Acta Diabetologica

, Volume 56, Issue 2, pp 151–161 | Cite as

Clinical and socio-demographic determinants of inadequate self-care in adults with type 1 diabetes mellitus: the leading role of self-care confidence

  • Rosario Caruso
  • Paola Rebora
  • Federica Dellafiore
  • Diletta Fabrizi
  • Barbara Riegel
  • Davide AusiliEmail author
  • Stefania Di Mauro
Original Article
Part of the following topical collections:
  1. Health education and psycho-social aspects



To describe self-care maintenance, monitoring, and management behaviors in adults with type 1 diabetes (T1DM), and to identify clinical and socio-demographic determinants of inadequate self-care.


A cross-sectional study was conducted in two diabetes outpatient clinics in Italy. Clinical and socio-demographic characteristics were collected from the medical records of 181 consecutively enrolled T1DM patients. The Self-Care of Diabetes Inventory was used to measure self-care maintenance, self-care monitoring, self-care management and self-care confidence. A standardized 0–100 score was used for each self-care dimension. A score < 70 was considered inadequate self-care. Three multiple logistic regression models were run to find determinants of inadequate self-care maintenance, monitoring, and management.


The majority of patients had adequate self-care maintenance (74%; n = 134), self-care monitoring (68.5%; n = 124) and self-care confidence (87.3%; n = 158), while self-care management was adequate for only a minority (34.8%; n = 63). The odds of inadequate self-care maintenance increased by 4.5 times when self-care confidence was inadequate (OR adjusted 4.589; 95% CI 1.611–13.071; p = 0.004). The odds of inadequate self-care monitoring increased four times when patients had inadequate self-care confidence (OR adjusted 4.116; 95% CI 1.457–11.628; p = 0.008). Inadequate self-care confidence increased the odds of performing inadequate self-care management more than five times (OR adjusted 5.313; 95% CI 1.143–24.686; p = 0.033).


Self-care management is commonly inadequate in adults with T1DM. Self-care confidence is the most important determinant of self-care behaviors in this population. Educational interventions are recommended to improve self-care confidence in adults with T1DM.


Self-care Self-management Self-efficacy Diabetes mellitus Type 1 diabetes mellitus Risk factors Health education 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Human and animal rights

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.

Informed consent

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


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Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Health Professions Research and Development UnitIRCCS Policlinico San DonatoSan Donato MilaneseItaly
  2. 2.Department of Medicine and SurgeryUniversity of Milano-BicoccaMonzaItaly
  3. 3.School of NursingUniversity of PennsylvaniaPhiladelphiaUSA

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