Article Figures & Data
Figures
- Figure 1.
Conceptual model for factors influencing HbA1c.
Tables
Variable Description Sociodemographic Age Years old Race White versus all other races Sex Male versus female Marital status Married versus unmarried Living arrangement Lives alone versus does not live alone Education High school diploma or less; some college/college graduate/some masters/masters graduate or terminal degree Income $0-$19,999; $20,000-$69,999; or ≥$70,000 Insurance Has insurance versus has no insurance Family support Family knowledge and support 8 questions about family helping patient cope with diabetes (family provides helps and support with diabetes, knows about diabetes, helps you follow a meal plan, take medication, care about your feet, get enough exercise, test blood glucose, and handle your feelings about diabetes) Rated using scale of 1 (none) to 5 (a lot) Health risks Tobacco use Smokes cigarettes versus does not smoke cigarettes Duration of diabetes Patient reports number of years since they have been diagnosed with diabetes Body mass index Weight (kg) divided by the height (m2) Mental/physical health SF-12 Health Survey Summary scores for mental and physical health35 Depressive symptoms PHQ-9, sum of score on 9-question scale (0 = not at all to 3 = nearly every day; scale range 0–27)33; higher score indicates more depressive symptoms Physician-patient communication Physician-patient relationship 12 questions: sees the same physician; physician explains diabetes to patient; patient agrees with physician's opinion; patient is given opportunities to answer questions; patient feels comfortable asking questions; patient issatisfied with physician discussions; physician asks about goals for treatment; patient is offered a choice for treatment; physician explains treatment to patient; physician explores how manageable this treatment would be for the patient; physician discusses patient's and physician's respective roles; and physician encourages the role the patient wants in their care. Rated using scale: 1 (no extent) to 5 (very great extent) Self-care behaviors Adherence-satisfaction to medications Combination percent adherence with medications and satisfaction with adherence Adherence-satisfaction to meal plans Combination percent adherence with meal plan and satisfaction with adherence Adherence-satisfaction to blood glucose testing Combination percent adherence with testing blood glucose and satisfaction with adherence. Patient reports yes/no to testing blood glucose at home Adherence-satisfaction with regular exercise Combination days/week exercised, minutes exercised/day and satisfaction with adherence Potential barriers to diabetes management Barriers to taking medications, following meal plan, testing, blood glucose, and exercising, regularly (total of 34 questions) 8 questions about medications, meal plans, testing blood glucose, and exercise (too busy; hassle; don't believe; don't like to do; don't understand; forgets; costs too much; depression interferes) Rated using scale: 1 (no extent) to 5 (very great extent) 2 questions (hurts; don't understand how to use results) about testing blood glucose Rated using scale: 1 (no extent) to 5 (very great extent) Diabetes knowledge 5 questions about the importance of testing blood glucose (to what extent type 2 diabetes is a serious disease; importance of keeping blood glucose close to normal; keeping blood glucose close to normal is too much work; and need to know about diabetes to make good decisions) Rated using scale: 1 (no extent) to 5 (very great extent) Confidence in ability to manage self-care behaviors 4 questions related to medication, meal plan, blood glucose, and exercise Rated using scale: 1 (not very confident) to 5 (very confident) Motivation to do a better job in self-care behaviors 4 questions related to medication, meal plan, blood glucose, and exercise Rated using scale: 1 (not very motivated) to 5 (very motivated) * R2 = 0.24.
SF-12, 12-item Short-Form Health Survey; PHQ-9, 9-item Patient Health Questionnaire.
Domains Categories (n) Mean HbA1c (%) P Socio-Demographics Age (years) 29–49 (n = 34) 7.74 .004 50–64 (n = 137) 7.10 65–89 (n = 82) 6.79 Marital status Married (n = 129) 6.90 .026 Not married (n = 112) 7.33 Years since diagnosis of diabetes ≤6 (n = 110) 6.77 .002 >6 (n = 115) 7.28 Family support Family provides help and support Lesser extent (n = 111) 7.39 .003 Greater extent (n = 126) 6.82 Family knows about diabetes Lesser extent (n = 96) 7.37 .014 Greater extent (n = 141) 6.87 Mental/physical health Depression* No depression (n = 145) 6.86 .007 Atypical depression (n = 45) 7.19 Major depression (n = 63) 7.53 SF-12 MCS† <40 (n = 58) 7.37 .078 40–50 (n = 53) 7.25 >50 (n = 102) 6.86 Physician-patient communication Patient feels comfortable asking physician questions about diabetes Lesser extent (n = 35) 7.71 .039 Greater extent (n = 207) 7.01 Barriers to diabetes management Cost of taking medication Lesser extent (n = 169) 6.99 .005 Greater extent (n = 39) 7.98 Depression interferes with taking medication Lesser extent (n = 185) 7.02 .012 Greater extent (n = 20) 8.62 Cost of following meal plan Lesser extent (n = 172) 6.97 .038 Greater extent (n = 42) 7.66 Depression interferes with following meal plan Lesser extent (n = 193) 7.01 .045 Greater extent (n = 21) 8.20 Cost of testing blood glucose Lesser extent (n = 185) 7.04 .006 Greater extent (n = 25) 7.90 Depression interferes with testing blood glucose Lesser extent (n = 192) 7.01 .021 Greater extent (n = 14) 9.16 Extent to which diabetes is considered a serious disease Lesser extent (n = 30) 6.62 .006 Greater extent (n = 213) 7.18 Confident with following meal plan as recommended Lesser extent (n = 95) 7.41 .002 Greater extent (n = 124) 6.81 * Depression as measured by the 9-item Patient Health Questionnaire. Major depression was either the first or second question with a rating of ≥2 and a totalscore >10. Atypical depression was both the first 2 questions with a rating of <2 and a total score of ≥10; either the first or second question with a rating of >2 and ≤5 and a total score <10; or the last question with a rating of ≥1 and a total score of <9.
† Substantially below average health = physical component summary-12 score <40; somewhat below average health = physical component summary-12 score of 40 to <50; and above average health = physical component summary-12 score of ≥50.
SF-12, 12-item Short-Form Health Survey; MCS, mental component summary.
- Table 3.
Self-care Behavior's Performance and Association of Glycosylated Hemoglobin (HbA1c) with Mean Adherence, Satisfaction, and Adherence-Satisfaction to Specific Self-Care Behaviors
Self-Care Behavior Adherence Spearman Correlation of HbA1c with Adherence Spearman Correlation of HbA1c with Satisfaction Spearman Correlation of Combined Adherence-Satisfaction HbA1c with Adherence-Satisfaction Mean HbA1c (n) Taking medication 96% −0.25‡ −0.12 −0.45‡ High: 6.87 (168)† Low: 7.91 (46) Following a meal plan 66% −0.21† −0.29‡ −0.68‡ High: 6.59 52)‡ Low: 7.26 (154) Testing blood glucose 81% −0.12 −0.12 −0.75‡ High: 6.93 (123)† Low: 7.40 (90) Exercising 52 minutes per week −0.03 −0.16* −0.71‡ High: 6.99 (66) Low: 7.05 (122) * P ≤ .05,
† P ≤ .01,
‡ P ≤ .001 for higher adherence, satisfaction, adherence-satisfaction being associated with lower HbA1c.
The reported adherence was a percentage of time completed activity in past month, with the exception of exercise, which was mean minutes per week. The reported satisfaction was measured on a rating scale of 0 = no satisfaction to 5 = very satisfied.
- Table 4.
Spearman Correlations between Barriers of Each Self-Care Behavior and Glycosylated Hemoglobin (HbA1c)
Barrier was a Significant Problem* Taking Medication (r) Following a Meal Plan (r) Monitoring Blood Glucose (r) Exercising Regularly (r) Costs too much 0.22§ 0.21‡ 0.23§ 0.17† Hassle 0.08 0.26§ 0.14† 0.11 Forgot 0.13† 0.17‡ 0.06 0.05 Depression interferes 0.21‡ 0.18‡ 0.16† 0.11 Too busy 0.07 0.14† 0.04 0.04 Don't understand 0.004 0.18‡ 0.15† 0.04 Don't like 0.05 0.14† 0.15† 0.18 It hurts N/A N/A 0.16† N/A Don't know how to use results N/A N/A 0.15† N/A Don't believe 0.07 0.13 0.12 0.06 * Barriers were rated from 1 to 5, with 5 indicating the item was a barrier to a greater extent.
† P ≤ .05;
‡ P ≤.01;
§ P ≤ .001.
- Table 5.
Final Multivariate Regression Model for Factors Associated with Glycosylated Hemoglobin (HbA1c)
Variables Coefficient P Married versus not married −0.46 .016 PHQ-9 total score (0–27) 0.04 .005 Medication adherence-satisfaction high versus low −0.90 .001 Test blood glucose adherence-satisfaction high versus low −0.40 .042 Belief that type 2 diabetes is serious disease 0.27 .049 PHQ-9, 9-item Patient Health Questionnaire.
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