Examining the Role of Social Resources in Diabetes Control among Middle-Aged and Older Adults

Abstract

Diabetes is a rapidly growing health issue in the United States and across the globe, and is currently the seventh leading cause of death in the United States. Uncontrolled diabetes can lead to other health complications, including coronary heart disease, stroke, kidney disease, vision loss, and Alzheimer’s disease. Diabetes also attributes to a large financial burden in the United States, costing an estimated $245 billion among individuals diagnosed with diabetes in 2012 and a 41 percent increase from 2007. Blood glucose control is essential to reducing diabetes complications and related health care costs. Social resources are central to adherence of these self-management practices, particularly in middle-aged and older adults. Past research has examined the effect of social resources on health behaviors and health outcomes, but little has been done to examine the role of chronic stress on this relationship. Chronic stress is important to diabetes control because stress can impair an individual’s ability to perform diabetes self-management behaviors. The purpose of this research was to fully identify: 1.) predictors of four diabetes control typologies, 2.) if chronic stress mediates the relationship between social embeddedness and diabetes control, and 3.) whether perceived social support moderates the relationship between chronic stress and diabetes control. Data from the 2006-2012 waves of the Health and Retirement Study, a nationally-representative study of adults in the United States, was utilized for these analyses. Study 1 found that perceived diabetes control predicted objective diabetes control. Multinomial logistic regression was employed to determine that age, race, income, self-rated health, perceived control over health, presence of ADLs and IADLs, duration of diabetes, restless sleep, smoking status, and taking oral medication and insulin to treat diabetes were significant predictors of at least one of the four diabetes control typologies, 1.) truly controlled, 2.) falsely controlled, 3.) falsely uncontrolled, and 4.) truly uncontrolled. The results of Study 1 suggest that other factors are associated with the disconnect between perceived and objective diabetes control. Study 2 found limited evidence of a relationship between social embeddedness and 1.) perceived and 2.) objective diabetes control. Generalized structural equation modeling was used to examine the mediating effect of 1.) number of chronic stressors and 2.) perceived stress on the relationship between social embeddedness and both types of diabetes control. One social embeddedness factor, contact with children through meeting in person and speaking on the phone, was fully mediated by perceived stress in its relationship with perceived diabetes control. However, perceived stress did not mediate the association between this social embeddedness factor and objective diabetes control. The results of Study 2 suggest that social embeddedness does not impact diabetes control in the presence of chronic stress, but that support from a social network may. Study 3 examined the relationship between perceived stress and five diabetes control outcomes, 1.) perceived diabetes control, 2.) objective diabetes control, 3.) use of oral medication to treat diabetes, 4.) use of insulin to treat diabetes, and 5.) insulin compliance based on doctor’s recommendation. This study also explored the moderating effect of perceived social support on the relationship between perceived stress and the five diabetes control outcomes. Overall, the findings from Study 3 suggest that perceived negative social support in the presence of high stress may hinder diabetes control and control-related behaviors, and that total social support from a spouse in the presence of high stress was predictive of insulin compliance. The project ultimately illustrated how perceptions of stress and support may impact perceptions of diabetes control and control-related behaviors, but not objective control. However, results of this study should be interpreted with caution because many of the psychosocial measures analyzed were not from validated survey instruments. Overall, future research must focus on how perceptions, whether of control, stress, or support, impact diabetes-related behaviors, and ultimately objective diabetes control. Public health programming can help to improve accurate perceptions of diabetes control by strengthening access to social resources and mitigating the impact of chronic stressors.