2021 Clinical Practice Guidelines for Diabetes: Pharmacotherapy and the Korean Diabetes Association Support System

The most important change introduced in the pharmacotherapy session for the 2021 Clinical Practice Guidelines for Diabetes is the recommendation of two different strategies according to the patient’s condition. One approach is to optimize the blood glucose levels, while the other approach is to reduce adverse cardiovascular events or mortality, especially in patients with comorbidities (e.g., heart failure, atherosclerotic cardiovascular disease, or chronic kidney disease). We suggest four algorithms that take into account the patient’s condition (algorithms 1 to 4). The Korean Diabetes Association (KDA) developed a web-based clinical decision support system, known as the KDA support system (KDASS), which helps with the diagnosis of diabetes or gestational diabetes and whether to use glucose-lowering agents according to the patient’s condition.

The Effects of Snack Control Education and Telephone Coaching on Self-Management, Social Support, Self-Efficacy, and Blood Glucose in Diabetes Patients

Dietary therapy for diabetes is the most basic way to manage blood glucose. Currently, the nutritional intake rate of diabetic patients in Korea is beyond the recommended rate of the Korean Diabetes Association, showing large amounts of carbohydrates in foods consumed as snacks with an additional focus on sugar. Thus, it is necessary to support healthy dietary habits through snack control. This study is a random assignment experimental study with a total of 56 participants; 28 participants were in the control group, while the remaining 28 patients had type 2 diabetes and had visited Kyung Hee University Hospital. The experimental group with snack control education and telephone coaching exhibited a higher self-management score (t = –9.494, P < 0.001), perceived social support score (t = 7.201, P < 0.001), and self-efficacy score (t = 7.185, P < 0.001) than the control group. Additionally, the experimental group showed lower levels of glycosylated hemoglobin and average blood glucose compared to the control group (t = –4.820, P < 0.001). Thus, snack control education and telephone coaching are effective in improving diabetes self-management behavior, perceived social support, self-efficacy, and reducing glycosylated hemoglobin and average blood glucose. These results confirm the usefulness of snack education materials, and I suggest snack control education as a means of arbitration to improve the self-care of diabetics.

Nutrition Management in Diabetes Patients during COVID-19: The Role of Nutrients in Immunity

Diabetes patients are vulnerable to coronavirus disease 2019 (COVID-19) infection. Therefore, challenges arise concerning how to manage nutrition support to strengthen the immune system in diabetes patients. The purpose of this paper is to review the roles of macronutrients and specific micronutrients such as vitamin D, B12, folate, selenium, and zinc in supporting the immune system and examine the nutritional management method of diabetes patients during the COVID-19 pandemic. Evidence indicates that adequate amounts of protein, high omega-3 fatty acids, low refined sugars, high fiber content such as whole grains, and micronutrients including vitamin D, Bsub>12, folate, selenium, and zinc impact immune system function in diabetes patients. Consumption of a balanced diet with these nutrients is best to support the immune system in diabetes patients during the COVID-19 pandemic.

2021 Korean Diabetes Association Clinical Practice Guidelines for Diabetes: Diabetic Kidney Disease

Diabetic kidney disease is one of the most serious complications of type 2 diabetes and a leading cause of end-stage kidney disease. Recently, the Korean Diabetes Association released a new version of clinical practice guidelines including substantial changes in the management of diabetic kidney disease. Of note, sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists are now the preferred glucose-lowering agents for reduced glomerular filtration rate or albuminuria. Convincing evidence from cardiovascular or renal outcome trials supports the recommendation of those drugs. This review summarizes the results of recent clinical studies on diabetic kidney disease and explains new clinical recommendations based on them.

A Position Statement of the Utilization and Support Status of Continuous Glucose Monitoring in Korea

The accuracy and convenience of continuous glucose monitoring (CGM), which efficiently evaluates glycemic variability and hypoglycemia, are improving. There are two types of CGM: professional CGM and personal CGM. Personal CGM is subdivided into real-time CGM (rt-CGM) and intermittently scanned CGM (isCGM). CGM is being emphasized in both domestic and foreign diabetes management guidelines. Regardless of age or type of diabetes, CGM is useful for diabetic patients undergoing multiple insulin injection therapy or using an insulin pump. rt-CGM is recommended for all adults with type 1 diabetes (T1D), and can also be used in type 2 diabetes (T2D) treatments using multiple insulin injections. In some cases, short-term or intermittent use of CGM may be helpful for patients with T2D who use insulin therapy other than multiple insulin injections and/or oral hypoglycemic agents. CGM can help to achieve A1C targets in diabetes patients during pregnancy. CGM is a safe and cost-effective alternative to self-monitoring blood glucose in T1D and some T2D patients. CGM used in diabetes management works optimally with proper education, training, and follow up. To achieve the activation of CGM and its associated benefits, it is necessary to secure sufficient repetitive training and time for data analysis, management, and education. Various supports such as compensation, insurance coverage expansion, and reimbursement are required to increase the effectiveness of CGM while considering the scale of benefit recipients, policy priorities, and financial requirements.

Body Composition and Diabetes

Representative body composition related to metabolic diseases in our body include fats and muscles, and accumulation of abdominal fats and loss of muscles caused by aging are the main causes of type 2 diabetes mellitus. Such changes in body composition vary according to sex and age; in particular, women exhibit significant changes, especially during menopause. Therefore it is necessary to determine new anthropometric indicators that reflect differences in muscles and fats mass changes caused by aging, as well as their distributions, and to establish diagnostic criteria for stratifying the risks of metabolic diseases in both men and women. This article summarizes the underlying mechanisms and recent epidemiological findings that support how muscles decrease and visceral fats increase the risk of type 2 diabetes mellitus.

Diabetes and COVID-19 Vaccination

Diabetes is one of the major comorbidities associated with increased risk of mortality and severe clinical outcomes in coronavirus disease 19 (COVID-19) patients. Thus, timely and appropriate vaccination is the most effective strategy for mitigating the risk of COVID-19 infection in people with diabetes. Recent studies have shown that immune response after vaccination is significant in both diabetes and non-diabetes groups, but slightly lower in patients with diabetes. Inadequate glucose control might impair the immune response. Blood glucose monitoring is required more often than usual for several days after vaccination. If a patient’s blood glucose is not controlled adequately, appropriate management should be provided.

2021 Clinical Practice Guidelines for Diabetes Mellitus in Korea

The Committee of Clinical Practice Guidelines of the Korean Diabetes Association (KDA) updated the previous clinical practice guidelines for Korean adults with diabetes and prediabetes and published the seventh edition in May 2021. We performed a comprehensive systematic review of recent clinical trials and evidence from real-world practice among the Korean population. The guidelines are intended for use at sites across the country by all healthcare providers (including physicians, diabetes experts, and certified diabetes educators) who treat diabetes. The recommendations for screening and antihyperglycemic agents have been revised and updated. Continuous glucose monitoring with insulin pump use and screening and treatment for non-alcoholic fatty liver disease were added in the type 2 diabetes sections. The KDA recommends active vaccination for COVID-19 in patients with diabetes. An abridgement that contains practical information for patient education and systematic clinic management was published separately.

2021 Clinical Practice Guidelines for Diabetes: Management of Cardiovascular Risk

The Committee of Clinical Practice Guidelines of the Korean Diabetes Association revised and updated the 7th Clinical Practice Guidelines in 2021. Intense multifactorial intervention including adequate control of glycemia, blood pressure, and low density lipoprotein cholesterol level and use of antiplatelet agents has been shown to reduce cardiovascular risk among patients with type 2 diabetes mellitus. In these recent guidelines, sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors) and glucagon-like peptide 1 receptor agonists (GLP-1 RAs) with proven benefits were recommended in patients with heart failure and/or atherosclerotic cardiovascular disease (ASCVD) as mono- or combination therapy. SGLT2 inhibitors such as dapagliflozin, empagliflozin, and ertugliflozin were recommended preferentially in patients with heart failure. In those with ASCVD, treatment including SGLT2 inhibitors such as empagliflozin and dapagliflozin or GLP-1 RAs such as dulaglutide, liraglutide, and semaglutide as a combination therapy was recommended.

Interventional Strategies Based on the Types of Family Characteristics for the Diabetes Educator

Family roles are important consideration in diabetes management. The various psychosocial contexts within families, especially those with a member with diabetes, are very complex and play a key role in comprehensive care. It is important that all diabetes educators are aware of such family characteristics when designing an intervention. Diabetes educators are required to understand diverse types of family characteristics and should be well trained regarding such roles to support families with a diabetic member.