Bridging Minds and Behaviours: Patient Empowerment Mediates Psychological Factors and Diabetes Self‐Management

OBJECTIVES: This multicenter cross-sectional study was designed to verify whether patient empowerment mediates the relationship between psychosocial factors and diabetes self-management behaviours and HbA1c. Patient empowerment is a key factor improving diabetes management. The mechanism underneath is less clear. METHODS: We conducted a multicenter cross-sectional study of 2005 type 2 diabetes from five university hospitals across diverse Chinese regions between December 2022 and May 2023. Demographic and lab values came from electronic medical record systems (EMS) while psychological factors were assessed via self-administered digital scales on a WeChat mini-program. The study examined patient empowerment's mediating role between psychological factors (Type D personality, DD, attitudes, subjective norms, perceived control, behaviour change intentions) and diabetes outcomes using mediation and chain mediation analyses. RESULTS: Patients with lower empowerment scores had shorter disease duration, poorer glycemic control, a higher prevalence of dyslipidemia and multiple complications, and greater socioeconomic disadvantage. Type D personality (OR = 2.201, p < 0.001) and diabetes distress (DD, OR = 1.053, p < 0.001) were identified as independent risk factors for low empowerment. Moreover, patient empowerment significantly mediated the associations between psychosocial factors and both self-management behaviours and HbA1c. Mediation analyses showed significant indirect effects of Type D personality (γ = -0.794, p < 0.001), DD (γ = -0.050, p = 0.024), attitude toward behaviour change (γ = 0.470, p < 0.001), subjective norm (γ = 0.287, p < 0.001), perceived behavioural control (γ = 0.489, p < 0.001) and behavioural intention (γ = 0.458, p < 0.001) on self-management behaviours through empowerment. CONCLUSION: Patient empowerment functions as a critical mediator linking psychosocial factors to self-management behaviours and glycemic control in individuals with type 2 diabetes. Type D personality and DD represent important risk factors for low empowerment. These findings suggest that patient empowerment-focused interventions may enhance diabetes self-management and glycemic control.