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Age and Ageing Advance Access published online on January 26, 2009
Age and Ageing, doi:10.1093/ageing/afn299
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© The Author 2009. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Improvement in diabetes self-efficacy and glycaemic control using telemedicine in a sample of older, ethnically diverse individuals who have diabetes: the IDEATel project

Paula M. Trief1, Jeanne A. Teresi2, Joseph P. Eimicke3, Steven Shea4 and Ruth S. Weinstock5

1 Departments of Psychiatry and Medicine, SUNY Upstate Medical University, 750 E. Adams Street, Syracuse, NY 13210, USA
2 Columbia University Stroud Center and New York State Psychiatric Institute, Research Division, Hebrew Home for the Aged at Riverdale, 5901 Palisade Avenue, Bronx, NY 10471, USA
3 Research Division, Hebrew Home for the Aged at Riverdale, 5901 Palisade Avenue, Bronx, NY 10471, USA
4 Department of Medicine and Public Health, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
5 Department of Medicine, Joslin Diabetes Center at SUNY Upstate Medical University, Veterans Affairs Medical Center, 750 E. Adams Street, Syracuse, NY 13210, USA

Address correspondence to: Paula M. Trief. Tel: 315-464-3120; Fax: 315-464-3163. Email: triefp{at}upstate.edu

Background: with increasing prevalence of diabetes in older people, it is important to understand factors that affect their outcomes. The Informatics for Diabetes Education and Telemedicine (IDEATel) project is a demonstration project to evaluate the feasibility and effectiveness of telemedicine with diverse, medically underserved, older diabetes patients. Subjects were randomised to telemedicine case management or usual care. This intervention has been shown to result in improved medical outcomes and self-efficacy. Self-efficacy refers to one's belief that (s)he can successfully engage in a behaviour. Self-efficacy has been shown to relate to behaviour change and glycaemic control in middle-aged individuals, but not studied in older individuals.

Objectives: to assess whether (a) diabetes self-efficacy relates to the primary medical outcome of glycaemic control, and to secondary outcomes (blood pressure and cholesterol), and (b) whether, after an intervention, change in diabetes self-efficacy relates to change in these medical outcomes in a group of older, ethnically diverse individuals.

Methods: three waves of longitudinal data from participants in IDEATel were analysed.

Results: diabetes self-efficacy at baseline correlated with glycaemic control, blood pressure and cholesterol. An increase in diabetes self-efficacy over time was related to an improvement in glycaemic control (P < 0.0001), but not in blood pressure and lipid levels. The intervention was significantly related to improved self-efficacy over time (P < 0.0001), and both directly (P = 0.022) and indirectly through self-efficacy (P < 0.001) to improved glycaemic control. The mediation effect of self-efficacy was also significant (P< 0.004).

Conclusions: diabetes self-efficacy is a relevant construct for older diabetes patients. Thus, interventions that target enhanced self-efficacy may also result in improved glycaemic control.

Keywords: diabetes, self-efficacy, glycaemic control, elderly

Received 28 May 2008; accepted in revised form 18 November 2008.


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