Diabetes is a growing health issue worldwide. It is a complex condition affecting how the body uses blood sugar, a primary energy source. Uncontrolled diabetes can lead to severe health complications. This article explores diabetes in Korea, examining its prevalence, unique contributing factors, healthcare responses, and the daily realities for those living with the condition.
Prevalence and Trends in Korea
Diabetes has become a significant public health concern in South Korea, with a noticeable increase in its prevalence over recent decades. As of 2022, the prevalence of diabetes among individuals aged 19 and older was 12.5%, rising to 14.8% for those aged 30 and older. The total number of people with diabetes aged 19 and above is estimated at 5.4 million.
While the age-standardized prevalence among individuals aged 19 and older remained relatively stable between 2011 (9.3%) and 2022 (9.1%), certain demographic shifts are apparent. The prevalence of diabetes has shown a distinct increase in older age groups, particularly among those aged 70 and older, rising from 25.9% in 2011 to 29.4% in 2022. Men generally experience a higher prevalence of diabetes than women, approximately 1.3 times more, and tend to develop the condition at a younger age, notably in their 30s and 40s.
The incidence of diabetes in Korea initially decreased from 8.1 per 1,000 persons in 2006 to 6.3 per 1,000 persons in 2014, but it subsequently rose to 7.5 per 1,000 persons by 2019. There has also been a significant increase in the incidence of type 1 diabetes, from 1.1 per 100,000 persons in 1995 to 4.8 per 100,000 persons in 2016. Additionally, gestational diabetes prevalence saw a substantial rise, from 4.1% in 2007 to 22.3% in 2023. Rural residents have also been identified as a vulnerable group with a higher risk of diabetes.
Distinct Contributing Factors
The rise and persistence of diabetes in Korea are influenced by a combination of evolving lifestyle patterns and specific genetic factors. The rapid economic development and subsequent Westernization of the traditional Korean diet have played a significant role. This shift involves increased consumption of processed foods and a move away from traditional meals emphasizing vegetables and fermented foods.
A higher intake of ultra-processed foods, particularly ham/sausage, instant noodles, ice cream, and carbonated beverages, is associated with an increased risk of type 2 diabetes in Korean adults. Their consumption was linked to a 34% increase in type 2 diabetes incidence over 15 years. This dietary transition, alongside increased obesity rates, contributes to a decrease in insulin sensitivity among Korean patients with type 2 diabetes.
Alongside dietary changes, reduced physical activity levels due to urbanization also contribute to the increasing prevalence of diabetes. Compliance with physical activity guidelines has been declining, with many Korean adults not meeting recommendations. A sedentary lifestyle is a recognized risk factor for diabetes in Korea.
Genetic predispositions also play a part in the susceptibility to type 2 diabetes within the Korean population. While environmental factors like diet and physical inactivity are primary drivers, genetic variants can influence an individual’s risk. Specific genetic associations for type 2 diabetes have been observed. Individuals with a higher genetic risk have also shown a faster decline in beta-cell function, which affects insulin production.
Healthcare Approaches and Public Health Initiatives
The South Korean healthcare system and public health bodies have implemented various strategies to address the growing burden of diabetes. The Korean Diabetes Association (KDA) plays a central role, updating clinical practice guidelines to reflect the latest research and suit the Korean population. These guidelines cover diagnosis, screening, prevention, and treatment of diabetes and its complications.
National screening programs are in place for early detection. The KDA recommends annual screening for adults aged 35 and older, and for those aged 19 and older with risk factors like overweight or obesity. Diagnostic criteria for diabetes in Korea include specific levels for glycosylated hemoglobin (HbA1c), fasting plasma glucose, or a 2-hour oral glucose tolerance test. The HbA1c test is widely used for its convenience.
The National Health Insurance Service (NHIS) covers 97% of the Korean population and plays a significant role in diabetes management by providing coverage for medical expenses. For type 1 diabetes, the NHIS covers a substantial portion of the costs for consumables like test strips, needles, lancets, syringes, and insulin pump supplies. The government has also expanded support for continuous glucose monitors (CGMs) and insulin pumps, particularly for youth under 19, reducing out-of-pocket costs.
Government-led prevention campaigns and patient education programs are also active. The Korea Disease Control and Prevention Agency (KDCA) conducts nationwide campaigns to raise awareness of cardio-cerebrovascular diseases, including hypertension and diabetes. The KDCA also operates registry programs that provide financial support to registered patients for medical expenses and offer education and consultations on self-monitoring, nutrition, and physical activity. Educational programs for diabetes patients, including multidisciplinary intensive management, are available for both inpatients and outpatients, offering individualized and group teaching. Technology is increasingly integrated into diabetes management, with platforms and mobile applications allowing patients to upload glucose data and receive feedback from medical teams, aiming for more efficient self-management.
Daily Life and Cultural Considerations
Living with diabetes in Korea involves navigating specific cultural nuances and daily practices that can either support or challenge disease management. Traditional Korean dietary habits, while often vegetable-rich and fermented, have undergone significant changes due to Westernization, impacting diabetes control. While a traditional Korean diet (K-diet) has shown beneficial effects on glycemic control, the increased consumption of white rice, noodles, and bread, alongside processed foods, can pose challenges. Patients are encouraged to incorporate multigrain rice and non-starchy vegetables in dishes like bibimbap and kimbap to manage blood sugar.
Family support plays a role in diabetes management, particularly concerning dietary adherence. Studies indicate that a higher level of family support specific to diet is associated with better glucose control among Korean patients with type 2 diabetes. This suggests that involving the entire family in diabetes education programs can be beneficial.
Despite these support systems, cultural stigmas associated with diabetes can present barriers to effective management. In Korea, diabetes is sometimes perceived as a result of “bad habits,” leading to a tendency for patients to conceal their condition due to fear of social stigmatization in workplaces and other social settings. This stigma can cause individuals to delay seeking help or even postpone necessary insulin treatment. This cultural aspect underscores the importance of public awareness campaigns to eliminate such prejudices and encourage open discussion about the condition.