White Audrey, Buschur Elizabeth, Harris Cara, Pennell Michael L, Soliman Adam, Wyne Kathleen, Dungan Kathleen M
Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
Division of Endocrinology, Diabetes & Metabolism, The Ohio State University, Columbus, OH, 43220, USA.
Diabetes Metab Syndr Obes. 2022 Aug 4;15:2323-2334. doi: 10.2147/DMSO.S327158. eCollection 2022.
To evaluate the relationship between health literacy, social support, and self-efficacy as predictors of change in A1c and readmission among hospitalized patients with type 2 diabetes (T2D).
This is a secondary analysis of patients with T2D (A1c >8.5%) enrolled in a randomized trial in which health literacy (Newest Vital Sign), social support (Multidimensional Scale of Perceived Social Support), and empowerment (Diabetes Empowerment Scale-Short Form) was assessed at baseline. Multivariable models evaluated whether these concepts were associated with A1c reduction at 12 weeks (absolute change, % with >1% reduction, % reaching individualized target) and readmission (14 and 30 days).
A1c (N=108) decreased >1% in 60%, while individualized A1c target was achieved in 31%. After adjustment for baseline A1c and potential confounders, health literacy was associated with significant reduction in A1c (Estimate -0.21, 95% CI -0.40, -0.01, p=0.041) and >1% decrease in A1c (OR 1.37, 95% CI 1.08, 1.73, p=0.009). However, higher social support was associated with greater adjusted odds of reaching the individualized A1c target (OR 1.63, 95% CI 1.04, 2.55, p=0.32). Both higher empowerment (OR 0.23, 95% CI 0.08, 0.64, p=0.005) and social support (OR 0.57, 95% CI 0.36, 0.91, p=0.018) were associated with fewer readmissions by 14 days, but not 30 days.
The study indicates that health literacy and social support may be important predictors of A1c reduction post-discharge among hospitalized patients with T2D. Social support and diabetes self-management skills should be addressed and early follow-up may be critical for avoiding readmissions.
NCT03455985.
评估健康素养、社会支持和自我效能作为2型糖尿病（T2D）住院患者糖化血红蛋白（A1c）变化及再入院预测因素之间的关系。
这是对参加一项随机试验的T2D患者（A1c>8.5%）的二次分析，在基线时评估了健康素养（最新生命体征）、社会支持（领悟社会支持多维量表）和赋权（糖尿病赋权量表简表）。多变量模型评估这些概念是否与12周时A1c的降低（绝对变化、降低>1%的比例、达到个体化目标的比例）和再入院（14天和30天）相关。
108例患者中，60%的A1c降低>1%，31%的患者达到个体化A1c目标。在对基线A1c和潜在混杂因素进行调整后，健康素养与A1c的显著降低相关（估计值-0.21，95%置信区间-0.40，-0.01，p=0.041）以及A1c降低>1%相关（比值比1.37，95%置信区间1.08，1.73，p=0.009）。然而，更高的社会支持与达到个体化A1c目标的调整后更高几率相关（比值比1.63，95%置信区间1.04，2.55，p=0.32）。更高的赋权（比值比0.23，95%置信区间0.08，0.64，p=0.005）和社会支持（比值比0.57，95%置信区间0.36，0.91，p=0.018）均与14天内再入院次数减少相关，但与30天内再入院次数无关。
该研究表明，健康素养和社会支持可能是T2D住院患者出院后A1c降低的重要预测因素。应关注社会支持和糖尿病自我管理技能，早期随访对于避免再入院可能至关重要。
NCT03455985。
