Factors Influencing Glycemic Control among Type 2 Diabetes Mellitus Patients: The Sixth Korea National Health and Nutrition Examination Survey (2013~2015)

Mee Ock Gu

doi:10.7475/kjan.2019.31.3.235

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Gu: Factors Influencing Glycemic Control among Type 2 Diabetes Mellitus Patients: The Sixth Korea National Health and Nutrition Examination Survey (2013~2015)

Original Article

Korean J Adult Nurs 2019;31(3):235-248.

Published online: 21 June 2019

DOI: https://doi.org/10.7475/kjan.2019.31.3.235

Factors Influencing Glycemic Control among Type 2 Diabetes Mellitus Patients: The Sixth Korea National Health and Nutrition Examination Survey (2013~2015)

Mee Ock Gu

Professor, College of Nursing, Gerontological Health Research Center in Institute of Health Sciences, Gyeongsang National University, Jinju, Korea

Corresponding author: Gu, Mee Ock https://orcid.org/0000-0002-9296-2041 College of Nursing, Gyeongsang National University, 816-15 Jinju-daero, Jinju 52727, Korea. Tel: +82-55-772-8226, Fax: +82-55-772-8222, E-mail: mogu@gnu.ac.kr

Received 18 February 201917 March 2019 Accepted 14 April 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was conducted to examine factors influencing glycemic control among type 2 Diabetes Mellitus (T2DM) patients using data from the sixth Korea National Health and Nutrition Examination Survey (2013~2015).

Methods

The subjects were 1,181 patients aged 30 years and older who were diagnosed with T2DM. The subjects were divided into three groups according to the glycated hemoglobin (HbA1c) values: good Glycemic Control Group (good GCT, HbA1c<7%), insufficient GCT (7≤ HbA1c <8%), and poor GCT (8%≥ HbA1c). Multivariate multi-nomial logistic regression was used to examine the association of sociodemographic, diabetes-related, health status, weight control, health behavior, and psychological factors with glycemic control among T2DM patients.

Results

The patients were distributed as follows: 44.1% in the good GCT, 29.1% in the insufficient GCT, and 26.8% in the poor GCT. In the insufficient GCT, DM duration, DM treatment, weight change, and smoking were significant factors influencing glycemic control with T2DM. In the poor GCT, age, DM duration, DM treatment, and hypertension were significant factors influencing glycemic control with T2DM.

Conclusion

Strategies for the insufficient GCT should include intensive glucose control interventions for patients with DM for over 1 year, combined therapy of oral hypoglycemic agents and insulin. In addition, it is necessary to actively perform nursing interventions for weight loss. Strategies for the poor GCT should include intensive glucose control interventions for younger age groups, more than 5 years of DM, combined therapy of oral hypoglycemic agents and insulin, and those without hypertension.

Keywords: Diabetes mellitus, type 2, Blood glucose, Glycated hemoglobin A

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Table 1.

Univariate Multinomial Logistic Regression of Sociodemographic and Diabetes-related Factors among the Three Glycemic Control Groups (n=1,181, N=2,138,501)

Characteristics	Categories	n (%)	Level of glycemic control			x² (p)	Insufficient	Poor
			Good (n=539 N=941,939)	Insufficient (n=365 N=623,009)	Poor (n=277 N=573,553)		glycemic control (ref: good glycemic control)	glycemic control (ref: good glycemic control)
			W (%)	W (%)	W (%)		OR (95% CI)	OR (95% CI)
Sociodemographic factors
Gender	Men	584 (49.4)	45.3	25.5	29.2	9.44	1.00	1.00
Gender	Women	597 (50.6)	42.6	33.3	24.1	(.046)	1.39 (0.99~1.96)	0.88 (0.62~1.25)
Age (year)	30~44	44 (3.7)	40.1	27.2	32.7	26.86	1.00	1.00
	45~64	475 (40.2)	39.7	28.8	31.5	(.004)	1.07 (0.47~2.46)	0.98 (0.44~2.18)
	65~74	452 (38.3)	47.2	28.2	24.6		0.88 (0.40~1.95)	0.64 (0.29~1.40)
	≥75	210 (17.8)	53.0	32.7	14.3		0.91 (0.39~2.12)	0.33 (0.14~0.80)^†
Education	Below elementary school	542 (46.7)	44.9	28.6	26.5	12.15	1.00	1.00
	Middle school	176 (15.1)	45.3	33.2	21.5	(.213)	1.15 (0.72~1.84)	0.80 (0.47~1.37)
	High school	279 (24.0)	39.1	33.0	27.9		1.33 (0.90~1.96)	1.21 (0.79~1.86)
	Above college	165 (14.2)	47.8	21.7	30.5		0.71 (0.44~1.15)	1.08 (0.67~1.74)
	Missing	19
Marital status	With spouse	859 (74.7)	44.7	28.3	27.0	2.34	1.00	1.00
	Without spouse	291 (25.3)	44.3	32.4	23.3	(.433)	1.16 (0.81~1.65)	0.87 (0.58~1.31)
	Missing	31
Current job	Yes	502 (43.2)	42.4	29.2	28.4	1.87	1.00	1.00
	No	660 (56.8)	45.5	29.4	25.1	(.508)	0.94 (0.68~1.30)	0.82 (0.59~1.14)
	Missing	19
Household income	Low	341 (29.1)	39.7	27.1	33.2	23.38	1.00	1.00
	Lower intermediate	284 (24.2)	45.4	34.3	20.3	(.010)	1.11 (0.72~1.71)	0.54 (0.33~0.88)^†
	Higher intermediate	266 (22.7)	44.3	24.4	31.3		0.81 (0.52~1.25)	0.85 (0.52~1.37)
	High	281 (24.0)	47.5	31.3	21.2		0.97 (0.63~1.48)	0.53 (0.33~0.86)^‡
	Missing	9
Diabetes-related factors
DM duration (year)	≤1	137 (12.1)	59.2	22.5	18.3	46.13	1.00	1.00
	＞1~5	360 (31.8)	49.8	31.0	19.2	(＜.001)	1.67 (0.96~2.78)	1.25 (0.65~2.42)
	＞5~10	295 (26.0)	38.5	27.3	34.2		1.87 (1.07~3.26)^†	2.88 (1.52~5.44)^‡
	＞10	341 (30.1)	35.7	30.9	33.4		2.27 (1.32~3.90)^‡	3.04 (1.59~5.79)^‡
	Missing	48
DM treatment	Only OHA	992 (84.1)	46.3	30.1	23.6	66.10	1.00	1.00
	OHA and insulin	80 (6.8)	10.1	32.2	57.7	(＜.001)	4.93 (1.73~14.03)^‡	11.25 (4.19~30.20)^‡
	No treatment	107 (9.1)	49.8	19.6	30.6		0.61 (0.34~1.10)	1.21 (0.67~2.17)
	Missing	2

n=unweighted sample size; N=weighted sample size; W=weighted; ref=reference; OR=odds ratio; CI=confidence interval; DM=diabetes mellitus; OHA=oral hypoglycemic agent;

^† p＜.050;

^‡ p＜.010.

Table 2.

Univariate Multinomial Logistic Regression of Health Status and Weight Control Factors among the Three Glycemic Control Groups

Characteristics	Categories	n (%)	Level of glycemic control			x² (p)	Insufficient glycemic control (ref: good glycemic control)	Poor glycemic control (ref: good glycemic control)
Characteristics	Categories	n (%)	Good W (%)	Insufficient W (%)	Poor W (%)	x² (p)	OR (95% CI)	OR (95% CI)
Health status factors
Subjective health status	Good	152 (13.0)	47.2	27.2	25.6	.93	0.84 (0.52~1.41)	0.85 (0.51~1.42)
	Fair	532 (45.4)	43.3	29.2	27.5	(.949)	1.00	1.00
	Poor	487 (41.6)	43.9	29.9	26.2		1.02 (0.72~1.43)	0.94 (0.66~1.35)
	Missing	10
Hypertension	Yes	759 (64.3)	47.9	28.6	23.5	12.28	0.78 (0.56~1.05)	0.60 (0.44~0.83)^‡
	No	421 (35.7)	38.7	30.0	31.3	(.009)	1.00	1.00
	Missing	1
Hyper-cholesterolemia	Yes	419 (37.0)	47.5	27.6	24.9	3.20	0.81 (0.58~1.12)	0.79 (0.57~1.10)
	No	713 (63.0)	41.9	30.3	27.8	(.269)	1.00	1.00
	Missing	49
Hyper-triglyceridemia	Yes	209 (22.6)	38.0	29.5	32.5	4.82	1.22 (0.80~1.85)	1.51 (0.97~2.34)
	No	714 (77.4)	45.4	28.9	25.7	(.175)	1.00	1.00
	Missing	258
Stroke	Yes	104 (8.9)	47.6	37.5	14.9	9.11	1.21 (0.66~2.21)	0.49 (0.24~1.03)
	No	1,067 (91.1)	43.7	28.5	27.8	(.186)	1.00	1.00
	Missing	10
Myocardial infarction or angina	Yes	97 (8.3)	48.1	34.4	17.5	4.40	1.09 (0.65~1.81)	0.58 (0.29~1.15)
	No	1,074 (91.7)	43.7	28.8	27.5	(.150)	1.00	1.00
	Missing	10
Weight control factors
BMI (kg/m²)	18.5 (underweight)	13 (1.1)	71.5	5.8	22.7	13.36	0.21 (0.07~0.60)^‡	0.27 (0.09~0.79)^†
	18.5~22.9 (normal)	335 (28.4)	43.4	25.3	31.3	(.059)	1.00	1.00
	23~24.9 (overweight)	303 (25.7)	46.5	31.6	21.9		2.11 (1.60~2.79)^‡	1.29 (0.94~1.77)
	≥25 (obesity)	529 (44.8)	42.6	30.7	26.7		3.65 (2.92~4.58)^‡	2.26 (1.72~2.97)^‡
	Missing	1
Waist circumference (M≺90cm, F≺85cm)	Normal	663 (56.1)	45.6	26.7	27.7	4.18	1.00	1.00
Waist circumference (M≺90cm, F≺85cm)	Obesity	518 (43.9)	42.1	32.2	25.7	(.210)	1.30 (0.95~1.78)	1.00 (0.72~1.39)
Weight change	No change	767 (66.6)	44.1	32.9	23.0	23.39	1.00	1.00
	Loss	253 (22.0)	45.7	20.5	33.8	(.017)	0.60 (0.40~0.90)^†	1.42 (0.96~2.11)
	Gain	131 (11.4)	42.2	25.7	32.1		0.82 (0.49~1.36)	1.46 (0.85~2.51)
	Missing	30

n=unweighted sample size; N=weighted sample size; W=weighted; ref=reference; OR=odds ratio; CI=confidence interval; BMI=body mass index; M=male; F=female;

^† p＜.050;

^‡ p＜.010.

Table 3.

Univariate Multinomial Logistic Regression of Health Behavior and Psychological Factors among the Three Glycemic Control Groups

Characteristics	Categories	n (%)	Level of glycemic control			x² (p)	Insufficient glycemic control (ref: good glycemic control)	Poor glycemic control (ref: good glycemic control)
Characteristics	Categories	n (%)	Good W (%)	Insufficient W (%)	Poor W (%)	x² (p)	OR (95% CI)	OR (95% CI)
Health behavior factors
Diet therapy	Yes	451 (41.7)	43.6	30.7	25.7	7.36	1.15 (0.83~1.59)	0.96 (0.68~1.37)
	No	630 (58.3)	43.6	29.4	27.0	(.252)	1.00	1.00
	Missing	100
Physical activities	Days of walking	(≥10min/w	week)
	Never	252 (21.7)	41.3	33.2	25.5	4.99	1.00	1.00
	1~2	171 (14.8)	46.5	27.4	26.1	(.744)	0.73 (0.44~1.22)	0.91 (0.52~1.59)
	3~4	208 (17.9)	46.1	24.6	29.3		0.66 (0.39~1.13)	1.03 (0.60~1.78)
	5~7	528 (45.6)	43.7	30.2	26.1		0.86 (0.57~1.29)	0.97 (0.62~1.53)
	Missing	22
	Days of strength	exercises
	Never	907 (78.1)	43.7	29.3	27.0	2.22	1.00	1.00
	1~2	86 (7.4)	42.2	32.3	25.5	(.958)	1.14 (0.62~2.09)	0.97 (0.53~1.79)
	3~4	74 (6.3)	45.3	30.3	24.4		1.00 (0.54~1.85)	0.86 (0.42~1.77)
	5~7	95 (8.2)	50.2	25.2	24.6		0.74 (0.41~1.34)	0.80 (0.39~1.62)
	Missing	19
Smoking	Current	219 (19.0)	39.7	26.2	34.1	16.32	0.88 (0.55~1.39)	1.44 (0.91~2.29)
	Former	297 (25.9)	51.7	26.6	21.7	(.027)	0.68 (0.47~0.99)^∗	0.71 (0.47~1.07)
	Never	632 (55.1)	42.6	32.1	25.3		1.00	1.00
	Missing	33
Drinking (frequency)	1/month	426 (46.7)	41.5	29.7	28.8	3.69	1.00	1.00
	1~4/month	263 (28.8)	45.0	30.7	24.3	(.628)	0.95 (0.64~1.42)	0.78 (0.50~1.22)
	≥2/week	223 (24.5)	47.3	25.9	26.8		0.76 (0.48~1.20)	0.81 (0.50~1.32)
	Missing	269
Sleep duration (hour)	≤6	562 (47.6)	46.5	27.6	25.9	3.28	0.78 (0.57~1.08)	0.82 (0.57~1.18)
	7~8	487 (41.2)	41.1	31.1	27.8	(.662)	1.00	1.00
	≥9	132 (11.2)	44.6	28.3	27.1		0.84 (0.50~1.40)	0.90 (0.50~1.62)
Health exam (during last 2 years)	Yes	786 (67.3)	46.6	27.0	26.4	8.62	1.00	1.00
	No	382 (32.7)	38.8	33.8	27.4	(.185)	1.50 (1.09~2.07)^†	1.25 (0.85~1.83)
	Missing	13
Psychological factors
Perceived stress	A lot	263 (22.9)	38.6	30.8	30.6	9.30	1.12 (0.73~1.73)	1.69 (1.04~2.72)^†
	Some	586 (50.9)	46.2	27.2	26.6	(.143)	0.83 (0.57~1.20)	1.23 (0.79~1.90)
	A little	302 (26.2)	45.8	32.7	21.5		1.00	1.00
	Missing	30
Depressive mood	Yes	137 (17.0)	43.7	23.6	32.7	13.03	0.80 (0.47~1.36)	1.19 (0.72~1.95)
	No	668 (83.0)	43.4	29.2	27.4	(.149)	1.00	1.00
	Missing	376

n=unweighted sample size; N=weighted sample size; W=weighted; ref=reference; OR=odds ratio; CI=confidence interval;

^† p＜.050.

Table 4.

Distribution of Type 2 Diabetes Mellitus Patients according to Glycated Hemoglobin (HbA1c, %) from the Sixth Korea National Health and Nutrition Examination Survey (2013~2015)(n=1,181, N=2,138,501)

Criteria of glycemic control (HbA1c, %)		Glycemic control group	n(%)	N	W (%)	HbA1c (%)
Criteria of glycemic control (HbA1c, %)		Glycemic control group	n(%)	N	W (%)	M± SD
ADA guideline	7	Good	539(45.6)	941,939	44.1	6.3±0.4
	7~＜8	Insufficient	365(30.9)	623,009	29.1	7.4±0.3
	≥8	Poor	277(23.5)	573,553	26.8	9.2±1.1

n=unweighted sample size; N=weighted sample size; W=weighted; ADA=American Diabetes Association.

Table 5.

Multivariate Multinomial Logistic Regression Analysis of Influencing Factors among the Three Glycemic Control Groups (n=1,089, N=1,981,910)

Characteristics	Categories	Insufficient glycemic control (ref: good glycemic control)(n=337, N=579,986)		Poor glycemic control (ref: good glycemic control)(n=254, N=526,229)
Characteristics	Categories	Adjusted OR (95% CI)	p	Adjusted OR (95% CI)	p
Age (year)	30~44	1.00		1.00
	45~64	0.90 (0.36~2.25)	.825	0.76 (0.31~1.86)	.550
	65~74	0.70 (0.28~1.75)	.448	0.47 (0.19~1.17)	.104
	≥75	0.66 (0.24~1.77)	.406	0.27 (0.10~0.72)	.009
Household income	Low	1.00		1.00
	Lower intermediate	1.21 (0.76~1.94)	.422	0.63 (0.35~1.08)	.089
	Higher intermediate	0.84 (0.52~1.37)	.489	0.91 (0.53~1.59)	.746
	High	1.04 (0.64~1.68)	.877	0.63 (0.37~1.09)	.099
DM duration (year)	≤1	1.00		1.00
	＞1~5	1.77 (1.02~3.07)	.044	1.41 (0.69~2.85)	.347
	＞5~10	2.06 (1.11~3.83)	.022	3.81 (1.91~7.61)	.001
	＞10	2.53 (1.39~4.59)	.002	3.69 (1.85~7.38)	.001
DM treatment	Only OHA	1.00		1.00
	OHA and insulin	3.17 (1.05~9.61)	.042	9.71 (3.51~26.91)	.001
	No treatment	0.70 (0.37~1.30)	.257	1.35 (0.70~2.60)	.373
Hypertension	No	1.00		1.00
Hypertension	Yes	0.71 (0.50~1.01)	.059	0.61 (0.41~0.89)	.010
BMI (kg/m²)	18.5 (underweight)	0.12 (0.01~1.19)	.069	0.51 (0.14~1.85)	.306
	18.5~22.9 (normal)	1.00		1.00
	23~24.9 (overweight)	1.11 (0.71~1.75)	.649	0.84 (0.49~1.45)	.525
	≥25 (obesity)	1.39 (0.94~2.08)	.102	1.36 (0.86~2.14)	.191
Weight change	No	1.00		1.00
	Loss	0.57 (0.36~0.90)	.016	1.31 (0.86~1.99)	.203
	Gain	0.79 (0.46~1.33)	.370	1.29 (0.69~2.39)	.422
Smoking	Never	1.00		1.00
	Current	0.93 (0.58~1.50)	.777	1.49 (0.90~2.46)	.121
	Former	0.65 (0.44~0.97)	.037	0.77 (0.48~1.22)	.256
Health exam (during last 2 years)	Yes	1.00		1.00
Health exam (during last 2 years)	No	1.33 (0.94~1.89)	.103	0.96 (0.63~1.47)	.866
Perceived stress	A lot	1.23 (0.75~2.02)	.412	1.31 (0.74~2.32)	.359
	Some	0.87 (0.58~1.31)	.505	1.06 (0.63~1.76)	.837
	A little	1.00		1.00

ref=reference; n=unweighted sample size; N=weighted sample size; W=weighted; OR=odds ratio; CI=confidence interval; DM=diabetes mellitus; BMI=body mass index.

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