Quality of Care Indicators, Health Behaviors, and Physical Functioning in Adults with Diabetes

Purpose: Physical functioning is an important and often neglected outcome in patients with diabetes. Identification of quality of care indicators and health behaviors associated with higher physical functioning may lead to improved care and outcomes for adult diabetic patients. Methods: We studied 3,521 adult persons with diabetes mellitus from 13 geographically dispersed, multi-specialty group practices in a cross-sectional survey. The outcome variable was the 10-item physical functioning scale. Independent variables included demographics, health behaviors, diabetes management, use of services, health status, risk for depression, comorbidities, and testing for albuminuria, glycosylated hemoglobin, and low-density lipoprotein. From these data, 10 quality-of-care indicators were constructed. We evaluated relationships between physical functioning and the quality of care indicators. Results: Participants had a mean age of 64.2 +/- 12.6 years, and 52% were female, 67% married, 78% had a high school education or higher, and 73% were white. Multivariate analyses revealed several factors independently associated with higher physical functioning score on the 10-item scale each p, 0.05, R-2 = 0.54): recent test for albuminuria or low-density lipoprotein lipids; no hospitalization or emergency admission in the prior year; being married; younger age; male gender; African American or Asian race; higher formal education; regular physical exercise; fewer comorbidities; better perceived health; not at risk for depression; not more limited in activities and health not worse compared to a year ago; nonsmoker; not being obese; and not taking insulin. Conclusions: We identified quality of care and health behaviors associated with higher physical functioning in adult patients with diabetes mellitus. Interventions to enhance the modifiable risk factors may lead to improved physical functioning and delay the onset of disability in these patients.