Adherence to Dietary Guidelines among Diabetes Patients: Comparison between Elderly and Non-Elderly Groups

Abstract

[5,6]. Dietary management is particularly important in a T2DM patient's self-management [7,8]. Previous studies that assessed the effects of dietary interventions such as the Dietary Approaches to Stop Hypertension diet or the Mediterranean diet have demonstrated beneficial effects on the management of serum HbA1c, cholesterol, and triglyceride levels [9]. Moreover, appropriate energy intake and reduced carbohydrate intake [10], moderate alcohol consumption [11], adequate consumption of seaweed and dietary fibers [12,13], and limiting sodium consumption [14] have been reported to have a direct impact on improving blood glucose level. Therefore, dietary management for patients with T2DM is essential for the prevention of potential complications. Recognition of the importance of self-management can vary between different age groups [15-17]. In general, older patients have higher risks of diabetic complications and hence the importance of management for these patients has been highly emphasized [18]. Meanwhile, younger patients with T2DM have a relatively longer remaining life expectancy, and therefore exhibit a prolonged risk period for potential complications since they have a longer duration of T2DM [18,19]. Thus, the management of T2DM is essential not only for older patients but also for younger patients. Many studies have evaluated drug compliance in patients with T2DM across different age groups [15-17], but limited studies have evaluated adherence levels to dietary guidelines by age. Accordingly, the purpose of this study was to compare the adherence level to dietary guidelines between non-elderly (30-64 years) and elderly (≥ 65 years) participants with T2DM in Korea to determine the gaps and necessary interventions for improving the overall compliance to dietary guidelines for T2DM. Adherence level to dietary guideline for T2DM was estimated using the Korean Diabetes Association-Korean Ministry of Health and Welfare (KDA-KMHW) index [20], consisting of 6 components of dietary guidelines (meal patterns and intake levels of total energy, carbohydrates, vegetable/seaweed, sodium, and alcohol). began using an annual survey with a rolling sample system [22]. This study used data from the 1st (1998) to the 6th (2013-2015) surveys. This study only included participants who aged 30 or older, were fully aware of their diabetes, and provided positive responses to the questions regarding clinician diagnoses, use of oral hypoglycemic agents, or insulin injections. The following responses were excluded from the analysis: missing values on sampling weights or those without T2DM (n = 107,763); responses from the participants who were pregnant or breastfeeding at the time of the survey (n = 590); and responses from the participants who had a daily energy intake below 500 kcal or exceeding 5,000 kcal (n = 110). Finally, 4,577 participants were included from the 1st-6th KNHANES (1st n = 248; 2nd n = 247; 3rd n = 295; 4th n = 1,169; 5th n = 1,346; 6th n = 1,272).