Predictors of self care behaviors of diabetes Type I adults in the Oregon Health Plan

Abstract

PURPOSE: Improved self-care behaviors in patients with DM Type I (DMI) have been linked to improved clinical outcomes. However, self-care behaviors among primarily Medicaid adults with DMI have not been previously reported. The purpose of this paper was to determine predictors of self-care (SC) behaviors recommended by the American Diabetes Association in Oregon Health Plan (OHP) adults based on an adapted Glasgow personal beliefs and barriers to self care model. METHODS: 97% of all OHP pts with a DMI ICD9 code were initially included. After application of exclusion criteria, 94 non-pregnant DMI pts 18–45 yo continuously enrolled for 10 or 12 months from June 1997–May 1998 were included. From a 1998 telephone survey, we constructed a two level SC index of the frequency of 5 behaviors: adjustment of insulin, following a meal plan, checking blood sugar, checking feet, smoking (worse 5 1–3, better 5 4–5). DMI related quality of life (DMQOL) was assessed with a 5 point, 5 item scale, examined by patient quartiles. Barriers/enablers to SC were determined through unmet medical needs, number of visits (0, 1–2, 3–6, .7), receipt of standard medical care (0–3, for education, referrals, physical examination), & health status (PCS12, 0–100 [high]). Three patient demographics, age, gender, and ethnicity, were based on self-report. RESULTS: Our pt population was 47% female, 79% white, aged 32 6 6 yo. Pts averaged 3.8 6 4.7 visits over 3 months, and averaged an MCS of 42 6 11, and PCS of 44 6 13. Pt’s self-reported quality of life averaged 16 6 4. 32% patients reported regularly adjusting insulin, 44% following a meal plan qd, 5% checking blood sugar qd, 62% checking their feet. 47% were non smokers. 26 patients (28%) reported better SC. Using logistic regression in SUDAN 7.5.2, patients were more likely to report better SC, at p , .05, if they had .7 visits in the past 3 months (OR 92.6) or were older (OR 1.2). Patients were more likely to report worse SC if they had a DMQOL of 5–13 or 14–17 (OR .13, .15) or were male (OR .2). CONCLUSION: Diabetes is inherently a disease of self management, in which complications can be prevented by judicious practice of self-care behaviors. However, these behaviors involve lifestyle changes that are difficult to practice consistently, even in the most motivated patient group. Our data suggest that DMI patients in low income populations who report a lower quality of life, who are male, or who are younger may need special attention to enhance self care behaviors. Patients with more encounters with their provider report markedly better SC. These data provide some evidence to suggest areas in which patient education and reinforcement of self-care behaviors can have significant impact on future morbidity from DMI.