InDiMa SIP Group

4. STAGE 4: PREDICTION OF DIABETES SELF MANAGEMENT OUTCOMES: THE RELATIONSHIP BETWEEN DIABETES HEALTH OUTCOMES AND DEMOGRAPHIC, DIABETES CLINICAL, I-D-E-A SCALES AND THE 4 ICS FACTORS

The term ‘prediction’, used by the psychometric expert, Prof. Dr. Joan Russo, is not describing a casual relationship but rather an outcome of ‘interrelated correlates and co-determining factors’.

4.1       DESCRIPTIVE STATISTICS FOR THE DIABETES SELF MANAGEMENT OUTCOMES

 

Table 8 (see page 20) presents the means, (standard deviations) and % nearly perfect or having high scores of “9” or “10” for the number of days, successfulness, need to improve or needing support for each outcome in the survey.

Table 9 (see page 21) presents the following people who could provide support for the individual in each of the diabetes self management areas.

Participants responded to each type of potential support. The percentages reflect those who feel that the support would ‘help much’ and ‘help very much’.

TABLE 8: SELF MANAGEMENT OF DIABETES:  NUMBER OF DAYS (OUT OF 10) AND SUCCESSFULNESS IN DEALING WITH SELF MANAGEMENT (“0” = “not successful” to “10” = “very successful”; Mean (SD), % “9” or “10”

 

  How many days (of 10)

do you …?

How Successful

(“0”-“10”) are you with this?

Overall Diabetes Self Management 7.2 (2.9), 42.5% 7.2 (2.8), 40.4%
Blood Sugar Monitoring 5.7 (4.1), 42.4% 7.3 (3.6), 56.3%
Taking Diabetes Medications 7.6 (4.0), 71.4% 9.2 (2.0), 86.0%
Taking Insulin (N = 263) 9.3 (1.8), 85.2% 8.8 (2.0), 72.4%
Preventative foot care 6.3 (4.0), 47.1% 8.4 (2.7), 68.9%
Eating healthy 6.8 (2.7), 29.9% 6.2 (2.6), 18.5%
Weighing yourself 2.6 (3.4), 12.1% 4.3 (3.2), 13.5%
Physical Exercise – 30 minutes 3.6 (3.2), 9.8% 4.3 (3.4), 15.3%
Smoking Cigarettes % Smokers = 16.9% Smokers only = 2.6 (3.2), 7.3%
Controlling your blood sugar 7.1 (2.7), 35.3%
Reaching blood pressure goals 7.9 (2.6), 55.3%
Dealing with the daily stress of diabetes 7.8 (2.6), 50.6%
“0” = “not at all regularly” to “10” = “definitely regularly”
Visiting your HCP 8.6 (2.5), 71.7%
Get laboratory tests for diabetes 8.6 (2.6), 74.2%
Eye Examinations 8.0 (3.0), 64.6%
Dentist Checkups 6.0 (4.0), 43.7%

 

Legend and Interpretation:

      Green: “Relatively good” in an insufficient macro-vascular disease therapy failure (because of inadequate cognitive therapy attempts for ‘patients with addictive patterns’.

Red: “Definite and urgent need for improvement”

TABLE 9: NEED FOR IMPROVEMENT OF DIABETES SELF-MANAGEMENT

 

   

Mean (SD)

% rating

“6” to “10”

% Rating

“7” to “10”

% rating

“8” to “10”

% Rating

“9” or “10”

Total

Overall Diabetes Self Management

4.8 (3.8) 46.7 39.8 32.0 22.7
(4) Blood Sugar Monitoring 3.3 (3.6) 30.4 25.6 21.1 16.6
Taking Diabetes Medications 1.4 (3.0) 12.8 11.0 9.7 7.3
Taking Insulin

N = 263

2.4 (3.5) 22.2 18.4 14.2 10.4
Preventative foot care 2.1 (3.3) 18.1 14.3 11.1 8.4
(1) Eating healthy / Weighing yourself 6.8 (3.1) 69.9 60.9 47.7 35.9
(2) Physical Exercise –

30 minutes

6.8 (3.3) 69.8 63.7 53.6 39.9
Smoking Cigarettes

N = 167

Smokers only:

6.9 (3.8)

65.3 62.9 58.7 55.1
(3) Controlling your blood sugar 4.9 (3.8) 47.7 42.7 34.8 24.8
Reaching blood pressure goals 3.2 (3.6) 29.4 24.0 19.0 13.3
Dealing with the daily stress of diabetes 3.2 (3.6) 28.3 23.2 18.7 12.4

 

 

Total: General Need for Improvement in Diabetes Self Management (47% of all patients with diabetes)

There is a general “need for improvement” (“some” = “6” to “urgent” = “10”) in Diabetes Self Management for 47% of the persons with diabetes.

This general need for improvement in ‘Diabetes Self Management’ is due to the fact that underlying are there ‘quasi addictive life style patterns’ which are reflected in

(1)    70% need for improvement (“6” to “10”) as to Healthy Eating / Weight Control, and

(2)    70% need for improvement (“6” to “10”) as to Physical Exercise.

The resulting ‘Macro-vascular Disease Pattern’ of Diabetes Type II is reflected in the (derived and directly correlated)

(3)    48% need for improvement (“6” to “10”) as to Controlling your Blood Sugar, and

(4)    30% need for improvement (“6” to “10”) as to Blood Sugar Monitoring.

IT APPEARS:

  • LITTLE IS DONE FOR ‘PREVENTION’ AND ‘CURE’.
  • SOMETHING IS DONE FOR CONTROLLING AND ‘MONITORING’ THE (OTHERWISE MIDTERM ‘LETAL’) SYMPTOM.

TABLE 10:  SUPPORT FROM THE HEALTH CARE SYSTEM IN DIABETES MANAGEMENT

   

Mean (SD)

% rating

“6” to “10”

% Rating

“7” to “10”

% rating

“8” to “10”

% Rating

“9” or “10”

Total

Overall Diabetes Self Management

3.7 (3.7), 33.1 28.3 21.3 16.1
Blood Sugar Monitoring 2.7 (3.6), 24.6 20.1 15.7 11.6
Taking Diabetes Medications 1.1 (2.5), 9.1 7.2 5.5 3.8
Taking Insulin

N = 263

2.0 (3.2), 17.0 13.5 11.2 9.3
Preventative foot care 1.9 (3.1), 15.7 12.2 9.9 7.1
(2) Eating healthy / Weighing yourself 5.4 (3.4), 50.4 43.0 32.9 24.0
(3) Physical Exercise – 30 minutes 5.0 (3.7), 46.6 40.6 30.3 23.5
Smoking Cigarettes Smokers only:

5.8 (4.1),

52.1 49.1 44.3 39.5
(4) Controlling your blood sugar 3.6 (3.7), 32.4 27.7 21.2 15.2
Reaching blood pressure goals 2.5 (3.4), 20.6 17.3 12.7 9.3
Dealing with the daily stress of diabetes 2.7 (3.4), 22.3 18.5 13.5 9.2

Total: General Support from the Health Care System in Diabetes Management

TABLE 11: PERSONS WHO COULD PROVIDE SUPPORT

 

  % Endorsing

MD or other HCP could help much or

very much

% Endorsing

Diabetes Support Group could help much or

very much

% Endorsing

Family or Friends

could help much or

very much

Total

Overall Diabetes Self Management

54.3% 31.7% 49.2%
Blood Sugar Monitoring 44.1% 25.3% 42.8%
Taking Diabetes Medications 35.4% 21.4% 18.8%
Taking Insulin

N = 263

52.3% 28.8% 43.7%
Preventative foot care 50.8% 23.0% 23.1%
Eating healthy / 55.2% 35.1% 61.2%
Weighing yourself
Physical exercise –

30 minutes

41.0% 24.3% 59.4%
Quitting smoking:

Smokers Only

34.1% 22.2% 35.9%
Controlling your blood sugar 55.9% 31.1% 47.3%
Reaching blood pressure goals 57.0% 22.4% 38.7%
Dealing with the daily stress of diabetes 44.6% 28.9% 45.2%

 

 

Family or friends, the ‘social environment’, is considered to be the ‘best supporter’ for:

–        Eating healthy (61.2%)

–        Physical exercise (59.4%)

–        Quitting smoking (35.9%)

–        Dealing with the daily stress in diabetes (45.2%)

 

 

MD or other HPC is considered to be the ‘best helper(s)’ for:

  • Overall diabetes self management (54.3%), followed by ‘family and friends’ (49.2%)
  • Blood sugar monitoring (44.1%), similar to ‘family and friends’ (42.8%)
  • “Controlling your blood sugar” (55.9%
  • “Reaching blood pressure goals (57.0%)

The concept of ‘Diabetes Support Groups’ does not really exist yet.

That 21.4% up to 35.1% expect “much” or ”very much” help from such groups is an indicator that Diabetes Support Groups might be ‘THE SOLUTION’ where the support of doctors and family/friends is NOT SUFFICIENT.

4.2       PREDICTION MODELS FOR THE DIABETES SELF CARE MANAGEMENT OUTCOMES

The outcomes are organized into two sets:

(1)    Number of days representing the quantitative (self-rated and therefore ‘not objective’) outcomes, and

(2)    a rating of successfulness with a given outcome representing the qualitative assessment.

Multiple regression models were used for both sets of outcomes.

Four hierarchical sets of predictors were entered into each model in the following order:

  • Demographics,
  • diabetes clinical characteristics,
  • I-D-E-A styles, and
  • the ICS factor scores.

If a set of predictors contributed a significant amount of variance to the ‘prediction’ of the outcome, then the indicators within the set will be examined to determine which factor(s) are contributing to the significance.

TABLE 12: QUANTITATIVE OUTCOMES

Better self management and compliance is associated with the following ‘criteria’:

 

  Total

R2

Demographics

R2

Diabetes Clinical Factors R2 IDEA Style Scales R2 ICS Factor Scale Scores R2
(1) Total

Overall Diabetes Self Management

44% 6%

Older age,

Female

5%

Low BMI

4%

Higher Social Initiative

29%

Higher I & IV

Lower II

Blood Sugar Monitoring 19% 1% 7%

Taking diabetes Medications/Insulin

2% 9%

Higher I, III, IV

Lower II

Taking Diabetes Medications 12% 4%

Older age

6%

Type II,

Not prescribed Insulin initially

1% 1%
Taking Insulin

N = 263

11% 4%

Older age

3%

Longer Duration of diabetes, not

prescribed insulin initially

1% 3%

Lower II

(2A)

Eating healthy

37% 4%

Older age

6%

Lower BMI, treating dia-

betes with diet and exer-cise and not medications

4%

High social flexibility

23%

Higher I & IV

Lower II

(2B)

Weighing yourself

10% 0% 3%

Lower BMI

2%

Higher social initiative

5%

Higher I

(2C)

Physical Exercise –

30 minutes

21% 2% 8%

Lower BMI

3%

Higher social flexibility

8%

Higher I

Preventative foot care 10% 4%

Older age

1% 2% 3%

Higher I & III

Lower II

Visiting your HCP 24% 10%

Older age

1% 3%

Higher social initiative

10%

Higher I & IV

Lower II

Get laboratory tests for diabetes 24% 10%

Older age

2% 2%

Higher social initiative

10%

Higher I & IV

Lower II

Eye Examinations 16% 8%

Older age

2% 2%

Higher social initiative

4%

Higher I & IV,

Lower II

Dentist Checkups 15% 5%

Older age, college educated

3%

Lower BMI

4%

Higher Social Initiative

3%

Higher I & IV

THE PSYCHOMETRIC SUMMARY

In summary, all the prediction models for the quantitative outcomes statistically significant at p < .001 and explained a significant amount of variance in each outcome. The total R2 or explained variance ranged from 44% for overall diabetes management to 10% for weighing oneself and preventative foot care.

The averaged total variance across the 12 domains was 20%.

The amount of shared variance attributable to the demographic variables (age, gender, education, race, education and marital status) was statistically significant in 10 of the 12 models.

The amount of shared variance between demographics and the quantitative outcomes ranged from 0% for weighing oneself to 10% for visiting your HCP and getting laboratory tests for diabetes.

The average amount of shared variance for demographic characteristics was 5%.

The amount of shared variance attributable to the diabetes clinical characteristics (type and duration of diabetes, treatment intensity, being prescribed insulin at first diagnosis of diabetes and BMI) after accounting for demographics was statistically significant in 8 of the 12 models:

The amount of shared variance between clinical characteristics and the quantitative outcomes ranged from 1% for preventative foot care and visiting your HCP to 7% for blood sugar monitoring.

The average amount of shared variance for diabetes clinical characteristics was 4%.

The amount of shared variance attributable to the four I-D-E-A Interaction & Communication Styles scales (social initiative, social style, social flexibility and self-steering) after accounting for demographics and clinical characteristics was statistically significant in 8 of the 12 models.

The amount of shared variance between the I-D-E-A scales and the quantitative outcomes ranged from 1% to 4% shared variance.

The average amount of shared variance for the IDEA scales was 3%.

The amount of shared variance attributable to the four Factor Score scales from the 158 item ICS was statistically significant in 11 of the 12 models after accounting for demographics, clinical characteristics and the IDEA style scales.

The amount of shared variance between the Factor Scores and the quantitative outcomes ranged from 29% for overall diabetes self management to 1% for taking diabetes medicine.

 

The average amount of shared variance for the factor scores was 9%.

The individual predictors were quite consistent across the 12 outcome categories:

  • Older age was associated with more adherence in 9/12 models. In terms of diabetes clinical characteristics the results were a bit more mixed.
  • Lower BMI was associated with more adherence in 5 of the models.
  • In six of the 12 models, ‘social initiative’ style was positively related to more adherence, and in two of the models ‘social flexibility’ was significantly related to more adherence.
  • The most important factor was Factor I, which accounted for significant variance in 10/12 models; followed by Factor II which was significant in 8/12 models; Factor III was significant in only 2 of the models, while Factor IV was significant in 6/12 models.
  • Higher scores on Factors I, III and IV were associated with MORE adherence, in contrast, higher scores on Factor II was associated with LESS adherence.

TABLE 13: QUALITATIVE OUTCOMES:  RATINGS OF SUCCESS IN EACH AREA

Higher scores indicate ratings of greater success associated with each domain:

 

  Total

R2

Demographics

R2

Diabetes Clinical factors R2 IDEA Style Scales R2 ICS Factor Scale Scores R2
(1) Total

Overall Diabetes Self Management

51% 6%

Older age,

Caucasian

7%

Lower BMI

3%

Higher social initiative

35%

Higher I & IV, Lower II & III

(3A)

Blood Sugar Monitoring

25% 5%

Older age

2% 2% 16%

Higher I & IV

Lower II

Taking Diabetes Medications 17% 7%

Older age

1% 3% 6%

Higher I & IV

Lower II

Taking Insulin

N = 263

8% 3%

Older Age

1% 1% 3%

Lower II

(2A)

Eating healthy

47% 4%

Older age

9%

Lower BMI, treating diabetes with diet and exercise and not medications

6%

Social flexibility, social initiative

28%

Higher I & IV

Lower II

(2B)

Weighing yourself

43% 3%

Female, Caucasian

20%

Lower BMI

3%

Higher social initiative

17%

Higher I & IV

Lower II

(2C)

Physical Exercise – 30 minutes

25% 2%

Female

9%

Lower BMI

5%

Higher social initiative

9%

Higher I

Lower II

(3B)

Controlling your blood sugar

48% 7%

Older age

4%

Lower BMI, treating diabetes with diet and exercise and not medications

3% 34%

Higher I & IV

Lower II & III

Reaching blood pressure goals 19% 3%

Older age

1% 4%

Social style

11%

Higher I & IV

Lower II

(2D)

Dealing with the daily stress of diabetes

42% 9%

Older age,

Male

2% 4%

Higher social initiative

27%

Higher I & IV

Lower II & III

Preventative foot care 21% 8%

Older age

2% 3%

Social flexibility

8%

Higher I & IV

Lower II

THE PSYCHOMETRIC SUMMARY

In summary, all the prediction models for the qualitative outcomes statistically significant at p < .001 and explained a significant amount of variance in each outcome. The total R2 or explained variance ranged from 51% for overall diabetes management to 8% for insulin use.

The averaged total variance across the 11 domains was 32%.

The amount of shared variance attributable to the demographic variables (age, gender, education, race, education and marital status) was statistically significant in all of the 11 models.

The amount of shared variance between demographics and the qualitative outcomes ranged from 2% to 9%.

The average amount of shared variance for demographic characteristics was 5%.

The amount of shared variance attributable to the diabetes clinical characteristics (type and duration of diabetes, treatment intensity, being prescribed insulin at first diagnosis of diabetes and BMI) after accounting for demographics was statistically significant in 5 of the 11 models:

The amount of shared variance between clinical characteristics and the outcomes ranged from 1% to 9%.

The average amount of shared variance for diabetes clinical characteristics was 5%.

The amount of shared variance attributable to the four I-D-E-A Interaction & Communication Styles scales (social initiative, social style, social flexibility and self-steering) after accounting for demographics and clinical characteristics was statistically significant in all of the 11 models.

The amount of shared variance between the IDEA scales and the quantitative outcomes ranged from 1% to 6% shared variance.

The average amount of shared variance for the IDEA scales was 4%.

The amount of shared variance attributable to the four Factor Score scales from the 158 item ICS was statistically significant in 11 of the 12 models after accounting for demographics, clinical characteristics and the I-D-E-A Interaction & Communication Styles scales.

The amount of shared variance between the Factor Scores and the quantitative outcomes ranged from 35% for overall diabetes self management to 3% for taking insulin.

 

The average amount of shared variance for the factor scores was 18%.

The individual predictors were quite consistent across the 11 outcome categories:

  • Older age was associated with more adherence in 9/11 models.
  • Race and gender were also predictors in 4 of the models.
  • In terms of diabetes clinical characteristics, lower BMI was associated with greater success in 5 of the models.
  • I-D-E-A Styles: In 5 of the 11 models, ‘social initiative’ style was positively related to more success, and in two of the models ‘social flexibility’ was significantly related to more success.
  • The most important factor was Factor I ‘(Realistic) Self Assessment’ or ‘Coping with Diabetes’), which accounted for significant variance in 10/11 models; followed by Factor II which was significant in all 11 models; Factor III was significant in only 3 of the models, while factor IV was significant in 9/11 models.
  • Higher scores on Factors I and IV were associated with MORE success, in contrast, higher scores on Factors II and III was associated with LESS success.

 

TABLE 14: OUTCOME: NEED FOR IMPROVEMENT OF DIABETES SELF-MANAGEMENT

Higher scores indicating more need for improvement; higher scores are associated with:

 

  Total

R2

Demographics

R2

Diabetes Clinical factors R2 IDEA Style Scales R2 ICS Factor Scale Scores

R2

(1) Total

Overall Diabetes Self Management

44% 4%

Younger age

5%

Higher BMI

1% 34%

Higher II & III

Lower I & IV

Blood Sugar Monitoring 29% 7%

Younger age

1% 1% 20%

Higher II & III

Lower I & IV

Taking Diabetes Medications 19% 10%

Younger age,

Caucasian

1% 1% 7%

Higher II

Lower I

(2A) Eating healthy (2B) Weighing yourself 33% 2%

Female

10%

Higher BMI

1% 20%

Higher II & III

Lower I

(2C)

Physical Exercise –

30 minutes

23% 1% 5%

Higher BMI

1% 16%

Lower I

Higher III

Controlling your blood sugar 36% 2%

Younger age

4%

Higher BMI, taking diabetes medications or insulin

1% 29%

Higher II & III

Lower I & IV

Reaching blood pressure goals 16% 3%

Younger age

1% 1% 11%

Higher II & III

Lower I & IV

Dealing with the daily stress of diabetes 35% 5%

Younger age,

Caucasian

1% 1% 28%

Higher II & III

Lower I & IV

TABLE 15: OUTCOME: SUPPORT FROM THE HEALTH CARE SYSTEM IN DIABETES MANAGEMENT

Higher scores indicating more need for support; hHigher scores are associated with:

 

  Total

R2

Demographics

R2

Diabetes Clinical factors R2 IDEA Style Scales R2 ICS Factor Scale Scores

R2

(1) Total

Overall Diabetes Self Management

47% 6%

Younger age

2%

Higher BMI

1% 38%

Higher II & III

Lower I & IV

Blood Sugar Monitoring 35% 8%

Younger age

2%

Higher BMI

0% 25%

Higher II & III

Lower I & IV

Taking Diabetes Medications 20% 9%

Younger age,

Caucasian

1% 0% 10%

Higher II & III

Lower I & IV

(2A) Eating healthy

(2B) Weighing yourself

43% 4%

Younger age

4%

Higher BMI

1% 34%

Higher II & III

Lower I & IV

Physical Exercise – 30 minutes 35% 4%

Younger age

3%

Higher BMI

0% 28%

Higher II & III

Lower I & IV

(2C)

Controlling your blood sugar

41% 6%

Younger age

2%

Higher BMI

1% 32%

Higher II & III

Lower I & IV

Reaching blood pressure goals 16% 3%

Younger age

1% 1% 11%

Higher II & III

Lower I & IV

Dealing with the daily stress of diabetes 38% 7%

Younger age

1% 1% 29%

Higher II & III

Lower I & IV