2023 Clinical Practice Guidelines for Diabetes Management in Korea: Full Version Recommendation of the Korean Diabetes Association

doi:10.4093/dmj.2024.0249

Practice Guideline

. 2024 Jul;48(4):546-708.

doi: 10.4093/dmj.2024.0249. Epub 2024 Jul 26.

2023 Clinical Practice Guidelines for Diabetes Management in Korea: Full Version Recommendation of the Korean Diabetes Association

Jun Sung Moon¹, Shinae Kang², Jong Han Choi³, Kyung Ae Lee⁴, Joon Ho Moon⁵, Suk Chon⁶, Dae Jung Kim⁷, Hyun Jin Kim⁸, Ji A Seo⁹, Mee Kyoung Kim¹⁰, Jeong Hyun Lim¹¹, Yoon Ju Song¹², Ye Seul Yang¹³, Jae Hyeon Kim¹⁴, You-Bin Lee¹⁴, Junghyun Noh¹⁵, Kyu Yeon Hur¹⁴, Jong Suk Park², Sang Youl Rhee⁶, Hae Jin Kim⁷, Hyun Min Kim¹⁶, Jung Hae Ko¹⁷, Nam Hoon Kim¹⁸, Chong Hwa Kim¹⁹, Jeeyun Ahn²⁰, Tae Jung Oh⁵, Soo-Kyung Kim²¹, Jaehyun Kim²², Eugene Han²³, Sang-Man Jin¹⁴, Jaehyun Bae²⁴, Eonju Jeon²⁵, Ji Min Kim²⁶, Seon Mee Kang²⁷, Jung Hwan Park²⁸, Jae-Seung Yun²⁹, Bong-Soo Cha³⁰, Min Kyong Moon³¹, Byung-Wan Lee³⁰

Affiliations

¹ Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.
² Division of Endocrinology and Metabolism, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
³ Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
⁴ Division of Endocrinology and Metabolism, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea.
⁵ Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
⁶ Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea.
⁷ Department of Endocrinology and Metabolism, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea.
⁸ Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
⁹ Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
¹⁰ Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
¹¹ Department of Food Service and Nutrition Care, Seoul National University Hospital, Seoul, Korea.
¹² Department of Food Science and Nutrition, The Catholic University of Korea, Bucheon, Korea.
¹³ Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
¹⁴ Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
¹⁵ Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
¹⁶ Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
¹⁷ Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
¹⁸ Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
¹⁹ Division of Endocrinology and Metabolism, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea.
²⁰ Department of Ophthalmology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
²¹ Division of Endocrinology and Metabolism, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
²² Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
²³ Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.
²⁴ Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea.
²⁵ Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea.
²⁶ Division of Endocrinology and Metabolism, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea.
²⁷ Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea.
²⁸ Division of Endocrinology & Metabolism, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
²⁹ Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
³⁰ Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
³¹ Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.

PMID: 39091005
PMCID: PMC11307112
DOI: 10.4093/dmj.2024.0249

Practice Guideline

2023 Clinical Practice Guidelines for Diabetes Management in Korea: Full Version Recommendation of the Korean Diabetes Association

Jun Sung Moon et al. Diabetes Metab J. 2024 Jul.

. 2024 Jul;48(4):546-708.

doi: 10.4093/dmj.2024.0249. Epub 2024 Jul 26.

Authors

Affiliations

¹ Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.
² Division of Endocrinology and Metabolism, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
³ Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
⁴ Division of Endocrinology and Metabolism, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea.
⁵ Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
⁶ Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea.
⁷ Department of Endocrinology and Metabolism, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea.
⁸ Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
⁹ Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
¹⁰ Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
¹¹ Department of Food Service and Nutrition Care, Seoul National University Hospital, Seoul, Korea.
¹² Department of Food Science and Nutrition, The Catholic University of Korea, Bucheon, Korea.
¹³ Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
¹⁴ Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
¹⁵ Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
¹⁶ Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
¹⁷ Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
¹⁸ Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
¹⁹ Division of Endocrinology and Metabolism, Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea.
²⁰ Department of Ophthalmology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
²¹ Division of Endocrinology and Metabolism, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
²² Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
²³ Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.
²⁴ Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea.
²⁵ Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea.
²⁶ Division of Endocrinology and Metabolism, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea.
²⁷ Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea.
²⁸ Division of Endocrinology & Metabolism, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
²⁹ Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
³⁰ Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
³¹ Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.

PMID: 39091005
PMCID: PMC11307112
DOI: 10.4093/dmj.2024.0249

No abstract available

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Conflict of interest statement

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

Figures

**Fig. 1.**
Number of people who should be screened for diabetes by age group [38]. NNS, number need to screen; NHIS-NSC, National Health Insurance Service-National Sample Cohort; KNHANES, Korea National Health and Nutrition Examination Survey.

**Fig. 2.**
Pharmacotherapy of type 2 diabetes mellitus algorithm. Implement and monitor diabetes self-management education immediately upon diagnosis. Prioritize treatment, including insulin, for severe symptomatic hyperglycemia. If comorbid atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), or chronic kidney disease (CKD) is present, prioritize sodium-glucose cotransporter-2 inhibitor (SGLT2i) or glucagon-like peptide-1 receptor agonist (GLP-1RA), whichever has demonstrated clinical benefit for each condition. In the absence of these conditions, metformin monotherapy is common, but other members of the class may be used based on patient condition and drug characteristics. If glycemic goals are not achieved with monotherapy, combination therapy with other classes of drugs may be considered based on drug characteristics. Patients with comorbid ASCVD, HF, or CKD who are using an SGLT2i or GLP-1RA may be added to metformin, with preference given to drugs from other classes that have demonstrated clinical benefit for each condition. Combination therapy may be initiated earlier in the course of diagnosis to reduce the risk of glycemic control failure, with early combination therapy strongly considered, especially if glycosylated hemoglobin (HbA1c) is greater than 7.5% or greater than 1.5% above target. If glycemic goals are not achieved with a combination of oral hypoglycemic agents, GLP-1RAs or basal insulin should be considered first, and a combination of GLP-1RAs or basal insulin, or insulin intensification, may be used to improve glycemic control. (1) A history of an acute coronary syndrome or myocardial infarction, stable or unstable angina, coronary heart disease with or without revascularization, other arterial revascularization, stroke, or peripheral artery disease assumed to be atherosclerotic in origin; (2) Current or prior symptoms of HF with documented HF with reduced ejection fraction (left ventricular ejection fraction [LVEF] ≤40) or HF with preserved ejection fraction (LVEF >40); (3) Estimated glomerular filtration rate <60 mL/min/1.73 m² or urine albumin-creatinine ratio ≥30 mg/g; (4) Dulaglutide, liraglutide, semaglutide; (5) Dapagliflozin, empagliflozin; (6) Dapagliflozin, empagliflozin, ertugliflozin; (7) Pioglitazone. ASCVD, atherosclerotic cardiovascular disease; TZD, thiazolidinedione; DPP-4i, dipeptidyl peptidase-4 inhibitor; SU, sulfonylurea; α-GI, α-glucosidase inhibitors; OAD, oral antidiabetic drug.

**Fig. 3.**
Hypertension management. BP, blood pressure; ACE, angiotensin-converting enzyme; ARB, angiotensin II receptor blocker.

**Fig. 4.**
Lipid management of diabetes. LDL, low-density lipoprotein; HDL, high-density lipoprotein; CVD, cardiovascular disease; PCSK9, proprotein convertase subtilisin/kexin 9.

**Fig. 5.**
Follow-up and care of pregnant women with diabetes. GDM, gestational diabetes mellitus.

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References

1. Oh JY, Lim S, Kim DJ, Kim NH, Kim DJ, Moon SD, et al. The diagnosis of diabetes mellitus in Korea: a pooled analysis of four community-based cohort studies. Diabet Med. 2007;24:217–8. - PubMed
1. Oh JY, Lim S, Kim DJ, Kim NH, Kim DJ, Moon SD, et al. A report on the diagnosis of intermediate hyperglycemia in Korea: a pooled analysis of four community-based cohort studies. Diabetes Res Clin Pract. 2008;80:463–8. - PubMed
1. American Diabetes Association Standards of medical care in diabetes: 2010. Diabetes Care. 2010;33 Suppl 1:S11–61. - PMC - PubMed
1. International Diabetes Federation Clinical Guidelines Task Force . Global guideline for type 2 diabetes. Brussels: International Diabetes Federation; 2005.
1. World Health Organization Regional Office for the Western Pacific . Type 2 diabetes: practical targets and treatments. 4th ed. Melbourne: International Diabetes Institute; 2005.

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[1] Oh JY, Lim S, Kim DJ, Kim NH, Kim DJ, Moon SD, et al. The diagnosis of diabetes mellitus in Korea: a pooled analysis of four community-based cohort studies. Diabet Med. 2007;24:217–8. - PubMed

[2] Oh JY, Lim S, Kim DJ, Kim NH, Kim DJ, Moon SD, et al. The diagnosis of diabetes mellitus in Korea: a pooled analysis of four community-based cohort studies. Diabet Med. 2007;24:217–8. - PubMed

[3] Oh JY, Lim S, Kim DJ, Kim NH, Kim DJ, Moon SD, et al. A report on the diagnosis of intermediate hyperglycemia in Korea: a pooled analysis of four community-based cohort studies. Diabetes Res Clin Pract. 2008;80:463–8. - PubMed

[4] Oh JY, Lim S, Kim DJ, Kim NH, Kim DJ, Moon SD, et al. A report on the diagnosis of intermediate hyperglycemia in Korea: a pooled analysis of four community-based cohort studies. Diabetes Res Clin Pract. 2008;80:463–8. - PubMed

[5] American Diabetes Association Standards of medical care in diabetes: 2010. Diabetes Care. 2010;33 Suppl 1:S11–61. - PMC - PubMed

[6] American Diabetes Association Standards of medical care in diabetes: 2010. Diabetes Care. 2010;33 Suppl 1:S11–61. - PMC - PubMed

[7] International Diabetes Federation Clinical Guidelines Task Force . Global guideline for type 2 diabetes. Brussels: International Diabetes Federation; 2005.

[8] International Diabetes Federation Clinical Guidelines Task Force . Global guideline for type 2 diabetes. Brussels: International Diabetes Federation; 2005.

[9] World Health Organization Regional Office for the Western Pacific . Type 2 diabetes: practical targets and treatments. 4th ed. Melbourne: International Diabetes Institute; 2005.

[10] World Health Organization Regional Office for the Western Pacific . Type 2 diabetes: practical targets and treatments. 4th ed. Melbourne: International Diabetes Institute; 2005.

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2023 Clinical Practice Guidelines for Diabetes Management in Korea: Full Version Recommendation of the Korean Diabetes Association

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2023 Clinical Practice Guidelines for Diabetes Management in Korea: Full Version Recommendation of the Korean Diabetes Association

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