Nutrition Research and Practice

The Korean Nutrition Society (한국영양학회)
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Analysis of dietary behavior and intake related to glycemic control in patients with type 2 diabetes aged 30 years or older in Korea: Utilizing the 8th Korea National Health and Nutrition Examination Survey (2019-2021)

  • Jin-Ah Seok (Department of Food Science & Nutrition, Kyungpook National University) ;
  • Yeon-Kyung Lee (Department of Food Science & Nutrition, Kyungpook National University)
  • Received : 2023.12.11
  • Accepted : 2024.03.20
  • Published : 2024.04.01
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Abstract

BACKGROUND/OBJECTIVES: Over the past 10 yrs, the prevalence of diabetes in Korea has continued to incline, and the importance of lifestyle modification to manage diabetes has been highlighted. For patients with diabetes, carbohydrate intake reduction is effective in improving glycemic control; thus, we aimed to analyze the effect of carbohydrate intake ratio and suggest an appropriate carbohydrate intake ratio. SUBJECTS/METHODS: Using the 8th Korea National Health and Nutrition Examination Survey (2019-2021), we analyzed the data including participants aged 30 yrs or older with diabetes, and they were stratified into good and poor glycemic control groups. To analyze the correlation between the dietary behavior characteristics of participants with diabetes and the carbohydrate intake ratio, sociodemographic characteristics, dietary behavior, and health behavior were adjusted, and multivariate logistic regression analysis was conducted to present the adjusted odds ratio and 95% confidence interval (CI). RESULTS: In the unadjusted crude model, when carbohydrate intake ratio in total energy intake increased by 1%, the likelihood of poor glycemic control increased by 1.007-fold (95% CI, 0.998-1.016; P = 0.121). In model 1, which uses age and sex as adjustment variables, an increase of up to 1.011-fold was possible (95% CI, 1.001-1.021; P = 0.008). In model 2, which added variables such as diabetes duration, frequency of fruit consumption, frequency of lunch and, frequency of dinner, the risk of poor glycemic control increased by 1.010-fold as the carbohydrate intake ratio increased (95% CI, 0.998-1.022; P < 0.001). CONCLUSION: This study confirmed that as the ratio of carbohydrate intake to total energy intake increases the likelihood of poor glycemic control also increases in patients with diabetes. Therefore, to improve glycemic control in patients with diabetes, controlling the carbohydrate intake may be helpful.

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References

  1. International Diabetes Federation. IDF Diabetes Atlas. 10th ed. Brussels: International Diabetes Federation; 2021.
  2. Korea Disease Control and Prevention Agency. Korea Health Statistics 2021: Korea National Health and Nutrition Examination Survey (KNHANES VIII-3). Cheongju: Korea Disease Control and Prevention Agency; 2022.
  3. Funnell MM, Anderson RM. Empowerment and self-management of diabetes. Clin Diabetes 2004;22:123-7. 
  4. 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;352:837-53.
  5. Korean Diabetes Association: Clinical Practice Guidelines for Diabetes. 8th ed. Seoul: Korean Diabetes Association; 2023.
  6. Kim Y, Cho E. Lifestyle factors related to glucose control for diabetes management strategies: Nested case control design using KNHANES data. J Korea Converg Soc 2019;10:501-10.
  7. Lim S, Bae JH, Kwon HS, Nauck MA. COVID-19 and diabetes mellitus: from pathophysiology to clinical management. Nat Rev Endocrinol 2021;17:11-30.
  8. Williamson EJ, Walker AJ, Bhaskaran K, Bacon S, Bates C, Morton CE, Curtis HJ, Mehrkar A, Evans D, Inglesby P, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature 2020;584:430-6.
  9. Barron E, Bakhai C, Kar P, Weaver A, Bradley D, Ismail H, Knighton P, Holman N, Khunti K, Sattar N, et al. Associations of type 1 and type 2 diabetes with COVID-19-related mortality in England: a wholepopulation study. Lancet Diabetes Endocrinol 2020;8:813-22.
  10. Kirkpatrick CF, Bolick JP, Kris-Etherton PM, Sikand G, Aspry KE, Soffer DE, Willard KE, Maki KC. Review of current evidence and clinical recommendations on the effects of low-carbohydrate and very-lowcarbohydrate (including ketogenic) diets for the management of body weight and other cardiometabolic risk factors: a scientific statement from the National Lipid Association Nutrition and Lifestyle Task Force. J Clin Lipidol 2019;13:689-711.e1.
  11. Schwingshackl L, Chaimani A, Hoffmann G, Schwedhelm C, Boeing H. A network meta-analysis on the comparative efficacy of different dietary approaches on glycaemic control in patients with type 2 diabetes mellitus. Eur J Epidemiol 2018;33:157-70.
  12. Meng Y, Bai H, Wang S, Li Z, Wang Q, Chen L. Efficacy of low carbohydrate diet for type 2 diabetes mellitus management: a systematic review and meta-analysis of randomized controlled trials. Diabetes Res Clin Pract 2017;131:124-31.
  13. Evert AB, Dennison M, Gardner CD, Garvey WT, Lau KHK, MacLeod J, Mitri J, Pereira RF, Rawlings K, Robinson S, et al. Nutrition therapy for adults with diabetes or prediabetes: a consensus report. Diabetes Care 2019;42:731-54.
  14. Ministry of Health and Welfare, The Korean Nutrition Society. Dietary Reference Intakes for Koreans 2020. Sejong: Ministry of Health and Welfare; 2020.
  15. Oh K, Kim Y, Kweon S, Kim S, Yun S, Park S, Lee YK, Kim Y, Park O, Jeong EK. Korea National Health and Nutrition Examination Survey, 20th anniversary: accomplishments and future directions. Epidemiol Health 2021;43:e2021025.
  16. Lee CK. Factors influencing glycemic control among type 2 diabetes mellitus patients: the seventh Korea National Health and Nutrition Examination Survey (2016-2018). Health & Nursing 2016-2018;33:15-26. 
  17. Jung KM, Lee SJ, Park ES, Park YJ, Kim SG, Choi DS. Self-care and related factors in young and middle adulthood patients with type 2 diabetes. J Korean Diabetes 2015;16:65-77.
  18. Jeong DJ, Lee JH, Yoon EJ. Study on nutrition, dietary and health status of middle-aged Korean men according to sedentary hours: based on the 2019 Korea National Health and Nutrition Examination Survey. J Nutr Health 2022;55:359-75.
  19. Park J, Yeo Y, Yoo JH. Dietary intake and nutritional status in young and middle-aged adults according to the meal frequency from the Korea National Health and Nutritional Survey. Korean J Fam Med 2022;43:319-26.
  20. Park H, Shin D, Lee KW. Association of main meal frequency and skipping with metabolic syndrome in Korean adults: a cross-sectional study. Nutr J 2023;22:24.
  21. Paoli A, Tinsley G, Bianco A, Moro T. The influence of meal frequency and timing on health in humans: the role of fasting. Nutrients 2019;11:719.
  22. Kim HR, Ryu DH, Lee CW, Lee J, Jeong YJ, Kim HS. Analysis of dietary intake profiles according to eating alone behavior: the eighth Korea National Health and Nutrition Examination Survey. Korean J Fam Pract 2023;13:112-9.
  23. Kwon JS, Kim WJ, Han YH, Kim HJ, Shin SY, Choi KH, Jun JH, Shim MS, Kim JY. Association between diabetes education status and clinical outcomes of patients with diabetes mellitus: analysis of the fifth Korea National Health and Nutrition Examination Survey (KNHANES V). J Korean Diabetes 2014;15:236-43. 
  24. Powers MA, Bardsley JK, Cypress M, Funnell MM, Harms D, Hess-Fischl A, Hooks B, Isaacs D, Mandel ED, Maryniuk MD, et al. Diabetes self-management education and support in adults with type 2 diabetes: a consensus report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. Diabetes Care 2020;43:1636-49.
  25. Lee SJ, Han MA, Park J, Ryu SY. Utilization of nutrition labels and related factors among patients with diabetes in Korea. Nutr Res Pract 2023;17:297-306.
  26. Razaz JM, Rahmani J, Varkaneh HK, Thompson J, Clark C, Abdulazeem HM. The health effects of medical nutrition therapy by dietitians in patients with diabetes: a systematic review and meta-analysis: nutrition therapy and diabetes. Prim Care Diabetes 2019;13:399-408.
  27. Cho Y, Lee M, Jang H, Rha M, Kim J, Park Y, et al. The clinical and cost effectiveness of medical nutrition therapy for patients with type 2 diabetes mellitus. Korean J Nutr 2008;41:147-55.
  28. Lean ME, Leslie WS, Barnes AC, Brosnahan N, Thom G, McCombie L, Peters C, Zhyzhneuskaya S, AlMrabeh A, Hollingsworth KG, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet 2018;391:541-51.
  29. Davies MJ, Aroda VR, Collins BS, Gabbay RA, Green J, Maruthur NM, Rosas SE, Del Prato S, Mathieu C, Mingrone G, et al. Management of hyperglycemia in type 2 diabetes, 2022. a consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2022;45:2753-86.
  30. Delevatti RS, Bracht CG, Lisboa SDC, Costa RR, Marson EC, Netto N, Kruel LFM. The role of aerobic training variables progression on glycemic control of patients with type 2 diabetes: a systematic review with meta-analysis. Sports Med Open 2019;5:22.
  31. Pan B, Ge L, Xun YQ, Chen YJ, Gao CY, Han X, Zuo LQ, Shan HQ, Yang KH, Ding GW, et al. Exercise training modalities in patients with type 2 diabetes mellitus: a systematic review and network metaanalysis. Int J Behav Nutr Phys Act 2018;15:72.
  32. Borror A, Zieff G, Battaglini C, Stoner L. The effects of postprandial exercise on glucose control in individuals with type 2 diabetes: a systematic review. Sports Med 2018;48:1479-91.
  33. Park JH, Lim SG, Yim ES, Kim YD, Jeong UJ. Factors associated with poor glycemic control among patients with type 2 diabetes mellitus: the fifth Korea National Health and Nutrition Examination Survey (2010-2012). Health Policy Manag 2016;26:125-34.
  34. Jung CH, Son JW, Kang S, Kim WJ, Kim HS, Kim HS, Seo M, Shin HJ, Lee SS, Jeong SJ, et al. Diabetes fact sheets in Korea, 2020: an appraisal of current status. Diabetes Metab J 2021;45:1-10.
  35. Bae JH, Han KD, Ko SH, Yang YS, Choi JH, Choi KM, Kwon HS, Won KC. Diabetes fact sheet in Korea 2021. Diabetes Metab J 2022;46:417-26.
  36. Yoon SH, Lee JH, Oh KW. National Health Statistics Plus. Current Status of People's Dietary Habits in Korea. Cheongju: Korea Disease Control and Prevention Agency; 2021.
  37. Salle A, Ryan M, Ritz P. Underreporting of food intake in obese diabetic and nondiabetic patients. Diabetes Care 2006;29:2726-7.
  38. Park K. Trends in adherence to dietary recommendations among Korean type 2 diabetes mellitus patients. Nutr Res Pract 2015;9:658-66.
  39. Jayedi A, Zeraattalab-Motlagh S, Jabbarzadeh B, Hosseini Y, Jibril AT, Shahinfar H, Mirrafiei A, Hosseini F, Bidar SS. Dose-dependent effect of carbohydrate restriction for type 2 diabetes management: a systematic review and dose-response meta-analysis of randomized controlled trials. Am J Clin Nutr 2022;116:40-56. 
  40. Lee YJ, Song S, Song Y. High-carbohydrate diets and food patterns and their associations with metabolic disease in the Korean population. Yonsei Med J 2018;59:834-42.
  41. Draznin B, Aroda VR, Bakris G, Benson G, et al. 5. Facilitating behavior change and well-being to improve health outcomes: standards of medical care in diabetes-2022. Diabetes Care 2022;45:S60-82.
  42. Hill-Briggs F, Adler NE, Berkowitz SA, Chin MH, Gary-Webb TL, Navas-Acien A, Thornton PL, HaireJoshu D. Social determinants of health and diabetes: a scientific review. Diabetes Care 2020;44:258-79.