Cited by 112Diabetes Management and EducationDiabetes Management and ResearchMedication Adherence and Compliance

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Factors Influencing Disease Self-Management Among Veterans with Diabetes and Poor Glycemic Control

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Nelson, Karin M., McFarland, Lynne, Reiber, Gayle·2007·Journal of General Internal Medicine

DOI 10.1007/s11606-006-0053-8PMC PMC1829424

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Abstract

Specific aim Although the Department of Veterans Affairs (VA) has made significant organizational changes to improve diabetes care, diabetes self-management has received limited attention. The purpose of this study is to assess factors influencing diabetes self-management among veterans with poorly controlled diabetes.Methods Surveys were mailed to patients with type 2 diabetes and a HbA1c of 8% or greater who attended 1 of 2 VA Medical Centers in Washington State (n = 1,286). Validated survey instruments assessed readiness to change, self-efficacy, provider advice, and diabetes self-care practices.Results Our response rate was 56% (n = 717). Most respondents 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 half of the sample reported readiness to change nutrition (52%) or physical activity (51%). 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 < .001 for all).Conclusions Although veterans with poor diabetes control receive appropriate medical advice, many were not sufficiently confident or motivated to make and maintain self-management changes. Targeted patient-centered interventions may need to emphasize increasing self-efficacy and readiness to change to further improve VA diabetes outcomes.

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Authors: Nelson, K. M., McFarland, L., & Reiber, G.
Affiliations: VA Puget Sound Health Care System (US)
University of Washington (US)
Corresponding author: Nelson, Karin M.
ORCID: Nelson, Karin M.
McFarland, Lynne
Venue: Journal of General Internal Medicine
Publisher: Springer Science and Business Media LLC
Published: 2007-02-17
Volume: 22
Issue: 4
Pages: 442-447
ISSN: 0884-8734 (ISSN-L)
1525-1497
DOI: 10.1007/s11606-006-0053-8
PMC: PMC1829424
OpenAlex: W1987728046
Cited by: 112
References: 54
Citations by year: 2026: 5 · 2025: 2 · 2024: 1 · 2023: 2 · 2022: 2 · 2021: 4 · 2020: 5 · 2019: 3 · 2018: 6 · 2017: 10 · 2016: 4 · 2015: 8 · 2014: 8 · 2013: 13 · 2012: 12
FWCI: 4.38
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.springer.com/tdm (tdm)
Locations: Journal of General Internal Medicine (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: U.S. Department of Veterans Affairs
Health Services Research and Development
Quality Enhancement Research Initiative
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
Keywords: diabetes self-management, veterans, type 2 diabetes, glycemic control, HbA1c, self-efficacy, readiness to change, medication adherence, physical activity, dietary fat intake, blood glucose monitoring, patient-centered interventions, Department of Veterans Affairs
MeSH terms: Adult, Aged, Data Collection, Diabetes Mellitus, Type 2, Female, Humans, Male, Middle Aged, Self Care, Veterans, Disease Management, Self Efficacy, Glycemic Index

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Factors Influencing Disease Self-Management Among Veterans with Diabetes and Poor Glycemic Control

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