PSYCHOSOCIAL CORRELATES OF GLYCEMIC CONTROL - THE PITTSBURGH EPIDEMIOLOGY OF DIABETES COMPLICATIONS (EDC) STUDY

The psychosocial correlates of glycemic control were examined in an in cident cohort of childhood onset insulin-dependent diabetic subjects a ged 18 years or older (n=592). Glycosylated hemoglobin was measured at subjects' clinical examination, and questionnaires on diabetes self-c are activity, barriers to regimen adherence and social support were co mpleted. Demographic information was also collected. Glycosylated hemo globin (GHb) was correlated with age, income and educational attainmen t (correlations coefficients between -0.1 and -0.2; P < 0.01), suggest ing that older, more educated and wealthier patients have better glyce mic control. GHb was also inversely associated with the degree of self -care activity (r=-0.11; P < 0.01), in particular administering inject ions at the recommended times and the frequency of performing blood/ur ine tests. Factors related to self-care behavior were identified, and included degree of social support (r=0.14; P < 0.001) and patients' re ports of difficulties adhering to their self-care regimen (r=-0.3; P < 0.0001). Gender was also related to self-care activities, with women reporting more self-care behavior than men (mean self-care scores 17.9 +/- 3.7 vs. 16.9 +/- 4.0; P < 0.01). Thus psychosocial factors (e.g. low income and education) may have an important effect on glycemic con trol in adults, and also (e.g. social support and adherence difficulti es) seem particularly important in influencing the performance of self -care. As good metabolic control may help avoid the progression of dia betic complications, efforts need to be directed towards patients with these characteristics who are more likely to experience difficulties with self-care.