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Risk of Depression according to Cumulative Exposure to a Low-Household Income Status in Individuals with Type 2 Diabetes Mellitus: A Nationwide Population- Based Study
So Hee Park, You-Bin Lee, Kyu-na Lee, Bongsung Kim, So Hyun Cho, So Yoon Kwon, Jiyun Park, Gyuri Kim, Sang-Man Jin, Kyu Yeon Hur, Kyungdo Han, Jae Hyeon Kim
Diabetes Metab J. 2024;48(2):290-301.   Published online January 3, 2024
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  • 194 Download
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
We aimed to identify the risk of incident depression according to cumulative exposure to a low-household income status in individuals with type 2 diabetes mellitus (T2DM).
For this retrospective longitudinal population-based cohort study, we used Korean National Health Insurance Service data from 2002 to 2018. Risk of depression was assessed according to cumulative exposure to low-household income status (defined as Medical Aid registration) during the previous 5 years among adults (aged ≥20 years) with T2DM and without baseline depression who underwent health examinations from 2009 to 2012 (n=2,027,317).
During an average 6.23 years of follow-up, 401,175 incident depression cases occurred. Advance in cumulative number of years registered for medical aid during the previous 5 years from baseline was associated with an increased risk of depression in a dose-dependent manner (hazard ratio [HR], 1.44 [95% confidence interval (CI), 1.38 to 1.50]; HR, 1.40 [95% CI, 1.35 to 1.46]; HR, 1.42, [95% CI, 1.37 to 1.48]; HR, 1.46, [95% CI, 1.40 to 1.53]; HR, 1.69, [95% CI, 1.63 to 1.74] in groups with 1 to 5 exposed years, respectively). Insulin users exposed for 5 years to a low-household income state had the highest risk of depression among groups categorized by insulin use and duration of low-household income status.
Cumulative duration of low-household income status, defined as medical aid registration, was associated with an increased risk of depression in a dose-response manner in individuals with T2DM.
Metabolic Risk/Epidemiology
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Low Household Income Status and Death from Pneumonia in People with Type 2 Diabetes Mellitus: A Nationwide Study
You-Bin Lee, So Hee Park, Kyu-na Lee, Bongsung Kim, So Yoon Kwon, Jiyun Park, Gyuri Kim, Sang-Man Jin, Kyu Yeon Hur, Kyungdo Han, Jae Hyeon Kim
Diabetes Metab J. 2023;47(5):682-692.   Published online June 22, 2023
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  • 127 Download
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
We explored the risk of death from pneumonia according to cumulative duration in low household income state (LHIS) among adults with type 2 diabetes mellitus (T2DM).
Using Korean National Health Insurance Service data (2002 to 2018), the hazards of mortality from pneumonia were analyzed according to duration in LHIS (being registered to Medical Aid) during the 5 years before baseline (0, 1–4, and 5 years) among adults with T2DM who underwent health examinations between 2009 and 2012 (n=2,503,581). Hazards of outcomes were also compared in six groups categorized by insulin use and duration in LHIS.
During a median 7.18 years, 12,245 deaths from pneumonia occurred. Individuals who had been exposed to LHIS had higher hazards of death from pneumonia in a dose-response manner (hazard ratio [HR], 1.726; 95% confidence interval [CI], 1.568 to 1.899 and HR, 4.686; 95% CI, 3.948 to 5.562 in those exposed for 1–4 and 5 years, respectively) compared to the non-exposed reference. Insulin users exposed for 5 years to LHIS exhibited the highest outcome hazard among six groups categorized by insulin use and duration in LHIS.
Among adults with T2DM, cumulative duration in LHIS may predict increased risks of mortality from pneumonia in a graded dose-response manner. Insulin users with the longest duration in LHIS might be the group most vulnerable to death from pneumonia among adults with T2DM.
Clinical Care/Education
Impact of Socioeconomic Status on Health Behaviors, Metabolic Control, and Chronic Complications in Type 2 Diabetes Mellitus
So Hun Kim, Seung Youn Lee, Chei Won Kim, Young Ju Suh, Seongbin Hong, Seong Hee Ahn, Da Hae Seo, Moon-Suk Nam, Suk Chon, Jeong-Taek Woo, Sei Hyun Baik, Yongsoo Park, Kwan Woo Lee, Young Seol Kim
Diabetes Metab J. 2018;42(5):380-393.   Published online June 29, 2018
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  • 73 Download
  • 13 Web of Science
  • 16 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   

The aim of the study was to assess the impact of socioeconomic status (SES) on health behaviors, metabolic control, and chronic complications in people with type 2 diabetes mellitus (T2DM) from South Korea, a country with universal health insurance coverage and that has experienced rapid economic and social transition.


A total of 3,294 Korean men and women with T2DM aged 30 to 65 years, participating in the Korean National Diabetes Program (KNDP) cohort who reported their SES and had baseline clinical evaluation were included in the current cross-sectional analysis. SES included the level of education and monthly household income.


Lower education level and lower income level were closely related, and both were associated with older age in men and women. Women and men with lower income and education level had higher carbohydrate and lower fat intake. After adjustment for possible confounding factors, higher education in men significantly lowered the odds of having uncontrolled hyperglycemia (glycosylated hemoglobin ≥7.5%) (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.43 to 0.91 for highest education; Ptrend=0.048), while higher household income in men significantly lowered the odds of having diabetic retinopathy (OR, 0.59; 95% CI, 0.37 to 0.95 for highest income level; Ptrend=0.048). In women, lower income was associated with a higher stress level.


Men with lower SES had higher odds of having diabetic retinopathy and uncontrolled hyperglycemia, showing the need to improve care targeted to this population.


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    International Journal of Preventive Medicine.2024;[Epub]     CrossRef
  • Socioeconomic status and the effect of prolonged pandemic confinement on anthropometric and glycaemic outcomes in adults with type 2 diabetes mellitus
    Chandana Wijeweera, Ummul Muhfaza, Reginald V. Lord, Peter Petocz, Juliana Chen, Veronica Preda
    Primary Care Diabetes.2024; 18(3): 308.     CrossRef
  • Income variability and incident cardiovascular disease in diabetes: a population-based cohort study
    Yong-Moon Mark Park, Jong-Ha Baek, Hong Seok Lee, Tali Elfassy, Clare C Brown, Mario Schootman, Marie-Rachelle Narcisse, Seung-Hyun Ko, Pearl A McElfish, Michael R Thomsen, Benjamin C Amick, Seong-Su Lee, Kyungdo Han
    European Heart Journal.2024; 45(21): 1920.     CrossRef
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    Botsi E, Karatzi K, Mavrogianni C, Kaloyan Tsochev, Esther M González-Gil, Radó S, Kivelä J, Wikström K, Cardon G, Rurik I, Liatis S, Tsvetalina Tankova, Violeta Iotova, Luis A. Moreno, Makrillakis K, Manios Y, Tsigos C
    Nutrition.2023; 105: 111805.     CrossRef
  • Sustained Low Income, Income Changes, and Risk of All-Cause Mortality in Individuals With Type 2 Diabetes: A Nationwide Population-Based Cohort Study
    Hong Seok Lee, Jimin Clara Park, Inkwan Chung, Junxiu Liu, Seong-Su Lee, Kyungdo Han
    Diabetes Care.2023; 46(1): 92.     CrossRef
  • Association of birth weight with risk of diabetes mellitus in adolescence and early adulthood: analysis of the Indonesian Family Life Survey
    Ratu Ayu Dewi Sartika, Fathimah Sulistyowati Sigit, Edy Purwanto, Norliyana Aris, Avliya Quratul Marjan, Wahyu Kurnia Yusrin Putra, Sutanto Priyo Hastono
    Annals of Pediatric Endocrinology & Metabolism.2023; 28(4): 267.     CrossRef
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    Chang Kyun Choi, Jungho Yang, Ji-An Jeong, Min-Ho Shin
    International Journal of Environmental Research and Public Health.2022; 19(23): 15781.     CrossRef
    Arjun Watane, Meghana Kalavar, Elizabeth A. Vanner, Kara Cavuoto, Jayanth Sridhar
    Retina.2021; 41(6): 1293.     CrossRef
  • Socioeconomic disparity in global vision loss burden due to diabetic retinopathy: an analysis on time trends from 1990 to 2017
    Yi Shan, Yufeng Xu, Lingxia Ye, Xiling Lin, Yaoyao Chen, Qi Miao, Juan Ye
    Endocrine.2021; 73(2): 316.     CrossRef
  • Tip 2 Diyabetli Bireylerin Hastalık Yönetiminde Karşılaştıkları Engellerin Değerlendirilmesi
    Adnan Menderes Üniversitesi Sağlık Bilimleri Fakültesi Dergisi.2021; 5(3): 514.     CrossRef
  • Socioeconomic inequalities in type 2 diabetes in employed individuals, nonworking spouses and pensioners
    Batoul Safieddine, Stefanie Sperlich, Johannes Beller, Karin Lange, Jelena Epping, Juliane Tetzlaff, Fabian Tetzlaff, Siegfried Geyer
    SSM - Population Health.2020; 11: 100596.     CrossRef
  • Thirteen-year trends in the prevalence of diabetes according to socioeconomic condition and cardiovascular risk factors in a Swiss population
    Carlos de Mestral, Silvia Stringhini, Idris Guessous, François R Jornayvaz
    BMJ Open Diabetes Research & Care.2020; 8(1): e001273.     CrossRef
  • Dietary Habits and Dietary Antioxidant Intake Are Related to Socioeconomic Status in Polish Adults: A Nationwide Study
    Małgorzata Elżbieta Zujko, Anna Waśkiewicz, Wojciech Drygas, Alicja Cicha-Mikołajczyk, Kinga Zujko, Danuta Szcześniewska, Krystyna Kozakiewicz, Anna Maria Witkowska
    Nutrients.2020; 12(2): 518.     CrossRef
  • Diabetes Fact Sheets in Korea, 2018: An Appraisal of Current Status
    Bo-Yeon Kim, Jong Chul Won, Jae Hyuk Lee, Hun-Sung Kim, Jung Hwan Park, Kyoung Hwa Ha, Kyu Chang Won, Dae Jung Kim, Kyong Soo Park
    Diabetes & Metabolism Journal.2019; 43(4): 487.     CrossRef
  • Gender in Endocrine Diseases: Role of Sex Gonadal Hormones
    R. Lauretta, M. Sansone, A. Sansone, F. Romanelli, M. Appetecchia
    International Journal of Endocrinology.2018; 2018: 1.     CrossRef
Effects of Comprehensive Support on Glycemic Control Using Community Networks in Low- Income Elderly Patients with Diabetes.
Nam Hoon Kim, Yun Jeong Lee, Hye Ok Kim, Cho Rong Oh, Ju Ri Park, Soo Yoen Park, Hee Young Kim, Ji A Seo, Nan Hee Kim, Kyung Mook Choi, Sei Hyun Baik, Dong Seop Choi, Sin Gon Kim
Korean Diabetes J. 2008;32(5):453-461.   Published online October 1, 2008
  • 2,377 View
  • 31 Download
  • 7 Crossref
AbstractAbstract PDF
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 > or = 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.


Citations to this article as recorded by  
  • The Effects of a Health Mentoring Program in Community-dwelling Vulnerable Elderly Individuals with Diabetes
    Ki wol Sung, Hye Seung Kang, Ji Ran Nam, Mi Kyung Park, Ji Hyeon Park
    Journal of Korean Academy of Nursing.2018; 48(2): 182.     CrossRef
  • Development of a scale to measure diabetes self‐management behaviors among older Koreans with type 2 diabetes, based on the seven domains identified by the American Association of Diabetes Educators
    Kyoungsan Seo, Misoon Song, Suyoung Choi, Se‐an Kim, Sun Ju Chang
    Japan Journal of Nursing Science.2017; 14(2): 161.     CrossRef
  • Current Status and Effects of Dining with Diabetes in Korea and Abroad
    Seung Hye Yang
    The Journal of Korean Diabetes.2017; 18(2): 117.     CrossRef
  • Diabetes Management through Care Communities
    Kyeong Ok Yun
    The Journal of Korean Diabetes.2016; 17(4): 271.     CrossRef
  • Understanding Psycho-Social Aspects and Social Welfare Information of Low-Income Diabetes Patients
    Been Yoo
    The Journal of Korean Diabetes.2015; 16(3): 212.     CrossRef
  • Newly Diagnosed Diabetes Mellitus With Pancreatic Cancer Manifested as Hyperglycemic Hyperosmolar State
    Tae Hyung Kwon, Min Seong Kim, Jun Ho Jeon, Dong Il Jeong, Sang Seok Yun, Yong Kyu Lee
    Journal of the Korean Geriatrics Society.2013; 17(2): 95.     CrossRef
  • Development of a Comprehensive Self-Management Program Promoting Self Efficacy for Type 2 Diabetic Patients
    Ju-Young Park, Il-Sun Ko
    Journal of Korean Academy of Fundamentals of Nursing.2012; 19(1): 74.     CrossRef

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