Influence of social determinants, diabetes knowledge, health behaviors, and glycemic control in type 2 diabetes: An analysis from real-world evidence

Abstract

Background Although important achievements have been done in type 2 diabetes mellitus (T2D) treatment and glycemic control, new strategies may take advantage of non-pharmacological approaches and of other potential determinants of health (e.g., socioeconomic status, education, diabetes knowledge, physical activity, and self-care behavior). However, the relationships between these factors are not totally clear and have not been studied in the context of large urban settings. This study aimed to explore the relationship between these determinants of glycemic control (GC) in a low-income urban population from Mexico City, focused in exploring potential the mediation of self-care behaviors in the association between diabetes knowledge and GC.Methods A multicenter cross-sectional study was conducted in patients with type 2 diabetes (T2D) from 28 primary care outpatient centers located in Mexico City. Using multivariable-adjusted models, we determined the associations between diabetes knowledge, self-care behaviors, and GC. The mediation analyses to determine the pathways on glycemic control were done using linear regression models, where the significance of indirect effects was calculated with bootstrapping.Results The population (N=513) had a mean age of 53.8 years (standard deviation: 11.3 yrs.), and 65.9% were women. Both socioeconomic status and level of education were directly associated with diabetes knowledge. Using multivariable-adjusted linear models, we found that diabetes knowledge was associated with GC (β: -0.102, 95% Confidence Interval [95% CI] -0.189, -0.014). Diabetes knowledge was also independently associated with self-care behavior (for physical activity: β: 0.181, 95% CI 0.088, 0.273), and self-care behavior was associated with GC (for physical activity: β: -0.112, 95% CI -0.194, -0.029). The association between diabetes knowledge and GC was not observed after adjustment for self-care behaviors, especially physical activity (β: -0.084, 95% CI -0.182, 0.014, p-value: 0.062). Finally, the mediation models showed that the effect of diabetes knowledge on GC was 17% independently mediated by physical activity (p-value: 0.049). Conclusions Socioeconomic and educational gradients influence diabetes knowledge among primary care patients with type 2 diabetes. Self-care activities, particularly physical activity, mediated the effect of diabetes knowledge on GC. Our results indicate that diabetes knowledge should be reinforced in low-income T2D patients, with an emphasis on the benefits physical activity has on improving GC.

The imperious need for telemedicine for the care of diabetes during the COVID-19 pandemic. A comprehensive approach study

“…8,9 The patients, who were previously referred from primary care health centers, are beneficiaries of the Health for Wellbeing Institute (public system), and a high proportion belong to economically disadvantaged social sectors. 10 In Mexico, on April 3, 2020, a health emergency was declared due to the COVID-19 pandemic, and subjects older than 60 years of age and/or with non-communicable diseases were advised to observe confinement in order to reduce the risk of transmission in this vulnerable group. This drove to a significant reduction in the provision of services for the care of chronic diseases due to a decrease in the attendance of patients to medical appointments and due to the allocation of resources for the care of the pandemic.…”

La imperiosa necesidad de telemedicina en la atención de diabetes durante la pandemia de COVID-19. Un estudio de abordaje integral

“…8,9 Los pacientes fueron referidos previamente de centros de salud de atención primaria, son beneficiarios del Instituto de Salud para el Bienestar (sistema público) y una alta proporción pertenece a sectores sociales económicamente desfavorecidos. 10 En México, el 3 de abril de 2020 se declaró una emergencia sanitaria por la pandemia de COVID-19 y se sugirió a los sujetos mayores de 60 años y con enfermedades no transmisibles atender el confinamiento para disminuir el riesgo de contagio en este grupo vulnerable. Lo anterior condicionó una importante reducción en la prestación de servicios de atención de enfermedades crónicas por la disminución en la asistencia de los pacientes a sus citas médicas y por la asignación de recursos para la atención de la pandemia.…”

The relationship between poor glycaemic control and risk factors in patients with type 2 diabetes mellitus

“…The mean age and sex of diabetic patient population of our study were similar to many reports. [2,3,[9][10][11][12] While most diabetic patients in developed countries range in age from 45-64, people over 64 years represent the majority of diabetics in developing countries. [13,14] The mean duration of diabetes in the patients who participated in our study was five years.…”