Factors Influencing Glycemic Control among Chinese Adults With Type 2 Diabetes Mellitus
thesisposted on 27.10.2017 by Keke Lin
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Background: Optimal glycemic control is key to prevent or delay diabetic complications. However, the glycemic control worldwide is suboptimal. In addition, health disparities between males and females in diabetes related morbidity and mortality exist. These disparities may be linked to variations in how males and females experience and manage their diabetes to achieve adequate glycemic control. Methods: A cross-sectional, quantitative study was completed to identify effects of diabetes self-efficacy, perceived role demands, attitudinal familism, diabetes distress, family support, and diabetes self-management behaviors on glycemic control and to compare gender differences during the glycemic control process. A total of 210 adult patients with type 2 diabetes were recruited from a community health center in Beijing, China. Results: The average mean HbA1c was 7.41%. One hundred participants (47.62%) achieved optimal glycemic control of HbA1c <7%. For the aggregate sample, only diabetes self-management behaviors and diabetes distress had direct impacts on glycemic control. Perceived role demands and attitudinal familism impacted glycemic control indirectly through diabetes self-management behaviors, and, attitudinal familism, family support, and diabetes distress had indirect impacts on glycemic control through both diabetes self-efficacy and diabetes self-management behaviors. Regarding gender differences, females had a significantly higher dietary management and complication management mean item score, a higher attitudinal familism score, a higher number of roles, and more perceived role demands for caregiving while males had a significantly higher exercise management mean item score, family supportive behaviors mean item score, and more perceived role demands related to their jobs. Unexpectedly, the direct effect of diabetes self-management behaviors on glycemic control was not statistically significant for the female participants. Additionally, the impact of perceived role demands on self-management was more pronounced for males than for females. Conclusion: Psychosocial and behavioral factors play vital roles in achieving optimal glycemic control. Our study’s findings emphasize the importance of including psychological screening to evaluate the patients’ diabetes related distress and suggests a need to address attitudinal familism and perceived role demands and to include family members in future interventions and diabetic education. Furthermore, it provides new insights for clinicians to consider when they design gender specific interventions.