Kanny Samantha, Hall Luke, Blackhurst Dawn, Sherrill Windsor Westbrook
Department of Public Health Sciences, Clemson University, Clemson, SC, USA.
The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA.
BMC Public Health. 2025 Apr 25;25(1):1538. doi: 10.1186/s12889-025-22627-1.
In the United States, 38.4 million people have been diagnosed with diabetes, and it continues to rise. The increasing rate of diabetes has become a significant public health challenge due, in part, to the association between diabetes and decreased levels of physical and emotional well-being. Currently, there are few assessments of the impact of diabetes self-management programs on individuals with diabetes quality of life and social vulnerability. This study examined pre- to post-program quality of life outcomes for participants in a community-based diabetes-self management and support (DSMS) program and assessed the association between the change in quality of life pre- to post-program and social vulnerability.
Health Extension for Diabetes (HED) is a 4-month, community-based DSMS program delivered in the Southeast region of the United States. HED includes standardized education and personalized support to help participants manage their diabetes. The 12-Item Short Form Health Survey (SF-12) was utilized to assess participants' physical and mental quality of life pre- and post-program participation. The Centers for Disease Control and Prevention's (CDC) Social Vulnerability Index (SVI) was used to determine individuals' social vulnerability level (low: 0-0.25, low-to-moderate: 0.2501-0.5, moderate-to-high: 0.501-0.75, high: 0.7501-1.0). Wilcoxon sign-ranked tests assessed changes in SF-12 pre- and post-HED and linear regressions examined the association between quality of life and social vulnerability level.
SF-12 scores indicated significant positive changes in physical and mental quality of life for all program participants (N = 1,006). All SVI subgroups were observed to have significant improvements in physical health scores. Individuals with moderate-to-high and high SVI scores showed significant improvement in mental health scores, while individuals with low and low-to-moderate SVI scores did not.
Participants of the community-based diabetes self-management and support program experienced improvements in quality of life across varying levels of social vulnerability, as measured by the SVI. While integrating upstream social determinants of health considerations into DSMS program design and delivery addresses health disparities, future research should consider the implementation of more general mental health resources to address the psychological burden associated with living with chronic disease.
在美国，有3840万人被诊断患有糖尿病，且这一数字仍在上升。糖尿病发病率的不断上升已成为一项重大的公共卫生挑战，部分原因是糖尿病与身体和情绪健康水平下降之间存在关联。目前，很少有研究评估糖尿病自我管理项目对糖尿病患者生活质量和社会脆弱性的影响。本研究调查了基于社区的糖尿病自我管理与支持（DSMS）项目参与者从项目开始到结束后的生活质量结果，并评估了项目前后生活质量变化与社会脆弱性之间的关联。
糖尿病健康拓展（HED）项目是一个为期4个月、基于社区的DSMS项目，在美国东南部地区开展。HED项目包括标准化教育和个性化支持，以帮助参与者管理糖尿病。采用12项简短健康调查问卷（SF - 12）评估参与者在参与项目前后的身体和心理健康生活质量。美国疾病控制与预防中心（CDC）的社会脆弱性指数（SVI）用于确定个体的社会脆弱性水平（低：0 - 0.25，低到中度：0.2501 - 0.5，中度到高度：0.501 - 0.75，高：0.7501 - 1.0）。Wilcoxon符号秩检验评估了HED项目前后SF - 12的变化，线性回归分析了生活质量与社会脆弱性水平之间的关联。
SF - 12评分显示，所有项目参与者（N = 1006）的身体和心理健康生活质量都有显著的积极变化。所有SVI亚组的身体健康评分均有显著改善。中度到高度和高度SVI评分的个体心理健康评分有显著改善，而低度和低到中度SVI评分的个体则没有。
通过SVI衡量，基于社区的糖尿病自我管理与支持项目的参与者在不同社会脆弱性水平下的生活质量都有所改善。虽然将上游健康的社会决定因素纳入DSMS项目的设计和实施中有助于解决健康差异问题，但未来的研究应考虑实施更全面的心理健康资源，以应对与慢性病生活相关的心理负担。
