BACKGROUND/OBJECTIVES: Metabolic risk factors should be managed effectively in patients with type 2 diabetes mellitus (T2DM) to prevent or delay diabetic complications. This study aimed to compare the self-management levels of diet and metabolic risk factors in patients with T2DM, according to the d...
BACKGROUND/OBJECTIVES: Metabolic risk factors should be managed effectively in patients with type 2 diabetes mellitus (T2DM) to prevent or delay diabetic complications. This study aimed to compare the self-management levels of diet and metabolic risk factors in patients with T2DM, according to the duration of illness, and to examine the trends in self-management levels during the recent decades. SUBJECTS/METHODS: Data were collected from the Korea National Health and Nutrition Examination Surveys (KNHANES, 1998-2014). In our analysis, 4,148 patients with T2DM, aged ${\geq}30years$, were categorized according to the duration of their illness (< 5 years, 5-9 years, and ${\geq}10years$). Demographic and lifestyle information was assessed through self-administered questionnaires, and biomarker levels (e.g., fasting glucose level, blood pressure, or lipid level) were obtained from a health examination. Dietary intake was assessed by a 24-recall, and adherence level to dietary guidelines (meal patterns and intake levels of calories, carbohydrates, vegetable/seaweed, sodium, and alcohol) were assessed. Multivariable generalized linear regression and unconditional logistic regression models were used to compare the prevalence rates of hyperglycemia, dyslipidemia, and hypertension according to the duration of patients' illness, accounting for the complex survey design of the KNHANES. RESULTS: In the multivariable adjusted models, patients with a longer duration (${\geq}10years$) of T2DM had a higher prevalence of hyperglycemia than those with a shorter duration of T2DM (< 5 years) (odds ratio 2.20, 95% confidence interval 1.61-3.01, P for trend < 0.001). We did not observe any associations of disease duration with the prevalence of hypertension and dyslipidemia. In addition, the adherence levels to dietary recommendations did not significantly differ according to disease duration, except adherence to moderate alcohol consumption. There were significant decreasing trends in the prevalence of hyperglycemia in patients with a duration of illness ${\geq}10years$ (P for trend = 0.004). CONCLUSION: Although the proportion of patients with adequate control of glucose levels has improved in recent decades, poorer self-management has been found in those with a longer disease duration. These findings suggest the need for well-planned and individualized patient education programs to improve self-management levels and quality of life by preventing or delaying diabetic complications.
BACKGROUND/OBJECTIVES: Metabolic risk factors should be managed effectively in patients with type 2 diabetes mellitus (T2DM) to prevent or delay diabetic complications. This study aimed to compare the self-management levels of diet and metabolic risk factors in patients with T2DM, according to the duration of illness, and to examine the trends in self-management levels during the recent decades. SUBJECTS/METHODS: Data were collected from the Korea National Health and Nutrition Examination Surveys (KNHANES, 1998-2014). In our analysis, 4,148 patients with T2DM, aged ${\geq}30years$, were categorized according to the duration of their illness (< 5 years, 5-9 years, and ${\geq}10years$). Demographic and lifestyle information was assessed through self-administered questionnaires, and biomarker levels (e.g., fasting glucose level, blood pressure, or lipid level) were obtained from a health examination. Dietary intake was assessed by a 24-recall, and adherence level to dietary guidelines (meal patterns and intake levels of calories, carbohydrates, vegetable/seaweed, sodium, and alcohol) were assessed. Multivariable generalized linear regression and unconditional logistic regression models were used to compare the prevalence rates of hyperglycemia, dyslipidemia, and hypertension according to the duration of patients' illness, accounting for the complex survey design of the KNHANES. RESULTS: In the multivariable adjusted models, patients with a longer duration (${\geq}10years$) of T2DM had a higher prevalence of hyperglycemia than those with a shorter duration of T2DM (< 5 years) (odds ratio 2.20, 95% confidence interval 1.61-3.01, P for trend < 0.001). We did not observe any associations of disease duration with the prevalence of hypertension and dyslipidemia. In addition, the adherence levels to dietary recommendations did not significantly differ according to disease duration, except adherence to moderate alcohol consumption. There were significant decreasing trends in the prevalence of hyperglycemia in patients with a duration of illness ${\geq}10years$ (P for trend = 0.004). CONCLUSION: Although the proportion of patients with adequate control of glucose levels has improved in recent decades, poorer self-management has been found in those with a longer disease duration. These findings suggest the need for well-planned and individualized patient education programs to improve self-management levels and quality of life by preventing or delaying diabetic complications.
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문제 정의
The aim of this study is to compare the self-management levels of diet and metabolic health biomarkers, including blood glucose, blood pressure, and blood lipid levels, in patients with T2DM according to their duration of illness, and to examine the secular trends of these patients’ self-management abilities in the past 16 years, using nationally representative Korean survey data.
제안 방법
However, as we analyzed data from the KNHANES, a nationwide survey that is representative of the Korean population, our findings can be generalized to Korean adults with T2DM. In addition, to the best of our knowledge, our study is the first to examine the trends in the self-management levels of metabolic risk factors among Korean patients with T2DM, considering their duration of disease and confounding factors.
Information on demographic characteristics, lifestyle, and health (age, sex, household income, educational level, smoking status, alcohol consumption, physical activity, self-perceived stress levels, and diabetes care status) was collected through a self-reported questionnaire. Dietary therapy and nutrition education data were only available from the KNHANES II-VI and III-V, respectively.
The prevalence of hyperglycemia in patients with type 2 diabetes mellitus by the duration of illness and survey year. Values are adjusted for age, sex, body mass index, educational level, smoking status, alcohol consumption, and use of oral hypoglycemic agents and insulin injection. Different superscript letters represent statistical difference by Tukey’s multiple comparison test.
Mean adherence levels for each component of the KDA-KMHW index by duration of diabetes. Values are adjusted for age, sex, body mass index, educational level, smoking status, and use of oral hypoglycemic agents and insulin injection. Alcohol consumption level was also adjusted except for the component of moderate alcohol consumption.
대상 데이터
Of 51,692 KNHANES participants aged ≥ 30 years without missing sampling weight, we only included patients with T2DM, defined as aforementioned, and we excluded pregnant or lactating women (n = 550) and those with an implausible energy intake ([ 500 kcal/day or ] 5,000 kcal/day, n =1,301) [17]. A total of 4,148 patients with T2DM were included in the final analysis (Fig. 1).
데이터처리
Different superscript letters represent statistical difference by Tukey’s multiple comparison test.
Potential confounding factors and effect modification were considered and examined through literature review [7-11,28,29] and descriptive statistical analysis approaches. Using SAS PROC SURVEYREG (version 9.4, SAS Institute Inc., Cary, NC, USA), multivariable generalized linear regression analysis was conducted to estimate means and standard errors (SE) of the prevalent hyperglycemia for the three different groups of illness duration for each survey. The P for trend was calculated using the median value for the prevalent hyperglycemia for each survey round between the KNHANES I (1998) and VI (2014).
성능/효과
4) Physical activity information was only available from KNHANES 2008-2013, and missing data was n = 1,247.
5) Diet therapy information was only available from KNHANES 2001-2014, and missing data was n=248.
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