Association between Diabetes Education Status and Clinical Outcomes of Patients with Diabetes Mellitus: Analysis of the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V)

Jun Sung Kwon; Won Jun Kim; Yang Hee Han; Hyun Joong Kim; Sa Young Shin; Kyoo Ho Choi; Jae Hyuck Jun; Myoung Sook Shim; Jin Yeob Kim

doi:10.4093/jkd.2014.15.4.236

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Kwon, Kim, Han, Kim, Shin, Choi, Jun, Shim, and Kim: Association between Diabetes Education Status and Clinical Outcomes of Patients with Diabetes Mellitus: Analysis of the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V)

Original Articles & Case Reports

J Korean Diabetes 2014;15(4):236-243.

Published online: 20 January 2014

DOI: https://doi.org/10.4093/jkd.2014.15.4.236

Association between Diabetes Education Status and Clinical Outcomes of Patients with Diabetes Mellitus: Analysis of the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V)

Jun Sung Kwon¹, Won Jun Kim², Yang Hee Han¹, Hyun Joong Kim¹, Sa Young Shin¹, Kyoo Ho Choi¹, Jae Hyuck Jun¹, Myoung Sook Shim², Jin Yeob Kim²

¹Departments of Internal Medicine, Ulsan University College of Medicine, Gangneung Asan Hospital, Gangneung, Korea

²Division of Endocrinology, Departments of Internal Medicine, Ulsan University College of Medicine, Gangneung Asan Hospital, Gangneung, Korea

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

Background

We aimed to study the importance of diabetes education by investigating diabetes education rate and the associations between the presence/absence of diabetes education and the clinical outcomes of diabetic patients in Korea.

Methods

In the Fifth Korea National Health and Nutrition Examination survey (KNHANES V), a cross-sectional national survey during 2010 and 2012, 1498 subjects aged over 30 years and older were diagnosed with diabetes by doctors. The subjects were analyzed by a complex samples model.

Results

Only 20.3% of diabetes patients received diabetes education, and this was not significantly different between age groups. Education was delivered in hospitals/clinics, public health centers, and public lectures (15.7%, 3.0% and 1.4%, respectively). After adjusting for age, sex, and duration of diabetes, the factors independently associated with the presence of diabetes education were higher education level, frequent walking habit, and parameters regarding the presence of dyslipidemia, insulin treatment, and non-pharmacologic treatment. Among continuous variables, only the duration of diabetes was associated with diabetes education status; metabolic parameters were not associated with diabetes education status.

Conclusion

Diabetes is a chronic disease and education on diabetes is very important. The education rate was low and quality of the education is doubtful. An effort to raise the rate of diabetes education and further study to raise the quality of diabetes training are necessary.

Keywords: Diabetes mellitus, Education, Epidemiology, National survey

References

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Table 1.

Baseline characteristics of patients with diagnosed diabetes

Variables	Total		Age < 50		50∼59		60∼69		Age > 70		P value
No.	1,498		133 (8.9)		305 (20.4)		509 (34.0)		551 (36.8)
Sex
Male	743	(49.9)	67	(53.8)	183	(60.4)	262	(49.6)	231	(41.9)	< 0.001
Female	755	(50.1)	66	(46.2)	123	(39.6)	246	(50.4)	320	(58.1)
Duration of diabetes (yr)	8.8 ± 0.6		4.8 ± 0.5		6.5 ± 0.7		8.7 ± 0.7		11.3 ± 0.8		< 0.001
Residential area
Urban Rural	1,118 380	(76.0) (24.0)	109 24	(85.3) (14.7)	237 69	(80.1) (14.7)	370 138	(72.3) (27.7)	402 149	(74.9) (25.1)	0.052
Education (yr)
≤ 12 > 12	1,311 186	(87.4) (12.6)	87 46	(64.1) (35.9)	257 48	(82.4) (17.6)	463 44	(93.0) (6.9)	503 48	(90.0) (10.0)	0.439
Income quartile (individual)
Lowest quartile Others	410 1,074	(26.8) (73.2)	39 94	(24.6) (75.4)	89 213	(29.7) (70.3)	144 359	(28.4) (71.6)	138 408	(23.5) (76.5)	0.469
Presence of Hypertension
No Yes	791 707	(54.0) (46.0)	102 31	(76.8) (23.2)	203 103	(68.7) (31.3)	259 249	(51.4) (48.6)	227 324	(41.4) (58.6)	< 0.001
Presence of dyslipidemia
No Yes	1,175 323	(77.9) (22.1)	102 31	(75.6) (24.4)	235 71	(75.6) (24.4)	374 134	(74.8) (25.2)	464 87	(83.3) (16.7)	0.122
The frequency of high risk alcohol intake in men
< 1/wk ≥ 1/wk	527 216	(84.7) (15.3)	39 28	(73.6) (26.4)	103 79	(74.5) (25.5)	190 73	(85.6) (14.4)	195 36	(93.3) (6.7)	< 0.001
The frequency of high risk alcohol intake in women
< 1/wk ≥ 1/wk	755 18	(98.5) (1.5)	62 4	(96.7) (3.3)	116 7	(97.3) (2.7)	241 5	(98.8) (1.2)	318 2	(99.6) (0.4)	0.016
Smoking status
No Yes Ex-smoker	771 295 432	(51.1) (19.8) (29.0)	67 37 29	(46.2) (26.3) (27.5)	135 93 78	(44.5) (29.6) (25.9)	262 90 156	(52.4) (18.9) (28.6)	307 75 169	(55.6) (12.4) (32.0)	0.594
Vigorous physical activity
No Yes	1,333 158	(89.3) (10.7)	118 15	(89.4) (10.6)	261 45	(85.0) (15.0)	444 61	(89.3) (10.7)	510 37	(92.6) (7.4)	0.049
Moderate physical activity
No Yes	1,372 120	(92.1) (7.9)	123 10	(94.2) (5.8)	277 29	(91.3) (8.7)	457 49	(90.2) (9.8)	515 32	(94.1) (5.9)	0.304
Walking
No Yes	921 567	(62.0) (38.0)	90 43	(65.5) (34.5)	185 120	(62.2) (37.8)	302 204	(60.0) (40.0)	344 200	(63.1) (36.9)	0.722
Nutritional education
No Yes	1,263 111	(91.6) (8.4)	103 7	(92.7) (7.3)	254 25	(90.3) (9.7)	427 35	(92.5) (7.5)	479 44	(91.5) (8.5)	0.680
Waist circumference (cm)	86.9	± 0.3	87.7	± 0.7	86.4	± 0.5	87.8	± 0.4	86.2	± 0.6	0.097
BMI (kg/m²)	24.7	± 0.1	25.9	± 0.2	25.0	± 0.2	24.8	± 0.2	24.2	± 0.2	< 0.001
Fasting glucose (mg/dL)	136.7	± 4.3	147.5	± 21.5	145.6	± 9.1	134.8	± 6.0	129.0	± 6.2	< 0.001
HbA1C (%)	7.3	± 0.2	7.5	± 0.8	7.5	± 0.4	7.2	± 0.3	7.2	± 0.3	< 0.001
HbA1c < 7%	599	(45.6)	46	(46.1)	123	(41.6)	204	(46.5)	226	(48.1)	0.990
HbA1c < 8%	942	(77.2)	69	(66.7)	198	(71.1)	336	(81.3)	339	(79.9)	0.884
Systolic BP (mmHg)	129.1	± 0.9	118.2	± 1.7	125.6	± 0.5	131.0	± 0.9	132.0	± 1.0	< 0.001
Diastolic BP (mmHg)	74.9	± 0.7	79.4	± 1.0	79.0	± 0.5	74.9	± 0.4	71.2	± 0.6	< 0.001
Total cholesterol (mg/dL)	180.2	± 1.2	187.7	± 1.2	184.0	± 1.9	178.0	± 1.8	177.9	± 2.1	< 0.001
Triglycerides (mg/dL)	166.6	± 5.2	198.3	± 13.6	193.1	± 4.9	155.7	± 6.7	150.0	± 7.0	< 0.001
LDL cholesterol (mg/dL)	106.9	± 2.3	114.5	± 4.6	109.1	± 2.2	104.8	± 3.7	102.2	± 7.5	0.379
DM treatment
No Yes	162 1336	(10.9) (89.1)	30 103	(24.9) (75.1)	40 266	(13.5) (86.5)	42 466	(8.1) (91.9)	50 501	(9.0) (91.0)	0.020
DM treatment with insulin ± OHA
No Yes	1357 141	(90.8) (9.2)	120 13	(89.1) (10.9)	275 31	(90.3) (9.7)	457 51	(91.4) (8.6)	505 46	(90.9) (9.1)	0.959
DM treatment with OHA
No Yes	224 1274	(14.7) (85.3)	37 96	(30.5) (69.5)	55 251	(16.4) (83.6)	67 441	(12.9) (87.1)	65 486	(12.0) (88.0)	0.007
DM treatment with non-pharmacologic method
No Yes	1252 246	(84.8) (15.2)	108 25	(83.7) (16.3)	252 54	(82.9) (17.1)	422 86	(85.0) (15.0)	470 81	(86.2) (13.8)	0.622

Values are presented as number (%) or mean ± SE. BMI, body mass index; BP, blood pressure; LDL, low-density lipoprotein; Systolic & diastolic BP, by averaging the values of he second and third BP measurements; DM, diabetes mellitus; OHA, oral hypoglycemic agents.

Table 2.

DM management education status and places

	Total	Age < 50	50∼59	60∼69	Age > 70	P value
DM management education
No	1,193 (79.7)	98 (71.2)	234 (77.2)	402 (79.9)	459 (82.9)	0.170
Yes	305 (20.3)	35 (28.8)	72 (22.8)	106 (20.1)	92 (17.1)
DM education from hospital
No	1,267 (84.3)	107 (76.5)	246 (80.7)	431 (85.6)	483 (87.2)	0.074
Yes	231 (15.7)	26 (23.5)	60 (19.3)	77 (14.4)	68 (12.8)
DM education from public health center
No	1452 (97.0)	128 (96.9)	303 (99.3)	487 (95.7)	534 (96.8)	0.020
Yes	46 (3.0)	5 (3.1)	3 (0.7)	21 (4.3)	17 (3.2)
DM education from public lectures
No	1,478 (98.6)	133 (100.0)	299 (97.6)	503 (98.9)	543 (98.8)	0.571
Yes	20 (1.4)	0 (0.0)	7 (2.4)	5 (1.1)	8 (1.2)
DM education from other places
No	1,486 (99.3)	129 (97.0)	304 (99.5)	504 (99.4)	549 (99.5)	0.088
Yes	12 (0.7)	4 (3.0)	2 (0.5)	4 (0.6)	2 (0.5)

P values were calculated by using complex samples cross sectional analysis. Values are presented as number (%). DM, diabetes mellitus.

Table 3.

The association between the presence/absence of DM management education and clinical characteristics

DM management education	No	Yes	Odds ratio (95% CI)	P value
Sex
Male	542 (78.8)	149 (21.2)	1.06 (0.75–1.51)	0.078
Female	589 (80.6)	135 (19.4)
Residential area
Urban	825 (78.0)	232 (22.0)	0.81 (0.51–1.28)	0.069
Rural	306 (84.9)	52 (15.1)
Education (yr)
≤ 12	1,022 (82.0)	218 (18.0)	2.44 (1.43–4.16)	< 0.001
> 12	108 (63.6)	66 (36.4)
Income quartile (individual)
Lowest quartile	329 (83.3)	61 (16.7)	1.14 (0.75–1.74)	0.126
Others	791 (78.3)	220 (21.7)
Presence of hypertension
No	587 (80.6)	155 (19.4)	0.96 (0.70–1.31)	0.492
Yes	544 (78.5)	129 (21.5)
Presence of dyslipidemia
No	916 (81.9)	200 (18.1)	1.62 (1.10–2.39)	0.033
Yes	215 (71.7)	84 (28.3)
Walking
No	719 (82.2)	155 (17.8)	1.55 (1.13–2.13)	0.004
Yes	403 (75.1)	128 (24.9)
DM treatment with insulin ± OHA
No	1,058 (82.4)	225 (17.6)	3.32 (2.00–5.52)	< 0.001
Yes	73 (53.0)	59 (47.0)
DM treatment with OHA
No	163 (76.6)	44 (23.4)	1.08 (0.71–1.66)	0.368
Yes	968 (80.2)	240 (19.8)
DM treatment with non-pharmacologic method
No	975 (82.2)	208 (17.8)	1.83 (1.24–2.71)	< 0.001
Yes	156 (65.7)	76 (34.3)

P values were calculated by using complex samples logistic regression model after adjusting for age, sex and diabetes duration. Values are presented as number (%). DM, diabetes mellitus; CI, confidence interval; OHA, oral hypoglycemic agents.

Table 5.

Ihe assoaatlon between the presence/absence OT UM management educatlon and blochemlcal characters

DM management education	No	Yes	P value
Waist circumference (cm)	86.8 ± 9.54	86.6 ± 9.01	0.519
BMI (kg/m²)	24.7 ± 3.5	24.6 ± 3.2	0.697
Fasting glucose (mg/dL)	137.0 ± 42.4	139.6 ± 43.8	0.787
HbA1C (%)	7.3 ± 1.4	7.6 ± 1.5	0.184
Systolic BP (mmHg)	129.1 ± 17.7	127.6 ± 16.7	0.831
Diastolic BP (mmHg)	74.8 ± 10.2	74.2 ± 10.1	0.454
Total cholesterol (mg/dL)	181.2 ± 39.5	176.9 ± 36.3	0.326
Triglycerides (mg/dL)	166.2 ± 138.2	160.9 ± 101.1	0.678
LDL cholesterol (mg/dL)	109.2 ± 38.2	103.5 ± 34.7	0.054

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