Social determinants of health in adults with type 2 diabetes--Contribution of mutable and immutable factors. Diabetes Res Clin Pract 2015 Nov;110(2):193-201
Date
09/29/2015Pubmed ID
26411692Pubmed Central ID
PMC4681588DOI
10.1016/j.diabres.2015.09.007Scopus ID
2-s2.0-84949976720 (requires institutional sign-in at Scopus site) 40 CitationsAbstract
AIMS: Socioeconomic, psychosocial, and neighborhood factors influence clinical outcomes and self-care behaviors in diabetes; however, few studies simultaneously assessed the impact of multiple social determinant of health factors on glycemic control. We used an explanatory model to examine the differential contribution of social determinants and clinical factors on glycemic control. Secondarily, we examined the contribution of mutable and immutable factors to identify meaningful future interventions.
METHODS: Six hundred and fifteen adults with type 2 diabetes in the southeastern United States were recruited. A hierarchical model was run with HbA1c as the dependent variable and independent variables entered in blocks: demographics (block 1), socioeconomic (block 2), psychosocial (block 3), built environment (block 4), clinical (block 5), and knowledge/self-care (block 6).
RESULTS: Significant associations for HbA1c included self-efficacy (β=-0.10, p<0.001), social support (β=0.01, p<0.05), comorbidity (β=-0.09, p<0.05), insulin use (β=0.95, p<0.001), medication adherence (β=-0.11, p<0.05), and being a former smoker (β=0.34, p<0.05); accounting for 24.4% of the variance.
CONCLUSIONS: Important factors that drive glycemic control are mutable, and amenable to health interventions. Greater attention should be given to interventions that increase self-efficacy and social support, reduce the burden of comorbidities, and enhance medication adherence and smoking cessation.
Author List
Walker RJ, Smalls BL, Egede LEAuthors
Leonard E. Egede MD Center Director, Chief, Professor in the Medicine department at Medical College of WisconsinRebekah Walker PhD Associate Professor in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultDiabetes Mellitus, Type 2
Female
Humans
Incidence
Male
Medication Adherence
Middle Aged
Risk Factors
Self Care
Self Efficacy
Social Determinants of Health
Social Support
United States
Young Adult
