Predictors of Successful Diabetes Self-Management in Appalachia

BACKGROUND: As the prevalence of diabetes increases, so does the importance of understanding which factors most strongly contribute to successful diabetes self-management. In order for this to be best accomplished, unique geographic regions must be studied, allowing for the development of strategies that will successfully promote self-management of this disease and improve overall health within these distinct areas. Working toward this goal, nine counties in Appalachian Ohio were surveyed, verifying that the prevalence rate of diabetes is considerably elevated in this rural region compared to state and national rates. Next, a statistical examination of the data was undertaken to determine which factors predict successful diabetes self-management. METHODS: A large-scale telephone survey (N = 3,841) was conducted to assess health status, chronic disease rates, relevant risk factors, and health care access, with a special emphasis on diabetes. The data were entered into a multivariate logistic regression model to establish which variables are related to successful diabetes self-management; with self-monitoring blood glucose levels at least daily as the marker of successful diabetes management. FINDINGS: For this rural sample, having attended a diabetes education class (p < .01) was the most significant predictor of diabetes self-management. Other significant predictors included depressed mood (p < .05) and self-reported health status (p < .05). The inability to pay for test strips, doctors visits, and medicine were not found to be significantly related to self-management; indicating that financial barriers are not primary indicators for unsuccessful management of this disease. Additionally, demographic variables (viz., gender, age, and level of education) and health risk indicators (viz., smoking status and BMI category) were not found to be significantly related to successful diabetes self-management. CONCLUSIONS: This study underscores the importance of studying health status at the regional level. It also identifies the role of health education and mental health in successful diabetes self-management for patients in the Appalachian region. Suggestions are proposed for strategies to improve diabetes self-management among patients living in the Appalachian region.