Can self-rated health be useful to primary care physicians as a diagnostic indicator of metabolic dysregulations amongst patients with type 2 diabetes? A population-based study.

Abstract

Background: Although most of the management of type 2 diabetes (T2DM) occurs in primary care, and physicians are tasked with using a 'whole person' approach, there is currently a lack of research on psychosocial diagnostic indicators for detecting metabolic abnormalities in T2DM patients. This study examined relations between SRH and metabolic abnormalities in patients with type 2 diabetes, adjusting for metabolic comorbidity.

Method: A total of 583 adults with type 2 diabetes were identified from the 2019 HSE (Health Survey for England). Data on metabolic syndrome (MetS) was extracted, including lipids (high density lipoprotein cholesterol (HDL-C)), glycated haemoglobin (HbA1c), blood pressure (systolic/diastolic), and anthropometric measures (BMI, waist/hip ratio). Bootstrapped hierarchical regression and structural equation modelling (SEM) were used to analyse the data.

Results: Adjusting for metabolic covariates attenuated significant associations between SRH and metabolic abnormalities (HDL-C, HbA1c), regardless of MetS status. Analysis by gender uncovered covariate-adjusted associations between SRH and both HDL-C (in men) and HbA1c (in women) (p's = 0.01), albeit these associations were no longer significant when evaluated against a Bonferroni-adjusted alpha value (p > 0.004). Sensitivity analysis indicated most findings were unaffected by the type of algorithm used to manage missing data. SEM revealed no indirect associations between SRH, metabolic abnormalities, and lifestyle factors.

Conclusions: While poor SRH can help primary care physicians identify T2DM patients with metabolic dysfunction, it may not offer added diagnostic usefulness over clinical biomarkers.