Management of Diabetes Mellitus and Factors Associated with Poor Glycemic Control in an Urban Area

BACKGROUND: We evaluated the current status of diabetes management and the predictors for poor glycemic control in an urban area. METHODS: This study included 1,138 community-dwelling adults (> or =50 years) with diabetes, of which 584 participated in the diabetes care survey. Logistic regression was used to identify the factors predicting poor glycemic control (hemoglobin A1c[HbA1c]> or =7%) in the total sample and to evaluate the relationship between the history of diabetes management checkup and poor glycemic control in the diabetes care survey sample. RESULTS: Of the 1,138 patients, 53.2% had blood pressure less than 130/80 mmHg, 41.7% had fasting glucose between 70 and 130 mg/dL, 48.6% had HbA1c below 7.0%, 60.1% had triglycerides below 150 mg/dL, 41.4% had low density lipoprotein cholesterol below 100 mg/dL, and 59.1% had normoalbuminuria (urine albumin-to-creatinine ratio <30 mg/g creatinine). Of the 584 patients completing the diabetes care survey, 63.9% had one or more lipid tests, 32.0% had one or more HbA1c tests, 43.8% had one or more microalbuminuria tests, and 42.5% had one or more fundoscopic examinations annually. Female gender (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.23-2.36), duration of diabetes (OR, 1.07; 95% CI, 1.06-1.09), and alcohol use (OR, 1.40; 95% CI, 1.06-1.85) were associated with an increased risk for poor glycemic control while age (OR, 0.97; 95% CI, 0.96-0.99) and antihypertensive medication (OR, 0.64; 95% CI, 0.50-0.83) were associated with a decreased risk. CONCLUSIONS: This study shows that glycemic control is likely to be poor in urban areas. We need to develop appropriate community-based strategies to achieve optimal glycemic control and prevent diabetes complications.

A Comparison of Fasting Glucose and HbA1c for the Diagnosis of Diabetes Mellitus Among Korean Adults / 예방의학회지

OBJECTIVES: The American Diabetes Association (ADA) has recently recommended the HbA1c assay as one of four options for making the diagnosis of diabetes mellitus, with a cut-point of > or =6.5%. We compared the HbA1c assay and the fasting plasma glucose level for making the diagnosis of diabetes among Korean adults. METHODS: We analyzed 8710 adults (age 45-74 years), who were not diagnosed as having diabetes mellitus, from the Namwon study population. A fasting plasma glucose level of > or =126 mg/dL and an A1c of > or =6.5% were used for the diagnosis of diabetes. The kappa index of agreement was calculated to measure the agreement between the diagnosis based on the fasting plasma glucose level and the HbA1c. RESULTS: The kappa index of agreement between the fasting plasma glucose level and HbA1c was 0.50. CONCLUSIONS: The agreement between the fasting plasma glucose and HbA1c for the diagnosis of diabetes was moderate for Korean adults.

Management of Diabetic Mellitus in Low-income Rural Patients / 예방의학회지

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. ankle-brachial 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+/-8.7 years and the duration of diabetes was 8.9+/-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.