title: Social support and lifestyle vs. medical diabetes self-management in the diabetes study of Northern California (DISTANCE).
abstract: BACKGROUND
  In chronic illness self-care, social support may influence some health behaviors more than others.
  
  
  OBJECTIVE
  Examine social support's association with seven individual chronic illness self-management behaviors: two healthy "lifestyle" behaviors (physical activity, diet) and five more highly skilled and diabetes-specific (medical) behaviors (checking feet, oral medication adherence, insulin adherence, self-monitored blood glucose, primary care appointment attendance).
  
  
  METHODS
  Using cross-sectional administrative and survey data from 13,366 patients with type 2 diabetes, Poisson regression models estimated the adjusted relative risks (ARR) of practicing each behavior at higher vs lower levels of social support.
  
  
  RESULTS
  Higher emotional support and social network scores were significantly associated with increased ARR of both lifestyle behaviors. Both social support measures were also associated with increased ARR for checking feet. Neither measure was significantly associated with other medical behaviors.
  
  
  CONCLUSIONS
  Findings suggest that social support diminished in importance as self-care progresses from lifestyle to more skilled "medical" behaviors.
authors.affiliation: VA Ann Arbor Center for Clinical Management Research, 2800 Plymouth Road, NCRC Building 16, 3rd Floor, Ann Arbor, MI, 48109, USA, arosland@umich.edu.
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Rosland
authors.forename: John D
authors.initials: JD
authors.lastname: Piette
authors.forename: Courtney R
authors.initials: CR
authors.lastname: Lyles
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Parker
authors.forename: Howard H
authors.initials: HH
authors.lastname: Moffet
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Adler
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Karter
mesh_terms: D002140:California / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D005260:Female; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D012648:Self Care / Q000523:psychology* / Q000706:statistics & numerical data; D012944:Social Support