Supporting autonomy to motivate patients with diabetes for glucose control.
OBJECTIVE
We applied the self-determination theory of human motivation to examine whether patient perceptions of autonomy supportiveness (i.e., patient centeredness) from their diabetes care providers related to improved glucose control over a 12-month period.


METHODS
We conducted a prospective cohort study of patients with diabetes from a diabetes treatment center at a university-affiliated community hospital. Participants were 128 patients between 18 and 80 years of age who took medication for diabetes, had no other major medical illnesses, and were responsible for monitoring their glucose and taking their medications. The main outcome measure was a change in HbA1c values over the 12 months of the study


RESULTS
Patient perception of autonomy support from a health care provider related to a change in HbA1c values at 12 months (P < 0.05). Further analyses showed that perceived autonomy support from the staff related to significant increases in patient autonomous motivation at 12 months (P < 0.05); that increases in autonomous motivation related to significant increases in perceived competence (P < 0.05); and that increases in a patient's perceived competence related to significant reductions in their HbA1c values over 12 months (P < 0.001).


CONCLUSIONS
The findings support the prediction of the self-determination theory that patients with diabetes whose health care providers are autonomy supportive will become more motivated to regulate their glucose levels, feel more able to regulate their glucose, and show improvements in their HbA1c values.
Department of Medicine, The Genesee Hospital, the University of Rochester, New York 14627, USA. williams@psych.rochester.edu
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D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring; D003710:Demography; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy* / Q000523:psychology*; D005260:Female; D005610:Freedom; D006442:Glycated Hemoglobin / Q000032:analysis; D006764:Hospitals, Community; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D009042:Motivation; D009518:New York; D010349:Patient Compliance; D012649:Self Concept; D012647:Self-Assessment; D012944:Social Support; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
D001786:Blood Glucose; D006442:Glycated Hemoglobin