{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:56:13Z","timestamp":1792788973438,"version":"4.5.0"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Tongji Hospital","id":[{"id":"https:\/\/ror.org\/04xy45965","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Natural Science Foundation"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Exercise management is important in type 2 diabetes mellitus (T2DM). However, individual variability in exercise-related knowledge, attitudes, and practices (KAP) is significantly associated with behavioral adherence yet is often overlooked in average-based analyses. This study applied Latent profile analysis (LPA) to characterize this heterogeneity and explored associations between the resulting behavioral profiles and clinical indicators.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a multicenter cross-sectional study of 516 adults with T2DM in China. LPA was performed using standardized exercise-related KAP indicators. Candidate solutions were evaluated using fit indices, classification diagnostics, interpretability, and bootstrap reproducibility. Clinical associations were examined using adjusted regression and posterior-probability pseudo-class analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four exploratory profiles were identified: Favorable Engagement (7.0%), Average Engagement (59.7%), Knowledge-Constrained (21.7%), and Attitude\u2013Practice Constrained (11.6%). After covariate adjustment, BMI differed across profiles; only the Average Engagement contrast remained significant after accounting for classification uncertainty. Glycemic indicators and diabetes-related complications did not differ robustly. The adjusted association with other chronic disease was sensitive to classification uncertainty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Exercise self-management heterogeneity included distinct knowledge-related and attitude\u2013practice constraints. These exploratory patterns may inform tailored support, but profile instability and cross-sectional data require independent prospective validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1892333","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T05:39:49Z","timestamp":1790055589000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Exercise self-management behavioral phenotypes in type 2 diabetes: a multicenter cross-sectional study"],"prefix":"10.3389","volume":"14","author":[{"given":"Xi","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Clinical Research Unit, Shanghai Tongji Hospital, Tongji University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liya","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Nursing, Shanghai Tongji Hospital, Tongji University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huili","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Shanghai Tongji Hospital, Tongji University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhao","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Clinical Research Ward, Cancer Center, Shanghai Tongji Hospital, Tongji University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fangping","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Clinical Research Ward, Cancer Center, Shanghai Tongji Hospital, Tongji University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaowen","family":"Zhai","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Shanghai Tongji Hospital, Tongji University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifan","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Hematology, Shanghai Tongji Hospital, Tongji University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunyan","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Nursing, Shanghai East Hospital, Tongji University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"He","sequence":"additional","affiliation":[{"name":"Department of Clinical Research Ward, Cancer Center, Shanghai Tongji Hospital, Tongji University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Clinical Research Ward, Cancer Center, Shanghai Tongji Hospital, Tongji University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Di","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Clinical Research Ward, Cancer Center, Shanghai Tongji Hospital, Tongji University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Xue","sequence":"additional","affiliation":[{"name":"Department of Clinical Research Ward, Cancer Center, Shanghai Tongji Hospital, Tongji University School of Medicine","place":["Shanghai, China"]},{"name":"Department of Hematology, Shanghai Tongji Hospital, Tongji University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fanglei","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Nursing, Shanghai Tongji Hospital, Tongji University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suwen","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Clinical Research Ward, Cancer Center, Shanghai Tongji Hospital, Tongji University School of Medicine","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e3558","DOI":"10.1002\/dmrr.3558","article-title":"Insulin resistance and beta-cell dysfunction in newly diagnosed type 2 diabetes: expression, aggregation and predominance. Verona newly diagnosed type 2 diabetes study 10","volume":"38","author":"Bonora","year":"2022","journal-title":"Diabetes Metab Res Rev"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"109119","DOI":"10.1016\/j.diabres.2021.109119","article-title":"IDF diabetes atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045","volume":"183","author":"Sun","year":"2022","journal-title":"Diabetes Res Clin Pract"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e1089","DOI":"10.1016\/S2468-2667(24)00250-0","article-title":"Diabetes in China part 1: epidemiology and risk factors","volume":"9","author":"Xu","year":"2024","journal-title":"Lancet Public Health"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1609","DOI":"10.2337\/dci19-0017","article-title":"Understanding the economic costs of diabetes and prediabetes and what we may learn about reducing the health and economic burden of these conditions","volume":"42","author":"O\u2019Connell","year":"2019","journal-title":"Diabetes Care"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"972","DOI":"10.1186\/s12913-018-3772-8","article-title":"Cost-of-illness of type 2 diabetes mellitus in low- and lower-middle-income countries: a systematic review","volume":"18","author":"Afroz","year":"2018","journal-title":"BMC Health Serv Res"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.69857\/joapr.v12i3.482","article-title":"Pathophysiology, lifestyle intervention and complications of type 2 diabetes: a review","volume":"12","author":"Basak","year":"2024","journal-title":"J Appl Pharm Res"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1056\/NEJMoa012512","article-title":"Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin","volume":"346","author":"Knowler","year":"2002","journal-title":"N Engl J Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1343","DOI":"10.1056\/NEJM200105033441801","article-title":"Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance","volume":"344","author":"Tuomilehto","year":"2001","journal-title":"N Engl J Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"2056","DOI":"10.1007\/s00125-022-05761-y","article-title":"Associations of polysocial risk score, lifestyle and genetic factors with incident type 2 diabetes: a prospective cohort study","volume":"65","author":"Zhao","year":"2022","journal-title":"Diabetologia"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"220210","DOI":"10.5888\/pcd20.220210","article-title":"Using patient profiles for sustained diabetes management among people with type 2 diabetes","volume":"20","author":"Chiou","year":"2023","journal-title":"Prev Chronic Dis"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e076464","DOI":"10.1136\/bmjopen-2023-076464","article-title":"Relationship between diabetic knowledge, attitudes and practices among patients with diabetes in China: a structural equation model","volume":"13","author":"Zhu","year":"2023","journal-title":"BMJ Open"},{"key":"ref12","first-page":"531","article-title":"Knowledge, attitude and practices of indigenous people towards non-communicable disease in Bera, Malaysia: a community-based study","volume":"79","author":"Abdullah","year":"2024","journal-title":"Med J Malaysia"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1707","DOI":"10.3390\/ijerph21121707","article-title":"Knowledge, attitudes, and practice regarding physical exercise in type 2 diabetic and non-diabetic staff at a tertiary institution","volume":"21","author":"Sibazo","year":"2024","journal-title":"Int J Environ Res Public Health"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e89221","DOI":"10.7759\/cureus.89221","article-title":"Knowledge, attitudes, and practices of family physicians regarding pre-travel counseling for patients with type 2 diabetes in Riyadh, Saudi Arabia","volume":"17","author":"Aldawsari","year":"2025","journal-title":"Cureus"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1186\/s12875-024-02600-4","article-title":"Diabetes knowledge, attitudes and practices among Chinese primary care physicians: a cross-sectional study","volume":"25","author":"Pi","year":"2024","journal-title":"BMC Prim Care"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e1\u2013e9","DOI":"10.4102\/safp.v66i1.5838","article-title":"Diabetes knowledge, attitudes, and practices in adults with type 2 diabetes at primary health care clinics in Kimberley, South Africa","volume":"66","author":"Alenbalu","year":"2024","journal-title":"S Afr Fam Pract (2004)"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e46190","DOI":"10.7759\/cureus.46190","article-title":"Knowledge, attitude, and practice regarding diabetic retinopathy screening and eye management among people with diabetes in Saudi Arabia","volume":"15","author":"Alqahtani","year":"2023","journal-title":"Cureus."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"2268109","DOI":"10.1080\/07853890.2023.2268109","article-title":"Heterogeneous subtypes of health literacy among individuals with metabolic syndrome: a latent class analysis","volume":"55","author":"Zhang","year":"2023","journal-title":"Ann Med"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"17246","DOI":"10.1038\/s41598-025-02142-4","article-title":"Latent profile analysis of nutrition knowledge, attitudes, and practices and their influencing factors in maintenance hemodialysis patients","volume":"15","author":"Xu","year":"2025","journal-title":"Sci Rep"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e0286974","DOI":"10.1371\/journal.pone.0286974","article-title":"Diabetes self-management education interventions and self-management in low-resource settings: a mixed-methods study","volume":"18","author":"Lamptey","year":"2023","journal-title":"PLoS One"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"44","DOI":"10.3928\/00989134-20251008-02","article-title":"Heterogeneity of ego depletion and its relationship with health promotion behavior among older adults with type 2 diabetes mellitus: latent profile analysis","volume":"51","author":"Shen","year":"2025","journal-title":"J Gerontol Nurs"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1670339","DOI":"10.3389\/fnut.2025.1670339","article-title":"Analysis of current status and potential categories of nutritional literacy in elderly patients with chronic diseases: a single-center cross-sectional study","volume":"12","author":"Wang","year":"2025","journal-title":"Front Nutr"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"112417","DOI":"10.1016\/j.jpsychores.2025.112417","article-title":"Depression profiles and hepatitis C treatment outcomes among people who inject drugs: the HERO study","volume":"199","author":"Pericot-Valverde","year":"2025","journal-title":"J Psychosom Res"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"105788","DOI":"10.1016\/j.actpsy.2025.105788","article-title":"Exploring latent profiles of digital game addiction, socio-emotional well-being, and resilience in Turkish preschoolers","volume":"261","author":"Kaya","year":"2025","journal-title":"Acta Psychol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"794","DOI":"10.1177\/02654075241307976","article-title":"Family relationship quality and psychological and cognitive health among grandparent caregivers: the moderating role of co-residence with adult children","volume":"42","author":"Jang","year":"2025","journal-title":"J Soc Pers Relat"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"805","DOI":"10.19813\/j.cnki.weishengyanjiu.2025.05.015","article-title":"Latent classes and their associated factors of sleep quality among police officers in Inner Mongolia Autonomous Region in 2021","volume":"54","author":"Dou","year":"2025","journal-title":"Wei Sheng Yan Jiu"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1080\/02640414.2025.2575416","article-title":"Young athletes\u2019 social goals during the children-to-youth sport transition: a latent profile and latent transition analysis","volume":"44","author":"J\u00f8rgensen","year":"2026","journal-title":"J Sports Sci"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1601198","DOI":"10.3389\/fpsyg.2025.1601198","article-title":"Self-perceived burden in elderly patients with chronic comorbidities: a latent profile analysis","volume":"16","author":"Chen","year":"2025","journal-title":"Front Psychol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"2333","DOI":"10.1111\/jocn.70132","article-title":"Competence of workplace violence management by nursing interns: a latent profile analysis","volume":"35","author":"Ren","year":"2026","journal-title":"J Clin Nurs"},{"key":"ref30","first-page":"6","article-title":"Analysis of the status quo and influencing factors of exercise self-management behavior in patients with type 2 diabetes mellitus","volume":"27","author":"Feng","year":"2024","journal-title":"Diabetes New World"},{"key":"ref31","first-page":"315","article-title":"Guideline for the prevention and treatment of type 2 diabetes mellitus in China (2020 edition)","volume":"13","year":"2021","journal-title":"Chin J Diabetes Mellit"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1177\/109019817400200403","article-title":"Historical origins of the health belief model","volume":"2","author":"Rosenstock","year":"1974","journal-title":"Health Educ Monogr"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1097\/00005650-197501000-00002","article-title":"Sociobehavioral determinants of compliance with health and medical care recommendations","volume":"13","author":"Becker","year":"1975","journal-title":"Med Care"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1016\/j.gerinurse.2024.10.025","article-title":"Self-management knowledge, attitudes, and behaviors among patients with type 2 diabetes mellitus in a community of western China: a cross-sectional study","volume":"61","author":"Liu","year":"2025","journal-title":"Geriatr Nurs"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"21163","DOI":"10.1038\/s41598-025-08537-7","article-title":"Knowledge, attitudes and practices of healthcare professionals regarding diabetes self-management education and support","volume":"15","author":"Wang","year":"2025","journal-title":"Sci Rep"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"1529","DOI":"10.3390\/ijerph21111529","article-title":"Diabetes-related knowledge, attitude, and practice towards exercise and its benefits among individuals with type 2 diabetes mellitus","volume":"21","author":"Mtshali","year":"2024","journal-title":"Int J Environ Res Public Health"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1007\/s00592-020-01480-1","article-title":"Physical activity recommendations for patients with type 2 diabetes: a cross-sectional survey","volume":"57","author":"Hou","year":"2020","journal-title":"Acta Diabetol"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1016\/j.freeradbiomed.2024.09.004","article-title":"Exercise performance and health: role of GLUT4","volume":"224","author":"McGee","year":"2024","journal-title":"Free Radic Biol Med"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"adi5377","DOI":"10.1126\/sciimmunol.adi5377","article-title":"Regulatory T cells shield muscle mitochondria from interferon-\u03b3-mediated damage to promote the beneficial effects of exercise","volume":"8","author":"Langston","year":"2023","journal-title":"Sci Immunol"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1228","DOI":"10.2337\/dc10-1881","article-title":"Effects of exercise on cardiovascular risk factors in type 2 diabetes: a meta-analysis","volume":"34","author":"Chudyk","year":"2011","journal-title":"Diabetes Care"},{"key":"ref41","doi-asserted-by":"crossref","first-page":"100127","DOI":"10.1016\/j.deman.2022.100127","article-title":"Effect of treatment intensification on glycemic control in patients with subcontrolled type 2 diabetes who failed on two oral antidiabetic agents","volume":"9","author":"Tan","year":"2023","journal-title":"Diabetes Epidemiol Manag"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1892333\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T05:39:52Z","timestamp":1790055592000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1892333\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,22]]},"references-count":41,"alternative-id":["10.3389\/fpubh.2026.1892333"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1892333","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,22]]},"article-number":"1892333"}}