Poorer glycaemic control in type 1 diabetes is associated with reduced self-management and poorer perceived health: A cross-sectional study

Seyda Ozcan*, Stephanie Amiel, Helen Rogers, Pratik Choudhary, Alison Cox, Nicole de Zoysa, David Hopkins, Angus Forbes

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Citations (Scopus)

Abstract

Aims
Many people with type 1 diabetes do not achieve optimal treatment targets despite high patient and professional input. To investigate the reasons underlying suboptimal control we have studied clinical characteristics and self-management behaviours in adults with type 1 diabetes attending a large treatment centre.

Methods
A questionnaire-based enquiry into self-care behaviours of 380 patients with type 1 diabetes (mean age: 48 (±15) years and mean duration of diabetes: 26 (±15) years), linked with validated measures of impact of treatment on perceived health and hypoglycaemia recognition (Insulin Treatment Satisfaction Questionnaire; and EuroQoL EQ-5D, Gold score) and retrospective case note review of biomedical parameters. The data were analysed using chi-square test, ANOVA, ANCOVA and post-hoc procedures (Tukey's-b) in SPSS-version 18. The minimum significance level was accepted as 0.05.

Results
Sixty three percent of participants used multiple daily injections; 36% continuous subcutaneous insulin infusion. Mean HbA1c was 7.7% (±1.2) [61 ± −10 mmol/mol]; 30% had impaired hypoglycaemia awareness (IHA). Factors significantly related to poor glycaemic control with IHA were longer duration of diabetes (p = 0.01); less frequent glucose self-monitoring (p = 0.05); and low level of patient-set glucose targets (p < 0.001). Patients with IHA and poorer control had significantly lower insulin treatment satisfaction (p < 0.001); and perceived health (p < 0.001).

Conclusions
Suboptimal biomedical outcomes in adults with type 1 diabetes attending a specialist intensified insulin therapy clinic are associated with longer duration of diabetes, fewer self-management behaviours and a trend towards poorer perceived health. These data suggest a need for greater emphasis on integration of psychological and self-management support with intensive medical management of type 1 diabetes.
Original languageEnglish
Pages (from-to)35-41
Number of pages7
JournalDiabetes Research and Clinical Practice
Volume106
Issue number1
DOIs
Publication statusPublished - Oct 2014

Keywords

  • Type 1 diabetes
  • Hypoglycaemia awareness
  • Impaired hypoglycaemia awareness
  • Hypoglycaemia unawareness
  • Intensive insulin therapy
  • Service development
  • SUBCUTANEOUS INSULIN INFUSION
  • QUALITY-OF-LIFE
  • SEVERE HYPOGLYCEMIA
  • STRUCTURED EDUCATION
  • IMPAIRED AWARENESS
  • THERAPY
  • EXPERIENCE
  • INJECTIONS
  • FREQUENCY
  • DURATION

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