糖尿病患者多维就医行为模式及影响因素研究OA

Background China has 148 million adult patients with diabetes,imposing a substantial disease burden,and patients'healthcare-seeking behaviors,as a core aspect of disease management,play a critical role in diabetes prevention and control.Objective Exploring multidimensional healthcare-seeking behavior patterns in diabetic patients and analyzing their associations with glycemic control and healthcare resource utilization to inform precision management strategies.Methods Based on the follow-up and diagnosis data of 30 509 patients with type 2 diabetes in Putuo District,Shanghai in 2023,latent class analysis(LCA)was used to identify the classification of medical-seeking behaviors.Multinomial Logistic regression was used to analyze the influence of demographic,behavioral and clinical characteristics on medical-seeking categories.Multivariate Logistic regression was used to analyze the influence of each medical-seeking category and other influencing factors on the annual blood glucose compliance.Results LCA classified patients'medical-seeking behaviors into four types:specialist-dominated type(n=4 480,14.68%),community-based type(n=7 161,23.47%),community-intensive type(n=11 812,38.72%),and comprehensive complex type(n=7 056,23.13%).Multinomial Logistic regression showed that male patients had a significantly increased likelihood of choosing the community-intensive healthcare-seeking behavior(OR=1.133,P<0.001).Patients aged 60 years and above were more likely to select the community-based or community-intensive type(OR=2.117-2.667,P<0.001).Prolonged disease duration was associated with a decreased tendency for the community-based type(OR=0.983,P<0.001)and an increased tendency for the comprehensive complex type(OR=1.041,P<0.001).Patients with complications/comorbidities significantly tended toward the community-intensive type(OR=1.498,2.506,P<0.001)and comprehensive complex type(OR=3.865,3.003,P<0.001).Ever or current smokers had a decreased tendency for the comprehensive complex type(OR=0.772,P=0.011).Patients with regular physical activity had decreased tendencies for the community-based(OR=0.835,P<0.001),community-intensive(OR=0.674,P<0.001),and comprehensive complex(OR=0.672,P<0.001)types.Patients with glycated hemoglobin testing frequency≥5 times/year showed reduced tendencies for the community-based and community-intensive types(OR=0.244,0.356,P<0.01),but an increased tendency for the comprehensive complex type(OR=1.464,P<0.01).Patients with achieved glycemic control had a decreased tendency for the community-intensive type(OR=0.926,P=0.048)and comprehensive complex type(OR=0.776,P<0.001).Multivariate Logistic regression analysis revealed that,with the specialist-dominated type as the reference,the community-intensive type(OR=0.923,P=0.041)and comprehensive complex type(OR=0.791,P<0.001)were associated with decreased annual glycemic control achievement.Regular physical activity(OR=1.107,P=0.002)and glycated hemoglobin testing≥2 times/year were protective factors for annual glycemic control achievement(OR=2.891-4.126,P<0.001).Smoking(OR=0.851,P=0.008),male gender(OR=0.906,P<0.001),complications(OR=0.790,P<0.001),comorbidities(OR=0.620,P<0.001),thyroid disease(OR=0.760,P<0.001),and diabetes with prolonged disease duration(OR=0.977,P<0.001)were identified as risk factors for annual glycemic control achievement.Conclusion There is significant heterogeneity in the medical-seeking behaviors of patients with type 2 diabetes.Advanced age,disease duration,and complications are the core driving factors for the differentiation of behavioral patterns.The blood glucose control effects vary significantly among different medical-seeking behavior categories.It is necessary to strengthen multidisciplinary collaboration for the specialist-dominated type,enhance comprehensive management capabilities for the community-based types,and optimize resource allocation for the comprehensive complex type,so as to achieve stratified and precise intervention.