Diabetes Metab J.  2025 Mar;49(2):183-193. 10.4093/dmj.2024.0836.

Older Adults with Diabetes in Korea: Latest Clinical and Epidemiologic Trends

• Kim K
• Kim B
• Lee K
• Ahn YB
• Ko SH
• Choi SH
• Han K
• Yun JS
• on Behalf of the Committee of Public Relation of the Korean Diabetes Association

• KMID: 2565343
• DOI: http://doi.org/10.4093/dmj.2024.0836

Abstract

Background
Diabetes in older adults is becoming a significant public burden to South Korea. However, a comprehensive understanding of epidemiologic trends and the detailed clinical characteristics of older adults with diabetes is lacking. Therefore, we evaluated epidemiologic trends and the metabolic and lifestyle characteristics of diabetes in Korean older adults.
Methods
We analyzed data from the Korea National Health and Nutrition Examination Survey to assess diabetes prevalence according to diabetes duration and lifestyle behaviors. In addition, we drew upon the National Health Information Database of the National Health Insurance System to assess physical activity levels, antidiabetic medication use, polypharmacy, medication adherence, and major comorbidities.
Results
The absolute number of newly diagnosed cases of diabetes among older adults doubled over the past decade. Management rates of metabolic indicators were higher in older adults with diabetes compared to those without diabetes. The proportion of older adults with diabetes meeting the minimum recommended physical activity increased over the years. Compared to 10 years before, the use of dipeptidyl peptidase-4 inhibitor or sodium-glucose cotransporter-2 inhibitor had increased, as had comorbidities such as dyslipidemia, dementia, cancer, heart failure, atrial fibrillation, and chronic kidney disease. Initial medication adherence was significantly lower in those with end-stage kidney disease or dementia, insulin use, high-risk alcohol use, and living alone. Continuing insulin use 1 year after diagnosis of diabetes was significantly higher in those who initiated insulin therapy at diagnosis, had retinopathy, were on triple antidiabetic medications, and had a history of cancer.
Conclusion
Comprehensive management of metabolic indicators and physical activity is essential for older adults with diabetes. Improvements in prescribing guidelines, personalized management of age-related comorbidities, and individualized approaches that consider the heterogeneous nature of older adults with diabetes are desirable. Further research, such as high-quality cohort and intervention studies specific to older adults, is needed to establish evidence-based management for older adults with diabetes.

Keyword

Aged; Comorbidity; Diabetes mellitus; Hypoglycemic agents; Insulin; Mortality; Polypharmacy

Figure

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  Fig. 1. Trends of comorbidities (excluding hypertension and dyslipidemia) among adults with diabetes aged 65 years and older, 60% sample cohort from National Health Information Database 2012 to 2022. AF, atrial fibrillation; ESKD, end-stage kidney disease; MI, myocardial infarction; PDR, proliferative diabetic retinopathy.

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  Fig. 2. Mortality risk within 3 years of major comorbidities among adults with diabetes aged 65 years and older, National Health Information Database 2015 to 2016. HR, hazard ratio; CI, confidence interval; ESKD, end-stage kidney disease; CKD, chronic kidney disease; MI, myocardial infarction.

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