Associations between economic hardship and markers of self-management in adults with type 2 diabetes: results from Diabetes MILES - Australia

Objective: A socioeconomic gradient exists in Australia for type 2 diabetes mellitus (T2DM). It remains unclear whether economic hardship is associated with T2DM self-management behaviours. Methods: Cross-sectional data from a subset of the Diabetes MILES - Australia study were used (n=915). The Economic Hardship Questionnaire was used to assess hardship. Outcomes included: healthy eating and physical activity (Diabetes Self-Care Inventory - Revised), medication-taking behaviour (Medication Adherence Rating Scales) and frequency of self-monitoring of blood glucose (SMBG). Regression modelling was used to explore the respective relationships. Results: Greater economic hardship was significantly associated with sub-optimal medication-taking (Coefficient: -0.86, 95 CI -1.54, -0.18), and decreased likelihood of regular physical activity (Odds Ratio: 0.47, 0.29, 0.77). However, after adjustments for a range of variables, these relationships did not hold. Being employed and higher depression levels were significantly associated with less-frequent SMBG, sub-optimal medication-taking and less-regular healthy eating. Engaging in physical activity was strongly associated with healthy eating. Conclusions: Employment, older age and depressive symptoms, not economic hardship, were commonly associated with diabetes self-management. Implications: Work-based interventions that promote T2DM self-management in younger, working populations that focus on negative emotions may be beneficial.