title: Independent effects of socioeconomic and psychological social determinants of health on self-care and outcomes in Type 2 diabetes.
abstract: OBJECTIVE
  The purpose of this study was to investigate the independent effects of socioeconomic and psychological social determinants of health on diabetes knowledge, self-care, diabetes outcomes and quality of life.
  
  
  METHODS
  Cross-sectional sample of 615 adults from two adult primary care clinics in the southeastern United States. Primary outcome variables were diabetes knowledge, self-care behaviors (diet, exercise, medication adherence, blood sugar testing, foot care) and diabetes outcomes (HbA1c, low-density lipoprotein, blood pressure, physical component summary score of SF12 quality of life, mental component summary score of SF12 quality of life). Covariates included age, sex, race/ethnicity, marital status, health literacy and comorbidity. Linear regression models were used to assess independent associations controlling for covariates.
  
  
  RESULTS
  In final adjusted models, significant associations for HbA1c included education [β = -0.72, 95% confidence interval (CI): -1.36 to -0.08], income (β = -0.66, CI: -1.30 to -0.16), self-efficacy (β = -0.12, CI: -0.15 to -0.08) and diabetes distress (β = 0.43, CI: 0.14 to 0.72). Significant associations for self-care included medication adherence with diabetes distress (β = -0.58, CI: -0.91 to -0.25) and perceived stress (β = -0.12, CI: -0.18 to -0.05) and exercise with depression (β = -0.06, CI: -0.10 to -0.01) and self-efficacy (β = 0.06, CI: 0.01 to 0.10). Significant associations for quality of life included depression (β = -0.08, CI: -0.12 to -0.03), serious psychological distress (β = -0.09, CI: -0.12 to -0.05), social support (β = 0.01, CI: 0.001 to 0.02) and perceived stress (β = -0.12, CI: -0.19 to -0.06).
  
  
  CONCLUSIONS
  Social determinants of health were significantly associated with diabetes self-care and outcomes with socioeconomic factors being most often associated with diabetes outcomes and psychological factors, specifically self-efficacy and perceived stress being most often associated with self-care and quality of life.
authors.affiliation: Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, Ralph H. Johnson VAMC, Charleston, SC; Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC; Department of Health Science and Research, Medical University of South Carolina, Charleston, SC.
authors.forename: Rebekah J
authors.initials: RJ
authors.lastname: Walker
authors.affiliation: Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, Ralph H. Johnson VAMC, Charleston, SC; Division of Public Health Sciences, Department of Medicine, Medical University of South Carolina, Charleston, SC.
authors.forename: Mulugeta
authors.initials: M
authors.lastname: Gebregziabher
authors.affiliation: Department of Health Science and Research, Medical University of South Carolina, Charleston, SC; Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Martin-Harris
authors.affiliation: Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, Ralph H. Johnson VAMC, Charleston, SC; Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC; Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, SC. Electronic address: egedel@musc.edu.
authors.forename: Leonard E
authors.initials: LE
authors.lastname: Egede
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015190:Blood Glucose Self-Monitoring / Q000523:psychology / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D004522:Educational Status; D015444:Exercise / Q000523:psychology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007182:Income / Q000706:statistics & numerical data; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D012648:Self Care / Q000523:psychology / Q000706:statistics & numerical data*; D020377:Self Efficacy; D012923:Social Class; D064890:Social Determinants of Health; D012944:Social Support; D013315:Stress, Psychological / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D008077:Lipoproteins, LDL; C517652:hemoglobin A1c protein, human
keywords: Diabetes; Psychological; Self-care; Social determinants; Socioeconomic
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