Factors influencing disease self-management among veterans with diabetes and poor glycemic control.
OBJECTIVE
Although the Department of Veterans Affairs (VA) has made significant organizational changes to improve diabetes care, diabetes self-management has received limited attention. The purpose of this study is to assess factors influencing diabetes self-management among veterans with poorly controlled diabetes.


METHODS
Surveys were mailed to patients with type 2 diabetes and a HbA1c of 8% or greater who attended 1 of 2 VA Medical Centers in Washington State (n = 1,286). Validated survey instruments assessed readiness to change, self-efficacy, provider advice, and diabetes self-care practices.


RESULTS
Our response rate was 56% (n = 717). Most respondents reported appropriate advice from physicians regarding physical activity, nutrition, and glucose monitoring (73%, 92%, and 98%, respectively), but many were not ready to change self-management behaviors. Forty-five percent reported non-adherence to medications, 42% ate a high-fat diet, and only 28% obtained either moderate or vigorous physical activity. The mean self-efficacy score for diabetes self-care was low and half of the sample reported readiness to change nutrition (52%) or physical activity (51%). Individuals with higher self-efficacy scores were more likely to adhere to medications, follow a diabetic meal plan, eat a lower fat diet, have higher levels of physical activity, and monitor their blood sugars (P < .001 for all).


CONCLUSIONS
Although veterans with poor diabetes control receive appropriate medical advice, many were not sufficiently confident or motivated to make and maintain self-management changes. Targeted patient-centered interventions may need to emphasize increasing self-efficacy and readiness to change to further improve VA diabetes outcomes.
Nelson
Karin M
KM
Primary and Specialty Medical Care Service, VA Puget Sound Health Care System, Seattle, WA, USA. Karin.Nelson@va.gov
McFarland
Lynne
L
Reiber
Gayle
G
D000328:Adult; D000368:Aged; D003625:Data Collection; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D019468:Disease Management; D005260:Female; D038321:Glycemic Index; D006801:Humans; D008297:Male; D008875:Middle Aged; D012648:Self Care / Q000379:methods / Q000523:psychology; D020377:Self Efficacy; D014728:Veterans / Q000523:psychology