical providers need to consider this more serious clinical course when planning and delivering care to type 2 diabetes patients with COVID-19 infection.

Hyperglycemic crisis is a metabolic emergency associated with diabetes mellitus. However, accurate epidemiologic information on cases of hyperglycemic crisis in Korea remains scarce. We evaluated trends in hyperglycemic crisis hospitalizations and in- and out-of-hospital mortality in Korea. We also predicted future trends. We extracted claims data with hyperglycemic crisis as the principal diagnosis from the National Health Insurance Service database in Korea from January 2004 to December 2013. We investigated the numbers of claims with hyperglycemic crisis and identified trends in hyperglycemic crisis based on those claims data. We predicted future trends by statistical estimation. The total annual number of claims of hyperglycemic crisis increased from 2,674 in 2004 to 5,540 in 2013. Statistical analysis revealed an increasing trend in hyperglycemic crisis hospitalizations (P for trend <0.01). In contrast, the hospitalization rate per 1,000 diabetes cases showed a decreasing trend (P for trend <0.01) during this period. The mortality rate per 1,000 diabetes cases also showed a decreasing trend (P for trend <0.0001). However, no distinct linear trend in the case-related fatality rate at <60 days over the last decade was observed. The predicted number of annual claims of hyperglycemic crisis will increase by 2030. The number of hyperglycemic crisis hospitalizations in Korea increased in the last decade, although the hospitalization rate per 1,000 diabetes cases and mortality rate decreased. Also, the predicted number of annual claims will increase in the future. Thus, it is necessary to establish long-term healthcare policies to prevent hyperglycemic crisis.

Background: Type 2 diabetes mellitus (T2DM) is a progressive metabolic disease. Early detection of prediabetes is important to reduce the risk of T2DM. Some cytokines are known to be associated with T2DM. Therefore, we aimed to identify cytokines as novel biomarkers of glucose dysmetabolism. Methods: The fast stage of the study included 43 subjects (13 subjects with newly diagnosed T2DM, 13 with prediabetes. and 16 with normoglycemia) for cytokine microarray analysis. Blood samples of the subjects were assessed for 310 cytokines to identify potential indicators of prediabetes. The second stage included 142 subjects (36 subjects with T2DM, 35 with prediabetes, and 71 with normoglycemia) to validate the potential cytokines associated with prediabetes. Results: We identified 41 cytokines that differed by 1.5-fold or more in at least one out of the three comparisons (normoglycemia vs. prediabetes, normoglycemia vs. T2DM, and prediabetes vs. T2DM) among 310 cytokines. Finally, we selected protein Z (PROZ) and validated this finding to determine its association with prediabetes. Plasma PROZ levels were found to be decreased in patients with prediabetes (1,490.32 +/- 367.19 pg/mL) and T2DM (1,583.34 +/- 465.43 pg/mL) compared to those in subjects with normoglycemia (1,864.07 +/- 450.83 pg/mL) (P<0.001). There were significantly negative correlations between PROZ and fasting plasma glucose (P =0.001) and hemoglobin Alc (P=0.010). Conclusion: PROZ levels were associated with prediabetes and T2DM. We suggest that PROZ may be a promising biomarker for the early detection of prediabetes. Further large-scale studies are needed to evaluate the relationship and mechanism between PROZ and prediabetes and T2DM.

Background/Objectives: Diabetic nephropathy is the leading cause of end-stage kidney disease (ESKD) worldwide. ESKD individuals with type 2 diabetes are known to have poor prognosis of survival. We aimed to investigate whether the recent mortality trends of ESKD individuals treated with hemodialysis with or without type 2 diabetes have changed in South Korea. Methods: We used a cohort of 3,394,502 deceased people from the Korean National Health Insurance Service claims database from 2006 to 2018. We requested the National Statistical Information Service database to link the records about their cause of death. We collected a total of 79,792 deaths among individuals with ESKD receiving hemodialysis, including 31,907 with type 2 diabetes and 47,885 without type 2 diabetes. Results: The mean age at death significantly increased over the study period among individuals with ESKD receiving hemodialysis, both with and without type 2 diabetes (p < 0.001). However, the mean age at death was consistently lower in those with type 2 diabetes compared to those without diabetes in both men and women. Type 2 diabetes was significantly associated with younger age at death in individuals undergoing hemodialysis (β = −0.012, p < 0.0001). The age-standardized mortality rate remained higher in those with type 2 diabetes throughout the study period. Conclusions: This nationwide study revealed that Korean individuals with type 2 diabetes undergoing hemodialysis had a consistently lower age at death and higher age-standardized mortality than those without type 2 diabetes. Although the mean age at death increased in both groups, individuals undergoing hemodialysis with type 2 diabetes continued to show poorer survival outcomes. These findings highlight the need for targeted clinical approaches to improve survival in this high-risk population.