Patients' perspective on self-management: type 2 diabetes in daily life.
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ABSTRACT: Background
The number of type 2 diabetes mellitus (T2DM) patients and related treatment costs are rapidly increasing. Consequentially, more cost-effective and efficient strategies for the treatment of T2DM are needed. One such strategy is improving patients' self-management. As patients are more and more expected to self-manage their disease, it is important to provide them with suitable self-management support. This way, success of self-management will increase and complications and related costs of T2DM can be reduced. Currently, self-management support is developed mainly from the perspective of health professionals and caregivers, rather than patients. This research focused on gaining a better understanding of patients' perspectives on self-management and support.Methods
Semi-structured interviews, preceded by preparatory assignments, were conducted with ten patients with T2DM treated in Dutch primary care.Results
We found that patients experience 'active' self-management when recently diagnosed. As time progresses and no problems occur, patients do not experience their disease-related behaviour as self-management. Diabetes has 'just' become part of their daily life, now including new routines taking diabetes into account.Conclusions
With this knowledge, support solutions can be designed and implemented that better fit the needs, preferences and abilities of patients with T2DM.
SUBMITTER: van Smoorenburg AN
PROVIDER: S-EPMC6714441 | biostudies-literature | 2019 Aug
REPOSITORIES: biostudies-literature
Publications
Patients' perspective on self-management: type 2 diabetes in daily life.
van Smoorenburg Astrid N AN Hertroijs Dorijn F L DFL Dekkers Tessa T Elissen Arianne M J AMJ Melles Marijke M
BMC health services research 20190828 1
<h4>Background</h4>The number of type 2 diabetes mellitus (T2DM) patients and related treatment costs are rapidly increasing. Consequentially, more cost-effective and efficient strategies for the treatment of T2DM are needed. One such strategy is improving patients' self-management. As patients are more and more expected to self-manage their disease, it is important to provide them with suitable self-management support. This way, success of self-management will increase and complications and rel ...[more]
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Project description:ImportanceA patient’s perceived barriers to diabetes self-management (DSM) may affect his or her risk of diabetic retinopathy (DR); however, few studies have examined this association.ObjectiveTo examine the association between perceived barriers to DSM and the severity spectrum of DR in Asian patients with type 2 diabetes.Design, setting, and participantsA cross-sectional clinic-based study, the Singapore Diabetes Management Project, was conducted from December 28, 2010, to March 20, 2013, at the Singapore National Eye Centre, a tertiary eye care institute. After excluding patients with type 1 diabetes and ungradable fundus images, 361 participants were included in the analyses. Statistical analysis was conducted from July 20 to September 8, 2017.ExposureThe degree of perceived barriers to DSM was assessed using a 23-item questionnaire comprising items about knowledge of DSM, access to care, and confidence in health care professionals. Rasch analysis was used to optimize the scale’s psychometric properties, with lower scores indicating a higher degree of self-perceived barriers.Main outcomes and measuresDiabetic retinopathy was graded from 2-field retinal images into categories of no DR (Early Treatment Diabetic Retinopathy Study levels 10-15; n = 154), mild to moderate DR (levels 20-43; n = 112), and severe DR (levels ≥53 and/or presence of clinically significant macular edema; n = 95) using the modified Airlie House classification system of DR. Multinomial logistic regression models were used to assess the association between perceived barriers and severity of DR in the worse-affected eye.ResultsAmong the 361 participants (105 women and 256 men; mean [SD] age, 57 [8] years), a greater magnitude of perceived barriers to DSM was independently associated with higher odds of having any DR (odds ratio, 1.32; 95% CI, 1.06-1.66), mild to moderate DR (odds ratio, 1.30; 95% CI, 1.01-1.68), and severe DR (odds ratio, 1.36; 95% CI, 1.03-1.79). This association was independent of diabetes control (hemoglobin A1c, blood pressure, and lipid levels), presenting visual acuity, and socioeconomic indicators.Conclusions and relevanceThese results suggest that greater perceived barriers to DSM are independently associated with severity of DR. Although longitudinal data are needed, these findings suggest that evidence-based interventions to reduce patient-, practitioner-, and system-related barriers to diabetes care may help reduce the risk of DR.
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Project description:PurposeDiabetes patients must be equipped with the necessary knowledge to confidently undertake appropriate self-care activities. We prepared a diabetes self-management education (DSME) intervention and assessed how it affected patients' self-reported levels of diabetes knowledge, self-care behaviors, and self-efficacy.Patients and methodsA before-and-after, two-group intervention study was conducted at Jimma University Medical Centre among adult patients with type 2 diabetes. At baseline, we randomly assigned 116 participants to the DSME intervention and 104 to a comparison group. Six interactive DSME sessions supported by an illustrative handbook and fliers, experience-sharing, and take-home activities were administered to the intervention group by two nurses during a six-month period. Diabetes knowledge, self-care behaviors, and self-efficacy were measured at baseline and at nine months following the commencement of DSME intervention (endpoint) in both groups.ResultsAt the endpoint, data from 78 intervention group participants and 64 comparison group participants were included in final analysis. The difference in the mean Diabetes Knowledge Scale scores before and after the DSME intervention was significantly greater in the intervention group (p = 0.044). The measured self-care behaviors included diet, exercise, glucose self-monitoring, footcare, smoking, alcohol consumption, and khat chewing. The mean number of days per week on which the intervention group participants followed general dietary recommendations increased significantly at the endpoint (p = 0.027). The intervention group followed specific dietary recommendations (p = 0.019) and performed footcare (p = 0.009) for a significantly greater number of days. There were no significant differences within or between the groups in other self-reported diabetes self-care behavior regimens or in diabetes self-efficacy.ConclusionOur study found significant improvements in the intervention participants' diabetes knowledge scores and in their adherence to dietary and footcare recommendations. This demonstrates that our DSME intervention may be of clinical importance in developing countries such as Ethiopia.Trial registrationClinicalTrials.gov, Identifier NCT03185689, retrospectively registered on June 14, 2017: https://clinicaltrials.gov/ct2/show/NCT03185689.
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Project description:Aims:We studied the association between fear of hypoglycaemia (FoH) and various diabetes self-management practices. Methods:Data from 798 individuals with type 1 diabetes participating in the FinnDiane Study were included. Self-reported questionnaires were used to assess FoH and self-management practices (e.g. dietary intake, insulin administration, physical activity). For glycaemic control, we used both the latest HbA1c measurements and the serial HbA1c measurements from the medical files. Factor analysis was used to reveal underlying constructs within the food frequency section of the diet questionnaire. Results:In all, 44% and 63% of men and women reported FoH, respectively. In men, FoH was associated with higher mean serial HbA1c levels, higher number of reported self-monitoring of blood glucose (SMBG), higher carbohydrate intake, and lower scores in the "high-fat" factor. In women, FoH was associated with a higher number of reported SMBGs and higher energy intake. No difference was observed in physical activity and insulin administration. Conclusions:FoH has various implications for the self-management of diabetes. More studies are however needed to assess on one hand the association between FoH and diabetes self-management, and on the other hand, FoH and its long term consequences, such as the emergence of diabetic complications and mortality.
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