title: Does physician communication influence older patients' diabetes self-management and glycemic control? Results from the Health and Retirement Study (HRS).
abstract: BACKGROUND
  Effective chronic disease self-management among older adults is crucial for improved clinical outcomes. We assessed the relative importance of two dimensions of physician communication-provision of information (PCOM) and participatory decision-making (PDM)-for older patients' diabetes self-management and glycemic control.
  
  
  METHODS
  We conducted a national cross-sectional survey among 1588 older community-dwelling adults with diabetes (response rate: 81%). Independent associations were examined between patients' ratings of their physician's PCOM and PDM with patients' reported diabetes self-management (medication adherence, diet, exercise, blood glucose monitoring, and foot care), adjusting for patient sociodemographics, illness severity, and comorbidities. Among respondents for whom hemoglobin A1c (HbA1c) values were available (n=1233), the relationship was assessed between patient self-management and HbA1c values.
  
  
  RESULTS
  In separate multivariate regressions, PCOM and PDM were each associated with overall diabetes self-management (p<.001) and with all self-management domains (p<.001 in all models), with the exception of PDM not being associated with medication adherence. In models with both PCOM and PDM, PCOM alone predicted medication adherence (p=.001) and foot care (p=.002). PDM alone was associated with exercise and blood glucose monitoring (both p<.001) and was a stronger independent predictor than PCOM of diet. Better patient ratings of their diabetes self-management were associated with lower HbA1c values (B= -.10, p=.005).
  
  
  CONCLUSIONS
  Among these older adults, both their diabetes providers' provision of information and efforts to actively involve them in treatment decision-making were associated with better overall diabetes self-management. Involving older patients in setting chronic disease goals and decision-making, however, appears to be especially important for self-care areas that demand more behaviorally complex lifestyle adjustments such as exercise, diet, and blood glucose monitoring.
authors.affiliation: Veterans Affairs Center for Practice Management & Outcomes Research, VA Ann Arbor Healthcare System, Michigan 48109, USA. mheisler@med.umich.edu
authors.forename: Michele
authors.initials: M
authors.lastname: Heisler
authors.forename: Ian
authors.initials: I
authors.lastname: Cole
authors.forename: David
authors.initials: D
authors.lastname: Weir
authors.forename: Eve A
authors.initials: EA
authors.lastname: Kerr
authors.forename: Rodney A
authors.initials: RA
authors.lastname: Hayward
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D003142:Communication; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010817:Physician-Patient Relations; D012648:Self Care
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin