Korean J Adult Nurs.  2019 Jun;31(3):235-248. 10.7475/kjan.2019.31.3.235.

Factors Influencing Glycemic Control among Type 2 Diabetes Mellitus Patients: The Sixth Korea National Health and Nutrition Examination Survey (2013~2015)

• Gu MO

• KMID: 2450088
• DOI: http://doi.org/10.7475/kjan.2019.31.3.235

Abstract

PURPOSE
This study was conducted to examine factors influencing glycemic control among type 2 Diabetes Mellitus (T2DM) patients using data from the sixth Korea National Health and Nutrition Examination Survey (2013~2015).
METHODS
The subjects were 1,181 patients aged 30 years and older who were diagnosed with T2DM. The subjects were divided into three groups according to the glycated hemoglobin (HbA1c) values: good Glycemic Control Group (good GCT, HbA1c<7%), insufficient GCT (7≤HbA1c <8%), and poor GCT (8%≥HbA1c). Multivariate multinomial logistic regression was used to examine the association of socio-demographic, diabetes-related, health status, weight control, health behavior, and psychological factors with glycemic control among T2DM patients.
RESULTS
The patients were distributed as follows: 44.1% in the good GCT, 29.1% in the insufficient GCT, and 26.8% in the poor GCT. In the insufficient GCT, DM duration, DM treatment, weight change, and smoking were significant factors influencing glycemic control with T2DM. In the poor GCT, age, DM duration, DM treatment, and hypertension were significant factors influencing glycemic control with T2DM.
CONCLUSION
Strategies for the insufficient GCT should include intensive glucose control interventions for patients with DM for over 1 year, combined therapy of oral hypoglycemic agents and insulin. In addition, it is necessary to actively perform nursing interventions for weight loss. Strategies for the poor GCT should include intensive glucose control interventions for younger age groups, more than 5 years of DM, combined therapy of oral hypoglycemic agents and insulin, and those without hypertension.

MeSH Terms

Blood Glucose
Diabetes Mellitus, Type 2*
Glucose
Health Behavior
Hemoglobin A, Glycosylated
Humans
Hypertension
Hypoglycemic Agents
Insulin
Korea*
Logistic Models
Nursing
Nutrition Surveys*
Psychology
Smoke
Smoking
Weight Loss
Blood Glucose
Glucose
Hypoglycemic Agents
Insulin
Smoke

Reference

1. Korean Diabetes Association. Diabetes fact sheet in Korea 2018 [Internet]. Seoul: Korean Diabetes Association;2018. [cited 2019 January 3]. Available from:. http://www.diabetes.or.kr/pro/news/admin.php?category=A&code=admin&number=1546&mode=view.

2. Statistics Korea. 2017 statistics of causes of death for Korea [Internet]. Seoul: Statistics Korea;2018. [cited 2019 January 25]. Available from:. http://kostat.go.kr/portal/korea/kor_nw/1/6/1/index.board?bmode=read&aSeq=370710.

3. United Kingdom Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). The Lancet. 1998; 352(9131):837–53. https://doi.org/10.1016/S0140-6736(98)07019-6.

4. Korean Diabetes Association. 2015 treatment guideline for diabetes. Seoul: Korean Diabetes Association;2015. p. 24–40.

5. American Diabetes Association. Glycemic targets: standards of medical care in diabetes-2018. Diabetes Care. 2018; 41(suppl. 1):S55–64. https://doi.org/10.2337/dc18-S006.

6. Park J, Lim S, Yim E, Kim Y, Chung W. Factors associated with poor glycemic control among patients with type 2 diabetes mellitus: the fifth Korea National Health and Nutrition Examination Survey (2010-2012). Health Policy and Management. 2016; 26(2):125–34. https://doi.org/10.4332/KJHPA.2016.26.2.125.

7. Jeon JY, Kim DJ, Ko S-H, Kwon H-S, Lim S, Choi SH, et al. Current status of glycemic control of patients with diabetes in Korea: the fifth Korea National Health and Nutrition Examination Survey. Diabetes & Metabolism Journal. 2014; 38(3):197–203. https://doi.org/10.4093/dmj.2014.38.3.197.

8. Pyo E-Y, Jung M-H, Kim YS. Factors related to blood glucose control in patients with diabetes. Korean Journal of Health Education and Promotion. 2012; 29(3):15–22.

9. Kim K. The influencing factors associated with glycemic control among adult diabetes patients. Journal of the Korean Aca-demia-Industrial cooperation Society. 2015; 16(5):3284–92. https://doi.org/10.5762/KAIS.2015.16.5.3284.

10. Kang H-Y, Gu MO. Comparative study on self-care behavior, diabetes-related stress, and stress coping among good, inadequate, and poor glycemic control groups. Journal of Korean Academy of Fundamentals of Nursing. 2012; 19(2):168–78.

11. Kim J-K, Gu MO. Comparative study on self-care behavior related factors for good, inadequate, and poor glycemic control groups: based on variables from theory of planned behavior, habit, and family support. Journal of Korean Academy of Fundamentals of Nursing. 2016; 23(3):245–55. https://doi.org/10.7739/jkafn.2016.23.3.245.

12. Korean Centers for Disease Control and Prevention. The sixth Korea National Health and Nutrition Examination Survey (2013-2015) [Internet]. Seoul: Korean Centers for Disease Control and Prevention;2015. [cited 2018 September 20]. Available from:. https://knhanes.cdc.go.kr/knhanes/sub03/sub03_02_02.do.

13. WHO expert consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. The Lancet. 2004; 363(9403):157–63. https://doi.org/10.1016/S0140-6736(03)15268-3.

14. Korean Society for the Study of Obesity. Diagnosis and evaluation of obesity [Internet]. Seoul: Korean Society for the Study of Obesity;2018. [cited 2018 October 20]. Available from:. http://general.kosso.or.kr/html/?pmode=obesityDiagnosis.

15. Kim SY. It's still not too late to make a change: current status of glycemic control in Korea. Diabetes & Metabolism Journal. 2014; 38(3):194–6. https://doi.org/10.4093/dmj.2014.38.3.194.

16. Rothenbacher D, Rüter G, Saam S, Brenner H. Younger patients with type 2 diabetes need better glycaemic control: results of a communitybased study describing factors associated with a high HbA1c value. British Journal of General Practice. 2003; 3(490):389–91.

17. El-Kebbi IM, Cook CB, Ziemer DC, Miller CD, Gallina DL, Phillips LS. Association of younger age with poor glycemic control and obesity in urban African Americans with type 2 diabetes. Archives of Internal Medicine. 2003; 163(1):69–75. https://doi.org/10.1001/archinte.163.1.69.

18. Jung KM. Related factors on self-care behavior in adolescent and adulthood patients with type 2 diabetes [master's thesis]. Seoul: Korea University;2013.

19. Kim HE, Kim EJ, Kim G. The effects of diabetes management programs using mobile app: a systematic review and a meta analysis. The Journal of Korea Contents Association. 2015; 15(1):300–7. https://doi.org/10.5392/JKCA.2015.15.01.300.

20. Guk MR, Choi JY. Factors associated with hospitalization among patients with diabetes mellitus. Korean Journal of Adult Nursing. 2017; 29(1):1–11. https://doi.org/10.7475/kjan.2017.29.1.1.

21. Egede LE, Gebregziabher M, Hunt KJ, Axon RN, Echols C, Gilbert GE, et al. Regional, geographic, and racial/ethnic var-iation in glycemic control in a national sample of veterans with diabetes. Diabetes Care. 2011; 34(4):938–43. https://doi.org/10.2337/dc10-1504.

22. Siram AT, Yanagisawa R, Skamagas M. Weight management in type 2 diabetes mellitus. Mount Sinal Journal of Medicine. 2010; 77(5):533–48. https://doi.org/10.1002/msj.20208.

23. Sargeant LA, Khaw K-T, Bingham S, Day NE, Luben RN, Oakes S, et al. Cigarette smoking and glycaemia: the EPIC-Norfolk study. International Journal of Epidemiology. 2001; 30(3):547–54. https://doi.org/10.1093/ije/30.3.547.

24. Jang J-E, Cho YI, Lee BW, Shin E-S, Lee SH. Effectiveness of exercise intervention in reducing body weight and glycosylated hemoglobin levels in patients with type 2 diabetes mellitus in Korea: a systematic review and metaanalysis. Diabetes & Metabolism Journal. 2018; 42:e45. https://doi.org/10.4093/dmj.2018.0062.

25. Choi EJ. Factors related to glycemic control in patients with type 2 diabetes mellitus [dissertation]. Seoul: Yonsei University;2007.

26. Chrvala CA, Sherr D, Lipman RD. Diabetes self-management education for adults with type 2 diabetes mellitus: a systematic review of the effect on glycemic control. Patient Education and Counselling. 2016; 99(6):926–43. https://doi.org/10.1016/j.pec.2015.11.003.

27. Sim KH, Hwang MS. Effect of self-monitoring of blood glucose based diabetes self-management education on glycemic control in type 2 diabetes. The Journal of Korean Academic Society of Nursing Education. 2013; 19(2):127–36. https://doi.org/10.5977/jkasne.2013.19.2.127.