Nutr Res Pract.  2018 Feb;12(1):69-77. 10.4162/nrp.2018.12.1.69.

Self-management levels of diet and metabolic risk factors according to disease duration in patients with type 2 diabetes

Affiliations
  • 1Department of Food and Nutrition, Yeungnam University, 280 Daehak-ro, Gyeongsan-si, Gyeongbuk 38541, Korea. kypark@ynu.ac.kr

Abstract

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 ≥ 30 years, were categorized according to the duration of their illness (< 5 years, 5-9 years, and ≥ 10 years). 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 (≥ 10 years) 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 ≥ 10 years (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.

Keyword

Diabetes mellitus; type 2; duration of illness; metabolic risk factors; glucose; self-management

MeSH Terms

Alcohol Drinking
Blood Pressure
Carbohydrates
Diabetes Complications
Diabetes Mellitus
Diabetes Mellitus, Type 2
Diet*
Dyslipidemias
Fasting
Glucose
Humans
Hyperglycemia
Hypertension
Korea
Life Style
Linear Models
Logistic Models
Nutrition Policy
Patient Education as Topic
Prevalence
Quality of Life
Risk Factors*
Self Care*
Sodium
Carbohydrates
Glucose
Sodium

Figure

  • Fig. 1 Flow chart of participants: Korea National Health and Nutrition Examination Survey (KNHANES) I–VI, 1998–2014

  • Fig. 2 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. Each point ranges from 0 (non-adherence) to 1 (perfect adherence); Multivariable general linear models were used to test differences in levels of adherence to each recommendation between groups with three different durations of illness (< 5, 5–9, ≥ 10). Different superscript letters represent statistical difference by Tukey's multiple comparison test. KDA, Korean Diabetes Association; KMHW, Korean Ministry of Health and Welfare.

  • Fig. 3 Mean adherence levels for total score 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. Multivariable general linear models were used to test differences in levels of adherence to each recommendation between groups with three different durations of illness (< 5, 5–9, ≥ 10), but no difference was observed between groups. KDA, Korean Diabetes Association; KMHW, Korean Ministry of Health and Welfare.

  • Fig. 4 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.


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