Examining the Relationship Between Delay Discounting, Delay Aversion, Diabetes Self-care Behaviors, and Diabetes Outcomes in U.S. Adults With Type 2 Diabetes

Abstract

OBJECTIVE Delay discounting and delay aversion are emerging areas for understanding diabetes management; however, few data exist on their relationship with multiple diabetes self-care behaviors and diabetes outcomes. RESEARCH DESIGN AND METHODS This cross-sectional study included 356 adults with type 2 diabetes across three racial/ethnic groups receiving care from two primary care clinics. The primary predictors were delay discounting and delay aversion. Outcomes included self-care behaviors, quality of life (QOL; mental health component score [MCS], physical component score), and A1C. Multiple linear regression models were run to examine the association between predictors and the outcomes, A1C, QOL, and each self-care behavior. RESULTS Higher delay discounting was associated with lower engagement in self-care behaviors for general diet (B =-0.06; 95% CI-0.12;-0.01), specific diet(B=-0.07; 95% CI-0.12;-0.03), and foot care (B =-0.10; 95% CI-0.17;-0.02). Higher delay aversion was associated with lower engagement in self-care behaviors for general diet (B =-0.06; 95% CI-0.10;-0.01), specific diet(B=-0.03; 95% CI-0.07;-0.01), foot care (B =-0.11; 95% CI-0.17;-0.05), and lower MCS (B =-0.38; 95% CI-0.71;-0.06). CONCLUSIONS In a diverse sample of adults with type 2 diabetes, higher delay discounting and higher delay aversion were significantly related to lower engagement in self-care behaviors. High delay aversion was specifically related to lower QOL. These findings offer new knowledge by highlighting the role that delay-related behaviors may have in the performance of self-care behaviors and the impact on QOL. Work is needed to further elucidate these relationships. Specifically, these results highlight the importance of targeting value and decision-making for diabetes self-management.