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Diabetes Self-Efficacy Strongly Influences Actual Control of Diabetes in Patients Attending a Tertiary Hospital in India

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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.

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References

  1. 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.

    Article  PubMed  CAS  Google Scholar 

  2. 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.

    Google Scholar 

  3. Bandura, A. (1989). Human agency in social cognitive theory. The American Psychologist, 44(9), 1175–1184.

    Article  PubMed  CAS  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. 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].

    Article  PubMed  Google Scholar 

  6. 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.

    Article  CAS  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. 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.

    Article  CAS  Google Scholar 

  10. 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.

    Article  PubMed  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  PubMed  Google Scholar 

  13. 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.

    Article  PubMed  CAS  Google Scholar 

  14. Hurley, A. C., & Shea, C. A. (1992). Self-efficacy: strategy for enhancing diabetes self-care. The Diabetes Educator, 18(2), 146–150.

    Article  PubMed  CAS  Google Scholar 

  15. MR, I. C. (2005). Guidelines for management of type 2 diabetes. New Delhi, India: Indian Council for Medical Research.

    Google Scholar 

  16. IDF. (2009). IDF diabetes atlas (4th ed.). Brussels, Belgium: International Diabetes Federation.

    Google Scholar 

  17. 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.

    Article  PubMed  CAS  Google Scholar 

  18. 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.

    PubMed  Google Scholar 

  19. 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.

    Article  PubMed  Google Scholar 

  20. 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.

    PubMed  Google Scholar 

  21. 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.

    Article  PubMed  Google Scholar 

  22. 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.

  23. 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.

    Article  Google Scholar 

  24. 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.

    PubMed  Google Scholar 

  25. 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.

    Article  PubMed  Google Scholar 

  26. 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.

    Article  PubMed  CAS  Google Scholar 

  27. 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.

    Article  CAS  Google Scholar 

  28. 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.

    Article  PubMed  Google Scholar 

  29. 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.

    Article  PubMed  CAS  Google Scholar 

  30. 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.

    Article  PubMed  Google Scholar 

  31. 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.

    Article  PubMed  Google Scholar 

  32. Puder, J. J., & Keller, U. (2003). Quality of diabetes care: problem of patient or doctor adherence? Swiss Medical Weekly, 133(39–40), 530–534.

    PubMed  Google Scholar 

  33. 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.

    PubMed  CAS  Google Scholar 

  34. 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.

    Google Scholar 

  35. 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.

    Article  PubMed  Google Scholar 

  36. 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.

    Article  PubMed  Google Scholar 

  37. 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.

    Article  Google Scholar 

  38. 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.

    Article  PubMed  Google Scholar 

  39. 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.

    Article  PubMed  Google Scholar 

  40. 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.

    Article  PubMed  Google Scholar 

  41. WHO. (1999). Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia: Report of a WHO/IDF consultation. Geneva, Switzerland: World Health Organization.

    Google Scholar 

  42. 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.

    Google Scholar 

  43. 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.

    PubMed  Google Scholar 

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Correspondence to Kavita Venkataraman.

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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

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