Factors affecting screening for diabetic complications in the community: a multilevel analysis

The association between health literacy and screening for disease-specific complications among community-dwelling adults with diabetes

Introduction

Diabetic retinopathy and nephropathy are examples of complications of uncontrolled diabetes. We hypothesized that health literacy has a defining role in understanding the importance of attending routine screening for diabetes complications. Therefore, our study investigated the relationship between verbal health literacy (VHL) and written health literacy (WHL) and screening for disease-specific complications in individuals with diabetes.

Methods

Cross-sectional data on 28,210 participants with diabetes was derived from the 2021 Korean Community Health Survey. Adjusted multiple logistic regression analysis was employed to investigate the association between VHL and WHL and diabetes complication screening. Further analysis was also carried out to further comprehend the relationship between those two forms of health literacy and other factors with diabetic retinopathy and nephropathy screening.

Results

Compared to those with high VHL, participants with low VHL had lower odds of diabetes complication screening; OR 0.89 (95% CI 0.84-0.95). The same was true for WHL, those who were uninterested reported the lowest odds ratio; OR 0.73 (95% CI 0.69-0.78), followed by low WHL; OR 0.88 (95% CI 0.82-0.94), of undergoing diabetes complication screening, when compared to individuals with high WHL. Our subgroup analysis presented similar results for diabetic nephropathy and retinopathy with both VHL and WHL.

Conclusion

Among individuals with diabetes, limited VHL and WHL was significantly associated with lower odds of diabetes complication screening. Interventions aimed at improving health literacy and associated health outcomes in the community setting are warranted.

Evaluating the Effects of Long-Term Exposure to Fine Particulate Matter (PM2.5) on Depressive Mood among Korean Older Adults Using Multilevel Analysis

Background

The harmful effects of particulate matter (PM) are amplified in older adults, who experience a decline in physiological function, reducing their ability to expel and detoxify inhaled PM. Moreover, older adults may be more vulnerable to fine particulate toxicity due to underlying medical conditions. We assessed the effects of long-term exposure to fine particulate matter (PM2.5) on depressive mood (DM) in adults aged > 65 yr using community-based data.

Methods

In the 2017, Korean Community Health Survey (KCHS) data, data of PM2.5 and community factors were constructed based on participants who responded to DM in a sample of 67,802 individuals. To evaluate the effect of PM2.5 on DM among older adults, a multilevel regression model was constructed using individual-(KCHS) and community-level data (PM2.5, green area per capita, urban area, social welfare budget, health, and social business). For PM2.5, an independent variable, quartiles were used to classify regions according to concentration.

Results

A positive correlation was found between PM2.5 and DM of older adults. Compared to Q1, the odds ratio increased to 1.15 (95% CI 0.76-1.74) in Q2, 1.55 (95% CI 1.02-2.35) in Q3, and 1.60 (95% CI 1.16-2.20) in Q4.

Conclusion

DM may increase in older individuals living in areas with high PM2.5. Systematic mental health management is required for older individuals residing in such areas.

Effects of Diabetes Quality Assessment on Diabetes Management Behaviors Based on a Nationwide Survey

Improved diabetes management in primary care is essential for reducing the public health burden of diabetes, and various programs are being implemented in Korea for this purpose. Although the Health Insurance Review and Assessment (HIRA) evaluates the quality of type 2 diabetes management in primary care clinics and hospitals, it is unclear whether the implementation of these evaluations is related to the adequate management of complications in diabetic patients. We evaluated the association between the proportion of clinics managing diabetes well and lifestyles and uptake of screening for complications in 24,620 diabetic participants of the 2019 Korean Community Health Survey (KCHS). Multivariate multilevel logistic regression was performed to evaluate the fixed effect of the district-level variable and the heterogeneity among districts. The proportion of clinics with good diabetes management per 10,000 inhabitants was positively related to screening for diabetes complications. Furthermore, this district variable was significantly related to engaging in walking activity (Odds ratio: 1.39, 95% CI: 1.10-1.76) and sufficiently explained the heterogeneity among districts. However, current smoking and weight control were not associated with the proportion of clinics with good diabetes management. The financial incentives to primary care clinics would improve the primary prevention of diabetic complications.

Factors Influencing the Utilization of Diabetes Complication Tests Under the COVID-19 Pandemic: Machine Learning Approach

OBJECTIVE

There are still not enough studies on the prediction of non-utilization of a complication test or a glycated hemoglobin test for preventing diabetes complications by using large-scale community-based big data. This study identified the ratio of not taking a diabetes complication test (fundus examination and microprotein urination test) among adult diabetic patients over 19 years using a national survey conducted in South Korea and developed a model for predicting the probability of not taking a diabetes complication test based on it.

METHODS

This study analyzed 25,811 subjects who responded that they had been diagnosed with diabetes by a doctor in the 2020 Community Health Survey. Outcome variables were defined as the utilization of the microprotein urination test and the fundus examination during the past year. This study developed a model for predicting the utilization of a diabetes complication test using logistic regression analysis and nomogram to understand the relationship of predictive factors on the utilization of a diabetes complication test.

RESULTS

The results of this study confirmed that age, education level, the recognition of own blood glucose level, current diabetes treatment, diabetes management education, not conducting the glycated hemoglobin test in the past year, smoking, single-person household, subjectively good health, and living in the rural area were independently related to the non-utilization of diabetes complication test after the COVID-19 pandemic.

CONCLUSION

Additional longitudinal studies are required to confirm the causality of the non-utilization of diabetes complication screening tests.