Rohani Tahereh, Hajian-Tilaki Karimollah, Hajiahmadi Mahmoud, Heidari Behzad, Rahimi Rahimabadi Natali, Geraili Zahra
Student Research Committee, Babol University of Medical Sciences, Babol, Iran.
Health Research Center of Social Determinants, Institute of Health Research, Babol University of Medical Sciences, Babol, Iran.
Caspian J Intern Med. 2024 Aug 30;15(4):615-622. doi: 10.22088/cjim.15.4.615. eCollection 2024 Fall.
Diabetes, a currently threatening disease, has severe consequences for individuals' health conditions. The present study aimed to investigate the factors affecting the changes in the longitudinal outcome of blood sugar using a three-level analysis with the presence of missing data in diabetic patients.
A total of 526 diabetic patients were followed longitudinally selected from the annual data collected from the rural population monitored by Tonekabon health centers in the North of Iran during 2018-2019 from the Iranian Integrated Health System (SIB) database. In analyzing this longitudinal data, the three-level model (level 1: observation (time), level 2: subject, level 3: health center) was carried out with multiple imputations of possible missing values in longitudinal data.
Results of fitting the three-level model indicated that every unit of change in the body mass index (BMI) significantly increased the fasting blood sugar by an average of 0.5 mg/dl (p=0.024). The impact of level 1 (observations) was insignificant in the three-level model. Still, the random effect of level 3 (healthcare centers) showed a highly significant measure for health centers (14.62, p<0.001).
The BMI reduction, the healthcare centers' socioeconomic status, and the health services provided have potential effects in controlling diabetes.
糖尿病是一种当前具有威胁性的疾病，对个体健康状况有严重影响。本研究旨在通过三级分析，在存在缺失数据的糖尿病患者中，调查影响血糖纵向结果变化的因素。
从2018 - 2019年伊朗综合卫生系统（SIB）数据库中，选取伊朗北部通卡本健康中心监测的农村人口年度数据中纵向随访的526例糖尿病患者。在分析这些纵向数据时，采用三级模型（第1级：观察（时间），第2级：个体，第3级：健康中心）对纵向数据中可能的缺失值进行多次插补。
三级模型拟合结果表明，体重指数（BMI）每变化一个单位，空腹血糖平均显著升高0.5mg/dl（p = 0.024）。在三级模型中，第1级（观察值）的影响不显著，但第3级（医疗中心）的随机效应显示医疗中心有高度显著的测量值（14.62，p < 0.001）。
体重指数降低、医疗中心的社会经济状况以及提供的卫生服务对控制糖尿病有潜在影响。
