Influence of Literacy, Self-Efficacy, and Social Support on Diabetes-Related Outcomes Following Hospital Discharge

Audrey White, Elizabeth Buschur, Cara Harris, Michael L Pennell, Adam Soliman, Kathleen Wyne, Kathleen M Dungan, Audrey White, Elizabeth Buschur, Cara Harris, Michael L Pennell, Adam Soliman, Kathleen Wyne, Kathleen M Dungan

Abstract

Objective: To evaluate the relationship between health literacy, social support, and self-efficacy as predictors of change in A1c and readmission among hospitalized patients with type 2 diabetes (T2D).

Methods: This is a secondary analysis of patients with T2D (A1c >8.5%) enrolled in a randomized trial in which health literacy (Newest Vital Sign), social support (Multidimensional Scale of Perceived Social Support), and empowerment (Diabetes Empowerment Scale-Short Form) was assessed at baseline. Multivariable models evaluated whether these concepts were associated with A1c reduction at 12 weeks (absolute change, % with >1% reduction, % reaching individualized target) and readmission (14 and 30 days).

Results: A1c (N=108) decreased >1% in 60%, while individualized A1c target was achieved in 31%. After adjustment for baseline A1c and potential confounders, health literacy was associated with significant reduction in A1c (Estimate -0.21, 95% CI -0.40, -0.01, p=0.041) and >1% decrease in A1c (OR 1.37, 95% CI 1.08, 1.73, p=0.009). However, higher social support was associated with greater adjusted odds of reaching the individualized A1c target (OR 1.63, 95% CI 1.04, 2.55, p=0.32). Both higher empowerment (OR 0.23, 95% CI 0.08, 0.64, p=0.005) and social support (OR 0.57, 95% CI 0.36, 0.91, p=0.018) were associated with fewer readmissions by 14 days, but not 30 days.

Conclusion: The study indicates that health literacy and social support may be important predictors of A1c reduction post-discharge among hospitalized patients with T2D. Social support and diabetes self-management skills should be addressed and early follow-up may be critical for avoiding readmissions.

Clinical trial: NCT03455985.

Keywords: A1c; basal insulin; hospital discharge; literacy; readmission; self-efficacy; social support; type 2 diabetes.

Conflict of interest statement

KMD discloses research support from Novo Nordisk, Sanofi, Viacyte, Abbott, Dexcom, consulting with Eli Lilly, Novo Nordisk, Dexcom, Boehringer-Ingelheim, and Tolerion, and honorarium from UptoDate, Medscape, Med Learning Group, Integritas and Elsevier. MLP discloses research support from Pfizer and grant from Sanofi. EB discloses research support from Dexcom and Juvenile Diabetes Research Foundation. KW discloses research support: Sanofi & Allergan. Consulting: Novo; honorarium from Nova Biomedical. The authors report no other conflicts of interest in this work.

© 2022 White et al.

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