Medical College of Wisconsin
CTSICores SearchResearch InformaticsREDCap

Direct and indirect effects of neighborhood factors and self-care on glycemic control in adults with type 2 diabetes. J Diabetes Complications 2015 Mar;29(2):186-91



Pubmed ID




Scopus ID

2-s2.0-84923008141 (requires institutional sign-in at Scopus site)   27 Citations


AIM: To determine whether neighborhood factors have direct or indirect effects, via self-care behaviors on glycemic control.

METHODS: Adult patients with type 2 diabetes were recruited from an academic medical center and Veterans Affairs Medical Center in the southeastern United States. Confirmatory factor analysis was used to create latent variables for neighborhood factors and diabetes self-care behavior. Structural equation modeling was used to test direct and indirect effects between neighborhood factors and glycemic control as assessed by HbA1c levels.

RESULTS: CFA yielded four latent variables for neighborhood factors (neighborhood violence, access to healthy food, social support, and neighborhood aesthetics) and one latent variable diabetes self-care. We found that social support (β=0.28, z=4.86, p<0.001) and access to healthy foods (β=-0.17, z=-2.95, p=0.003) had direct effects on self-care; self-care (β=-0.15, z=-2.48, p=0.013) and neighborhood aesthetics (β=0.12, z=2.19, p=0.03) had direct effects on glycemic control; while social support (β=-0.04, z=-2.26, p=0.02) had an indirect effect on glycemic control via self-care.

CONCLUSION: This study showed that self-care behaviors and neighborhood aesthetics have direct effects on glycemic control, social support and access to health foods had direct effects on self-care, and social support had an indirect effect on glycemic control via self-care.

Author List

Smalls BL, Gregory CM, Zoller JS, Egede LE


Leonard E. Egede MD Center Director, Chief, Professor in the Medicine department at Medical College of Wisconsin

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

Blood Glucose Self-Monitoring
Combined Modality Therapy
Cross-Sectional Studies
Diabetes Mellitus, Type 2
Diet, Diabetic
Factor Analysis, Statistical
Food Supply
Middle Aged
Models, Psychological
Residence Characteristics
Self Care
Self Report
Social Support
South Carolina
Young Adult