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

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• 作者：Donna M. Zulman^a ; ^b ; ^{dzulman@stanford.edu} ; Ann-Marie Rosland^c ; ^d ; HwaJung Choi^c ; ^e ; Kenneth M. Langa^c ; ^d ; Michele Heisler^c ; ^d ; ^e ; ^f
• 关键词：Diabetes ; Self-management ; Self-efficacy ; Diabetes distress
• 刊名：Patient Education and Counseling
• 出版年：2012
• 期刊代码：217_07383991
• 类别：med
• 出版时间：April, 2012
• 卷：87
• 期：1
• 页码：74-80
• 文件大小：295 K

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 鈭?.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.