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Socio-demographic and clinical determinants of self-care in adults with type 2 diabetes: a multicentre observational study

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Abstract

Aims

To describe self-care as defined by the Middle Range Theory of Self-Care of Chronic Illness and to identify clinical and socio-demographic determinants in a T2DM population.

Methods

A multicentre observational cross-sectional study was conducted involving 540 adults with a confirmed diagnosis of T2DM from six outpatient diabetes services in Italy. Socio-demographic and clinical data were collected from medical records. The Self-Care of Diabetes Inventory (SCODI) was used to measure self-care maintenance, monitoring, management, and confidence dimensions. For each separate scale, scores were standardized 0–100 with higher SCODI scores indicating better self-care; a score ≥ 70 is adequate. Multiple quantile regression models were performed to identify determinants of each self-care dimension.

Results

Self-care maintenance (median = 81.3) and self-care confidence (median = 79.5) were adequate in most of the subjects. Self-care monitoring was adequate in only half of the sample (median = 70.6). Self-care management was poor (median = 59.4). Lower self-care maintenance was associated with lower self-care confidence (p < 0.001). Lower self-care monitoring was associated with being male (p < 0.001), having lower self-care confidence (p < 001), and having diabetes for < 10 years (p < 0.001). Lower self-care management was associated with being male (p = 0.002), being older (p = 0.005), having a low income (p = 0.030), being employed (p = 0.008), having missed diabetes education in the last year (p = 0.002), and lower self-care confidence (p < 0.0001). Lower self-care confidence was associated with having diabetes for < 10 years (p = 0.008), and having at least one comorbid condition (p = 0.006).

Conclusions

Determinants of self-care maintenance, monitoring, management and confidence include both clinical and socio-demographic variables. Modifiable determinants such as self-care confidence and diabetes self-care management education could be used to tailor interventions to improve diabetes self-care.

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Authors and Affiliations

  1. Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20099, Monza, Italy

    Davide Ausili, Michela Luciani, Silvia Androni & Stefania Di Mauro

  2. Centre of Biostatistics for Clinical Epidemiology, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy

    Emanuela Rossi & Paola Rebora

  3. Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy

    Michela Luciani & Ercole Vellone

  4. University of Brescia, Brescia, Italy

    Luca Tonoli & Enrico Ballerini

  5. University of Pennsylvania, Philadelphia, PA, USA

    Barbara Riegel

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  1. Davide Ausili
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  2. Emanuela Rossi
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Correspondence to Davide Ausili.

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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 1975 Declaration of Helsinki, as revised in 2008.

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Informed consent was obtained from all patients for being included in the study.

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Ausili, D., Rossi, E., Rebora, P. et al. Socio-demographic and clinical determinants of self-care in adults with type 2 diabetes: a multicentre observational study. Acta Diabetol 55, 691–702 (2018). https://doi.org/10.1007/s00592-018-1135-x

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