scholarly journals Determinants of Glycemic Control among Urban Patients with Type 2 Diabetes: A mediation analysis from real-world evidence

2020 ◽  
Author(s):  
Rubén Silva-Tinoco ◽  
Teresa Cuatecontzi-Xochitiotzi ◽  
Viridiana De la Torre-Saldaña ◽  
Enrique León-García ◽  
Javier Serna-Alvarado ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Primary Care ◽  
Socioeconomic Status ◽  
Low Income ◽  
Self Care ◽  
P Value ◽  
Diabetes Knowledge ◽  
Care Behavior

Abstract Background Evidence suggests there is a relationship between determinants of health and worse diabetes outcomes, especially among individuals with low socioeconomic status and education level. Few studies have shown the relationship between diabetes knowledge, self-care behaviors, and clinical outcomes in low-income urban populations. This study aimed to explore the determinants of glycemic control (GC) in a low-income urban population and to provide insight into the pathways of the effect of diabetes knowledge on GC. Methods A multicenter cross-sectional study was conducted in patients with type 2 diabetes (PwD) from 28 primary care outpatient centers located in Mexico City. Using the multivariable-adjusted models, we determined the associations between diabetes knowledge, self-care behaviors, and GC. The mediation analyses used linear regression models, where the significance of indirect effects was calculated with bootstrapping. Results The population (N=513) had a mean age of 53.8 years (standard deviation: 11.3 yrs.), and 65.9% were women. Both socioeconomic status and level of education were directly associated with diabetes knowledge. Using multivariable-adjusted linear models, we found that diabetes knowledge was associated with GC (β: -0.102, 95% Confidence Interval [95% CI] -0.189, -0.014). Diabetes knowledge was also independently associated with self-care behavior (for physical activity: β: 0.181, 95% CI 0.088, 0.273), and self-care behavior was associated with GC (for physical activity: β: -0.112, 95% CI -0.194, -0.029).The association between diabetes knowledge and GC was lost after adjustment for self-care behaviors, especially physical activity (β: -0.084, 95% CI -0.182, 0.014, p -value: 0.062). Finally, the mediation models showed that the effect of diabetes knowledge on GC was 17% independently mediated by physical activity ( p -value: 0.049). Conclusions Socioeconomic and educational gradients influence diabetes knowledge among primary care patients with type 2 diabetes. Self-care activities, particularly physical activity, mediated the effect of diabetes knowledge on GC. Our results indicate that diabetes knowledge should be reinforced in low-income PwD, with an emphasis on the benefits physical activity has on improving GC.

scholarly journals Influence of social determinants, diabetes knowledge, health behaviors, and glycemic control in type 2 diabetes: An analysis from real-world evidence

2020 ◽  
Author(s):  
Rubén Silva-Tinoco ◽  
Teresa Cuatecontzi-Xochitiotzi ◽  
Viridiana De la Torre-Saldaña ◽  
Enrique León-García ◽  
Javier Serna-Alvarado ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Primary Care ◽  
Glycemic Control ◽  
Mexico City ◽  
Low Income ◽  
Self Care ◽  
Diabetes Knowledge ◽  
Care Behavior

Abstract Background Although important achievements have been done in type 2 diabetes mellitus (T2D) treatment and glycemic control, new strategies may take advantage of non-pharmacological approaches and of other potential determinants of health (e.g., socioeconomic status, education, diabetes knowledge, physical activity, and self-care behavior). However, the relationships between these factors are not totally clear and have not been studied in the context of large urban settings. This study aimed to explore the relationship between these determinants of glycemic control (GC) in a low-income urban population from Mexico City, focused in exploring potential the mediation of self-care behaviors in the association between diabetes knowledge and GC.Methods A multicenter cross-sectional study was conducted in patients with type 2 diabetes (T2D) from 28 primary care outpatient centers located in Mexico City. Using multivariable-adjusted models, we determined the associations between diabetes knowledge, self-care behaviors, and GC. The mediation analyses to determine the pathways on glycemic control were done using linear regression models, where the significance of indirect effects was calculated with bootstrapping.Results The population (N=513) had a mean age of 53.8 years (standard deviation: 11.3 yrs.), and 65.9% were women. Both socioeconomic status and level of education were directly associated with diabetes knowledge. Using multivariable-adjusted linear models, we found that diabetes knowledge was associated with GC (β: -0.102, 95% Confidence Interval [95% CI] -0.189, -0.014). Diabetes knowledge was also independently associated with self-care behavior (for physical activity: β: 0.181, 95% CI 0.088, 0.273), and self-care behavior was associated with GC (for physical activity: β: -0.112, 95% CI -0.194, -0.029). The association between diabetes knowledge and GC was not observed after adjustment for self-care behaviors, especially physical activity (β: -0.084, 95% CI -0.182, 0.014, p-value: 0.062). Finally, the mediation models showed that the effect of diabetes knowledge on GC was 17% independently mediated by physical activity (p-value: 0.049). Conclusions Socioeconomic and educational gradients influence diabetes knowledge among primary care patients with type 2 diabetes. Self-care activities, particularly physical activity, mediated the effect of diabetes knowledge on GC. Our results indicate that diabetes knowledge should be reinforced in low-income T2D patients, with an emphasis on the benefits physical activity has on improving GC.

scholarly journals Determinants of Glycemic Control among Urban Patients with Type 2 Diabetes: A mediation analysis from real-world evidence

2020 ◽  
Author(s):  
Rubén Silva-Tinoco ◽  
Teresa Cuatecontzi-Xochitiotzi ◽  
Viridiana De la Torre-Saldaña ◽  
Enrique León-García ◽  
Javier Serna-Alvarado ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Low Income ◽  
Self Care ◽  
P Value ◽  
Diabetes Knowledge ◽  
Linear Regression Models ◽  
Care Behavior

Abstract Aims To explore the determinants of glycemic control (GC) among patients with type 2 diabetes (PwD) to provide insight into the pathways of the effect of diabetes knowledge on GC.Methods A multicenter cross-sectional study was conducted in PwD from 28 primary outpatient centers located in Mexico City. Using the multivariable-adjusted models, we determined the associations between diabetes knowledge, self-care behaviors, and glycemic control. The mediation analyses used linear regression models, where the significance of indirect effects was calculated with bootstrapping.Results The population (N=513) had a mean age of 53.8 years (standard deviation: 11.3 yrs.), and 65.9% were women. Using multivariable-adjusted linear models, we found that diabetes knowledge was associated with glycemic control (β: -0.102, 95% Confidence Interval [95% CI] -0.189, -0.014). Diabetes knowledge was also independently associated with self-care behavior (for physical activity: β: 0.181, 95% CI 0.088, 0.273), and self-care behavior was associated with glycemic control (for physical activity: β: -0.112, 95% CI -0.194, -0.029).The association between diabetes knowledge and glycemic control was lost after adjustment for self-care behaviors, especially physical activity (β: -0.084, 95% CI -0.182, 0.014, p -value: 0.062). Finally, the mediation models showed that the effect of diabetes knowledge on glycemic control was 17% independently mediated by physical activity ( p -value: 0.049).Conclusions Self-care activities, particularly physical activity, mediated the effect of diabetes knowledge on glycemic control. Our results indicate that diabetes knowledge should be reinforced in low-income PwD, with an emphasis on the benefits physical activity has on improving GC.

scholarly journals Determinants of Glycemic Control among Urban Patients with Type 2 Diabetes: A mediation analysis from real-world evidence

2020 ◽  
Author(s):  
Rubén Silva-Tinoco ◽  
Teresa Cuatecontzi-Xochitiotzi ◽  
Viridiana De la Torre-Saldaña ◽  
Enrique León-García ◽  
Javier Serna-Alvarado ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Low Income ◽  
Self Care ◽  
P Value ◽  
Diabetes Knowledge ◽  
Linear Regression Models ◽  
Care Behavior

Abstract Aims To explore the determinants of glycemic control (GC) among patients with type 2 diabetes (PwD) to provide insight into the pathways of the effect of diabetes knowledge on GC.Methods A multicenter cross-sectional study was conducted in PwD from 28 primary outpatient centers located in Mexico City. Using the multivariable-adjusted models, we determined the associations between diabetes knowledge, self-care behaviors, and glycemic control. The mediation analyses used linear regression models, where the significance of indirect effects was calculated with bootstrapping.Results The population (N=513) had a mean age of 53.8 years (standard deviation: 11.3 yrs.), and 65.9% were women. Using multivariable-adjusted linear models, we found that diabetes knowledge was associated with glycemic control (β: -0.102, 95% Confidence Interval [95% CI] -0.189, -0.014). Diabetes knowledge was also independently associated with self-care behavior (for physical activity: β: 0.181, 95% CI 0.088, 0.273), and self-care behavior was associated with glycemic control (for physical activity: β: -0.112, 95% CI -0.194, -0.029).The association between diabetes knowledge and glycemic control was lost after adjustment for self-care behaviors, especially physical activity (β: -0.084, 95% CI -0.182, 0.014, p -value: 0.062). Finally, the mediation models showed that the effect of diabetes knowledge on glycemic control was 17% independently mediated by physical activity ( p -value: 0.049).Conclusions Self-care activities, particularly physical activity, mediated the effect of diabetes knowledge on glycemic control. Our results indicate that diabetes knowledge should be reinforced in low-income PwD, with an emphasis on the benefits physical activity has on improving GC.

scholarly journals Influence of social determinants, diabetes knowledge, health behaviors, and glycemic control in type 2 diabetes: An analysis from real-world evidence

2020 ◽  
Author(s):  
Rubén Silva-Tinoco ◽  
Teresa Cuatecontzi-Xochitiotzi ◽  
Viridiana De la Torre-Saldaña ◽  
Enrique León-García ◽  
Javier Serna-Alvarado ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Primary Care ◽  
Glycemic Control ◽  
Mexico City ◽  
Low Income ◽  
Self Care ◽  
Diabetes Knowledge ◽  
Care Behavior

Abstract Background Although important achievements have been done in type 2 diabetes mellitus (T2D) treatment and glycemic control, new strategies may take advantage of non-pharmacological approaches and of other potential determinants of health (e.g., socioeconomic status, education, diabetes knowledge, physical activity, and self-care behavior). However, the relationships between these factors are not totally clear and have not been studied in the context of large urban settings. This study aimed to explore the relationship between these determinants of glycemic control (GC) in a low-income urban population from Mexico City, focused in exploring potential the mediation of self-care behaviors in the association between diabetes knowledge and GC.Methods A multicenter cross-sectional study was conducted in patients with type 2 diabetes (T2D) from 28 primary care outpatient centers located in Mexico City. Using multivariable-adjusted models, we determined the associations between diabetes knowledge, self-care behaviors, and GC. The mediation analyses to determine the pathways on glycemic control were done using linear regression models, where the significance of indirect effects was calculated with bootstrapping.Results The population (N=513) had a mean age of 53.8 years (standard deviation: 11.3 yrs.), and 65.9% were women. Both socioeconomic status and level of education were directly associated with diabetes knowledge. Using multivariable-adjusted linear models, we found that diabetes knowledge was associated with GC (β: -0.102, 95% Confidence Interval [95% CI] -0.189, -0.014). Diabetes knowledge was also independently associated with self-care behavior (for physical activity: β: 0.181, 95% CI 0.088, 0.273), and self-care behavior was associated with GC (for physical activity: β: -0.112, 95% CI -0.194, -0.029). The association between diabetes knowledge and GC was not observed after adjustment for self-care behaviors, especially physical activity (β: -0.084, 95% CI -0.182, 0.014, p-value: 0.062). Finally, the mediation models showed that the effect of diabetes knowledge on GC was 17% independently mediated by physical activity (p-value: 0.049). Conclusions Socioeconomic and educational gradients influence diabetes knowledge among primary care patients with type 2 diabetes. Self-care activities, particularly physical activity, mediated the effect of diabetes knowledge on GC. Our results indicate that diabetes knowledge should be reinforced in low-income T2D patients, with an emphasis on the benefits physical activity has on improving GC.

Self-Reported Physical Activity in Medically Underserved Adults With Type 2 Diabetes in Clinical and Community Settings

2015 ◽  
Vol 12 (7) ◽  
pp. 968-975 ◽  
Author(s):  
John Cooper ◽  
Barbara Stetson ◽  
Jason Bonner ◽  
Sean Spille ◽  
Sathya Krishnasamy ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Low Income ◽  
Short Form ◽  
International Comparisons ◽  
Self Care ◽  
Community Dwelling ◽  
Self Report ◽  
Clinical Settings

Background:This study assessed physical activity (PA) in community dwelling adults with Type 2 diabetes, using multiple instruments reflecting internationally normed PA and diabetes-specific self-care behaviors.Methods:Two hundred and fifty-three Black (44.8%) and White (55.2%) Americans [mean age = 57.93; 39.5% male] recruited at low-income clinic and community health settings. Participants completed validated PA self-report measures developed for international comparisons (International Physical Activity Questionnaire Short Form), characterization of diabetes self-care (Summary of Diabetes Self-Care Activities Measure; SDSCA) and exercise-related domains including provider recommendations and PA behaviors and barriers (Personal Diabetes Questionnaire; PDQ).Results:Self-reported PA and PA correlates differed by instrument. BMI was negatively correlated with PA level assessed by the PDQ in both genders, and assessed with SDSCA activity items in females. PA levels were low, comparable to previous research with community and diabetes samples. Pain was the most frequently reported barrier; females reported more frequent PA barriers overall.Conclusions:When using self-report PA measures for PA evaluation of adults with diabetes in clinical settings, it is critical to consider population and setting in selecting appropriate tools. PA barriers may be an important consideration when interpreting PA levels and developing interventions. Recommendations for incorporating these measures in clinical and research settings are discussed.

scholarly journals APPLICATION OF HEALTH PROMOTION MODEL FOR BETTER SELF-CARE BEHAVIOR IN PATIENTS WITH DIABETES MELLITUS

2019 ◽  
Vol 5 (6) ◽  
pp. 239-245
Author(s):  
Made Mahaguna Putra ◽  
Kusnanto Kusnanto ◽  
Candra Panji Asmoro ◽  
Tintin Sukartini
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Health Promotion ◽  
Socioeconomic Status ◽  
Family Support ◽  
Self Care ◽  
Personal Factors ◽  
Health Promotion Model ◽  
Care Behavior

Background: Diabetes mellitus (DM) is a major health problem in the world. DM patients should be able to perform self-care behavior. Diabetic self-care behavior is an effective strategy for controlling diabetes.Objective: The purpose of this study was to examine a health promotion model in patients with type 2 diabetes mellitus.Methods: A cross-sectional design was used, which involved 177 patients with type 2 diabetes from primary health care in Denpasar Bali Indonesia with a stratified random sampling. Independent variables were personal factors (age, sex, education, body mass index, socioeconomic status, self-motivation, illness perception, and belief), self-efficacy, and family support. The dependent variable was self-care behavior. A structural equation model was used to confirm the hypothesis model.Results: Personal factors (education, socioeconomic, and perceptions) (t = 2.891) and family support (t = 5.746) were associated with self-care behavior. Self-efficacy did not affect self-care behavior (t = .139).Conclusion: Diabetes self-care behavior is influenced by socioeconomic status, level of education, perception of the illness, and family support. Therefore, it is suggested for nurses to apply the health promotion model approach to increase self-care behavior of patients with type 2 diabetes mellitus.

scholarly journals Health Locus of Control and Self Care Behavior in Patients with Type 2 Diabetes Mellitus

2020 ◽  
pp. 22
Author(s):  
Siti Aisyah Dwi Asri ◽  
Nur Widayati ◽  
Latifa Aini
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Locus Of Control ◽  
Health Locus Of Control ◽  
Self Care ◽  
Significant Negative Correlation ◽  
P Value ◽  
Care Behavior

Health Locus of Control (HLC) is an individual belief in controlling current health conditions, which is possibly determined by internal or external factors. Belief in the source of health control will influence the effectiveness of diabetes self-care management. This study aimed to analyze the correlation between Internal Health Locus of Control (IHLC), Powerful others Health Locus of Control (PHLC), and Chance Health Locus of Control (CHLC) with self-care behavior in type 2 diabetes mellitus patients. This research applied an observational analytic design with a cross-sectional approach. A total of 84 respondents were enrolled in this study by using the consecutive sampling technique. Data collection was conducted by administering questionnaires of the Multidimensional Health Locus of Control Scale (MHLCS) and Summary of Diabetes Self Care Activities (SDSCA). Data were analyzed by using the Pearson correlation test with a significance level of 0.05. The result showed that PHLC had the highest score of the mean value (26.95) compared to IHLC (25.55) and CHLC (19.25). The mean value of self-care behavior was 3.5. There was significant positive correlation between IHLC and self-care behavior (p-value: 0.001; r: 0.485), significant negative correlation between PHLC and self-care behavior (p-value: 0.048; r: -0.217), and significant negative correlation between CHLC and self-care behavior (p-value: 0.001; r: -0.350). The higher the IHLC score in type 2 DM patients, the better the patient's self-care behavior. However, the higher the PHLC or CHLC score in type 2 DM patients, the lower the patient's self-care behavior. Patients with high IHLC depend on themselves and have awareness of the importance of health. This study suggests the importance of assessing the patient's HLC and providing psychoeducation about HLC, control behaviors, and self-awareness to optimize diabetes self-care in type 2 diabetes mellitus patients.

scholarly journals Life-course pathways from childhood socioeconomic status to type 2 diabetes in mid-late Chinese adulthood

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Xiaoning Zhang ◽  
Xue Jiang ◽  
Mengqi Sha ◽  
Qiong Zhou ◽  
Wen Li ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Socioeconomic Status ◽  
Standard Deviation ◽  
Life Course ◽  
Food Shortage ◽  
Late Adulthood ◽  
Childhood Health ◽  
Childhood Socioeconomic Status

AbstractThe relationship between childhood socioeconomic status (SES) and type 2 diabetes (T2D) remains inconclusive, and the pathways and mechanisms driving this relationship have yet to be clarified. This study aimed to examine the pathways linking childhood SES to T2D prevalence in mid-late adulthood in a low- and middle-income country. The incidence of T2D diagnosed in mid-late Chinese adulthood was assessed using self-reports from the Health and Retirement Longitudinal Study (CHARLS). Childhood SES was assessed by the education, occupation, survivorship of the parents and the financial situation of the family, whereas adulthood SES was assessed by education and wage. This study performed structural equation modeling to clarify the direct and indirect pathways from childhood SES to T2D via childhood health, childhood food shortage, adulthood SES and physical activity. A total of 15,132 participants were included, and the prevalence of T2D was 5.24%. This study found that childhood SES was directly associated with T2D in mid-late adulthood, the probability of developing T2D increased by 9.20% of the standard deviation for each decrease in standard deviation in childhood SES. Childhood SES was indirectly associated with T2D via adulthood SES, physical activity, childhood health and food shortage. Adulthood SES and physical activity mainly mediated the indirect pathway from childhood SES and T2D. This study showed direct and indirect pathways from disadvantaged childhood SES to increased risk of T2D in mid-late Chinese adulthood. Childhood SES, adulthood SES, physical activity, childhood health and food shortage were identified as life-course interventional targets that should be considered in the development of effective strategies to reduce the burden of T2D and SES-related health inequities in childhood.

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