Factors Influencing Glycemic Control in Older Adults With Diabetes in South Korea: Analysis Using the 2022 KNHANES Data

Maintaining optimal glycemic control, as measured by hemoglobin A1c (HbA1c), is critical for preventing diabetes-related complications in older adults. The current study investigated determinants of glycemic control in older adults with diabetes in South Korea, aligning with the latest clinical guidelines from the American Diabetes Association and World Health Organization. This cross-sectional study analyzed data from the 2022 Korea National Health and Nutrition Examination Survey. A total of 372 adults aged ≥65 years with physician-diagnosed diabetes were included. Participants were categorized into well-controlled (HbA1c <7%) and poorly controlled (HbA1c ≥7%) groups. Factors influencing glycemic control, including psychological distress, physical activity, and socioeconomic variables, were assessed using binary logistic regression. Depression (Patient Health Questionnaire-9 ≥4; odds ratio [OR] = 1.986, p = 0.019), anxiety (General Anxiety Disorder-7 ≥2; OR = 1.800, p = 0.041), and insufficient strength training (<2 times/week; OR = 0.496, p = 0.025) were significant predictors of poor glycemic control. Current smoking was also associated with elevated HbA1c (OR = 2.228, p = 0.030). No significant associations were observed for demographic or socioeconomic factors. Psychological distress, insufficient strength training, and smoking are key modifiable predictors of poor glycemic control in older adults with diabetes. These findings highlight the need for integrated interventions that address mental health support, lifestyle modifications, and smoking cessation in diabetes management for older adults. Further longitudinal studies are recommended to confirm causality.