Structural Equation Modeling Analysis of Factors Influencing Glycemic Control in Type 2 Diabetes Patients
Keywords:
Diabetes mellitus, HbA1c, SEMAbstract
Introduction: Type 2 diabetes mellitus is a major public health problem in Thailand. Glycemic control among patients with diabetes remains a challenge because it is influenced by multiple interrelated factors across various dimensions. Therefore, structural equation modeling was applied to systematically explain the causal influences of these factors.
Objective: To develop and test the goodness-of-fit of a structural equation model of factors influencing glycated hemoglobin (HbA1c) levels among patients with type 2 diabetes mellitus.
Methods: This quantitative study employed a causal relationship analysis using structural equation modeling. The sample consisted of 300 patients with type 2 diabetes mellitus, selected through a systematic random sampling method. The research instruments were questionnaires assessing diabetes knowledge, health beliefs, self-efficacy, social support, medication adherence, and self-care behaviors, with reliability coefficients of 0.82, 0.89, 0.94, 0.91, 0.83, and 0.87, respectively. Data were collected between August and September 2025. Data analysis included descriptive and inferential statistics, namely Pearson’s correlation coefficient, confirmatory factor analysis (CFA), and structural equation modeling (SEM).
Results: The SEM demonstrated a good fit with the empirical data (c2/df = 2.76, CFI = 0.956, TLI = 0.951, RMSEA = 0.052, SRMR = 0.045). The model explained 72% of the variance in HbA1c levels (R² = 0.72). Direct effects on HbA1c levels were found for self-care behaviors (β = −0.42, p-value < .001) and medication adherence (β = −0.25, p-value < .001). Indirect effects were observed for self-efficacy (β = −0.14, p-value < .001), health beliefs (β = −0.09, p-value < .01), diabetes knowledge (β = −0.08, p-value < .01), and social support (β = −0.07, p-value < .01), all of which significantly influenced HbA1c levels through self-care behaviors.
Conclusion: Self-care behaviors and medication adherence had direct effects on changes in glycated hemoglobin levels. Self-efficacy, health beliefs, diabetes knowledge, and social support exerted indirect effects on changes in glycated hemoglobin levels through self-care behaviors.
Implication: Healthcare professionals should develop strategies to promote self-care behaviors for glycemic control by systematically and continuously integrating multiple causal factors into the design of care activities for patients with type 2 diabetes mellitus.
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