Abstract
A cross-sectional survey of 507 in- and out-patients, with diagnosed Type 2 diabetes mellitus (T2DM) was undertaken to study the relationships between personal, disease and treatment-related factors and diabetes control in a tertiary care hospital. On multivariate logistic regression analysis, self-efficacy (odds ratio (OR) = 2.94; 95% confidence interval (CI) = 1.92–4.54); P < 0.001) was the single most important determinant of current diabetes control (HbA1c ≤ 7%), along with absence of hyperglycemic symptoms in the past year (OR = 1.83; 95% CI = 1.15–2.93, P < 0.01), current treatment with oral medication (OR = 1.77; 95% CI = 1.17–2.66; P < 0.007), and adherence to dietary restrictions (OR = 2.7; 95% CI = 1.28–5.88; P < 0.009). Self-efficacy was itself influenced by educational status, employment, availability of family support, and positive mental attitudes. Our findings suggest that health care delivery inputs, patients’ personal characteristics including education and attitude, and family support for care are complexly processed to determine patients’ ability to manage their disease, which ultimately influences disease outcomes.
Similar content being viewed by others
References
Aljasem, L. I., Peyrot, M., Wissow, L., & Rubin, R. R. (2001). The impact of barriers and self-efficacy on self-care behaviors in type 2 diabetes. The Diabetes Educator, 27(3), 393–404.
WHO Expert Consultation. (2004). Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet, 363(9403), 157–163. doi:10.1016/S0140-6736(03)15268-3.
Bandura, A. (1989). Human agency in social cognitive theory. The American Psychologist, 44(9), 1175–1184.
Benoit, S. R., Fleming, R., Philis-Tsimikas, A., & Ji, M. (2005). Predictors of glycemic control among patients with type 2 diabetes: A longitudinal study. BMC Public Health, 5, 36. doi:10.1186/1471-2458-5-36.
Bjork, S., Kapur, A., King, H., Nair, J., & Ramachandran, A. (2003). Global policy: Aspects of diabetes in India. Health Policy, 66(1), 61–72. doi:S0168851003000447[pii].
Chobanian, A. V., Bakris, G. L., Black, H. R., et al. (2003). The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: The JNC 7 report. The Journal of the American Medical Association, 289(19), 2560–2572. doi:10.1001/jama.289.19.2560.
Cook, C. B., Castro, J. C., Schmidt, R. E., et al. (2007). Diabetes care in hospitalized noncritically ill patients: More evidence for clinical inertia and negative therapeutic momentum. Journal of Hospital Medicine, 2(4), 203–211. doi:10.1002/jhm.188.
DiMatteo, M. R. (2004). Social support and patient adherence to medical treatment: A meta-analysis. Health Psychology, 23(2), 207–218. doi:10.1037/0278-6133.23.2.207.
Fitzgerald, J. T., Davis, W. K., Connell, C. M., Hess, G. E., Funnell, M. M., & Hiss, R. G. (1996). Development and validation of the Diabetes Care Profile. Evaluation and the Health Professions, 19(2), 208–230.
Fox, K. M., Gerber Pharmd, R. A., Bolinder, B., Chen, J., & Kumar, S. (2006). Prevalence of inadequate glycemic control among patients with type 2 diabetes in the United Kingdom general practice research database: A series of retrospective analyses of data from 1998 through 2002. Clinical Therapeutics, 28(3), 388–395. doi:10.1016/j.clinthera.2006.03.005.
Grace, S. L., Barry-Bianchi, S., Stewart, D. E., Rukholm, E., & Nolan, R. P. (2007). Physical activity behavior, motivational readiness and self-efficacy among Ontarians with cardiovascular disease and diabetes. Journal of Behavioral Medicine, 30(1), 21–29. doi:10.1007/s10865-006-9080-5.
Heisler, M., Smith, D. M., Hayward, R. A., Krein, S. L., & Kerr, E. A. (2003). How well do patients’ assessments of their diabetes self-management correlate with actual glycemic control and receipt of recommended diabetes services? Diabetes Care, 26(3), 738–743.
Howteerakul, N., Suwannapong, N., Rittichu, C., & Rawdaree, P. (2007). Adherence to regimens and glycemic control of patients with type 2 diabetes attending a tertiary hospital clinic. Asia Pacific Journal of Public Health, 19(1), 43–49.
Hurley, A. C., & Shea, C. A. (1992). Self-efficacy: strategy for enhancing diabetes self-care. The Diabetes Educator, 18(2), 146–150.
MR, I. C. (2005). Guidelines for management of type 2 diabetes. New Delhi, India: Indian Council for Medical Research.
IDF. (2009). IDF diabetes atlas (4th ed.). Brussels, Belgium: International Diabetes Federation.
Jacob, K. S., Bhugra, D., & Mann, A. H. (1997). The validation of the 12-item General Health Questionnaire among ethnic Indian women living in the United Kingdom. Psychological Medicine, 27(5), 1215–1217.
Johnston-Brooks, C. H., Lewis, M. A., & Garg, S. (2002). Self-efficacy impacts self-care and HbA1c in young adults with type I diabetes. Psychosomatic Medicine, 64(1), 43–51.
King, D. K., Glasgow, R. E., Toobert, D. J., et al. (2010). Self-efficacy, problem solving, and social-environmental support are associated with diabetes self-management behaviors. Diabetes Care, 33(4), 751–753. doi:dc09-1746[pii]10.2337/dc09-1746.
Kosachunhanun, N., Benjasuratwong, Y., Mongkolsomlit, S., et al. (2006). Thailand diabetes registry project: Glycemic control in Thai type 2 diabetes and its relation to hypoglycemic agent usage. Journal of the Medical Association of Thailand, 89(Suppl 1), S66–S71.
Lange, L. J., & Piette, J. D. (2005). Perceived health status and perceived diabetes control: Psychological indicators and accuracy. Journal of Psychosomatic Research, 58(2), 129–137. doi:10.1016/j.jpsychores.2004.08.004.
Lee, A., Siu, C. F., Leung, K. T., Lau, L. C., Chan, C. C., & Wong, K. K. (2011). General practice and social service partnership for better clinical outcomes, patient self efficacy and lifestyle behaviours of diabetic care: Randomised control trial of a chronic care model. Postgraduate Medical Journal. doi:10.1136/pgmj.2011.118885.
Lerman, I., Lozano, L., Villa, A. R., et al. (2004). Psychosocial factors associated with poor diabetes self-care management in a specialized center in Mexico City. Biomedicine and Pharmacotherapy, 58(10), 566–570. doi:10.1016/j.biopha.2004.09.003.
Mahmood, K., & Aamir, A. H. (2005). Glycemic control status in patients with type-2 diabetes. Journal of the College of Physicians and Surgeons—Pakistan, 15(6), 323–325.
Matsushita, Y., Yokoyama, T., Homma, T., Tanaka, H., & Kawahara, K. (2005). Relationship between the ability to recognize energy intake and expenditure, and blood sugar control in type 2 diabetes mellitus patients. Diabetes Research and Clinical Practice, 67(3), 220–226. doi:10.1016/j.diabres.2004.07.019.
Mishali, M., Omer, H., & Heymann, A. D. (2011). The importance of measuring self-efficacy in patients with diabetes. Family Practice, 28(1), 82–87. doi:cmq086[pii]10.1093/fampra/cmq086.
Misra, A., Vikram, N. K., Gupta, R., Pandey, R. M., Wasir, J. S., & Gupta, V. P. (2006). Waist circumference cutoff points and action levels for Asian Indians for identification of abdominal obesity. International Journal of Obesity (Lond), 30(1), 106–111. doi:0803111[pii]10.1038/sj.ijo.0803111.
Nagpal, J., & Bhartia, A. (2006). Quality of diabetes care in the middle- and high-income group populace: The Delhi Diabetes Community (DEDICOM) survey. Diabetes Care, 29(11), 2341–2348. doi:10.2337/dc06-0783.
Nichols, G. A., Hillier, T. A., Javor, K., & Brown, J. B. (2000). Predictors of glycemic control in insulin-using adults with type 2 diabetes. Diabetes Care, 23(3), 273–277.
Osborn, C. Y., Bains, S. S., & Egede, L. E. (2010). Health literacy, diabetes self-care, and glycemic control in adults with type 2 diabetes. Diabetes Technology and Therapeutics, 12(11), 913–919. doi:10.1089/dia.2010.0058.
Osborn, C. Y., Cavanaugh, K., Wallston, K. A., & Rothman, R. L. (2010). Self-efficacy links health literacy and numeracy to glycemic control. Journal of Health Communication, 15(Suppl 2), 146–158. doi:10.1080/10810730.2010.499980.
Puder, J. J., & Keller, U. (2003). Quality of diabetes care: problem of patient or doctor adherence? Swiss Medical Weekly, 133(39–40), 530–534.
Raheja, B. S., Kapur, A., Bhoraskar, A., et al. (2001). DiabCare Asia—India study: Diabetes care in India—current status. The Journal of the Association of Physicians of India, 49, 717–722.
Rayappa, P. H., Raju, K. N. M., Kapur, A., Bjork, S., Sylvest, C., & Kumar, K. M. D. (1999). The impact of socio-economic factors on diabetes care. International Journal of Diabetes in Developing Countries, 19, 8–16.
Resnick, H. E., Foster, G. L., Bardsley, J., & Ratner, R. E. (2006). Achievement of American Diabetes Association clinical practice recommendations among U.S. adults with diabetes, 1999–2002: The National Health and Nutrition Examination Survey. Diabetes Care, 29(3), 531–537.
Rosland, A. M., Kieffer, E., Israel, B., et al. (2008). When is social support important? The association of family support and professional support with specific diabetes self-management behaviors. Journal of General Internal Medicine, 23(12), 1992–1999. doi:10.1007/s11606-008-0814-7.
Schillinger, D., Grumbach, K., Piette, J., et al. (2002). Association of health literacy with diabetes outcomes. The Journal of the American Medical Association, 288(4), 475–482.
Shi, Q., Ostwald, S. K., & Wang, S. (2010). Improving glycaemic control self-efficacy and glycaemic control behaviour in Chinese patients with type 2 diabetes mellitus: randomised controlled trial. Journal of Clinical Nursing, 19(3–4), 398–404. doi:10.1111/j.1365-2702.2009.03040.x.
Trief, P. M., Morin, P. C., Izquierdo, R., et al. (2006). Depression and glycemic control in elderly ethnically diverse patients with diabetes: the IDEATel project. Diabetes Care, 29(4), 830–835.
Venkataraman, K., Kannan, A. T., & Mohan, V. (2009). Challenges in diabetes management with particular reference to India. International Journal of Diabetes in Developing Countries, 29(3), 103–109. doi:10.4103/0973-3930.54286.
WHO. (1999). Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia: Report of a WHO/IDF consultation. Geneva, Switzerland: World Health Organization.
WHO. (2002). Diet, nutrition and the prevention of chronic diseases. Joint WHO/FAO Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases. Geneva, Switzerland: World Health Organization.
Wynn Nyunt, S., Howteerakul, N., Suwannapong, N., & Rajatanun, T. (2010). Self-efficacy, self-care behaviors and glycemic control among type-2 diabetes patients attending two private clinics in Yangon, Myanmar. The Southeast Asian Journal of Tropical Medicine and Public Health, 41(4), 943–951.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Venkataraman, K., Kannan, A.T., Kalra, O.P. et al. Diabetes Self-Efficacy Strongly Influences Actual Control of Diabetes in Patients Attending a Tertiary Hospital in India. J Community Health 37, 653–662 (2012). https://doi.org/10.1007/s10900-011-9496-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10900-011-9496-x