Diabetes & Metabolism Journal

Original Articles

Clinical Care/Education
Association of Self-Care Behaviors and Quality of Life among Patients with Type 2 Diabetes Mellitus: Chaldoran County, Iran: Towhid Babazadeh, Mostafa Dianatinasab, Amin Daemi, Hossein Ali Nikbakht, Fatemeh Moradi, Saber Ghaffari-fam; Diabetes Metab J. 2017;41(6):449-456. Published online December 20, 2017; DOI: https://doi.org/10.4093/dmj.2017.41.6.449

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Background

Self-care of diabetes is an essential part for controlling the disease and improvement of quality of life in type 2 diabetes mellitus (T2DM) patients. This study aimed to analyze the associated factors of quality of life in patients with T2DM in order to design effective interventions.

Methods

This cross-sectional study was conducted on 120 T2DM patients referred to health centers of Chaldoran, West Azerbaijan Province, Iran. The quality of life's questionnaires from World Health Organization and the self-care behaviors' questionnaires were used for data collection.

Results

The mean age of patients was 46.30% and 53.30% of them were male. Among demographic variables, gender (P=0.002), age groups (P=0.007), and household monthly income (P=0.009) were significantly associated with total quality of life. Also, self-care nutrition (odds ratio [OR], 1.47; P=0.001), self-management of blood glucose control (OR, 1.29; P=0.002), and self-medication behavior (OR, 1.18; P=0.030) were identified as factors significantly associated with quality of life.

Conclusion

Self-care behaviors were significantly associated with quality of life; among them, the greatest influence was observed in self-care nutrition behavior. According to the findings of this study, appropriate interventions on self-care behaviors about nutrition can improve the quality of life for T2DM patients.

Citations

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Subjective Assessment of Diabetes Self-Care Correlates with Perceived Glycemic Control but not with Actual Glycemic Control: Jung Hun Ohn, Ju Hee Lee, Eun Shil Hong, Bo Kyung Koo, Sang Wan Kim, Ka Hee Yi, Min Kyong Moon; Diabetes Metab J. 2015;39(1):31-36. Published online February 16, 2015; DOI: https://doi.org/10.4093/dmj.2015.39.1.31

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Abstract PDF PubReader

Background

We investigated whether patients' perceived glycemic control and self-reported diabetes self-care correlated with their actual glycemic control.

Methods

A survey was administered among patients with diabetes mellitus at an outpatient clinic with structured self-report questionnaires regarding perceived glycemic control and diabetes self-management. Actual glycemic control was defined as a change in glycated hemoglobin (A1C) or fasting plasma glucose (FPG) since the last clinic visit.

Results

Patients who perceived their glycemic control as "improved" actually showed a mild but significant decrease in the mean A1C (-0.1%, P=0.02), and those who perceived glycemic control as "aggravated" had a significant increase in the mean FPG (10.5 mg/dL or 0.59 mmol/L, P=0.04) compared to the "stationary" group. However, one-half of patients falsely predicted their actual glycemic control status. Subjective assessment of diabetes self-care efforts, such as adherence to a diet regimen or physical activity, correlated positively with perceived glycemic control but showed no association with actual glycemic control.

Conclusion

Patients should be encouraged to assess and monitor diabetes self-care more objectively to motivate behavioral modifications and improve their actual glycemic control.

Citations

Citations to this article as recorded by

Social Networking Services-Based Communicative Care for Patients with Diabetes Mellitus in Korea
Hun-Sung Kim, Yoo Jeong, Sun Baik, So Yang, Tong Kim, Hyunah Kim, Hyunyong Lee, Seung-Hwan Lee, Jae Cho, In-Young Choi, Kun-Ho Yoon
Applied Clinical Informatics.2016; 07(03): 899. CrossRef

Depression and Self-care Behavior in Patients with Diabetes Mellitus.: Su Yoen Kim, Jae Ho Lee, Ha Neul Kim, Dong Kyu Kim, Young Na, Guil Sun Kim, Mee Kyoung Kim, Ki Hyun Baek, Moo IL Kang, Kwang Woo Lee, Ki Ho Song; Korean Diabetes J. 2009;33(5):432-438. Published online October 1, 2009; DOI: https://doi.org/10.4093/kdj.2009.33.5.432

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Abstract PDF

BACKGROUND
Depression is known to be a risk factor for type 2 diabetes mellitus. Conversely, diabetes is also a risk factor for depression, and patients with diabetes have nearly twice the risk of comorbid depression as the general population. Depression in patients with diabetes may cause poor clinical outcomes through lower adherence to self-care activities such as exercise, diet control, and glucose monitoring. Furthermore, diabetic patients with depression are more likely to suffer from microvascular or macrovascular complications. We explored the prevalence of major depressive disorder in Korean diabetic patients and its impact on self-care activities and glucose control. METHODS: We surveyed depressive symptoms and self-care activities in 191 type 2 diabetic patients from the outpatient clinic of the St. Mary's hospital. Two questionnaires were used for assessment, the Harvard Department of Psychiatry/National Depression Screening Day Scale (HANDS) and the Summary of Diabetes Self-Care Activities (SDSCA). RESULTS: Of the 191 respondents who completed questionnaires, 39 (20.4%) patients were categorized as having major depressive disorder. Among the depressed patients, only six (15.3%) had been previously evaluated and managed for their psychiatric problems. The incidence of depression was significantly higher in female diabetic patients compared to patients without depression (74.4% vs. 45.4%, P<0.001). Patients with depression showed significantly poorer diet control (18.5 vs. 15.9, P = 0.046) and less glucose monitoring (4.1 vs. 2.7, P = 0.047). However, there were no differences in exercise, foot care, or smoking status between the two groups. Additionally, metabolic parameters such as HbA1C and lipid profile were not significantly different between the two groups. CONCLUSION: Many diabetic patients are suffering from depression and exhibit poorer self-care activities than patients without depression. Identifying and managing depressed diabetic patients may help improve their self-care activities.

Citations

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The Effects of the 2030 Diabetes Camp Program on Depression, Anxiety, and Stress in Diabetic Patients
Jin Hee Jung, Jung Hwa Lee
The Journal of Korean Diabetes.2019; 20(3): 194. CrossRef
Association of Resilience and Depression with Self-care Competence in Adult Patients with Diabetes Mellitus
Youngrye Park, Eun Hee Jang, Ji Ok Kim
Korean Journal of Adult Nursing.2018; 30(5): 555. CrossRef
Health-Related Quality-of-Life and Diabetes Self-Care Activity in Elderly Patients with Diabetes in Korea
Hacksun Kim, Kisook Kim
Journal of Community Health.2017; 42(5): 998. CrossRef
Associations between Smoking, Drinking and Depression among Korean Adults: The 5th Korea National Health and Nutrition Examination Survey
Sun Mi Park, Mi Ah Han, Jong Park, So Yeon Ryu, Seong Woo Choi, Hwan Ho Shin, Mi Hyun Joo
Korean Journal of Health Promotion.2016; 16(2): 111. CrossRef
Diabetes and Depressive Symptoms in Korean Women: The Fifth Korean National Health and Nutrition Examination Survey (2010-2011)
Han Na Sung, Hong Seok Chae, Eung Soo Kim, Jong Sung Kim
Korean Journal of Family Medicine.2014; 35(3): 127. CrossRef
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Alcohol Drinking Problems and Diabetes Self-care in Male Diabetics.: Soo Mi Jang, Kyung Ae Choi, Hyung Joon Yoo; Korean Diabetes J. 2004;28(2):139-148. Published online April 1, 2004

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Abstract PDF: BACKGROUND
Heavy alcohol drinking negatively influences the self-care of diabetics requiring strict management of their lifestyle. However, related studies on the clinical interventions for diabetics with alcohol drinking problems are rare. Thus, the relationship between alcohol drinking problems and self-care of male diabetics was studied, and the physician's recognition of the drinking problems also evaluated. METHODS: The subjects of this study were 88 middle-aged male diabetics. They were selected from 4 general hospitals between Nov. 2001 and Feb. 2002. The subjects' alcohol drinking problems and degree of diabetes self-care were examined. Their charts were also reviewed for the physician's recognition of diabetic' alcohol related drinking problems. RESULT: Among the subjects, 53.4% were categorized as problem drinkers and 26% as alcohol dependent. Furthermore, 67.5% of diabetics with drinking problems had their alcohol drinking problems recognized by the physician. The mean self-care among diabetics with and without alcohol drinking problems were 15.0. The mean self-care among diabetics without alcohol drinking problems was 20.6(p<0.001). CONCLUSION: In this study, the importance of educator's sensitivity to diabetics' drinking problems and the use of screening tools to find alcohol drinking problems at an early stage have been highlighted. Further studies on the development of new program are suggested in order to effectively intervene in diabetics with alcohol drinking problems.

Frequency of Anti-GAD Antibody in Non-obese, Adult-onset Type 2 Diabetes in Korea and Clinical and Biological Characteristics According to Anti-GAD Antibody.: Chul Sik Kim, Jina Park, Min Ho Cho, Jong Suk Park, Joo Young Nam, Dol Mi Kim, Chul Woo Ahn, Bong Soo Cha, Sung Kil Lim, Kyung Rae Kim, Hyun Chul Lee; Korean Diabetes J. 2004;28(2):66-74. Published online April 1, 2004

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Abstract PDF: BACKGROUND
Some of the characteristic features of diabetes mellitus in Korea are that 70-80% of patients are non-obese or adult-onset type, and type 1 diabetes is very rare. Occasionally, autoantibodies to glutamic acid decarboxylase(GAD) are found in typical, type 2 diabetes mellitus patients(T2DM). The role of the autoantibody to GAD in T2DM is unknown. The aim of this study was to determine the clinical and biochemical characteristics between GAD-positive and GAD-negative non-obese, adult-onset diabetics in Korea. METHODS: A cohort of 428 type 2 diabetes patients was included. The measured autoantibodies to GAD were measured, and the C-peptide and HbA1c levels, anthropometric data(weight, height, body mass index and waist circumference), blood pressure and lipid profiles compared between the two groups. RESULTS: Compared to the antibody-negative group(n=374; 87.4%), patients with the anti-GAD antibody(n=54; 12.6%) had significantly lower C-peptide levels and were significantly younger. The anti GAD-positive group had a lower BMI, more frequently needed insulin supplements, and a lower prevalence of hypertension. There were no significant differences in gender and family history of diabetes between the two groups. CONCLUSION: The presence of the autoantibody to GAD allowed the group with more deteriorated beta-cell function and more frequent need for insulin supplements, but a lower prevalence of obesity and hypertension to be determined.

Analysis of Insulin Injection Focused Self-Care and Related Factors in Diabetics.: Joo Wha Yoo, Moon Ja Suh; Korean Diabetes J. 2003;27(2):153-164. Published online April 1, 2003

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Abstract PDF: BACKGROUND
The purposes of this study were to investigate the level of insulin injection focused self-care, in patients with diabetes mellitus, and to identify the relationship between the perceived sensitivity/severity, perceived benefits, perceived barriers, self-efficacy and situational barriers relating to the insulin injection focused self-care. METHODS: The data were collected from Type 2 diabetic patients (n=120), at an outpatients clinic of a University Hospital in Seoul, Korea, between March and May 2001. The reliability of the instrument ranged from 0.64 to 0.87 Cronbach's Alpha. The data were analyzed using the SPSS PC+, version 10.0 software: descriptive statistics were conducted for the characteristics of the sample. T-tests, Pearson correlation coefficients and multivariate multiple regression analyses were conducted to identify the associations between the cognitive-affective factors and the insulin injection focused self-care. RESULTS: 1) The average level of self-injection was 4.72+/-.45. The average of coping with hypoglycemia was 2.98 .57. The average self-monitored blood glucose was 2.83 1.15. Among these three insulin injection focused self-care activities, the average for both the coping with hypoglycemia and self-monitored blood glucose were lower than the average for self-injection. 2) The mean scores for perceived sensitivity/severity, perceived benefits, perceived barriers, self-efficacy and situational barriers were 3.32+/-.97 (range 1-5); 3.74+/-.65, 2.49+/-.76, 72.86+/-16.70 (range 10-100) and 1.10+/-.19 (range 1-4), respectively. 3) The education was significantly correlated with the insulin injection focused self-care (p=.012), but the age was not. The frequency of the self-monitoring was significantly correlated with the insulin injection-focused self-care (p=.000) and self- efficacy (p=.000). 4) The self-efficacy was significantly positively correlated with the insulin injection focused self-care (p<.01) and perceived benefits (p<.01), but negatively correlated with situational barriers (p<.05). The perceived benefits were significantly positive correlated with the insulin injection focused self-care (p<.01) and the perceived sensitivity/severity (p<.05). The perceived barriers was also significantly positively correlated with the perceived sensitivity/severity (p<.05). CONCLUSION: Our results suggest that improving the level of insulin injection focused self-care may be increased by increasing the self-efficacy, perceived benefits and perceived sensitivity/severity, and by improving the capabilities for problem solving with the situational barriers faced. Since the purposed of this study was investigate the level of insulin injection focused self-care, rather than the overall management of diabetics, there is the need to develop substantial data to support nursing interventions for the improvement of self-care in patients with diabetes mellitus.

Self-Care and Related Factors in Patients with Diabetes.: Jin Ho Chun, Soo Boon Jung, Hae Sook Sohn; Korean Diabetes J. 1999;23(2):193-206. Published online January 1, 2001

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Abstract PDF: BACKGROUND
In patients with diabetes, self-care might be important for the prevention of complications and the improvement of quality of life. METHODS: To investigate the factors related to self-care in patients with diabetes, a questionnaire study of 128 diabetic patients at three hospitals in Pusan was done from November 1997 to March 1998. The questionnaire included the level of self-care, the knowledge of diabetes, health belief, the support of the family, stresses relating to the disease, personal characteri.;tics, medical history, relationship with medical personnel. The data was analyzed by PC SAS program (version 6.12) with the level of significance (a=0.05). RESULTS: In univariate analysis, the level of self-care was higher in the group with a greater level of knowledge, health belief, the support of family, and it was lower in the group with a greater level of stress (p<0.05). In the multiple regression analysis with the level of self-care as the dependent variable and each characteristic as independent variables, knowledge (9=0.132), health belief (g=0.469), stresses (B=-0.105), body mass index (9=-0.898), regular hospital visit (g=2.318), relationship with the physician (B=3.987) and current smoking habits (B=-5.205) were detected as significant factors (p<0.05), and current drinking factors (B=-3.742) were not significant (p>0.05). The value of R-square was 61%. CONCLUSIONS: To enhance the effectiveness for diabetes control through the enhancement of the patients self-care level, it suggested that self control of weight, smoking and stress would be necessary, and the level of knowledge and health belief should be increased with a good relationship with his physician. And thought it necessary to let them visit a physician regularly through efforts from family members and medical personnel.

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