Multidimensional behavioral factors for diabetes management among middle-aged adults: a population-based study

To determine the multifactorial influences that modulate adherence to diabetes management.

We enrolled 9392 middle-aged adults with diabetes from the nationwide cross-sectional 2019 Korea Community Health Survey by the Korea Disease Control and Prevention Agency and stratified the cohort by four diabetes management types: none; therapeutic lifestyle-change only; medical therapy only; and therapeutic lifestyle change–medical therapy. Biological, psychological, contextual, and interpersonal predictors were used to characterize each pattern of diabetes management in the multivariable logistic regression model.

The diabetes management type was associated with biological, psychological, contextual, and interpersonal predictors. Medical therapy was positively associated with sex, age, and diabetes duration and negatively associated with unfavorable psychological and interpersonal factors. Therapeutic lifestyle change among participants who were receiving medical therapy was associated with the patient’s age and diabetes duration, with similar associations as for receiving medical therapy, including the positive association with psychological factors, social participation, and contextual factors. It was higher in those who were living in an urban area, had higher education level, and were unemployed.

Diabetes management constitutes a multifactorial behavioral outcome, rather than being attributable to any single factor, and each type of diabetes management was characterized by the contributions of different factors. The results suggest the need for a multidimensional approach to enhance diabetes management practice for individuals in different disease-progression stages and to improve the extent of adherence to diabetes management.