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Self-care of patients with type 2 diabetes mellitus over the course of illness: implications for tailoring support

Journal of Diabetes & Metabolic Disorders volume 19, pages 81–89 (2020)Cite this article

Abstract

Purpose

Type 2 diabetes requires patients to make lifestyle changes and perform daily self-care. To determine at what stages patients may need particular self-management support, we examined (1) whether patients’ performance of self-care related to their diabetes duration, and (2) whether illness characteristics (treatment and complications) and diabetes-related distress influenced this relationship.

Methods

Cross-sectional data from 590 type 2 diabetes patients were analysed through linear and logistic regression analysis. Self-care behaviours were assessed by the revised Summary of Diabetes Self-Care Activities (SDSCA) measure. Diabetes duration (model 1), treatment and complications (model 2), and distress, as assessed by the Problem Areas In Diabetes (PAID) scale (model 3), were stepwise included. Sociodemographic characteristics were added to all models to account for confounding.

Results

Patients with a longer history of diabetes were less physically active, but monitored their blood glucose levels more frequently than more recently diagnosed patients. These relationships were mediated by the presence of complications and the use of insulin, with lower levels of physical activity being found among patients with macrovascular complications and higher frequencies of glucose monitoring among patients on insulin. All predictors together explained maximally 5% of the variance in self-care, except for glucose monitoring (37%) and smoking (11%).

Conclusion

Type 2 diabetes patients’ self-care activity changes over the course of illness. To provide tailored self-management support, diabetes care providers should take into account patients’ phase of illness, including their treatment and complications, as well as their personal characteristics and distress level.

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Acknowledgements

The authors thank all patients, general practitioners and supportive staff in the primary care practices, cardiologists and supportive staff in the hospitals who participated in the Diacourse study. All other members of the Diacourse study group are acknowledged for their important contribution to the implementation of the Diacourse study: Guy Rutten, Kees Gorter, Rimke Vos (University Medical Center Utrecht, Utrecht, Netherlands); Amber van der Heijden (Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands); Caroline Baan (Tilburg University, Tilburg, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, Netherlands). The Wiley Editing Service team provided basic editing services.

Author information

Author notes

  1. Marise Kasteleyn and Lianne de Vries contributed equally to this work.

Affiliations

  1. NIVEL (the Netherlands Institute for Health Services Research), PO Box 1568, 3500, BN, Utrecht, the Netherlands

    Anne van Puffelen, Mieke Rijken, Monique Heijmans & François Schellevis

  2. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584, CG, Utrecht, the Netherlands

    Marise Kasteleyn

  3. Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, location VUmc, Van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands

    Lianne de Vries, Giel Nijpels & François Schellevis

  4. Department of Health and Social Management, University of Eastern Finland, PO Box 1627, FI-70211, Kuopio, Finland

    Mieke Rijken

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  1. Anne van Puffelen
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  2. Marise Kasteleyn
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  3. Lianne de Vries
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Correspondence to Anne van Puffelen.

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Funding

This work was supported by the Dutch Diabetes Research Foundation (2009.70).

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van Puffelen, A., Kasteleyn, M., de Vries, L. et al. Self-care of patients with type 2 diabetes mellitus over the course of illness: implications for tailoring support. J Diabetes Metab Disord 19, 81–89 (2020). https://doi.org/10.1007/s40200-019-00479-y

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Keywords

  • Diabetes mellitus type 2
  • Self-care
  • Diabetes duration
  • Complications
  • Distress