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The Committee of Clinical Practice Guidelines of the Korean Diabetes Association (KDA) updated the previous clinical practice guidelines for Korean adults with diabetes and prediabetes and published the seventh edition in May 2021. We performed a comprehensive systematic review of recent clinical trials and evidence that could be applicable in real-world practice and suitable for the Korean population. The guideline is provided for all healthcare providers including physicians, diabetes experts, and certified diabetes educators across the country who manage patients with diabetes or the individuals at the risk of developing diabetes mellitus. The recommendations for screening diabetes and glucose-lowering agents have been revised and updated. New sections for continuous glucose monitoring, insulin pump use, and non-alcoholic fatty liver disease in patients with diabetes mellitus have been added. The KDA recommends active vaccination for coronavirus disease 2019 in patients with diabetes during the pandemic. An abridgement that contains practical information for patient education and systematic management in the clinic was published separately.

Additional file 1. Supplementary Table 1. Search Strategy in MEDLINE through PubMed. Supplementary Table 2. The framework of PICO in developing the focused question. Supplementary Table 3. Characteristics of randomized controlled trials included in the meta-analysis to evaluate the effects of carbohydrate-restricted diets. Supplementary Table 4. Characteristics of randomized controlled trials included in the meta-analysis to evaluate the effects of intermittent fasting. Supplementary Table 5. Classification of carbohydrate-restricted diets. Supplementary Table 6. Quality of the evidence assessment for included studies evaluating the effects of carbohydrate-restricted diets in adults with overweight/obesity. Supplementary Table 7. Quality of the evidence assessment for included studies evaluating the effects of intermittent fasting (IF) in adults with overweight/obesity. Supplementary Table 8. Quality of the evidence assessment for included studies evaluating the effects of carbohydrate-restricted diets in adults with diabetes. Supplementary Table 9. Quality of the evidence assessment for included studies evaluating the effects of carbohydrate-restricted diets in adults with hypertension. Supplementary Fig. 1. PRISMA study flow for literature selection and exclusion process. Supplementary Fig. 2. Risk of bias assessment in studies evaluating the effects of carbohydrate-restricted diets in adults with overweight/obesity. Supplementary Fig. 3. Effects of carbohydrate-restricted diet on body mass index (BMI) in adults with overweight/obesity. Supplementary Fig. 4. Effects of carbohydrate-restricted diets on waist circumference in adults with overweight/obesity. Supplementary Fig. 5. Effects of carbohydrate-restricted diets on fat mass in adults with overweight/obesity. Supplementary Fig. 6. Effects of carbohydrate-restricted diets on body fat percentage in adults with overweight/obesity. Supplementary Fig. 7. Effects of carbohydrate-restricted diets on serum lipid profile in adults with overweight/obesity. Supplementary Fig. 8. Effects of carbohydrate-restricted diets on blood pressure in adults with overweight/obesity. Supplementary Fig. 9. Effects of carbohydrate-restricted diets on fasting glucose, HbA1c, and fasting insulin levels in adults with overweight/obesity. Supplementary Fig. 10. Effects of carbohydrate-restricted diets on serum adiponectin and C reactive protein (CRP) levels in adults with overweight/obesity. Supplementary Fig. 11. Effects of carbohydrate-restricted diets on fat free mass in adults with overweight/obesity. Supplementary Fig. 12. Adverse events reported regarding carbohydrate-restricted diets in adults with overweight/obesity. Supplementary Fig. 13. Risk of bias assessment in studies evaluating the effects of intermittent fasting in adults with overweight/obesity. Supplementary Fig. 14. Effect of Intermittent fasting on (A) Body weight, (B) Body mass index, (C) Waist circumference, (D) Fat free mass, (E) Fat mass, and (F) Fat mass in adults with overweight/obesity. Supplementary Fig. 15. Effect of Intermittent fasting on (A) Triglyceride (mg/dl), (B) HDL cholesterol (HDL-C, mg/dl), (C) LDL cholesterol (LDL-C, mg/dl), (D) Hemoglobin A1C (%), (E) Fasting glucose (mg/dl), (F) Fasting insulin (μU/mL), (G) HOMA-IR (%), (H) Systolic blood pressure (mmHg), and (I) Diastolic blood pressure(mmHg) in adults with overweight/obesity. Supplementary Fig. 16. Risk of bias assessment in studies evaluating the effects of carbohydrate-restricted diets in adults with diabetes. Supplementary Fig. 17. Effect of carbohydrate-restricted diets on glycosylated hemoglobin (HbA1c) in adults with diabetes in East-Asian countries (China, Japan, Taiwan). Supplementary Fig. 18. Effect of carbohydrate-restricted diets on body weight in adults with diabetes. Supplementary Fig. 19. Effect of carbohydrate-restricted diets on blood pressure in adults with diabetes. Supplementary Fig. 20. Effect of carbohydrate-restricted diets on lipid profiles in adults with diabetes. Supplementary Fig. 21. Effect of carbohydrate-restricted diets on fasting glucose in adults with diabetes. Supplementary Fig. 22. Effect of carbohydrate-restricted diets on insulin resistance (HOMA-IR) in adults with diabetes. Supplementary Fig. 23. Risk of bias assessment in studies evaluating the effects of carbohydrate-restricted diets in adults with hypertension. Supplementary Fig. 24. Effect of carbohydrate-restricted diets on body weight in adults with hypertension. Supplementary Fig. 25. Effect of carbohydrate-restricted diets on lipid profile in adults with hypertension

Supplemental Digital Content is available in the text, This study investigated trends in the prescription of antidiabetic medications for patients with type 2 diabetes, focusing on changing patterns of prescriptions and the cost of drugs during the last 10 years. Retrospective data on patients with type 2 diabetes aged 30 years or older were analyzed using information from the National Health Information Database collected by the National Health Insurance Service in Korea from January 2002 to December 2013. We identified patients with type 2 diabetes who had at least one service claim in each year during the study period. The prescribing information was collected and fixed-dose combination tablets were counted as each of their constituent classes. The total number of adults with type 2 diabetes who were treated using antidiabetic agents increased from 0.87 million in 2002 to 2.72 million in 2013 in Korea. Among antidiabetic medications in 2002, sulfonylurea (SU) was the most commonly used agent (87.2%), and metformin was the second (52.9%). However, in 2013, the use of metformin increased to 80.4% of the total antidiabetic prescriptions. The use of dipeptidyl peptidase-4 (DPP-4) inhibitor increased remarkably after release in late 2008 and composed one-third of the market share with 1 million prescriptions (38.4%) in 2013. Among the prescriptions for monotherapy, only 13.0% were metformin in 2002, but the amount increased to 53.2% by 2013. In contrast, the use of SU declined dramatically from 75.2% in 2002 to 30.6% in 2013. Dual and triple combinations steadily increased from 35.0% and 6.6% in 2002 to 44.9% and 15.5% in 2013, respectively. In 2013, SU with metformin (41.7%) and metformin with DPP-4 inhibitor (32.5%) combination were most frequently prescribed. The total antidiabetic medication cost increased explosively from U.S. $70 million (82.5 billion won) in 2002 to U.S. $4 billion (480 billion won) in 2013. The use of antidiabetic agents and their costs have been increasing steadily. Metformin is the most commonly used drug recently. The use of DPP-4 inhibitor increased significantly over the past decade, whereas the use of SU decreased. However, SUs still remain the most commonly prescribed second-line agents with metformin in 2013.