Analysis On The Vulnerability Of Patients With Diabetes Mellitus In Tianjin

Objective:To understand the vulnerability of diabetes mellitus in Tianjin and to identify the vulnerable index of disease.Through qualitative study,the social and cultural factors affecting patients were discussed,and vulnerable themes and factors of patients with diabetes were excavated deeply,then the characteristics of the vulnerable population were analyzed.This paper aimed to provide theoretical support and practical basis for targeted health interventions and medical decisions,so as to effectively prevent and control diabetes.Methods:A total of 260 patients with diabetes in 13 top three hospitals and 2dimethyl hospitals in Tianjin were selected as the study subjects,with a total of 26groups of 10 patients.In the planning stage,an interview syllabus was designed based on local vulnerability and its resource distribution.Prior to the interview,professional doctors were trained and the respondents were selected.The 26 groups of patients were then interviewed.Each interview lasted approximately 120 minutes.Finally,a total of 260 documents were completed,excluding missing and unqualified documents,and 229 valid documents were eventually included in the analysis.This study summarized the interview documents through thematic analysis of qualitative research,and combined with the basic information,to explore the vulnerable index of diabetic patients in Tianjin.Then,the vulnerability factors of the patients were analyzed by latent class analysis,and the characteristics of diabetes mellitus were revealed.Results:Among the 229 patients included in the study,aged from 22 to 86 years old with the average age of 53 years old,and the maximum number of the elderly was107.There were 106 males and 123 females.The majority of Han people were 221;The number of married people is 214;207 urban households and 22 rural residents;222 cases in Type 2 diabetes,7 cases in type 1 diabetes;Family history of 144 cases,no family history of 85 cases;55 cases were smoking and 173 cases not;68 cases were drinking and 160 cases not.There were 169 patients with complications and 59cases not.There were 75 patients with comorbidities and 144 cases not;The median duration of the disease was 13.0(12.0)years;The median BMI was 25.9(5.0)kg/m~2,after grouping by BMI,the number of lean,normal,overweight,and obese individuals was 6,62,94,and 67,respectively.There were 139 patients with abdominal obesity and 74 without abdominal obesity.The median of HbA1c was 8.4(2.9)%,and there were 37 cases reached the standard of blood sugar and 167 people did not meet the standard.The results of the interview analysis were as follows:There were 12 vulnerable themes of diabetes mellitus in Tianjin,including economic constraints,severe disease,health literacy,health beliefs,medical environment,life restriction,lifestyle change,lack of time,mental status,levels of support;social integration and experience transformation.There are 28 factors of diabetes vulnerability and it covered four categories:biological factors,economic factors,psychological factors and socio-cultural factors.And then summarized twelve factors that were the most important vulnerable factors,respectively economic constraints,severe disease,low level of health literacy and incorrect health belief,lack of medical resources,life restriction,lifestyle change,lack of time,poor mental state,low level of support,low degree of social integration and experience transformation.Finally,patients with diabetes were divided into three groups according to the main vulnerable factors:high income and low resource utilization group(12.2%),low literacy and severe group(29.7%)and low income and low health belief group(58.1%).There was a statistically significant difference in the blood glucose between the three groups(?~2=7.239,P=0.029).Conclusion:Through qualitative study,this paper analyzed and summarized vulnerable themes and factors of diabetes patients in Tianjin,and which were discovered the biology,psychology,sociology and economics.The latent class model was used to cluster the characters of diabetes vulnerability factors,at the same time of"dimension reduction",dig the potential value of vulnerability information.Thus it provided a theoretical basis for proposing health interventions and health promotion.