Abstract
Aims
To describe self-care of T2DM patients and to evaluate outcomes associated with self-care in T2DM patients.
Methods
A multicentre cross-sectional study was conducted on a sample of 302 randomly selected T2DM patients. Clinical and socio-demographic data were collected by medical records. The Summary of Diabetes Self-care Activities was used to measure self-care about diet, blood testing, exercise and foot care. The EQ-5D was used to measure perceived quality of life. Multiple regression models were used to evaluate the associations between self-care and body mass index (BMI), glycated haemoglobin (HbA1c), presence of diabetes complications and quality of life (QoL).
Results
Self-care was lower about exercise (median = 2.0) and foot care (median = 3.5) than about diet (median = 5.2) and blood testing (median = 4.5). HbA1c was associated with diet (p = 0.025), exercise (p = 0.017) and blood testing (p = 0.034). BMI was associated with exercise (p = 0.0071). Diabetes complications were associated with exercise (p = 0.031) and blood testing (p < 0.009). QoL was associated with exercise (p < 0.0001), blood testing (p = 0.032) and foot care (p = 0.013).
Conclusions
Self-care influences both clinical outcomes and quality of life of T2DM patients. Although exercise is more frequently associated with positive outcomes, it is particularly poor in T2DM population. Blood testing and foot care should be performed to prevent complications and not only when a health problem is already occurred. Interventions aimed to improve exercise are recommended. Further research is needed to explore barriers to exercise.
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References
ADA (2016) Standards of medical care in diabetes. Diabetes Care 39(Suppl 1)
Idf Diabetes Atlas G (2015) Update of mortality attributable to diabetes for the IDF Diabetes Atlas: estimates for the year 2013. Diabetes Res Clin Pract 109:461
Diabetes in Europe. Policy Puzzle. The state we are http://www.fend.org
Handelsman Y, Bloomgarden ZT, Grunberger G et al (2015) American Association of Clinical Endocrinologists and American College of Endocrinology—clinical practice guidelines for developing a diabetes mellitus comprehensive care plan—2015. Endocr Pract 21(Suppl 1):1–87
Standards for Medical Care in Diabetes. http://care.diabetesjournals.org/content/37/Supplement_1/S14.full.pdf+html
Powers MA, Bardsley J, Cypress M, Duker P, Funnell MM, Hess Fischl A, Maryniuk MD, Siminerio L, Vivian E (2015) Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Diabetes Care 38(7):1372–1382
Saleh F, Mumu SJ, Ara F, Hafez MA, Ali L (2014) Non-adherence to self-care practices & medication and health related quality of life among patients with type 2 diabetes: a cross-sectional study. BMC Public Health 14:431
Sun W, Aodeng S, Tanimoto Y, Watanabe M, Han J, Wang B, Yu L, Kono K (2015) Quality of life (QOL) of the community-dwelling elderly and associated factors: a population-based study in urban areas of China. Arch Gerontol Geriatr 60(2):311–316
da Rocha Fernandes J, Ogurtsova K, Linnenkamp U, Guariguata L, Seuring T, Zhang P, Cavan D, Makaroff LE (2016) IDF Diabetes Atlas estimates of 2014 global health expenditures on diabetes. Diabetes Res Clin Pract 117:48–54
Riegel B, Jaarsma T, Stromberg A (2012) A middle-range theory of self-care of chronic illness. ANS Adv Nurs Sci 35(3):194–204
Ausili D, Masotto M, Dall’Ora C, Salvini L, Di Mauro S (2014) A literature review on self-care of chronic illness: definition, assessment and related outcomes. Prof Inferm 67(3):180–189
AADE (2008) AADE7 self-care behaviors. Diabetes Educ 34(3):445–449
Sherr D, Lipman RD (2015) The diabetes educator and the diabetes self-management education engagement: the 2015 National Practice Survey. Diabetes Educ 41:616–624
Nicolucci A, Kovacs Burns K, Holt RI et al (2013) Diabetes Attitudes, Wishes and Needs second study (DAWN2): cross-national benchmarking of diabetes-related psychosocial outcomes for people with diabetes. Diabet Med 30(7):767–777
Schmitt A, Reimer A, Kulzer B, Haak T, Gahr A, Hermanns N (2014) Assessment of diabetes acceptance can help identify patients with ineffective diabetes self-care and poor diabetes control. Diabet Med 31(11):1446–1451
Smith KJ, Rabasa-Lhoret R, Strychar I, Karelis AD, Clyde M, Levasseur J, Pinaroc C, Pedneault M, Schmitz N (2014) Good vs. poor self-rated diabetes control: differences in cardiovascular risk and self-care activities. Exp Clin Endocrinol Diabetes 122(4):236–239
Crowley MJ, Holleman R, Klamerus ML, Bosworth HB, Edelman D, Heisler M (2014) Factors associated with persistent poorly controlled diabetes mellitus: clues to improving management in patients with resistant poor control. Chronic Illn 10(4):291–302
Peyrot M, Burns KK, Davies M et al (2013) Diabetes Attitudes Wishes and Needs 2 (DAWN2): a multinational, multi-stakeholder study of psychosocial issues in diabetes and person-centred diabetes care. Diabetes Res Clin Pract 99(2):174–184
Ausili D, Rebora P, Di Mauro S, Riegel B, Valsecchi MG, Paturzo M, Alvaro R, Vellone E (2016) Clinical and socio-demographic determinants of self-care behaviours in patients with heart failure and diabetes mellitus: a multicentre cross-sectional study. Int J Nurs Stud 63:18–27
Al Harbi TJ, Tourkmani AM, Al-Khashan HI, Mishriky AM, Al Qahtani H, Bakhiet A (2015) Adherence to the American Diabetes Association standards of care among patients with type 2 diabetes in primary care in Saudi Arabia. Saudi Med J 36(2):221–227
Toobert DJ, Hampson SE, Glasgow RE (2000) The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care 23(7):943–950
Compean Ortiz LG, Del Angel Perez B, Resendiz Gonzalez E, Pinones Martinez S, Gonzalez Quirarte NH, Berry DC (2016) Self-care behaviors and glycemic control in low-income adults in Mexico with type 2 diabetes mellitus may have implications for patients of mexican heritage living in the United States. Clin Nurs Res 25(2):120–138
Primozic S, Tavcar R, Avbelj M, Dernovsek MZ, Oblak MR (2012) Specific cognitive abilities are associated with diabetes self-management behavior among patients with type 2 diabetes. Diabetes Res Clin Pract 95(1):48–54
Whittemore R, D’Eramo Melkus G, Grey M (2005) Metabolic control, self-management and psychosocial adjustment in women with type 2 diabetes. J Clin Nurs 14(2):195–203
Park H, Hong Y, Lee H, Ha E, Sung Y (2004) Individuals with type 2 diabetes and depressive symptoms exhibited lower adherence with self-care. J Clin Epidemiol 57(9):978–984
Nicolucci A, Rossi MC, Pellegrini F, Lucisano G, Pintaudi B, Gentile S, Marra G, Skovlund SE, Vespasiani G (2014) Group B-DS: benchmarking network for clinical and humanistic outcomes in diabetes (BENCH-D) study: protocol, tools, and population. Springerplus 3:83
Nicolucci A, Kovacs Burns K, Holt RI et al (2013) Diabetes Attitudes, Wishes and Needs second study (DAWN2): cross-national benchmarking of diabetes-related psychosocial outcomes for people with diabetes. Diabet Med 30(7):767–777
Ausili D, Bezze S, Canizzaro C, Bulgheroni M, Toolbert DJ, Genovese S, Di Mauro S (2015) Self-care assessment in type-2 diabetes: the Italian translation and validation of the Summary of Diabetes Self-Care Activities. Prof Inferm 68(1):9–18
Konerding U, Elkhuizen SG, Faubel R, Forte P, Malmstrom T, Pavi E, Janssen MF (2014) The validity of the EQ-5D-3L items: an investigation with type 2 diabetes patients from six European countries. Health Qual Life Outcomes 12:181
EuroQol G (1990) EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 16(3):199–208
Cooper J, Stetson B, Bonner J, Spille S, Krishnasamy S, Mokshagundam SP (2015) Self-reported physical activity in medically underserved adults with type 2 diabetes in clinical and community settings. J Phys Act Health 12(7):968–975
Koponen AM, Simonsen N, Suominen S (2017) Determinants of physical activity among patients with type 2 diabetes: the role of perceived autonomy support, autonomous motivation and self-care competence. Psychol Health Med 22(3):332–344
Egan AM, Mahmood WA, Fenton R, Redziniak N, Kyaw Tun T, Sreenan S, McDermott JH (2013) Barriers to exercise in obese patients with type 2 diabetes. QJM 106(7):635–638
Korkiakangas EE, Alahuhta MA, Husman PM, Keinanen-Kiukaanniemi S, Taanila AM, Laitinen JH (2011) Motivators and barriers to exercise among adults with a high risk of type 2 diabetes–a qualitative study. Scand J Caring Sci 25(1):62–69
Awotidebe TO, Adedoyin RA, Afolabi MA, Opiyo R (2016) Knowledge, attitude and practice of exercise for plasma blood glucose control among patients with type-2 diabetes. Diabetes Metab Syndr 10:S1–S6
Ouyang CM, Dwyer JT, Jacques PF, Chuang LM, Haas CF, Weinger K (2015) Diabetes self-care behaviours and clinical outcomes among Taiwanese patients with type 2 diabetes. Asia Pac J Clin Nutr 24(3):438–443
Dixon JB, Browne JL, Mosely KG, Rice TL, Jones KM, Pouwer F, Speight J (2014) Severe obesity and diabetes self-care attitudes, behaviours and burden: implications for weight management from a matched case-controlled study. Results from Diabetes MILES–Australia. Diabet Med 31(2):232–240
Kueh YC, Morris T, Ismail AA (2017) The effect of diabetes knowledge and attitudes on self-management and quality of life among people with type 2 diabetes. Psychol Health Med 22(2):138–144
Kueh YC, Morris T, Borkoles E, Shee H (2015) Modelling of diabetes knowledge, attitudes, self-management, and quality of life: a cross-sectional study with an Australian sample. Health Qual Life Outcomes 13:129
Adepoju OE, Bolin JN, Phillips CD, Zhao H, Ohsfeldt RL, McMaughan DK, Helduser JW, Forjuoh SN (2014) Effects of diabetes self-management programs on time-to-hospitalization among patients with type 2 diabetes: a survival analysis model. Patient Educ Couns 95(1):111–117
Association AD (2016) Standards of medical care in diabetes—2016 abridged for primary care providers. Clin Diabetes 34(1):3–21
Iunes DH, Rocha CB, Borges NC, Marcon CO, Pereira VM, Carvalho LC (2014) Self-care associated with home exercises in patients with type 2 diabetes mellitus. PLoS ONE 9(12):e114151
Tol A, Shojaeezadeh D, Eslami A, Alhani F, Mohajeritehrani M, Baghbanian A, Sharifirad G (2012) Evaluation of self-care practices and relative components among type 2 diabetic patients. J Educ Health Promot 1:19
Bonner T, Foster M, Spears-Lanoix E (2016) Type 2 diabetes-related foot care knowledge and foot self-care practice interventions in the United States: a systematic review of the literature. Diabet Foot Ankle 7:29758
Yang S, Hsue C, Lou Q (2015) Does patient empowerment predict self-care behavior and glycosylated hemoglobin in chinese patients with type 2 diabetes? Diabetes Technol Ther 17(5):343–348
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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.
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Ausili, D., Bulgheroni, M., Ballatore, P. et al. Self-care, quality of life and clinical outcomes of type 2 diabetes patients: an observational cross-sectional study. Acta Diabetol 54, 1001–1008 (2017). https://doi.org/10.1007/s00592-017-1035-5
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DOI: https://doi.org/10.1007/s00592-017-1035-5