Recall of HbA1c and self-management behaviours, patient activation, perception of care and diabetes distress in Type 2 diabetes.

AIMS: The aim of this study was to investigate associations between HbA1c recall by patients with Type 2 diabetes and self-management behaviours, patient activation, perception of care and diabetes distress. METHODS: In a cross-sectional survey, 993 patients with Type 2 diabetes reported their latest HbA(1c). Validated scales measured self-management behaviours, patient activation, perception of care and diabetes distress. Self-reported HbA(1c) was compared with latest measured HbA(1c). Using logistic regressions, associations between HbA(1c) recall and the variables of interest were investigated. RESULTS: Sixty-four per cent of patients recalled their latest HbA(1c). Poor HbA(1c) recall was significantly associated with unhealthy eating behaviour, low level of exercise, low level of patient activation, poor glycaemic control, not knowing target HbA(1c) level, low educational level and being female. There were no associations between recall of HbA(1c) and diabetes distress or perceived care. CONCLUSIONS: Recall of HbA(1c) level may increase patient activation and health-promoting behaviours. However, low educational level may be a barrier for using HbA(1c) as a motivator for health-promoting behaviours. This study indicates a need for studies of causal relationships, as well as mechanisms and challenges in using patient awareness of HbA(1c) as a driver for health-promoting behaviours.

Patient factors and glycaemic control--associations and explanatory power.

AIMS: To investigate the association between glycaemic control and patient socio-demographics, activation level, diabetes-related distress, assessment of care, knowledge of target HbA(1c), and self-management behaviours, and to determine to what extent these factors explain the variance in HbA(1c) in a large Danish population of patients with Type 2 diabetes. METHODS: Cross-sectional survey and record review of 2045 patients from a specialist diabetes clinic. Validated scales measured patient activation, self-management behaviours, diabetes-related emotional distress, and perceived care. The electronic patient record provided information about HbA(1c), medication, body mass index, and duration of diabetes. Data were analysed using multiple linear regression models with stepwise addition of covariates. RESULTS: The response rate was 54% (n = 1081). Good glycaemic control was significantly associated with older age, higher education, higher patient activation, lower diabetes-related emotional distress, better diet and exercise behaviours, lower body mass index, shorter duration of disease and knowledge of HbA(1c) targets (P < 0.05 for all). Patient socio-demographics, behaviour; perceptions of care and diabetes distress accounted for 14% of the total variance in HbA(1c) levels (P = 0.0134), but the variance explained was higher for respondents treated with medications other than insulin. CONCLUSIONS: Our study emphasizes the complex relationships between patient activation, distress and behaviour, specific treatment modalities and glycaemic control. Knowledge of treatment goals, achieving patient activation in coping with diabetes, and lowering disease-related emotional stress are important patient education goals. However, the large unexplained component of HbA(1c) variance highlights the need for more research to understand the mechanisms of glycaemic control.