Korea's diabetes treatment strategy is being reorganized into "individualized, tailored complication prevention." Major countries including the United States and Europe, as well as the Korean Diabetes Association, have already ended metformin's exclusive status as the first-line therapy and recommended priority prescribing based on a patient's cardiovascular and kidney disease risk. This shift comes as new drugs that have demonstrated organ-protective effects, beyond simple blood sugar reduction, have moved into the mainstream.
But despite this medical progress, experts warn that because the domestic reimbursement system has not adopted the latest guidelines, patients' treatment choices are limited and their risk of complications is being left unaddressed.
◇ "Type 2 diabetes control rate 32.4%… from blood sugar management to integrated care"
Korea Novo Nordisk held a media event on Apr. 14 at the Courtyard Marriott Hotel in Jung-gu, Seoul, under the theme "Shifts in the treatment paradigm for type 2 diabetes and how it is applied in Korea's clinical settings."
On the day, endocrinologists including Professor Ryu Yeong-sang of Chosun University College of Medicine and Chosun University Hospital, Professor Cho Yun-gyeong of Ulsan University College of Medicine and Asan Medical Center, and Professor Park Cheol-yeong of Sungkyunkwan University School of Medicine and Kangbuk Samsung Hospital presented unmet needs in diabetes management in Korea and policy tasks for improvement.
As of 2022, among Korean adults 30 and older, there are about 5.33 million people with type 2 diabetes and about 14 million in the prediabetes stage. Type 2 diabetes occurs when some insulin secretion remains but insulin resistance increases due to various factors such as obesity. Type 1 diabetes is an autoimmune disease in which the body's immune system mistakes the pancreatic islets for external invaders and destroys them.
According to Professor Ryu's presentation, while diabetes awareness in Korea is high at 74.7%, the diabetes control rate—meaning the proportion whose blood sugar is well controlled with glycated hemoglobin (HbA1c) below 6.5%—is only 32.4%.
Ryu said, "The risk of death for people with diabetes is 1.55 times higher than for those without, and the heart and kidneys are closely linked, with deterioration in one worsening the other," adding, "For those with complications, the risk of reduced quality of life is up to three times higher, and medical costs can surge by as much as 79 times, so integrated management beyond simple blood sugar control is urgent."
For this reason, academic circles at home and abroad have changed treatment guidelines. Professor Cho explained, "It is now the global standard to use GLP-1RA (glucagon-like peptide-1 receptor agonists) or SGLT-2 inhibitors with proven cardiovascular and kidney protection early, tailored to each patient's characteristics."
Cho added, "In particular, for patients with obesity who need weight loss or when powerful glucose control is required, guidelines recommend using GLP-1RA before basal insulin."
◇ "Policy changes that consider patients' quality of life are urgent"
Experts say, however, that there is a wide gap between the latest medical guidelines and the domestic insurance reimbursement system. Clinicians pointed to the "general principles for antidiabetic agents," which serve as the reimbursement criteria under national health insurance, as a key barrier to the latest treatment strategies.
On this, Professor Park Cheol-yeong said, "The current principles for reimbursing diabetes drugs in Korea were established so long ago that they have become an obstacle in clinical practice."
Park explained, "Global guidelines recommend freely combining medications based on patient benefit, but the domestic reimbursement system remains bound to the old rule of 'metformin first, no matter what.'"
He went on, "Because of this, even when we want to use innovative new drugs like Ozempic (GLP-1RA) in effective combinations, the lack of insurance coverage limits patients' treatment opportunities." He said the reimbursement principles should be revised based on medical evidence.
Park said, "Academic societies are in ongoing discussions with the National Health Insurance Service and the Health Insurance Review and Assessment Service to find common ground, but it will take time to implement."
Experts on the day emphasized, "The ultimate goal of diabetes treatment should be 'patients' survival and quality of life,' not 'simply managing glucose levels,' and a macro perspective is needed that factors in the medical costs that will be saved over the long term by preventing complications."