Predictors of glycemic control in insulin-using adults with type 2 diabetes.
OBJECTIVE
To determine the characteristics that influence glycemic control among insulin-using adults with type 2 diabetes.


METHODS
We studied all 1,333 eligible members of a large not-for-profit health maintenance organization who responded to a 1997 survey. We tested associations among demographic, treatment, and psychometric variables with mean 1997 HbA1c values. The Problem Areas in Diabetes (PAID) instrument was used to assess the emotional effect of living with diabetes, and the Short Form 12 Physical Function Scale was used to assess the effect of physical limitations on daily activities. Based on differences between and within treatment groups, we built models to predict glycemic control for subgroups of subjects who were using insulin alone and those who were using insulin in combination with an oral hypoglycemic agent.


RESULTS
Younger age, lower BMI, and increased emotional distress about diabetes (according to the PAID scale) were all significant predictors (P < 0.05) of worse glycemic control. However, except among individuals with an HbA1c level of >8.0 who were receiving combination therapy, only approximately 10% of the variance in glycemic control could be predicted by demographic, treatment, or psychometric characteristics.


CONCLUSIONS
Personal characteristics explain little of the variation in glycemic control in insulin-using adults with type 2 diabetes. Possible explanations are that the reduced complexity of control in type 2 diabetes makes the disease less sensitive to personal factors than control in type 1 diabetes, that health-related behavior is less driven by personal and environmental characteristics among older individuals, or that, in populations exposed to aggressive glycemic control with oral hypoglycemic agents and nurse care managers, personal differences become largely irrelevant.
Nichols
G A
GA
Center for Health Research, Kaiser Permanente Northwest Division, Portland, Oregon 97227-1098, USA. greg.nichols@kp.org
Hillier
T A
TA
Javor
K
K
Brown
J B
JB
D000203:Activities of Daily Living; D000328:Adult; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy / Q000523:psychology*; D004644:Emotions; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D015438:Health Behavior; D006279:Health Maintenance Organizations; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009922:Oregon; D012044:Regression Analysis
D015415:Biomarkers; D006442:Glycated Hemoglobin; D007328:Insulin