title: The influence of diabetes psychosocial attributes and self-management practices on change in diabetes status.
abstract: OBJECTIVE
  To examine the influence of diabetes psychosocial attributes and self-management on glycemic control and diabetes status change.
  
  
  METHODS
  Using data from the Health and Retirement Study, a nationally representative longitudinal study of U.S. adults >51 years, we examined cross-sectional relationships among diabetes psychosocial attributes (self-efficacy, risk awareness, care understanding, prioritization of diabetes, and emotional distress), self-management ratings, and glycemic control. We then explored whether self-management ratings and psychosocial attributes in 2003 predicted change in diabetes status in 2004.
  
  
  RESULTS
  In multivariate analyses (N=1834), all diabetes psychosocial attributes were associated with self-management ratings, with self-efficacy and diabetes distress having the strongest relationships (adj coeff=8.1, p<0.01 and -4.1, p<0.01, respectively). Lower self-management ratings in 2003 were associated cross-sectionally with higher hemoglobin A1C (adj coeff=0.16, p<0.01), and with perceived worsening diabetes status in 2004 (adj OR=1.36, p<0.05), with much of this latter relationship explained by diabetes distress.
  
  
  CONCLUSIONS
  Psychosocial attributes, most notably diabetes-related emotional distress, contribute to difficulty with diabetes self-management, poor glycemic control, and worsening diabetes status over time.
  
  
  CONCLUSIONS
  Self-management and adherence interventions should target psychosocial attributes such as disease-related emotional distress.
authors.affiliation: Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park, CA 94025, USA. dzulman@stanford.edu
authors.forename: Donna M
authors.initials: DM
authors.lastname: Zulman
authors.forename: Ann-Marie
authors.initials: AM
authors.lastname: Rosland
authors.forename: Hwajung
authors.initials: H
authors.lastname: Choi
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Langa
authors.forename: Michele
authors.initials: M
authors.lastname: Heisler
mesh_terms: D000368:Aged; D015190:Blood Glucose Self-Monitoring; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000523:psychology* / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology* / Q000628:therapy; D019468:Disease Management; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D007722:Health Knowledge, Attitudes, Practice; D006304:Health Status; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D012648:Self Care / Q000379:methods / Q000523:psychology; D020377:Self Efficacy; D012720:Severity of Illness Index; D012944:Social Support; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D006442:Glycated Hemoglobin