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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (6): 1145-1152. doi: 10.19723/j.issn.1671-167X.2025.06.019

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Analyzing the influential factors of dietary patterns and blood glucose control in type 2 diabetes patients based on the model of health action process approach model

Hewei MIN1, Yibo WU1, Yuhui SHI1, Mingzi LI2, Xinying SUN1,*()   

  1. 1. Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China
    2. Peking University School of Nursing, Beijing 100191, China
  • Received:2024-02-18 Online:2025-12-18 Published:2025-09-16
  • Contact: Xinying SUN
  • Supported by:
    the National Natural Science Foundation of China(72174008)

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Abstract:

Objective: To explore the factors influencing dietary patterns and blood glucose control in patients with type 2 diabetes based on the health action process approach (HAPA) model. Methods: Patients with type 2 diabetes were selected in 11 community health centers affiliated to Dongcheng Hospital of Dongying City, Shandong Province. The glycosylated hemoglobin (HbA1c) level was detected by venous blood collection, and general data questionnaire, food frequency questionnaire, the Summary of Diabetes Self-Care Activities measure and HAPA scale were used to collect information. The dietary patterns of the patients were divided into different types by factor analysis. The effects of various dimensions of HAPA model on dietary patterns and blood glucose control of the type 2 diabetes patients were analyzed by structural equation model. Results: A total of 819 patients with type 2 diabetes were enrolled in the study, and the overall HbA1c level was 7.1%±1.1%. The overall diet management scores of the study subjects were 5.0 (1.0, 7.0), and the specific daily diets were divided into medium/low glycemic index (GI) dietary pattern, meat dietary pattern, fruit dietary pattern, high GI and starch dietary patterns, and egg and milk dietary pattern. Structural equation model results showed that positive outcome expectancies (β=0.417, P < 0.001), negative outcome expectancies (β=-0.239, P < 0.001) and perceived risk severity (β=0.075, P=0.036) affected dietary management behavior intention. Beha-vioral intention of diet management affected action planning (β=0.531, P < 0.001) and coping planning (β=0.228, P < 0.001). Action planning influenced overall diet management behavior (β=0.183, P < 0.001). The overall diet management behavior affected medium/low GI dietary pattern (β=0.133, P < 0.001), fruit dietary pattern (β=-0.103, P=0.003), high GI and starch dietary pattern (β=-0.110, P=0.002) and egg and milk dietary pattern (β=0.076, P=0.031). Medium/low GI dietary pattern (β=-0.086, P=0.013) and meat dietary pattern (β=0.084, P=0.015) affected the level of HbA1c. In addition, action self-efficacy can affect behavior intention (β=0.384, P < 0.001), action planning (β=0.122, P=0.006) and coping planning (β=0.146, P=0.001). Maintenance self-efficacy affected action planning (β=0.170, P < 0.001), coping planning (β=0.408, P < 0.001), and overall diet management behavior (β=0.265, P < 0.001). Conclusion: There were differences in dietary patterns among the participants with type 2 diabetes, and the weekly diet management behavior was not good enough of the patients with type 2 diabetes, because HAPA model could explain the dietary patterns and blood glucose control level of type 2 diabetes patients. In the future, targeted dietary interventions can be developed based on the HAPA model to improve the overall diet management level of patients and promote patients to develop a healthy diet pattern with low GI, thus controlling blood sugar level and improving quality of life.

Key words: Type 2 diabetes, Health action process approach model, Dietary pattern

CLC Number: 

  • R193.3

Table 1

Dimension, definition, and Cronbach' s α of HAPA scale"

Dimension Number Definition Sample question Cronbach’s α

Perceived risk susceptibility		 3 Awareness of the probability of the occurrence of T2DM-related risk My blood sugar levels are likely to rise 0.918
Perceived risk severity 2 Awareness of the severity of T2DM-related risk The aggravation of diabetes will affect my normal life and work 0.883
Positive outcome expectancies 3 Expectation of potential positive outcomes of diet management Adopting a diabetic diet can make me feel better 0.801
Negative outcome expectancies 3 Expectation of potential negative outcomes of diet management I waste more energy following a diabetic diet 0.706
Intention 3 Willingness to engage in diet management I will learn about diabetes diet 0.769
Action planning 4 Planning for when, where, and how to engage in diet management I know when to eat healthy 0.892
Coping planning 3 Planning for management to address obstacles that may disrupt diet management I already know what to do if something happens that interferes with my eating plan 0.942
Action self-efficacy 3 Confidence in carrying out diet management While it took some time to adjust to the new way of eating, I remained confident in sticking to my diet plan 0.620
Maintenance self-efficacy 5 Confidence in addressing obstacles that may disrupt diet management Even when I’m out, I’m confident I’ll stick to my eating plan 0.923
Recovery self-efficacy 3 Confidence in overcoming setbacks and resuming diet management after failure I have confidence in sticking to my eating plan when I encounter difficulties (like not having time to buy or cook the right foods) 0.850

Table 2

General characteristics of people with type 2 diabetes"

Items Population (n = 819)
Age/years, ${\bar x}$±s 64.7±8.2
Gender, n (%)
  Male 444 (54.2)
  Female 375 (45.8)
Nation, n (%)
  Han 813 (99.3)
  Minority 6 (0.7)
Residence, n (%)
  Urban 615 (75.1)
  Rural 204 (24.9)
Education level, n (%)
  Junior high school or lower 382 (46.6)
  Senior high school or technical secondary school 265 (32.4)
  Junior college or higher 172 (21.0)
Marital status, n (%)
  Unmarried 5 (0.6)
  Married 745 (91.0)
  Divorced or bereft of one’s spouse 69 (8.4)
Average household monthly income/yuan, n (%)
  ≤1 000 85 (10.4)
  >1 000-≤3 000 185 (22.6)
  >3 000-≤5 000 282 (34.4)
  ＞5 000 267 (32.6)
HbA1c/%, ${\bar x}$±s 7.1±1.1

Table 3

Dietary patterns and major food factor loadings of people with type 2 diabetes"

Component Medium/low GI pattern Meat pattern Fruit pattern High GI and starchy pattern Egg and milk pattern
Low/medium GI staple food 0.682
High GI staple food 0.276 0.351 0.433 -0.246
Tubers products 0.292 0.719
Starchy vegetables 0.694 0.277
Green vegetables 0.636 0.211 -0.281
Low/medium GI fruits 0.225 0.755
High GI fruits 0.782
Red meat 0.758
White meat 0.719
Processed meat 0.645
Eggs 0.707
Milk products 0.727
Teas 0.491

Table 4

HAPA score of people with type 2 diabetes"

Dimension Total score Actual score, M (P25, P75)
Perceived risk susceptibility 15 9.0 (6.0, 11.0)
Perceived risk severity 10 6.0 (4.0, 8.0)
Positive outcome expectancies 15 12.0 (10.0, 13.0)
Negative outcome expectancies 15 10.0 (8.0, 12.0)
Intention 15 12.0 (10.0, 13.0)
Action planning 20 16.0 (12.0, 16.0)
Coping planning 15 12.0 (9.0, 13.0)
Action self-efficacy 15 10.0 (8.0, 12.0)
Maintenance self-efficacy 25 18.0 (14.0, 20.0)
Recovery self-efficacy 15 9.0 (7.0, 11.0)

Figure 1

Structural equation model of HAPA influencing dietary patterns and HbA1c level"

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