Sex Difference in the Effect of Body Mass Index and Stress on High-Risk Diabetes Mellitus in Korean Adults

PURPOSE: This study aimed to investigate sex differences in the effect of body mass index (BMI) and stress on high-risk diabetes mellitus (DM). METHODS: Secondary analysis of data from 4,271 male and female adults participating in the Sixth Korea National Health and Nutrition Examination Survey 2015 was performed. The participants were evaluated using questionnaires and blood tests. Data were analyzed using descriptive statistics, t-test, χ2-test, and multiple logistic regression analysis (SPSS 24.0). RESULTS: To identify sexspecific effects, interaction variables were included. Hemoglobin A1c (HbA1c) level was higher in men than in women, and the risk of DM decreased 0.31 times in women compared to that in men. As age increased, the odds of risk DM increased 1.03. The risk of DM increased 1.99 times in overweight individuals and 2.79 times for obese individuals compared to that in individuals with normal weight. Stress levels were higher in women than in men, but stress is not an influential factor in high-risk DM. In age-sex interaction, the odds of risk DM increased 1.02 in women compared to that in men as age increased. CONCLUSION: HbA1c level was affected by age-sex interaction, and age and sex should be considered in the application of HbA1c in the diagnosis of DM.

Risk Factors for the Development and Progression of Diabetic Kidney Disease in Patients with Type 2 Diabetes Mellitus and Advanced Diabetic Retinopathy

BACKGROUND: Some patients with type 2 diabetes mellitus (T2DM) do not develop diabetic kidney disease (DKD) despite the presence of advanced diabetic retinopathy (DR). We aimed to investigate the presence of DKD and its risk factors in patients with T2DM and advanced DR. METHODS: We conducted a cross-sectional study in 317 patients with T2DM and advanced DR. The phenotypes of DKD were divided into three groups according to the urine albumin/creatinine ratio (uACR, mg/g) and estimated glomerular filtration rate (eGFR, mL/min/1.73 m²): no DKD (uACR <30 and eGFR ≥60), non-severe DKD (uACR ≥30 or eGFR <60), and severe DKD (uACR ≥30 and eGFR <60). Mean systolic and diastolic blood pressure, mean glycosylated hemoglobin (HbA1c) level, and HbA1c variability (standard deviation [SD] of serial HbA1c values or HbA1c-SD) were calculated for the preceding 2 years. RESULTS: The prevalence of no DKD, non-severe DKD, and severe DKD was 37.2% (n=118), 37.0% (n=117), and 25.8% (n=82), respectively. HbA1c-SD and the triglyceride/high density lipoprotein cholesterol (TG/HDL-C) ratio correlated positively with uACR and negatively with eGFR. Multiple linear regression analyses showed that the HbA1c-SD and TG/HDL-C ratio were significantly related with eGFR. Multiple logistic regression analyses after adjusting for several risk factors showed that HbA1c-SD and the TG/HDL-C ratio were significant risk factors for severe DKD. CONCLUSION: The prevalence of DKD was about 60% in patients with T2DM and advanced DR. HbA1c variability and TG/HDL-C ratio may affect the development and progression of DKD in these patients.

A Nationwide Survey about the Current Status of Glycemic Control and Complications in Diabetic Patients in 2006: The Committee of the Korean Diabetes Association on the Epidemiology of Diabetes Mellitus / 당뇨병

BACKGROUND: The Committee of the Korean Diabetes Association on the Epidemiology of Diabetes Mellitus performed a nationwide survey about the current status of glycemic control and diabetic complications in 2006. METHODS: The current study included 5,652 diabetic patients recruited from the rosters of endocrinology clinics of 13 tertiary hospitals in Korea. Age, gender, height, weight, waist circumference and blood pressure were investigated by standard method. Fasting and postprandial 2 hour glucose, glycosylated hemoglobin (HbA1c), lipid profiles, fasting insulin and c-peptide levels were measured. Microvascular (microalbuminuria, retinopathy and neuropathy) and macrovascular (coronary artery disease [CAD], cerebrovascular disease [CVD] and peripheral artery disease [PAD]) complications were reviewed in their medical records. RESULTS: Mean age of total subjects was 58.7 (+/- 11.6) years and duration of diabetes was 8.8 (0~50) years. Mean fasting and postprandial 2 hour glucose levels were 145.9 +/- 55.0 and 208.0 +/- 84.4 mg/dL, respectively. Their mean HbA1c was 7.9 +/- 1.9%: the percentage of patients within target goal of glycemic control (< 7% of HbA1c) was 36.7%. In this study, 30.3%, 38.3% and 44.6% of patients was found to have microalbuminuria, retinopathy and nephropathy, respectively. Prevalence of CAD, CVD and PAD was 8.7%, 6.7% and 3.0%, respectively. Diabetic complications were closely related with age, duration of diabetes and glycemic control, and this relationship was stronger in microvascular complications than macrovascular ones. CONCLUSION: Only about one third of patients with diabetes was found to reach target glycemic control in tertiary hospitals of Korea. More tight control is needed to reduce deleterious complications of diabetes in Korea.

The Relationship between Depression, Self-Care Activity and HbA1c in Clients with Type-2 Diabetes Mellitus / 기본간호학회지

PURPOSE: This study was done to investigate the relationship between depression, self-care activity and HbA1c in clients with type-2 diabetes mellitus (DM) clients. METHOD: This was a cross sectional descriptive study and data were collected between October 4 and 27, 2006 using a questionnaire. The participants were inpatients and outpatients with type-2 diabetes being seen in one of two hospitals. The questionnaire included general as well as disease related characteristics, a depression scale (CES-D), and the self-care activity scale developed by Kim (1996). HbA1c was obtained from medical records. RESULTS: There were 50 men (41.7%) and 70 women (58.3%). The mean scores for depression and self-care activity were 18.22+/-10.03 and 3.51, respectively. Almost half of the participants (46.7%) had an HbA1c greater than 7%. Self-care activity was negatively correlated with depression (r=-.436, p=0.00) and HbA1c (r=-.269, p=0.03). Depression was positively correlated with HbA1c (r=-.325, p=0.00). Participants who had diabetes education showed a significantly lower level of HbA1c than the group who had never had diabetes education. Conclusions: It is important to make ensure that patients with diabetes have education on diabetes mellitus and to screen and manage depression as part of the care for these patients.