Self-management Status And Its Influencing Factors Of Newly Diagnosed Young Patients With Type 2 Diabetes

Objective:To explore(i)the current situation of self-management among young patients with newly-diagnosed type 2 diabetes mellitus(T2DM).(ii)the determinants of self-management in young patients with newly-diagnosed T2DM.Methods:From February 2017 to December 2017,214 young patients with newly-diagnosed T2DM were selected in outpatient department or ward of endocrinology department at China-Japanese Friendship Hospital based on unified inclusion and exclusion criteria by convenience sampling.The survey instruments included the general condition questionnaire,the summary of diabetes self-care activities(SDSCA),the self-efficacy for diabetes(SED),self-management attitude scale for diabetes patients,diabetes distress scale(DDS),diabetes knowledge test(DKT),medical coping modes questionnaire(MCMQ),social support rating scale(SSRS).Statistical description was used to analyze the level of self-management among young patients.Spearman correlation,non-parametric test,chi-square test,multiple stepwise regression analysis and logistic regression were used to analyze the determinants of self-management of patients.Results:(i)The median of self-management in young patients with newly-diagnosed T2DM was 4.25 in diet(P25=3.25,P75=5.50),2.00 in exercise(P25=1.50,P75=6.00),2.00 in blood-glucose testing(P25=0.50,P75=4.00),0.00 in foot care(P25=0.00,P75=2.00),7.00 in medication taking(P25=6.00,P75=7.00).There were 66 patients(30.84%)among 214 patients with smoking for 13.42 per day.(ii)For 214 young patients with newly-diagnosed T2DM,the median of self-efficacy was 7.50 with 96.73%of patients in a moderate or higher level.The median of self-management attitude was 0.92.The median of diabetes distress was 1.74 along with 39.72%of patients with distress.The median of diabetes knowledge was 64.29.In coping style,the score of confrontation was lower than that of norm,and the score of avoidance was higher than that of norm(P<0.01).The total score and scores of dimensions of social support were lower than those of norm(P<0.01).(iii)Multiple stepwise regression analysis showed that self-efficacy,diabetes distress,condition on joining diabetes related tissue or Wechat,fasting blood-glucose(FBG)could explain 19.6%of the variance of diet self-management;self-efficacy,diabetes knowledge,condition on joining diabetes related tissue or Wechat,condition on joining diabetes related education could explain 25.2%of the variance of exercise self-management;average income per person in family,confrontation,condition on joining diabetes related tissue or Wechat,length of time since T2DM diagnosis,family history of diabetes could explain 19.3%of the variance of blood-glucose testing self-management;confrontation,education,condition on joining diabetes related tissue or Wechat,self-efficacy could explain 13.9%of the variance of foot care self-management;diabetes knowledge,condition on joining diabetes related education could explain 7.0%of the variance of medication taking self-management.Logistic regression showed that female and diabetes knowledge was the protective factor of smoking,being with religious belief was the risk factor of smoking,which could explain 27.5%of the variance of smoking.Conclusion:The self-management of young patients with newly-diagnosed T2DM are with the highest level in medication taking,the lowest level in foot care and a lower level in blood-glucose testing.About 40%young patients with newly-diagnosed T2DM experience diabetes distress.They also have general level of diabetes knowledge,negative coping style and low level of social support.The major determinants of self-management are condition on joining diabetes related tissue or Wechat,self-efficacy,diabetes knowledge which were related with three or more dimensions of self-management.Besides,confrontation and condition on joining diabetes related education are also related with self-management of young patients with newly-diagnosed T2DM.Patients did not join diabetes related tissue or Wechat have worse level of diet,exercise,blood-glucose testing,foot care self-management than those joined.Patients with a low level of self-efficacy have a low level of diet,exercise,foot care self-management.Patients with a low level of diabetes knowledge have a low level of exercise and medication taking self-management.We should carry out nursing intervention for young patients who did not join diabetes related tissue or Wechat,are with a low level of self-efficacy and diabetes knowledge,guide patients to adopt confrontation,encourage patients to join diabetes related education so as to improve self-management of young patients.