Yonsei Med J.  2020 Feb;61(2):169-178. 10.3349/ymj.2020.61.2.169.

Sociodemographic Factors Associated with Participation in Diabetes Education among Community-Dwelling Adults with Diabetes

• Lee YH

• KMID: 2468492
• DOI: http://doi.org/10.3349/ymj.2020.61.2.169

Abstract

PURPOSE
This study investigated the sociodemographic factors associated with participation in diabetes self-management education (DSME) among community-dwelling adults with diabetes.
MATERIALS AND METHODS
Data from 23400 people aged ≥30 years who were diagnosed with diabetes from the nationwide 2016 Korea Community Health Survey were analyzed. The relationship between sociodemographic factors and participation in DSME was examined by logistic regression analysis. The study sample was classified according to the type of institution providing DSME: hospitals/medical clinics (HMCs) and/or public health institutions (PHIs).
RESULTS
Of the total sample population with diabetes, 27.2% had attended DSME programs, including 21.9% at HMCs, 4.0% at PHIs, and 1.3% at both types of institutions. As age increased and educational level and monthly household income decreased, the odds ratios (ORs) of participation in DSME decreased in a fully adjusted model. Respondents living in rural areas had lower ORs for attending DSME compared to those living in urban areas [OR, 0.85; 95% confidence interval (CI), 0.80-0.91]. Service/sales workers and mechanical/manual workers had lower ORs for attending DSME (OR, 0.84; 95% CI, 0.71-0.99; and OR, 0.81; 95% CI, 0.69-0.94, respectively) compared to professional/managerial workers. However, in the subgroup of participants receiving education at PHIs, the likelihood of participation in DSME increased as age increased, and respondents living in rural areas had higher ORs compared to those living in urban areas (OR, 1.73; 95% CI, 1.51-1.98).
CONCLUSION
Customized DSME programs targeting socioeconomically vulnerable groups, including residential region and reimbursement of DSME by public insurance, are needed to resolve the inequalities in participation in DSME.

Keyword

Diabetes mellitus; education; socioeconomic factors; social class

MeSH Terms

Adult*
Diabetes Mellitus
Education*
Family Characteristics
Health Surveys
Humans
Insurance
Korea
Logistic Models
Odds Ratio
Public Health
Self Care
Social Class
Socioeconomic Factors
Surveys and Questionnaires

Reference

1. Cho NH, Shaw JE, Karuranga S, Huang Y, da Rocha Fernandes JD, Ohlrogge AW, et al. IDF Diabetes Atlas: global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018; 138:271–281. PMID: 29496507.

2. Korea Centers for Disease Control and Prevention. The Seventh Korea National Health and Nutrition Examination Survey (KNHANES VII-2). 2017. accessed on 2019 April 9. Available at: https://knhanes.cdc.go.kr/knhanes/sub04/sub04_03.do?classType=7.

3. American Diabetes Association. 5. Lifestyle management: standards of medical care in diabetes-2019. Diabetes Care. 2019; 42:S46–S60. PMID: 30559231.

4. He X, Li J, Wang B, Yao Q, Li L, Song R, et al. Diabetes self-management education reduces risk of all-cause mortality in type 2 diabetes patients: a systematic review and meta-analysis. Endocrine. 2017; 55:712–731. PMID: 27837440.

5. 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 Educ Couns. 2016; 99:926–943. PMID: 26658704.

6. Cochran J, Conn VS. Meta-analysis of quality of life outcomes following diabetes self-management training. Diabetes Educ. 2008; 34:815–823. PMID: 18832286.

7. Strawbridge LM, Lloyd JT, Meadow A, Riley GF, Howell BL. Oneyear outcomes of diabetes self-management training among medicare beneficiaries newly diagnosed with diabetes. Med Care. 2017; 55:391–397. PMID: 27753746.

8. Kim JM, Hong JW, Noh JH, Kim DJ. Factors associated with participation in diabetes education: The Korea National Health and Nutrition Examination Survey 2007 to 2009. Diabetes Metab J. 2016; 40:447–453. PMID: 27766791.

9. Jung JH, Lee JH, Noh JW, Park JE, Kim HS, Yoo JW, et al. Current status of management in type 2 diabetes mellitus at general hospitals in South Korea. Diabetes Metab J. 2015; 39:307–315. PMID: 26301192.

10. Kim HT, Lee K, Jung SY, Oh SM, Jeong SM, Choi YJ. Barrier factors to the completion of diabetes education in Korean diabetic adult patients: Korea National Health and Nutrition Examination Surveys 2007-2012. Korean J Fam Med. 2015; 36:203–209. PMID: 26435809.

11. Hessler DM, Fisher L, Mullan JT, Glasgow RE, Masharani U. Patient age: a neglected factor when considering disease management in adults with type 2 diabetes. Patient Educ Couns. 2011; 85:154–159. PMID: 21112720.

12. Adjei Boakye E, Varble A, Rojek R, Peavler O, Trainer AK, Osazuwa-Peters N, et al. Sociodemographic factors associated with engagement in diabetes self-management education among people with diabetes in the United States. Public Health Rep. 2018; 133:685–691. PMID: 30223759.

13. Cauch-Dudek K, Victor JC, Sigmond M, Shah BR. Disparities in attendance at diabetes self-management education programs after diagnosis in Ontario, Canada: a cohort study. BMC Public Health. 2013; 13:85. PMID: 23360373.

14. Rhee MK, Cook CB, El-Kebbi I, Lyles RH, Dunbar VG, Panayioto RM, et al. Barriers to diabetes education in urban patients: perceptions, patterns, and associated factors. Diabetes Educ. 2005; 31:410–417. PMID: 15919641.

15. Wu H, Lau ES, Kong AP, Ma RC, Ozaki R, Cheung KK, et al. Association between educational level and cardiovascular disease and all-cause mortality in patients with type 2 diabetes: a prospective study in the Joint Asia Diabetes Evaluation Program. Clin Epidemiol. 2018; 10:1561–1571. PMID: 30464636.

16. Ministry of Health and Welfare. Health and Welfare Statistical Yearbook 2017. accessed on 2019 April 10. Available at: http://www.mohw.go.kr/react/jb/sjb030301vw.jsp?PAR_MENU_ID=03&MENU_ID=032901&CONT_SEQ=343458.

17. Greenwood DA, Gee PM, Fatkin KJ, Peeples M. A systematic review of reviews evaluating technology-enabled diabetes self-management education and support. J Diabetes Sci Technol. 2017; 11:1015–1027. PMID: 28560898.

18. Mulvaney SA, Ritterband LM, Bosslet L. Mobile intervention design in diabetes: review and recommendations. Curr Diab Rep. 2011; 11:486–493. PMID: 21960031.

19. Peyrot M, Rubin RR, Funnell MM, Siminerio LM. Access to diabetes self-management education: results of national surveys of patients, educators, and physicians. Diabetes Educ. 2009; 35:246–263. PMID: 19208816.

20. Schäfer I, Pawels M, Küver C, Pohontsch NJ, Scherer M, van den Bussche H, et al. Strategies for improving participation in diabetes education. A qualitative study. PLoS One. 2014; 9:e95035. PMID: 24733428.

21. Shah BR, Booth GL. Predictors and effectiveness of diabetes selfmanagement education in clinical practice. Patient Educ Couns. 2009; 74:19–22. PMID: 18805668.

22. Icks A, Rathmann W, Haastert B, Mielck A, Holle R, Löwel H, et al. [Quality of care and extent of complications in a population-based sample of patients with type 2 diabetes mellitus. The KORA Survey 2000]. Dtsch Med Wochenschr. 2006; 131:73–78. PMID: 16418944.

23. Shaw K, Killeen M, Sullivan E, Bowman P. Disparities in diabetes self-management education for uninsured and underinsured adults. Diabetes Educ. 2011; 37:813–819. PMID: 22021026.

24. Silbert R, Salcido-Montenegro A, Rodriguez-Gutierrez R, Katabi A, McCoy RG. Hypoglycemia among patients with type 2 diabetes: epidemiology, risk factors, and prevention strategies. Curr Diab Rep. 2018; 18:53. PMID: 29931579.

25. Misra-Hebert AD, Pantalone KM, Ji X, Milinovich A, Dey T, Chagin KM, et al. Patient characteristics associated with severe hypoglycemia in a type 2 diabetes cohort in a large, integrated health care system from 2006 to 2015. Diabetes Care. 2018; 41:1164–1171. PMID: 29549082.

26. Barnett A. Dosing of insulin glargine in the treatment of type 2 diabetes. Clin Ther. 2007; 29:987–999. PMID: 17692716.

27. Ahrén B. Avoiding hypoglycemia: a key to success for glucoselowering therapy in type 2 diabetes. Vasc Health Risk Manag. 2013; 9:155–163. PMID: 23637538.

28. Steinsbekk A, Rygg LØ, Lisulo M, Rise MB, Fretheim A. Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis. BMC Health Serv Res. 2012; 12:213. PMID: 22824531.