title: Reducing the health risks of diabetes: how self-determination theory may help improve medication adherence and quality of life.
abstract: The purpose of this study is to apply the self-determination theory (SDT) model of health behavior to predict medication adherence, quality of life, and physiological outcomes among patients with diabetes.
  
  
  
  Patients with diabetes (N = 2973) receiving care from an integrated health care delivery system in 2003 and 2004 were identified from automated databases and invited to participate in this study. In 2005, patients responded to a mixed telephone-and-mail survey assessing perceived autonomy support from health care providers, autonomous self-regulation for medication use, perceived competence for diabetes self-management, medication adherence, and quality of life. In 2006, pharmacy claims data were used to indicate medication adherence, and patients' non-high-density lipoprotein (HDL) cholesterol, A1C, and glucose levels were assessed.
  
  
  
  The SDT model of health behavior provided adequate fit to the data. As hypothesized, perceived autonomy support from health care providers related positively to autonomous self-regulation for medication use, which in turn related positively to perceived competence for diabetes self-management. Perceived competence then related positively to quality of life and medication adherence, and the latter construct related negatively to non-HDL cholesterol, A1C, and glucose levels.
  
  
  
  Health care providers' support for patients' autonomy and competence around medication use and diabetes self-management related positively to medication adherence, quality of life, and physiological outcomes among patients with diabetes.
authors.affiliation: The University of Rochester, Rochester, New York (Dr G. C. Williams, Dr Patrick, Mr Niemiec)
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Williams
authors.affiliation: The University of Rochester, Rochester, New York (Dr G. C. Williams, Dr Patrick, Mr Niemiec)
authors.forename: Heather
authors.initials: H
authors.lastname: Patrick
authors.affiliation: The University of Rochester, Rochester, New York (Dr G. C. Williams, Dr Patrick, Mr Niemiec)
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Niemiec
authors.affiliation: Henry Ford Hospital, Detroit, Michigan (Dr L. K. Williams, Dr Divine, Dr Lafata, Dr Tunceli, Dr Pladevall)
authors.forename: L Keoki
authors.initials: LK
authors.lastname: Williams
authors.affiliation: Henry Ford Hospital, Detroit, Michigan (Dr L. K. Williams, Dr Divine, Dr Lafata, Dr Tunceli, Dr Pladevall)
authors.forename: George
authors.initials: G
authors.lastname: Divine
authors.affiliation: Henry Ford Hospital, Detroit, Michigan (Dr L. K. Williams, Dr Divine, Dr Lafata, Dr Tunceli, Dr Pladevall)
authors.forename: Jennifer Elston
authors.initials: JE
authors.lastname: Lafata
authors.affiliation: Veterans Affairs Center for Clinical Practice Management Research, Ann Arbor Health System, Ann Arbor, Michigan (Dr Heisler)|Department of Internal Medicine, University of Michigan, Ann Arbor (Dr Heisler)|Diabetes Research and Training Center, Ann Arbor, Michigan (Dr Heisler)
authors.forename: Michele
authors.initials: M
authors.lastname: Heisler
authors.affiliation: Henry Ford Hospital, Detroit, Michigan (Dr L. K. Williams, Dr Divine, Dr Lafata, Dr Tunceli, Dr Pladevall)
authors.forename: Kaan
authors.initials: K
authors.lastname: Tunceli
authors.affiliation: Henry Ford Hospital, Detroit, Michigan (Dr L. K. Williams, Dr Divine, Dr Lafata, Dr Tunceli, Dr Pladevall)
authors.forename: Manel
authors.initials: M
authors.lastname: Pladevall