State-level Differences in Diabetes Care Behaviors Open Access

Abstract

Diabetes is a major problem in the United States but engaging in specific diabetes care behaviors can lessen the disease's complications. Healthy People 2020 is a set of national health goals which include targets for diabetes care behaviors such as self-monitoring of blood glucose (SMBG), biannual HbA1c tests, diabetes education, and annual foot examinations. These preventative and self-management behaviors have determinants at multiple levels, including the state level. Therefore, the purpose of this study was to determine if there were state-level differences in the proportion meeting the recommendations for the diabetes care behaviors, whether these differences changed over time, and what their state-level determinants are. Data from 2000-2010 Behavioral Risk Factor Surveillance System (BRFSS) were used to generate age-adjusted prevalences for each behavior across all years and in two time points: 2000-2005 and 2006-2010. Results indicated that there were disparities by state, but no large changes occurred over time. Few states are currently on track to meet the Healthy People 2020 objectives. Only HbA1c had one significant state-level predictor, proportion on Medicaid, and SMBG had two significant state-level predictors, proportion female and proportion on Medicaid. Implications and directions for future research are discussed.

Table of Contents

Table of Contents
Chapter 1 1
Diabetes Epidemiology 1
Diabetes Care Behaviors 2
Rationale for State-level Analysis 4
Andersen's Behavioral Model of Health Services Use 6
Research questions 8
Chapter 2 - Literature Review 10
Daily Blood Glucose Self-Monitoring and HbA1C Measurement 10
Annual Foot Examination 10
Diabetes Education 11
Determinants of and Disparities in Diabetes Care Behaviors 11
Surveillance of Diabetes Care Behaviors 14
Theory applications 16
Summary 17
Chapter Three - Methods 18
Procedure. 19
Outcome Measures. 19
Demographic Measures from BRFSS. 21
Predictors from other sources. 22
Analysis. 23
Chapter 4 - Results 25
Prevalence of state-level diabetes care behaviors. 26
Changes over time in state-level diabetes care behaviors 27
Bivariate associations of state-level diabetes care behaviors and predictors. 28
Predictors of state-level diabetes care behaviors. 29
Chapter 5 - Discussion 31
Strengths and Limitations 36
Implications 39
References 43
Tables 49
Figures 94

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Diabetes
Committee Chair / Thesis Advisor	Kegler, Michelle C, Emory University
Committee Members	Venkat Narayan, K.M., Emory University Mehta, Neil K., Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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