Journal of Nutrition and Health

  • 제52권2호
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  • Pages.206-216
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  • 2019
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  • 2288-3886(pISSN)
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  • 2288-3959(eISSN)
한국영양학회 (The Korean Nutrition Society)
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성인 당뇨병 환자의 소득수준에 따른 혈당, 당화혈색소, 혈압, 및 혈중지질 지표의 변화 추이 : 국민건강영양조사 1998~2014 분석 결과

Trends in metabolic risk factors among patients with diabetes mellitus according to income levels: the Korea National Health and Nutrition Examination Surveys 1998~2014

  • 조수경 (영남대학교 식품영양학과) ;
  • 박경 (영남대학교 식품영양학과)
  • Cho, Sukyung (Department of Food and Nutrition, Yeungnam University) ;
  • Park, Kyong (Department of Food and Nutrition, Yeungnam University)
  • 투고 : 2018.11.13
  • 심사 : 2019.01.22
  • 발행 : 2019.04.30
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초록

본 연구는 당뇨병 환자들의 소득수준에 따라 대사위험지표 관리수준을 비교하고, 최근 관리 추이를 관찰하여 궁극적으로 당뇨병 환자들의 합병증 예방 관련 전략을 마련할 수 있는 기초자료를 마련하기 위하여 1998 ~ 2014년 국민건강영양조사 자료를 분석하였다. 국민건강영양조사에 참여한 조사대상자 중 당뇨병 환자이면서 본인의 질환을 인지하고 있는 대상자들을 추출하였고, 가구소득정보를 이용하여 세 그룹으로 분류하여 분석하였다. 당뇨병 환자들의 기본정보, 생활습관정보, 영양소 섭취 정보, 혈액지표 등은 건강설문조사, 영양조사, 검진조사를 통해 수집되었다. 자료 분석은 변수 특성에 따라 카이검정, 일원분산분석 등을 실시하였고, 다중선형회귀분석을 이용하여 혈압 및 혈액지표의 보정평균을 산출하였다. 당뇨환자들의 공복혈당, HbA1c 및 혈중지질 농도의 평균은 소득수준에 따라 유의적인 차이를 보이지 않았다. 조사기간인 1998년부터 2014년간의 16년 동안 대사위험지표 변화 추이를 살펴본 결과, 모든 그룹에서 혈압의 유의미한 감소 추세를 보였다 (p < 0.001). 소득이 가장 높은 그룹에서는 공복혈당 (p = 0.004), 총 콜레스테롤 (p < 0.001), LDL-콜레스테롤 농도 (p = 0.01)가 유의하게 감소하는 추이를 보였고, HDL-콜레스테롤 농도 (p < 0.001)는 유의하게 증가하는 추이를 보였다. 저소득층에서는 공복혈당 (p = 0.02), 총 콜레스테롤 (p < 0.001), 중성지방 농도 (p = 0.003)가 시간 경과에 따라 유의적으로 감소하는 경향을 보였다. 그러나 중간소득층에서는 혈압을 제외한 모든 대사 위험 인자에 유의적인 변화 추이가 발견되지 않았다. 결론적으로 당뇨병 환자의 소득수준에 따른 대사 위험 인자의 관리수준에는 차이가 없었다. 최근 16년의 관찰 기간 동안 소득이 가장 높은 그룹과 가장 낮은 그룹은 대사 위험 인자의 유의미한 개선 추이를 보였으나, 중간소득 그룹은 변화가 관찰되지 않았다. 본 연구는 당뇨병 환자들의 지표 관리에 대한 전략 마련과 효과적인 보건대책을 위한 기초자료로서 중요한 의미가 있다고 사료된다.

Purpose: Management of the metabolic risk factors in diabetes patients is essential for preventing or delaying diabetic complications. This study compared the levels of the metabolic risk factors in diabetes patients according to the income levels, and examined the secular trends in recent decades. Methods: The data from the Korea National Health and Nutrition Examination Survey 1998 ~ 2014 were used. The diabetes patients were divided into three groups based on their household income levels. General information was obtained through self-administered questionnaires, and the blood biomarkers and blood pressure data were obtained from a health examination. Multivariable linear regression models were used to compare the metabolic biomarker levels according to the household income levels, adjusting for potential confounding factors. Results: The fasting blood glucose, hemoglobin A1c, and blood lipid (total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride) levels were similar in the three groups. During the survey period of 16 years, the blood pressure showed a significant decreasing trend with time in all groups (p < 0.001). In contrast, the fasting blood glucose (p = 0.004), total cholesterol (p < 0.001), and LDL-cholesterol levels (p = 0.007) decreased significantly, and the HDL-cholesterol level (p < 0.001) increased significantly in the highest-income groups. In the lowest-income group, the fasting blood glucose (p = 0.02), total cholesterol (p < 0.001), and triglyceride (p = 0.003) levels showed a significant decreasing trend over time. On the other hand, the middle-income group showed no significant change in any of the metabolic risk factors except for blood pressure. Conclusion: The level of management of metabolic risk factors according to the income level of Korean diabetes patients was similar. On the other hand, the highest- and lowest-income groups showed positive trends of management of these factors during 16 years of observation, whereas the middle-income group did not show any improvement.

키워드

참고문헌

  1. World Health Organization. Global report on diabetes [Internet]. Geneva: World Health Organization; 2016 [cited 2016 Jun 18]. Available from: http://apps.who.int/iris/bitstream/ 10665/204874/1/WHO_NMH_NVI_16.3_eng.pdf.
  2. Ministry of Health and Welfare; Korea Centers for Disease Control and Prevention. Korea Health Statistics 2014: Korea National Health and Nutrition Examination Survey (KNHANES VI-2). Sejong: Ministry of Health and Welfare; 2015.
  3. American Diabetes Association. Complications [Internet]. Arlington (VA): American Diabetes Association; 2016 [cited 2016 Oct 4]. Available from: http://www.diabetes.org/livingwith-diabetes/complications.
  4. Vijan S, Stevens DL, Herman WH, Funnell MM, Standiford CJ. Screening, prevention, counseling, and treatment for the complications of type II diabetes mellitus. Putting evidence into practice. J Gen Intern Med 1997; 12(9): 567-580. https://doi.org/10.1046/j.1525-1497.1997.07111.x
  5. Ohkubo Y, Kishikawa H, Araki E, Miyata T, Isami S, Motoyoshi S, Kojima Y, Furuyoshi N, Shichiri M. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract 1995; 28(2): 103-117. https://doi.org/10.1016/0168-8227(95)01064-K
  6. Diabetes Control and Complications Trial Research Group; Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, Davis M, Rand L, Siebert C. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329(14): 977-986. https://doi.org/10.1056/NEJM199309303291401
  7. Rubin RR, Peyrot M. Quality of life and diabetes. Diabetes Metab Res Rev 1999; 15(3): 205-218. https://doi.org/10.1002/(SICI)1520-7560(199905/06)15:3<205::AID-DMRR29>3.0.CO;2-O
  8. American Diabetes Association. Standards of medical care in diabetes-2015 abridged for primary care providers. Clin Diabetes 2015; 33(2): 97-111. https://doi.org/10.2337/diaclin.33.2.97
  9. Korean Diabetes Association. Treatment guideline for diabetes [Internet]. Seoul: Korean Diabetes Association; 2016 [cited 2016 Oct 4]. Available from: http://www.diabetes.or.kr/pro/ publish/guide.php?code=guide&mode=view&number=625.
  10. Agardh E, Allebeck P, Hallqvist J, Moradi T, Sidorchuk A. Type 2 diabetes incidence and socio-economic position: a systematic review and meta-analysis. Int J Epidemiol 2011; 40(3): 804-818. https://doi.org/10.1093/ije/dyr029
  11. Robbins JM, Vaccarino V, Zhang H, Kasl SV. Socioeconomic status and type 2 diabetes in African American and non- Hispanic white women and men: evidence from the Third National Health and Nutrition Examination Survey. Am J Public Health 2001; 91(1): 76-83. https://doi.org/10.2105/AJPH.91.1.76
  12. Karter AJ, Ferrara A, Liu JY, Moffet HH, Ackerson LM, Selby JV. Ethnic disparities in diabetic complications in an insured population. JAMA 2002; 287(19): 2519-2527. https://doi.org/10.1001/jama.287.19.2519
  13. Hwang J, Shon C. Relationship between socioeconomic status and type 2 diabetes: results from Korea National Health and Nutrition Examination Survey (KNHANES) 2010-2012. BMJ Open 2014; 4(8): e005710. https://doi.org/10.1136/bmjopen-2014-005710
  14. Ko KD, Kim BH, Park SM, Oh SI, Um CS, Shin DW, Lee HW. What are patient factors associated with the quality of diabetes care?: results from the Korea National Health and Nutrition Examination Survey. BMC Public Health 2012; 12(1):689. https://doi.org/10.1186/1471-2458-12-689
  15. Boo SJ. Glucose, blood pressure, and lipid control in Korean adults with diagnosed diabetes. Korean J Adult Nurs 2012; 24(4): 406-416. https://doi.org/10.7475/kjan.2012.24.4.406
  16. Pyo EY, Jung MH, Kim YS. Factors related to blood glucose control in patients with diabetes. Korean J Health Educ Promot 2012; 29(3): 15-22.
  17. Jeon JY, Kim DJ, Ko SH, Kwon HS, Lim S, Choi SH, Kim CS, An JH, Kim NH, Won JC, Kim JH, Cha BY, Song KH; Taskforce Team of Diabetes Fact Sheet of the Korean Diabetes Association. Current status of glycemic control of patients with diabetes in Korea: the fifth Korea national health and nutrition examination survey. Diabetes Metab J 2014; 38(3): 197-203. https://doi.org/10.4093/dmj.2014.38.3.197
  18. Seligman HK, Jacobs EA, López A, Tschann J, Fernandez A. Food insecurity and glycemic control among low-income patients with type 2 diabetes. Diabetes Care 2012; 35(2): 233-238. https://doi.org/10.2337/dc11-1627
  19. Ainsworth BE, Haskell WL, Leon AS, Jacobs DR Jr, Montoye HJ, Sallis JF, Paffenbarger RS Jr. Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc 1993; 25(1): 71-80. https://doi.org/10.1249/00005768-199301000-00011
  20. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000; 894: i-xii, 1-253.
  21. Park K. Trends in adherence to dietary recommendations among Korean type 2 diabetes mellitus patients. Nutr Res Pract 2015; 9(6): 658-666. https://doi.org/10.4162/nrp.2015.9.6.658
  22. Cho S, Jang H, Park K. Trends in the management levels of metabolic risk factors in middle-aged and elderly patients with type 2 diabetes mellitus: The Korean National Health and Nutrition Examination Survey 1998-2014. PLoS One 2017; 12(12): e0189361. https://doi.org/10.1371/journal.pone.0189361
  23. Korean Society of Lipidology and Atherosclerosis. Dyslipidemia fact sheet in Korea 2015 [Internet]. Seoul: Korean Society of Lipidology and Atherosclerosis; 2015 [cited 2016 Oct 4]. Available from: http://www.lipid.or.kr/bbs/index.html?code=fact_sheet&category=&gubun=&page=1&number=632&mode=view&keyfield=&key=.
  24. Kojda G, Harrison D. Interactions between NO and reactive oxygen species: pathophysiological importance in atherosclerosis, hypertension, diabetes and heart failure. Cardiovasc Res 1999; 43(3): 562-571. https://doi.org/10.1016/S0008-6363(99)00169-8
  25. Krauss RM. Lipids and lipoproteins in patients with type 2 diabetes. Diabetes Care 2004; 27(6): 1496-1504. https://doi.org/10.2337/diacare.27.6.1496
  26. World Health Organization. WHO mortality database [Internet]. Geneva: World Health Organization; 2016 [cited 2016 Oct 4]. Available from: http://apps.who.int/healthinfo/statistics/mortality/causeofdeath_query.
  27. Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, Hadden D, Turner RC, Holman RR. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000; 321(7258): 405-412. https://doi.org/10.1136/bmj.321.7258.405
  28. UK 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). Lancet 1998; 352(9131): 837-853. https://doi.org/10.1016/S0140-6736(98)07019-6
  29. UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 1998; 352(9131): 854-865. https://doi.org/10.1016/S0140-6736(98)07037-8
  30. James PA, Oparil S, Carter BL, Cushman WC, Dennison- Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, Smith SC Jr, Svetkey LP, Taler SJ, Townsend RR, Wright JT Jr, Narva AS, Ortiz E. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014; 311(5): 507-520. https://doi.org/10.1001/jama.2013.284427
  31. Go AS, Bauman MA, Coleman King SM, Fonarow GC, Lawrence W, Williams KA, Sanchez E. An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention. J Am Coll Cardiol 2014; 63(12): 1230-1238. https://doi.org/10.1016/j.jacc.2013.11.007
  32. Task Force for the management of arterial hypertension of the European Society of Hypertension; Task Force for the management of arterial hypertension of the European Society of Cardiology. 2013 ESH/ESC guidelines for the management of arterial hypertension. Blood Press 2013; 22(4): 193-278. https://doi.org/10.3109/08037051.2013.812549
  33. Stark Casagrande S, Fradkin JE, Saydah SH, Rust KF, Cowie CC. The prevalence of meeting A1C, blood pressure, and LDL goals among people with diabetes, 1988-2010. Diabetes Care 2013; 36(8): 2271-2279. https://doi.org/10.2337/dc12-2258
  34. Yu NC, Su HY, Chiou ST, Yeh MC, Yeh SW, Tzeng MS, Sheu WH. Trends of ABC control 2006-2011: a National Survey of Diabetes Health Promotion Institutes in Taiwan. Diabetes Res Clin Pract 2013; 99(2): 112-119. https://doi.org/10.1016/j.diabres.2012.11.018
  35. Ali MK, Bullard KM, Saaddine JB, Cowie CC, Imperatore G, Gregg EW. Achievement of goals in U.S. diabetes care, 1999-2010. N Engl J Med 2013; 368(17): 1613-1624. https://doi.org/10.1056/NEJMsa1213829
  36. Vouri SM, Shaw RF, Waterbury NV, Egge JA, Alexander B. Prevalence of achievement of A1c, blood pressure, and cholesterol (ABC) goal in veterans with diabetes. J Manag Care Pharm 2011; 17(4): 304-312.
  37. International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care 2009; 32(7): 1327-1334. https://doi.org/10.2337/dc09-9033
  38. Bertoni AG, Clark JM, Feeney P, Yanovski SZ, Bantle J, Montgomery B, Safford MM, Herman WH, Haffner S; Look AHEAD Research Group. Suboptimal control of glycemia, blood pressure, and LDL cholesterol in overweight adults with diabetes: the Look AHEAD study. J Diabetes Complications 2008; 22(1): 1-9. https://doi.org/10.1016/j.jdiacomp.2006.10.003
  39. Health Insurance Review and Assessment Service. Medical benefit system [Internet]. Wonju: Health Insurance Review and Assessment Service; 2015 [cited 2016 Oct 4]. Available from: http://field.incheon.go.kr/program/fileDownload.do?fileNo=560341.
  40. Choi B, Shin H. Equity in health care utilization by target population. Health Welf Policy Forum 2005; 106: 90-98.
  41. National Health Insurance Service. 2015 major health insurance statistics [Internet]. Wonju: National Health Insurance Service; 2016 [cited 2016 Oct 4]. Available from: http://www.nhis.or.kr/ bbs7/boards/B0074/17042?boardKey=29&sort=sequence&order=desc&rows=10&messageCategoryKey=&pageNumber=1&viewType=generic&targetType=12&targetKey=29&status=&period =&startdt=&enddt=&queryField=&query=.

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  1. The Associated Factors of Medical Treatment in Diabetic Patients vol.46, pp.3, 2019, https://doi.org/10.21032/jhis.2021.46.3.302