Timely recognition of diabetes risk by primary care physicians facilitates appropriate interventions, reducing the risk of complications and improving quality of life in diabetics. Therefore, primary care physicians diagnosing diabetes must be aware of the advantages and disadvantages of various tests. Diabetes can be diagnosed by plasma blood glucose, glycated hemoglobin, or oral glucose tolerance testing. Since the fasting plasma blood glucose test has low sensitivity for diagnosing diabetes, it should be combined with glycated hemoglobin or oral glucose tolerance testing. In particular, in the case of glycated hemoglobin of 6.1% or more, fasting plasma glucose of 110~125 mg/dL, or with a risk factor for diabetes, the oral glucose tolerance test should be performed. The two important criteria that distinguish type 1 from type 2 diabetes are islet autoantibody status and C-peptide. If patients are autoantibody-positive or have a C-peptide level less than 0.6 ng/mL, a diagnosis of type 1 diabetes is suggested. Monogenic diabetes is likely among patients under the age of 35 (mainly under the age of 25) with one or more of the following features: A1C < 7.5% at diagnosis, one parent with diabetes, and features of a specific monogenic cause. In that case, primary care physicians should request a genetic test.

The prevalence of prediabetes has steadily increased in Korea, driven by rising obesity rates and lifestyle changes. A structured lifestyle modification program has been shown to significantly reduce the prevalence of diabetes among adults with prediabetes, with this effect sustained over time. Lifestyle modifications including medical nutrition, exercise, and behavioral psychological therapy are effective for preventing and managing diabetes, with medical nutrition therapy playing a crucial role. This study reviews the latest academic guidelines and medical nutrition therapy for diabetes prevention and to introduce the KDPS-hLSM (Korean Diabetes Prevention Study hospital-based lifestyle modification).

The Korean Diabetes Association published the 2023 Clinical Practice Guidelines for Diabetes, which reflected recent clinical research on diabetes medications. The emergence of new medications effective in preventing and delaying cardiorenal complications has led to changes in the existing treatment paradigm. Reflecting this reality, in April 2023, the Health Insurance Review & Assessment Service exceptionally allowed triple therapy including sodium glucose cotransporter 2 (SGLT2) inhibitors. However, a gap still exists between revised medication recommendations and insurance coverage standards. Therefore, it is important for primary care providers to understand both the updated recommendations and insurance coverage criteria in order to effectively counsel their diabetic patients. Given this background, this article aims to summarize the key medication treatment recommendations from the 2023 Clinical Practice Guidelines for Diabetes and the relevant insurance reimbursement criteria from a primary care perspective.

Diabetes, one of the representative chronic diseases and a key risk factor for cardiovascular disease, is continuously increasing in prevalence. The complications associated with metabolic diseases, such as hypertension and dyslipidemia are becoming significant public health concern. In general, diabetes is a progressive disease that requires active treatment upon onset, and the number of medications needed tends to increase over time. Due to these characteristics, treatment and management in the prediabetic stage are being emphasized. In addition to the increasing prevalence of diabetes, the prevalence of prediabetes in Korea is also gradually increasing to 41.1% in adults aged 30 years or older and 47.7% in adults aged 65 years or older. This trend is driven by various factors such as westernized lifestyle, rising obesity rates, and environmental factors such as age, diet, lack of exercise, stress, and medications. In this article, I introduce key points for prevention of progression to diabetes in the prediabetic stage.

Gestational diabetes mellitus (GDM) affects 2~10% of pregnant women worldwide, with an increasing prevalence in South Korea that reached 18.2% in 2021. Unmanaged GDM can lead to serious complications for both mother and fetus. Effective management requires blood glucose monitoring and lifestyle changes, but many women lack sufficient knowledge about the condition. This study explores the use of smart platforms, like continuous glucose monitoring devices and mobile apps, to improve GDM education. Devices such as Dexcom G7 and FreeStyle Libre 2 enable real-time blood glucose monitoring, while apps like Health2Sync help patients share data with healthcare providers. Although these technologies offer major benefits, challenges remain in patient engagement, data accuracy, and accessibility. In conclusion, while smart platforms can enhance GDM management, they must be combined with ongoing professional support to improve health outcomes.

Type 2 diabetes mellitus (T2DM) is a chronic condition characterized by hyperglycemia. While lifestyle modifications and oral medications are initial treatments, many patients require injectable therapies like insulin and incretin-based drugs. Insulin therapy, a cornerstone treatment for T2DM, can effectively control blood sugar but is associated with hypoglycemia and weight gain. Incretin-based therapies, such as glucagon-like peptide-1 (GLP-1) receptor agonists offer improved glycemic control, weight loss, and reduced cardiovascular risk. Recent studies have shown the superiority of incretin-based therapies over basal insulin. Among these, GLP-1/GIP (glucose-dependent insulinotropic polypeptide) receptor dual agonists like tirzepatide have demonstrated significant weight loss and improved glycemic control. Selection of injectable therapy should be individualized based on factors like glycemic goals, cardiovascular risk, hypoglycemia risk, and patient preference. While insulin remains a useful option, incretin-based therapies, especially newer agents, offer promising therapeutic benefits for many patients with T2DM.

Diabetic kidney disease (DKD) is a major cause of end-stage renal disease and a key driver of morbidity and mortality in individuals with type 2 diabetes (T2D). Despite established therapies, including renin-angiotensin-aldosterone system inhibitors and sodium glucose cotransporter 2 inhibitors, many patients continue to experience progressive kidney function decline. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) like semaglutide have demonstrated potential kidney-protective effects independent of their glucose-lowering properties through mechanisms that include reducing inflammation, oxidative stress, and fibrosis. The FLOW (Research study to see how semaglutide works compared to placebo in people with type 2 diabetes and chronic kidney disease) trial provided the first large-scale evidence that semaglutide slows the progression of chronic kidney disease in individuals with T2D, reducing the risk of clinically significant kidney outcomes by 24%. These findings suggest that GLP-1RAs may play an increasingly important role in DKD management, complementing existing therapies. This review examines the mechanisms underlying GLP-1RA-mediated kidney protection, summarizes recent clinical trial data, and discusses the implications for future treatment strategies.

Diabetic kidney disease (DKD) is a leading cause of chronic kidney disease (CKD) and end-stage renal disease in Korea, with an increasing prevalence due to the aging population and rising diabetes cases. While glycemic control has improved, DKD prevention requires a multifaceted approach addressing blood pressure, lipid levels, and lifestyle factors. This study reviews the current status of DKD management in Korea and proposes strategies for optimization. Patients with DKD frequently present with comorbidities such as hypertension, dyslipidemia, and obesity. Although renin-angiotensin-aldosterone system inhibitors are commonly prescribed, the utilization of newer therapies, such as sodium glucose cotransporter 2 (SGLT2) inhibitors, remains low. Effective management necessitates comprehensive risk factor control, careful medication selection, and public education on the risk of nephrotoxic drugs and unverified supplements. Policy changes are needed to improve access to advanced therapies and personalized care. Expanding the use of SGLT2 inhibitors, glucagon-like peptide-1 receptor agonists, and mineralocorticoid receptor antagonists can delay disease progression and enhance patient outcomes. Additionally, public education and monitoring systems are critical to prevent the misuse of nephrotoxic agents. In conclusion, DKD is a growing public health challenge in Korea. Collaborative efforts among healthcare providers, policymakers, and patients are needed to improve patient care through integrated, data-driven strategies.

Mental health literacy is important for early detection and treatment of mental disorders. Diabetic patients are at increased risk of developing mental illnesses such as depression, anxiety, and eating disorders, which can impact blood sugar control and quality of life. Despite this, mental health service use among diabetic patients remains low. This paper highlights the importance of a tailored approach to enhancing mental health literacy in this population, focusing on three key areas: recognizing early signs of mental illness, promoting help-seeking behavior, and preventing suicide.