Journal of Preventive Medicine and Public Health

The Korean Society for Preventive Medicine (대한예방의학회)
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Management of Diabetic Mellitus in Low-income Rural Patients

일개 농촌지역 저소득층 당뇨병환자의 관리 상태

  • Kim, Hye-Yeon (Department of Preventive Medicine, Chonnam National University Medical School) ;
  • Yun, Woo-Jun (Department of Preventive Medicine, Chonnam National University Medical School) ;
  • Shin, Min-Ho (Department of Preventive Medicine, Chonnam National University Medical School) ;
  • Kweon, Sun-Seong (Jeonman Regional Cancer Center, Chonnam National University Hwasun Hospital) ;
  • Ahn, Hye-Ran (Department of Preventive Medicine, Chonnam National University Medical School) ;
  • Choi, Seong-Woo (Department of Preventive Medicine, Chonnam National University Medical School) ;
  • Lee, Young-Hoon (Department of Preventive Medicine, College of Medicine, Seonam University) ;
  • Cho, Dong-Hyeok (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Rhee, Jung-Ae (Department of Preventive Medicine, Chonnam National University Medical School)
  • 김혜연 (전남대학교 의과대학 예방의학교실) ;
  • 윤우준 (전남대학교 의과대학 예방의학교실) ;
  • 신민호 (전남대학교 의과대학 예방의학교실) ;
  • 권순석 (화순전남대학교병원 전남지역암센터) ;
  • 안혜란 (전남대학교 의과대학 예방의학교실) ;
  • 최성우 (전남대학교 의과대학 예방의학교실) ;
  • 이영훈 (서남대학교 의과대학 예방의학교실) ;
  • 조동혁 (전남대학교 의과대학 내과학 교실) ;
  • 이정애 (전남대학교 의과대학 예방의학교실)
  • Published : 2009.09.30
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Abstract

Objectives : Knowledge about the management status of diabetic melitus (DM) is essential to improve diabetic management. Moreover, low income is associated with poor adherence to treatment and increased mortality. This study was performed to evaluate the management status of DM in low-income patients in a rural area. Methods : We enrolled 370 patients with type 2 DM living in Gokseong county, JeollaNamdo. A well-trained examiner measured the height, weight, waist circumference, blood pressure, total cholesterol, triglyceride, high density lipoprotein cholesterol, fasting blood sugar and glycosylated hemoglobin (HbA1c) levels. Carotid ultrasonography was used to measure carotid artery carotid artery intima media thickness (IMT) and plaque. anklebrachial index (ABI) was used to evaluate peripheral artery disease. A fundoscopic examination was performed to evaluate diabetic retinopathy. A history of diabetes complications and health-related questionnaires were also completed. Results : The age of diabetic subjects was 68.7$\pm$8.7 years and the duration of diabetes was 8.9$\pm$8.2 years. Most (63.5%) had hypertension, and 45.7% had triglycerides below 150 mg/dl, 38.1% had low density lipoprotein cholesterol (LDL) cholesterol below 100 mg/dl, 48.7% had urine albumin to creatinine ratio (UACR) below 30 mg/g. Less than half (45.9%) achieved the goal of HbA1c less than 7% suggested by the American Diabetes Association (ADA). 10.6% had peripheral vascular disease, 11.9% had retinopathy, and 60.8% had chronic kidney disease. Conclusions : DM management in low income patients is very poor and requires further work to improve.

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References

  1. Amos AF, McCarty DJ, Zimmet P. The rising global burden of diabetes and its complications: Estimates and projections to the year 2010. Diabet Med 1997; 14(Suppl 5): S1-S85 https://doi.org/10.1002/(SICI)1096-9136(199712)14:5+3.0.CO;2-R
  2. World Health Organization. Prevention of Diabetes Mellitus (Technical report series. no. 844). Geneva: World Health Organization; 1994
  3. World Health Organization. WHO Diabetes Programme. Geneva: World Health Organization; c2009 [cited 2009 Mar 26]. Available from: URL: http://www.who.int/diabetes/en
  4. Park YS, Lee HK, Koh CS, Min HG, Yoo KY, Kim YI, et al. Prevalence of diabetes and IGT in Younchon country, South-Korea. Diabetes Care 1995; 18(4): 545-548 https://doi.org/10.2337/diacare.18.4.545
  5. Kim SM, Lee JS, Lee J, Na JK, Han JH, Yoon DK, et al. Prevalence of diabetes and impaired fasting glucose in Korea. Diabetes Care 2006; 29(2): 226-231 https://doi.org/10.2337/diacare.29.02.06.dc05-0481
  6. Kim JS, Kim YJ, Park SI, Hong YP. Mean fasting blood glucose level and an estimated prevalence of diabetes mellitus among a representative adult Korean population. Korean J Prev Med 1993; 26(3): 311-320. (Korean)
  7. Korea Institute for Health and Social Affairs. The Third Korea National Health and Nutrition Examination Survey (KNHANES III) 2005. Seoul: Korea Institute for Health and Social Affairs; 2006. (Korean)
  8. Korea Center for Disease Control and Prevention; Yonsei University. In-deep Analyses of the Third National Health and Nutrition Examination Survery: The Health Examination Part. Seoul: Korea Center for Disease Control and Prevention; 2007. p.135. (Korean)
  9. Park SW, Kim DJ, Min KW, Baik SH, Choi KM, Park IB, et al. Current status of diabetes management in Korea using National Insurance Database. J Korean Diabetes Assoc 2007; 31(4): 362-367. (Korean) https://doi.org/10.4093/jkda.2007.31.4.362
  10. Kim SA, Park WS, Ohrr HC, Kang HY, Lee DH, Yi SW, et al. Prevalence and management status of diabetes mellitus in Korea. Korean J Med 2005; 68: 10-17. (Korean)
  11. Noh JH, Kim SK, Cho YJ, Nam HU, Kim IJ, Jeong IK, et al. Current status of diabetes management in elderly Koreans with diabetes. Diabetes Res Clin Pract 2007; 77(Suppl 1): S71-S75 https://doi.org/10.1016/j.diabres.2007.01.047
  12. Task Force Team for Constructing Basic Statistics of Diabetes Mellitus in Korea. Diabetes in Korea 2007: Task Force Team for Constructing Basic Statistics of Diabetes Mellitus in Korea Report. 1st ed. Seoul: Hwang Geum Eo Jang Co.; 2007. p.64 (Korean)
  13. Levey AS. Greene T, Kusek J, Beck GJ, Group MS. A simplified equation to predict glomerular filtration rate from serum creatinine. (Abstract) J Am Soc Nephrol 2000; 11: A0828
  14. Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, et al. National Kidney Foundation practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. Ann Intern Med 2003; 139(2): 137-147 https://doi.org/10.7326/0003-4819-139-2-200307150-00013
  15. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasm, without use of the preparative ultracentrifuge. Clin Chem 1972; 18(6): 499-502
  16. Chobanian AV, Bakris Gl, Black HR, Cushman WC, Green LA, Izzo Jr, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report. JAMA 2003; 289:(190): 2560-2572 https://doi.org/10.1001/jama.289.19.2560
  17. Diabetic retinopathy study. Report Number 6. Design, methods, and baseline results. Report Number 7. A modification of the Airlie House classification of diabetic retinopathy. Prepared by the Diabetic Retinopathy. Invest Ophthalmol Vis Sci 1981; 21(1 Pt 2): 1-226
  18. Stoffers HE, Kester AD, Kaiser V, Rinkens PE, Kitslaar PJ, Knottnerus JA. The diagnostic value of the measurement of the ankle-brachial systolic pressure index in primary health care. J Clin Epidemiol 1996; 49(12): 1401-1405 https://doi.org/10.1016/S0895-4356(96)00275-2
  19. US Department of Health and Human Service. Healthy People 2010/Diabetes. Washington: US Department of Health and Human Service; [cited 2009 May 13]. Available from URL: http://www.healthypeople.gov/Document/HTML/Volume1/05Diabetes.htm
  20. American Diabetes Association. Standards of Medical Care in Diabetes-2008. Diabetes Care 2008; 31(Suppl 1): S12-S54 https://doi.org/10.2337/dc08-S012
  21. Deedwania PC. Hypertension and diabetes: New therapeutic options. Arch Intern Med 2000; 160(11): 1585-1594 https://doi.org/10.1001/archinte.160.11.1585
  22. Statton IM, Adler AI, Neil Ha. Association of glycemia and macrovascular and microvascular complications in type 3diabetes: Prospective observational study. BMJ 2000; 321(7258): 405-412 https://doi.org/10.1136/bmj.321.7258.405
  23. Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 2003; 348(5): 383-393 https://doi.org/10.1056/NEJMoa021778
  24. Mooradian AD. Dyslipidemia in type 2 diabetes mellitus. Nat Clin Pract Endocrinol Metab 2009; 5(3): 150-159 https://doi.org/10.1038/ncpendmet1066
  25. Mattock MB, Barnes DJ, Viberti G, Keen H, Burt D, Hughes JM, et al. Microalbuminuria and coronary heart disease in NIDDM: An incidence study. Diabetes 1998; 47(11): 1786-1792 https://doi.org/10.2337/diabetes.47.11.1786
  26. Klausen KP, Scharling H, Jensen JS. Very low level of microalbuminuria is associated with increased risk of death in subjects with cardiovascular or cerebrovascular diseases. J Intern Med 2006; 260(3): 231-237 https://doi.org/10.1111/j.1365-2796.2006.01679.x
  27. Klausen K, Borch-Johnsen K, Feldt-Rasmussen B, Jensen G, Clausen P, Scharling H, et al. Very low levels of microalbuminuria are associated with increased risk of coronary heart disease and death independently of renal function, hypertension, and diabetes. Circulation 2004; 110(1): 32-35 https://doi.org/10.1161/01.CIR.0000133312.96477.48
  28. Christensen PK, Larsen S, Horn T, Olsen S, Parving HH. Renal function and structure in albuminuric type 2 diabetic patients without retinopathy. Nephrol Dial Transplant 2001; 16(2): 2337-2347 https://doi.org/10.1093/ndt/16.12.2337
  29. Naidoo DP. The link between microalbuminuria, endothelial dysfunction and cardiovascular disease in diabetes. Cardiovasc J S Afr 2002; 13(4): 194-199
  30. American Diabetes Association. Peripheral arterial disease in people with diabetes. Diabetes Care 2003; 26(12): 3333-3341 https://doi.org/10.2337/diacare.26.12.3333
  31. Gregg EW, Sorlie P, Oaulose-Ram R, Gu Q, Eberhardt MS, Wolz M, et al. 1999-2000 national health and nutrition examination survey: Prevalence of lower-extremity disease in the US adult population $\geq$ 40 years of age with and without diabetes. Diabetes Care 2004; 27(7): 1591-1597 https://doi.org/10.2337/diacare.27.7.1591
  32. Kim SG, Lim CS, Han DC, Kim GS, Chin HJ, Kim SJ, et al. The prevalence of chronic kidney disease (CKD) and the associated factors to CKD in urban Korea: A population-based cross-sectional epidemiologic study. J Korean Med Sci 2009; 24(Suppl 1): S11-S21 https://doi.org/10.3346/jkms.2009.24.S1.S11
  33. Moon EJ, Jo YE, Park TC, Kim YK, Jung SH, Kim HJ, et al. Clinical Characteristics and Direct Medical Costs of Type 2 Diabetic Patients. Korean Diabetes J 2008; 32(4): 358-365. (Korean) https://doi.org/10.4093/kdj.2008.32.4.358
  34. Hamdy O, Goodyear LJ, Horton ES. Diet and exercise in thpe 2 diabetes mellitus. Endocrinol Metab Clin North Am 2001; 30(4): 883-907 https://doi.org/10.1016/S0889-8529(05)70220-6
  35. Eliasson B, Attvall S, Taskinen MR, Smith U. The insulin resistance syndrome in smokers is related to smoking habits. Arterioscler Thromb 1994; 14(12): 1946-1950 https://doi.org/10.1161/01.ATV.14.12.1946
  36. American Diabetes Association. Nutrition recommendations and principles for people with diabetes mellitus. Diabetes Care 2000; 23(Suppl 1): S43-S46
  37. Franz MJ, Horton ES Sr, Bantle JP, Beebe CA, Brunzell JD, Coulston Am, et al. Nutritional principles for the management of diabetes and related complications. Diabetes Care 1994; 17(5): 490-518 https://doi.org/10.2337/diacare.17.5.490

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