Perceived Diabetes Self-Management Research Articles

Care Partner Experiences in Supporting Deaf and Hard of Hearing Adults With Diabetes

OBJECTIVE Care partners play an important role in diabetes management of people with diabetes. Although deaf and hard of hearing (DHH) adults experience diabetes at a higher rate than their hearing counterparts, there is a lack of information regarding the experience of care partners assisting those in the DHH community. There is a need to identify intentional support for this population. The purpose of this study was to explore how care partners of DHH people with diabetes provide helpful and unhelpful support, the care partner experience of providing support, and care partners’ perceived diabetes self-management education, support needs, and recommendations. METHODS We engaged a community advisory board of care partners to DHH people with diabetes to explore how care partners provide support, their individual experiences in providing support, and their suggestions for diabetes self-management education. We used thematic analysis to analyze individual and collective responses. RESULTS Three emergent themes were identified suggesting that care partners give support in a variety of ways, are often overwhelmed in meeting the demanding and ongoing needs of DHH people with diabetes, and have a multitude of suggestions for implementing a future diabetes care partner education program. We also identified some DHH population-specific challenges to diabetes care, including communication barriers with health care providers, inability to use hearing cues if a person with diabetes experiences a fall, and limited access to diabetes care education in sign language. CONCLUSION These findings highlight a need to provide more support for care partners of DHH people with diabetes and to address the needs of DHH populations to ensure more equitable diabetes care. Further research is needed to adequately inform successful interventions for DHH people with diabetes and their care partners.

EATING DISORDERS, SELF-MANAGEMENT, AND ANXIETY DISORDERS IN DIABETICS DURING THE COVID-19 PANDEMIC: A CROSS-SECTIONAL STUDY

Objective: This study aimed to determine the frequency of eating disorders and symptoms, anxiety and self-care management status, and factors that have an impact on eating disorders in diabetics during the COVID-19 pandemic. Method: This cross-sectional web-based study used a survey comprising a socio-demographic information form, the Bulimic Investigation Test of Edinburgh (BITE), Perceived Diabetes Self-Management Scale (PDSMS), and Generalized Anxiety Disorder Scale (GAD-7). Independent samples t Test, Mann Whitney U Test, Chi Square Test, Pearson correlation analysis, and Simple Regression Analysis were applied to the variables. Results: Totally, 110 (52 Type 1, 58 Type 2) diabetics aged 18-65 participated in the study. BITE total score was determined as 20.92±7.99 (Min:8; Max:32). Eating disorder frequency was 29.1% while anxiety disorders frequency was 30.9%. Perceived Diabetes Self-Management Scale point is 24.80±3.85 (Min:8; Max:40). Married individuals and diabetics with anxiety disorder mostly had eating disorders (p<.005). There was no significant relationship between anxiety disorder, eating disorder and PDSMS scores of the participants and socio-demographics (p>.05). Anxiety was a significant predictor of eating disorders in diabetics (R=.45; R2 =.20; F (1.108)=28.61, p<.001). Conclusion: Eating disorder symptoms and severity of diabetics, and their coping styles with anxiety should be determined during the pandemic by diabetes care and specialist. Family eating habits and the presence of anxiety disorders should be taken into account to reduce eating disorders. People with diabetes can be emotionally and self-management empowered through online training and counseling.

A Structural Equation Modeling Analysis to Explore Diabetes Self-Care Factors in a Rural Sample.

Diabetes is a public health problem that requires management to avoid health sequelae. Little is known about the determinants that influence diabetes self-care activities among rural populations. The purpose of this analysis was to explore the relationships among diabetes self-care activities, diabetes knowledge, perceived diabetes self-management, diabetes fatalism, and social support among an underserved rural group in the southern United States. A diabetes health promotion program was tested during a cluster randomized trial that tested a disease risk reduction program among adults living with prediabetes and diabetes. A structural equation model was fit to test psychosocial factors that influence diabetes self-care activities using the Information–Motivation–Behavioral Skills Model of Diabetes Self-Care (IMB-DSC) to guide the study. Perceived diabetes self-management significantly predicted self-care behaviors, and there was also a correlation between perceived diabetes self-management and diabetes fatalism. Perceived diabetes self-management influenced diabetes self-care activities in this rural sample and had an association with diabetes fatalism. The findings of this study can facilitate clinical care and community programs targeting diabetes and advance health equity among underserved rural groups.

Food insecurity, diabetes, and perceived diabetes self-management among Latinos in California: Differences by nativity and duration of residence

We examined associations between food security (FS) status and type 2 diabetes (T2D) prevalence and perceived T2D self-management by nativity and US duration of residence among Latinos living in California. We used the California Health Interview Survey (2012–2017) and included Latinos who lived below 200% of the federal poverty line (n = 16,254) and for our management outcome, those with T2D (n = 2284). Latinos with low FS (OR = 1.44, 95% CI 1.14–1.83) or very low FS (OR = 1.87, 95% CI 1.33–2.61) had a higher odds of T2D compared to their food-secure counterparts. When stratified by nativity/duration in the US, US-born Latinos and Latino immigrants with >10 years duration had a higher odds of T2D if they reported low FS (US-born: OR = 1.60, 95% CI 1.02–2.52; >10 yrs: OR = 1.48, 95% CI 1.12–1.97) or very low FS (US-born: OR = 2.37, 95% CI 1.45–3.86; >10 yrs: OR = 1.78, 95% CI 1.15–2.76) compared to their food-secure counterparts. There was no association among immigrants with <10 years duration. For perceived T2D self-management, those with low or very low FS had lower odds of reporting proper management (OR = 0.56, 95% CI 0.36–0.86; OR = 0.46, 95% CI 0.26–0.83) compared to their food-secure counterparts. When stratified by nativity, the US-born did not differ in their perceived self-management by FS status, while immigrants with low or very FS had lower odds of perceived self-management (OR = 0.54, 95% CI 0.34–0.86; OR = 0.36, 95% CI 0.17–0.74), compared to their food-secure counterparts. Food insecurity may be an important contributor to T2D prevalence and perceived T2D self-management for Latino immigrants.

Factors Associated with Diabetes Outcomes among Rural African Americans.

Diabetes is a major public health threat and contributory risk factor for cardiovascular disease, especially among underserved populations living in the rural, southern states. In these areas, African Americans have the highest rates of both diabetes and cardiovascular disease, but not much is known about the psychosocial factors that influence diabetes outcomes. This study examined bivariate correlations among diabetes knowledge, diabetes self-care activities, perceived diabetes self-management, diabetes fatalism, and social support. The data were collected during a cluster randomized trial involving rural African American participants living with diabetes and prediabetes in a rural, southeastern area. The findings of this analysis point to associations among social support, diabetes fatalism, diabetes self-care activities, and perceived diabetes self-management. Diabetes knowledge was not significantly correlated with any of these factors or their subscales.

The Effect of Self-Efficacy in Self-Management on Diabetes Distress in Young People with Type 2 Diabetes.

To understand the relationship among glycemic control, self-efficacy in diabetes management, and diabetes distress in young people with type 2 diabetes, a cross-sectional descriptive study with convenience sampling was designed. A total of 60 young people who had type 2 diabetes (T2D), with 24 (40%) males and 36 (60%) females were included. The mean age was 17.2 and ranged from 10.5 to 24.5 years, and they completed a Perceived Diabetes Self-Management Scale, the Problem Areas in Diabetes Scale and their pharmacologic management and life adjustment. Glycated hemoglobin (HbA1c) was routinely drawn before the outpatient visit. HbA1c and diabetic distress were positively correlated. Self-efficacy was negatively correlated with HbA1c and diabetic distress. In the hierarchical multiple regression analysis, only the duration of illness and self-efficacy remained significant in the final model. The variance for the overall model was 64%, with self-efficacy alone explaining 30% of the variance. In addition, 31.6% of participants had extremely high levels of psychological distress. Conclusions: T2D is an early onset chronic disease, and the young people may have had other health problems, which made the diabetes management a complex process. Nursing staff should regularly assess both the confidence and ability to manage treatment regimen of young people with type 2 diabetes and their psychological distress.

Fatalism, Social Support and Self-Management Perceptions among Rural African Americans Living with Diabetes and Pre-Diabetes.

Diabetes is a public health problem and a major risk factor for cardiovascular disease, the leading cause of death in the United States. Diabetes is prevalent among underserved rural populations. The purposes of this study were to perform secondary analyses of existing clinical trial data to determine whether a diabetes health promotion and disease risk reduction intervention had an effect on diabetes fatalism, social support, and perceived diabetes self-management and to provide precise estimates of the mean levels of these variables in an understudied population. Data were collected during a cluster randomized trial implemented among African American participants (n = 146) in a rural, southern area and analyzed using a linear mixed model. The results indicated that the intervention had no significant effect on perceived diabetes management (p = 0.8), diabetes fatalism (p = 0.3), or social support (p = 0.4). However, the estimates showed that, in the population, diabetes fatalism levels were moderate (95% CI = (27.6, 31.3)), and levels of social support (CI = (4.0, 4.4)) and perceived diabetes self-management (CI = (27.7, 29.3)) were high. These findings suggest that diabetes fatalism, social support, and self-management perceptions influence diabetes self-care and rural health outcomes and should be addressed in diabetes interventions.

Effects of a health education technology program on long-term glycemic control and self-management ability of adults with type 2 diabetes: A randomized controlled trial

AimsThis study aimed to explore the effects of a health technology education program on long-term glycemic control and the self-management ability of adults with type 2 diabetes (T2D). MethodsThe study was a randomized controlled trial with repeated measures design. The experimental group (n = 53) received a novel health technologies education program plus focus groups and routine shared care, the control group (n = 55) received routine shared care. Glycosylated hemoglobin (HbA1c) level and self-management ability were the primary and secondary outcomes. Subject self-management ability was evaluated using the Chinese version of Perceived Diabetes Self-Management Scale (PDSMS). A linear mixed-effect model for repeated measures was used to analyze changes in HbA1c level and self-management ability after controlling for pretest effects. ResultsThe mean HbA1c levels in the experimental group decreased by 0.692% (7.564 mmol/mol) and 0.671% (7.332 mmol/mol) at 3 and 6 months after the intervention (p < 0.05) while the mean increase in the PDSMS scores at 3 and 6 months after the intervention were significantly higher than those in the control group (p < 0.05). ConclusionThe health technology education program was more effective than routine shared care alone in lowering HbA1c and increasing self-management ability in T2D patients.

Ready or not? Greater readiness for independent self-care predicts better self-management but not HbA1c in teens with type 1 diabetes.

Prior to the transfer from paediatric to adult health care transition, teens with type 1 diabetes seek increasing independence in diabetes self-care while parent involvement in care decreases. Yet, few teens attain glycaemic targets. This study aimed to assess changes in perceived readiness for independent self-care in teens with type 1 diabetes over 18 months, from both teens' and parents' perspectives, and to evaluate its predictive value for diabetes self-management and haemoglobin A1c (HbA1c ). At baseline, 6, 12 and 18months, 178 teens with type 1 diabetes (mean±SD age 14.9±1.3years; HbA1c 8.5±1.0% (69±11mmol/mol); 48% female) and their parents completed the Readiness for Independent Self-Care Questionnaire (RISQ-T and RISQ-P, respectively) and a measure of self-management. Chart review provided HbA1c values. Statistical analyses encompassed bivariate correlations, paired t-tests and multivariable longitudinal mixed models. Teens perceived greater self-care readiness than their parents at baseline and over 18 months of follow-up. Both teen and parent perceptions of teen readiness for independent self-care increased over time, and significantly predicted higher teen self- and parent proxy-reported teen diabetes self-management, respectively, but not improved HbA1c . The current findings may point to a disconnect between how increased readiness for independent self-care may translate into better perceived diabetes self-management, but not into better HbA1c . In an effort to optimize HbA1c in teens with type 1 diabetes, future research is needed to design interventions that align perceived readiness for independent self-care with self-care behaviours that improve HbA1c .

Barriers and facilitators to perceived diabetes self-management in Arab American patients with diabetes

AimsTo assess perceptions surrounding diabetes self-management (DSM) behaviors in Arab American patients with diabetes. MethodsA 39-item survey was constructed from focus group discussions designed to better understand the impact of Arab American culture on DSM behaviors. The survey assessed perceptions about diet, adherence to medications, exercise, healthy lifestyle, and family support. ResultsTwo hundred Arab Americans with diabetes completed the survey via face-to-face interviews. Most patients were female (59%), over fifty years of age (79%), and immigrated from Lebanon (73%). Receiving instructions in Arabic, having family support, family understanding of food choices, and employment status were found to be important predictors of the perceived importance of DSM. ConclusionsOur findings suggest that there are multiple factors that dictate Arab American’s perception of the importance of DSM. The survey that was constructed may serve as a valuable tool for providers to assess DSM perceptions in order to provide patient-centered care that will help to improve diabetes outcomes. This study supports the importance of integrating cultural influences into DSM education and support when providing care to a population with a strong cultural identity.

Diyabetik Ayak Ülseri Olan Hastalarda Uyku Kalitesi Ve Öz-Yönetim Algısı: Çorum/Türkiye

Abstract: This study was conducted in order to evaluate sleep quality and perception of diabetes self-management in Turkish patients with diabetic foot ulcers (DFU). This study was conducted as a descriptive and cross-sectional study in patients with diabetic foot ulcers. This study was conducted with 61 people in the Diabetic Foot Clinic of the university hospital in Corum. Patient Introduction Form, Pittsburgh Sleep Quality Index (PSQI) and Perceived Diabetes Self-Management Scale (PDSMS) were used as data collection tools. Of the patients included, 82% had a PSQI score 5≥ and the sleep quality was found to be poor. The mean PSQI score was significantly higher and poorer in smokers and those with other diseases/comorbidities (p<0.05). The mean PDSMS score of the patients was found as 22.75± 2.03. The mean PDSMS score was found to be statistically significantly higher in patienst with longer duration of diabetes than in patients with shorter duration of diabetes (p<0.05). The poor sleep quality of individuals with diabetic foot ulcers leads to the failure of diabetes management. It is therefore important that health professionals focus on determining the conditions that affect sleep quality in patients with diabetic foot problems.

Barriers and Facilitators to Perceived Diabetes Self-Management in Arab Americans with Diabetes

Arab Americans (AAs) are at increased risk of type 2 diabetes, with a reported prevalence of 18%. Despite the increasing prevalence, there remains a lack of data on diabetes self-management (DSM) practices and barriers to care in this population. The purpose of this study was to assess patient perceptions of DSM behaviors in order to facilitate individualized care plans by providers. A 39-item survey was created based on focus group discussions designed to understand the impact of AA culture on DSM. The survey assessed diet, adherence to medications, exercise, healthy lifestyle, and family support. Two hundred AAs with diabetes completed the survey via face-to-face interviews. Most participants were above fifty years of age (79%), females (59%), and originated from Lebanon (73%). Individuals receiving Arabic instructions perceived that good portion control (p=0.07), food selection (p=0.01), and maintaining a healthy lifestyle (p=0.003) were important DSM behaviors, compared to those who did not receive Arabic instructions. Unemployed individuals were less likely to perceive regular exercise (p=0.05), portion control (p=0.06), and maintaining a healthy lifestyle (p=0.08) as important DSM behaviors compared to employed individuals. Individuals who had family support and encouragement were more likely to perceive that discussions with their clinicians were important (p=0.003) compared to those without family support. Individuals with family who understood their food choices were more likely to perceive regular exercise (p=0.03) as important compared to those with families who did not understand food choices. In conclusion, this survey may serve as a valuable tool for providers to assess perceptions surrounding DSM behaviors in order to provide patient-centered care that will help to improve patient outcomes. This study supports the importance of integrating cultural influences into DSM education and support when providing care to a population with a strong cultural identity. Disclosure D. El Masri: None. G. Piatt: None. N.J. Koscielniak: None. L. Jaber: None.

Psychometric evaluation of the short version of the Personal Diabetes Questionnaire to assess dietary behaviors and exercise in patients with type 2 diabetes

BackgroundPatients with diabetes and of lower socioeconomic status have difficulty adhering to dietary recommendations. Practical and effective tools assessing self-management behaviors are needed to help evaluate interventions tailored to the needs of individual patients or population groups. This study examined the psychometric properties of a short 11-item version of the Personal Diabetes Questionnaire scale (PDQ-11) using data from the Public-Private Partnership to Improve Diabetes Education trial. MethodsPatients (n=411) with type 2 diabetes from ten safety net primary care clinics in the Mid-Cumberland Region of Tennessee completed the PDQ-11, the Summary of Diabetes Self-Care Activities (SDSCA), the Perceived Diabetes Self-Management Scale (PDSMS), and the Adherence to Refills and Medications Scale (ARMS). Statistical analyses were conducted to explore the subscale structure of the PDQ-11, and the internal consistency and validity of its subscales. ResultsExploratory factor analysis of the PDQ-11 revealed four components (Cronbach's α=0.50 to 0.81): Eating Behavior Problems; Use of Information for Dietary Decision Making; Calorie Restriction; and Activity and Exercise. Eating Behavior Problems and Use of Information for Dietary Decision Making had the strongest associations with the diet subscales of the SDSCA and were also correlated with the PDSMS and the ARMS scores (all ps<0.001). Different PDQ-11 subscales were correlated with BMI (Calorie Restriction Activity and Exercise) and blood pressure (Eating Behavior Problems). ConclusionsThe PDQ-11 is a useful measure of dietary behaviors in patients with type 2 diabetes; its use may help providers tailor individual nutrition intervention strategies to patients.

Comprehensive and Medically Appropriate Food Support Is Associated with Improved HIV and Diabetes Health.

Food insecurity is associated with negative chronic health outcomes, yet few studies have examined how providing medically appropriate food assistance to food-insecure individuals may improve health outcomes in resource-rich settings. We evaluated a community-based food support intervention in the San Francisco Bay Area for people living with HIV and/or type 2 diabetes mellitus (T2DM) to determine the feasibility, acceptability, and potential impact of the intervention on nutritional, mental health, disease management, healthcare utilization, and physical health outcomes. The 6-month intervention provided meals and snacks designed to comprise 100% of daily energy requirements and meet nutritional guidelines for a healthy diet. We assessed paired outcomes at baseline and 6months using validated measures. Paired t tests and McNemar exact tests were used with continuous and dichotomous outcomes, respectively, to compare pre-post changes. Fifty-two participants (out of 72 initiators) had both baseline and follow-up assessments, including 23 with HIV, 24 with T2DM, and 7 with both HIV and T2DM. Median food pick-up adherence was 93%. Comparing baseline to follow-up, very low food security decreased from 59.6% to 11.5% (p < 0.0001). Frequency of consumption of fats (p = 0.003) decreased, while frequency increased for fruits and vegetables (p = 0.011). Among people with diabetes, frequency of sugar consumption decreased (p = 0.006). We also observed decreased depressive symptoms (p = 0.028) and binge drinking (p = 0.008). At follow-up, fewer participants sacrificed food for healthcare (p = 0.007) or prescriptions (p = 0.046), or sacrificed healthcare for food (p = 0.029). Among people with HIV, 95% adherence to antiretroviral therapy increased from 47 to 70% (p = 0.046). Among people with T2DM, diabetes distress (p < 0.001), and perceived diabetes self-management (p = 0.007) improved. Comprehensive, medically appropriate food support is feasible and may improve multiple health outcomes for food-insecure individuals living with chronic health conditions. Future studies should formally test the impact of medically appropriate food support interventions for food-insecure populations through rigorous, randomized controlled designs.

Perceived resource support for chronic illnesses among diabetics in north-western China.

A high level of social support can improve long-term diabetes self-management. Support from a single source has been evaluated. This study aims to analyze support from multiple and multilevel sources for diabetic patients by using the Chronic Illness Resources Survey (CIRS). Factors influencing the utilization of the CIRS were also evaluated. A total of 297 patients with diabetes were investigated using the CIRS and Perceived Diabetes Self-management Scale in Shihezi City, China. Descriptive statistics were used to explain demographic variables and scores of the scales. Factors affecting the utilization of chronic illness resources were determined through univariate analysis and then examined by multivariate logistic regression analysis. Of the 297 diabetic patients surveyed, 67% failed to reach the standard (more than 3 points) of utilizing chronic illness resources. Moreover, utilization of chronic illness resources was positively moderately correlated with self-management of diabetes (r = 0.75, P < 0.05). According to the multivariate logistic regression analysis, age (OR, 3.42; 95%CI, 1.19-9.84) and monthly income (OR, 5.27; 95%CI, 1.86-14.90) were significantly positively associated with the CIRS score. Individuals with high school (OR, 2.61; 95%CI, 1.13-6.05) and college (OR, 3.02; 95%CI, 1.13-8.04) degrees obtained higher scores in the survey than those with elementary school education. Results indicated that utilization of resources and support for chronic illness self-management, particularly personal adjustment and organization, were not ideal among diabetics in the communities of north-western China. Improved utilization of chronic illness resources was conducive for proper diabetes self-management. Furthermore, the level of utilization of chronic illness resources increased with age, literacy level, and monthly income.

Validation of Malaysian Versions of Perceived Diabetes Self-Management Scale (PDSMS), Medication Understanding and Use Self-Efficacy Scale (MUSE) and 8-Morisky Medication Adherence Scale (MMAS-8) Using Partial Credit Rasch Model.

The Diabetes Mellitus (DM) is a common silent epidemic disease with frequent morbidity and mortality. The psychological and psychosocial health factors are negatively influencing the glycaemic control in diabetic patients. Therefore, various questionnaires were developed to address the psychological and psychosocial well-being of the diabetic patients. Most of these questionnaires were first developed in English and then translated into different languages to make them useful for the local communities. The main aim of this study was to translate and validate the Malaysian versions of Perceived Diabetes Self-Management Scale (PDSMS), Medication Understanding and Use Self-Efficacy Scale (MUSE), and to revalidate 8-Morisky Medication Adherence Scale (MMAS-8) by Partial Credit Rasch Model (Modern Test Theory). Permission was obtained from respective authors to translate the English versions of PDSMS, MUSE and MMAS-8 into Malay language according to established standard international translation guidelines. In this cross-sectional study, 62 adult DM patients were recruited from Hospital Kuala Lumpur by purposive sampling method. The data were extracted from the self-administered questionnaires and entered manually in the Ministeps (Winsteps) software for Partial Credit Rasch Model. The item and person reliability, infit/outfit Z-Standard (ZSTD), infit/outfit Mean Square (MNSQ) and point measure correlation (PTMEA Corr) values were analysed for the reliability analyses and construct validation. The Malay version of PDSMS, MUSE and MMAS-8 found to be valid and reliable instrument for the Malaysian diabetic adults. The instrument showed good overall reliability value of 0.76 and 0.93 for item and person reliability, respectively. The values of infit/outfit ZSTD, infit/outfit MNSQ, and PTMEA Corr were also within the stipulated range of the Rasch Model proving the valid item constructs of the questionnaire. The translated Malay version of PDSMS, MUSE and MMAS-8 was found to be a highly reliable and valid questionnaire by Partial Credit Model. The Malay version was conceptually equivalent to original version, easy to understand and can be used for the Malaysian adult diabetic patients for future studies.

Measurement of Parental Self-Efficacy for Diabetes Management in Young Children

Self-efficacy is an important construct in diabetes management, especially for parents of young children. The Parental Self-Efficacy Scale for Diabetes Management (PSESDM) was adapted from the Perceived Diabetes Self-Management Scale (PDSMS) to measure parental self-efficacy for diabetes management of young children. The PSESDM was administered to 49 primary caregivers of youth between 2–9 years of age with type 1 diabetes (T1D). Cronbach’s alpha for the 8-item measure demonstrated adequate internal consistency (α = 0.84). Criterion-related validity was established. Higher scores on the PSESDM were associated with better glycemic control and quality of life in children. These preliminary findings provide support for the reliability and validity of the PSESDM, which may be a useful screening measure of diabetes-related parental self-efficacy for young children.

The Relationship between Demographic Variables and Diabetes Self-Management in Diabetic Patients in Amman City/Jordan

Background:Diabetes is a chronic disease that requires routine and complicated self care. Although self care can be managed by most diabetes patients, there are many variables that may make diabetes self-management difficult.Aim:The study examined the relationship between clients’ demographic variables and diabetes self-management in diabetic clients in Amman city/Jordan.Method:The data were collected through a self-completed questionnaire developed by the researchers and combined with the perceived diabetes self-management scale (PDSMS). The sampling of the investigation comprised 178 diabetes clients from Amman city/Jordan.Findings:There was proportional little relationship between income level and diabetes self management, and reversely proportional low relationship between duration of diabetes and diabetes self management. Other variables had no relationship with diabetes self management.Conclusion:The demographic variables related to diabetes self-management in this study are income level and duration of diabetes. As income level increases, diabetes self-management become better, and the longer the duration of diabetes, the worse is diabetes self-management.

Self-efficacy Affects Blood Sugar Control Among Adolescents With Type I Diabetes Mellitus

Self-management is crucial to diabetes control. To investigate the effectiveness of self-management in reaching target hemoglobin A1c (HbA1c) level, we conducted a study among Taiwanese adolescents with type 1 diabetes mellitus (DM). Patients aged 12-20 years with type 1 DM participated in an annual integrated DM care clinic at a medical center in Taiwan. All patients completed a questionnaire that included demographic data and self-efficacy measured by the Perceived Diabetes Self-Management Scale (PDSMS) in February 2008. Laboratory tests were also done at the same visit. The target HbA1c was < 7.0% in accordance with the general standard of the American Diabetes Association for patients with type 1 DM. Logistic regression analysis was used to explore the relationship between age, sex, duration of diabetes, PDSMS score, and HbA1c level. Fifty-two patients were enrolled. The mean age was 16.0 +/- 2.4 years, and mean HbA1c level was 8.6 +/- 1.6%. Pearson correlation analysis showed a positive correlation between body mass index and preprandial blood sugar level (r = 0.297, p < 0.05). Negative correlations were found between PDSMS scores and duration of diabetes (r = -0.365, p < 0.01) as well as HbA1c level (r = -0.295, p < 0.05). Logistic regression analysis demonstrated that sex and PDSMS scores significantly influenced glycemic control. In multivariate logistic regression analysis, patients with higher PDSMS scores were 1.63 times (95% confidence interval = 1.03-2.59) more likely to reach target diabetes control after adjustment for other variables. Male patients also had a higher probability (odds ratio = 19.80, 95% confidence interval = 1.34-291.93) of reaching target diabetes control. This study demonstrates that adolescents with type 1 DM and higher self-efficacy, especially males, have a higher probability of reaching target diabetes control.

Psychometric Properties of the Perceived Diabetes Self-Management Scale (PDSMS)

Patients with chronic medical conditions such as diabetes mellitus need to self-manage their condition for optimal outcomes. The degree to which patients with diabetes feel competent or self-efficacious in managing their diabetes has been related to behaviors such as dieting or exercise as well as to indicators of glycemic control. A diabetes-specific adaptation of the Perceived Medical-Condition Self-Management Scale was administered to 398 patients with either type 1 (n=57) or type 2 (n=341) diabetes. Cronbach's alpha of the 8-item Perceived Diabetes Self-Management Scale (PDSMS) was .83 indicating internal consistency. PDSMS scores were uncorrelated with age, years since diagnosis, and years of schooling, but were negatively correlated with body mass index. Those with type 1 DM had higher PDSMS scores than those with type 2 DM. PDSMS scores were positively correlated with a number of self-reported self-care activities and negatively related to measures of glycemic control. The PDSMS is a valid measure of diabetes self-efficacy, and the more generic template from which it was adapted can easily be altered for use with other chronic medical conditions.