Diabetes Fact Sheet 2025: Comparative Epidemiology and Clinical Features of Obese and Non-Obese Diabetes in Korea

Abstract

Background: The growing burden of obesity has profoundly influenced the epidemiology and phenotype of diabetes. This study aimed to compare the epidemiology and clinical features between obese and non-obese diabetes in Korean adults using nationwide database. Methods: We analyzed data from the Korea National Health and Nutrition Examination Survey (2012-2023) to evaluate the prevalence and management of diabetes, as well as associated comorbidities. Data from the Korean National Health Insurance Service were used to assess antidiabetic medication use, metabolic surgery trends, and cancer outcomes. Results: Diabetes prevalence was nearly twice as high in adults with obesity compared with those without (17.6% vs. 9.5%), with the larger difference observed in individuals aged 30 to 59 years. Obese diabetes was associated with higher rates of hypertension and dyslipidemia and lower rates of achieving glycemic, blood pressure, and lipid targets; only 21.0% achieved all three goals. Although sodium-glucose cotransporter 2 inhibitors and thiazolidinediones were more frequently prescribed in obese diabetes, overall use remained low. Metabolic surgery was less common in individuals with diabetes than in those without; sleeve gastrectomy predominated, while Roux-en-Y gastric bypass was performed more often in those with diabetes. Higher body mass index was associated with increased incidence of thyroid, breast, prostate, and kidney cancers. Conclusion: Obese diabetes represents a distinct, high-risk phenotype in Korea, characterized by a greater cardiometabolic burden and suboptimal risk-factor control. Comprehensive management strategies integrating weight reduction with metabolic and cardiovascular risk control are essential to improve outcomes in this population.