Self-care and health outcomes of diabetes: How do co-morbid conditions and health perception influence this relationship

Self-care in patients with diabetes mellitus (DM) has been linked to improved glycemic control and other health outcomes. However, virtually all of the related literature that examines the relationship between DM self-care and health outcomes focuses on the components of DM self-care that comprise routine health behaviors such as treatment adherence---referred to as DM self-care maintenance. Thus far, the relationship between other self-care components---those that fall under the rubric of DM self-care management---and health outcomes has not been studied. DM self-care management comprises the decision-making processes whereby patients determine how and when to respond to signs and symptoms of their disease, and their subsequent behaviors. The current study utilized a cohort design with secondary data analysis of longitudinal data from adults 50 years of age and older who participated in the Health and Retirement Study. The aim of the study was to test a model postulating the influence of DM self-care on specific health outcomes---primarily, resource utilization (hospitalization, number of hospital stays, length of hospital stay, and health care provider visits) and secondarily glycemic control (hemoglobinA1c). In addition, this study examined whether and how the relationship between DM self-care and health outcomes might be affected by co-morbid conditions and health perception. Multivariable analyses were conducted to achieve the overall aim of this study with the final sample (n=726). The principal findings of this study were that: 1) the two components of DM self-care (self-care maintenance and management) each influence health outcomes, albeit differently. DM self-care maintenance significantly influences all of the health outcomes measured: hospitalization, health care provider visits, number of hospital stays, length of hospital stay, and hemoglobinA1c. On the other hand, DM self-care management influences a specific subset of the health outcomes measured: number of hospital stays and length of hospital stay, 2) an increased number of co-morbid conditions was significantly associated with worse health outcomes, and 3) co-morbid conditions moderate the relationship between eating more snacks or desserts and health care provider visits. These results underscore the importance of tailoring DM patient education so as to enhance decision-making processes as well as to foster treatment adherence. Additionally, patients' co-morbid conditions should be factored in during the design and implementation of DM self-care interventions.