1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
2Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea.
3Center for Medical Informatics, Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea.
Copyright © 2018 Korean Diabetes Association
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CONFLICTS OF INTEREST: No potential conflict of interest relevant to this article was reported.
Values are presented as median (interquartile range), number (%), or mean±standard deviation.
HbA1c, glycosylated hemoglobin; BUN, blood urea nitrogen; GFR, glomerular filtration rate; AST, aspartate transferase; ALT, alanine transferase; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; CAD, coronary artery disease; CVA, cerebrovascular accident; CKD, chronic kidney disease.
aDefined as absolute reduction of HbA1c ≥0.6% or HbA1c level at follow-up <7%.
HbA1c, glycosylated hemoglobin; OR, odds ratio; CI, confidence interval.
aModel 1: unadjusted, bModel 2: adjusted for age and sex, cModel 3: adjusted for age, sex, benefit type of National Health Insurance service, baseline HbA1c, and use of statin, dModel 4: adjusted for age, sex, benefit type of National Health Insurance service, baseline HbA1c, and use of statin, body mass index, presence of diabetic retinopathy, and daily insulin dose.
Characteristic | Total | Improvementa | P value | |
---|---|---|---|---|
− | + | |||
Number | 409 | 264 | 145 | |
Age, yr | 67 (60–73) | 67 (59–72) | 67 (60–75) | 0.234 |
Male sex | 194 (47.4) | 121 (45.8) | 73 (50.3) | 0.382 |
Body mass index, kg/m2 | 24.7 (22.8–27.4) | 24.5 (22.6–27.1) | 25.5 (23.2–27.8) | 0.078 |
Duration of diabetes, yr | 19.1±8.0 | 19.0±8.3 | 19.7±7.7 | 0.430 |
Systolic blood pressure, mm Hg | 128.6±14.9 | 128.0±14.9 | 129.8±14.8 | 0.246 |
Diastolic blood pressure, mm Hg | 72.4±10.6 | 71.6±10.8 | 73.8±10.2 | 0.046 |
HbA1c, % | 8.5±1.3 | 8.2±1.0 | 9.1±1.6 | <0.001 |
Fasting serum glucose, mg/dL | 137 (105–175) | 126 (101–160) | 154 (122–202) | <0.001 |
Fasting C-peptide, ng/mL | 1.6 (0.9–2.4) | 1.6 (0.9–2.3) | 1.6 (0.9–2.5) | 0.649 |
Urine albumin to creatinine ratio | 37.5 (12.3–203.8) | 36.7(11.8–173.6) | 38.7(12.8–329.0) | 0.317 |
BUN, mg/dL | 16 (13–22) | 16 (13–21) | 17 (14–24) | 0.058 |
Creatinine, mg/dL | 0.9 (0.7–1.2) | 0.9 (0.7–1.2) | 0.9 (0.7–1.2) | 0.226 |
Estimated GFR, mL/min/1.73 m2 | 71.4±27.8 | 72.6±25.9 | 69.2±31.0 | 0.263 |
AST, IU/L | 23 (19–31) | 23 (20–30) | 22 (17–31) | 0.256 |
ALT, IU/L | 22 (16–32) | 22 (17–33) | 21 (15–29) | 0.172 |
Total cholesterol, mg/dL | 146 (129–167) | 145 (129–163) | 151 (127–171) | 0.449 |
Triglyceride, mg/dL | 123 (91–168) | 123 (93–162) | 120 (86–192) | 0.984 |
HDL-C, mg/dL | 43 (37–51) | 45 (37–52) | 43 (36–51) | 0.607 |
LDL-C, mg/dL | 79 (65–97) | 77 (64–94) | 84 (65–97) | 0.194 |
Hypertension | 324 (79.2) | 212 (80.3) | 112 (77.2) | 0.465 |
History of CAD | 45 (11.0) | 29 (11.0) | 16 (11.0) | 0.988 |
History of CVA | 25 (6.1) | 16 (6.10) | 9 (6.2) | 0.953 |
Diabetic retinopathy | 204/311 (65.6) | 133/197 (67.5) | 71/114 (62.3) | 0.349 |
Non-proliferative | 131/311 (42.1) | 88/197 (44.7) | 43/114 (37.7) | |
Proliferative | 73/311 (23.5) | 45/197 (22.8) | 28/114 (24.6) | |
Diabetic nephropathy | 236/408 (57.8) | 151/264 (57.2) | 85/144 (59.0) | 0.720 |
Microalbuminuria | 123/393 (31.3) | 85/254 (33.5) | 38/139 (27.3) | |
Overt proteinuria | 84/393 (21.4) | 49/254 (19.3) | 35/139 (25.2) | |
CKD stage 3 | 98/408 (24.0) | 65/264 (24.6) | 33/144 (22.9) | |
CKD stage 4–5 | 38/408 (9.3) | 18/264 (6.8) | 20/144 (13.9) | |
Duration of insulin treatment, yr | 0.936 | |||
1–5 | 94 (23.0) | 61 (23.1) | 33 (22.8) | |
>5 | 315 (77.0) | 203 (76.9) | 112 (77.2) | |
Daily dose of insulin, IU | 34 (22–52) | 34 (22–52) | 32 (22–52) | 0.791 |
National Health Insurance service | 0.012 | |||
Medical Aid | 46 (11.2) | 22 (8.3) | 24 (16.6) | |
Medical Insurance | 363 (88.8) | 242 (91.7) | 121 (83.4) | |
Duration of diabetes ≥20 yr | 204/403 (50.6) | 128/259 (49.4) | 76/144 (52.8) | 0.518 |
Baseline HbA1c >8.2% | 199 (48.7) | 107 (40.5) | 92 (63.4) | <0.001 |
Presence of hypoglycemia | 46/406 (11.3) | 33/261 (12.6) | 13/145 (9.0) | 0.263 |
<1/mo | 13/406 (3.2) | 9/261 (3.4) | 4/145 (2.8) | |
1–3/mo | 31/406 (7.6) | 23/261 (8.8) | 8/145 (5.5) | |
>3/mo | 2/406 (0.5) | 1/261 (0.4) | 1/145 (0.7) | |
Use of antihypertensive drug | 308 (75.3) | 198 (75.0) | 110 (75.9) | 0.847 |
Use of statin | 331 (80.9) | 223 (84.5) | 108 (74.5) | 0.014 |
Variable | Baseline | After 6 monthsa | P valueb |
---|---|---|---|
Total | |||
HbA1c, % | 8.5±1.3 | 8.2±1.2 | <0.001 |
Fasting serum glucose, mg/dL | 146.0±64.0 | 138.5±55.9 | 0.015 |
Mean insulin dose, IU/day | 41.0±28.1 | 40.7±26.8 | 0.415 |
No improvement | |||
HbA1c, % | 8.2±1.0 | 8.5±1.0 | <0.001 |
Fasting serum glucose, mg/dL | 134.1±50.9 | 140.6±51.9 | 0.077 |
Mean insulin dose, IU/day | 42.1±28.0 | 42.2±25.8 | 0.874 |
Improvement | |||
HbA1c, % | 9.1±1.6 | 7.7±1.2 | <0.001 |
Fasting serum glucose, mg/dL | 171.1±78.1 | 139.2±63.4 | <0.001 |
Mean insulin dose, IU/day | 40.6±29.0 | 39.8±28.9 | 0.271 |
Variable | ra | P value |
---|---|---|
Age | 0.086 | 0.302 |
Duration of diabetes | 0.020 | 0.810 |
Body mass index | −0.239 | 0.008 |
HbA1c | −0.694 | <0.001 |
Fasting serum glucose | −0.349 | <0.001 |
C-peptide | −0.226 | 0.016 |
Urine albumin to creatinine ratio | −0.025 | 0.773 |
BUN | −0.099 | 0.241 |
Creatinine | −0.021 | 0.807 |
AST | 0.044 | 0.597 |
ALT | −0.014 | 0.871 |
Total cholesterol | −0.041 | 0.628 |
Triglyceride | −0.166 | 0.054 |
HDL-C | 0.106 | 0.221 |
LDL-C | −0.090 | 0.308 |
Total daily dose of insulin | −0.222 | 0.007 |
Total daily dose of insulin/body weight | −0.204 | 0.024 |
Variable | Model 1a | Model 2b | Model 3c | Model 4d | ||||
---|---|---|---|---|---|---|---|---|
OR (95% CI) | P value | OR (95% CI) | P value | OR (95% CI) | P value | OR (95% CI) | P value | |
Medical Aid vs. Insurance | 2.182 (1.176–4.049) | 0.013 | 2.319 (1.240–4.336) | 0.008 | 2.316 (1.213–4.419) | 0.011 | 2.459 (1.138–5.314) | 0.022 |
HbA1c | 2.547 (1.677–3.868) | <0.001 | 2.710 (1.771–4.148) | <0.001 | 2.676 (1.737–4.123) | <0.001 | 2.766 (1.576–4.857) | <0.001 |
Fasting serum glucose | 1.010 (1.006–1.014) | <0.001 | 1.010 (1.006–1.014) | <0.001 | 1.007 (1.003–1.011) | 0.001 | 1.009 (1.004–1.015) | 0.001 |
Use of statin | 0.537 (0.325–0.885) | 0.015 | 0.540 (0.325–0.896) | 0.017 | 0.565 (0.334–0.955) | 0.033 | 0.531 (0.265–1.066) | 0.075 |
Values are presented as median (interquartile range), number (%), or mean±standard deviation. HbA1c, glycosylated hemoglobin; BUN, blood urea nitrogen; GFR, glomerular filtration rate; AST, aspartate transferase; ALT, alanine transferase; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; CAD, coronary artery disease; CVA, cerebrovascular accident; CKD, chronic kidney disease. aDefined as absolute reduction of HbA1c ≥0.6% or HbA1c level at follow-up <7%.
Values are presented as mean±standard deviation. HbA1c, glycosylated hemoglobin. aValue at 6 months from the index date (last observation carried forward), b
HbA1c, glycosylated hemoglobin; BUN, blood urea nitrogen; AST, aspartate transferase; ALT, alanine transferase; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol. aSpearman's correlation coefficient.
HbA1c, glycosylated hemoglobin; OR, odds ratio; CI, confidence interval. aModel 1: unadjusted, bModel 2: adjusted for age and sex, cModel 3: adjusted for age, sex, benefit type of National Health Insurance service, baseline HbA1c, and use of statin, dModel 4: adjusted for age, sex, benefit type of National Health Insurance service, baseline HbA1c, and use of statin, body mass index, presence of diabetic retinopathy, and daily insulin dose.