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Time preference, outcome expectancy, and self-management in patients with type 2 diabetes

Authors Karl FM, Holle R, Schwettmann L, Peters A, Laxy M

Received 23 May 2018

Accepted for publication 21 July 2018

Published 26 September 2018 Volume 2018:12 Pages 1937—1945


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Johnny Chen

Florian M Karl,1,2 Rolf Holle,1,2 Lars Schwettmann,1 Annette Peters,2,3 Michael Laxy1,2

1Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH), German Research Center for Environmental Health, Neuherberg, Germany; 2German Center for Diabetes Research (DZD), Neuherberg, Germany; 3Institute of Epidemiology II, Helmholtz Zentrum München (GmbH), German Research Center for Environmental Health, Neuherberg, Germany

Background: Patient self-management is crucial to prevent complications and mortality in type 2 diabetes. From an economic perspective, time preference predicts short-sighted decision making and thus might help to explain non-adherence to self-anagement recommendations. However, recent studies on this association have shown mixed results.
Purpose: In this study, we tested whether the combination of time preference and outcome expectancy can improve the predictions of self-management behavior.
Patients and methods: Data from 665 patients with type 2 diabetes were obtained from the cross-sectional KORA (Cooperative Health Research in the Region of Augsburg) GEFU 4 study. Time preference and outcome expectancy were measured by one question each, which were answered on a 4-point Likert scale. Their association with six self-managing behaviors was tested in logistic and linear regression analyses. Likewise, we examined the association between self-management and the interaction of outcome expectancy and time preference.
Results: A high time preference was associated with a significantly lower sum of self-management behaviors (β=-0.29, 95% CI [-0.54, -0.04]). Higher outcome expectancy was associated with a higher self-management score (β=0.21, 95% CI [-0.03, 0.45]). The interaction model showed that low time preference was only associated with better self-management when combined with a high outcome expectancy (β=0.05, 95% CI [-0.28, 0.39] vs β=0.27, 95% CI [-0.09, 0.63]).
Conclusion: Time preference and outcome expectancy are interrelated predictors of patient self-management and could be used to identify and to intervene on patients with a potentially poor self-management.

Keywords: behavioral economics, adherence, temporal discounting, health behavior

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