Exploring Multidimensional Diabetes Self-Management and Health-Related Functioning in Relation to Vascular Complications

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Background/Objectives: Diabetes mellitus is associated with complex behavioral, psychosocial, and functional challenges that may influence disease burden and complication profiles. This study aimed to identify latent dimensions of diabetes self-management and health-related functioning and to evaluate their association with the type of diabetes-related complications. Methods: A cross-sectional study was conducted in 300 patients with type 2 diabetes, classified into microvascular and macrovascular complication groups. A questionnaire comprising DSMQ (diabetes self-management questionnaire) derived items, SF-36-derived items, and other questions was administered to all participants. Exploratory factor analysis was performed to identify latent dimensions related to self-management, emotional burden, dietary behavior, glycemic control challenges, glucose monitoring, and functional status. Composite scores were calculated for factors with acceptable internal consistency. Between-group comparisons, Spearman correlation analysis, and binary logistic regression models adjusted for age, sex, residence area, marital status, education, diabetes duration, and treatment type were applied. Results: Six latent factors were identified: Emotional Burden, Dietary Self-Management, Functional Limitations, Glycemic Control Challenges, Glucose Monitoring, and General Health Perception. However, only the factors demonstrating acceptable internal consistency were retained for subsequent analyses: Emotional Burden, Functional Limitations, and Glycemic Control Challenges. Functional Limitations showed the strongest association with complication type, with patients with macrovascular complications reporting greater functional impairment. After adjustment for potential confounders and correction for multiple comparisons, higher adherence to the recommended meal plan (DSMQ2) and greater functional limitations remained the principal differences between the complication groups. Functional Limitations Score remained independently associated with complication type in both unadjusted and adjusted logistic regression models. Conclusions: These cross-sectional findings support the integration of functional, psychosocial, and behavioral assessment into comprehensive diabetes care and highlight differences in patient-reported outcomes across complication groups.

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