Associations between self-stigma and health promotion behaviors in overweight/obese patients with type 2 diabetes: a cross-sectional study

Associations between self-stigma and health promotion behaviors in overweight/obese patients with type 2 diabetes: a cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Associations between self-stigma and health promotion behaviors in overweight/obese patients with type 2 diabetes: a cross-sectional study Shilian Niu, Rao Li, Li Yuan, Dan Huang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4549917/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The correlation between stigma and health-promoting behaviors in overweight/obese type 2 diabetes (T2DM) patients is unclear. Therefore, this study aimed to investigate the association between the two in this particular population. Data were collected from an offline cross-sectional survey of 200 overweight/obese patients with T2DM aged 18-84 who were admitted to the Department of a tertiary general hospital in Chengdu, Sichuan Province, China between July 2022 and July 2023. Respondents were assessed for Stigma and health promoting behaviors using the SSCI and T2DHPS scales. Additionally, to examine the factors that influenced stigma, we utilized multiple linear regression analysis. Results revealed that stigma was significantly associated with health-promoting behaviors, with negative correlations with stress management and enjoyment of life. Several factors were found to increase the chronic disease stigma, including low monthly income, hypoglycemia, inpatient, and GLP-1RA treatment. Health sciences/Endocrinology/Endocrine system and metabolic diseases Health sciences/Endocrinology Health sciences/Health care Introduction Stigma has multiple negative impacts on an individual's dignity, health, self-care, and well-being 1 – 3 . International organizations have called on drawing more attention to stigma,aiming to address stigma in disease management and make it a research priority.Stigma is primarily caused by blame, fear, and disgust resulting from negative stereotypes and misinformation 4 .It is estimated that by 2040, the number of obese adults will increase by sixfold and the prevalence of diabetes will increase to 642 million 5 .Due to the rapid urbanization and the change of life style, the rate of overweight/obesity and diabetes may continual to increasing. This group is prone to have feelings of shame and low self-esteem due to overweight, changes in appearance, or recognition of their diseases 6 . With the awareness and publicity of diabetes and overweight/obesity through traditional concepts and new social media, this group has been labeled as gluttonous, lazy, and irresponsible. Patients are prone to feel stigma and even aggravate this psychological burden 7 . Studies have shown that patients experiencing stigma are more prone to engage in unhealthy behaviors such as overeating and eating to reduce stress, higher levels of diabetes distress 8 , poorer self-management on diabetes, and fewer clinical visits, leading to under-diagnosis and under-treatment of the disease 9 . Diabetes self-care strategies emphasize a series of complex and demanding disease management activities such as the adjustment of diet, exercise, adherence of medication regimens and self-monitor on blood glucose. Patients commonly experience emotional distress and reduced quality of life when managing their disease.Health-promoting behaviors have been recognized as important strategies for maintaining and improving the quality of life for people with chronic disabilities, focusing on the individual ability to remain proactive in all aspects of life 10 , 11 .Health-promoting behaviors help alleviate and reduce the risk of microvascular and macrovascular complications in individuals with high BMI and diabetes, and improve the individual's positive psychological level, so as to improve the quality of life 12 .Previous research has found that experiencing stigma can negatively impact patients' health behaviors, such as affecting the emotional state of people with diabetes. However, there is a lack of relevant research on whether stigma has an impact on health-promoting behaviors in overweight/obese patients with T2DM 13 .Therefore, we specifically assessed the association between health-promotion behaviors and experienced stigma in overweight/obese patients with T2DM.To facilitate healthcare professionals in developing interventions aimed at reducing stigma and improving overall health promotion levels among overweight/obese patients with T2DM.Thus, this study investigated the association between stigma and diabetes health promotion behaviors among overweight/obese patients with T2DM in a tertiary general hospital in Sichuan Province, China. Methods Study design This study employed a cross-sectional questionnaire-based approach, utilizing convenience sampling to examine overweight/obese individuals with T2DM. Participants were recruited from both the inpatient and outpatient departments specializing in endocrinology and metabolism at a tertiary general hospital located in Sichuan Province, China. Inclusion criteria include: (a) age ≥ 18 years; (b) fulfillment of the 1999 WHO diagnostic criteria for diabetes mellitus; (c)BMI ≥ 25kg/m 2 ;(d) patients agreed to sign an informed consent form. The study excluded patients with severe mental disorders, cognitive impairment, absolute bedridden, and disturbance of consciousness.Conducted from July 2022 to July 2023, this study involved rigorous preparation and adhered to methodological standards. Before commencement of the survey, investigators underwent professional training to familiarize themselves with the study's objectives and questionnaire collection methods. Notably, all investigators were qualified medical personnel. All subjects voluntarily accepted the questionnaire and signed the informed consent after understanding the purpose and significance of the study. In instances where patients encountered difficulty completing the questionnaire independently, investigators assisted using neutral language and recorded responses accurately. Missing data were promptly addressed through communication with patients. Given the inclusion of 25 variables in the questionnaire, a sample size of at least 138 was deemed necessary, following Kendall's rough estimation method, which suggested a sample size of 5–10 times the number of variables. Consequently, 200 questionnaires were distributed, resulting in a valid return rate of 98.5%, with 197 questionnaires being considered valid for analysis. Instruments General demographic characteristics obtained included gender, age, education, marital status, occupation, per capita monthly household income, and patient origin. Clinical information of the participants was also collected, such as Body Mass Index (BMI), time since diagnosis (in years), treatment modalities, diabetes-related symptoms, diabetes-related complications, comorbidities of chronic diseases, abdominal obesity, glycated hemoglobin (HbA1c) levels, and the use of GLP-1RA therapy. BMI was calculated as the ratio of body weight in kilograms to squared body height in meters (kg/m 2 ).Participants were categorized as overweight (BMI, 25.0–29.9 kg·m 2 ), or obese (BMI ≥ 30.0 kg·m 2 ), according to the criteria of the WHO International BMI Classification of adults 14 .The number of diabetes-related complications was calculated as a simple composite of six complications, referencing the Diabetes Complications Index (DCI), with scores ranging from 0 to 6 15 . The number of comorbidities of chronic diseases was calculated by a simple composite of comorbidity types outlined in the International Classification of Diseases (ICD-10) overview 16 .Abdominal obesity was determined by waist perimeter (WC), WC was measured midway between the bottom of the twelfth rib and the anterior superior iliac spines while the subject was standing. Abdominal obesity was defined as having waist circumference > 90cm in men and > 85cm in women 17 .HbA1c levels were based on the most recent laboratory test results within the past three months for each patient. The Stigma Scale for Chronic Illness (SSCI) was used to assess the level of stigma. The Chinese version of the SSCI scale comprised 24 assessment items allowing for five responses on a Likert scale 18 : never, rarely, sometimes, often, and always, with scores of 0, 1, 2, 3, and 5 respectively. The total possible scores ranged from 24 to 120, and the scores were considered continuous. The higher the scores, the higher the levels of self-stigmatisation. In this study, the internal consistency of the scale was 0.948. The T2DHPS scale was developed by Chen et al in 2013 to assess health promotion behaviors in patients with T2DM. Cao et al assessed the reliability and validity of the scale and confirmed its applicability to the Chinese population 19 .The T2DHPS comprised 28 items covering six dimensions: physical activity (7 items), risk reduction (7 items), stress management (5 items), enjoy life (3 items), health responsibilities (3 items), and healthy eating (3 items). The scale used a 5-point Likert scale (never = 1, occasionally = 2, about half the time = 3, often = 4, and always = 5) with a total score between 28 and 140. Higher scores indicated greater health promotion for people with diabetes. In this study, the T2DHPS showed high reliability and validity with a Cronbach's alpha of 0.905. Ethics This study has been approved by the Biomedical Ethics Committee of West China Hospital of Sichuan University (Batch Number: 2022 Review [1500]).Informed consent was obtained from all the participants. All surveys were anonymous, and each participant completed the same set of questionnaires. This study was based on the tenets of the Declaration of Helsinki. Analysis SPSS version 27.0 was used for statistical analyses. Categorical variables were described by frequencies and percentages, and continuous variables were described by means and standard deviations. T-tests and ANOVA were employed to assess variations in stigma across socio-demographic variables. Pearson correlation analysis was utilized to examine the association between stigma and health promotion behaviors among overweight/obese diabetic patients. Multiple linear regression analysis was used to explore the predictors of stigma. P-values of less than 0.05 were considered statistically significant. Results 200 overweight/obese people diagnosed with T2DM, both outpatients and inpatients, were invited to participated in this study. Written informed consent was obtained from all. However, three responses were considered incomplete or inconclusive and were excluded. The analysis was based on data from 197 valid responses. Table 1 shows the demographic characteristics of the study subjects and the univariate analysis of stigma with different characteristics. Among the 197 overweight/obese patients with T2DM, 126 (64%) were males and 71 (36%) were females. The age of the patients range from 18 to 84, with an average age of 54.12 ± 13.14 years. The average BMI of patients was 27.27 ± 3.11, 133(67.5%) patients were overweight, 64(32.5%) patients were obese, and the average HbA1c was 8.36 ± 1.81 (mmol/mol). The average number of diabetes-related symptoms was 1.71 ± 1.64, the average of diabetes-related complications was 0.58 ± 0.93, and the average of chronic disease comorbidities was 1.58 ± 1.15. The results of the T-test and ANOVA showed statistically significant differences between patients in terms of monthly household income, diabetes complications, hypoglycemia, patient origin, and GLP-1RA treatment (p < .05).LSD post-hoc test was conducted for more than three groups of items, p 10,000 RMB and the other groups. Table 1 Distribution of stigma scores in overweight/obese patients with T2DM with different demographic characteristics (N = 197, x ± s) Characteristic N (%) Stigma t/F P Sex 3.63 0.058 Male 126(64.00) 53.25 ± 7.93 Female 71(36.00) 55.85 ± 9.74 Age 1.627 0.199 < 40 29(14.70) 52.03 ± 1.12 40–60 95(48.20) 55.19 ± 0.97 ≥ 60 73(37.10) 53.74 ± 0.99 BMI 0.314 0.576 Overweight 133(67.50) 53.8 ± 8.90 Obese 64(32.50) 54.98 ± 8.26 Occupation 0.116 0.891 Employed 100(50.80) 54.11 ± 8.55 Retired 91(46.20) 54.37 ± 8.95 Others 6(3.00) 52.67 ± 8.33 Marriage 1.038 0.356 Married 9(4.60) 56.56 ± 7.38 Unmarried 181(91.90) 53.93 ± 8.58 Divorced or widowed 7(3.60) 57.86 ± 12.66 Educational 1.402 0.243 Primary school and below 32(16.50) 55.19 ± 8.64 Junior High School 43(22.60) 56.05 ± 10.45 High School/College 31(15.70) 54.16 ± 10.43 Undergraduate and above 91(45.20) 54.25 ± 8.06 Residential Status 1.906 0.13 Living Alone 17(8.60) 56.35 ± 9.50 Living with Spouse 143(72.60) 54.57 ± 9.10 Living with Children 28(14.20) 50.79 ± 4.96 Other 9(4.60) 54.67 ± 8.10 Per capita monthly household income (RMB) 3.178 0.025 <2000 9(4.60) 60.33 ± 13.95 2000–4999 36(18.30) 56.14 ± 10.97 5000–10000 66(33.50) 54.36 ± 8.77 ≥ 10000 86(43.70) 52.59 ± 6.27 Duration of diabetes 1.758 0.175 ≤ 5 years 99(50.20) 53.05 ± 7.48 5–10 years 33(16.80) 55.7 ± 9.84 ≥ 10 years 65(33.00) 55.15 ± 9.66 Diabetes Related Symptoms 0.018 0.893 Yes 131(66.50) 54.69 ± 8.68 No 66(33.50) 53.18 ± 8.69 Complications of diabetes 5.261 0.023 Yes 69(35.00) 56.1 ± 9.97 No 128(65.00) 53.16 ± 7.76 Comorbidity 1.258 0.263 Yes 159(80.71) 54.44 ± 7.11 No 38(19.29) 53.13 ± 9.03 Abdominal obesity 0.015 0.902 Yes 178(9.60) 54.26 ± 8.74 No 19(90.40) 53.53 ± 8.41 hypoglycemia 14.746 <0.001 Yes 44(22.30) 58.11 ± 11.33 No 153(77.70) 53.06 ± 7.44 Ketoacidosis 0.063 0.803 Yes 10(5.10) 54.80 ± 10.19 No 187(94.90) 54.05 ± 8.61 Patient origin 13.055 <0.001 Outpatient 117(59.40) 52.5 ± 7.22 Inpatient 80(40.60) 56.65 ± 10.02 Primary treatment 0.323 0.809 Lifestyle 24(12.20) 53.04 ± 6.70 Oral hypoglycemic agents 76(38.60) 54.07 ± 9.85 Insulin injections 23(11.70) 55.52 ± 8.72 Insulin injections and oral hypoglycemic agents 74(37.60) 54.27 ± 8.06 GLP-1RA 7.842 0.006 Yes 21(10.70) 58.62 ± 11.13 No 176(89.30) 53.66 ± 8.23 The overall stigma score of overweight/obese T2DM patients was 4.19 ± 8.69, the overall health-promoting behaviors score was 87.75 ± 16.75. See Table 2 for details. Table 2 Current status of SSCI and T2DHPS in overweight/obese patients with T2DM [n = 197, x ± s, ] Variables Average score Total score of dimensions Average score of each item SSCI Total Score 54.19 ± 8.69 120 2.25 ± 0.36 Self-stigma 30.59 ± 6.01 65 2.35 ± 0.46 Enacted stigma 23.60 ± 3.44 55 2.14 ± 0.31 T2DHPS Total Score 87.75 ± 16.75 140 3.13 ± 0.59 Physical activity 18.35 ± 7.72 35 2.62 ± 1.10 Risk reduction 19.88 ± 5.33 35 2.61 ± 0.79 Stress management 18.68 ± 3.29 25 3.73 ± 0.65 Enjoy life 10.82 ± 2.25 15 3.85 ± 0.66 Health responsibility 9.48 ± 2.74 15 3.16 ± 0.91 Healthy diet 9.80 ± 2.78 15 3.26 ± 0.92 Table 3 presents the results of an analysis examining the correlation between stigma and health-promoting behaviors. Pearson correlation analysis revealed a significant correlation between stigma and the overall score of health promotion behaviors (r = -0.144, P < 0.05). However, only two dimensions, namely stress management (r = -0.312, P < 0.01) and enjoy life (r = -0.254, P < 0.01), exhibited a significant negative correlation with self-stigma. Table 3 Correlation between stigma and health-promoting behaviors in overweight/obese patients with T2DM Variables SSCI Total Score Self-stigma Enacted stigma T2DHPS Total Score Physical activity Risk reduction Stress management Enjoylife Health responsibility Healthy diet SSCI Total Score 1 Self-stigma .955** 1 Enacted stigma .856** .665** 1 T2DHPS Total Score − .144* -0.098 − .192** 1 Physical Activity -0.069 -0.052 -0.082 .822** 1 Risk Reduction -0.011 0.034 -0.088 .797** .549** 1 Stress Management − .312** − .277** − .305** .649** .337** .440** 1 Enjoy life − .254** − .224** − .249** .645** .344** .482** .919** 1 Health responsibility -0.059 -0.007 -0.136 .555** .272** .400** .274** .301** 1 Healthy diet 0.004 0.043 -0.065 .560** .290** .314** .314** .325** .370** 1 *: P<0.05, **༚P<0.01 In the multiple regression analyses, a stepwise approach was used to select the independent variables. Statistically significant socio-demographic data were then modeled, including monthly household income, hypoglycemia incidence, patient origin, GLP-1RA use, diabetes complications, and stress management. Regression analyses were performed on dummy variables for each group. The results of the analyses showed that complications, hypoglycemia, patient origin, GLP-1RA use, and stress management were the main predictors of stigma in overweight/obese T2DM patients. ( F = 7.162, p < .001, R 2 = 0.278, R 2 ad = 0.239)( Table 4 ) The results of the multiple linear regression analysis showed that the presence of complications, hypoglycemia incidence, Patient origin, GLP-1RA use, and stress management explained 23.9% of the patients' feelings of stigma. Stigma was higher in those with complications, susceptibility to hypoglycemia, inpatients, use of GLP-1RA, and weak stress management. Table 4 Multiple stratified linear regression analysis of stigma in overweight/obese patients with T2DM Variables B SE β t P 95%CI Per capita monthly household income (RMB) -1.25 0.636 -0.127 -1.966 0.051 -2.505 ~ 0.004 Hypoglycaemia 3.327 1.354 0.16 2.457 0.015 0.655 ~ 5.999 Patient origin 3.834 1.162 0.217 3.3 0.001 1.542 ~ 6.125 GLP-1RA 4.213 1.804 0.15 2.335 0.021 0.654 ~ 7.773 Retinopathy 2.725 1.864 0.106 1.462 0.146 -0.953 ~ 6.403 Nephropathy 1.054 1.576 0.047 0.669 0.504 -2.056 ~ 4.164 neuropathy 2.735 1.575 0.129 1.736 0.084 -0.373 ~ 5.842 T2DHPS Total Score 0.002 0.044 0.004 0.052 0.959 -0.085 ~ 0.089 Stress management -1.105 0.43 -0.419 -2.567 0.011 -1.954~-0.256 Enjoy life 0.873 0.622 0.226 1.403 0.162 -0.355 ~ 2.101 F = 7.162, p < .001, R 2 = 0.278 , R 2 ad = 0.239 Discussion This study aimed to examine the association between stigma and health promotion behaviors among overweight/obese T2DM patients in China. In this study, the overall patient morbidity stigma was 54.19 ± 8.69, which was higher than in a study by Li in Chinese T2DM patients with normal BMI 20 .The distinctive feature of this study group lies in the fact that the overweight/obese cohort frequently encounters socially imposed negative perceptions, such as those related to body size, rendering them susceptible to external discrimination, thereby eliciting negative emotions 21 . The average score for health promotion behaviors (87.75 ± 16.75) exceeded those reported by Wang in a study conducted in China, potentially due to differences in age distribution among the study cohorts 22 . Additionally, the research revealed a correlation between stigma and reduced engagement in health promotion behaviors among patients, particularly evident in decreased stress management and enjoy life. In conclusion, these preliminary findings suggested the necessity for further research to elucidate the mechanisms by which stigma influences health behaviors within this population.This study found that patients with complications, a history of hypoglycemia, hospitalization, use of GLP-1RA therapy, and poorer stress management skills face more pronounced stigma. Particularly among overweight/obese T2DM patients, those with complications experience significantly higher levels of stigma, consistent with previous research 21 , 23 . However, the mechanisms through which complications influence stigma remain unclear. It is plausible that changes in body image resulting from complications may the self-identity and social interactions of patients, exacerbating their experiences of stigma. Similarly, patients with a history of hypoglycemia also exhibit heightened stigma, aligning with prior research suggesting that fear of hypoglycemia exacerbates stigma as patients avoid public situations to prevent hypoglycemic episodes and gradually withdraw from social relationships 20 . The finding that inpatients had higher levels of stigma than outpatients supports some previous studies that patients with T2DM may be at greater risk of stigmatization by healthcare providers and may face greater and potentially exponentially increased health risks as a result of prejudicial attitudes and negative stereotypes lifestyles about weight and diabetes 24 .The finding that inpatients experience higher levels of shame than outpatients supports previous research suggesting that patients may face greater stigma from healthcare providers due to discriminatory attitudes and negative stereotypes surrounding weight and diabetes management. This heightened sense of stigma could lead to increasing health risks for patients, which could even be exponential.The finding that patients treated with GLP-1RA were more likely to experience stigma was unexpected. Other previous studies have suggested a role for treatment in increasing stigma. The patients in this study who used GLP-1 RA medication may have seen their use of the medication as a 'failure' in their ability to achieve weight control through their behavior and lifestyle. This societal bias may have led to negative feelings about themselves and increased stigma. Patients with poor stress management skills have higher levels of stigma. Previous studies have shown that most people with diabetes report higher levels of perceived stress, anxiety, and fatigue than people in the general population 25 , 26 . Stigma can diminish patients' ability to cope with stress 9 .Stress management interventions in HIV populations have effectively reduced stigma 27 , 28 . However, the intervention studies targeting diabetes patients still be lacked at present. Our study revealed a significant negative correlation between two dimensions of diabetes health promotion behaviors—stress management and enjoy life—and stigma. This finding aligns with previous research on perceived stress among diabetic populations. It may be attributed to the significant increase in the risk of complications associated with chronic disease, coupled with the burden of healthcare expenditure, treatment, societal judgment, and self-blame, all of which can profoundly impact the emotional well-being of patients 29 – 31 .Hence, there is a critical need to develop individualized psychosocial support programs aimed at fostering positive changes in stress management skills and stigma reduce. Physical activity, risk reduction, health responsibility, and healthy eating were not clearly shown to correlate with stigma in this study. However, Puhl 9 、Cho 32 、Khezerloo 33 et al showed that diabetes stigma was associated with poorer diabetes self-management .This may be because diabetes requires long-term management in terms of diet, exercise, medication, and blood glucose monitoring, and patients consider these behaviors as part of their lives, so physical activity, risk reduction, health responsibility, and healthy eating scored higher. Therefore, this study suggests that healthcare professionals should pay more attention to patient's psychological state, guide patients to effectively buffer the negative impact of stressful life events, promote a positive psychological state, reduce patients' sense of stigma and improve their quality of life, in order to improve patients' stress resilience. However, the sources of participants' perceived stress, which may influence stigma, were not explored in detail in this study. To confirm these findings, further intervention studies are needed. New studies to clarify these effects are recommended in the future.. This study has several limitations that warrant acknowledgment. Firstly, its cross-sectional design implies the necessity for follow-up investigations with larger sample sizes to validate the impact of stigma on health-promoting behaviors, such as dietary habits and exercise, among overweight/obese diabetic patients. Secondly, the recruitment of all participants from the specialized inpatient/outpatient department of a general hospital underscores the need for broader representation and expansion in both the size and source of the study population. Moreover, the stigma measurement tool utilized in this study did not rigorously distinguish weight stigma from diabetes stigma, limiting its capacity to accurately discern whether patients' perceived stigma stemmed from weight-related issues or their diabetes diagnosis. Notwithstanding these limitations, several key implications can be drawn from thstudy. To enhance health behaviors and treatment effectiveness among overweight/obese T2DM patients, healthcare providers should prioritize assessing stigma levels and stress management. It is crucial to develop tailored intervention strategies to mitigate stigma and enhance health-promoting behaviors. By addressing these factors, healthcare professionals can foster improved physical and psychological well-being in this group. Declarations Contributors Shilian Niu and Rao Li contributed equally and are co-first authors. Shilian Niu, Rao Li, and Dan Huang designed the study. Shilian Niu and Dan Huang collected the data. Rao Li and Dan Huang were involved in data cleaning. Shilian Niu and Dan Huang analyzed the data. Shilian Niu drafted the manuscript. Li Yuan and Rao Li contributed to the interpretation of the results and critical revision of the manuscript for important intellectual content and approved the final version of the manuscript. All authors have read and approved the final manuscript. Funding This work was supported by the Key R&D Project of Sichuan Science and Technology Department (2022YFS0271). Conflict of interest No potential conflicts of interest were reported by the author(s). Data availability statement Data are available upon reasonable request. The data supporting our findings are available from the corresponding author upon reasonable request. Ethics statements Patient consent for publication Not applicable. Acknowledgments Thanks to all the participants and researchers involved in this study. References Jacoby, A. et al. Epilepsy and social identity: the stigma of a chronic neurological disorder [J]. Lancet Neurology, 2005, 4(3): 171–178. Kisala, P.A. et al. Measuring stigma after spinal cord injury: Development and psychometric characteristics of the SCI-QOL Stigma item bank and short form [J]. Journal of Spinal Cord Medicine, 2015, 38(3): 386–396. Ma, H.I. et al. 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Influence of Diabetes Knowledge, Self-Stigma, and Self-Care Behavior on Quality of Life in Patients with Diabetes [J]. Healthcare, 2022, 10(10):1983 Khezerloo, S. et al. A survey of relationship between perceived self-efficacy and self-care performance in diabetic patients referring to Urmia Diabetes Center [J]. Journal of Urmia Nursing & Midwifery Faculty (2228–6411), 2012, 10(3). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4549917","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":318294191,"identity":"0485c0ec-e894-4309-b2c8-e03e9f912681","order_by":0,"name":"Shilian Niu","email":"","orcid":"","institution":"Sichuan University, Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Shilian","middleName":"","lastName":"Niu","suffix":""},{"id":318294192,"identity":"b635ce85-1c26-46d4-90fe-55cf99e51e2c","order_by":1,"name":"Rao Li","email":"","orcid":"","institution":"Sichuan University, Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Rao","middleName":"","lastName":"Li","suffix":""},{"id":318294193,"identity":"44dd4fb7-c3a4-41e9-b001-39b4a8d5aede","order_by":2,"name":"Li Yuan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAy0lEQVRIiWNgGAWjYBACNoaDjQ8+/KiRk5c/fIA4LXyMhw8bzuw5Zmw4gy2BOC1yzMfSpHnYmBMbbvAYEOkwtjNm0jw8bIyNs3s+3njDYCen20BIC88ZY8s5FjLM7DJnN1vOYUg2NjtASIvEGcMbb3jY2BgbcrdJ8zAcSNxGUIv8GwMJoF+AinOeEamF4ViSJFCLBMONHDZitUAC2cAQGNCWcwyI8It8AyQq6+ezNz+88abCTo6gFhQgQWzUIGshVccoGAWjYBSMCAAAwAdC0gSjBSwAAAAASUVORK5CYII=","orcid":"","institution":"Sichuan University, Sichuan University","correspondingAuthor":true,"prefix":"","firstName":"Li","middleName":"","lastName":"Yuan","suffix":""},{"id":318294194,"identity":"5862a274-3c5c-4884-9cbe-7509dc74c512","order_by":3,"name":"Dan Huang","email":"","orcid":"","institution":"Sichuan University, Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Dan","middleName":"","lastName":"Huang","suffix":""}],"badges":[],"createdAt":"2024-06-08 09:31:42","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4549917/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4549917/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":71089661,"identity":"9094c07d-b036-4850-9c5b-62bf25e2c9cd","added_by":"auto","created_at":"2024-12-11 04:31:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":709766,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4549917/v1/97a9ce0a-df1f-4d2a-8d8e-a3c2481479d4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Associations between self-stigma and health promotion behaviors in overweight/obese patients with type 2 diabetes: a cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eStigma has multiple negative impacts on an individual's dignity, health, self-care, and well-being\u003csup\u003e\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. International organizations have called on drawing more attention to stigma,aiming to address stigma in disease management and make it a research priority.Stigma is primarily caused by blame, fear, and disgust resulting from negative stereotypes and misinformation\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e.It is estimated that by 2040, the number of obese adults will increase by sixfold and the prevalence of diabetes will increase to 642 million\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e.Due to the rapid urbanization and the change of life style, the rate of overweight/obesity and diabetes may continual to increasing. This group is prone to have feelings of shame and low self-esteem due to overweight, changes in appearance, or recognition of their diseases\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. With the awareness and publicity of diabetes and overweight/obesity through traditional concepts and new social media, this group has been labeled as gluttonous, lazy, and irresponsible. Patients are prone to feel stigma and even aggravate this psychological burden\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Studies have shown that patients experiencing stigma are more prone to engage in unhealthy behaviors such as overeating and eating to reduce stress, higher levels of diabetes distress\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e, poorer self-management on diabetes, and fewer clinical visits, leading to under-diagnosis and under-treatment of the disease\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Diabetes self-care strategies emphasize a series of complex and demanding disease management activities such as the adjustment of diet, exercise, adherence of medication regimens and self-monitor on blood glucose. Patients commonly experience emotional distress and reduced quality of life when managing their disease.Health-promoting behaviors have been recognized as important strategies for maintaining and improving the quality of life for people with chronic disabilities, focusing on the individual ability to remain proactive in all aspects of life\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e.Health-promoting behaviors help alleviate and reduce the risk of microvascular and macrovascular complications in individuals with high BMI and diabetes, and improve the individual's positive psychological level, so as to improve the quality of life\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e.Previous research has found that experiencing stigma can negatively impact patients' health behaviors, such as affecting the emotional state of people with diabetes. However, there is a lack of relevant research on whether stigma has an impact on health-promoting behaviors in overweight/obese patients with T2DM\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.Therefore, we specifically assessed the association between health-promotion behaviors and experienced stigma in overweight/obese patients with T2DM.To facilitate healthcare professionals in developing interventions aimed at reducing stigma and improving overall health promotion levels among overweight/obese patients with T2DM.Thus, this study investigated the association between stigma and diabetes health promotion behaviors among overweight/obese patients with T2DM in a tertiary general hospital in Sichuan Province, China.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis study employed a cross-sectional questionnaire-based approach, utilizing convenience sampling to examine overweight/obese individuals with T2DM. Participants were recruited from both the inpatient and outpatient departments specializing in endocrinology and metabolism at a tertiary general hospital located in Sichuan Province, China. Inclusion criteria include: (a) age\u0026thinsp;\u0026ge;\u0026thinsp;18 years; (b) fulfillment of the 1999 WHO diagnostic criteria for diabetes mellitus; (c)BMI\u0026thinsp;\u0026ge;\u0026thinsp;25kg/m\u003csup\u003e2\u003c/sup\u003e ;(d) patients agreed to sign an informed consent form. The study excluded patients with severe mental disorders, cognitive impairment, absolute bedridden, and disturbance of consciousness.Conducted from July 2022 to July 2023, this study involved rigorous preparation and adhered to methodological standards. Before commencement of the survey, investigators underwent professional training to familiarize themselves with the study's objectives and questionnaire collection methods. Notably, all investigators were qualified medical personnel. All subjects voluntarily accepted the questionnaire and signed the informed consent after understanding the purpose and significance of the study. In instances where patients encountered difficulty completing the questionnaire independently, investigators assisted using neutral language and recorded responses accurately. Missing data were promptly addressed through communication with patients. Given the inclusion of 25 variables in the questionnaire, a sample size of at least 138 was deemed necessary, following Kendall's rough estimation method, which suggested a sample size of 5\u0026ndash;10 times the number of variables. Consequently, 200 questionnaires were distributed, resulting in a valid return rate of 98.5%, with 197 questionnaires being considered valid for analysis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eInstruments\u003c/h2\u003e \u003cp\u003eGeneral demographic characteristics obtained included gender, age, education, marital status, occupation, per capita monthly household income, and patient origin. Clinical information of the participants was also collected, such as Body Mass Index (BMI), time since diagnosis (in years), treatment modalities, diabetes-related symptoms, diabetes-related complications, comorbidities of chronic diseases, abdominal obesity, glycated hemoglobin (HbA1c) levels, and the use of GLP-1RA therapy. BMI was calculated as the ratio of body weight in kilograms to squared body height in meters (kg/m\u003csup\u003e2\u003c/sup\u003e).Participants were categorized as overweight (BMI, 25.0\u0026ndash;29.9 kg\u0026middot;m\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e), or obese (BMI\u0026thinsp;\u0026ge;\u0026thinsp;30.0 kg\u0026middot;m\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e), according to the criteria of the WHO International BMI Classification of adults\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e.The number of diabetes-related complications was calculated as a simple composite of six complications, referencing the Diabetes Complications Index (DCI), with scores ranging from 0 to 6\u003csup\u003e15\u003c/sup\u003e. The number of comorbidities of chronic diseases was calculated by a simple composite of comorbidity types outlined in the International Classification of Diseases (ICD-10) overview\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e.Abdominal obesity was determined by waist perimeter (WC), WC was measured midway between the bottom of the twelfth rib and the anterior superior iliac spines while the subject was standing. Abdominal obesity was defined as having waist circumference\u0026thinsp;\u0026gt;\u0026thinsp;90cm in men and \u0026gt;\u0026thinsp;85cm in women\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e.HbA1c levels were based on the most recent laboratory test results within the past three months for each patient.\u003c/p\u003e \u003cp\u003eThe Stigma Scale for Chronic Illness (SSCI) was used to assess the level of stigma. The Chinese version of the SSCI scale comprised 24 assessment items allowing for five responses on a Likert scale\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e: never, rarely, sometimes, often, and always, with scores of 0, 1, 2, 3, and 5 respectively. The total possible scores ranged from 24 to 120, and the scores were considered continuous. The higher the scores, the higher the levels of self-stigmatisation. In this study, the internal consistency of the scale was 0.948.\u003c/p\u003e \u003cp\u003eThe T2DHPS scale was developed by Chen et al in 2013 to assess health promotion behaviors in patients with T2DM. Cao et al assessed the reliability and validity of the scale and confirmed its applicability to the Chinese population\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e.The T2DHPS comprised 28 items covering six dimensions: physical activity (7 items), risk reduction (7 items), stress management (5 items), enjoy life (3 items), health responsibilities (3 items), and healthy eating (3 items). The scale used a 5-point Likert scale (never\u0026thinsp;=\u0026thinsp;1, occasionally\u0026thinsp;=\u0026thinsp;2, about half the time\u0026thinsp;=\u0026thinsp;3, often\u0026thinsp;=\u0026thinsp;4, and always\u0026thinsp;=\u0026thinsp;5) with a total score between 28 and 140. Higher scores indicated greater health promotion for people with diabetes. In this study, the T2DHPS showed high reliability and validity with a Cronbach's alpha of 0.905.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eEthics\u003c/h2\u003e \u003cp\u003e This study has been approved by the Biomedical Ethics Committee of West China Hospital of Sichuan University (Batch Number: 2022 Review [1500]).Informed consent was obtained from all the participants. All surveys were anonymous, and each participant completed the same set of questionnaires. This study was based on the tenets of the Declaration of Helsinki.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eAnalysis\u003c/h2\u003e \u003cp\u003eSPSS version 27.0 was used for statistical analyses. Categorical variables were described by frequencies and percentages, and continuous variables were described by means and standard deviations. T-tests and ANOVA were employed to assess variations in stigma across socio-demographic variables. Pearson correlation analysis was utilized to examine the association between stigma and health promotion behaviors among overweight/obese diabetic patients. Multiple linear regression analysis was used to explore the predictors of stigma. P-values of less than 0.05 were considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e200 overweight/obese people diagnosed with T2DM, both outpatients and inpatients, were invited to participated in this study. Written informed consent was obtained from all. However, three responses were considered incomplete or inconclusive and were excluded. The analysis was based on data from 197 valid responses.\u003c/p\u003e\n\u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e shows the demographic characteristics of the study subjects and the univariate analysis of stigma with different characteristics. Among the 197 overweight/obese patients with T2DM, 126 (64%) were males and 71 (36%) were females. The age of the patients range from 18 to 84, with an average age of 54.12\u0026thinsp;\u0026plusmn;\u0026thinsp;13.14 years. The average BMI of patients was 27.27\u0026thinsp;\u0026plusmn;\u0026thinsp;3.11, 133(67.5%) patients were overweight, 64(32.5%) patients were obese, and the average HbA1c was 8.36\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81 (mmol/mol). The average number of diabetes-related symptoms was 1.71\u0026thinsp;\u0026plusmn;\u0026thinsp;1.64, the average of diabetes-related complications was 0.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93, and the average of chronic disease comorbidities was 1.58\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15. The results of the T-test and ANOVA showed statistically significant differences between patients in terms of monthly household income, diabetes complications, hypoglycemia, patient origin, and GLP-1RA treatment (p\u0026thinsp;\u0026lt;\u0026thinsp;.05).LSD post-hoc test was conducted for more than three groups of items, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. The LSD post-hoc test results showed that there was a significant difference between the group with a monthly household income of \u0026gt;\u0026thinsp;10,000 RMB and the other groups.\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDistribution of stigma scores in overweight/obese patients with T2DM with different demographic characteristics (N\u0026thinsp;=\u0026thinsp;197, x\u0026thinsp;\u0026plusmn;\u0026thinsp;s)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCharacteristic\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u0026nbsp;(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStigma\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003et/F\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e126(64.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e53.25\u0026thinsp;\u0026plusmn;\u0026thinsp;7.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e71(36.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e55.85\u0026thinsp;\u0026plusmn;\u0026thinsp;9.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.627\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.199\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29(14.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e52.03\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u0026ndash;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e95(48.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e55.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e73(37.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e53.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.314\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.576\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOverweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e133(67.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e53.8\u0026thinsp;\u0026plusmn;\u0026thinsp;8.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eObese\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e64(32.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54.98\u0026thinsp;\u0026plusmn;\u0026thinsp;8.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.891\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e100(50.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54.11\u0026thinsp;\u0026plusmn;\u0026thinsp;8.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e91(46.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54.37\u0026thinsp;\u0026plusmn;\u0026thinsp;8.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6(3.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e52.67\u0026thinsp;\u0026plusmn;\u0026thinsp;8.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarriage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.356\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9(4.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e56.56\u0026thinsp;\u0026plusmn;\u0026thinsp;7.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e181(91.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e53.93\u0026thinsp;\u0026plusmn;\u0026thinsp;8.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDivorced or widowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7(3.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e57.86\u0026thinsp;\u0026plusmn;\u0026thinsp;12.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducational\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.402\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.243\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary school and below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32(16.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e55.19\u0026thinsp;\u0026plusmn;\u0026thinsp;8.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJunior High School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e43(22.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e56.05\u0026thinsp;\u0026plusmn;\u0026thinsp;10.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh School/College\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31(15.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54.16\u0026thinsp;\u0026plusmn;\u0026thinsp;10.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUndergraduate and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e91(45.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54.25\u0026thinsp;\u0026plusmn;\u0026thinsp;8.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eResidential Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.906\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLiving Alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17(8.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e56.35\u0026thinsp;\u0026plusmn;\u0026thinsp;9.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLiving with Spouse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e143(72.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54.57\u0026thinsp;\u0026plusmn;\u0026thinsp;9.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLiving with Children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28(14.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e50.79\u0026thinsp;\u0026plusmn;\u0026thinsp;4.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9(4.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54.67\u0026thinsp;\u0026plusmn;\u0026thinsp;8.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePer capita monthly household income (RMB)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;2000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9(4.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60.33\u0026thinsp;\u0026plusmn;\u0026thinsp;13.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2000\u0026ndash;4999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36(18.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e56.14\u0026thinsp;\u0026plusmn;\u0026thinsp;10.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5000\u0026ndash;10000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e66(33.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54.36\u0026thinsp;\u0026plusmn;\u0026thinsp;8.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;10000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e86(43.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e52.59\u0026thinsp;\u0026plusmn;\u0026thinsp;6.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDuration of diabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.758\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.175\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e99(50.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e53.05\u0026thinsp;\u0026plusmn;\u0026thinsp;7.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u0026ndash;10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33(16.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e55.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e65(33.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e55.15\u0026thinsp;\u0026plusmn;\u0026thinsp;9.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiabetes Related Symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.893\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e131(66.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54.69\u0026thinsp;\u0026plusmn;\u0026thinsp;8.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e66(33.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e53.18\u0026thinsp;\u0026plusmn;\u0026thinsp;8.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eComplications of diabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.261\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e69(35.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e56.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e128(65.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e53.16\u0026thinsp;\u0026plusmn;\u0026thinsp;7.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eComorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.258\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.263\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e159(80.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54.44\u0026thinsp;\u0026plusmn;\u0026thinsp;7.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38(19.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e53.13\u0026thinsp;\u0026plusmn;\u0026thinsp;9.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAbdominal obesity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.902\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e178(9.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54.26\u0026thinsp;\u0026plusmn;\u0026thinsp;8.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19(90.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e53.53\u0026thinsp;\u0026plusmn;\u0026thinsp;8.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ehypoglycemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.746\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e44(22.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e58.11\u0026thinsp;\u0026plusmn;\u0026thinsp;11.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e153(77.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e53.06\u0026thinsp;\u0026plusmn;\u0026thinsp;7.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKetoacidosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.803\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10(5.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54.80\u0026thinsp;\u0026plusmn;\u0026thinsp;10.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e187(94.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54.05\u0026thinsp;\u0026plusmn;\u0026thinsp;8.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatient origin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOutpatient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e117(59.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e52.5\u0026thinsp;\u0026plusmn;\u0026thinsp;7.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInpatient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e80(40.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e56.65\u0026thinsp;\u0026plusmn;\u0026thinsp;10.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.323\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.809\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLifestyle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24(12.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e53.04\u0026thinsp;\u0026plusmn;\u0026thinsp;6.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOral hypoglycemic agents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e76(38.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54.07\u0026thinsp;\u0026plusmn;\u0026thinsp;9.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInsulin injections\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23(11.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e55.52\u0026thinsp;\u0026plusmn;\u0026thinsp;8.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInsulin injections and oral hypoglycemic agents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e74(37.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54.27\u0026thinsp;\u0026plusmn;\u0026thinsp;8.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGLP-1RA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.842\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21(10.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e58.62\u0026thinsp;\u0026plusmn;\u0026thinsp;11.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e176(89.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e53.66\u0026thinsp;\u0026plusmn;\u0026thinsp;8.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eThe overall stigma score of overweight/obese T2DM patients was 4.19\u0026thinsp;\u0026plusmn;\u0026thinsp;8.69, the overall health-promoting behaviors score was 87.75\u0026thinsp;\u0026plusmn;\u0026thinsp;16.75. See Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e for details.\u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCurrent status of SSCI and T2DHPS in overweight/obese patients with T2DM [n\u0026thinsp;=\u0026thinsp;197, x\u0026thinsp;\u0026plusmn;\u0026thinsp;s, ]\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAverage score\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal score of dimensions\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAverage score of each item\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSSCI Total Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54.19\u0026thinsp;\u0026plusmn;\u0026thinsp;8.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf-stigma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30.59\u0026thinsp;\u0026plusmn;\u0026thinsp;6.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEnacted stigma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23.60\u0026thinsp;\u0026plusmn;\u0026thinsp;3.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT2DHPS Total Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e87.75\u0026thinsp;\u0026plusmn;\u0026thinsp;16.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePhysical activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.35\u0026thinsp;\u0026plusmn;\u0026thinsp;7.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.62\u0026thinsp;\u0026plusmn;\u0026thinsp;1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRisk reduction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.88\u0026thinsp;\u0026plusmn;\u0026thinsp;5.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStress management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.68\u0026thinsp;\u0026plusmn;\u0026thinsp;3.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEnjoy life\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.82\u0026thinsp;\u0026plusmn;\u0026thinsp;2.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHealth responsibility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.48\u0026thinsp;\u0026plusmn;\u0026thinsp;2.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHealthy diet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.80\u0026thinsp;\u0026plusmn;\u0026thinsp;2.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e presents the results of an analysis examining the correlation between stigma and health-promoting behaviors. Pearson correlation analysis revealed a significant correlation between stigma and the overall score of health promotion behaviors (r = -0.144, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, only two dimensions, namely stress management (r = -0.312, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and enjoy life (r = -0.254, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), exhibited a significant negative correlation with self-stigma.\u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCorrelation between stigma and health-promoting behaviors in overweight/obese patients with T2DM\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSSCI Total Score\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSelf-stigma\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEnacted stigma\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eT2DHPS Total Score\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePhysical activity\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRisk reduction\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStress management\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEnjoylife\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHealth responsibility\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHealthy diet\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSSCI Total Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf-stigma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.955**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEnacted stigma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.856**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.665**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT2DHPS Total Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.144*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.192**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePhysical Activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.822**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRisk Reduction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.797**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.549**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStress Management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.312**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.277**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.305**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.649**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.337**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.440**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEnjoy life\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.254**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.224**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;\u0026thinsp;.249**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.645**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.344**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.482**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.919**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHealth responsibility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.555**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.272**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.400**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.274**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.301**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHealthy diet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.560**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.290**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.314**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.314**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.325**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.370**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003cp\u003e*: P\u0026lt;0.05, **༚P\u0026lt;0.01\u003c/p\u003e\n \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\n \u003cp\u003eIn the multiple regression analyses, a stepwise approach was used to select the independent variables. Statistically significant socio-demographic data were then modeled, including monthly household income, hypoglycemia incidence, patient origin, GLP-1RA use, diabetes complications, and stress management. Regression analyses were performed on dummy variables for each group. The results of the analyses showed that complications, hypoglycemia, patient origin, GLP-1RA use, and stress management were the main predictors of stigma in overweight/obese T2DM patients. ( F\u0026thinsp;=\u0026thinsp;7.162, p\u0026thinsp;\u0026lt;\u0026thinsp;.001, R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.278, R\u003csup\u003e2\u003c/sup\u003e\u003csub\u003ead\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;0.239)( Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\n \u003cp\u003eThe results of the multiple linear regression analysis showed that the presence of complications, hypoglycemia incidence, Patient origin, GLP-1RA use, and stress management explained 23.9% of the patients\u0026apos; feelings of stigma. Stigma was higher in those with complications, susceptibility to hypoglycemia, inpatients, use of GLP-1RA, and weak stress management.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMultiple stratified linear regression analysis of stigma in overweight/obese patients with T2DM\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026beta;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePer capita monthly household income (RMB)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.636\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.966\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.505\u0026thinsp;~\u0026thinsp;0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypoglycaemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.327\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.354\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.457\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.655\u0026thinsp;~\u0026thinsp;5.999\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatient origin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.834\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.217\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.542\u0026thinsp;~\u0026thinsp;6.125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGLP-1RA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.804\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.335\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.654\u0026thinsp;~\u0026thinsp;7.773\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRetinopathy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.725\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.864\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.462\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.953\u0026thinsp;~\u0026thinsp;6.403\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNephropathy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.576\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.669\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.504\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.056\u0026thinsp;~\u0026thinsp;4.164\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eneuropathy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.735\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.575\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.736\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.084\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.373\u0026thinsp;~\u0026thinsp;5.842\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT2DHPS Total Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.959\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.085\u0026thinsp;~\u0026thinsp;0.089\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStress management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.419\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.567\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.954~-0.256\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEnjoy life\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.873\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.622\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.403\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.355\u0026thinsp;~\u0026thinsp;2.101\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003e\u003cstrong\u003eF\u0026thinsp;=\u0026thinsp;7.162, p\u0026thinsp;\u0026lt;\u0026thinsp;.001, R\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/sup\u003e\u0026thinsp;\u003cstrong\u003e=\u0026thinsp;0.278\u003c/strong\u003e, R\u003csup\u003e2\u003c/sup\u003e\u003csub\u003ead\u003c/sub\u003e\u0026thinsp;\u003cstrong\u003e=\u0026thinsp;0.239\u003c/strong\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to examine the association between stigma and health promotion behaviors among overweight/obese T2DM patients in China. In this study, the overall patient morbidity stigma was 54.19\u0026thinsp;\u0026plusmn;\u0026thinsp;8.69, which was higher than in a study by Li in Chinese T2DM patients with normal BMI\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e.The distinctive feature of this study group lies in the fact that the overweight/obese cohort frequently encounters socially imposed negative perceptions, such as those related to body size, rendering them susceptible to external discrimination, thereby eliciting negative emotions\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe average score for health promotion behaviors (87.75\u0026thinsp;\u0026plusmn;\u0026thinsp;16.75) exceeded those reported by Wang in a study conducted in China, potentially due to differences in age distribution among the study cohorts\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Additionally, the research revealed a correlation between stigma and reduced engagement in health promotion behaviors among patients, particularly evident in decreased stress management and enjoy life. In conclusion, these preliminary findings suggested the necessity for further research to elucidate the mechanisms by which stigma influences health behaviors within this population.This study found that patients with complications, a history of hypoglycemia, hospitalization, use of GLP-1RA therapy, and poorer stress management skills face more pronounced stigma. Particularly among overweight/obese T2DM patients, those with complications experience significantly higher levels of stigma, consistent with previous research\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. However, the mechanisms through which complications influence stigma remain unclear. It is plausible that changes in body image resulting from complications may the self-identity and social interactions of patients, exacerbating their experiences of stigma. Similarly, patients with a history of hypoglycemia also exhibit heightened stigma, aligning with prior research suggesting that fear of hypoglycemia exacerbates stigma as patients avoid public situations to prevent hypoglycemic episodes and gradually withdraw from social relationships\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe finding that inpatients had higher levels of stigma than outpatients supports some previous studies that patients with T2DM may be at greater risk of stigmatization by healthcare providers and may face greater and potentially exponentially increased health risks as a result of prejudicial attitudes and negative stereotypes lifestyles about weight and diabetes\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e.The finding that inpatients experience higher levels of shame than outpatients supports previous research suggesting that patients may face greater stigma from healthcare providers due to discriminatory attitudes and negative stereotypes surrounding weight and diabetes management. This heightened sense of stigma could lead to increasing health risks for patients, which could even be exponential.The finding that patients treated with GLP-1RA were more likely to experience stigma was unexpected. Other previous studies have suggested a role for treatment in increasing stigma. The patients in this study who used GLP-1 RA medication may have seen their use of the medication as a \u0026apos;failure\u0026apos; in their ability to achieve weight control through their behavior and lifestyle. This societal bias may have led to negative feelings about themselves and increased stigma. Patients with poor stress management skills have higher levels of stigma. Previous studies have shown that most people with diabetes report higher levels of perceived stress, anxiety, and fatigue than people in the general population\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. Stigma can diminish patients\u0026apos; ability to cope with stress\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.Stress management interventions in HIV populations have effectively reduced stigma\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. However, the intervention studies targeting diabetes patients still be lacked at present.\u003c/p\u003e\n\u003cp\u003eOur study revealed a significant negative correlation between two dimensions of diabetes health promotion behaviors\u0026mdash;stress management and enjoy life\u0026mdash;and stigma. This finding aligns with previous research on perceived stress among diabetic populations. It may be attributed to the significant increase in the risk of complications associated with chronic disease, coupled with the burden of healthcare expenditure, treatment, societal judgment, and self-blame, all of which can profoundly impact the emotional well-being of patients\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e.Hence, there is a critical need to develop individualized psychosocial support programs aimed at fostering positive changes in stress management skills and stigma reduce. Physical activity, risk reduction, health responsibility, and healthy eating were not clearly shown to correlate with stigma in this study. However, Puhl\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e、Cho\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e、Khezerloo\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e et al showed that diabetes stigma was associated with poorer diabetes self-management .This may be because diabetes requires long-term management in terms of diet, exercise, medication, and blood glucose monitoring, and patients consider these behaviors as part of their lives, so physical activity, risk reduction, health responsibility, and healthy eating scored higher. Therefore, this study suggests that healthcare professionals should pay more attention to patient\u0026apos;s psychological state, guide patients to effectively buffer the negative impact of stressful life events, promote a positive psychological state, reduce patients\u0026apos; sense of stigma and improve their quality of life, in order to improve patients\u0026apos; stress resilience. However, the sources of participants\u0026apos; perceived stress, which may influence stigma, were not explored in detail in this study. To confirm these findings, further intervention studies are needed. New studies to clarify these effects are recommended in the future..\u003c/p\u003e\n\u003cp\u003eThis study has several limitations that warrant acknowledgment. Firstly, its cross-sectional design implies the necessity for follow-up investigations with larger sample sizes to validate the impact of stigma on health-promoting behaviors, such as dietary habits and exercise, among overweight/obese diabetic patients. Secondly, the recruitment of all participants from the specialized inpatient/outpatient department of a general hospital underscores the need for broader representation and expansion in both the size and source of the study population. Moreover, the stigma measurement tool utilized in this study did not rigorously distinguish weight stigma from diabetes stigma, limiting its capacity to accurately discern whether patients\u0026apos; perceived stigma stemmed from weight-related issues or their diabetes diagnosis.\u003c/p\u003e\n\u003cp\u003eNotwithstanding these limitations, several key implications can be drawn from thstudy. To enhance health behaviors and treatment effectiveness among overweight/obese T2DM patients, healthcare providers should prioritize assessing stigma levels and stress management. It is crucial to develop tailored intervention strategies to mitigate stigma and enhance health-promoting behaviors. By addressing these factors, healthcare professionals can foster improved physical and psychological well-being in this group.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eContributors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eShilian Niu and Rao Li contributed equally and are co-first authors. Shilian Niu, Rao Li, and Dan Huang designed the study. Shilian Niu and Dan Huang collected the data. Rao Li and Dan Huang were involved in data cleaning. Shilian Niu and Dan Huang analyzed the data. Shilian Niu drafted the manuscript. Li Yuan and Rao Li contributed to the interpretation of the results and critical revision of the manuscript for important intellectual content and approved the final version of the manuscript. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Key R\u0026amp;D Project of Sichuan Science and Technology Department (2022YFS0271).\u003c/p\u003e\n\u003ch2\u003eConflict of interest\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eNo potential conflicts of interest were reported by the author(s).\u003c/p\u003e\n\u003ch2\u003eData availability statement\u003c/h2\u003e\n\u003cp\u003eData are available upon reasonable request.\u0026nbsp;The data supporting our findings are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003ch2\u003eEthics statements\u003c/h2\u003e\n\u003ch3\u003ePatient consent for publication\u003c/h3\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eAcknowledgments\u003c/h2\u003e\n\u003ch3\u003eThanks to all the participants and researchers involved in this study.\u003c/h3\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJacoby, A. et al. Epilepsy and social identity: the stigma of a chronic neurological disorder [J]. Lancet Neurology, 2005, 4(3): 171\u0026ndash;178.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKisala, P.A. et al. Measuring stigma after spinal cord injury: Development and psychometric characteristics of the SCI-QOL Stigma item bank and short form [J]. Journal of Spinal Cord Medicine, 2015, 38(3): 386\u0026ndash;396.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMa, H.I. et al. Stigma as a key determinant of health-related quality of life in Parkinson's disease [J]. Quality of Life Research, 2016, 25(12): 3037\u0026ndash;3045.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpeight, J.et al. Bringing an end to diabetes stigma and discrimination: an international consensus statement on evidence and recommendations [J]. Lancet Diabetes \u0026amp; Endocrinology, 2024, 12(1): 61\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMagliano, D.J. et al. Trends in incidence of total or type 2 diabetes: systematic review [J]. Bmj-British Medical Journal, 2019, 366.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbdoli, S. et al. A discussion paper on stigmatizing features of diabetes [J]. Nursing Open, 2018, 5(2): 113\u0026ndash;119.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHunt, D. et al. A WHO key informant language survey of people with lived experiences of diabetes: Media misconceptions, values-based messaging, stigma, framings and communications considerations [J]. Diabetes Research and Clinical Practice, 2022, 193:110109\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePuhl, R.M. et al. Weight Stigma and Diabetes Stigma: Implications for Weight-Related Health Behaviors in Adults With Type 2 Diabetes [J]. Clinical diabetes: a publication of the American Diabetes Association, 2022, 40(1): 51\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePuhl, R.M. et al. Weight stigma and diabetes stigma in US adults with type 2 diabetes: Associations with diabetes self-care behaviors and perceptions of health care [J]. Diabetes Research and Clinical Practice, 2020, 168:108387\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMendoza-nunez,V.M. et al.Implementation of an active aging model in Mexico for prevention and control of chronic diseases in the elderly [J]. BMC geriatrics, 2009, 9: 1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhao, F.F. et al. The association of diabetes-related self-care activities with perceived stress, anxiety, and fatigue: a cross-sectional study [J]. Patient Preference and Adherence, 2018, 12: 1677\u0026ndash;1686.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNie, R. et al. 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The associations between social support, self-regulatory fatigue, and health-promoting behaviors among people with type 2 diabetes mellitus: a cross-sectional survey [J]. Frontiers in public health, 2023, 11: 1281065.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKato, A. et al. Association between self-stigma and self-care behaviors in patients with type 2 diabetes: a cross-sectional study [J]. Bmj Open Diabetes Research \u0026amp; Care, 2016, 4(1).e000156.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGudzune, K.A. et al. Perceived judgment about weight can negatively influence weight loss: A cross-sectional study of overweight and obese patients [J]. Preventive Medicine, 2014, 62: 103\u0026ndash;107.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrigsby, A.B. et al. Prevalence of anxiety in adults with diabetes - A systematic review [J]. 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Prevalence and determinants of depressive and anxiety symptoms in adults with type 2 diabetes in China: a cross-sectional study [J]. Bmj Open, 2016, 6(8).e012540\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilliams, R. et al. Global and regional estimates and projections of diabetes-related health expenditure: Results from the International Diabetes Federation Diabetes Atlas, 9th edition [J]. Diabetes Research and Clinical Practice, 2020, 162:108072\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSelvarajah, D. et al. The contributors of emotional distress in painful diabetic neuropathy [J]. Diabetes \u0026amp; Vascular Disease Research, 2014, 11(4): 218\u0026ndash;225.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCho, S.E. et al. Influence of Diabetes Knowledge, Self-Stigma, and Self-Care Behavior on Quality of Life in Patients with Diabetes [J]. Healthcare, 2022, 10(10):1983\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhezerloo, S. et al. A survey of relationship between perceived self-efficacy and self-care performance in diabetic patients referring to Urmia Diabetes Center [J]. Journal of Urmia Nursing \u0026amp; Midwifery Faculty (2228\u0026ndash;6411), 2012, 10(3).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4549917/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4549917/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe correlation between stigma and health-promoting behaviors in overweight/obese type 2 diabetes (T2DM) patients is unclear. Therefore, this study aimed to investigate the association between the two in this particular population. Data were collected from an offline cross-sectional survey of 200 overweight/obese patients with T2DM aged 18-84 who were admitted to the Department of a tertiary general hospital in Chengdu, Sichuan Province, China between July 2022 and July 2023. Respondents were assessed for Stigma and health promoting behaviors using the SSCI and T2DHPS scales. Additionally, to examine the factors that influenced stigma, we utilized multiple linear regression analysis. Results revealed that stigma was significantly associated with health-promoting behaviors, with negative correlations with stress management and enjoyment of life. Several factors were found to increase the chronic disease stigma, including low monthly income, hypoglycemia, inpatient, and GLP-1RA treatment.\u003c/p\u003e","manuscriptTitle":"Associations between self-stigma and health promotion behaviors in overweight/obese patients with type 2 diabetes: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-27 15:49:03","doi":"10.21203/rs.3.rs-4549917/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1129de94-8ab3-45e7-94e6-da9b1a244ba4","owner":[],"postedDate":"June 27th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":33653302,"name":"Health sciences/Endocrinology/Endocrine system and metabolic diseases"},{"id":33653303,"name":"Health sciences/Endocrinology"},{"id":33653304,"name":"Health sciences/Health care"}],"tags":[],"updatedAt":"2024-12-11T04:23:38+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-27 15:49:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4549917","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4549917","identity":"rs-4549917","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}