Independent effects of socioeconomic and psychological social determinants of health on self-care and outcomes in Type 2 diabetes

Objective: The purpose of this study was to investigate the independent effects of socioeconomic and psychological social determinants of health on diabetes knowledge, self-care, diabetes outcomes and quality of life. Research design and methods: Cross-sectional sample of 615 adults from two adult primary care clinics in the southeastern United States. Primary outcome variables were diabetes knowledge, self-care behaviors (diet, exercise, medication adherence, blood sugar testing, foot care) and diabetes outcomes (HbA1c, low-density lipoprotein, blood pressure, physical component summary score of SF12 quality of life, mental component summary score of SF12 quality of life). Covariates included age, sex, race/ethnicity, marital status, health literacy and comorbidity. Linear regression models were used to assess independent associations controlling for covariates. Results: In final adjusted models, significant associations for HbA1c included education [β=-0.72, 95% confidence interval (CI): 1.36 to 0.08], income (β=-0.66, CI: 1.30 to 0.16), self-efficacy (β=-0.12, CI: 0.15 to 0.08) and diabetes distress (β=0.43, CI: 0.14 to 0.72). Significant associations for self-care included medication adherence with diabetes distress (β=-0.58, CI: 0.91 to 0.25) and perceived stress (β=-0.12, CI: 0.18 to 0.05) and exercise with depression (β=-0.06, CI: 0.10 to 0.01) and self-efficacy (β=0.06, CI: 0.01 to 0.10). Significant associations for quality of life included depression (β=-0.08, CI: 0.12 to 0.03), serious psychological distress (β=-0.09, CI: 0.12 to 0.05), social support (β=0.01, CI: 0.001 to 0.02) and perceived stress (β=-0.12, CI: 0.19 to 0.06). Conclusions: Social determinants of health were significantly associated with diabetes self-care and outcomes with socioeconomic factors being most often associated with diabetes outcomes and psychological factors, specifically self-efficacy and perceived stress being most often associated with self-care and quality of life.