Prevalence of Diabetes Mellitus and Prediabetes in Dalseong-gun, Daegu City, Korea

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1 Originl Article doi: /dmj pissn eissn D I A B E T E S & M E T A B O L I S M J O U R N A L Prevlence of Dibetes Mellitus nd Predibetes in Dlseong-gun, Degu City, Kore Jung-Eun Lee 1, Sung-Chng Jung 2, Gui-Hw Jung 2, Sung-Woo H 2, Bo-Wn Kim 2, Shung-Chull Che 2, Wee-Hyun Prk 2, Ji-Sun Lim 3, Jin-Hoon Yng 3, Sin Km 3, Byung-Yeol Chun 3, Jong-Yeon Kim 4, Jung-Jeung Lee 5, Kyeong-Soo Lee 6, Moon-Young Ahn 7, Young-Ae Kim 8, Jung-Guk Kim 2 1 Deprtment of Internl Medicine, CHA Gumi Medicl Center, CHA University School of Medicine, Gumi, Deprtments of 2 Internl Medicine, 3 Preventive Medicine nd Public Helth, Kyungpook Ntionl University School of Medicine, 4 Deprtment of Preventive Medicine nd Public Helth, Ctholic University of Degu School of Medicine, 5 Deprtment of Preventive Medicine nd Public Helth, Keimyung University School of Medicine, 6 Deprtment of Preventive Medicine nd Public Helth, Yeungnm University School of Medicine, 7 Public Helth nd Hygiene Division, 8 Dlseong Public Helth Center, Degu, Kore Bckground: The im of the present study ws to determine the popultion-bsed prevlence of dibetes mellitus (DM) nd predibetes in rurl district of Degu City, Kore. Methods: Between August nd November 2003, community-bsed helth survey of dults ged 20 yers nd older ws performed in the rurl district of Dlseong-gun in Degu City. A totl of 1,806 of ll eligible individuls greed to prticipte. Fsting plsm glucose ws mesured in ll prticipnts. Two hour orl glucose tolernce ws mesured in the 1,773 prticipnts for whom there ws neither n estblished dignosis of DM nor evidence of DM ccording to fsting glucose levels. The prevlence of DM nd predibetes ws determined ccording to the 2003 criteri of the Americn Dibetes Assocition. Subjects with predibetes were clssified into one of three ctegories of glucose intolernce: isolted impired fsting glucose (IFG); isolted impired glucose tolernce (IGT); or combined IFG nd IGT. Results: The prevlence of DM ws 12.2%. The highest prevlence rtes were observed in subjects in their seventies. A totl of 34.7% of ll subjects who were ssigned dignosis of DM in the present study hd not been dignosed previously. The prevlence of predibetes ws 22.7%. The highest prevlence rtes were observed in subjects in their fifties. Conclusion: The present study identified prevlence rtes of 12.2% for DM (ge-stndrdized prevlence rte [ASR], 6.8%), nd 22.7% for predibetes (ASR 18.5%). These results emphsize the need for community helth promotion strtegies to prevent or dely the onset of DM in individuls with predibetes. Keywords: Dibetes mellitus, Epidemiology, Predibetic stte INTRODUCTION In South Kore, economic development nd ltered eting ptterns hve been ccompnied by incresed rtes of overweight, obesity, nd dibetes mellitus (DM) [1,2]. The prevlence of dibetes mellitus (DM) in South Kore hs incresed over the pst three decdes, from 0.91% in Jeollbuk-do Province in 1971 to 7.2% in Yonchon in 1993, nd from 7.1% in Jungup in 1997 to 13.7% in Nmwon in 1999, nd most drmticlly, to 20.5% nd 22.1% in southwestern Seoul in 1999 nd 2002, respectively [1-8]. A study in the Koren city of Degu in 2001 demonstrted Corresponding uthor: Jung-Guk Kim Deprtment of Internl Medicine, Kyungpook Ntionl University Hospitl, Kyungpook Ntionl University School of Medicine, 50 Smdeok-dong 2-g, Jung-gu, Degu , Kore E-mil: jugkim@knu.c.kr Received: Jul. 16, 2010; Accepted: Dec. 22, 2010 This is n Open Access rticle distributed under the terms of the Cretive Commons Attribution Non-Commercil License ( which permits unrestricted non-commercil use, distribution, nd reproduction in ny medium, provided the originl work is properly cited. Copyright 2011 Koren Dibetes Assocition

2 Lee J-E, et l. tht endocrine disese ws the fifth leding cuse of deth, nd tht DM in prticulr hd been ssocited with two-fold increse in mortlity over the preceding decde [9]. In 2003, hypertension-dm mngement center ws estblished in Degu to fcilitte the prevention nd erly tretment of DM nd hypertension. This inititive ws the result of collbortion between public nd privte helth cre providers. An epidemiologicl reserch tem ws creted to investigte the prevlence of hypertension, DM, nd metbolic syndrome in locl residents, nd to recruit cohort to investigte disese incidence over 5-yer period, s well s determintion of risk nd prognostic fctors. The im of the present study ws to determine the prevlence of DM nd predibetes in the popultion of the rurl district of Dlseong-gun in Degu, popultion which is less mobile thn those in other res of Degu City. METHODS Study subjects Between August nd November 2003, community-bsed helth survey ws performed in Dlseong-gun to determine the prevlence of DM nd predibetes in dults ged 20 yers or older. Dlseong-gun is rurl district of Degu, Kore. According to the 2000 census, pproximtely 101,104 of its residents re bove the ge of 20 yers. The study popultion ws selected using multi-stge cluster smpling method without use of weight fctor. The ctchment res of nine primry helth cre centers were selected s collection districts. Two or three villges from ech collection district were then selected t rndom. Thus, totl of 26 villges were smpled nd 1,806 individuls were recruited. A totl of 1,773 subjects (681 men nd 1,092 women) underwent full evlution of glucose tolernce sttus. Since metbolic risk fctor dt were vilble for only 1,755 of the 1,773 subjects, only these were included in the nlysis of metbolic risk fctors. The study ws pproved by the Institutionl Review Bord of Kyungpook Ntionl University Hospitl, nd ll subjects provided written informed consent. Methods All subjects underwent stndrdized series of physicl exmintions tht were performed by trined personnel. Systolic blood pressure (SBP) nd distolic blood pressure (DBP) were mesured in the sitting position fter 10-minute period of rest. The verge of two blood pressure redings ws used in the nlysis. Weight (mesured without shoes nd in light outdoor clothing) nd height were mesured, nd body mss index (BMI, kg/m 2 ) ws clculted by dividing weight (kg) by height squred (m 2 ). Wist circumference ws mesured midwy between the lower rib mrgin nd the ilic crest t the end of expirtion. All blood smples were tken in the morning following n overnight fst of t lest eight hours. Venous blood ws drwn with miniml stsis from the ntecubitl vein. In ll subjects, fsting cpillry whole blood glucose ws mesured with n Accu Check glucometer (Roche Dignostics, Penzberg, Germny), nd fsting plsm glucose ws mesured with Beckmn Glucose Anlyzer (Beckmn Instruments, Irvine, CA, USA). All eligible prticipnts were then subjected to n orl glucose tolernce test (OGTT). A 75-g glucose solution ws dministered orlly, nd plsm glucose ws mesured fter n intervl of two hours. Prticipnts with known DM or fsting cpillry whole blood glucose level of 200 mg/dl were excluded from the nlysis of orl glucose tolernce. In these prticipnts, DM ws confirmed by re-checking fsting plsm glucose levels. Serum totl cholesterol (TC), triglycerides (TG), nd high density lipoprotein cholesterol (HDL-C) were mesured using enzymtic methods (Dimension AR; Dde Behring Inc., Deerfield, IL, USA). DM nd predibetes were dignosed ccording to the 2003 criteri of the Americn Dibetes Assocition (ADA) [10]. A subject ws considered to hve known DM if they were receiving phrmcologicl tretment for DM t the time of inclusion in the study, irrespective of their mesured glucose levels. Subjects with fsting plsm glucose level of 126 mg/dl or 2-hour post-lod plsm glucose level of 200 mg/dl were ssigned dignosis of DM. Subjects with predibetes were clssified into one of three ctegories: isolted impired fsting glucose (I-IFG), isolted impired glucose tolernce (I-IGT), or combined IFG nd IGT (C-IFG/IGT) [10,11]. I-IFG ws defined by fsting plsm glucose level of between 100 nd 125 mg/dl, nd 2-hour post-lod plsm glucose level of <140 mg/dl. I-IGT ws defined by fsting plsm glucose level of <100 mg/dl, nd 2-hour post-lod plsm glucose level of between 140 nd 199 mg/dl. C-IFG/IGT ws defined by fsting plsm glucose level of between 100 nd 125 mg/ dl, nd 2-hour post-lod plsm glucose level of between 140 nd 199 mg/dl. 256

3 Prevlence of dibetes mellitus nd predibetes Sttisticl nlysis The ge-stndrdized prevlence rte (ASR) of DM nd predibetes nd the 95% confidence intervl (CI) were clculted using the 2005 Koren popultion (ged 20 to 99 yers) s the stndrd popultion. The ge groups 20 to 39, 40 to 49, 50 to 59, 60 to 69, nd 70 yers were considered seprtely. The chi-squre test ws used to nlyze differences in the prevlence of DM nd predibetes between the sexes nd different ge groups. For both DM nd predibetes, prevlence ws nlyzed without use of weight fctor. Logistic regression models were used to ssess the reltionship between metbolic risk fctors nd DM nd predibetes. All dt were nlyzed using the SPSS sttisticl pckge version 15.0 (SPSS Inc., Chicgo, IL, USA). RESULTS Demogrphic chrcteristics Dt from 1,773 subjects were nlyzed (681 men, 38.4%; 1,092 women, 61.6%). The men ge ws 58.7 yers (59.1 in men, 58.5 in women) (Tble 1). Prevlence of dibetes mellitus The prevlence of DM ws 12.2% (ASR 6.8%). No sttisticlly significnt difference in the prevlence of DM ws observed between men nd women (13.1% [ASR 6.6%] in men; 11.6% [ASR 7.0%] in women). A totl of 34.7% of ll subjects who were ssigned dignosis of DM hd not been previously dignosed (39.3% men, 31.5% women). The prevlence of DM incresed with ge, nd peked in the ge-group 70 yers (P for trend<0.01). The highest prevlence rtes were detected in the ge group 60 to 69 yers for men (P for trend<0.01) nd in the ge group 70 yers for women (P for trend<0.01) (Tble 2). Prevlence of predibetes The prevlence of predibetes ws 22.7% (ASR 18.5%) overll, 26.1% (ASR 27.1%) in men nd 20.5% (ASR 13.9%) in women. The prevlence of I-IFG ws 15.3% (ASR 13.2%), 19.4% (ASR 20.8%) in men nd 12.8% (ASR 9.0%) in women. The prevlence of I-IGT ws 3.7% (ASR 2.6%), 3.8% (ASR 3.7%) in men nd 3.6% (ASR 2.0%) in women. The prevlence of C- IFG/IGT ws 3.7% (ASR 2.7%), 2.9% (ASR 2.5%) in men nd 4.1% (ASR 2.9%) in women. The prevlence of I-IFG ws sig- Tble 1. Age nd sex of study subjects Age, yr Men Women Totl (6.3) 76 (7.0) 119 (6.7) (16.2) 191 (17.5) 301 (17.0) (24.8) 243 (22.3) 412 (23.2) (30.7) 390 (35.7) 599 (33.8) (22.0) 192 (17.6) 342 (19.3) Totl 681 (38.4) 1,092 (61.6) 1,773 (100.0) Dt re presented s number (%). Tble 2. Prevlence of dibetes mellitus ccording to sex nd ge Age, yr Previously dignosed dibetes, % Newly dignosed dibetes, % Totl dibetes mellitus, % Men Women Totl Men Women Totl Men Women Totl Totl (95% CI) 7.9 ( ) Age-djusted (95% CI) 4.4 ( ) 8.0 ( ) 3.9 ( ) 8.0 ( ) 3.2 ( ) 5.1 ( ) 3.4 ( ) 3.7 ( ) 2.6 ( ) 4.2 ( ) 2.9 ( ) 13.1 ( ) 6.6 ( ) 11.6 ( ) 7.0 ( ) 12.2 ( ) 6.8 ( ) P vlue b P for trend c < 0.01 < 0.01 < < 0.01 < 0.01 < 0.01 < 0.01 CI, confidence intervl. Age-djusted prevlence (%), b P vlue for comprison between men nd women, c P vlue for trend cross incresing ge. 257

4 Lee J-E, et l. nificntly higher thn tht of I-IGT or C-IFG/IGT (P<0.01) (Tble 3). The prevlence of predibetes incresed with ge nd peked t 25.5% in the 50 to 59 yer ge group (P for trend<0.01). In men, the prevlence of predibetes peked t 31.8% in the ge group 40 to 49 yers. In women, the prevlence of predibetes peked t 24.3% in the ge group 50 to 59 yers. The prevlence of I-IFG did not increse with ge nd peked t 19.7% in the ge group 50 to 59 yers. In men, the prevlence of I- IFG peked t 27.3% in the ge group 40 to 49 yers. In women, the prevlence of I-IFG peked t 17.7% in the ge group 50 to 59 yers. The prevlence of I-IGT incresed with ge (P for trend=0.01), nd peked in the ge group 70 yers t 5.3% for men nd 5.2% for women. When the sexes were consid- Tble 3. Prevlence of predibetes ccording to sex nd ge Age, yr I-IFG, % I-IGT, % C-IFG/IGT, % Totl predibetes,% Men Women Totl Men Women Totl Men Women Totl Men Women Totl Totl (95% CI) Age-djusted (95% CI) 19.4 ( ) 20.8 ( ) 12.8 ( ) 9.0 ( ) 15.3 ( ) 13.2 ( ) 3.8 ( ) 3.7 ( ) 3.6 ( ) 2.0 ( ) 3.7 ( ) 2.6 ( ) 2.9 ( ) 2.5 ( ) 4.1 ( ) 2.9 ( ) 3.7 ( ) 2.7 ( ) 26.1 ( ) 27.1 ( ) 20.5 ( ) 13.9 ( ) 22.7 ( ) 18.5 ( ) P vlue b < <0.01 P for < < trend c C-IFG/IGT, combined impired fsting glucose nd impired glucose tolernce; I-IFG, isolted impired fsting glucose; I-IGT, isolted impired glucose tolernce, CI, confidence intervl. Age-djusted prevlence (%), b P vlue for comprison between men nd women, c P vlue for trend cross incresing ge. Tble 4. Associted metbolic risk fctors ccording to dignostic criteri (n=1,755) Vrible NGT (n=1,146) I-IFG (n=271) Predibetes (n=397) I-IGT (n=63) C-IFG/IGT (n=63) Totl (n=397) Dibetes (n=212) P for trend BMI, kg/m 2 b 23.3± ±3.0 c 24.4±3.7 d 24.8±3.8 e 24.2±3.2 f 24.6±3.1 g <0.01 Wist, cm b 81.2± ±8.2 c 85.6±8.3 d 85.7±8.4 e 84.7±8.2 f 87.5±8.0 g <0.01 SBP, mm Hg b 129.0± ±18.1 c 140.8±19.0 d 140.1±20.5 e 135.5±18.9 f 139.2±20.8 g <0.01 DBP, mm Hg b 81.3± ±10.7 c 87.1±10.2 d 87.2±10.6 e 84.7±10.7 f 84.4±10.1 g <0.01 TG, mg/dl b 143.0± ±190.6 c 180.9± ± ±166.6 f 205.1±147.4 g <0.01 TC, mg/dl b 193.9± ±34.7 c 202.0± ±42.9 e 203.6±38.6 f 202.7±40.3 g <0.01 HDL-C, mg/dl b 52.2± ± ± ± ± ±13.2 g <0.01 NGT, norml glucose tolernce; I-IFG, isolted impired fsting glucose; I-IGT, isolted impired glucose tolernce; C-IFG/IGT, combined impired fsting glucose nd impired glucose tolernce; BMI, body mss index; Wist, wist circumference; SBP, systolic blood pressure; DBP, distolic blood pressure; TG, triglyceride; TC, totl cholesterol; HDL-C, high density lipoprotein cholesterol. P for trend ws used to compre norml, predibetes, nd dibetes groups, b Expressed s men±sd, c Significnt difference of norml/isolted impired fsting glucose (P<0.05), d Significnt difference of norml/isolted impired glucose tolernce (P<0.05), e Significnt difference of norml/combined impired fsting glucose nd impired glucose tolernce (P<0.05), f Significnt difference of norml/predibetes (P<0.05), g Significnt difference of norml/dibetes (P<0.05). 258

5 Prevlence of dibetes mellitus nd predibetes ered seprtely, the prevlence of I-IGT ws found to increse with ge in women (P for trend=0.04), but not in men. The prevlence of C-IFG/IGT lso incresed with ge (P for trend =0.03), nd peked in the ge group 70 yers t 6.0% for men nd 5.7% for women (Tble 3). Associted metbolic risk fctors The nlyses of metbolic risk fctors reveled tht BMI, wist circumference, SBP, nd DBP were significntly higher in the I-IFG, I-IGT, C-IFG/IGT, nd DM groups thn in the norml glucose tolernce (NGT) group (P<0.01). TG levels were significntly higher in the I-IFG nd DM groups thn in the NGT group (P<0.01). TC ws significntly higher in the I-IFG, C- IFG/IGT, nd DM groups thn in the NGT group (P<0.01). HDL-C ws significntly lower only in the DM group compred to the NGT group (P<0.01). BMI, wist circumference, SBP, DBP, TG, nd TC were significntly incresed nd HDL- C ws significntly decresed in the predibetes group compred to the NGT group. Differences with the NGT group were more pronounced for subjects with DM thn for subjects with predibetes (P for trend<0.01) (Tble 4). Multiple logistic regression nlysis djusted for ge nd sex, nd using stndrdized vlues s vribles, showed tht the following metbolic risk fctors were ssocited with DM: wist circumference (odds rtio [OR], 1.817; P<0.001), SBP (OR, 1.719; P<0.001), DBP (OR, 0.719; P=0.009), nd TG (OR, 1.302; P<0.001). Multiple logistic regression nlysis djusted for ge nd sex, nd using stndrdized vlues s vribles, showed tht the following metbolic risk fctors were ssocited with predibetes: wist circumference (OR, 1.252; P=0.026), TG (OR, 1.310; P<0.001), TC (OR, 1.143; P=0.045), nd HDL- C (OR, 1.155; P=0.037) (Tble 5). DISCUSSION The prevlence of DM in Dlseong-gun, Degu, Kore ws 12.2% (ASR 6.8%), 13.1% (ASR 6.6%) in men nd 11.6% (ASR 7.0%) in women. In both sexes, the prevlence of DM incresed significntly with ge, nd the most pronounced increse ws observed in the fifth decde of life. The highest prevlence rtes were found for men in the ge group 60 to 69 yers nd women in the ge group 70 yers. Previous studies hve investigted the prevlence of DM in Kore using the 1997 criteri of the ADA. A prevlence of 7.1% ws reported in Jungup in 1997, nd study in Nmwon in 1999 reported prevlence of 13.7% [5,7]. Studies performed within the context of the Koren Ntionl Helth nd Nutritionl Survey reported tht the prevlence of DM decresed between 1998 nd 2001 in both sexes [12,13]. Rtes of 12% in men nd 9.7% in women were found in 1998, compred with 9.0% nd 7.2%, respectively, in 2001 [12,13]. According to n nlysis of the Koren Ntionl Helth Insurnce Dtbse on Dibetes in 2003, the prevlence of DM ws 7.7% [14]. The men ge of the subjects in the present study ws 58.7 yers, which is higher thn in previous studies. The ASR of DM in the present study ws lower thn tht reported in previous studies in Kore [5,7,12-14]. The reson for this is uncler. The prevlence of dibetes my be lower in rurl res, where the popultion follows more trditionl lifestyle, thn in urbn res. Furthermore, the present study included reltively young Tble 5. Multiple logistic regression nlysis of the reltionship between metbolic risk fctors nd dibetes mellitus nd predibetes Metbolic risk fctor Dibetes mellitus Predibetes Adjusted OR (95% CI) P vlue Adjusted OR (95% CI) P vlue BMI ( ) ( ) Wist ( ) < ( ) SBP ( ) < ( ) DBP ( ) ( ) TG ( ) < ( ) < TC ( ) ( ) HDL-C ( ) ( ) OR, odds rtio; CI, confidence intervl; BMI, body mss index; Wist, wist circumference; SBP, systolic blood pressure; DBP, distolic blood pressure; TG, triglyceride; TC, totl cholesterol; HDL-C, high density lipoprotein cholesterol. OR djusted for ge nd sex using stndrdized vlues s vribles, P<0.05 is sttisticlly significnt. 259

6 Lee J-E, et l. subjects, becuse the inclusion criterion ws n ge of 20 yers or bove. Comprisons with previous findings my thus be limited, since previous studies tended to only include subjects who were bove the ge of 30 or 40 yers. Previous studies hve shown tht the prevlence of DM ws positively correlted with ge, nd tht there ws rpid increse in DM prevlence during the fifth nd sixth decdes of life [5-7,12,13]. The present results re consistent with those of study in the Koren district of Jungup. This study showed tht the prevlence of DM incresed significntly throughout middle ge in both sexes, nd tht the highest prevlence rtes were in the ge group 50 to 59 yers for men nd 70 yers for women [5]. In the 1998 Koren Ntionl Helth nd Nutritionl Survey study, the prevlence of DM incresed throughout middle ge, nd the highest prevlence rtes were observed in men in their fifties nd in women in their sixties [12]. In the 2005 Koren Ntionl Helth nd Nutritionl Survey study, the highest prevlence rtes were found for men in their fifties nd women in their seventies [13]. In the present study, 34.7% of ll subjects who were ssigned dignosis of DM hd not been dignosed previously. The percentge of newly dignosed subjects ws pproximtely 50% lower thn the percentges reported from comprble studies [5,7]. In prticulr, the rtio of newly to previously dignosed DM in the present popultion ws lower in the 50 yer ge groups thn in the 20 to 49 yer ge groups. Erly detection of DM ppers to hve incresed in recent yers s result of screening progrms. However, the present study hs demonstrted tht mny subjects with DM were undignosed nd untreted. In the present study, the prevlence of predibetes ws 22.7% (ASR 18.5%). The most common ctegory of predibetes ws I-IFG, which ccounted for 67.4% of ll subjects with predibetes. Together I-IGT nd C-IFG/IGT ccounted for 16.3% of ll subjects with predibetes. The prevlence of predibetes ws significntly higher in men thn in women (P<0.01), nd the prevlence of I-IFG ws lso significntly higher in men thn in women (P<0.01). However, the prevlence of I-IGT nd C- IFG/IGT did not differ between the sexes. The highest prevlence of I-IFG ws found in subjects in their fifties, nd the rte decresed bove the ge of 60. However, the prevlence of I- IGT nd C-IFG/IGT incresed significntly with ge. In 1999, Weyer et l. [15] were the first to clssify predibetes into three ctegories of glucose intolernce: I-IFG, I-IGT, nd C-IFG/IGT. The norml rnge of fsting plsm glucose ws defined s <110 mg/dl, nd this cutoff ws pplied by both the ADA nd the World Helth Orgniztion (WHO) in their 1997 dignostic criteri [16,17]. In 2001, the Interntionl Dibetes Federtion (IDF) defined predibetes ccording to the sme criteri s the WHO [11]. However, the 2003 criteri of the ADA defined the norml rnge of fsting plsm glucose s <100 mg/dl [10]. Therefore, the prevlence of predibetes identified in the present study cnnot be directly compred with tht reported by previous studies in Kore becuse different fsting plsm glucose cutoff vlues were used. A popultion study performed t helth promotion center in Gyeonggi-do in 2006 reported tht 46.4% of subjects hd predibetes. Of these, 20.7% hd I-IFG, 7.7% hd I-IGT, nd 18.0% hd C-IFG/IGT [18]. It is impossible to directly compre the results of this study with the present findings, since fsting plsm glucose cut off vlue of <110 mg/dl ws used [18]. Yet, the prevlence of predibetes in the present study ws lower, despite the use of lower fsting plsm glucose cutoff vlue of <100 mg/dl. Recently, pooled nlysis of four lrge-scle Koren community-bsed studies ws performed. This included dt from the 1993 Yonchon study, the 1997 Mokdong study, the 1997 Jungup study, nd the 2000 Ansn study [19]. Using the optiml cutoff point for fsting plsm glucose of 100 mg/ dl, the prevlence of predibetes ws found to be 29.8% (I- IFG 17.0%, I-IGT 6.7%, nd C-IFG/IGT 6.1%) [19]. Thus, the study reported higher prevlence of predibetes thn in the present study. However, it disclosed lower rtes of I-IFG compred to I-IGT nd C-IFG/IGT thn in the present study [19]. Severl studies hve investigted the pthophysiology of IFG nd IGT [11,15,20-26]. In the mjority of the popultions studied, IGT ws more prevlent thn IFG, nd differences in phenotype nd gender distribution were observed between the two ctegories [11]. The 5-yer Inter99 study of Dnish popultion suggested tht I-IFG ppers to be cused by impired bsl insulin secretion nd first-phse insulin relese, nd subsequent decline in heptic insulin sensitivity [22]. In contrst, the uthors suggested tht the I-IGT my be cused by low whole body insulin sensitivity nd progressive decline in β-cell function, which indictes loss of β-cell compenstion [22]. This implies there re differences in pthogenesis between the vrious forms of predibetes, nd thus in the risk of developing DM. The findings of the present study suggest tht Koren individuls with predibetes re geneticlly more susceptible to inherent insulin secretory dysfunction nd heptic insulin resistnce thn to n indequte compenstory 260

7 Prevlence of dibetes mellitus nd predibetes insulin secretory response nd peripherl insulin resistnce. Further studies re wrrnted to determine whether IFG is more prevlent thn IGT in the Koren popultion s whole. According to n IDF consensus sttement on IGT/IFG in 2001, the prevlence of IFG tends to plteu in 40 to 50 yer ge group nd is more common in men thn in women in virtully ll ge groups [11]. Conversely, the prevlence of IGT is higher in women thn in men in ll ge groups, with the exception of the over 60 ge group in Asin popultions [11]. These findings re consistent with the present findings. Other recent epidemiologicl studies hve reported similr sex differences in the prevlence of IFG nd IGT, with IFG being more common in men nd IGT more common in women [27,28]. It hs been hypothesized tht the finding of higher prevlence of IGT in women my result from the use of fixed glucose lod in the OGTT irrespective of body size, despite the fct tht women generlly hve smller stture nd less muscle mss thn men [27]. It is uncler whether other fctors my influence these results, since studies in number of geogrphiclly nd ethniclly diverse popultions hve demonstrted sex differences [28]. Further studies will be necessry to estblish whether our results pply to other popultions, nd to elucidte the mechnisms underlying sex differences in glucose metbolism. The present study identified significnt differences in DMssocited metbolic risk fctors such s BMI, wist circumference, SBP, DBP, TG, TC, nd HDL-C between the NGT group nd the predibetes nd DM groups. Thus, the present findings re in ccordnce with those of previous studies nd suggest tht predibetes is ssocited with crdiovsculr risk fctors, such s hypertension nd dyslipidemi [7,11,12]. The present study hd severl limittions. Previous studies from Kore used different stndrd popultions nd pplied different dignostic criteri for DM nd predibetes. Thus, the prevlence of DM nd predibetes identified in the present study cnnot be compred directly to those reported by previous studies. Cution should be exercised in interpreting the results s n indiction of the epidemiology of DM in Kore, since the investigtion of the Dlseong cohort represents well-controlled epidemiologicl survey. In conclusion, the prevlence of DM in the present rurl cohort ws 12.2% (ASR 6.8%), nd tht of predibetes ws 22.7% (ASR 18.5%). These findings could be used s bseline dt for 5-yer follow-up study of the prevlence nd incidence of DM nd predibetes, nd of the risk fctors ssocited with the development of DM in the Dlseong-gun community. The present study hs demonstrted the effectiveness of community helth promotion strtegies in fcilitting the erly detection nd prevention of DM through liison between public nd privte helth services. Such strtegies re useful tool in evluting pst nd current helth promotion policies, nd in estblishing long-term ntionl helth promotion policies. CONFLICTS OF INTEREST No potentil conflict of interest relevnt to this rticle ws reported. ACKNOWLEDGMENTS This study ws funded by grnt from the Degu Medicl Assocition. We re grteful to the Degu Metropolitn City nd to the Degu Medicl Assocition for their support. We lso wish to thnk the Dlseong Public Helth Center, the Degu nd Kyungpook Committees of the Koren Dibetes Assocition, nd the Koren Society of Crdiology. The uthors hve no competing finncil interests to disclose. REFERENCES 1. Chn JC, Mlik V, Ji W, Kdowki T, Yjnik CS, Yoon KH, Hu FB. Dibetes in Asi: epidemiology, risk fctors, nd pthophysiology. JAMA 2009;301: Yoon KH, Lee JH, Kim JW, Cho JH, Choi YH, Ko SH, Zimmet P, Son HY. Epidemic obesity nd type 2 dibetes in Asi. Lncet 2006;368: Lee DY, Kim EJ, Kim KS, Choi CH. Epidemiologicl study on dibetes mellitus mong rurl Koren. J Koren Dibetes Assoc 1972;1: Prk Y, Lee H, Koh CS, Min H, Yoo K, Kim Y, Shin Y. Prevlence of dibetes nd IGT in Yonchon County, South Kore. Dibetes Cre 1995;18: Kim YI, Choi CS, Kim SW, Lee JS, Kim HH, Lee MS, Lee SI, Prk JY, Hong SK, Lee KU. Prevlence of dibetes mellitus nd impired glucose tolernce in Koren dults living in Jungup district, South Kore. J Koren Dibetes Assoc 1998;22: Oh JY, Lee HJ, Hong ES, Hong YS, Sung YA, Lee SH. The prevlence nd incidence of dibetes in Mokdong, Seoul. J Koren Dibetes Assoc 2003;27: Kim SG, Yng SW, Jng AS, Seo JP, Hn SW, Yeom CH, Kim YC, 261

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