Quantifying direct effects of social determinants of health on glycemic control in adults with type 2 diabetes

Rebekah J. Walker, Mulugeta Gebregziabher, Bonnie Martin-Harris, Leonard E. Egede*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

42 Scopus citations


Background: The aim of this study was to investigate if self-care is the pathway through which social determinants of health impact diabetes outcomes by analyzing the direct and indirect effects of socioeconomic and psychosocial factors on self-care and glycemic control. Subjects and Methods: Six hundred fifteen adults were recruited from two primary care clinics in the southeastern United States. A series of confirmatory factor analyses identified the latent factors underlying social status, psychosocial determinants (psychological distress, self-efficacy, and social support), and self-care (diet, exercise, foot care, glucose testing, and medication adherence). Structured equation modeling investigated the relationship among social determinants, self-care and glycemic control. Results: Latent variables were created for diabetes self-care, psychological distress, self-efficacy, social support, and social status. The final model [χ2(275)=450.07, P<0.001, R2=99, root mean square error of approximation=0.03, comparative fit index=0.98] showed lower psychological distress (r=-0.13, P=0.012), higher social support (r=0.14, P=0.01), and higher self-efficacy (r=0.47, P<0.001) were significantly related to diabetes self-care. Lower psychological distress (r=0.10, P=0.03), lower social support (r=0.10, P=0.02), and higher self-efficacy (r=-0.37, P<0.001) were significantly related to lower glycemic control. When social determinants of health variables were included in the model, self-care was no longer significantly associated with glycemic control (r=0.01, P=0.83). Conclusions: This study suggests a direct relationship between psychosocial determinants of health and glycemic control. Although associated with self-care, the relationship between social determinants of health and glycemic control is not mediated by self-care. Development of interventions should take psychosocial factors into account as independent influences on diabetes outcomes, rather than as indirect influences via self-care behavior.

Original languageEnglish (US)
Pages (from-to)80-87
Number of pages8
JournalDiabetes Technology and Therapeutics
Issue number2
StatePublished - Feb 1 2015

ASJC Scopus subject areas

  • Medical Laboratory Technology
  • Endocrinology
  • Endocrinology, Diabetes and Metabolism


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