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http://dx.doi.org/10.3961/jpmph.2009.42.5.315

Management of Diabetic Mellitus in Low-income Rural Patients  

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)
Publication Information
Journal of Preventive Medicine and Public Health / v.42, no.5, 2009 , pp. 315-322 More about this Journal
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.
Keywords
Diabetic mellitus; Low-income; Management status;
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1 World Health Organization. WHO Diabetes Programme. Geneva: World Health Organization; c2009 [cited 2009 Mar 26]. Available from: URL: http://www.who.int/diabetes/en
2 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   DOI   ScienceOn
3 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
4 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   DOI   ScienceOn
5 American Diabetes Association. Standards of Medical Care in Diabetes-2008. Diabetes Care 2008; 31(Suppl 1): S12-S54   DOI   PUBMED   ScienceOn
6 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   DOI   ScienceOn
7 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   DOI   ScienceOn
8 American Diabetes Association. Peripheral arterial disease in people with diabetes. Diabetes Care 2003; 26(12): 3333-3341   DOI   PUBMED   ScienceOn
9 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)   DOI   ScienceOn
10 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   DOI
11 Deedwania PC. Hypertension and diabetes: New therapeutic options. Arch Intern Med 2000; 160(11): 1585-1594   DOI   PUBMED   ScienceOn
12 Hamdy O, Goodyear LJ, Horton ES. Diet and exercise in thpe 2 diabetes mellitus. Endocrinol Metab Clin North Am 2001; 30(4): 883-907   DOI   ScienceOn
13 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   DOI   ScienceOn
14 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   PUBMED
15 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   DOI   ScienceOn
16 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   DOI   PUBMED   ScienceOn
17 Naidoo DP. The link between microalbuminuria, endothelial dysfunction and cardiovascular disease in diabetes. Cardiovasc J S Afr 2002; 13(4): 194-199   ScienceOn
18 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   DOI   ScienceOn
19 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   DOI   PUBMED   ScienceOn
20 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
21 Mooradian AD. Dyslipidemia in type 2 diabetes mellitus. Nat Clin Pract Endocrinol Metab 2009; 5(3): 150-159   DOI   ScienceOn
22 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   DOI   ScienceOn
23 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   DOI   ScienceOn
24 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)
25 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   DOI   ScienceOn
26 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
27 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)
28 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   DOI   ScienceOn
29 World Health Organization. Prevention of Diabetes Mellitus (Technical report series. no. 844). Geneva: World Health Organization; 1994
30 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   DOI   ScienceOn
31 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   DOI   PUBMED
32 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)   과학기술학회마을
33 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   DOI   ScienceOn
34 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)
35 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)   DOI   ScienceOn
36 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)
37 American Diabetes Association. Nutrition recommendations and principles for people with diabetes mellitus. Diabetes Care 2000; 23(Suppl 1): S43-S46   PUBMED