Seyda Ozcan1, Stephanie A Amiel2, Helen Rogers2, Pratik Choudhary2, Alison Cox2, Nicole de Zoysa3, David Hopkins4, Angus Forbes5. 1. King's College London Florence Nightingale School of Nursing and Midwifery and King's College Hospital Koç University, School of Nursing, Istanbul, Turkey. Electronic address: sozcan@ku.edu.tr. 2. Department of Diabetes, King's College Hospital NHS Foundation Trust, London, United Kingdom. 3. Diabetes and Cardiac Rehabilitation, King's College Hospital NHS Foundation Trust, London, United Kingdom. 4. Division of Ambulatory Care & Local Networks, King's College Hospital NHS Foundation Trust, London, United Kingdom. 5. Department of Primary and Intermediate Care, Florence Nightingale School of Nursing and Midwifery, King's College London, London, United Kingdom.
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±-10mmol/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.
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±-10mmol/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.
Authors: Karolina Linden; Carina Sparud-Lundin; Annsofie Adolfsson; Marie Berg Journal: Int J Environ Res Public Health Date: 2016-08-22 Impact factor: 3.390
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Authors: Ahmed O Almobarak; Sufian K Noor; Wadie M Elmadhoun; Sarra O Bushara; Reham S Salim; Sittana A Forawi; Heitham Awadalla; Einas S Elwali; Mohamed H Ahmed Journal: J Family Med Prim Care Date: 2017 Apr-Jun