Socioeconomic status and glycemic control in adult patients with type 2 diabetes: a mediation analysis

Houle, Janie; Lauzier-Jobin, François; Beaulieu, Marie-Dominique; Meunier, Sophie; Coulombe, Simon; Côté, José; Lespérance, François; Chiasson, Jean‐Louis; Bherer, Louis; Lambert, Jean

doi:10.1136/bmjdrc-2015-000184

Cited by 81 publications

(74 citation statements)

References 81 publications

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“…The high rate of illiteracy among the studied subjects with DM stands out. The prevalence of inadequate glycemic control was not associated with this variable in the final model, although the results may point to a more adequate control tendency when the level of education increases, corroborating the results of other studies (13)(14)(15)(16) which demonstrated that having a higher education level is associated with better glycemic control. One justification for this may be a tendency for people with a higher education level to be more concerned about adhering to the prescribed therapy, as well as to comply with the clinical recommendations proposed by the health team involved (12)(13) .…”

Section: Discussionsupporting

confidence: 87%

Factors associated with glycemic control in people with diabetes at the Family Health Strategy in Pernambuco

Lima

Fontbonne

Carvalho

et al. 2016

Rev. esc. enferm. USP

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Objective: Identifying factors associated with glycemic control in people with type 2 Diabetes Mellitus (DM) registered in the Family Health Strategy (FHS) in Pernambuco, Brazil. Method: Associations between glycemic control (glycosylated hemoglobin A lower or equal to 7%) presented by people with DM and variables related to sociodemographic conditions, lifestyle, characteristics of diabetes, treatment and follow-up of patients by health services were investigated by multiple regression. Results: More than 65% of the participants presented inadequate glycemic control, especially those with lower age, longer illness duration, more annual contacts with FHS and complex therapeutic regimen. People with DM without referrals to specialists presented greater glycemic control. Associations with education level and obesity did not remain significant in the multivariate model. Conclusion: The evolution of diabetes hinders adequate control, however, attention to younger people with DM and referrals to specialists are factors that can improve glycemic control. DESCRIPTORS

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Section: Discussionsupporting

confidence: 87%

Factors associated with glycemic control in people with diabetes at the Family Health Strategy in Pernambuco

Lima

Fontbonne

Carvalho

et al. 2016

Rev. esc. enferm. USP

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“…40,41 Similarly, a lack of association between PAM and a specific diet could be that the specific diabetes diet may be financially prohibitive. 42,43 These results highlight the importance of addressing all self-care domains to improve self-management for patients with comorbid diabetes and CKD across all spectrums of activation.…”

Section: Discussionmentioning

confidence: 94%

“…A possible reason for the lack of association between PAM and exercise and foot checking is that both these activities require a certain degree of physical fitness and ability, which is compromised in patients with diabetes and CKD due to comorbidity . Similarly, a lack of association between PAM and a specific diet could be that the specific diabetes diet may be financially prohibitive . These results highlight the importance of addressing all self‐care domains to improve self‐management for patients with comorbid diabetes and CKD across all spectrums of activation.…”

Section: Discussionmentioning

confidence: 99%

The association between patient activation and self‐care practices: A cross‐sectional study of an Australian population with comorbid diabetes and chronic kidney disease

Zimbudzi

Ranasinha

et al. 2017

Health Expectations

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ObjectiveThis study aimed to examine the association between performance of self‐care activities and patient or disease factors as well as patient activation levels in patients with diabetes and chronic kidney disease (CKD) in Australia.MethodsA cross‐sectional study was conducted among adults with diabetes and CKD (eGFR <60 mL/min/1.73m2) who were recruited from renal and diabetes clinics of four tertiary hospitals in Australia. Demographic and clinical data were collected, as well as responses to the Patient Activation Measure (PAM) and the Summary of Diabetes Self‐Care Activities (SDSCA) scale. Regression analyses were performed to determine the relationship between activation and performance of self‐care activities.ResultsA total of 317 patients (70% men) with a mean age of 66.9 (SD=11.0) years participated. The mean (SD) PAM and composite SDSCA scores were 57.6 (15.5) % (range 0‐100) and 37.3 (11.2) (range 0‐70), respectively. Younger age, being male, advanced stages of CKD and shorter duration of diabetes were associated with lower scores in one or more self‐care components. Patient activation was positively associated with the composite SDSCA score, and in particular the domains of general diet and blood sugar checking (P<.05), but not specific diet, exercising and foot checking.ConclusionIn people with diabetes and CKD, a high level of patient activation was positively associated with a higher overall level of self‐care. Our results identify subgroups of people who may benefit from tailored interventions to further improve their health outcomes. Further prospective studies are warranted to confirm present findings.

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“…Furthermore, not perceiving oneself as sick might be interpreted as an avoidant coping strategy. Studies have shown that people with low socioeconomic status tend to use avoidant coping as their primary coping strategy due to few resources (Christensen, Schmidt, Hougaard, Kriegbaum, & Holstein, 2006;Houle et al, 2016;Mathiesen et al, 2017). The avoidant coping strategy of participants might have been reinforced by diabetes being a silent disease and, moreover, by the provision of tacit practical support from the informal network.…”

Section: Discussionmentioning

confidence: 99%

Preferring to manage by myself: A qualitative study of the perspectives of hardly reached people with type 2 diabetes on social support for diabetes management

Bech

Jacobsen

Mathiesen

et al. 2019

Journal of Clinical Nursing

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Aims and objectives To explore the perspectives of hardly reached people with type 2 diabetes on social support for diabetes management from their formal and informal networks. Background People with low socioeconomic status and poorly controlled type 2 diabetes may be categorised as hardly reached. Social support is increasingly perceived to be a cornerstone in the management of type 2 diabetes. Few studies have, however, explored social support for diabetes management from the perspective of hardly reached people. Methods A qualitative design with individual semi‐structured interviews captured the unique perspectives of hardly reached people. Data from 14 participants were analysed using conventional content analysis. The article adheres to the COREQ guidelines for reporting qualitative research. Results Participants preferred not to involve family and friends (the informal network) in diabetes management due to dysfunctional or lacking networks, existing norms and not wanting to burden vulnerable relationships. Others simply did not perceive themselves as sick and therefore saw no need for support. Opposed to this, participants wished for continuity and a personalised relationship with health professionals (the formal network). This entailed consultations that facilitated discussion of issues of importance to the participants. Conclusions Hardly reached people with type 2 diabetes preferred to spare their informal networks from diabetes management. Instead, they wished for more presence and individualised support from health professionals. Relevance to Clinical practice It appears timely to rethink the current “one‐size‐fits‐all” approach for people with type 2 diabetes in order to allocate resources to those most in need. It is important that health professionals elicit perceptions of support needs and potential sources of support in hardly reached people with type 2 diabetes both from the formal and from informal networks in regard to managing their diabetes. To better reach hardly reached people with type 2 diabetes, specialised education of health professionals may be necessary to capture the complex underlying dynamics influencing disease management.

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Socioeconomic status and glycemic control in adult patients with type 2 diabetes: a mediation analysis

Cited by 81 publications

References 81 publications

Factors associated with glycemic control in people with diabetes at the Family Health Strategy in Pernambuco

Factors associated with glycemic control in people with diabetes at the Family Health Strategy in Pernambuco

The association between patient activation and self‐care practices: A cross‐sectional study of an Australian population with comorbid diabetes and chronic kidney disease

Preferring to manage by myself: A qualitative study of the perspectives of hardly reached people with type 2 diabetes on social support for diabetes management

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