Relationship of diabetes-specific knowledge to self-management activities, ambulatory preventive care, and metabolic outcomes.
BACKGROUND
Educational interventions increase diabetes patients' knowledge and self-care activities, but their impact on the use of health services to prevent diabetes complications is unclear. We sought to determine the relationship of patients' diabetes-specific knowledge with self-management behaviors, use of ambulatory preventive care, and metabolic outcomes.


METHODS
We surveyed 670 adults with diabetes from three managed care plans to assess diabetes knowledge (using an eight-item scale) and self-management activities. With chart review, we assessed five processes of care--retinal and foot examinations, low-density lipoprotein cholesterol (LDL-C) testing, hemoglobin A1c (HbA1c) testing, and urine microalbumin testing--and three metabolic outcomes--HbA1c < or = 9.5%, LDL-C <130 mg/dL (3.36 mmol/L), and last blood pressure <140/90 mm Hg.


RESULTS
In adjusted analyses, a one-point increase on the knowledge scale was associated with following a diabetes diet (OR 1.23, 95% CI 1.10-1.38), blood glucose self-measurement (OR 1.29, 95% CI 1.13-1.48), and regular exercise (OR 1.15, 95% CI 1.03-1.28) but not with processes of care or metabolic outcomes.


CONCLUSIONS
Knowledgeable patients were more likely to perform self-management activities but not to receive recommended ambulatory care or reach metabolic outcome goals. Providing patient education about diabetes care processes should be tested as a means of increasing ambulatory care to prevent diabetes complications.
Persell
Stephen D
SD
Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Keating
Nancy L
NL
Landrum
Mary Beth
MB
Landon
Bruce E
BE
Ayanian
John Z
JZ
Borbas
Catherine
C
Guadagnoli
Edward
E
D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D002784:Cholesterol / Q000097:blood; D003920:Diabetes Mellitus / Q000097:blood / Q000451:nursing / Q000517:prevention & control*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention / Q000706:statistics & numerical data; D012648:Self Care; D012959:Socioeconomic Factors
D002784:Cholesterol