Role of self-care in management of diabetes mellitus

Abstract

Diabetes mellitus (DM) is a chronic progressive metabolic disorder characterized by hyperglycemia mainly due to absolute (Type 1 DM) or relative (Type 2 DM) deficiency of insulin hormone. World Health Organization estimates that more than 346 million people worldwide have DM. This number is likely to more than double by 2030 without any intervention. The needs of diabetic patients are not only limited to adequate glycemic control but also correspond with preventing complications; disability limitation and rehabilitation. There are seven essential self-care behaviors in people with diabetes which predict good outcomes namely healthy eating, being physically active, monitoring of blood sugar, compliant with medications, good problem-solving skills, healthy coping skills and risk-reduction behaviors. All these seven behaviors have been found to be positively correlated with good glycemic control, reduction of complications and improvement in quality of life. Individuals with diabetes have been shown to make a dramatic impact on the progression and development of their disease by participating in their own care. Despite this fact, compliance or adherence to these activities has been found to be low, especially when looking at long-term changes. Though multiple demographic, socio-economic and social support factors can be considered as positive contributors in facilitating self-care activities in diabetic patients, role of clinicians in promoting self-care is vital and has to be emphasized. Realizing the multi-faceted nature of the problem, a systematic, multi-pronged and an integrated approach is required for promoting self-care practices among diabetic patients to avert any long-term complications.

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References

  1. 1.

    World health organization: Definition, diagnosis and classification of diabetes mellitus and its complications. Geneva: World health organization; 1999.

    Google Scholar 

  2. 2.

    Kinra S, Bowen LJ, Lyngdoh T, Prabhakaran D, Reddy KS, Ramakrishnan L: Socio-demographic patterning of non-communicable disease risk factors in rural India: a cross sectional study. BMJ 2010, 341: c4974. 10.1136/bmj.c4974

    PubMed  PubMed Central  Google Scholar 

  3. 3.

    Chuang LM, Tsai ST, Huang BY, Tai TY: The status of diabetes control in Asia–a cross-sectional survey of 24 317 patients with diabetes mellitus in 1998. Diabet Med 2002,19(12):978–985. 10.1046/j.1464-5491.2002.00833.x

    CAS  PubMed  Google Scholar 

  4. 4.

    Narayanappa D, Rajani HS, Mahendrappa KB, Prabhakar AK: Prevalence of pre-diabetes in school-going children. Indian Pediatr 2011,48(4):295–299. 10.1007/s13312-011-0061-6

    CAS  PubMed  Google Scholar 

  5. 5.

    American Diabetes Association: Implications of the United Kingdom Prospective Diabetes Study. Diabetes Care 2004,27(Suppl 1):28–32.

    Google Scholar 

  6. 6.

    Zucchi P, Ferrari P, Spina ML: Diabetic foot: from diagnosis to therapy. G Ital Nefrol 2005,22(Suppl 31):S20-S22.

    PubMed  Google Scholar 

  7. 7.

    World health organization: Diabetes – Factsheet. 2012. http://www.who.int/mediacentre/factsheets/fs312/en/index.html

    Google Scholar 

  8. 8.

    Mohan D, Raj D, Shanthirani CS, Datta M, Unwin NC, Kapur A: Awareness and knowledge of diabetes in Chennai - The Chennai urban rural epidemiology study. J Assoc Physicians India 2005, 53: 283–287.

    PubMed  Google Scholar 

  9. 9.

    Wild S, Roglic G, Green A, Sicree R, King H: Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care 2004,27(5):1047–1053. 10.2337/diacare.27.5.1047

    PubMed  PubMed Central  Google Scholar 

  10. 10.

    Pradeepa R, Mohan V: The changing scenario of the diabetes epidemic: Implications for India. Indian J Med Res 2002, 116: 121–132.

    CAS  PubMed  Google Scholar 

  11. 11.

    Katulanda P, Constantine GR, Mahesh JG, Sheriff R, Seneviratne RD, Wijeratne S: Prevalence and projections of diabetes and pre-diabetes in adults in Sri Lanka - Sri Lanka Diabetes, Cardiovascular Study (SLDCS). Diabet Med 2008,25(9):1062–1069. 10.1111/j.1464-5491.2008.02523.x

    CAS  PubMed  Google Scholar 

  12. 12.

    Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A: Improving chronic illness care: translating evidence into action. Health Aff (Millwood) 2001,20(6):64–78. 10.1377/hlthaff.20.6.64

    CAS  Google Scholar 

  13. 13.

    UKPDS: Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998,352(9131):837–853.

    Google Scholar 

  14. 14.

    Ohkubo Y, Kishikawa H, Araki E, Miyata T, Isami S, Motoyoshi S: Intensive insulin therapy prevents the progression of diabetic micro-vascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract 1995,28(2):103–117. 10.1016/0168-8227(95)01064-K

    CAS  PubMed  Google Scholar 

  15. 15.

    Shobana R, Augustine C, Ramachandran A, Vijay V: Improving psychosocial care: The Indian experience. Diabetes Voice 2005,50(1):19–21.

    Google Scholar 

  16. 16.

    Chew LD: The impact of low health literacy on diabetes outcomes. Diabetes Voice 2004,49(3):30–32.

    Google Scholar 

  17. 17.

    Grey M, Thurber FW: Adaptation to chronic illness in childhood: diabetes mellitus. J Pediatr Nurs 1991,6(5):302–309.

    CAS  PubMed  Google Scholar 

  18. 18.

    Glasgow RE, Hiss RG, Anderson RM, Friedman NM, Hayward RA, Marrero DG: Report of the health care delivery work group: behavioral research related to the establishment of a chronic disease model for diabetes care. Diabetes Care 2001,24(1):124–130. 10.2337/diacare.24.1.124

    CAS  PubMed  Google Scholar 

  19. 19.

    Peel E, Douglas M, Lawton J: Self monitoring of blood glucose in type-2 diabetes: longitudinal qualitative study of patients’ perspectives. BMJ 2007,335(7618):493. 10.1136/bmj.39302.444572.DE

    PubMed  PubMed Central  Google Scholar 

  20. 20.

    Cooper H, Booth K, Gill G: Patients’ perspectives on diabetes health care education. Health Educ Res 2003,18(2):191–206. 10.1093/her/18.2.191

    CAS  PubMed  Google Scholar 

  21. 21.

    Paterson B, Thorne S: Developmental evolution of expertise in diabetes self management. Clin Nurs Res 2000,9(4):402–419. 10.1177/10547730022158663

    CAS  PubMed  Google Scholar 

  22. 22.

    Etzwiler DD: Diabetes translation: a blueprint for the future. Diabetes Care 1994,17(Suppl. 1):1–4.

    PubMed  Google Scholar 

  23. 23.

    Bradley C: Handbook of Psychology and Diabetes. Chur, Switzerland: Harwood Academic; 1994.

    Google Scholar 

  24. 24.

    Johnson SB: Health behavior and health status: concepts, methods and applications. J Pediatr Psychol 1994,19(2):129–141. 10.1093/jpepsy/19.2.129

    CAS  PubMed  Google Scholar 

  25. 25.

    McNabb WL: Adherence in diabetes: can we define it and can we measure it? Diabetes Care 1997,20(2):215–218.

    CAS  PubMed  Google Scholar 

  26. 26.

    American Association of Diabetes Educators: AADE7 Self-Care Behaviors. Diabetes Educ 2008, 34: 445–449.

    Google Scholar 

  27. 27.

    Povey RC, Clark-Carter D: Diabetes and healthy eating: A systematic review of the literature. Diabetes Educ 2007,33(6):931–959. 10.1177/0145721707308408

    PubMed  Google Scholar 

  28. 28.

    Boule NG, Haddad E, Kenny GP, Wells GA, Sigal RJ: Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: A meta-analysis of controlled clinical trials. JAMA 2001,286(10):1218–1227. 10.1001/jama.286.10.1218

    CAS  Google Scholar 

  29. 29.

    American Diabetes Association: Standards of Medical Care in Diabetes - 2009. Diabetes Care 2009,32(Suppl 1):S13-S61.

    PubMed Central  Google Scholar 

  30. 30.

    Odegard PS, Capoccia K: Medication taking and diabetes: A systematic review of the literature. Diabetes Educ 2007,33(6):1014–1029. 10.1177/0145721707308407

    PubMed  Google Scholar 

  31. 31.

    Deakin T, McShane CE, Cade JE, Williams RD: Group based training for self management strategies in people with type 2 diabetes mellitus. Cochrane Database Syst Rev 2005, 2: CD003417.

    Google Scholar 

  32. 32.

    Herschbach P, Duran G, Waadt S, Zettler A, Amch C: Psychometric properties of the questionnaire on stress in patients with diabetes-revised (QSD-R). Health Psychol 1997,16(2):171–174.

    CAS  PubMed  Google Scholar 

  33. 33.

    Shobhana R, Begum R, Snehalatha C, Vijay V, Ramachandran A: Patients’ adherence to diabetes treatment. J Assoc Physicians India 1999,47(12):1173–1175.

    CAS  PubMed  Google Scholar 

  34. 34.

    Poulsen P, Kyvik OK, Vag A, Nielsen-Beck H: Heritability of type II diabetes mellitus and abnormal glucose tolerance – a population-based twin study. Diabetologia 1999,42(2):139–145. 10.1007/s001250051131

    CAS  PubMed  Google Scholar 

  35. 35.

    American college of endocrinology: The American association of clinical endocrinologist guidelines for the management of diabetes mellitus: the AACE system of diabetes self-management. Endocr Pract 2002, 8: S41-S84.

    Google Scholar 

  36. 36.

    Hendra JT, Sinclair AJ: Improving the care of elderly diabetic patients: the final report of the St. Vincent joint task force. Age and Aging 1997,26(1):3–6. 10.1093/ageing/26.1.3

    CAS  Google Scholar 

  37. 37.

    Mensing C, Boucher J, Cypress M, Weinger K, Mulcahy K, Barta P: National standards for diabetes self-management education. Diabetes Care 2006,29(Suppl 1):S78-S85.

    PubMed  Google Scholar 

  38. 38.

    Williams GC, Freedman ZR, Deci EL: Supporting autonomy to motivate patients with diabetes for glucose control. Diabetes Care 1998,21(10):1644–1651. 10.2337/diacare.21.10.1644

    CAS  PubMed  Google Scholar 

  39. 39.

    Norris SL, Lau J, Smith SJ, Schmid CH, Engelgau MM: Self-management education for adults with type-2 diabetes: a meta-analysis of the effect on glycemic control. Diabetes Care 2002,25(7):1159–1171. 10.2337/diacare.25.7.1159

    PubMed  Google Scholar 

  40. 40.

    Glasgow RE, Strycker LA: Preventive care practices for diabetes management in two primary care samples. Am J Prev Med 2000,19(1):9–14. 10.1016/S0749-3797(00)00157-4

    CAS  PubMed  Google Scholar 

  41. 41.

    Walker E: Characteristics of the adult learner. Diabetes Educ 1999,25(6 Suppl):16–24. 10.1177/014572179902500619

    CAS  PubMed  Google Scholar 

  42. 42.

    American Diabetes Association: Standards of medical care in diabetes - 2011. Diabetes Care 2011,34(Suppl 1):S11-S61.

    PubMed Central  Google Scholar 

  43. 43.

    Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR: Exercise and type-2 diabetes. Diabetes Care 2010,33(12):2692–2696. 10.2337/dc10-1548

    PubMed  PubMed Central  Google Scholar 

  44. 44.

    Mora S, Lee IM, Buring JE, Ridker PM: Association of physical activity and body mass index with novel and traditional cardiovascular biomarkers in women. JAMA 2006,295(12):1412–1419. 10.1001/jama.295.12.1412

    CAS  PubMed  Google Scholar 

  45. 45.

    Physical Activity Guidelines Advisory Committee: Physical Activity Guidelines Advisory Committee Report, 2008. Washington, DC, USA: US Department of Health and Human Services; 2008.

    Google Scholar 

  46. 46.

    United States Department of Health and Human Services : Physical Activity Guidelines for Americans; 2008.

  47. 47.

    Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA: Physical activity and public health: updated recommendation for adults from the American college of sports medicine and the American heart association. Med Sci Sports Exerc 2007,39(8):1423–1434. 10.1249/mss.0b013e3180616b27

    PubMed  Google Scholar 

  48. 48.

    Goodall TA, Halford WK: Self-management of diabetes mellitus: a critical review. Health Psychol 1991,10(1):1–8.

    CAS  PubMed  Google Scholar 

  49. 49.

    Marrero DG, Kako KS, Mayfield J, Wheeler ML, Fineberg N: Nutrition management of type-2 diabetes by primary care physicians. J Gen Intern Med 2000,15(11):818–821. 10.1046/j.1525-1497.2000.t01-1-90907.x

    CAS  PubMed  PubMed Central  Google Scholar 

  50. 50.

    Kotwani A, Ewen M, Dey D, Iyer S, Lakshmi PK, Patel A: Prices and availability of common medicines at six sites in India using a standard methodology. Indian J Med Res 2007,25(5):645–654.

    Google Scholar 

  51. 51.

    Harris MI: National institute of diabetes & digestive & kidney disease (NIDDKD): Diabetes in America – 2001. www.niddk.nih.gov/health/diabetes/dia/contents.htm

  52. 52.

    Toljamo M, Hentinen M: Adherence to self-care and glycemic control among people with insulin-dependent diabetes mellitus. J Adv Nurs 2001,34(6):780–786. 10.1046/j.1365-2648.2001.01808.x

    CAS  PubMed  Google Scholar 

  53. 53.

    Wing RR, Goldstein MG, Kelly JA, Birch LL, Jakic JM, Sallis JF: Behavioral science research in diabetes. Diabetes Care 2001,24(1):117–123. 10.2337/diacare.24.1.117

    CAS  PubMed  Google Scholar 

  54. 54.

    Ockleford E, Shaw RL, Willars J, Dixon-Woods M: Education and self-management for people newly diagnosed with type 2 diabetes: a qualitative study of patients’ views. Chronic Illn 2008,4(1):28–37. 10.1177/1742395307086673

    PubMed  Google Scholar 

  55. 55.

    Ramachandran A, Ramachandran S, Snehalatha C, Augustine C, Murugesan N, Viswanathan V: Increasing expenditure on health care incurred by diabetic subjects in a developing country: A study from India. Diabetes Care 2007,30(2):252–256. 10.2337/dc06-0144

    PubMed  Google Scholar 

  56. 56.

    Debussche X, Debussche BM, Besançon S, Traore AS: Challenges to diabetes self-management in developing countries. Diabetes Voice 2009, 54: 12–14.

    Google Scholar 

  57. 57.

    Ciechanowski PS, Katon WJ, Russo JE, Walker EA: The patient-provider relationship: attachment theory and adherence to treatment in diabetes. Am J Psychiatry 2001,158(1):29–35. 10.1176/appi.ajp.158.1.29

    CAS  PubMed  Google Scholar 

  58. 58.

    Grant RW, Devita NG, Singer DE, Meigs JB: Poly-pharmacy and medication adherence in patients with type 2 diabetes. Diabetes Care 2003,26(5):1408–1412. 10.2337/diacare.26.5.1408

    PubMed  Google Scholar 

  59. 59.

    Chin MH, Cook S, Jin L, Drum ML, Harrison JF, Koppert J: Barriers to providing diabetes care in community health center. Diabetes Care 2001,24(2):268–274. 10.2337/diacare.24.2.268

    CAS  PubMed  Google Scholar 

  60. 60.

    Nam S, Chesla C, Stotts NA, Kroon L, Janson SL: Barriers to diabetes management: patient and provider factors. Diabetes Res Clin Pract 2011,93(1):1–9. 10.1016/j.diabres.2011.02.002

    PubMed  Google Scholar 

  61. 61.

    Preventative care practices among persons with diabetes - United States: 1995–2001. Morb Mortal Wkly Rep 2002,51(43):965–970.

    Google Scholar 

  62. 62.

    Anderson RM: Patient empowerment and the traditional medical model: a case of irreconcilable differences? Diabetes Care 1995,18(3):412–415.

    CAS  PubMed  Google Scholar 

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Correspondence to Saurabh RamBihariLal Shrivastava.

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There was no conflict of interest to be stated.

Authors’ contributions

SRS wrote the first draft of the article and performed intensive review of literature. PSS edited the article continuously. JR read and approved the final manuscript. All authors read and approved the final manuscript.

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Shrivastava, S.R., Shrivastava, P.S. & Ramasamy, J. Role of self-care in management of diabetes mellitus. J Diabetes Metab Disord 12, 14 (2013). https://doi.org/10.1186/2251-6581-12-14

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Keywords

  • Diabetes
  • Self-care
  • Compliance
  • Physical activity
  • Lifestyle modification