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The Role of Self-Efficacy in Patients with Comorbid Type 2 Diabetes and Coronary Artery Disease in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Trial

Sansing, Veronica Vera (2011) The Role of Self-Efficacy in Patients with Comorbid Type 2 Diabetes and Coronary Artery Disease in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Trial. Doctoral Dissertation, University of Pittsburgh.

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    Abstract

    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 &beta;=0.06, p=0.66) and T2DM (insulin sensitizers vs. insulin providers &beta;=0.06, p=0.65) in patients with baseline self-efficacy scores &le;8. The second paper (N=1,562) verified a negative association between baseline self-efficacy and follow-up HbA1c (&beta;=-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.


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    Item Type: University of Pittsburgh ETD
    ETD Committee:
    ETD Committee TypeCommittee MemberEmailORCID
    Committee ChairBrooks, Maria Moribrooks@edc.pitt.edu
    Committee MemberRichardson, Gale Agar@pitt.edu
    Committee MemberMatthews, KarenMatthewsKA@upmc.edu
    Committee MemberThomas, Stephen Bsbt@umd.edu
    Title: The Role of Self-Efficacy in Patients with Comorbid Type 2 Diabetes and Coronary Artery Disease in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Trial
    Status: Unpublished
    Abstract: 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 &beta;=0.06, p=0.66) and T2DM (insulin sensitizers vs. insulin providers &beta;=0.06, p=0.65) in patients with baseline self-efficacy scores &le;8. The second paper (N=1,562) verified a negative association between baseline self-efficacy and follow-up HbA1c (&beta;=-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.
    Date: 31 January 2011
    Date Type: Completion
    Defense Date: 11 October 2010
    Approval Date: 31 January 2011
    Submission Date: 29 November 2010
    Access Restriction: 5 year -- Restrict access to University of Pittsburgh for a period of 5 years.
    Patent pending: No
    Institution: University of Pittsburgh
    Thesis Type: Doctoral Dissertation
    Refereed: Yes
    Degree: PhD - Doctor of Philosophy
    URN: etd-11292010-224630
    Uncontrolled Keywords: coronary artery disease; diabetes; self-efficacy
    Schools and Programs: Graduate School of Public Health > Epidemiology
    Date Deposited: 10 Nov 2011 15:06
    Last Modified: 15 May 2012 13:07
    Other ID: http://etd.library.pitt.edu/ETD/available/etd-11292010-224630/, etd-11292010-224630

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