SUPPORTING AUTONOMY TO MOTIVATE PATIENTS WITH DIABETES FOR GLUCOSE CONTROL

OBJECTIVE - Wt applied the self-determination theory of human motivati on to examine whether patient perceptions of autonomy supportiveness ( i.e., patient centeredness) from their diabetes care providers related to improved glucose control over a 12-month period. RESEARCH DESIGN A ND METHODS - We conducted a prospective cohort study of patients with diabetes from a diabetes treatment center at a university-affiliated c ommunity hospital. Participants were 128 patients between 18 and 80 ye ars of age who took medication for diabetes, had no other major medica l illnesses, and were responsible for monitoring their glucose and tak ing their medications. The main outcome measure was a change in HbA(1c ) values over the 12 months of the study. RESULTS - Patient perception of autonomy support from a health care provider related to a change i n HbA(1c) values at 12 months (P < 0.05). Further analyses showed that perceived autonomy support from the staff related to significant incr eases in patient autonomous motivation at 12 months (P < 0.05); that i ncreases in autonomous motivation related to significant increases in perceived competence (P < 0.05); and that increases in a patient's per ceived competence related to significant reductions in their HbA(1c) v alues over 12 months (P < 0.001). CONCLUSIONS - The findings support t he prediction of the self-determination theory that patients with diab etes whose health care providers are autonomy supportive will become m ore motivated to regulate their glucose levels, feel more able to regu late their glucose, and show improvements in their HbA1(c) values.