Glycemic control: Risk factors, quality of life, workforce participation, and mortality among US adults with type 2 diabetes

Despite research showing the benefits of glycemic control, it remains suboptimal among adults with diabetes in the United States. Possible reasons include unaddressed risk factors as well as lack of awareness of its immediate and long term consequences. The objectives of this study were to, using cross-sectional data, (1) ascertain the association between suboptimal (Hemoglobin A1c (HbA1c) .7%), borderline (HbA1c 7-8.9%), and poor (HbA1c .9%) glycemic control and potentially new risk factors (e.g. work characteristics), and (2) assess whether aspects of poor health and well-being such as poor health related quality of life (HRQOL), unemployment, and missed-work are associated with glycemic control; and (3) using prospective data, assess the relationship between mortality risk and glycemic control in US adults with type 2 diabetes. Data from the 1988-1994 and 1999-2004 National Health and Nutrition Examination Surveys were used. HbA1c values were used to create dichotomous glycemic control indicators. Binary logistic regression models were used to assess relationships between risk factors, employment status and glycemic control. Multinomial logistic regression analyses were conducted to assess relationships between glycemic control and HRQOL variables. Zero-inflated Poisson regression models were used to assess relationships between missed work days and glycemic control. Cox-proportional hazard models were used to assess effects of glycemic control on mortality risk. Using STATA software, analyses were weighted to account for complex survey design and non-response. Multivariable models adjusted for socio-demographics, body mass index, among other variables. Results revealed that being a farm worker and working over 40 hours/week were risk factors for suboptimal glycemic control. Having greater days of poor mental was associated with suboptimal, borderline, and poor glycemic control. Having greater days of inactivity was associated with poor glycemic control while having greater days of poor physical health was associated with borderline glycemic control. There were no statistically significant relationships between glycemic control, self-reported general health, employment, and missed work. Finally, having an HbA1c value less than 6.5% was protective against mortality. The findings suggest that work-related factors are important in a person’s ability to reach optimal diabetes management levels. Poor glycemic control appears to have significant detrimental effects on HRQOL.^

Glycemic Control: Risk Factors, Quality of Life, Workforce Participation, and Mortality Among US Adults with Type 2 Diabetes

Despite research showing the benefits of glycemic control, it remains suboptimal among adults with diabetes in the United States. Possible reasons include unaddressed risk factors as well as lack of awareness of its immediate and long term consequences. The objectives of this study were to, using cross-sectional data, 1) ascertain the association between suboptimal (Hemoglobin A1c (HbA1c) ≥7%), borderline (HbA1c 7-8.9%), and poor (HbA1c ≥9%) glycemic control and potentially new risk factors (e.g. work characteristics), and 2) assess whether aspects of poor health and well-being such as poor health related quality of life (HRQOL), unemployment, and missed-work are associated with glycemic control; and 3) using prospective data, assess the relationship between mortality risk and glycemic control in US adults with type 2 diabetes. Data from the 1988-1994 and 1999-2004 National Health and Nutrition Examination Surveys were used. HbA1c values were used to create dichotomous glycemic control indicators. Binary logistic regression models were used to assess relationships between risk factors, employment status and glycemic control. Multinomial logistic regression analyses were conducted to assess relationships between glycemic control and HRQOL variables. Zero-inflated Poisson regression models were used to assess relationships between missed work days and glycemic control. Cox-proportional hazard models were used to assess effects of glycemic control on mortality risk. Using STATA software, analyses were weighted to account for complex survey design and non-response. Multivariable models adjusted for socio-demographics, body mass index, among other variables. Results revealed that being a farm worker and working over 40 hours/week were risk factors for suboptimal glycemic control. Having greater days of poor mental was associated with suboptimal, borderline, and poor glycemic control. Having greater days of inactivity was associated with poor glycemic control while having greater days of poor physical health was associated with borderline glycemic control. There were no statistically significant relationships between glycemic control, self-reported general health, employment, and missed work. Finally, having an HbA1c value less than 6.5% was protective against mortality. The findings suggest that work-related factors are important in a person’s ability to reach optimal diabetes management levels. Poor glycemic control appears to have significant detrimental effects on HRQOL.

A model of school managerial control : the systematic analysis of managerial behaviors, processes, and indicators

The theoretical construct of control has been defined as necessary (Etzioni, 1965), ubiquitous (Vickers, 1967), and on-going (E. Langer, 1983). Empirical measures, however, have not adequately given meaning to this potent construct, especially within complex organizations such as schools. Four stages of theory-development and empirical testing of school building managerial control using principals and teachers working within the nation's fourth largest district are presented in this dissertation as follows: (1) a review and synthesis of social science theories of control across the literatures of organizational theory, political science, sociology, psychology, and philosophy; (2) a systematic analysis of school managerial activities performed at the building level within the context of curricular and instructional tasks; (3) the development of a survey questionnaire to measure school building managerial control; and (4) initial tests of construct validity including inter-item reliability statistics, principal components analyses, and multivariate tests of significance. The social science synthesis provided support of four managerial control processes: standards, information, assessment, and incentives. The systematic analysis of school managerial activities led to further categorization between structural frequency of behaviors and discretionary qualities of behaviors across each of the control processes and the curricular and instructional tasks. Teacher survey responses (N=486) reported a significant difference between these two dimensions of control, structural frequency and discretionary qualities, for standards, information, and assessments, but not for incentives. The descriptive model of school managerial control suggests that (1) teachers perceive structural and discretionary managerial behaviors under information and incentives more clearly than activities representing standards or assessments, (2) standards are primarily structural while assessments are primarily qualitative, (3) teacher satisfaction is most closely related to the equitable distribution of incentives, (4) each of the structural managerial behaviors has a qualitative effect on teachers, and that (5) certain qualities of managerial behaviors are perceived by teachers as distinctly discretionary, apart from school structure. The variables of teacher tenure and school effectiveness reported significant effects on school managerial control processes, while instructional levels (elementary, junior, and senior) and individual school differences were not found to be significant for the construct of school managerial control.