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. 2012 Apr;87(1):74-80.
doi: 10.1016/j.pec.2011.07.013. Epub 2011 Aug 15.

The influence of diabetes psychosocial attributes and self-management practices on change in diabetes status

Donna M Zulman  1 , Ann-Marie Rosland, Hwajung Choi, Kenneth M Langa, Michele Heisler
Affiliations

The influence of diabetes psychosocial attributes and self-management practices on change in diabetes status

Donna M Zulman et al. Patient Educ Couns. 2012 Apr.

Abstract

Objective: To examine the influence of diabetes psychosocial attributes and self-management on glycemic control and diabetes status change.

Methods: Using data from the Health and Retirement Study, a nationally representative longitudinal study of U.S. adults >51 years, we examined cross-sectional relationships among diabetes psychosocial attributes (self-efficacy, risk awareness, care understanding, prioritization of diabetes, and emotional distress), self-management ratings, and glycemic control. We then explored whether self-management ratings and psychosocial attributes in 2003 predicted change in diabetes status in 2004.

Results: In multivariate analyses (N=1834), all diabetes psychosocial attributes were associated with self-management ratings, with self-efficacy and diabetes distress having the strongest relationships (adj coeff=8.1, p<0.01 and -4.1, p<0.01, respectively). Lower self-management ratings in 2003 were associated cross-sectionally with higher hemoglobin A1C (adj coeff=0.16, p<0.01), and with perceived worsening diabetes status in 2004 (adj OR=1.36, p<0.05), with much of this latter relationship explained by diabetes distress.

Conclusion: Psychosocial attributes, most notably diabetes-related emotional distress, contribute to difficulty with diabetes self-management, poor glycemic control, and worsening diabetes status over time.

Practice implications: Self-management and adherence interventions should target psychosocial attributes such as disease-related emotional distress.

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Figures

Figure 1
Figure 1
Hypothesized relationships among psychosocial attributes, self-reported self-management, and perceived diabetes status change over one year
Figure 2
Figure 2
Predicted probability of worsening diabetes status (2004) with varying levels of diabetes-specific emotional distress and self-reported self-management (2003) *Self-management rating refers to the number of self-management tasks (taking medications, exercising regularly, following recommended diet, checking blood sugar, checking feet for wounds or sores) that patient rated as “Not Difficult: I got it exactly right.
See this image and copyright information in PMC

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