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

  • Davide Ausili
  • Emanuela Rossi
  • Paola Rebora
  • Michela Luciani
  • Luca Tonoli
  • Enrico Ballerini
  • Silvia Androni
  • Ercole Vellone
  • Barbara Riegel
  • Stefania Di Mauro
Original Article
  • 63 Downloads

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.

Keywords

Diabetes mellitus Type 2 diabetes mellitus Self-management Chronic disease Self-efficacy Risk factors Health education 

Notes

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 1975 Declaration of Helsinki, as revised in 2008.

Informed consent

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

Supplementary material

592_2018_1135_MOESM1_ESM.docx (14 kb)
Supplementary material 1 (DOCX 13 kb)

References

  1. 1.
    International Diabetes Federation (2015) IDF diabetes Atlas 2015, 7th edn. International Diabetes Federation, BrusselsGoogle Scholar
  2. 2.
    Alberti KG, Zimmet PZ (1998) Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 15(7):539–553.  https://doi.org/10.1002/(SICI)1096-9136(199807)15:7%3C539::AID-DIA668%3E3.0.CO;2-S CrossRefPubMedGoogle Scholar
  3. 3.
    Scollan-Koliopoulos M, Bleich D, Rapp KJ et al (2013) Health-related quality of life, disease severity, and anticipated trajectory of diabetes. Diabetes Educ 39:83–91.  https://doi.org/10.1177/0145721712467697 CrossRefPubMedGoogle Scholar
  4. 4.
    Timar R, Velea PI, Timar B et al (2016) Factors influencing the quality of life perception in patients with type 2 diabetes mellitus. Patient Prefer Adherence 10:2471–2477.  https://doi.org/10.2147/PPA.S124858 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Bommer C, Heesemann E, Sagalova V et al (2017) The global economic burden of diabetes in adults aged 20–79 years: a cost-of-illness study. Lancet Diabetes Endocrinol 5:423–430.  https://doi.org/10.1016/S2213-8587(17)30097-9 CrossRefPubMedGoogle Scholar
  6. 6.
    Morrish NJ, Wang S-L, Stevens LK et al (2001) Mortality and causes of death in the WHO multinational study of vascular disease in diabetes. Diabetologia 44:S14.  https://doi.org/10.1007/PL00002934 CrossRefPubMedGoogle Scholar
  7. 7.
    Chen L, Magliano DJ, Zimmet PZ (2011) The worldwide epidemiology of type 2 diabetes mellitus—present and future perspectives. Nat Rev Endocrinol 8:228–236.  https://doi.org/10.1038/nrendo.2011.183 CrossRefPubMedGoogle Scholar
  8. 8.
    Ausili D, Bulgheroni M, Ballatore P et al (2017) Self-care, quality of life and clinical outcomes of type 2 diabetes patients: an observational cross-sectional study. Acta Diabetol 54:1001–1008.  https://doi.org/10.1007/s00592-017-1035-5 CrossRefPubMedGoogle Scholar
  9. 9.
    Song M (2010) Diabetes mellitus and the importance of self-care. J Cardiovasc Nurs 25:93–98.  https://doi.org/10.1097/JCN.0b013e3181c5a364 CrossRefPubMedGoogle Scholar
  10. 10.
    Powers MA, Bardsley J, Cypress M et al (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 38:1372–1382.  https://doi.org/10.2337/dc15-0730 CrossRefPubMedGoogle Scholar
  11. 11.
    Mashitani T, Hayashino Y, Okamura S et al (2015) Diabetes treatment-related quality of life is associated with levels of self-care activities in insulin injection among Japanese patients with type 2 diabetes: diabetes Distress and Care Registry at Tenri (DDCRT 8). Acta Diabetol 52:639–647.  https://doi.org/10.1007/s00592-015-0725-0 CrossRefPubMedGoogle Scholar
  12. 12.
    Riandini T, Wee HL, Khoo EYH et al (2018) Functional status mediates the association between peripheral neuropathy and health-related quality of life in individuals with diabetes. Acta Diabetol 55:155–164.  https://doi.org/10.1007/s00592-017-1077-8 CrossRefPubMedGoogle Scholar
  13. 13.
    Rossi MC, Candido R, Ceriello A et al (2015) Trends over 8 years in quality of diabetes care: results of the AMD annals continuous quality improvement initiative. Acta Diabetol 52:557–571.  https://doi.org/10.1007/s00592-014-0688-6 CrossRefPubMedGoogle Scholar
  14. 14.
    Karbalaeifar R, Kazempour-Ardebili S, Amiri P et al (2016) Evaluating the effect of knowledge, attitude and practice on self-management in patients with type 2 diabetes. Acta Diabetol 53:1015–1023.  https://doi.org/10.1007/s00592-016-0905-6 CrossRefPubMedGoogle Scholar
  15. 15.
    Riegel B, Jaarsma T, Strömberg A (2012) A middle-range theory of self-care of chronic illness. ANS Adv Nurs Sci 35:194–204.  https://doi.org/10.1097/ANS.0b013e318261b1ba CrossRefPubMedGoogle Scholar
  16. 16.
    Vellone E, Pancani L, Greco A et al (2016) Self-care confidence may be more important than cognition to influence self-care behaviors in adults with heart failure: testing a mediation model. Int J Nurs Stud 60:191–199.  https://doi.org/10.1016/j.ijnurstu.2016.04.016 CrossRefPubMedGoogle Scholar
  17. 17.
    Jaarsma T, Cameron J, Riegel B, Stromberg A (2017) Factors related to self-care in heart failure patients according to the middle-range theory of self-care of chronic illness: a literature update. Curr Heart Fail Rep 14:71–77.  https://doi.org/10.1007/s11897-017-0324-1 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Riegel B, Dickson VV (2008) A situation-specific theory of heart failure self-care. J Cardiovasc Nurs 23:190–196.  https://doi.org/10.1097/01.JCN.0000305091.35259.85 CrossRefPubMedGoogle Scholar
  19. 19.
    Clari M, Matarese M, Ivziku D, De Marinis MG (2017) Self-care of people with chronic obstructive pulmonary disease: a meta-synthesis. Patient.  https://doi.org/10.1007/s40271-017-0218-z PubMedGoogle Scholar
  20. 20.
    Ausili D, Rebora P, Di Mauro S et al (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.  https://doi.org/10.1016/j.ijnurstu.2016.08.006 CrossRefPubMedGoogle Scholar
  21. 21.
    Vellone E, Fida R, D’Agostino F et al (2015) Self-care confidence may be the key: a cross-sectional study on the association between cognition and self-care behaviors in adults with heart failure. Int J Nurs Stud 52:1705–1713.  https://doi.org/10.1016/j.ijnurstu.2015.06.013 CrossRefPubMedGoogle Scholar
  22. 22.
    Gomersall T, Madill A, Summers LKM (2011) A metasynthesis of the self-management of type 2 diabetes. Qual Health Res 21:853–871.  https://doi.org/10.1177/1049732311402096 CrossRefPubMedGoogle Scholar
  23. 23.
    Bohanny W, Wu S-FV, Liu C-Y et al (2013) Health literacy, self-efficacy, and self-care behaviors in patients with type 2 diabetes mellitus. J Am Assoc Nurse Pract 25:495–502.  https://doi.org/10.1111/1745-7599.12017 PubMedGoogle Scholar
  24. 24.
    Coyle ME, Francis K, Chapman Y (2013) Self-management activities in diabetes care: a systematic review. Aust Health Rev 37:513.  https://doi.org/10.1071/AH13060 CrossRefPubMedGoogle Scholar
  25. 25.
    O’Shea MP, Teeling M, Bennett K (2014) Comorbidity, health-related quality of life and self-care in type 2 diabetes: a cross-sectional study in an outpatient population. Ir J Med Sci 1971–184:623–630.  https://doi.org/10.1007/s11845-014-1190-4 Google Scholar
  26. 26.
    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.  https://doi.org/10.3402/dfa.v7.29758 PubMedPubMedCentralGoogle Scholar
  27. 27.
    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 22:332–344.  https://doi.org/10.1080/13548506.2016.1154179 CrossRefPubMedGoogle Scholar
  28. 28.
    Clark ML, Utz SW (2014) Social determinants of type 2 diabetes and health in the United States. World J Diabetes 5:296–304.  https://doi.org/10.4239/wjd.v5.i3.296 CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Hyman I, Shakya Y, Jembere N et al (2017) Provider- and patient-related determinants of diabetes self-management among recent immigrants: implications for systemic change. Can Fam Physician 63:e137PubMedPubMedCentralGoogle Scholar
  30. 30.
    Lu Y, Xu J, Zhao W, Han H-R (2016) Measuring self-care in persons with type 2 diabetes: a systematic review. Eval Health Prof 39:131–184.  https://doi.org/10.1177/0163278715588927 CrossRefPubMedGoogle Scholar
  31. 31.
    Caro-Bautista J, Martín-Santos FJ, Morales-Asencio JM (2014) Systematic review of the psychometric properties and theoretical grounding of instruments evaluating self-care in people with type 2 diabetes mellitus. J Adv Nurs 70:1209–1227.  https://doi.org/10.1111/jan.12298 CrossRefPubMedGoogle Scholar
  32. 32.
    American Diabetes Association (2016) Standards of medical care in diabetes. Diabetes Care 39(Suppl.1):S6–S12.  https://doi.org/10.2337/dc16-S004 Google Scholar
  33. 33.
    Karimy M, Araban M, Zareban I et al (2016) Determinants of adherence to self-care behavior among women with type 2 diabetes: an explanation based on health belief model. Med J Islam Repub Iran 30:368PubMedPubMedCentralGoogle Scholar
  34. 34.
    Ouyang C-M, Dwyer JT, Jacques PF et al (2015) Determinants of dietary self-care behaviours among Taiwanese patients with type 2 diabetes. Asia Pac J Clin Nutr 24:430–437PubMedGoogle Scholar
  35. 35.
    Walker RJ, Gebregziabher M, Martin-Harris B, Egede LE (2014) Independent effects of socioeconomic and psychological social determinants of health on self-care and outcomes in type 2 diabetes. Gen Hosp Psychiatry 36:662–668.  https://doi.org/10.1016/j.genhosppsych.2014.06.011 CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Ausili D, Barbaranelli C, Rossi E et al (2017) Development and psychometric testing of a theory-based tool to measure self-care in diabetes patients: the self-care of diabetes inventory. BMC Endocr Disord.  https://doi.org/10.1186/s12902-017-0218-y PubMedPubMedCentralGoogle Scholar
  37. 37.
    Nicolucci A, Kovacs Burns K, Holt RIG 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 J Br Diabet Assoc 30:767–777.  https://doi.org/10.1111/dme.12245 CrossRefGoogle Scholar
  38. 38.
    Egan AM, Mahmood WAW, Fenton R et al (2013) Barriers to exercise in obese patients with type 2 diabetes. QJM Mon J Assoc Physicians 106:635–638.  https://doi.org/10.1093/qjmed/hct075 CrossRefGoogle Scholar
  39. 39.
    Naegeli AN, Stump TE, Hayes RP (2010) A psychometric evaluation of the Diabetes Symptom Checklist-Revised (DSC-R) cognitive distress, fatigue, hyperglycemia, and hypoglycemia subscales in patients with type 1 and type 2 diabetes. Diabetes Metab Syndr Obes Targets Ther 3:27–30CrossRefGoogle Scholar
  40. 40.
    van Puffelen AL, Heijmans MJWM, Rijken M et al (2015) Illness perceptions and self-care behaviours in the first years of living with type 2 diabetes; does the presence of complications matter? Psychol Health 30:1274–1287.  https://doi.org/10.1080/08870446.2015.1045511 CrossRefPubMedGoogle Scholar
  41. 41.
    Riegel B, Dickson VV, Faulkner KM (2016) The situation-specific theory of heart failure self-care: revised and updated. J Cardiovasc Nurs 31:226–235.  https://doi.org/10.1097/JCN.0000000000000244 CrossRefPubMedGoogle Scholar
  42. 42.
    Lee Y-J, Shin S-J, Wang R-H et al (2016) Pathways of empowerment perceptions, health literacy, self-efficacy, and self-care behaviors to glycemic control in patients with type 2 diabetes mellitus. Patient Educ Couns 99:287–294.  https://doi.org/10.1016/j.pec.2015.08.021 CrossRefPubMedGoogle Scholar
  43. 43.
    Reisi M, Mostafavi F, Javadzade H et al (2016) Impact of health literacy, self-efficacy, and outcome expectations on adherence to self-care behaviors in iranians with type 2 diabetes. Oman Med J 31:52–59.  https://doi.org/10.5001/omj.2016.10 CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Yee LM, McGuire JM, Taylor SM et al (2016) Factors promoting diabetes self-care among low-income, minority pregnant women. J Perinatol Off J Calif Perinat Assoc 36:13–18.  https://doi.org/10.1038/jp.2015.134 CrossRefGoogle Scholar
  45. 45.
    Cocchieri A, Riegel B, D’Agostino F et al (2015) Describing self-care in Italian adults with heart failure and identifying determinants of poor self-care. Eur J Cardiovasc Nurs 14:126–136.  https://doi.org/10.1177/1474515113518443 CrossRefPubMedGoogle Scholar
  46. 46.
    Caruso R, Arrigoni C, Magon A et al (2017) Health determinants in Italian type 2 diabetes mellitus (T2DM) patients: a critical gender differences analysis. J Res Gend Stud 7:93–108.  https://doi.org/10.22381/JRGS7220176 CrossRefGoogle Scholar
  47. 47.
    McCollum M, Hansen LB, Lu L, Sullivan PW (2005) Gender differences in diabetes mellitus and effects on self-care activity. Gend Med 2:246–254.  https://doi.org/10.1016/S1550-8579(05)80054-3 CrossRefPubMedGoogle Scholar
  48. 48.
    Weinger K, Beverly EA, Smaldone A (2014) Diabetes self-care and the older adult. West J Nurs Res 36:1272–1298.  https://doi.org/10.1177/0193945914521696 CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Compeán Ortiz LG, Del Ángel Pérez B, Reséndiz González E et al (2016) Self-care behaviors and glycemic control in low-income adults in México with type 2 diabetes mellitus may have implications for patients of Mexican heritage living in the United States. Clin Nurs Res 25:120–138.  https://doi.org/10.1177/1054773815586542 CrossRefPubMedGoogle Scholar
  50. 50.
    Dickson VV, McCauley LA, Riegel B (2008) Work-heart balance: the influence of biobehavioral variables on self-care among employees with heart failure. AAOHN J Off J Am Assoc Occup Health Nurses 56:63–73 (quiz 74–76) Google Scholar
  51. 51.
    Sicuro J, Charrier L, Berchialla P et al (2014) Self-management education by group care reduces cardiovascular risk in patients with type 2 diabetes: analysis of the ROMEO clinical trial: figure 1. Diabetes Care 37:e192–e193.  https://doi.org/10.2337/dc14-1054 CrossRefPubMedGoogle Scholar
  52. 52.
    Ahmed AT, Karter AJ, Liu J (2006) Alcohol consumption is inversely associated with adherence to diabetes self-care behaviours. Diabet Med J Br Diabet Assoc 23:795–802.  https://doi.org/10.1111/j.1464-5491.2006.01878.x CrossRefGoogle Scholar
  53. 53.
    Nagrebetsky A, Brettell R, Roberts N, Farmer A (2014) Smoking cessation in adults with diabetes: a systematic review and meta-analysis of data from randomised controlled trials. BMJ Open 4:e004107.  https://doi.org/10.1136/bmjopen-2013-004107 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

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

Authors and Affiliations

  • Davide Ausili
    • 1
  • Emanuela Rossi
    • 2
  • Paola Rebora
    • 2
  • Michela Luciani
    • 3
    • 1
  • Luca Tonoli
    • 4
  • Enrico Ballerini
    • 4
  • Silvia Androni
    • 1
  • Ercole Vellone
    • 3
  • Barbara Riegel
    • 5
  • Stefania Di Mauro
    • 1
  1. 1.Department of Medicine and SurgeryUniversity of Milano-BicoccaMonzaItaly
  2. 2.Centre of Biostatistics for Clinical Epidemiology, Department of Medicine and SurgeryUniversity of Milano-BicoccaMonzaItaly
  3. 3.Department of Biomedicine and PreventionUniversity of Rome Tor VergataRomeItaly
  4. 4.University of BresciaBresciaItaly
  5. 5.University of PennsylvaniaPhiladelphiaUSA

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