Date of Award

9-29-2010

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Susan Forster

Second Advisor

Hylton Mayer, MD

Third Advisor

Jimmy Zhou, MSc, PhD; Ron Adelman, MD, MPH, FACS

Abstract

The purpose of this study is to assess the following hypotheses: concern for vision loss is associated with self-care behavior and glucose control; concern for overall diabetes complications is associated with self-care behavior and glucose control; concern for vision loss accounts for a significant proportion of the association between concern for overall diabetes complications and self-care behavior and glucose control in Type 1 and Type 2 diabetic subjects. The study sample consists of 100 participants (24 Type 1 diabetics, 69 Type 2 diabetics, 7 unknown) over the age of 18 presenting to the Yale Diabetes Center from June 2009 to August 2009. In addition to demographic and health-related surveys, the following questionnaires were administered: Visual Functioning Questionnaire (VFQ), Fear of Complications Questionnaire (FCQ), and Summary of Diabetes Self-Care Activities (SDSCA) questionnaire. The VFQItem 3 score is used to measure concern for overall eyesight (lower scores correlate with greater concern); the FCQVision score to measure concern for potential vision loss (lower scores correlate with decreased concern); the FCQComposite score to measure concern for overall diabetes complications (lower scores correlated with decreased concern); and the SDSCAComposite score to measure self-care behavior (lower scores correlate with poorer self-care behavior). Spearman Correlation analysis, Linear Regression analysis, ANCOVA and ANOVA are used to assess relationships between VFQ, FCQ, SDSCA composite and subscale scores and HgA1c. The main outcome measures are self-care behavior and HgA1c. Results show that in the Type 1 Diabetes group, lower SDSCAComposite scores correlate with lower VFQItem 3 scores (rSpearman = 0.521, p = 0.009). The correlation is further confirmed by linear regression analysis. For the Type 2 Diabetics group, there is a statistically significant positive linear relationship between HgA1c levels and FCQVision (FLinear (1,53) = 7.56, p = 0.008, ω = 0.468) and FCQComposite scores (FLinear (1,53) = 7.80, p = 0.007, ω=0.504). In conclusion, Type 1 diabetics with poor self-care practices are more concerned about overall eyesight and vice versa. Type 2 diabetics with poor glycemic control have greater concern for potential vision loss and overall diabetes complications and vice versa. This knowledge may be used to target patient education efforts to effectively improve self-care behavior in both Type 1 and Type 2 diabetic populations. Future research is needed to investigate factors contributing to these associations.

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