Correlates of Diabetes Self-Care Behaviors in Adults with Type 2 Diabetes and Comorbid Heart Failure
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Date
2019-07
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Addis Ababa University
Abstract
Background: Effective performance of diabetes self-care behaviors in type 2 diabetes (T2D) iscrucial for improving glycemic control and managing diabetes-related comorbidities including heart failure (HF). Compared to persons without T2D those with T2D have 2-3 fold higher incidence of comorbid HF which often result in increased morbidity and poorer survival. Little is known, however, about the correlates of diabetes self-care behaviors and outcomes in people with T2D and comorbid HF.
Objective: The purpose of this secondary analysis study was to provide a deeper conceptual understanding of the correlates of diabetes self-care behaviors in adults with T2D and comorbid HF.
Methods: Baseline data of 180 participants from a randomized clinical trial that tested a 6-month integrated self-care intervention for adult persons with comorbid HF and T2D were analyzed.Study-developed data extraction forms and a battery of standardized instruments were used to collect demographic, clinical, and psychosocial data from medical records and self-report.
Diabetes self-care behaviors were measured using the Summary of Diabetes Self-Care Activities (SDSCA). Glycated hemoglobin (HbA1c) and fasting blood glucose (FBG) were analyzed from whole blood sample at baseline. Correlational bivariate, multiple logistic regression and hierarchical linear regression analysis were performed to examine associations and predictors of
diabetes self-care behaviors and glycemic control. The IBM SPSS for Windows version 24 was used to analyze the data.
Result: The participants mean age was 58.1±10.7 years and the majority were male (n = 118,65.6%) and African American (n = 119, 66.1%). Good self-rated health and presence of an implantable cardioverter defibrillator (p < 0.01) predicted better diabetes self-efficacy while taking both oral antiglycemic medication and insulin, history of depression, cardiac pacemaker,
and digitalis (p < 0.05) predicted lower diabetes self-efficacy. Number of comorbidities >2(p<0.001), having more than a high school education (p< 0.05) and African American ethnicity(p< 0.05) predicted better exercise, blood glucose testing, and foot care behaviors, respectively.The use of an aldosterone inhibitor(p< 0.05) predicted worse exercise performance, higher
Charlson comorbidity index scores (p< 0.01) predicted worse SMBG, and treatment with diet plus medication (p< 0.05) and dyslipidemia (p< 0.001) predicted worse foot care behaviors. In a bivariate analysis, the SDSCA general diet (p = 0.036) and SDSCA exercise (p = 0.029) were negatively associated with HbA1c, while SDSCA specific diet (p = 0.047) was positively
associated. None of the diabetes self-care behaviors emerged as independent predictors of eitherHbA1c or FBG in the regression models. Diabetic-end organ failure, taking insulin only, taking oral ant glycemic and insulin, African American race, and dyslipidemia predicted higher HbA1c values (p< 0.05). Years since diagnosis of HF (p< 0.05), taking insulin (p< 0.01), diabetic-end
organ failure (p< 0.01), and total daily medications (p< 0.05) predicted higher FBG values.
Conclusion: This study identified demographic, clinical, and psychosocial factors associated with diabetes self-care behaviors and with diabetes self-efficacy. Nevertheless, the diabetes selfcare behaviors’ lack of influence of
HbA1c and FBG is a major finding of this study.This underscores that the conventional disease-specific approach to diabetes self-care intervention cannot help to improve patient outcomes in people with T2D and comorbid
HF. Therefore ,it is imperative to shift from disease-specific approach to integrated diabetes self-care model to improve outcomes for this population.
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Keywords
Diabetes Self-Care Behaviors in Adults , Type 2 Diabetes , Comorbid Heart Failure