The Association Between Patient-Reported Self-management Behavior, Intermediate Clinical Outcomes, and Mortality in Patients With Type 2 Diabetes: Results From the KORA-A Study

Abstract

OBJECTIVELittle is known about the impact of diabetes self-management behavior (SMB) on long-term outcomes. We aimed to examine the association among patientreported SMB, intermediate clinical outcomes, and mortality in patients with type 2 diabetes. RESEARCH DESIGN AND METHODSData were collected from 340 patients with type 2 diabetes of the KORA-A study (1997/1998) who were recruited from two previous population-based surveys (n = 161) and a myocardial infarction registry (n = 179) in southern Germany. Based on previous methodological work, a high level of SMB was defined as being compliant with at least four of six different self-care dimensions, comprising physical exercise, foot care, blood glucose self-monitoring, weight monitoring, having a diet plan, and keeping a diabetes diary. The vital status of the participants was observed until 2009. Multivariable linear, logistic, and Cox regression models were applied to assess the association with intermediate clinical outcomes at baseline and to predict mortality over the follow-up period, adjusted for sociodemographic, behavioral, and disease-related factors. RESULTSIn the cross-sectional perspective, a high level of SMB was weakly associated with a lower glycated hemoglobin A 1c level (20.44% [24.8 mmol/mol] [95% CI 20.88 to 0.00]), but not with low-density lipoprotein cholesterol, systolic blood pressure, or the presence of microalbuminuria, peripheral arterial disease, or polyneuropathy. During a mean follow-up time of 11.6 years, 189 patients died. SMB was a preventive factor for all-cause (hazard ratio 0.61 [95% CI 0.40-0.91]) and cardiovascular mortality (0.65 [95% CI 0.41-1.03]). CONCLUSIONSAlthough measuring SMB is difficult and the used operationalization might be limited, our results give some indication that a high level of SMB is associated with prolonged life expectancy in patients with type 2 diabetes and highlight the potential impact of the patients' active contribution on the long-term trajectory of the disease. We assume that the used proxy for SMB is associated with unmeasured, but important, dimensions of health behavior.

A survey on patients' characteristics, perception of family support and diabetes self‐management among type 2 diabetes patients in South‐West Nigeria

“…Likewise, this study finding regarding association between DSM and perception of family support is supported by several other authors (Beverly, Penrod, & Wray, 2007;García-Huidobro et al, 2010;Stephens et al, 2010;Vaccaro et al, 2014;Watanabe et al, 2010), but contrary to that of Adejoh (2012) and Mayberry and Osborn (2012). (Laxy et al, 2014). However, the instrument for assessing the DSM was different from the one used in this study.…”

“…The mean DSM score of patients was high with 61.9% of participants having a good self‐management, of which self‐reported DSM comprised diet adherence, exercise, glucose monitoring, medication adherence and follow‐up/use of healthcare facilities. Contrary to this report, only about 16% of diabetes patients in Germany were reported to have a high level of self‐management behaviour while the rest had a low level (Laxy et al, ). However, the instrument for assessing the DSM was different from the one used in this study.…”

Family‐centred approaches to healthcare interventions in chronic diseases in adults: a quantitative systematic review

“…Application of self-care in chronic conditions has improved outcomes such as readmission rates (Carr et al 2014), mortality rates (Laxy et al 2014), and quality of life (DeWalt et al 2012) and reduced healthcare cost (Mej ıa et al 2014). However, interventions aimed at improving outcomes were described in the literature mainly without identifying the elements that led to their success.…”

“…), mortality rates (Laxy et al . ), and quality of life (DeWalt et al . ) and reduced healthcare cost (Mejía et al .…”

Influencing Pathways to Quality of Life and HbA1c in Patients With Diabetes: A Longitudinal Study That Inform Evidence‐Based Practice

“…Diabetes requires patients to adjust their lifestyle, such as taking medication, increasing physically activity, and controlling their diet. Cross‐sectional and longitudinal studies have supported that high levels of self‐care behaviors are associated with low HbA1C levels (Laxy et al., ; Wang, Wu, & Hsu, ). Other studies have also discovered that self‐care behaviors are positively associated with QoL (Kuznetsov et al., ; Saleh, Mumu, Ara, Hafez, & Ali, ).…”