Institute of General Practice and Family Medicine, Medical Faculty of Martin Luther-University Halle-Wittenberg, Halle (Saale), Germany.
Institute of Medical Sociology, Medical Faculty of Martin Luther-University Halle-Wittenberg, Halle (Saale), Germany.
PLoS One. 2021 Mar 19;16(3):e0248992. doi: 10.1371/journal.pone.0248992. eCollection 2021.
Few studies on diabetes self-management considered the patterns and relationships of different self-management behaviours (SMB). The aims of the present study are 1) to identify patterns of SMB among persons with diabetes, 2) to identify sociodemographic and disease-related predictors of SMB among persons with diabetes.
The present analysis includes data of 1,466 persons (age 18 to 99 years; 44.0% female; 56.0% male) with diabetes (type I and II) from the population-based study German Health Update 2014/2015 (GEDA 2014/2015-EHIS). We used latent class analysis in order to distinguish different patterns of self-management behaviours among persons with diabetes. The assessment of SMB was based on seven self-reported activities by respondents (dietary plan, diabetes-diary, diabetes health pass, self-assessment of blood glucose, self-examination of feet, retinopathy-screenings and assessment of HbA1c). Subsequent multinomial latent variable regressions identified factors that were associated with self-management behaviour.
Latent class analysis suggested a distinction between three patterns of SMB. Based on modal posterior probabilities 42.8% of respondents showed an adherent pattern of diabetes self-management with above-average frequency in all seven indicators of SMB. 32.1% showed a nonadherent pattern with a below-average commitment in all seven forms of SMB. Another 25.1% were assigned to an ambivalent type, which showed to be adherent with regard to retinopathy screenings, foot examinations, and the assessment of HbA1c, yet nonadherent with regard to all other forms of SMB. In multivariable regression analyses, participation in Diabetes Self-Management Education programs (DSME) was the most important predictor of good self-management behaviour (marginal effect = 51.7 percentage points), followed by attentiveness towards one's personal health (31.0 percentage points). Respondents with a duration of illness of less than 10 years (19.5 percentage points), employed respondents (7.5 percentage points), as well as respondents with a high socioeconomic status (24.7 percentage points) were more likely to show suboptimal forms of diabetes self-management.
In the present nationwide population-based study, a large proportion of persons with diabetes showed suboptimal self-management behaviour. Participation in a DSME program was the strongest predictor of good self-management. Results underline the need for continual and consistent health education for patients with diabetes.
很少有研究关注糖尿病自我管理中不同自我管理行为（SMB）的模式和关系。本研究的目的是 1）确定糖尿病患者 SMB 的模式，2）确定糖尿病患者 SMB 的社会人口学和疾病相关预测因素。
本分析包括来自基于人群的 2014/2015 年德国健康更新研究（GEDA 2014/2015-EHIS）的 1466 名糖尿病患者（年龄 18 至 99 岁；44.0%为女性；56.0%为男性）的数据。我们使用潜在类别分析来区分糖尿病患者之间不同的自我管理行为模式。SMB 的评估基于受访者的七项自我报告活动（饮食计划、糖尿病日记、糖尿病健康通行证、自我评估血糖、自我检查足部、视网膜筛查和 HbA1c 评估）。随后的多项潜在变量回归确定了与自我管理行为相关的因素。
潜在类别分析表明，SMB 存在三种模式。基于模态后验概率，42.8%的受访者表现出糖尿病自我管理的依从模式，在 SMB 的所有七种指标中均具有较高的频率。32.1%表现出非依从模式，在 SMB 的所有七种形式中均表现出较低的承诺。另外 25.1%被分配到一个矛盾的类型，其表现为在视网膜筛查、足部检查和 HbA1c 评估方面具有依从性，但在所有其他形式的 SMB 方面则表现出不依从性。在多变量回归分析中，参加糖尿病自我管理教育计划（DSME）是良好自我管理行为的最重要预测因素（边际效应=51.7 个百分点），其次是对个人健康的关注（31.0 个百分点）。患病时间少于 10 年的受访者（19.5 个百分点）、在职受访者（7.5 个百分点）以及社会经济地位较高的受访者（24.7 个百分点）更有可能表现出次优的糖尿病自我管理形式。
在本全国性基于人群的研究中，很大一部分糖尿病患者表现出次优的自我管理行为。参加 DSME 项目是良好自我管理的最强预测因素。结果强调了持续和一致的健康教育对糖尿病患者的必要性。
