Department of Psychiatry and Behavioral Sciences, State University of New York Upstate Medical University, NY, Syracuse, USA.
The Biostatistics Center, George Washington University, Washington, DC, USA.
J Gen Intern Med. 2023 Nov;38(14):3152-3161. doi: 10.1007/s11606-023-08305-1. Epub 2023 Jul 28.
Established diabetes care ("diabetes home") and regular healthcare visits are important to achieve optimal health. Nothing is known about psychosocial factors that predict healthcare usage (HCU) in young adults with youth-onset type 2 diabetes, at risk for early complications.
To identify psychosocial predictors of HCU in the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY2) cohort.
Longitudinal, measured at T1 (baseline) and T2 (1 year later). Logistic and linear regressions, adjusted for potential confounders, identified predictors of sub-optimal HCU (defined as no diabetes home, 0 visits for routine care, or ≥ 1 urgent care visit in prior 6 months).
N = 366 TODAY2 participants with T1 and T2 data (381 consented). Mean age = 26.0 years, 67.8% female, 37.7% non-Hispanic Black, 35.8% Hispanic, 20.2% non-Hispanic white, 6.3% "other," mean HbA1c = 9.4%.
HCU survey; reliable and valid measures of diabetes self-efficacy, depressive symptoms, anxiety symptoms, diabetes distress, beliefs about medicines, diabetes attitudes, material need insecurities, self-management support.
25.4% had no diabetes home, 23.7% had 0 routine care visits, 46% had ≥ 1 urgent care visit (prior 6 months). Beliefs in the necessity of (adjusted odds ratio [OR] = 1.28; 95% confidence interval [CI] = 1.12, 1.46, p < 0.001), and concerns about (OR = 1.29;CI = 1.08,1.54, p = 0.004), diabetes medicines, and its negative psychosocial impacts (OR = 1.57;CI = 1.04, 2.38, p = 0.03), predicted higher odds of having a diabetes home at T2. Beliefs that medicines are harmful predicted lower odds of a diabetes home (OR = 0.56;CI = 0.37,0.85, p = 0.006). Necessity beliefs (OR = 1.2;CI = 1.06,1.36, p = 0.004), and self-management support (OR = 1.5;CI = 1.08,2.07, p = 0.01) predicted higher odds of having ≥ 1 diabetes care visit, harm beliefs predicted lower odds (OR = 0.6;CI = 0.41,0.88, p = 0.01).
Sub-optimal healthcare usage, common in young adults with youth-onset type 2 diabetes, is predicted by beliefs about medicines, diabetes impact, and self-management support. We must address these factors to help this vulnerable group establish stable diabetes care.
对于患有青年起病 2 型糖尿病的年轻人来说，接受既定的糖尿病护理（“糖尿病居家护理”）和定期进行常规医疗保健访视对于实现最佳健康状况非常重要。但目前还不知道哪些心理社会因素可以预测在青年起病 2 型糖尿病患者中，有发生早期并发症风险的年轻人的医疗保健使用情况（HCU）。
确定青少年和青年 2 型糖尿病治疗选择（TODAY2）队列中 HCU 的预测因素。
纵向，在 T1（基线）和 T2（1 年后）测量。通过逻辑和线性回归，调整潜在混杂因素，确定亚最佳 HCU 的预测因素（定义为没有糖尿病居家护理、常规护理就诊次数为 0 次，或在过去 6 个月内有≥1 次紧急护理就诊）。
具有 T1 和 T2 数据的 TODAY2 参与者（n = 366，有 381 人同意）。平均年龄为 26.0 岁，67.8%为女性，37.7%为非西班牙裔黑人，35.8%为西班牙裔，20.2%为非西班牙裔白人，6.3%为“其他”，平均 HbA1c 为 9.4%。
HCU 调查；经过验证的、可靠的糖尿病自我效能、抑郁症状、焦虑症状、糖尿病困扰、对药物的信念、糖尿病态度、物质需求不安全感、自我管理支持的测量方法。
25.4%没有糖尿病居家护理，23.7%没有常规护理就诊，46%有≥1 次紧急护理就诊（过去 6 个月）。对药物的必要性的信念（调整后的优势比 [OR] = 1.28；95%置信区间 [CI] = 1.12，1.46，p < 0.001）和对药物的担忧（OR = 1.29；CI = 1.08，1.54，p = 0.004），以及对药物的负面心理社会影响的信念（OR = 1.57；CI = 1.04，2.38，p = 0.03），预测了 T2 时更有可能拥有糖尿病居家护理。对药物有害的信念预测糖尿病居家护理的可能性更低（OR = 0.56；CI = 0.37，0.85，p = 0.006）。对药物的必要性的信念（OR = 1.2；CI = 1.06，1.36，p = 0.004）和自我管理支持（OR = 1.5；CI = 1.08，2.07，p = 0.01）预测了更有可能有≥1 次糖尿病护理就诊，而药物危害的信念预测可能性更低（OR = 0.6；CI = 0.41，0.88，p = 0.01）。
在青年起病 2 型糖尿病患者中，亚最佳的医疗保健使用情况很常见，这与对药物的信念、糖尿病的影响和自我管理支持有关。我们必须解决这些因素，以帮助这一脆弱群体建立稳定的糖尿病护理。
