The influence of diabetes psychosocial attributes and self-management practices on change in diabetes status.

TitleThe influence of diabetes psychosocial attributes and self-management practices on change in diabetes status.
Publication TypeJournal Article
Year of Publication2012
AuthorsZulman, DM, Rosland, AMarie, Choi, H, Langa, KM, Heisler, MM
JournalPatient Educ Couns
Date Published2012 Apr
ISSN Number1873-5134
KeywordsAged, Blood Glucose Self-Monitoring, Cross-Sectional Studies, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Disease Management, Female, Glycated Hemoglobin, Health Knowledge, Attitudes, Practice, Health Status, Humans, Interviews as Topic, Male, Middle Aged, Multivariate Analysis, Risk Factors, Self Care, Self Efficacy, Severity of Illness Index, Social Support, Stress, Psychological, Surveys and Questionnaires, Treatment Outcome

OBJECTIVE: To examine the influence of diabetes psychosocial attributes and self-management on glycemic control and diabetes status change.

METHODS: Using data from the Health and Retirement Study, a nationally representative longitudinal study of U.S. adults >51 years, we examined cross-sectional relationships among diabetes psychosocial attributes (self-efficacy, risk awareness, care understanding, prioritization of diabetes, and emotional distress), self-management ratings, and glycemic control. We then explored whether self-management ratings and psychosocial attributes in 2003 predicted change in diabetes status in 2004.

RESULTS: In multivariate analyses (N=1834), all diabetes psychosocial attributes were associated with self-management ratings, with self-efficacy and diabetes distress having the strongest relationships (adj coeff=8.1, p<0.01 and -4.1, p<0.01, respectively). Lower self-management ratings in 2003 were associated cross-sectionally with higher hemoglobin A1C (adj coeff=0.16, p<0.01), and with perceived worsening diabetes status in 2004 (adj OR=1.36, p<0.05), with much of this latter relationship explained by diabetes distress.

CONCLUSION: Psychosocial attributes, most notably diabetes-related emotional distress, contribute to difficulty with diabetes self-management, poor glycemic control, and worsening diabetes status over time.

PRACTICE IMPLICATIONS: Self-management and adherence interventions should target psychosocial attributes such as disease-related emotional distress.


Zulman, Donna M Rosland, Ann-Marie Choi, Hwajung Langa, Kenneth M Heisler, Michele U01 AG09740/AG/NIA NIH HHS/ Ireland Patient Educ Couns. 2012 Apr;87(1):74-80. Epub 2011 Aug 15.

User Guide Notes

Endnote Keywords

Diabetes/glycemic control/glycemic control/psycho-social/self-management

Endnote ID


Alternate JournalPatient Educ Couns
Citation Key7718
PubMed ID21840149
PubMed Central IDPMC3229832
Grant ListP30 DK092926 / DK / NIDDK NIH HHS / United States
U01 AG009740 / AG / NIA NIH HHS / United States
U01 AG009740-22 / AG / NIA NIH HHS / United States
U01 AG09740 / AG / NIA NIH HHS / United States