Recent research has shown that glucose control relates directly to lower morbidity (e.g. retinopathy, nephropathy, neuropathy) for diabetics, suggesting that it is extremely important for diabetic patients to adhere to medical regimens that result in normalization of blood sugar. These Diabetes Control and Complications Trial (DCCT) findings emerged from a study in which patients were preselected as being likely to adhere, but it raises the critical question of what factors promote adherence for all patients. The proposed work integrates research from the literatures on Self Determination Theory, patient activation, patient empowerment and motivational interviewing to formulate a model of patient self-regulation and to derive hypotheses about enhancing glucose control. Previous work suggests that activating patients leads to improved HbA1c so the proposed research explores the mediating processes through which this occurs. The proposal hypothesizes that patients' autonomous self regulation mediates this effect. If confirmed, this hypothesized mediation will point to other factors in the health care climate that could influence patient adherence. Two studies in a Diabetes Center are proposed. The first is an observational study and the second is an evaluation of a patient intervention. The studies employ data from questionnaires, ratings of audiotaped provider-patient interactions, glucometers, medical records, and medical tests (HbA1c) to test the investigator's model of the relations among the health care climate, patients' motivation, patients' behavior and health outcomes. This work could be of considerable significance for developing potentially cost-effective strategies for health care practitioners to use in enhancing patient motivation and adherence and thus reducing the long term health consequences of diabetes.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project (R01)
Project #
5R01DK050807-02
Application #
2458930
Study Section
Behavioral Medicine Study Section (BEM)
Program Officer
Garfield, Sanford A
Project Start
1996-08-09
Project End
2000-07-31
Budget Start
1997-09-10
Budget End
1998-07-31
Support Year
2
Fiscal Year
1997
Total Cost
Indirect Cost
Name
University of Rochester
Department
Other Basic Sciences
Type
Schools of Arts and Sciences
DUNS #
208469486
City
Rochester
State
NY
Country
United States
Zip Code
14627
Williams, Geoffrey C; McGregor, Holly; Zeldman, Allan et al. (2005) Promoting glycemic control through diabetes self-management: evaluating a patient activation intervention. Patient Educ Couns 56:28-34
Williams, Geoffrey C; McGregor, Holly A; Zeldman, Allan et al. (2004) Testing a self-determination theory process model for promoting glycemic control through diabetes self-management. Health Psychol 23:58-66
Williams, G C; Freedman, Z R; Deci, E L (1998) Supporting autonomy to motivate patients with diabetes for glucose control. Diabetes Care 21:1644-51
Williams, G C; Rodin, G C; Ryan, R M et al. (1998) Autonomous regulation and long-term medication adherence in adult outpatients. Health Psychol 17:269-76
Williams, G C; Deci, E L (1998) The importance of supporting autonomy in medical education. Ann Intern Med 129:303-8