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Du QH, Zhang ZC, Yang Y, Luo XX, Liu L, Jia HH. How health seeking behavior develops in patients with type 2 diabetes: a qualitative study based on health belief model in China. Front Public Health 2024; 12:1414903. [PMID: 39045167 PMCID: PMC11263333 DOI: 10.3389/fpubh.2024.1414903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/28/2024] [Indexed: 07/25/2024] Open
Abstract
Background Type 2 diabetes(T2DM) is a global health problem which is accompanied with multi-systemic complications, and associated with long-term health burden and economic burden. Effective health seeking behavior (HSB) refers to reasonably utilize health resources, effectively prevent and treat diseases, and maintain health. Effective health seeking behavior (HSB) is vital to mitigate the risk of T2DM complications. However, health seeking behavior for T2DM patients remains sub-optimal worldwide. Objective The study aimed to explore the internal logic of how health seeking behavior of T2DM patients develops and the influencing factors of health seeking behavior. With a view to provide a reference basis for improving the health seeking behavior situation of T2DM patients. Methods This study was conducted at an integrated tertiary hospital in China. People who were diagnosed with T2DM, capable of expressing clearly and had no mental illness, were approached based on a purposive sampling. The experience of T2DM and health seeking behavior were collected via in-depth interviews. A theory-driven thematic analysis based on Health Belief Model (HBM) was applied for data analysis. Inductive reasoning was used to identify emerging themes which were not included in HBM. Results 26 patients with T2DM were included in the current study. Seven themes were identified, including: (1) T2DM diagnosis and severity; (2) T2DM treatment and management; (3) Perceived susceptibility of diabetes progression; (4) Perceived severity of diabetes progression; (5) Perceived benefits of health seeking behavior; (6) Perceived barriers of health seeking behavior; (7) Perception of behavioral cues. Generally, patients with T2DM lacked reliable sources of information, considered T2DM to be slow-progressing and without posing an immediate threat to life. Consequently, they did not fully grasp the long-term risks associated with T2DM or the protective effects of health seeking behavior. Conclusion This study highlighted the challenges in health seeking behavior for patients with T2DM. It suggested that future interventions and strategies should involve multi-faceted approaches, targeting healthcare providers (HCPs), patients with T2DM, and their support networks. This comprehensive strategy can help patients better understand their condition and the importance of effective health seeking behavior. Ultimately, enhancing their capacity for adopting appropriate health-seeking practices.
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Affiliation(s)
- Qiu-hui Du
- Department of Nursing, Harbin Medical University (Daqing), Daqing, China
| | - Zi-chen Zhang
- Department of Nursing, Harbin Medical University (Daqing), Daqing, China
| | - You Yang
- Department of Ultrasound, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xiao-xi Luo
- Department of Nursing, Harbin Medical University (Daqing), Daqing, China
| | - Li Liu
- Department of Nursing, Harbin Medical University (Daqing), Daqing, China
| | - Hong-hong Jia
- Department of Nursing, Harbin Medical University (Daqing), Daqing, China
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Alsaidan AA, Thirunavukkarasu A, Alhassan HH, Bin Ahmed IA, Alnasiri AS, Alhirsan WM, Alazmi NNM, Alkhlaf AK, Alderbas JM, Alkhaldi MA. Evaluation of Self-Management Behaviors and Its Correlation with the Metabolic Syndrome among the Type 2 Diabetes Mellitus Patients of Northern Saudi Arabia. J Clin Med 2023; 13:118. [PMID: 38202125 PMCID: PMC10779580 DOI: 10.3390/jcm13010118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/16/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Self-management behavior among diabetes patients is essential to monitor blood sugar levels, make necessary lifestyle changes, and help patients reduce their risk of complications from diabetes. We assessed the prevalence of metabolic syndrome (MS) and its association with self-management behavior and sociodemographic characteristics among 310 patients with type 2 diabetes mellitus (T2DM) attending different diabetes care centers in northern Saudi Arabia. We evaluated the self-management behaviors of patients with T2DM using a validated Arabic version of the Summary of Diabetes Self-Care Activities Scale. Regarding MS, we applied the National Cholesterol Education Program (NCEP) Adult Treatment Plan-3 (ATP-3) guidelines. A logistic regression analysis was used to identify the predictors of MS. We found that more than one-third (36.5%) of patients had MS according to the NCEP ATP-3 criteria. The prevalence of MS was significantly associated with unsatisfactory self-management behaviors. Regarding sociodemographic predictors for MS, we found a significant association between gender (ref: female: Adjusted OR (AOR) = 1.89, 95%CI = 1.17-2.95, p = 0.007) and body mass index (ref.: normal range: AOR = 2.98, 95%CI = 1.31-5.07, p = 0.003). Our findings suggest a tailor-made multifaceted intervention to improve the self-management behaviors of T2DM patients, which, in turn, can reduce MS.
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Affiliation(s)
- Aseel Awad Alsaidan
- Department of Family and Community Medicine, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia;
| | - Ashokkumar Thirunavukkarasu
- Department of Family and Community Medicine, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia;
| | - Hassan H. Alhassan
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Jouf University, Sakaka 72388, Saudi Arabia;
| | - Ibrahim Abdullah Bin Ahmed
- Department of Family Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh 11432, Saudi Arabia;
| | - Anas Salem Alnasiri
- King Abdulaziz Specialist Hospital, Ministry of Health, Sakaka 72345, Saudi Arabia;
| | - Wejdan Madallah Alhirsan
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia; (W.M.A.); (N.N.M.A.); (A.K.A.); (M.A.A.)
| | - Nouf Nashmi M. Alazmi
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia; (W.M.A.); (N.N.M.A.); (A.K.A.); (M.A.A.)
| | - Abdalaziz Khaled Alkhlaf
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia; (W.M.A.); (N.N.M.A.); (A.K.A.); (M.A.A.)
| | - Jumanah Mohammed Alderbas
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia; (W.M.A.); (N.N.M.A.); (A.K.A.); (M.A.A.)
| | - Motaz Abdulsalam Alkhaldi
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia; (W.M.A.); (N.N.M.A.); (A.K.A.); (M.A.A.)
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Zhang Y, Zhang B, Chen C, Feng X, Song S, Wang H. The Mediation Effect of Attitude on the Association Between Knowledge and Self-Management Behaviors in Chinese Patients With Diabetes. Int J Public Health 2023; 68:1606022. [PMID: 37771845 PMCID: PMC10522835 DOI: 10.3389/ijph.2023.1606022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/03/2023] [Indexed: 09/30/2023] Open
Abstract
Objective: This study aims to investigate the level of knowledge, attitude and self-management behaviors of diabetic patients, to explore the mediating role of attitude in the relationship between knowledge and self-management behaviors. Methods: 900 diabetes patients were randomly selected from the eastern, central and western regions of Shandong Province, China, and recovered 863 valid questionnaires. Path analysis was used to examine the mediating role of attitude in the relationship between knowledge and self-management behaviors in patients with diabetes. Results: The mean score (SD) of the diabetes self-management questionnaire (DSMQ) in this study was 35.01 (6.87). The direct effect value of knowledge level on self-management behaviors was 0.357, accounting for 62.09% of the total effect. The indirect effect value of knowledge on self-management behaviors through attitude was 0.218, accounting for 37.91%. Conclusion: Level of knowledge has a significant direct impact on self-management behaviors and an indirect impact on self-management behaviors through attitude. Therefore, it is necessary to strengthen health education on diabetes to improve awareness, ameliorate attitudes toward diabetes, and change self-management behaviors.
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Affiliation(s)
- Yu Zhang
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Beibei Zhang
- Department of Clinical Laboratory, Shandong Mental Health Center, Shandong University, Jinan, Shandong, China
| | - Cunchuan Chen
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Xia Feng
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Suhang Song
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, United States
| | - Haipeng Wang
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, China
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Zhang A, Wang J, Wan X, Guo Z, Zhang Z, Zhao S, Bai S, Miao Y, Zhang J. The mediating effect of self-efficacy on the relationship between diabetes self-management ability and patient activation in older adults with type 2 diabetes. Geriatr Nurs 2023; 51:136-142. [PMID: 36940508 DOI: 10.1016/j.gerinurse.2023.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the level of diabetes self-management ability in older patients with type 2 diabetes and analyse its relationship with patient activation. Besides, the mediating effect of self-efficacy on the relationship between the two was assessed in the study. METHODS Using a cross-sectional design, 200 elderly patients with type 2 diabetes were recruited from the community of Yangzhou, China. The Patient Activation Measure (PAM), The Self-efficacy for Diabetes (SED), and The Summary of Diabetes Self-Care Activities Measure (SDSCA) were used in the questionnaires. Data analysis was performed using SPSS 27.0 and PROCESS macro. RESULTS Pearson correlation analysis revealed a significant positive correlation (p< 0.01) between diabetes self-management ability and patient activation (r=0.312) and self-efficacy (r=0.367). Self-efficacy partially mediated the effect between patient activation and self-management ability in older patients with type 2 diabetes, and the mediating effect accounted for 49.33% of the total effect (p< 0.001). CONCLUSIONS Older patients with type 2 diabetes in the community have a moderate level of self-management ability. Patient activation can improve patients' self-management ability through self-efficacy.
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Affiliation(s)
- Anqi Zhang
- The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225003, Jiangsu, China; School of Nursing and Public Health, Yangzhou University, Yangzhou 225009, Jiangsu, China
| | - Jinsong Wang
- The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225003, Jiangsu, China; School of Nursing and Public Health, Yangzhou University, Yangzhou 225009, Jiangsu, China; Yangzhou Commission of Health, Yangzhou 225012, Jiangsu, China.
| | - Xiaojuan Wan
- School of Nursing and Public Health, Yangzhou University, Yangzhou 225009, Jiangsu, China
| | - Zihe Guo
- Yangzhou Commission of Health, Yangzhou 225012, Jiangsu, China
| | - Ziyi Zhang
- School of Nursing and Public Health, Yangzhou University, Yangzhou 225009, Jiangsu, China
| | - Shuhan Zhao
- School of Nursing and Public Health, Yangzhou University, Yangzhou 225009, Jiangsu, China
| | - Shuo Bai
- School of Nursing and Public Health, Yangzhou University, Yangzhou 225009, Jiangsu, China
| | - Yamin Miao
- School of Nursing and Public Health, Yangzhou University, Yangzhou 225009, Jiangsu, China
| | - Jing Zhang
- Yangzhou Commission of Health, Yangzhou 225012, Jiangsu, China
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Hu L, Jin X, Li Y, Yang D, Zhang Z, He X, Chen W, Gong N. A Mixed Methods Assessment of Self- Management Needs and Preferences of People with Type 2 Diabetes Mellitus in China. Patient Prefer Adherence 2023; 17:653-666. [PMID: 36935941 PMCID: PMC10022447 DOI: 10.2147/ppa.s394003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/25/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Consistent and effective self-management is a major challenge for people with diabetes and long-term effects can be difficult to sustain despite the many interventions. Interventions often fail to take patients' perceptions of self-management into account from their perspective. Exploring the needs preferences and the influencing factors of self-management in patients can improve the effectiveness of self-management. METHODS This study used a mixed research approach, exploring patient needs and preferences through web crawl methods and using qualitative interviews to explore the logic of preferences. 1605 data were obtained from 4 online health communities through web crawlers. Data were coded using grounded theory to analyze self-management needs. The codes were also coded for frequency statistics and ranked to explain the self-management preferences. The second phase explained the logic of the ranked distribution of preferences through one-on-one interviews with 22 patients. RESULTS This study summarized six self-management needs of people with diabetes through web crawler data, among which medication management and conflict between disease and daily life were the most important concerns of patients. The reasons why patients are particularly concerned about these two needs were explored through qualitative interviews, and it was found that patients' concerns about medication were mainly due to the following three aspects: the effect of drugs is direct and obvious, medication use makes life less complicated, and progressive side effects. The patients' concerns about the conflict between disease and daily life are often caused by the following three aspects: diabetes impacts social roles, disease complicates life, and reducing the impact of the disease on life. CONCLUSION The self-management needs of Chinese diabetics have six themes. Medication management, conflict between disease and daily life, diet, diabetes knowledge, blood glucose monitoring and exerciseIn order of frequency of mention and possible preference: medication management, conflict between disease and daily life were the most frequent needs, while diet, knowledge about diabetes, blood glucose monitoring and exercise were their least frequent needs.Understanding the individual's perception and understanding of diabetes self-management and the expression of the patient's daily life situations can guide the medical team to optimize collaboration on personalized care plans.
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Affiliation(s)
- Lei Hu
- School of Nursing, Jinan University, Guangzhou, Guangdong, People’s Republic of China
| | - Xiaoyuan Jin
- Department of Social Medicine of School of Public Health, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China
| | - Yundong Li
- School of Ethnology and Sociology, Yunnan University, Kunming, Yunnan, People’s Republic of China
| | - Dan Yang
- School of Nursing, Jinan University, Guangzhou, Guangdong, People’s Republic of China
| | - Ziqing Zhang
- School of Nursing, Jinan University, Guangzhou, Guangdong, People’s Republic of China
| | - Xiaoyu He
- School of Nursing, Jinan University, Guangzhou, Guangdong, People’s Republic of China
| | - Weiju Chen
- School of Nursing, Jinan University, Guangzhou, Guangdong, People’s Republic of China
| | - Ni Gong
- School of Nursing, Jinan University, Guangzhou, Guangdong, People’s Republic of China
- Correspondence: Ni Gong; Weiju Chen, School of Nursing, Jinan University, No. 601 West Huangpu Avenue, Tianhe District, Guangzhou, Guangdong, People’s Republic of China, Tel +86 15013217344;+86 18688898425, Email ;
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Dai Z, Jing S, Liu X, Zhang H, Wu Y, Wang H, Xiao W, Huang Y, Fu J, Chen X, Gao L, Su X. Development and validation of the diabetic self-management scale based on information-motivation-behavioral skills theory. Front Public Health 2023; 11:1109158. [PMID: 36908406 PMCID: PMC9998917 DOI: 10.3389/fpubh.2023.1109158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/07/2023] [Indexed: 03/14/2023] Open
Abstract
Background Self-management is important for the blood sugar control of middle-aged and elderly Type 2 diabetes mellitus (T2DM) patients, of which diet, exercise, and drug compliance are the most common components. The Information-Motivation-Behavioral Skills Model (IMB) has been widely used in health behavior management and intervention. Objective The purpose of this study is to develop and validate the Diabetic Self-Management Scale (DSMS) based on the IMB model. Methods Self-report survey data was collected from middle-aged and elderly T2DM patients in Zhongmu City, Henan Province, China in November 2021 using convenience sampling. The original DSMS was developed through a literature review and summary of previous similar scales using an inductive approach. Item modification was finished by a panel of specialists. Exploratory factor analysis and confirmatory factor analysis were used to evaluate the reliability, convergent validity, discriminant validity, and criterion validity of DSMS. Results Four hundred and sixty nine T2DM patients completed the questionnaire survey. The final DSMS consists of 22 items with three dimensions, including information (five items), motivation (eight items), and behavior skills (nine items). The results of simple factor analysis showed that the KMO value was 0.839, Bartlett spherical test 2 = 3254.872, P < 0.001. The results of confirmatory factor analysis showed that 2/df = 2.261, RMSEA = 0.073, CFI = 0.937, TLI = 0.930, and SRMR = 0.096. The standardized factor loadings of 22 DSMS items were all above 0.6, and the CR values of 3 dimensions were all higher than 0.9. In addition, DSMS also showed good discriminant and criterion validity. Conclusion The 22-item DSMS has good reliability and validity, and can be used to make diabetic self-management assessment regarding diet, physical activity, and medication among middle-aged and elderly Chinese T2DM patients. DSMS is of moderate length and easy to understand. It can be promoted in China in the future to understand the self-management status of middle-aged and elderly T2DM patients in China.
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Affiliation(s)
- Zhenwei Dai
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu Jing
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoyang Liu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haoran Zhang
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yijin Wu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weijun Xiao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yiman Huang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiaqi Fu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Chen
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Gao
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaoyou Su
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Liu Y, Jiang J, You W, Gong D, Ma X, Wu M, Li F. Exploring facilitators and barriers to self-management engagement of Chinese people with type 2 diabetes mellitus and poor blood glucose control: a descriptive qualitative study. BMC Endocr Disord 2022; 22:294. [PMID: 36435767 PMCID: PMC9701421 DOI: 10.1186/s12902-022-01214-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/11/2022] [Indexed: 11/28/2022] Open
Abstract
AIMS To explore facilitators and barriers to self-management engagement of Chinese people with poorly controlled type 2 diabetes. METHODS Purposive sampling method was used for recruitment. Semi-structured interview and thematic analysis was used for data collection and analysis. RESULTS Twenty-six semi-structured interviews were conducted. Poor blood glucose control introduced awareness of susceptibility to complications, while mental disorders could be concomitant. General knowledge about healthy lifestyle and unhealthy habits impeded lifestyle management. Temporary remission of hyperglycemia and no perceived symptoms interfered engagement of medication therapy and regular blood glucose monitoring. Family and work environments could impact self-management engagement. Accessibility to reliable diabetes-related information influenced self-management engagement. CONCLUSIONS Awareness of susceptibility to complications motivated self-management engagement, while the awareness could cause mental disorders that need to be addressed. Customized lifestyle plans and behavior change technologies were crucial for lifestyle management. The progression of diabetes, importance of continuity of medication therapy, and the value of blood glucose monitoring should be clarified in diabetes education. Building diabetes-friendly social environments and providing reliable diabetes-related information were essential.
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Affiliation(s)
- Yuan Liu
- National Metabolic Management Center, Institute for Chronic Disease Management, Jining No. 1 People's Hospital, Jining, China.
| | - Jiajia Jiang
- National Metabolic Management Center, Institute for Chronic Disease Management, Jining No. 1 People's Hospital, Jining, China
| | - Wenjun You
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
| | - Dandan Gong
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
| | - Xiaoqing Ma
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
| | - Min Wu
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
| | - Feng Li
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
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