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Factors Influencing Disease Self-Management Among Veterans with Diabetes and Poor Glycemic Control

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Journal of General Internal Medicine Aims and scope Submit manuscript

Specific Aim

Although the Department of Veterans Affairs (VA) has made significant organizational changes to improve diabetes care, diabetes self-management has received limited attention. The purpose of this study is to assess factors influencing diabetes self-management among veterans with poorly controlled diabetes.

Methods

Surveys were mailed to patients with type 2 diabetes and a HbA1c of 8% or greater who attended 1 of 2 VA Medical Centers in Washington State (n = 1,286). Validated survey instruments assessed readiness to change, self-efficacy, provider advice, and diabetes self-care practices.

Results

Our response rate was 56% (n = 717). Most respondents reported appropriate advice from physicians regarding physical activity, nutrition, and glucose monitoring (73%, 92%, and 98%, respectively), but many were not ready to change self-management behaviors. Forty-five percent reported non-adherence to medications, 42% ate a high-fat diet, and only 28% obtained either moderate or vigorous physical activity. The mean self-efficacy score for diabetes self-care was low and half of the sample reported readiness to change nutrition (52%) or physical activity (51%). Individuals with higher self-efficacy scores were more likely to adhere to medications, follow a diabetic meal plan, eat a lower fat diet, have higher levels of physical activity, and monitor their blood sugars (P < .001 for all).

Conclusions

Although veterans with poor diabetes control receive appropriate medical advice, many were not sufficiently confident or motivated to make and maintain self-management changes. Targeted patient-centered interventions may need to emphasize increasing self-efficacy and readiness to change to further improve VA diabetes outcomes.

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Acknowledgements

This project received funding from Health Services Research and Development, Department of Veterans Affairs, Diabetes QUERI (DIB 04-385). The views expressed in this article are those of the authors and do not represent the views of the Department of Veterans Affairs. This research was presented in part at the April 26–29, 2006 annual meeting of the Society for General Internal Medicine and the February 21--23, 2007 annual meeting of VA Health Services Research and Development. Thanks to Jane Emens for administrative support.

Potential Financial Conflicts of Interest

None disclosed.

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Authors and Affiliations

  1. Primary and Specialty Medical Care Service, VA Puget Sound Health Care System, Seattle, WA, USA

    Karin M. Nelson MD, MSHS

  2. Department of Medicine, University of Washington, Seattle, WA, USA

    Karin M. Nelson MD, MSHS

  3. Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA, USA

    Karin M. Nelson MD, MSHS, Lynne McFarland PhD & Gayle Reiber PhD, MPH

  4. Departments of Health Services and Epidemiology, University of Washington, Seattle, WA, USA

    Lynne McFarland PhD & Gayle Reiber PhD, MPH

  5. 1660 South Columbian Way, S-111-GIMC, Seattle, WA, 98108-1597, USA

    Karin M. Nelson MD, MSHS

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  1. Karin M. Nelson MD, MSHS
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Correspondence to Karin M. Nelson MD, MSHS.

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Nelson, K.M., McFarland, L. & Reiber, G. Factors Influencing Disease Self-Management Among Veterans with Diabetes and Poor Glycemic Control. J GEN INTERN MED 22, 442–447 (2007). https://doi.org/10.1007/s11606-006-0053-8

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