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Patterns and associated factors of diabetes self-management: Results of a latent class analysis in a German population-based study

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  • Marcus Heise
  • Astrid Fink
  • Jens Baumert
  • Christin Heidemann
  • Yong Du
  • Thomas Frese
  • Solveig Carmienke

Abstract

Objective: Few studies on diabetes self-management considered the patterns and relationships of different self-management behaviours (SMB). The aims of the present study are 1) to identify patterns of SMB among persons with diabetes, 2) to identify sociodemographic and disease-related predictors of SMB among persons with diabetes. Research design and methods: The present analysis includes data of 1,466 persons (age 18 to 99 years; 44.0% female; 56.0% male) with diabetes (type I and II) from the population-based study German Health Update 2014/2015 (GEDA 2014/2015-EHIS). We used latent class analysis in order to distinguish different patterns of self-management behaviours among persons with diabetes. The assessment of SMB was based on seven self-reported activities by respondents (dietary plan, diabetes-diary, diabetes health pass, self-assessment of blood glucose, self-examination of feet, retinopathy-screenings and assessment of HbA1c). Subsequent multinomial latent variable regressions identified factors that were associated with self-management behaviour. Results: Latent class analysis suggested a distinction between three patterns of SMB. Based on modal posterior probabilities 42.8% of respondents showed an adherent pattern of diabetes self-management with above-average frequency in all seven indicators of SMB. 32.1% showed a nonadherent pattern with a below-average commitment in all seven forms of SMB. Another 25.1% were assigned to an ambivalent type, which showed to be adherent with regard to retinopathy screenings, foot examinations, and the assessment of HbA1c, yet nonadherent with regard to all other forms of SMB. In multivariable regression analyses, participation in Diabetes Self-Management Education programs (DSME) was the most important predictor of good self-management behaviour (marginal effect = 51.7 percentage points), followed by attentiveness towards one’s personal health (31.0 percentage points). Respondents with a duration of illness of less than 10 years (19.5 percentage points), employed respondents (7.5 percentage points), as well as respondents with a high socioeconomic status (24.7 percentage points) were more likely to show suboptimal forms of diabetes self-management. Discussion: In the present nationwide population-based study, a large proportion of persons with diabetes showed suboptimal self-management behaviour. Participation in a DSME program was the strongest predictor of good self-management. Results underline the need for continual and consistent health education for patients with diabetes.

Suggested Citation

  • Marcus Heise & Astrid Fink & Jens Baumert & Christin Heidemann & Yong Du & Thomas Frese & Solveig Carmienke, 2021. "Patterns and associated factors of diabetes self-management: Results of a latent class analysis in a German population-based study," PLOS ONE, Public Library of Science, vol. 16(3), pages 1-23, March.
    • Handle: RePEc:plo:pone00:0248992
    DOI: 10.1371/journal.pone.0248992
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    References listed on IDEAS

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    1. Mary D Adu & Usman H Malabu & Aduli E O Malau-Aduli & Bunmi S Malau-Aduli, 2019. "Enablers and barriers to effective diabetes self-management: A multi-national investigation," PLOS ONE, Public Library of Science, vol. 14(6), pages 1-22, June.
    2. Stanley Sclove, 1987. "Application of model-selection criteria to some problems in multivariate analysis," Psychometrika, Springer;The Psychometric Society, vol. 52(3), pages 333-343, September.
    3. Richard Williams, 2012. "Using the margins command to estimate and interpret adjusted predictions and marginal effects," Stata Journal, StataCorp LP, vol. 12(2), pages 308-331, June.
    4. Razel B. Milo & Cynthia D. Connelly, 2019. "Predictors of glycemic management among patients with type 2 diabetes," Journal of Clinical Nursing, John Wiley & Sons, vol. 28(9-10), pages 1737-1744, May.
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