The influence of diabetes psychosocial attributes and self-management practices on change in diabetes status |
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Authors: | Zulman Donna M Rosland Ann-Marie Choi Hwajung Langa Kenneth M Heisler Michele |
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Institution: | Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park, CA 94025, USA. dzulman@stanford.edu |
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Abstract: | ObjectiveTo examine the influence of diabetes psychosocial attributes and self-management on glycemic control and diabetes status change.MethodsUsing 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.ResultsIn 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.ConclusionPsychosocial attributes, most notably diabetes-related emotional distress, contribute to difficulty with diabetes self-management, poor glycemic control, and worsening diabetes status over time.Practice implicationsSelf-management and adherence interventions should target psychosocial attributes such as disease-related emotional distress. |
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Keywords: | Diabetes Self-management Self-efficacy Diabetes distress |
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