Endocrinology and Metabolism

Original Article

Fibrate-Statin Combination Therapy and Change of Hepatic Steatosis-Related Indices in Patients with Dyslipidemia: A Retrospective Study Using Korean National Health Insurance Data: Jong Han Choi, Bongseong Kim, Kyungdo Han, Dong-Lim Kim, Suk Kyeong Kim, Keeho Song; Received January 6, 2026 Accepted March 25, 2026 Published online July 7, 2026; DOI: https://doi.org/10.3803/EnM.2026.2891 [Epub ahead of print]

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Abstract PDF Supplementary Material PubReader ePub: Background
The role of fibrates in modifying hepatic steatosis-related outcomes remains uncertain, particularly in real-world populations receiving statin therapy for dyslipidemia. We investigated the association between fibrate use and longitudinal changes in hepatic steatosis-related indices in statin-treated patients with moderate hypertriglyceridemia using nationwide health screening data.
Methods
We analyzed data from 307,992 adults with triglyceride level of 150–500 mg/dL receiving statin therapy, identified from the Korean National Health Insurance Service database. Participants were classified according to fibrate exposure (users vs. non-users). Hepatic steatosis was operationally assessed using two validated surrogate indices, the fatty liver index (FLI) and the hepatic steatosis index (HSI), measured at baseline and follow-up health checkups. Propensity score matching was performed to balance baseline characteristics. Subgroup analyses were conducted according to medication possession ratio (MPR <0.8 vs. ≥0.8).
Results
In propensity score-matched analyses, fibrate use was associated with lower odds of hepatic steatosis as defined by FLI (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.84 to 0.95) and HSI (OR, 0.82; 95% CI, 0.78 to 0.87). Among participants with high medication adherence (MPR ≥0.8), stronger associations were observed (FLI OR, 0.30; HSI OR, 0.34).
Conclusion
In this large nationwide cohort, fibrate use in statin-treated patients with moderate hypertriglyceridemia was associated with lower prevalence of hepatic steatosis-related indices, particularly among individuals with high medication adherence. These findings should be interpreted as associations based on surrogate markers rather than definitive evidence of histologic improvement. Further studies incorporating imaging or histological endpoints are warranted to clarify the role of fibrates in the management of metabolic dysfunction-associated steatotic liver disease.

Review Articles

Diabetes, obesity and metabolism
Contemporary Type 2 Diabetes Guidelines: Converging Evidence, Diverging Strategies, and the Position of the Korean Diabetes Association Framework: Suk Kyeong Kim, Dong-Lim Kim, Keeho Song, Shinae Kang, Byung-Wan Lee, Jong Han Choi; Endocrinol Metab. 2026;41(3):351-357. Published online June 16, 2026; DOI: https://doi.org/10.3803/EnM.2026.3080

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Abstract PDF PubReader ePub: The pharmacological management of type 2 diabetes mellitus has changed markedly over the past decade, largely in response to evidence generated by cardiovascular and renal outcome trials. Although contemporary guidelines are informed by a broadly shared evidence base, they differ in how they organize treatment concepts and translate evidence into clinical algorithms. This review compares major diabetes guidelines from the American Diabetes Association (ADA), the National Institute for Health and Care Excellence (NICE), the Japan Diabetes Society (JDS), and the Korean Diabetes Association (KDA), with particular attention to pharmacological algorithms, comorbidity-driven treatment strategies, and the conceptual principles underlying each framework. The ADA guideline uses a person-centered, risk-based approach that prioritizes sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists for patients with cardiorenal disease. The NICE guideline applies a more structured strategy, recommending early dual or triple therapy within a cost-effectiveness framework. The JDS guideline emphasizes pathophysiology-based treatment selection tailored to East Asian populations. The KDA guideline retains a glycemia-centered treatment structure while incorporating comorbidity-based decision-making and allowing early, flexible combination therapy. Thus, despite substantial convergence in the evidence base, these guidelines differ in how cardiovascular risk, glycemic control, and pathophysiological heterogeneity are incorporated into treatment decisions. The KDA framework can be viewed as a pragmatic hybrid model that integrates these dimensions and is further extended by recent consensus efforts addressing disease severity and pathophysiology.

Diabetes, Obesity and Metabolism
Renal Protection of Mineralocorticoid Receptor Antagonist, Finerenone, in Diabetic Kidney Disease: Dong-Lim Kim, Seung-Eun Lee, Nan Hee Kim; Endocrinol Metab. 2023;38(1):43-55. Published online February 27, 2023; DOI: https://doi.org/10.3803/EnM.2022.1629

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Chronic kidney disease (CKD) is the most common cause of end-stage renal disease in patients with type 2 diabetes mellitus (T2DM). CKD increases the risk of cardiovascular diseases; therefore, its prevention and treatment are important. The prevention of diabetic kidney disease (DKD) can be achieved through intensive glycemic control and blood pressure management. Additionally, DKD treatment aims to reduce albuminuria and improve kidney function. In patients with T2DM, renin-angiotensin-aldosterone system inhibitors, sodium glucose cotransporter 2 inhibitors, and glucagon-like peptide-1 receptor agonists can delay the progression of DKD. Hence, there is a need for novel treatments that can effectively suppress DKD progression. Finerenone is a first-in-class nonsteroidal mineralocorticoid receptor antagonist with clinically proven efficacy in improving albuminuria, estimated glomerular filtration rate, and risk of cardiovascular events in early and advanced DKD. Therefore, finerenone is a promising treatment option to delay DKD progression. This article reviews the mechanism of renal effects and major clinical outcomes of finerenone in DKD.

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Original Articles

Clinical Study
Impaired Cortisol and Growth Hormone Counterregulatory Responses among Severe Hypoglycemic Patients with Type 2 Diabetes Mellitus: Young A Rhyu, Ju-Young Jang, Sooyoun Park, Jee Hyun An, Dong-Lim Kim, Suk Kyeong Kim, Kee-Ho Song; Endocrinol Metab. 2019;34(2):187-194. Published online June 24, 2019; DOI: https://doi.org/10.3803/EnM.2019.34.2.187

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Background

Elevated levels of cortisol and growth hormone are critical counterregulatory responses to severe hypoglycemia. However, the proportion and clinical characteristics of patients with type 2 diabetes mellitus (DM) who fail to show appropriate cortisol and/or growth hormone secretion in response to severe hypoglycemia have not been investigated.

Methods

We measured plasma cortisol and growth hormone levels in type 2 DM patients with severe hypoglycemia who visited the emergency department between 2006 and 2015.

Results

Of 112 hypoglycemic patients, 23 (20.5%) had an impaired cortisol response (<18 µg/dL) and 82 patients (73.2%) had an impaired growth hormone response (<5 ng/mL). Nineteen patients (17.0%) had impaired responses to both cortisol and growth hormone. The patients with impaired responses of cortisol, growth hormone, and both hormones were significantly older and more likely to be female, and had higher admission rates, lower growth hormone levels, and lower adrenocorticotropic hormone levels than the patients with a normal hormonal response. Multivariate logistic regression analysis indicated that an impaired growth hormone response was significantly associated with advanced age, shorter DM duration, a higher admission rate, and a higher body mass index (BMI). An impaired cortisol response was significantly associated with growth hormone levels. Patients with an impaired growth hormone response had higher admission rates than patients with a normal response.

Conclusion

A considerable number of type 2 DM patients had impaired cortisol and/or growth hormone responses to severe hypoglycemia. Advanced age, shorter DM duration, and higher BMI were independently associated with an abnormal growth hormone response.

Citations

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Effects of Vildagliptin or Pioglitazone on Glycemic Variability and Oxidative Stress in Patients with Type 2 Diabetes Inadequately Controlled with Metformin Monotherapy: A 16-Week, Randomised, Open Label, Pilot Study: Nam Hoon Kim, Dong-Lim Kim, Kyeong Jin Kim, Nan Hee Kim, Kyung Mook Choi, Sei Hyun Baik, Sin Gon Kim; Endocrinol Metab. 2017;32(2):241-247. Published online June 23, 2017; DOI: https://doi.org/10.3803/EnM.2017.32.2.241

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Abstract PDF PubReader

Background

Glycemic variability is associated with the development of diabetic complications through the activation of oxidative stress. This study aimed to evaluate the effects of a dipeptidyl peptidase 4 inhibitor, vildagliptin, or a thiazolidinedione, pioglitazone, on glycemic variability and oxidative stress in patients with type 2 diabetes.

Methods

In this open label, randomised, active-controlled, pilot trial, individuals who were inadequately controlled with metformin monotherapy were assigned to either vildagliptin (50 mg twice daily, n=17) or pioglitazone (15 mg once daily, n=14) treatment groups for 16 weeks. Glycemic variability was assessed by calculating the mean amplitude of glycemic excursions (MAGE), which was obtained from continuous glucose monitoring. Urinary 8-iso prostaglandin F₂α, serum oxidised low density lipoprotein, and high-sensitivity C-reactive protein were used as markers of oxidative stress or inflammation.

Results

Both vildagliptin and pioglitazone significantly reduced glycated hemoglobin and mean plasma glucose levels during the 16-week treatment. Vildagliptin also significantly reduced the MAGE (from 93.8±38.0 to 70.8±19.2 mg/dL, P=0.046), and mean standard deviation of 24 hours glucose (from 38±17.3 to 27.7±6.9, P=0.026); however, pioglitazone did not, although the magnitude of decline was similar in both groups. Markers of oxidative stress or inflammation including urinary 8-iso prostaglandin F₂α did not change after treatment in both groups.

Conclusion

In this 16-week treatment trial, vildagliptin, but not pioglitazone, reduced glycemic variability in individuals with type 2 diabetes who was inadequately controlled with metformin monotherapy, although a reduction of oxidative stress markers was not observed.

Citations

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