Nutr Res Pract.  2015 Dec;9(6):658-666. 10.4162/nrp.2015.9.6.658.

Trends in adherence to dietary recommendations among Korean type 2 diabetes mellitus patients

Affiliations
  • 1Department of Food and Nutrition, Yeungnam University, 280 Daehak-Ro, Gyeongsan, Gyeongbuk 712-749, Korea. kypark@ynu.ac.kr

Abstract

BACKGROUND/OBJECTIVES
The current study examined trends in adherence to dietary recommendations and compared the levels of adherence between diagnosed and undiagnosed subjects with type 2 diabetes mellitus (T2DM) in Korea over the past 14 years.
SUBJECTS/METHODS
Data were collected from the 1998-2012 Korea National Health and Nutrition Examination Surveys (KNHANES). Diagnosed diabetes was defined as giving a positive response to questions about awareness of the disease, a physician's diagnosis of diabetes, or medical treatment for diabetes, whereas undiagnosed diabetes was defined as having a fasting glucose level > or = 126 mg/dl. Assessment of adherence level was based on 6 components of dietary guidelines, considering meal patterns and intake levels of calories, carbohydrates, vegetable/seaweed, sodium, and alcohol. The participants received 1 point if they met the criteria for each of the 6 components, and the total possible score ranged from 0 to 6 points. Multivariate generalized linear regression was performed, taking into account the complex survey design.
RESULTS
Among all diabetic patients aged 30 years or older, the proportion of diagnosed diabetes increased dramatically, from 40.9% in 1998 to 75.9% in 2012 (P for trend < 0.001). The overall adherence levels to dietary recommendations were low and did not significantly differ between diagnosed and undiagnosed subjects with T2DM for all survey years. Several improvements were observed, including increased adherence to maintaining sufficient vegetable/seaweed consumption (increased from 0.12 to 0.16 points) and limiting sodium intake (increased from 0.12-0.13 points to 0.19-0.24 points; P for trend < 0.001), while adherence to maintaining moderate alcohol consumption decreased.
CONCLUSIONS
Analysis of data collected by the KNHANES indicates that Korean T2DM patients have poor adherence to dietary recommendations and maintenance of a healthy lifestyle, regardless of disease awareness. This finding suggests that development of practical, evidence-based guidelines is necessary and that provision and expansion of educational programs for T2DM patients is critical after diagnosis.

Keyword

Adherence; dietary recommendations; Korean; type 2 diabetes mellitus

MeSH Terms

Alcohol Drinking
Carbohydrates
Diabetes Mellitus, Type 2*
Diagnosis
Fasting
Glucose
Humans
Korea
Life Style
Linear Models
Meals
Nutrition Policy
Sodium
Carbohydrates
Glucose
Sodium

Figure

  • Fig. 1 Flowchart for the subjects of the present analysis: Korean National Health and Nutrition Examination Survey (KNHANES) 1998-2012. 1) implausible total energy intake, representing < 25% or > 300% of the estimated energy requirements

  • Fig. 2 Trends in diagnosed type 2 diabetes among people aged 30 years or older with self-reported diabetes or fasting glucose levels of ≥ 126 mg/dL

  • Fig. 3 The mean adherence levels and 95% confidence intervals for each recommendation (the 6 components of the KDA-KMHW index), ranging from 0 (non-adherence) to 1 (perfect adherence), for diagnosed (DD, solid lines) and undiagnosed T2DM patients (UD, dashed lines) during the survey years of 1998-2012. Multivariate general linear models were used to test for differences in adherence to each recommendation between UD and DD for all survey years, and no significant differences were observed (P > 0.05). Values are adjusted for age, sex, body mass index, education, household income, and smoking status. T2DM, type 2 diabetes mellitus; KDA-KMHW, Korean Diabetes Association-Korean Ministry of Health and Welfare

  • Fig. 4 Trends in adherence to the recommendations of the KDA-KMHW index, ranging from 0 (non-adherence) to 6 (perfect adherence), for diagnosed (DD, solid lines) and undiagnosed T2DM patients (UD, dashed lines) during the survey years of 1998-2012. A multivariate general linear model was used test for differences in adherence to the KDA-KMHW index between UD and DD for all survey years, and no significant differences were observed (P > 0.05). Values are adjusted for age, sex, body mass index, education, household income, and smoking status. T2DM, type 2 diabetes mellitus; KDA-KMHW, Korean Diabetes Association-Korean Ministry of Health and Welfare


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