일부 도시지역의 당뇨병 관리실태와 혈당관리 수준과 관련된 요인
Management of Diabetes Mellitus and Factors Associated with Poor Glycemic Control in an Urban Area
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연구배경: 본 연구는 도시지역 당뇨병 환자들의 관리 현황과 혈당 관리에 영향을 미치는 요인들을 파악하고자 하였다. 방법: 본 연구의 대상은 도시지역에 거주하는 50세 이상당뇨병환자 1,138명이며 그중 584명에 대해 당뇨병 관리에 대한 설문조사가 이루어졌다. 당화혈색소가 7.0% 이상일 때 혈당관리가 미흡하다고 정의하고 다변량 로지스틱분석을 이용하여 전체 대상자에서 혈당관리 수준에 영향을 주는 요인들을 파악하였고 당뇨병 관리 설문조사에 응한 584명에서 당뇨병 관리 검사력과 혈당 관리 수준과의관련성을 알아보았다. 결과: 전체 1138명 중 혈압 130/80 mmHg 미만은53.2%, 공복혈당 70-130 mg/dL 41.7%, 당화혈색소 7%미만은 48.6%, 중성지방 150 mg/dL 미만 60.1%, 저밀도지단백 콜레스테롤 100 mg/dL 미만 41.4%, 미세알부민뇨음성 59.1%였다. 당뇨관리 설문조사를 받은 584명 중 최근1년 이내의 합병증 검사비율은 고지혈증 검사 63.9%, 당화혈색소 검사 32.0%, 미세알부민뇨 검사 43.8%, 그리고 안저검사 42.5% 이었다. 다변량 로지스틱 회귀분석에서 여성(odds ratio [OR], 1.71; 95% confidence interval [CI],1.23-2.36), 당뇨병 유병기간(OR, 1.07; 95% CI, 1.06-1.09)이 긴 경우, 음주(OR, 1.40; 95% CI, 1.06-1.85)를 하는 경우에서 혈당관리가 미흡하였고 고연령층에서(OR, 0.97;95% CI, 0.96-0.99), 항고혈압제를 복용(OR, 0.64; 95%CI, 0.50-0.83)한 경우에서 혈당관리가 잘 되었다. 결론: 본 연구는 도시지역 당뇨병 환자들의 당뇨병 관리상태가 좋지 않음을 보여주고 있다. 지역사회 당뇨병 환자들의 적절한 혈당 관리와 합병증의 예방을 위해서는 지역사회에 기반을 둔 관리 대책의 수립이 필요할 것으로 생각된다.
Abstract
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 (≥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]≥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 albuminto-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.
참고문헌 (30)
- "Health at a glance: Asia/Pacific 2010" (2011)[URL]
- "WHO Diabetes Programme. Fact sheet No. 312 "Diabetes"" (2011)[URL]
- Wild S, "Gobal prevalence of diabetes: estimates for the year 2000 and projections for 2030", Diabetes Care, 27(5), pp.1047~1053 (2004)
- The Fourth Korea National Health and Nutritional Examination Survey (KNHANES Ⅳ-3) 2009, "Korea Ministry of Health and Welfare", Korea Ministry of Health and Welfare, ~ (2009)
- Cowie CC, "Full accounting of diabetes and pre-diabetes in the U.S. population in 1988-1994 and 2005-2006", Diabetes Care, 32(2), pp.287~294 (2009)
- Kannel WB, "Diabetes and cardiovascular disease. The Framingham study", JAMA, 241(19), pp.2035~2038 (1979)
- Gu K, "Diabetes and decline in heart disease mortality in US adults", JAMA, 281(14), pp.1291~1297 (1999)
- Alexander CM, "Third National Health and Nutrition Examination Survey(NHANES III); National Cholesterol Education Program(NCEP). NCEP-defined metabolic syndrome, diabetes, and prevalence of coronary heart disease among NHANES III participants age 50 years and older", Diabetes, 52(5), pp.1210~1214 (2003)
- Harch S, "Management of type 2 diabetes - a community partnership approach", Aust Fam Physician, 41(1), pp.73~76 (2012)
- 김혜연, "일개 농촌지역 저소득층 당뇨병환자의 관리 상태", 예방의학회지, 42(5), pp.315~322 (2009), 대한예방의학회
- In deep analysis of the Third National Health and Nutritional Examination Survey: The Health Examination part, "Korea Center for Disease Control and Prevention; Yonsei University", Korea Center for Disease Control and Prevention, 135~ (2007)
- Ford ES, "Trends in A1C concentrationsamong U.S. adults with diagnosed diabetes from 1999 to 2004", Diabetes Care, 31(1), pp.102~104 (2008)
- Clark MJ Jr, "Diabetes guidelines: a summary and comparison of the recommendations of the American Diabetes Association, Veterans Health Administration, and American Association of Clinical Endocrinologists", Clin Ther, 22(8), pp.899~910 (2000)
- 박석원, "전국표본조사에 의한 우리나라 당뇨병 관리실태: 건강보험자료 분석결과", Diabetes and Metabolism Journal, 31(4), pp.362~367 (2007), 대한당뇨병학회
- Keenan NL, "Centers for Disease Control and Prevention (CDC). Prevalence of hypertension and controlled hypertension - United States, 2005-2008", MMWR Surveill Summ, 60(Suppl), pp.94~97 (2011)
- Deedwania PC, "Hypertension and diabetes: new therapeutic options", Arch Intern Med, 160(11), pp.1585~1594 (2000)
- Jacobs MJ, "Prevalence and control of dyslipidemia among persons with diabetes in the United States", Diabetes Res Clin Pract, 70(3), pp.263~269 (2005)
- Muacevic-Katanec D, "Diabetic dyslipidemia or 'diabetes lipidus'?", Expert Rev Cardiovasc Ther, 9(3), pp.341~348 (2011)
- ADA 2008 American Diabetes Association, "Standards of medical care in diabetes-2008", Diabetes Care, 31(suppl 1), pp.S12~S54 (2008)
- Ramsey F, "Prevalence of selected risk behaviors and chronic diseases--Behavioral Risk Factor Surveillance System (BRFSS), 39 steps communities, United States, 2005", MMWR Surveill Summ, 57(11), pp.1~20 (2008)
- 박이병, "우리나라 당뇨병의 역학적 특성 -대한당뇨병학회·건강보험심사평가원 공동연구 결과를 중심으로-", Diabetes and Metabolism Journal, 33(5), pp.357~362 (2009), 대한당뇨병학회
- 이석우, "폐경 후 여성에서 혈청 렙틴 농도와 대사증후군과의 관계", Obstetrics & Gynecology Science, 53(03), pp.254~263 (2010), 대한산부인과학회
- Ding EL, "Sex differences of endogenous sex hormones and risk of type 2 diabetes: a systematic review and meta-analysis", JAMA, 295(11), pp.1288~1299 (2006)
- Andersson B, "Testosterone concentrations in women and men with NIDDM", Diabetes Care, 17(5), pp.405~411 (1994)
- 이영실, "일개 대학병원에서의 당뇨병 관리 현황", Diabetes and Metabolism Journal, 33(3), pp.241~250 (2009), 대한당뇨병학회
- Koro CE, "Glycemic control from 1988 to 2000 among U.S. adults diagnosed with type 2 diabetes: a preliminary report", Diabetes Care, 27(1), pp.17~20 (2004)
- El-Kebbi IM, "Association of younger age with poor glycemic control and obesity in urban African Americans with type 2 diabetes", Arch Intern Med, 163(1), pp.69~75 (2003)
- Baliunas DO, "Alcohol as a risk factor for type 2 diabetes: a systematic review and meta-analysis", Diabetes Care, 32(11), pp.2123~2132 (2009)
- Kim JY, "Chronic ethanol consumption-induced pancreatic {beta}-cell dysfunction and apoptosis through glucokinase nitration and its down-regulation", J Biol Chem, 285(48), pp.37251~37262 (2010)
- Gress TW, "Hypertension and antihypertensive therapy as risk factors for type 2 diabetes mellitus. Atherosclerosis Risk in Communities Study", N Engl J Med, 342(13), pp.905~912 (2000)