title: Patient factors and glycaemic control--associations and explanatory power.
abstract: OBJECTIVE
  To investigate the association between glycaemic control and patient socio-demographics, activation level, diabetes-related distress, assessment of care, knowledge of target HbA(1c), and self-management behaviours, and to determine to what extent these factors explain the variance in HbA(1c) in a large Danish population of patients with Type 2 diabetes.
  
  
  METHODS
  Cross-sectional survey and record review of 2045 patients from a specialist diabetes clinic. Validated scales measured patient activation, self-management behaviours, diabetes-related emotional distress, and perceived care. The electronic patient record provided information about HbA(1c), medication, body mass index, and duration of diabetes. Data were analysed using multiple linear regression models with stepwise addition of covariates.
  
  
  RESULTS
  The response rate was 54% (n = 1081). Good glycaemic control was significantly associated with older age, higher education, higher patient activation, lower diabetes-related emotional distress, better diet and exercise behaviours, lower body mass index, shorter duration of disease and knowledge of HbA(1c) targets (P < 0.05 for all). Patient socio-demographics, behaviour; perceptions of care and diabetes distress accounted for 14% of the total variance in HbA(1c) levels (P = 0.0134), but the variance explained was higher for respondents treated with medications other than insulin.
  
  
  CONCLUSIONS
  Our study emphasizes the complex relationships between patient activation, distress and behaviour, specific treatment modalities and glycaemic control. Knowledge of treatment goals, achieving patient activation in coping with diabetes, and lowering disease-related emotional stress are important patient education goals. However, the large unexplained component of HbA(1c) variance highlights the need for more research to understand the mechanisms of glycaemic control.
authors.affiliation: Steno Health Promotion Centre, Steno Diabetes Centre, Gentofte, Denmark.
authors.forename: S
authors.initials: S
authors.lastname: Rogvi
authors.forename: I
authors.initials: I
authors.lastname: Tapager
authors.forename: T P
authors.initials: TP
authors.lastname: Almdal
authors.forename: M L
authors.initials: ML
authors.lastname: Schiøtz
authors.forename: I
authors.initials: I
authors.lastname: Willaing
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000453:epidemiology*; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003718:Denmark / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012648:Self Care; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin