Health Care System Affects Diabetes Self-Management
Excerpt from Continuing Care
July / August 2002

The organization of the health care system has a great effect on how patients manage their disease, according to research presented at the 62nd annual meeting of the American Diabetes Association.

"Our findings show that, among many factors -- including patient age, sex and beliefs about diabetes, and the type and duration of diabetes -- it's the health care system's organization and accessibility that are the most powerful predictors of successful management," said Richard Rubin, Ph.D., lead author of the presentation, associate professor of medicine and pediatrics at the John Hopkins University School of Medicine. Diabetic complications include heart disease, retinopathy, nephropathy, and neuropathy.

Specific findings include:

1. Accessibility of health care providers predicted all outcomes except adherence to self-monitoring of blood glucose.

2. The patient's relationship with the primary provider predicted blood glucose control and psychosocial adjustment.

3. Availability of team care predicted blood glucose control.

4. Communication among providers predicted patient adherence to exercise recommendations.

5. Patient belief that health care providers have primary responsibility for diabetes care predicted diet adherence but worse psychosocial adjustment.

6. Patient belief that diabetes care is burdensome predicted worse outcomes in terms of psychosocial adjustment, blood glucose control and diet adherence.

Both studies were part of a larger international study, Diabetes Attitudes, Wishes and Needs, the largest psychosocial diabetes survey of its kind ever conducted.

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