Composite adherence to self-care practices and healthy behaviors and its association with mortality: A retrospective cohort study from a national managed care program.

Abstract

This study aimed to examine the association between composite adherence to self-care practices and healthy behaviors and mortality among individuals aged 30 years and older with type 2 diabetes mellitus (T2DM). This study included 17,378 individuals with T2DM enrolled in the National Diabetes Pay-for-Performance Program at a medical center in central Taiwan. Adherence to self-care and healthy behaviors was evaluated on the basis of self-care (blood glucose self-monitoring [≥ 1 time/week] and foot care), and health behaviors (weight control status [normal or overweight], smoking history, physical activity, and dietary intake of macronutrients [carbohydrates ≤ 65%, fats ≥ 20%, and proteins ≥ 10% of total energy]). Alcohol consumption was excluded from the composite score. The overall mortality rate was 24.57 per 1000 person-years. Each one-unit increase in the adherence score was linked to a 22% reduction in all-cause mortality (hazard ratio [HR]: 0.78; 95% confidence interval [CI]: 0.76-0.80), with similar associations for expanded (HR: 0.73; 95% CI: 0.69-0.78 and 0.85; 0.80-0.91 for follow-up period shorter and longer than 7.88 years, respective) and non-expanded CVD mortalities (HR: 0.79; 95% CI: 0.76-0.82). Increased adherence to combined self-care and lifestyle behaviors was associated with reduced risks of all-cause, expanded CVD, and non-expanded CVD mortalities compared with adherence to fewer than five behaviors.