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 Article

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.

Original Article

Diabetes, obesity and metabolism
Current Status of Delay in Injectable Therapy among Type 2 Diabetes Mellitus Patients in South Korea: Multicenter Retrospective Study (2015–2021): Jong Han Choi, Min Kyong Moon, Hae Jin Kim, Kyung Ae Lee, Hyun Jin Kim, Jung Hae Ko, Jae-Seung Yun, Seung-Hyun Ko, Suk Chon, Nam Hoon Kim; Endocrinol Metab. 2025;40(5):727-736. Published online May 29, 2025; DOI: https://doi.org/10.3803/EnM.2024.2280

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Background
We aimed to assess the therapeutic inertia associated with injectable therapies and the factors influencing glycemic control following these therapies in patients with type 2 diabetes mellitus (T2DM) in South Korea.
Methods
This multicenter, retrospective cohort study included 2,598 T2DM patients aged 20 to 75 years from 10 referral medical centers in South Korea. These patients had been treated with three or four oral antidiabetic drugs (OADs) and were subsequently initiated on insulin (n=1,942) or glucagon-like peptide-1 receptor agonists (GLP-1RAs, n=656) between January 2015 and December 2021. We analyzed the time to initiation of injectable therapy, changes in glycated hemoglobin (HbA1c), and associations between clinical factors and glycemic control.
Results
At the time of injectable therapy initiation, the mean HbA1c was 9.54%, with insulin users having a higher HbA1c level (9.79%) than GLP-1RA users (8.70%). The mean time from starting 3 or 4 OADs to initiating injectable therapy was 3.19 years: 53.5% of patients had started injectable therapy after 2 years, and 24.2% started after 5 years. Among insulin users, older age (P= 0.004), higher body mass index (P=0.035), and lower HbA1c levels at insulin initiation (P<0.001) were associated with better glycemic control. Among GLP-1RA users, only the HbA1c level at therapy initiation (P<0.001) was a significant factor.
Conclusion
This study highlighted significant delays in initiating injectable therapies, particularly insulin, in T2DM patients in South Korea. Early initiation of injectable therapy may improve long-term glycemic control in these patients.

Citations

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Bridging Evidence and Practice: A Consensus Statement from the Korean Diabetes Association on Diabetes Screening, Pharmacological Treatment and Severe Diabetes
Jong Han Choi, Shinae Kang, Soo-Kyung Kim, Won Jun Kim, Ji Min Kim, Jaehyun Bae, Jae-Seung Yun, Eonju Jeon, Young-Eun Kim, Jae Hyun Bae, Hun Jee Choe, Young Min Cho, Seung-Hyun Ko, Sang Yong Kim, Hae Jin Kim, You-Cheol Hwang, Min Kyong Moon, Suk Chon, Seo
Diabetes & Metabolism Journal.2025; 49(6): 1155. CrossRef

Special Article

Adrenal gland
2023 Korean Endocrine Society Consensus Guidelines for the Diagnosis and Management of Primary Aldosteronism: Jeonghoon Ha, Jung Hwan Park, Kyoung Jin Kim, Jung Hee Kim, Kyong Yeun Jung, Jeongmin Lee, Jong Han Choi, Seung Hun Lee, Namki Hong, Jung Soo Lim, Byung Kwan Park, Jung-Han Kim, Kyeong Cheon Jung, Jooyoung Cho, Mi-kyung Kim, Choon Hee Chung, The Committee of Clinical Practice Guideline of Korean Endocrine Society, The Korean Adrenal Study Group of Korean Endocrine Society; Endocrinol Metab. 2023;38(6):597-618. Published online October 13, 2023; DOI: https://doi.org/10.3803/EnM.2023.1789

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Abstract PDF PubReader ePub

Primary aldosteronism (PA) is a common, yet underdiagnosed cause of secondary hypertension. It is characterized by an overproduction of aldosterone, leading to hypertension and/or hypokalemia. Despite affecting between 5.9% and 34% of patients with hypertension, PA is frequently missed due to a lack of clinical awareness and systematic screening, which can result in significant cardiovascular complications. To address this, medical societies have developed clinical practice guidelines to improve the management of hypertension and PA. The Korean Endocrine Society, drawing on a wealth of research, has formulated new guidelines for PA. A task force has been established to prepare PA guidelines, which encompass epidemiology, pathophysiology, clinical presentation, diagnosis, treatment, and follow-up care. The Korean clinical guidelines for PA aim to deliver an evidence-based protocol for PA diagnosis, treatment, and patient monitoring. These guidelines are anticipated to ease the burden of this potentially curable condition.

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Original Article

Diabetes, obesity and metabolism Big Data Articles (National Health Insurance Service Database)
Risk for Newly Diagnosed Type 2 Diabetes Mellitus after COVID-19 among Korean Adults: A Nationwide Matched Cohort Study: Jong Han Choi, Kyoung Min Kim, Keeho Song, Gi Hyeon Seo; Endocrinol Metab. 2023;38(2):245-252. Published online April 5, 2023; DOI: https://doi.org/10.3803/EnM.2023.1662

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Background
Coronavirus disease 2019 (COVID-19) can cause various extrapulmonary sequelae, including diabetes. However, it is unclear whether these effects persist 30 days after diagnosis. Hence, we investigated the incidence of newly diagnosed type 2 diabetes mellitus (T2DM) in the post-acute phase of COVID-19.
Methods
This cohort study used data from the Health Insurance Review and Assessment Service, a representative national healthcare database in Korea. We established a cohort of 348,180 individuals diagnosed with COVID-19 without a history of diabetes between January 2020 and September 2021. The control group consisted of sex- and age-matched individuals with neither a history of diabetes nor COVID-19. We assessed the hazard ratios (HR) of newly diagnosed T2DM patients with COVID-19 compared to controls, adjusted for age, sex, and the presence of hypertension and dyslipidemia.
Results
In the post-acute phase, patients with COVID-19 had an increased risk of newly diagnosed T2DM compared to those without COVID-19 (adjusted HR, 1.30; 95% confidence interval [CI], 1.27 to 1.33). The adjusted HRs of non-hospitalized, hospitalized, and intensive care unit-admitted patients were 1.14 (95% CI, 1.08 to 1.19), 1.34 (95% CI, 1.30 to 1.38), and 1.78 (95% CI, 1.59 to 1.99), respectively. The risk of T2DM in patients who were not administered glucocorticoids also increased (adjusted HR, 1.29; 95% CI, 1.25 to 1.32).
Conclusion
COVID-19 may increase the risk of developing T2DM beyond the acute period. The higher the severity of COVID-19 in the acute phase, the higher the risk of newly diagnosed T2DM. Therefore, T2DM should be included as a component of managing long-term COVID-19.

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Review Article

Diabetes, Obesity and Metabolism
Homeostatic Regulation of Glucose Metabolism by the Central Nervous System: Jong Han Choi, Min-Seon Kim; Endocrinol Metab. 2022;37(1):9-25. Published online February 28, 2022; DOI: https://doi.org/10.3803/EnM.2021.1364

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Evidence for involvement of the central nervous system (CNS) in the regulation of glucose metabolism dates back to the 19th century, although the majority of the research on glucose metabolism has focused on the peripheral metabolic organs. Due to recent advances in neuroscience, it has now become clear that the CNS is indeed vital for maintaining glucose homeostasis. To achieve normoglycemia, specific populations of neurons and glia in the hypothalamus sense changes in the blood concentrations of glucose and of glucoregulatory hormones such as insulin, leptin, glucagon-like peptide 1, and glucagon. This information is integrated and transmitted to other areas of the brain where it eventually modulates various processes in glucose metabolism (i.e., hepatic glucose production, glucose uptake in the brown adipose tissue and skeletal muscle, pancreatic insulin and glucagon secretion, renal glucose reabsorption, etc.). Errors in these processes lead to hyper- or hypoglycemia. We here review the current understanding of the brain regulation of glucose metabolism.

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Original Article

Diabetes, Obesity and Metabolism
Distinct Ultradian Rhythms in Plasma Clusterin Concentrations in Lean and Obese Korean Subjects: Jong Han Choi, Eunheui Jeong, Byung Soo Youn, Min-Seon Kim; Endocrinol Metab. 2018;33(2):245-251. Published online May 4, 2018; DOI: https://doi.org/10.3803/EnM.2018.33.2.245

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Background

Blood levels of many hormones show rhythmic fluctuations with variable duration of cycles. Clusterin/apolipoprotein J is a glycoprotein which is highly expressed in the plasma and has modulatory roles in immune and inflammatory reactions, neurobiology, lipid metabolism, and leptin signaling. In this study, we examined the diurnal fluctuations of plasma clusterin concentrations in lean and obese young men.

Methods

For the study, 14 subjects (five lean and five obese men; two lean and two obese women) were admitted to the research ward and blood samples were drawn every 30 minutes during light-on period (6:00 AM to 10:00 PM) and every hour during light-off period.

Results

Notably, plasma clusterin concentrations displayed a unique ultradian rhythm with five cycles a day in both men and women. During the light-on period, circulating clusterin levels showed fluctuating curves with 4 hours regular intervals with sharp peaks and troughs. In contrast, single oscillation curve during light-off exhibited a smoothened/lower peak and longer (8-hour) duration. In obese men, these cycles were phase-advanced by approximately 1 hour, and had reduced amplitude of fluctuating curves and blunted diurnal pattern. Cyclic fluctuations of plasma clusterin were preserved under fasting and unexpected meal condition, suggesting that rhythmic oscillations in plasma clusterin levels are not generated by meal-related cues.

Conclusion

These findings firstly demonstrate a novel pattern of plasma clusterin fluctuations with extremely regular cycles.

Citations

Citations to this article as recorded by

Clusterin and Related Scoring Index as Potential Early Predictors of Response to Sorafenib in Hepatocellular Carcinoma
Satoshi Narahara, Takehisa Watanabe, Katsuya Nagaoka, Nahoko Fujimoto, Yoki Furuta, Kentaro Tanaka, Takayuki Tokunaga, Takeshi Kawasaki, Yoko Yoshimaru, Hiroko Setoyama, Kentaro Oniki, Junji Saruwatari, Masakuni Tateyama, Hideaki Naoe, Motohiko Tanaka, Ya
Hepatology Communications.2022; 6(5): 1198. CrossRef
The role of circadian rhythm in choroid plexus functions
Telma Quintela, André Furtado, Ana C. Duarte, Isabel Gonçalves, Jihwan Myung, Cecília R.A. Santos
Progress in Neurobiology.2021; 205: 102129. CrossRef
A Novel Multi-Biomarker Assay for Non-Invasive Quantitative Monitoring of Kidney Injury
Drew Watson, Joshua Y. C. Yang, Reuben D. Sarwal, Tara K. Sigdel, Juliane M. Liberto, Izabella Damm, Victoria Louie, Shristi Sigdel, Devon Livingstone, Katherine Soh, Arjun Chakraborty, Michael Liang, Pei-Chen Lin, Minnie M. Sarwal
Journal of Clinical Medicine.2019; 8(4): 499. CrossRef

Case Report

Adrenal gland
Multiple Myeloma in a Patient with Acromegaly: Yu Mi Kang, Jong Han Choi, Min Jung Lee, Ari Ahn, Chan-Jeoung Park, Kiju Chang, Seyoung Seo, Sun In Hong, Min-Seon Kim; Endocrinol Metab. 2015;30(1):110-115. Published online March 27, 2015; DOI: https://doi.org/10.3803/EnM.2015.30.1.110

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Acromegaly is a slowly progressing condition resulting from excess growth hormone (GH), generally caused by a GH-secreting pituitary adenoma. Cancer is the third most common cause of mortality in patients with acromegaly, and insulin-like growth factor 1 (IGF-1) is known to influence tumor formation by increasing cell proliferation and inhibiting apoptosis. Multiple myeloma (MM) is a plasma cell neoplasm, and previous studies have suggested the possible role of IGF-1 in its development of MM. However, no cases of acromegaly accompanied with MM have been reported in Asia to date. We here report the case of a 58-year-old woman with acromegaly accompanied with MM who presented with longstanding acromegalic manifestations resulting from a GH-secreting pituitary adenoma and also exhibited anemia, a reversed albumin/globulin ratio, and plasmacytosis on bone marrow examination. Because IGF-1 has been suggested to play an important role in the development and progression of MM, the patient promptly underwent surgical removal of the pituitary adenoma via a transsphenoidal approach. Since there is currently no consensus on therapeutic guidelines and suggested prognosis for MM with acromegaly, long-term follow-up of such cases is needed.

Citations

Citations to this article as recorded by

Hematological Malignancy in a Hypophysectomised Acromegalic Patient Under 4-Year Therapy with Somatostatin Analogues: From a Rib Lump Underlying Bone Plasmatocytoma Features to Multiple Myeloma
Mihaela Stanciu, Alina Cătană, Ruxandra Paula Ristea, Denisa Tanasescu, Mara Carsote, Florina Ligia Popa, Ioana-Codruța Lebădă
Diagnostics.2025; 15(20): 2623. CrossRef
Co-Occurrence of Acromegaly and Hematological Disorders: A Myth or Common Pathogenic Mechanism
Prakamya Gupta, Pinaki Dutta
Integrative Medicine International.2017; 4(1-2): 94. CrossRef

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