Sociology, Department of


Date of this Version



Published in Primary Care Diabetes 12 (2018), pp 224–230. doi 10.1016/j.pcd.2017.11.004


Copyright © 2017 Primary Care Diabetes Europe. Published by Elsevier Ltd. Used by permission.


Objective: To evaluate adherence to care standards for people with diabetes (PWDs) on insulin therapy versus PWDs who are not on insulin therapy, controlling for social determinants.

Research design and methods: Utilizing the United States 2015 Behavioral Risk Factor Surveillance System Survey, this study used logistic regression analyses to estimate differences in self-care behaviors, healthcare provider quality of care, and diabetic complications for individuals on insulin therapy and individuals not on insulin therapy.

Results: PWDs on insulin therapy are more likely to adhere to self-care measures (self-glucose checks [OR: 7.57], self-foot checks [OR: 1.27], diabetes class participation [OR: 1.96]), adherence to provider care standards (diabetes-related doctor visits [OR: 1.24], comprehensive foot exam [OR: 1.80], dilated eye exam [OR: 1.34]), and to self-report diabetic complications (retinopathy [OR: 2.77], kidney disease [OR:2.14]), controlling for sociodemographic variables.

Conclusion: PWDs on insulin and their healthcare providers are more likely to meet the treatment goals set by the American Diabetes Association. PWDs on insulin therapy may have better overall relationships with providers due to a reduction in stigmatization based on the social construction of diabetes.