Treatment beliefs, health behaviors and their association with treatment outcome in type 2 diabetes.
OBJECTIVE
While the prevalence of type 2 diabetes is growing, it is increasingly well recognized that treatment outcomes in primary care practice are often suboptimal. The aim of this study is to examine the extent to which treatment beliefs and health behaviors predict diabetes health outcome as measured by glycated hemoglobin (HbA1c) level, blood pressure, and lipid profile.


METHODS
This was a large-scale cross-sectional, registry-based study involving a well-defined type 2 diabetes population, in the county of Funen, Denmark. Registry data were combined with a 27-item self-reported survey administered to all insulin-treated people in the registry (n=3160). The survey was constructed to operationalize key concepts of diabetes management, diabetes treatment beliefs, and health behaviors.


RESULTS
In total, 1033 respondents answered the survey. The majority of treatment beliefs and health behaviors examined were predictors of glycemic control and, to a large extent, lipid profile. Absence from, or a low frequency of, self-measured blood glucose, non-adherence to general medical advice and the prescribed treatment, a low primary care utilization, and perceived low treatment efficacy were factors positively associated with HbA1c levels, s-cholesterol, and low-density lipoprotein. Conversely, infrequent self-measured blood glucose was associated with a significantly higher likelihood of having a blood pressure below 130/80 mm Hg. Perceived low treatment efficacy was the only health belief associated with poorer levels of health outcome other than HbA1c.


CONCLUSIONS
Health behaviors were stronger predictors for health outcomes than treatment beliefs. Self-reported adherence to either the treatment regimen or general medical advice most consistently predicted both glycemic control and cardiovascular risk factors.
Center for Health Economic Research (COHERE), University of Southern Denmark, Odense, Denmark; Department of Epidemiology, Novo Nordisk A/S, Søborg, Denmark.
Lill-Brith Wium
LB
von Arx
Department of Epidemiology , Novo Nordisk A/S , Søborg , Denmark.
Helge
H
Gydesen
Department of Health Economy and Outcomes Research , Novo Nordisk A/S , Søborg , Denmark.
Søren
S
Skovlund
Cardiovascular Health; Health Behavior; Health Beliefs; Metabolic Control