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Modeling predictors of changes in glycemic control and diabetes-specific quality of life amongst adults with type 1 diabetes 1 year after structured education in flexible, intensive insulin therapy

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Abstract

Few studies have identified determinants of glycemic control (HbA1c) and diabetes-specific quality of life (DSQoL) in adults with type 1 diabetes. To identify factors predicting outcomes following structured diabetes education. 262 participants completed biomedical and questionnaire assessments before, and throughout 1 year of follow-up. The proportion of variance explained ranged from 28 to 62 % (DSQoLS) and 14–20 % (HbA1c). When change in psychosocial variables were examined, reduced hypoglycemia fear, lower ‘perceived diabetes seriousness’, greater self-efficacy and well-being predicted QoL improvements from baseline to 3-months. Increased frequency of blood glucose testing predicted improvements in HbA1c from baseline to 6-months. Greater benefits may be achieved if programs focus explicitly on psychosocial factors. Self-care behaviours did not predict HbA1c suggesting existing assessment tools need refinement. Evaluation of treatment mechanisms in selfmanagement programs is recommended.

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Acknowledgments

This article presents independent research commissioned by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0606-1184). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. We thank all the research participants for their time and interest in the study; and Dr. Celia Emery and all the DAFNE educators and administrators who helped with recruitment.

Conflict of Interest

Debbie Cooke, Rod Bond, Julia Lawton, David Rankin, Simon Heller, Marie Clark, and Jane Speight declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. School of Health Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK

    Debbie Cooke

  2. School of Psychology, University of Sussex, Brighton, UK

    Rod Bond

  3. Department of Population Health Sciences, Edinburgh University, Edinburgh, Scotland, UK

    Julia Lawton & David Rankin

  4. Academic Unit of Diabetes, University of Sheffield, Sheffield, UK

    Simon Heller

  5. Epidemiology and Public Health, University College London, London, UK

    Marie Clark

  6. AHP Research, Hornchurch, UK

    Jane Speight

  7. The Australian Centre for Behavioural Research in Diabetes, Diabetes Australia – Vic, Melbourne, VIC, Australia

    Jane Speight

  8. Centre for Mental Health and Wellbeing Research, School of Psychology, Deakin University, Burwood, VIC, Australia

    Jane Speight

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  1. Debbie Cooke
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Correspondence to Debbie Cooke.

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For the UK NIHR DAFNE Study Group.

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Cooke, D., Bond, R., Lawton, J. et al. Modeling predictors of changes in glycemic control and diabetes-specific quality of life amongst adults with type 1 diabetes 1 year after structured education in flexible, intensive insulin therapy. J Behav Med 38, 817–829 (2015). https://doi.org/10.1007/s10865-015-9649-y

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