Determinants of Glycemic Control among Urban Patients with Type 2 Diabetes: A mediation analysis from real-world evidence

Abstract Aims To explore the determinants of glycemic control (GC) among patients with type 2 diabetes (PwD) to provide insight into the pathways of the effect of diabetes knowledge on GC.Methods A multicenter cross-sectional study was conducted in PwD from 28 primary outpatient centers located in Mexico City. Using the multivariable-adjusted models, we determined the associations between diabetes knowledge, self-care behaviors, and glycemic control. The mediation analyses used linear regression models, where the significance of indirect effects was calculated with bootstrapping.Results The population (N=513) had a mean age of 53.8 years (standard deviation: 11.3 yrs.), and 65.9% were women. Using multivariable-adjusted linear models, we found that diabetes knowledge was associated with glycemic control (β: -0.102, 95% Confidence Interval [95% CI] -0.189, -0.014). Diabetes knowledge was also independently associated with self-care behavior (for physical activity: β: 0.181, 95% CI 0.088, 0.273), and self-care behavior was associated with glycemic control (for physical activity: β: -0.112, 95% CI -0.194, -0.029).The association between diabetes knowledge and glycemic control was lost after adjustment for self-care behaviors, especially physical activity (β: -0.084, 95% CI -0.182, 0.014, p -value: 0.062). Finally, the mediation models showed that the effect of diabetes knowledge on glycemic control was 17% independently mediated by physical activity ( p -value: 0.049).Conclusions Self-care activities, particularly physical activity, mediated the effect of diabetes knowledge on glycemic control. Our results indicate that diabetes knowledge should be reinforced in low-income PwD, with an emphasis on the benefits physical activity has on improving GC.