Skip to main content

11-06-2018 | Diabetes self-management | Article

Exploring how patients understand and assess their diabetes control

Journal: BMC Endocrine Disorders

Authors: Anjali Gopalan, Katherine Kellom, Kevin McDonough, Marilyn M. Schapira

Publisher: BioMed Central




Poor understanding of diabetes management targets is associated with worse disease outcomes. Patients may use different information than providers to assess their diabetes control. In this study, we identify the information patients use to gauge their current level of diabetes control and explore patient-perceived barriers to understanding the hemoglobin A1c value (HbA1c).


Adults who self-reported a diagnosis of diabetes were recruited from outpatient, academically-affiliated, Internal Medicine clinics. Semi-structured interviews were conducted with participants and collected data were analyzed using thematic analysis.


The mean age of the 25 participants was 56.8 years. HbA1c was one of several types of information participants used to assess diabetes control. Other information included perceived self-efficacy and adherence to self-care, the type and amount of medications taken, the presence or absence of symptoms attributed to diabetes, and feedback from self-monitoring of blood glucose. Most participants reported familiarity with the HbA1c (22 of 25), though understanding of the value’s meaning varied significantly. Inadequate diabetes education and challenges with patient-provider communication were cited as common barriers to understanding the HbA1c.


In addition to the HbA1c, several categories of information influenced participants’ assessments of their diabetes control. Increased provider awareness of the factors that influence patients’ perceptions of diabetes control can inform effective, patient-centered approaches for communicating vital diabetes-related information, facilitating behavior change towards improved patient outcomes.
Trivedi H, et al. Self-knowledge of HbA1c in people with type 2 diabetes mellitus and its association with glycaemic control. Prim Care Diabetes. 2017;11:414–20. CrossRef
Beard E, Clark M, Hurel S, Cooke D. Do people with diabetes understand their clinical marker of long-term glycemic control (HbA1c levels) and does this predict diabetes self-care behaviours and HbA1c? Patient Educ Couns. 2010;80:227–32. CrossRef
Berikai P, et al. Gain in patients’ knowledge of diabetes management targets is associated with better glycemic control. Diabetes Care. 2007;30:1587–9. CrossRef
Yang S, et al. Knowledge of A1c predicts diabetes self-management and A1c level among Chinese patients with type 2 diabetes. PLoS One. 2016;11:e0150753. CrossRef
Heisler M, et al. The relationship between knowledge of recent HbA1c values and diabetes care understanding and self-management. Diabetes Care. 2005;28:816–22. CrossRef
Zikmund-Fisher BJ, Exe NL, Witteman HO. Numeracy and literacy independently predict patients’ ability to identify out-of-range test results. J Med Internet Res. 2014;16:e187. CrossRef
Ferguson MO, et al. Low health literacy predicts misperceptions of diabetes control in patients with persistently elevated A1C. Diabetes Educ. 2015;41:309–19. CrossRef
Gopalan A, et al. Translating the hemoglobin A1C with more easily understood feedback: a randomized controlled trial. J Gen Intern Med. 2014;29:996–1003. CrossRef
K. Glanz, B.K. Rimer, K. Viswanath, Health behavior : theory, research, and practice, Fifth edition. ed., 2015.
Wagner EH. Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract. 1998;1:2–4. PubMed
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101. CrossRef
Jones H, et al. Changes in diabetes self-care behaviors make a difference in glycemic control: the diabetes stages of change (DiSC) study. Diabetes Care. 2003;26:732–7. CrossRef
Gao J, et al. Effects of self-care, self-efficacy, social support on glycemic control in adults with type 2 diabetes. BMC Fam Pract. 2013;14:66. CrossRef
Lee YY, Lin JL. The effects of trust in physician on self-efficacy, adherence and diabetes outcomes. Soc Sci Med. 2009;68:1060–8. CrossRef
Grant RW, et al. Diabetes oral medication initiation and intensification: patient views compared with current treatment guidelines. Diabetes Educ. 2011;37:78–84. CrossRef
Ng CJ, et al. Barriers and facilitators to starting insulin in patients with type 2 diabetes: a systematic review. Int J Clin Pract. 2015;69:1050–70. CrossRef
Nielsen AB, Gannik D, Siersma V, Olivarius Nde F. The relationship between HbA1c level, symptoms and self-rated health in type 2 diabetic patients. Scand J Prim Health Care. 2011;29:157–64. CrossRef
Bulpitt CJ, Palmer AJ, Battersby C, Fletcher AE. Association of symptoms of type 2 diabetic patients with severity of disease, obesity, and blood pressure. Diabetes Care. 1998;21:111–5. CrossRef
Fritschi C, Quinn L. Fatigue in patients with diabetes: a review. J Psychosom Res. 2010;69:33–41. CrossRef
Fritschi C, et al. Fatigue in women with type 2 diabetes. Diabetes Educ. 2012;38:662–72. CrossRef
Holt RI, de Groot M, Golden SH. Diabetes and depression. Curr Diab Rep. 2014;14:491. CrossRef
Professional Practice Committee. Standards of Medical Care in Diabetes-2016. Diabetes Care. 2016;39(Suppl 1):S107–8.