Faculty Collaboration Database

Quantifying direct effects of social determinants of health on glycemic control in adults with type 2 diabetes. Diabetes Technol Ther 2015 Feb;17(2):80-7

Date

11/02/2014

Pubmed ID

25361382

Pubmed Central ID

PMC4322090

DOI

10.1089/dia.2014.0166

Scopus ID

2-s2.0-84922453988 (requires institutional sign-in at Scopus site)   47 Citations

Abstract

BACKGROUND: The aim of this study was to investigate if self-care is the pathway through which social determinants of health impact diabetes outcomes by analyzing the direct and indirect effects of socioeconomic and psychosocial factors on self-care and glycemic control.

SUBJECTS AND METHODS: Six hundred fifteen adults were recruited from two primary care clinics in the southeastern United States. A series of confirmatory factor analyses identified the latent factors underlying social status, psychosocial determinants (psychological distress, self-efficacy, and social support), and self-care (diet, exercise, foot care, glucose testing, and medication adherence). Structured equation modeling investigated the relationship among social determinants, self-care and glycemic control.

RESULTS: Latent variables were created for diabetes self-care, psychological distress, self-efficacy, social support, and social status. The final model [χ(2)(275)=450.07, P<0.001, R(2)=99, root mean square error of approximation=0.03, comparative fit index=0.98] showed lower psychological distress (r=-0.13, P=0.012), higher social support (r=0.14, P=0.01), and higher self-efficacy (r=0.47, P<0.001) were significantly related to diabetes self-care. Lower psychological distress (r=0.10, P=0.03), lower social support (r=0.10, P=0.02), and higher self-efficacy (r=-0.37, P<0.001) were significantly related to lower glycemic control. When social determinants of health variables were included in the model, self-care was no longer significantly associated with glycemic control (r=0.01, P=0.83).

CONCLUSIONS: This study suggests a direct relationship between psychosocial determinants of health and glycemic control. Although associated with self-care, the relationship between social determinants of health and glycemic control is not mediated by self-care. Development of interventions should take psychosocial factors into account as independent influences on diabetes outcomes, rather than as indirect influences via self-care behavior.

Author List

Walker RJ, Gebregziabher M, Martin-Harris B, Egede LE

MESH terms used to index this publication - Major topics in bold

Adult
Blood Glucose
Blood Glucose Self-Monitoring
Diabetes Mellitus, Type 2
Exercise
Feeding Behavior
Female
Health Knowledge, Attitudes, Practice
Humans
Male
Middle Aged
Self Care
Social Determinants of Health
Social Support
Southeastern United States