Journal List > Korean Diabetes J > v.32(5) > 1002251

Kim, Lee, Kim, Oh, Park, Park, Kim, Seo, Kim, Choi, Baik, Choi, and Kim: Effects of Comprehensive Support on Glycemic Control Using Community Networks in Low-Income Elderly Patients with Diabetes



Diabetes is common among elderly, and low-income is associated with poor adherence to treatment and increased mortality. We evaluated whether comprehensive support using community networks improves glycemic control among low-income elderly patients with diabetes.


A total of 49 low-income elderly patients with type 2 diabetes, mean age 73 years, were enrolled. For 1 year, study subjects underwent various lifestyle modification programs provided by community networks. The biochemical data including glycemic markers and anthropometric data were obtained at the baseline and at the end of the study. Also, the patients were asked to complete a questionnaire about their quality of life, self-confidence and self-care behavior.


After lifestyle modification program, overall changes of fasting plasma glucose, HbA1c, blood pressure, body weight, and other biochemical markers were not significantly different. In a subgroup analysis of 21 patients with poorly controlled diabetes (fasting glucose > 140 mg/dL or HbA1c > 7.5%), fasting plasma glucose was significantly reduced (P = 0.030). Among patients with baseline HbA1c level ≥ 8%, HbA1c levels after intervention decreased from 9.33 ± 1.07% to 8.27 ± 1.15% (P = 0.092). The results of the questionnaires revealed significant increases in the scores of quality of life, self-confidence and self-care behavior (P < 0.05).


Among low-income, elderly patients with type 2 diabetes, lifestyle modification through community networks showed no significant changes in glycemic control markers. More intensive and precise interventions using community networks are needed for the glycemic control of low-income, elderly patients with type 2 diabetes.

Figures and Tables

Table 1
General baseline characteristics
Table 2
Baseline characteristics associated with the management of diabetes
Table 3
Characteristics associated with lifestyle
Table 4
Comparisons of body weight, waist circumference, BMI, blood pressure, and biochemical markers before and after interventions among a total of 49 subjects
Table 5
Comparisons of body weight, waist circumference, BMI, blood pressure, and biochemical markers before and after interventions among 20 subjects whose fasting glucose > 140 mg/dL or HbA1c > 7.5%
Table 6
Comparisons of self-confidence, self-care behavior and quality of life before and after interventions


1. Kim SM, Lee JS, Lee J, Na JK, Han JR, Yoon DK, Baik SH, Choi DS, Choi KM. Prevalence of diabetes and impaired fasting glucose in Korea: Korean National Health and Nutrition Survey 2001. Diabetes Care. 2006. 29:226–231.
3. American Diabetes Association. Standards of medical care in diabetes-2008. Diabetes Care. 2008. 31:Suppl 1. S12–S54.
4. Pastors JG, Warshaw H, Daly A, Franz M, Kulkarni K. The evidence for the effectiveness of medical nutrition therapy in diabetes management. Diabetes Care. 2002. 25:608–613.
7. Sone H, Katagiri A, Ishibashi S, Abe R, Saito Y, Murase T, Yamashita H, Yajima Y, Ito H, Ohashi Y, Akanuma Y, Yamada N. JD Study Group. Effects of lifestyle modifications on patients with type 2 diabetes: the Japan Diabetes Complications Study (JDCS) study design, baseline analysis and three year-interim report. Horm Metab Res. 2002. 34:509–515.
11. Brown AF, Mangione CM, Saliba D, Sarkisian CA. California Healthcare Foundation/American Geriatrics Society Panel on Improving Care for Elders with Diabetes. Guidelines for improving the care of the older person with diabetes mellitus. J Am Geriatr Soc. 2003. 51:5 Suppl Guidelines. S265–S280.
12. Noh JH, Kim SK, Cho YJ, Nam HU, Kim IJ, Jeong IK, Choi MG, Yoo HJ, Ahn YH, Bae HY, Jang HC. Current status of diabetes management in elderly Koreans with diabetes. Diabetes Res Clin Pract. 2007. 77:Suppl 1. S71–S75.
13. UKPDS group. UK Prospective Diabetes Study 7: response of fasting plasma glucose to diet therapy in newly presenting type II diabetic patients, UKPDS Group. Metabolism. 1990. 39:905–912.
14. Franz MJ, Monk A, Barry B, McClain K, Weaver T, Cooper N, Upham P, Bergenstal R, Mazze RS. Effectiveness of medical nutrition therapy provided by dietitians in the management of non-insulin-dependent diabetes mellitus: a randomized, controlled clinical trial. J Am Diet Assoc. 1995. 95:1009–1017.
15. Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C. Physical activity/exercise and type 2 diabetes. Diabetes Care. 2004. 27:2518–2539.
16. Norris SL, Lau J, Smith SJ, Schmid CH, Engelgau MM. Self-management education for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control. Diabetes Care. 2002. 25:1159–1171.
19. Gardner CD, Kiazand A, Alhassan S, Kim S, Stafford RS, Balise RR, Kraemer HC, King AC. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial. JAMA. 2007. 297:969–977.
20. Foster GD, Wyatt HR, Hill JO, McGuckin BG, Brill C, Mohammed BS, Szapary PO, Rader DJ, Edman JS, Klein S. A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med. 2003. 348:2082–2090.
21. Stern L, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, Williams M, Gracely EJ, Samaha FF. The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Ann Intern Med. 18. 140:778–785.
Similar articles