OBJECTIVES: Type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) are highly comorbid conditions that are affected by psychological factors, such as self-efficacy. Psychological factors can either hinder or promote medical interventions. Self-efficacy, the belief that one is able to make changes necessary for self-management, is associated with glycemic control and cardiac symptom burden, as well as behaviors that affect CAD prevention and outcomes.
METHODS: Using data from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial, we assessed the relationship between self-efficacy and the treatment, risk factor control, and cardiac outcomes of patients with T2DM and CAD.
RESULTS: The first paper (N=889) showed no significant relationships between self-efficacy and randomized treatment for CAD (revascularization vs. medical therapy β=0.06, p=0.66) and T2DM (insulin sensitizers vs. insulin providers β=0.06, p=0.65) in patients with baseline self-efficacy scores ≤8. The second paper (N=1,562) verified a negative association between baseline self-efficacy and follow-up HbA1c (β=-0.03, p<.001) and a positive association with self-efficacy and physical functioning in which time negatively modified the association(interaction p=0.02). A lagged association (feedback loop) was shown between self-efficacy and HbA1c, physical functioning, and BMI over time. The feedback loops were stronger in White non-Hispanic patients compared to minority patients. In the third paper (N=1,817), poor baseline self-efficacy was associated with an increased risk of a composite endpoint of death/myocardial infarction/stroke (hazard ratio [HR] =1.34, p=0.01), subsequent revascularizations (HR=1.30, p=0.004), subsequent PCIs (HR=1.43, p<.001), and angina (odds ratio [OR] =1.11, p<.001) compared to Fair-Excellent self-efficacy, but not after adjusting for baseline covariates. A decrease in self-efficacy from baseline to Year 1 was positively associated with all-cause mortality (adjusted HR=2.32, p<.001) and death/MI/stroke (adjusted HR=1.79, p<.001).
CONCLUSIONS: In summary, self-efficacy was associated with clinical risk factors and cardiac outcomes in patients with CAD and T2DM. This is of public health significance because it stresses the importance of improving a patient's confidence in managing their conditions outside of the medical setting.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-11292010-224630 |
| Date | 31 January 2011 |
| Creators | Sansing, Veronica Vera |
| Contributors | Maria Mori Brooks, Stephen B. Thomas, Gale A. Richardson, Karen Matthews |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-11292010-224630/ |
| Rights | restricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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