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the international diabetes federation stated that 382 million people worldwide suffered from diabetes in 2013 , and this number is expected to rise to 592 million by 2035 .
diabetes resulted in 1.3 million mortalities in 2010 , which was twice as high as that in 1990 .
furthermore , diabetes - related complications , such as retinopathy , neuropathy , nephropathy , and cardiovascular and cerebrovascular diseases , are increasing the burden on individuals and healthcare systems .
the american diabetes association ( ada ) and european association for the study of diabetes recommend that the management of patients with type 2 diabetes should include glucose control to achieve a hemoglobin a1c ( a1c ) level of  7% , as well as lifestyle changes , including smoking cessation and control of blood pressure ( bp ) and lipid levels .
the prevalence of diabetes increased from 8.6% to 11.0% from 2001 to 2013 in a nationally representative sample of koreans aged  30 years , and the prevalence of diabetes is expected to rise to 5.5 million by 2030 , which is 10.9% of the adult population aged  20 years .
the prevalence of diabetes has increased particularly in individuals aged  70 years ; the rate of diabetes in this age group was 27.6% in 2013 , which was approximately twice as high as that in 2001 .
in addition , the prevalence of diabetes has also increased slightly in younger and middle - aged subjects .
the median age of new patients with diabetes decreased by approximately 6 years from 2004 to 2012 .
several studies have shown that the onset of type 2 diabetes at a younger age may lead to poorer glycemic control , greater risk of complications , and higher morality compared with an older age of onset [ 9 - 11 ] . according to the diabetes fact sheet of the korean diabetes association ( kda ) ,
the prevalence of prediabetes , defined as a fasting glucose level of 100 to 125 mg / dl , also increased from 21.5% to 25.0% from 2006 to 2013 .
annually , 5% to 10% of those with prediabetes progress to diabetes , and prediabetes also causes concomitant damage to end organs such as the eyes , kidneys , blood vessels , and the heart .
considering this situation , effective and diverse strategies to prevent diabetes and prediabetes are needed .
the ada recommended obesity control to prevent progression from prediabetes to diabetes and to improve glycemic control in type 2 diabetes .
in korea , the prevalence of obesity has increased from 29.2% in 2001 to 31.8% in 2013 . in particular , the number of obese patients with diabetes has increased . according to a primary care clinic - based survey , 77% of patients with newly diagnosed diabetes have a body mass index ( bmi ) > 23.0 kg / m . in 2013 ,
the prevalence of obesity / overweight with diabetes was 71.6% in men and 74.2% in women .
the mean bmi of patients with diabetes increased from 21.9 to 24.8 kg / m over nearly two decades .
furthermore , an inverse linear relationship was detected between bmi and age at diabetes diagnosis among newly diagnosed patients .
the mean bmi decreased from 30.4 kg / m in the youngest age group to 24.4 kg / m in the oldest age group .
the diabetes control and complications trial ( dcct ) and the united kingdom prospective diabetes study showed that improving glycemic control , lowering bp and lipid levels , and avoiding smoking help reduce microvascular and macrovascular diseases [ 22 - 27 ] .
therefore , guidelines for diabetes care recommend management of lifestyle ( diet , weight control , smoking cessation , and physical activity ) and risk factors ( a1c < 7.0% , bp < 140/90 mmhg , and low density lipoprotein cholesterol [ ldl - c ] < 100 mg / dl ) and regular screening to treat conditions related to diabetes during the early stages . the 2015 kda 's guideline recommended a bp target of < 140/85 mmhg in patients with diabetes . because reduced adherence to regimens results in poor health outcomes , comprehensive management of type 2 diabetes should consider adherence to relevant medications .
according to the kda , the medication adherence rate , which is estimated using the medication possession ratio , increased from 12.8% to 44.9% from 2002 to 2013 .
the proportion of patients with diabetes treated with antihypertensive medications increased from 56.0% to 62.5% during 2006 to 2013 .
approximately 50% of patients with diabetes were being treated with lipid - lowering medications in 2013 , a 1.8-fold increase since 2006 . according to the 2014 korea national health and nutrition examination survey ( knhanes ) study ,
< 7.0% , 72.8% achieved bp < 140/85 mmhg , and 58.0% achieved ldl - c < 100 mg / dl .
only 19.7% of patients with diabetes had good control of all three parameters ( fig . 1 , unpublished data ) .
control rates in 2014 improved compared with those from the 2005 health insurance data , in which 40.3% of patients achieved a1c < 7.0% , 58.6% achieved bp < 140/90 mmhg , and 38.3% achieved ldl - c < 100 mg / dl .
in particular , the glycemic control rate ( defined as a1c  8.0% ) decreased steadily from 33.6% in 2005 to 25.9% in 2012 to 22.5% in 2014 ( fig .
almost half of the male patients with diabetes are still smoking ( fig . 1 , unpublished data ) . the a1c level is considered a clinical marker of diabetes as well as a precise indicator of long - term glycemic control .
thus , many studies have translated a1c values into blood glucose levels to increase understanding of the clinical implications of a1c . in korea , kim et al
.   also suggested an association between the mean blood glucose level measured by the oral glucose tolerance test and a1c , expressed as a linear regression : mean glucose ( mg / dl ) = 49.4  a1c ( % )  149.6 ( r = 0.54 , p < 0.001 ) .
the linear regression equation was fairly dissimilar from that in the a1c derived average glucose study and dcct cohort .
diabetes is associated with chronic complications , such as microvascular and macrovascular diseases , and other diseases including dementia and depression . the dcct / edic demonstrated that achieving glycemic control reduces the rate of microvascular complications .
previous studies have shown that the duration of diabetes is associated with an increased risk of micro- and macrovascular complications .
the prevalence rates of neuropathy , retinopathy , and nephropathy in korea are 33.5% , 20.0% , and 5.5% , respectively , in patients with diabetes . according to the diabetes fact sheet , 1.2% of patients with type 2
diabetes have end - stage renal disease ( esrd ) , and 15.9% have diabetic retinopathy .
in particular , the incidence of diabetic nephropathy is increasing rapidly , and it is the most common cause of esrd .
the prevalence rates of cardiovascular , cerebrovascular , and peripheral vascular diseases in patients with type 2 diabetes were 5.5% , 5.0% , and 1.1% , respectively , during 2006 to 2009 according to the korean national diabetes program .
the 2009 to 2011 health insurance review and assessment database indicated that the prevalence rates of coronary artery , cerebrovascular , and peripheral artery diseases were 14.1% , 8.8% , and 0.3% , respectively , in patients newly diagnosed with type 2 diabetes .
the presence of macrovascular complications was higher in patients with type 2 diabetes than in those without ( 295 cases of ischemic stroke , 248 cases of ischemic heart disease , and 41 cases of cerebral hemorrhage/10,000 persons with diabetes ; 62 cases of ischemic stroke , 59 cases of ischemic heart disease , and 17 cases of cerebral hemorrhage/10,000 non - diabetic persons ) .
however , only 36.3% and 40.5% of patients received screening for diabetic retinopathy and nephropathy , respectively , in korea .
convincing evidence indicates that diabetes is associated with an increased risk of several types of cancers .
the presence of cancer - related hospitalization in korea was higher in patients with type 2 diabetes than in those without . specifically , in subjects with type 2 diabetes , the risks of hospitalization events due to stomach , colorectal , liver , pancreatic , and lung cancers were 37.9 , 43 , 48 , 17.6 , and 36/10,000 persons , respectively .
the knhanes reported that diabetes is associated with a marked increase in suicidal ideation and suicide attempts .
.   showed that patients with diabetes had a higher risk of mild cognitive impairment that did those without . according to the diabetes fact sheet ,
the prevalence of dementia in patients with type 2 diabetes increased from 1.2% to 5.2% during 2006 to 2013 and was higher than in those without diabetes .
as the korean population ages and the prevalence of diabetes increases , it will become increasingly crucial to find ways to overcome associated complications through good diabetes management .
diabetes self - management education is an important element of care for all those with diabetes and those at risk of developing the disease .
however , only 39.4% of patients with diabetes have received comprehensive diabetes self - management education in korea .
therefore , a systematic approach to manage diabetes , including self - management education , is needed to prevent or delay complications .
more concentrated efforts should be focused on early detection and management of diabetic complications and psychiatric disorders .
the government needs to establish a long - term policy to address the growing burden posed by diabetes .
diabetes mellitus is an increasing global health problem . 
 guidelines for diabetic care recommend management of lifestyle and risk factors ( glucose , blood pressure , and cholesterol ) , as well as regular screening for complications associated with treatment of the conditions related to diabetes . 
 the prevalence of diabetes increased from 8.6% to 11.0% from 2001 to 2013 . according to the diabetes fact sheet 2015 , the proportion of patients with diabetes treated with antihypertensive medications increased from 56.0% to 62.5% from 2006 to 2013 , and 49.5% of those with diabetes 
 were being treated with lipid - lowering medications in 2013 , a 1.8-fold increase since 2006 . according to the 2014 korea national health and nutrition examination survey data , 
 45.6% of patients with diabetes achieved a hemoglobin a1c level of < 7.0% , 72.8% achieved a blood pressure of < 140/85 mmhg , and 58.0% achieved a low density lipoprotein cholesterol level of < 100 mg / dl . 
 only 19.7% of patients with diabetes had good control of all three of these parameters . despite improvements in health promotion efforts , the rates of adherence to medication and risk - factor control are low 
 . 
 therefore , a systematic approach to managing diabetes , including self - management education , is needed to prevent or delay complications . 
 the government needs to establish a long - term policy to address the growing burden of diabetes .