The Role of Social Relationships and Self-Efficacy in Diabetes Management

描述（由申请人提供）：本R21申请旨在支持一项关于婚姻状况、社会支持和自我效能在美国不同中老年人群糖尿病管理有效性中的作用的调查。拟议的研究将使用结构方程模型来分析2002年和2004年从全国代表性健康与退休研究（HRS）的核心访谈中收集的数据。再加上2003年补充糖尿病特定邮件调查的数据，以性别、年龄组和主要种族类别来检查这些关系。这项研究的意义在于，在过去的几十年里，美国所有人群中2型糖尿病的发病率都在飙升，但主要是在中年和老年人中。对肥胖和缺乏身体活动及其与糖尿病发病、并发症和社会成本的联系的关注，导致了国家一级的公共卫生任务，例如《2010年健康人》，旨在扭转这些趋势。虽然预防糖尿病当然是一个重要的目标，但对已经诊断为糖尿病的个人进行更有效的管理对于减少未来并发症的风险也至关重要。目前，在所有成年糖尿病患者中，只有不到八分之一的人遵循良好管理指南；老年人遵循这一标准的比例更低。许多过去的研究表明，自我效能感和社会关系是糖尿病相关行为和健康结果的关键因素，但由于使用了非代表性数据集、横断面分析和对其他可能也需要考虑的重要因素的控制不足，这些研究受到了限制。本应用程序的目的是研究社会关系（特别是婚姻）和自我效能如何影响糖尿病相关生活方式行为的坚持和健康结果，以便开发和测试干预措施，为糖尿病患者提供更有效的支持。特别是，我们将：(1)研究婚姻状况作为中老年糖尿病患者行为（饮食和运动）和健康结果（血糖控制和糖尿病相关生活质量）的预测因子；(2)探讨自我效能感和糖尿病支持是否在婚姻状况与糖尿病行为和健康结局之间起中介作用；(3)了解婚姻状况、糖尿病支持、自我效能、行为和健康结果之间的关联是否受性别、年龄组或种族的调节。更清楚地了解婚姻和自我效能感的作用，特别是糖尿病管理在中老年已婚和未婚成年人之间是否以及如何不同，可能会为成人糖尿病患者制定更有效的干预措施提供信息。鉴于最近的研究表明，由于婚姻环境和共同生活的环境，配偶本身患糖尿病的风险可能会增加，这一知识可能更加重要。对肥胖和缺乏身体活动及其与糖尿病的联系的关注导致了公共卫生任务，例如2010年健康人中包括的旨在扭转这些趋势的任务。虽然预防糖尿病是一个重要的目标，但对已经诊断为糖尿病的个人进行更有效的管理对于减少未来并发症的风险也至关重要。目前，只有不到八分之一的成年糖尿病患者遵循良好管理指南；老年人遵循这一标准的比例更低。了解社会关系（尤其是婚姻）和自我效能如何影响中老年糖尿病患者的良好糖尿病管理，可能是开发和测试干预措施的关键，这些干预措施可以提供更有效的支持，对已婚夫妇来说更重要，因为如果他们的伴侣患有糖尿病，他们自己患糖尿病的风险可能更高。

DESCRIPTION (provided by applicant):This R21 application seeks support for an investigation of the roles of marital status, social support, and self- efficacy in the effectiveness of diabetes management in a diverse population of middle-aged and older adults in the U.S. The proposed research will use structural equation modeling to analyze data collected in 2002 and 2004 from core interviews of the nationally representative Health and Retirement Study (HRS), plus data from the 2003 supplemental diabetes-specific mail survey to examine these relationships by gender, age group, and major race-ethnicity categories. The significance of the proposed research lies in the skyrocketing rates of type 2 diabetes in the U.S. over the past few decades in all segments of the population, but primarily in middle aged and older adults. Concerns about obesity and physical inactivity and their links to the onset, complications, and societal costs of diabetes have led to public health mandates at the national level-such as those included in Healthy People 2010-aimed at reversing those trends. Although prevention of diabetes is certainly an important goal, more effective management for individuals already diagnosed with diabetes is also critical for reducing the risks of future complications. Currently, less than one in eight of all adults with diabetes follow the guidelines for good management; and older adults follow them at even lower rates. Many past studies showing that self-efficacy and social relationships are key factors in diabetes-related behavioral and health outcomes are limited by their use of non-representative data sets, cross-sectional analyses, and inadequate controls on other factors that may also be important to consider. This application's goal is to examine how social relationships (and particularly marriage) and self-efficacy influence adherence to diabetes-related lifestyle behaviors and health outcomes in order to develop and test interventions that provide more effective supports for adults living with diabetes. In particular, we will: (1) examine marital status as a predictor of behavioral (diet and exercise) and health outcomes (glycemic control and diabetes-related quality of life) in middle-aged and older adults living with diabetes; (2) investigate whether self-efficacy and diabetes support mediate the link between marital status and behavioral and health outcomes of diabetes; and (3) discern whether associations among marital status, diabetes support, self-efficacy, and behavioral and health outcomes are moderated by gender, age group, or race-ethnicity. Understanding more clearly the role of marriage and self-efficacy, and particularly if and how diabetes management differs between middle-aged and older married and unmarried adults, may inform the development of more effective interventions for adults living with diabetes. This knowledge may also be all the more important given recent studies showing spouses may be at increased risk for developing diabetes themselves because of the marital context and shared environment. PUBLIC HEALTH RELEVANCE Concerns about obesity and physical inactivity and their links to diabetes have led to public health mandates- such as those included in Healthy People 2010-aimed at reversing those trends. Although prevention of diabetes is an important goal, more effective management for individuals already diagnosed with diabetes is also critical for reducing the risks of future complications. Currently, less than one in eight adults with diabetes follow the guidelines for good management; and older adults follow them at even lower rates. Understanding how social relationships (and particularly marriage) and self-efficacy influence good diabetes management in middle-aged and older adults living with diabetes may be key to developing and testing interventions that provide more effective supports, and all the more important to married couples because spouses may be at higher risk for developing diabetes themselves if their partner has diabetes.