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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. (Unpublished)

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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 β=0.06, p=0.66) and T2DM (insulin sensitizers vs. insulin providers β=0.06, p=0.65) in patients with baseline self-efficacy scores ≤8. The second paper (N=1,562) verified a negative association between baseline self-efficacy and follow-up HbA1c (β=-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
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Sansing, Veronica
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairBrooks, Maria Moribrooks@edc.pitt.eduMBROOKS
Committee MemberRichardson, Gale Agar@pitt.eduGAR
Committee MemberMatthews, KarenMatthewsKA@upmc.eduXYOO
Committee MemberThomas, Stephen
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.
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: coronary artery disease; diabetes; self-efficacy
Other ID:, etd-11292010-224630
Date Deposited: 10 Nov 2011 20:06
Last Modified: 19 Dec 2016 14:37


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