지역사회의 포괄적 지지가 경제적으로 어려운 60세 이상 노인 당뇨병환자의 혈당조절에 미치는 영향

Abstract

Background: 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. Methods: 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. Results: 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). Conclusion: 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. (KOREAN DIABETES J 32:453-461, 2008)