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Canadian Journal of Public Health

, Volume 99, Issue 3, pp 226–231 | Cite as

Health-related Behaviours in Adults with Diabetes

Associations with Health Care Utilization and Costs
  • Ronald C. PlotnikoffEmail author
  • Maria Kotovych
  • Nandini D. Karunamuni
  • Lawrence W. Svenson
  • Jeffrey A. Johnson
Article
  • 1 Downloads

Abstract

Objectives

The primary objective of this study was to examine whether physical activity, diet, and smoking behaviours are associated with health resource utilization and costs in the Canadian context. A secondary objective was to evaluate demographic and health behavioural characteristics of the participants of the study to assess the degree of respondent bias.

Methods

Self-reported physical activity, diet and smoking status were obtained from a large population-based sample of adults with diabetes (N=2311). Resource utilization and cost information was obtained by linking these data to the provincial government’s administrative database. Multiple regression models examined predictors of resource utilization and costs for individuals with type 1 (T1D) and type 2 (T2D) diabetes separately. To assess the degree of responder bias, characteristics of individuals who consented to link data were compared with those who did not consent.

Results

Various measures of health care utilization and costs were negatively associated with physical activity behaviour in both T1D and T2D groups. Ever having smoked cigarettes was associated with higher resource utilization in individuals with T2D when controlling for demographic and health variables. Significant differences in demographic and health behavioural characteristics of the participants who provided consent for data linkage and those who did not were also found.

Conclusion

These findings are of interest considering that PA is a critical but understudied component of individuals with diabetes, and this appears to be one of the first studies to directly examine the relationship between health-related behaviours and health care utilization and costs. The findings may be useful in guiding targeted health promotion programs for individuals with diabetes. The results also indicate that studies involving linkage of administrative and survey data could be over-represented by healthy individuals.

Key words

Diabetes mellitus type 1 diabetes mellitus type 2 health behaviour health care costs 

Résumé

Objectifs

Notre étude visait principalement à déterminer si l’activité physique, le régime et l’usage du tabac sont associés à l’utilisation et aux coûts des ressources en santé dans le contexte canadien. Accessoirement, nous avons analysé le profil démographique et les habitudes de santé des participants de l’étude pour déterminer l’importance du biais statistique.

Méthode

Nous avons obtenu des données auto-déclarées sur l’activité physique, le régime et l’usage du tabac auprès d’un vaste échantillon représentatif d’adultes diabétiques (n=2 311). Les données sur l’utilisation et les coûts des ressources ont été obtenues en effectuant des maillages avec la base de données administratives du gouvernement provincial. À l’aide de modèles de régression multiple, nous avons examiné les variables prédictives de l’utilisation et des coûts des ressources pour les personnes atteintes du diabète de type I (DT1) et pour celles atteintes du diabète de type II (DT2). Pour déterminer le biais statistique, nous avons comparé les caractéristiques des personnes ayant consenti à nous donner accès à leurs données administratives et celles des personnes n’ayant pas donné leur consentement.

Résultats

Diverses mesures de l’utilisation et des coûts des soins de santé étaient liées négativement à l’activité physique dans les deux groupes (DT1 et DT2). Compte tenu des effets des variables démographiques et de santé, le fait d’avoir déjà fumé la cigarette était associé à une plus forte utilisation des ressources chez les personnes ayant le DT2. Nous avons également observé des écarts significatifs dans le profil démographique et les habitudes de santé des participants ayant consenti au maillage des données et de ceux qui n’y ont pas consenti.

Conclusion

Ces constatations sont intéressantes, car l’activité physique est un élément crucial, mais insuffisamment étudié, du profil des personnes diabétiques, et notre étude semble être l’une des premières à avoir examiné directement la relation entre les habitudes de santé et l’utilisation et les coûts des soins de santé. L’étude pourrait donc servir à orienter les programmes de promotion de la santé qui ciblent les diabétiques. Il semble aussi, d’après nos résultats, que les sujets en bonne santé pourraient être sur-représentés dans les études qui comportent des maillages de données administratives et de données d’enquête.

Mots clés

diabète de type I diabète de type II habitudes de santé coûts des soins de santé 

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References

  1. 1.
    Simpson SH, Corabian P, Jacobs P, Johnson JA. The cost of major comorbidity in people with diabetes mellitus. CMAJ 2003;168:1661–67.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Zacker RJ. Exercise: A key component of diabetes management. Diabetes Spectrum 2004;17:142–44.CrossRefGoogle Scholar
  3. 3.
    Peirce NS. Diabetes and exercise. Br J Sports Med 1999;33(3):161–72.CrossRefGoogle Scholar
  4. 4.
    Tsui E, Zinman B. Exercise and diabetes: New insights on therapeutic goals. Endocrinologist 1995;5:263–71.CrossRefGoogle Scholar
  5. 5.
    Campaigne BN, Lampman RM. Physical Activity in the Clinical Management of Diabetes. Champaign, IL: Human Kinetics, 1994.Google Scholar
  6. 6.
    Lehmann R, Kasplan V, Bingisser R, Bloch KE, Spinas GA. Impact of physical activity on cardiovascular risk factors in IDDM. Diabetes Care 1997;20:1603–11.CrossRefGoogle Scholar
  7. 7.
    Schneider SH, Khachadurian AK, Amorosa LF, Clemow L, Ruderman NB. Ten-year experience with an exercise-based outpatient life-style modification program in the treatment of diabetes mellitus. Diabetes Care 1992;15:1800–10.CrossRefGoogle Scholar
  8. 8.
    Kang J, Robertson RJ, Hagberg JM, Kelley DE, Goss FL, DaSilva SG, et al. Effect of exercise intensity on glucose and insulin metabolism in obese individuals and obese NIDDM patients. Diabetes Care 1996;19:341–49.CrossRefGoogle Scholar
  9. 9.
    Moran M. The evolution of the nutritional management of diabetes. Proceedings of the Nutrition Society 2004;63(4):615–20.CrossRefGoogle Scholar
  10. 10.
    Haire-Joshu D, Glasgow RE, Tibbs TL. Smoking and diabetes. Diabetes Care 1999;22:1887–98.CrossRefGoogle Scholar
  11. 11.
    American Diabetes Association. Smoking and diabetes: Position Statement. Diabetes Care 2004;27:S74–S75.CrossRefGoogle Scholar
  12. 12.
    MacFarlane IA. The smoker with diabetes: A difficult challenge. Postgrad Med J 1991;67:928–30.CrossRefGoogle Scholar
  13. 13.
    Stacy RD, Loyd BH. An investigation of beliefs about smoking among diabetes patients: Information for improving cessation efforts. Patient Educ Couns 1990;15:181–89.CrossRefGoogle Scholar
  14. 14.
    Ford ES, Mokdad AH, Gregg EW. Trends in cigarette smoking among US adults with diabetes: Findings from the Behavioral Risk Factor Surveillance System. Prev Med 2004;39:1238–42.CrossRefGoogle Scholar
  15. 15.
    Canadian Diabetes Association Clinical Practice Guidelines Expert Committee: Canadian Diabetes Association 2003 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes 2003;27:s1–s140.Google Scholar
  16. 16.
    Plotnikoff R, Taylor L, Wilson P, Courneya K, Sigal R, Birkett N, et al. Factors associated with physical activity in Canadian adults with diabetes. Med Sci Sports Exerc 2006;38(8):1526–34.CrossRefGoogle Scholar
  17. 17.
    Plotnikoff RC, Lippke S, Prodaniuk T, Wild TC, Barrett JE. Demographic, health, and behavioral factors associated with smoking in adults with type 1 or type 2 diabetes. Am J Health Behav 2007;31(1):13–23.CrossRefGoogle Scholar
  18. 18.
    Plotnikoff R. Physical activity in the management of diabetes: Population-based perspectives and strategies. Can J Diabetes 2006;30(1):52–62.CrossRefGoogle Scholar
  19. 19.
    Statistics Canada. Census. 1996. Available online at: https://doi.org/www.www12.statcan.ca/english/census01/ (Accessed July 16, 2005).Google Scholar
  20. 20.
    Plotnikoff RC, Brez S, Brunet S. Are exercise social-cognitive factors and behaviours different for adults with diabetes? A randomized community sample. Psychology, Health & Medicine 2003;8:465–71.CrossRefGoogle Scholar
  21. 21.
    Plotnikoff R, Brez S, Hotz S. Exercise behavior in a community sample with diabetes: Understanding the determinants of exercise behavioural change. Diabetes Educ 2000;26:450–59.CrossRefGoogle Scholar
  22. 22.
    Godin G, Shephard RJ. A simple method to assess exercise behavior in the community. Can J Appl Sport Sci 1985;10:141–46.PubMedGoogle Scholar
  23. 23.
    Brown WJ, Bauman AE. Comparison of estimates of population levels of physical activity using two measures. Aust N Z J Public Health 2000;24:520–25.CrossRefGoogle Scholar
  24. 24.
    Toobert DJ, Hampson SE, Glasgow RE. The summary of Diabetes Self-care Activities Measure: Results from seven studies and revised scale. Diabetes Care 2000;23:943–50.CrossRefGoogle Scholar
  25. 25.
    Health Canada. Responding to the Challenge of Diabetes in Canada: First Report of the National Diabetes Surveillance System (NDSS). Ottawa, Health Canada, 2003;1–122.Google Scholar
  26. 26.
    Hu FB, Manson JE, Stampfer MJ. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med 2001;345(11):790–97.CrossRefGoogle Scholar
  27. 27.
    Clark D. Physical activity efficacy and effectiveness among older adults and minorities. Diabetes Care 1997;20:1176–81.CrossRefGoogle Scholar
  28. 28.
    Health Canada. Diabetes in Canada — Chapter 3: Risk Factors; 2003. Available online at: https://doi.org/www.phacaspc.gc.ca/publicat/dicdac2/english/22chap3_e.html (Accessed July 2006).Google Scholar
  29. 29.
    Booth GL, Hux JE. Relationship between avoidable hospitalizations for diabetes mellitus and income level. Arch Intern Med 2003;163(1):101–6.CrossRefGoogle Scholar
  30. 30.
    Marmot MG. Understanding social inequalities in health. Perspect Biol Med 2003;46(3 Suppl):S9–S23.CrossRefGoogle Scholar
  31. 31.
    Wee CC, Phillips RS, Legedza AT, Davis RB, Soukup JR, Colditz GA, et al. Health care expenditures associated with overweight and obesity among US adults: Importance of age and race. Am J Public Health 2005;95(1):159–65.CrossRefGoogle Scholar

Copyright information

© The Canadian Public Health Association 2008

Authors and Affiliations

  • Ronald C. Plotnikoff
    • 1
    • 2
    Email author
  • Maria Kotovych
    • 3
  • Nandini D. Karunamuni
    • 1
  • Lawrence W. Svenson
    • 4
    • 5
    • 6
  • Jeffrey A. Johnson
    • 3
    • 4
  1. 1.Centre for Health Promotion Studies, School of Public HealthUniversity of AlbertaEdmontonCanada
  2. 2.Faculty of Physical Education and Recreation, and Alberta Centre for Active LivingUniversity of AlbertaCanada
  3. 3.Institute of Health EconomicsEdmontonCanada
  4. 4.School of Public HealthUniversity of AlbertaCanada
  5. 5.Alberta Health and WellnessEdmontonCanada
  6. 6.Department of Community Health SciencesUniversity of CalgaryCalgaryCanada

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