Self-management behavior and fasting plasma glucose control in patients with type 2 diabetes mellitus over 60 years old: multiple effects of social support on quality of life

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Abstract

Objective

Elderly patients with type 2 diabetes mellitus are highly vulnerable due to severe complications. However, there is a contradiction in the relationship between social support and quality of life, which warrants further exploration of the internal mechanism. This study assessed the quality of life and its interfering factors in this patient population.

Methods

In total, 571 patients with type 2 diabetes mellitus over 60 years old were recruited from two community clinics in Heilongjiang Province, China. We collected data on health status, quality of life, self-management behavior, fasting plasma glucose (FPG) level, and social support. Structural equation modeling and the bootstrap method were used to analyze the data.

Results

The average quality of life score was − 29.25 ± 24.41. Poorly scored domains of quality of life were “Psychological feeling” (− 8.67), “Activity” (− 6.36), and “Emotion” (− 6.12). Of the 571 patients, 65.32% had normal FPG, 9.8% had high-risk FPG, 15.94% had good self-management behavior, and 22.07% had poor social support. Significant correlations among social support, self-management behavior, FPG level, and quality of life were noted. A multiple mediator model revealed that social support influenced quality of life in three ways: (1) directly (c′ = 0.6831); (2) indirectly through self-management behavior (a1*b1 = 0.1773); and (3) indirectly through FPG control (a2*b2 = 0.1929). Self-management behavior influenced the quality of life directly and indirectly through FPG control.

Conclusion

Improving self-management behavior and monitoring hypoglycemia should become priority targets for future intervention. Scheduled social support to self-management projects should be put into the standardized management procedure. Physicians should provide substantial and individualized support to the elderly patients with type 2 diabetes mellitus regarding medication, blood glucose monitoring, and physical exercise.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12955-021-01881-y.

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Most cited references 111

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Hypotheses involving mediation are common in the behavioral sciences. Mediation exists when a predictor affects a dependent variable indirectly through at least one intervening variable, or mediator. Methods to assess mediation involving multiple simultaneous mediators have received little attention in the methodological literature despite a clear need. We provide an overview of simple and multiple mediation and explore three approaches that can be used to investigate indirect processes, as well as methods for contrasting two or more mediators within a single model. We present an illustrative example, assessing and contrasting potential mediators of the relationship between the helpfulness of socialization agents and job satisfaction. We also provide SAS and SPSS macros, as well as Mplus and LISREL syntax, to facilitate the use of these methods in applications.

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Global estimates of the prevalence of diabetes for 2010 and 2030.

J E Shaw, R. A. Sicree, P Zimmet (2010)

We estimated the number of people worldwide with diabetes for the years 2010 and 2030. Studies from 91 countries were used to calculate age- and sex-specific diabetes prevalences, which were applied to national population estimates, to determine national diabetes prevalences for all 216 countries for 2010 and 2030. Studies were identified using Medline, and contact with all national and regional International Diabetes Federation offices. Studies were included if diabetes prevalence was assessed using a population-based methodology, and was based on World Health Organization or American Diabetes Association diagnostic criteria for at least three separate age-groups within the 20-79 year range. Self-report or registry data were used if blood glucose assessment was not available. The world prevalence of diabetes among adults (aged 20-79 years) will be 6.4%, affecting 285 million adults, in 2010, and will increase to 7.7%, and 439 million adults by 2030. Between 2010 and 2030, there will be a 69% increase in numbers of adults with diabetes in developing countries and a 20% increase in developed countries. These predictions, based on a larger number of studies than previous estimates, indicate a growing burden of diabetes, particularly in developing countries. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

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Prevalence of diabetes recorded in mainland China using 2018 diagnostic criteria from the American Diabetes Association: national cross sectional study

Yongze Li, Di Teng, Xiaoguang Shi … (2020)

Abstract Objective To assess the prevalence of diabetes and its risk factors. Design Population based, cross sectional study. Setting 31 provinces in mainland China with nationally representative cross sectional data from 2015 to 2017. Participants 75 880 participants aged 18 and older—a nationally representative sample of the mainland Chinese population. Main outcome measures Prevalence of diabetes among adults living in China, and the prevalence by sex, regions, and ethnic groups, estimated by the 2018 American Diabetes Association (ADA) and the World Health Organization diagnostic criteria. Demographic characteristics, lifestyle, and history of disease were recorded by participants on a questionnaire. Anthropometric and clinical assessments were made of serum concentrations of fasting plasma glucose (one measurement), two hour plasma glucose, and glycated haemoglobin (HbA1c). Results The weighted prevalence of total diabetes (n=9772), self-reported diabetes (n=4464), newly diagnosed diabetes (n=5308), and prediabetes (n=27 230) diagnosed by the ADA criteria were 12.8% (95% confidence interval 12.0% to 13.6%), 6.0% (5.4% to 6.7%), 6.8% (6.1% to 7.4%), and 35.2% (33.5% to 37.0%), respectively, among adults living in China. The weighted prevalence of total diabetes was higher among adults aged 50 and older and among men. The prevalence of total diabetes in 31 provinces ranged from 6.2% in Guizhou to 19.9% in Inner Mongolia. Han ethnicity had the highest prevalence of diabetes (12.8%) and Hui ethnicity had the lowest (6.3%) among five investigated ethnicities. The weighted prevalence of total diabetes (n=8385) using the WHO criteria was 11.2% (95% confidence interval 10.5% to 11.9%). Conclusion The prevalence of diabetes has increased slightly from 2007 to 2017 among adults living in China. The findings indicate that diabetes is an important public health problem in China.

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Author and article information

Contributors

Xinye Qi: qixinye1992@163.com

Jiao Xu: xujiao0417@126.com

Guiying Chen: cgy669@163.com

Huan Liu: liuhuan00813@163.com

Jingjing Liu: 15001290091@163.com

Jiahui Wang: wangjiahui0629@126.com

Xin Zhang: zhangxin199509@163.com

Yanhua Hao: hyhyjw@126.com

Qunhong Wu:

ORCID: http://orcid.org/0000-0002-2873-5266

wuqunhong@163.com

Mingli Jiao: minglijiao@126.com

Journal

Journal ID (nlm-ta): Health Qual Life Outcomes

Journal ID (iso-abbrev): Health Qual Life Outcomes

Title: Health and Quality of Life Outcomes

Publisher: BioMed Central (London )

ISSN (Electronic): 1477-7525

Publication date (Electronic): 12 November 2021

Publication date PMC-release: 12 November 2021

Publication date Collection: 2021

Volume: 19

Electronic Location Identifier: 254

Affiliations

[1 ]GRID grid.410736.7, ISNI 0000 0001 2204 9268, Department of Health Policy, Health Management College, , Harbin Medical University, ; 157 Baojian Road, Nangang District, Harbin, Heilongjiang China

[2 ]GRID grid.410736.7, ISNI 0000 0001 2204 9268, Department of Social Medicine, School of Public Health, , Harbin Medical University, ; 157 Baojian Road, Nangang District, Harbin, Heilongjiang China

[3 ]GRID grid.412596.d, ISNI 0000 0004 1797 9737, Department of Cardiology, , First Affiliated Hospital of Harbin Medical University, ; Harbin, Heilongjiang China

Author information

Qunhong Wu http://orcid.org/0000-0002-2873-5266

Article

Publisher ID: 1881

DOI: 10.1186/s12955-021-01881-y

PMC ID: 8588678

PubMed ID: 34772424

SO-VID: 6febeebe-5014-433d-8f68-c0e71b96c852

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 28 September 2020

Date accepted : 4 October 2021

Funding

Funded by: the national social science fund of china

Award ID: No.19AZD013

Award Recipient : Qunhong Wu

Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;

Award ID: 71333003

Award Recipient : Qunhong Wu

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ScienceOpen disciplines: Health & Social care

Keywords: elderly,hypoglycemia,quality of life,patient self-management,social support

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ScienceOpen disciplines: Health & Social care

Keywords: elderly, hypoglycemia, quality of life, patient self-management, social support

Self-management behavior and fasting plasma glucose control in patients with type 2 diabetes mellitus over 60 years old: multiple effects of social support on quality of life

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Supplementary Information

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Most cited references 111

Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models.

Global estimates of the prevalence of diabetes for 2010 and 2030.

Prevalence of diabetes recorded in mainland China using 2018 diagnostic criteria from the American Diabetes Association: national cross sectional study

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