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

PATIENT EDUCATION AND COUNSELING

卷:87

Article

Zulman, Donna M.^1,2  Rosland, Ann-Marie^3,4  Choi, HwaJung^3,5  Langa, Kenneth M.^3,4  Heisler, Michele^3,4,5,6 

[1] VA Palo Alto Hlth Care Syst, Ctr Hlth Care Evaluat, Menlo Pk, CA 94025 USA

[2] Stanford Univ, Dept Internal Med, Div Gen Med Disciplines, Stanford, CA 94305 USA

[3] Univ Michigan, Dept Internal Med, Ann Arbor, MI 48109 USA

[4] Hlth Serv Res & Dev Ctr Excellence, Dept Vet Affairs, Ann Arbor, MI USA

[5] Univ Michigan, Robert Wood Johnson Fdn, Clin Scholars Program, Ann Arbor, MI 48109 USA

[6] Univ Michigan, Sch Publ Hlth, Dept Hlth Behav & Hlth Educ, Ann Arbor, MI 48109 USA

关键词: Diabetes;    Self-management;    Self-efficacy;    Diabetes distress;   

DOI  :  10.1016/j.pec.2011.07.013

来源: Elsevier

【 摘 要 】

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. Published by Elsevier Ireland Ltd.

【 授权许可】

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