title: Diabetes symptoms and self-management behaviors in rural older adults.
abstract: OBJECTIVE
  To evaluate the demographic and health correlates of reporting diabetes symptoms, and the relationship between diabetes symptoms and self-management behaviors in rural older adults.
  
  
  METHODS
  Cross-sectional interviews were conducted with 489 African American, American Indian, and white female and male adults 60 years and older. Participants with diabetes were recruited from eight North Carolina counties. Participants completed the 34-item Diabetes Symptom Checklist (DSC). Associations of demographic and health characteristics with reported symptoms were evaluated. Multivariate linear regression models were used to examine the associations of DSC scores and diabetes self-management.
  
  
  RESULTS
  Participants had low scores on the DSC. They largely practiced appropriate diabetes self-management behaviors (self-foot checks, fruit and vegetable consumption, and self-monitoring blood glucose). Correlates of DSC included women having higher scores for hypoglycemia, psychological total, and fatigue dimensions. Neuropathic pain and vision dimensions were significantly associated with educational attainment. Most DSC dimensions were associated with ethnicity or economic status. Taking oral diabetes medicine was correlated with hyperglycemia; insulin use was associated with most DSC dimensions. HbA1c was not associated with any DSC dimension; diabetes duration >10 years was correlated with all dimensions except neuropathic pain and vision. Higher levels of psychological fatigue were significantly associated with fewer self-management behaviors.
  
  
  CONCLUSIONS
  Demographic and health characteristics are associated with reported symptoms. Fatigue is a symptom negatively associated with diabetes self-management behavior in older adults. Health care providers are uniquely positioned to assess patient symptoms and potential relationships with successful diabetes management.
authors.affiliation: Department of Family and Community Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States of America. Electronic address: jkirk@wfubmc.edu.
authors.forename: Julienne K
authors.initials: JK
authors.lastname: Kirk
authors.affiliation: Department of Family and Community Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States of America.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Arcury
authors.affiliation: Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States of America.
authors.forename: Edward
authors.initials: E
authors.lastname: Ip
authors.affiliation: Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States of America.
authors.forename: Ronny A
authors.initials: RA
authors.lastname: Bell
authors.affiliation: Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States of America.
authors.forename: Santiago
authors.initials: S
authors.lastname: Saldana
authors.affiliation: Department of Family and Community Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States of America.
authors.forename: Ha T
authors.initials: HT
authors.lastname: Nguyen
authors.affiliation: Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States of America.
authors.forename: Sara A
authors.initials: SA
authors.lastname: Quandt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000628:therapy*; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D012648:Self Care; D012959:Socioeconomic Factors
keywords: Diabetes; Elders; Geriatrics; Glucose; Self-management; Symptoms