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Patient-Provider Communication and Self-care Behavior Among Type 2 Diabetes Patients

From the Departments of Family Medicine and Psychiatry, University of Michigan Medical School, Ann Arbor (Dr Aikens); the University of Michigan Transportation Research Center, Ann Arbor (Dr Bingham); and the Center for Practice Management and Outcomes Research at VA Ann Arbor Health Care System and the Department of Internal Medicine and the Michigan Diabetes Research and Training Center, University of Michigan Medical School, Ann Arbor (Dr Piette).

Correspondence to James E. Aikens, Department of Family Medicine, University of Michigan, 1018 Fuller Street (Box 0708), Ann Arbor, MI 48109 (aikensj{at}umich.edu).

Purpose

The purpose of this study was to determine whether diabetes self-care behaviors mediate the association between patient-provider communication (PPC) and diabetes outcomes.

Methods

An ethnically diverse sample of 752 patients with type 2 diabetes was recruited from 3 different health systems. Subjects were interviewed by telephone about their general and diabetes-specific PPC, diabetes self-care behaviors (medication use, glucose testing, eating, and physical activity), and functional status (physical and mental). Glycemic control was assessed with the HbA1c assay. Statistical tests of the hypothetical path model were adjusted for age, gender, marital status, income, ethnicity, medication regimen, and number of comorbid conditions.

Results

General PPC was associated with mental functioning and physical functioning, and diabetes-specific PPC was associated with glycemic control. However, these associations were not mediated by self-care behaviors, which were independently associated with diabetes outcomes.

Conclusions

Although self-care and PPC are both important determinants of diabetes patients' health status, these effects are independent. Thus, attempts to improve diabetes outcomes must focus on both good communication andthe direct enhancement of illness self-management behaviors.

The Diabetes Educator, Vol. 31, No. 5, 681-690 (2005)
DOI: 10.1177/0145721705280829


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