National Meeting 2007

1047 — Factors Influencing Disease Self-Management among Veterans with Diabetes and Poor Glycemic Control

Nelson KM (Primary and Specialty Medical Care Service and HSR&D, VA Puget Sound; University of Washington) , McFarland L (HSR&D, VA Puget Sound; University of Washington), Reiber G (HSR&D, VA Puget Sound; University of Washington)

The Department of Veterans Affairs (VA) has implemented many effective organizational changes to improve diabetes care. Although significant improvements in clinical outcomes have been achieved, a large number of veterans still have poorly controlled diabetes. Less emphasis has been placed on supporting patient disease self-management, including medication adherence, nutrition therapy, and physical activity, which is strongly related to disease control. Information about current diabetes self-management practices is needed to guide continued quality improvement efforts. The purpose of this study is to assess factors influencing diabetes self-management among veterans with poorly controlled diabetes.

Surveys were mailed to patients with type 2 diabetes and a hemoglobin A1c of 8% or greater who had attended one of two VA Medical Centers in Washington State. Validated survey instruments assessed readiness to change, self-efficacy, provider advice, and diabetes self-care practices.

Of 1,286 potential respondents, 717 completed surveys (response rate 56%). Their mean HbA1c was 9.4%. Most reported appropriate advice from physicians regarding physical activity, nutrition, and glucose monitoring (73%, 92%, and 98% respectively), but many were not ready to change self-management behaviors. Forty five percent reported non-adherence to medications, 42% ate a high fat diet, and only 28% obtained either moderate or vigorous physical activity. The mean self-efficacy score for diabetes self-care was low and less than half of the sample reported readiness to change their nutrition (48%) or physical activity (49%). Individuals with higher self-efficacy scores were more likely to adhere to medications, follow a diabetic meal plan, eat a lower fat diet, have higher levels of physical activity, and monitor their blood sugars (p<0.001 for all).

Although veterans with poor diabetes control had available health care and diabetic educational programs and received appropriate medical advice about diabetes self-management, many were not sufficiently confident or motivated to make and maintain self-management changes.

The high rates of medication non-adherence and unhealthy lifestyles suggest that interventions aimed solely at changing provider behavior may not be effective. Targeted patient-centered interventions, specifically to increase self-efficacy and readiness to change health behaviors, may be needed to achieve further gains in VA diabetes outcomes.