Diabetes is a major public health concern worldwide. Low and middle-income countries are the most affected. Diabetes self-management can significantly reduce the burden of diabetes complications and mortality. This cross-sectional study was conducted at the outpatient department of a county referral hospital in Kenya, from 1st August 2022 to 30th October 2022. Patients with known type II diabetes of age ≥ 20 years visiting the hospital for routine follow-up visits were included. A 7-tem Summary of Diabetes Self-care Activities (SDSAC) Questionnaire was used to assess Diabetes self-care activities. For data entry and statistical analysis, SPSS for Windows version 27.0 was used. There were 96 (39.2%) males and 149 (60.8%) females. Most of the participants were more than 61 years, 148 (60.4%). Significant association was found between the sum scale scores of dietary activities, blood glucose testing, physical activity, foot care, and neuropathy at 95% CI and (p < 0.001). Scores on the Blood glucose testing and foot care activities subscale were significantly associated with Retinopathy (p < 0.001). Additionally, significant associations were found between the presence of nephropathy and dietary activities, foot care, and physical activity subscale (p ≤ 0.001). Conclusions: Diabetes self-management activities have an impact on microvascular complications in patients with diabetes.
References
[1]
Mathur, P., Leburu, S. and Kulothungan, V. (2022) Prevalence, Awareness, Treatment and Control of Diabetes in India from the Countrywide National NCD Monitoring Survey. Frontiers in Public Health, 10, Article 748157. https://doi.org/10.3389/fpubh.2022.748157
[2]
Sun, H., Saeedi, P., Karuranga, S., Pinkepank, M., Ogurtsova, K., Duncan, B.B., et al. (2022) IDF Diabetes Atlas: Global, Regional and Country-Level Diabetes Prevalence Estimates for 2021 and Projections for 2045. Diabetes Research and Clinical Practice, 183, Article 109119. https://doi.org/10.1016/j.diabres.2021.109119
[3]
Marsh, Z., Teegala, Y. and Cotter, V. (2022) Improving Diabetes Care of Community-Dwelling Underserved Older Adults. Journal of the American Association of Nurse Practitioners, 34, 1156-1166. https://doi.org/10.1097/jxx.0000000000000773
[4]
Tang, J., Wu, T., Hu, X. and Gao, L. (2021) Self-Care Activities among Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study. International Journal of Nursing Practice, 27, e12987. https://doi.org/10.1111/ijn.12987
[5]
Alanazi, M. (2021) Determinants of Successful Diabetes Self-Management Behaviors among Women of Arab Descent with Type 2 Diabetes. Primary Care Diabetes, 15, 306-313. https://doi.org/10.1016/j.pcd.2020.10.009
[6]
Ary, D.V., Toobert, D., Wilson, W. and Glasgow, R.E. (1986) Patient Perspective on Factors Contributing to Nonadherence to Diabetes Regimen. Diabetes Care, 9, 168-172. https://doi.org/10.2337/diacare.9.2.168
[7]
Shrivastava, S.R., Shrivastava, P.S. and Ramasamy, J. (2013) Role of Self-Care in Management of Diabetes Mellitus. Journal of Diabetes & Metabolic Disorders, 12, Article No. 14. https://doi.org/10.1186/2251-6581-12-14
[8]
Lin, K., Yang, X., Yin, G. and Lin, S. (2015) Diabetes Self-Care Activities and Health-Related Quality-of-Life of Individuals with Type 1 Diabetes Mellitus in Shantou, China. Journal of International Medical Research, 44, 147-156. https://doi.org/10.1177/0300060515597933
[9]
Aquino, J.A., Baldoni, N.R., Flôr, C.R., Sanches, C., Di Lorenzo Oliveira, C., Alves, G.C.S., et al. (2018) Effectiveness of Individual Strategies for the Empowerment of Patients with Diabetes Mellitus: A Systematic Review with Meta-Analysis. Primary Care Diabetes, 12, 97-110. https://doi.org/10.1016/j.pcd.2017.10.004
[10]
Aronson, R., Brown, R.E., Jiandani, D., Walker, A., Orzech, N. and Mbuagbaw, L. (2018) Assessment of Self-Management in Patients with Diabetes Using the Novel LMC Skills, Confidence and Preparedness Index (SCPI). Diabetes Research and Clinical Practice, 137, 128-136. https://doi.org/10.1016/j.diabres.2017.10.028
[11]
Afaya, R.A., Bam, V., Lomotey, A.Y. and Afaya, A. (2022) Clinical Factors Influencing Knowledge and Self-Care Practice among Adults with Type 2 Diabetes Mellitus. Nursing Open, 10, 2492-2500. https://doi.org/10.1002/nop2.1506
[12]
Khosravizadeh, O., Ahadinezhad, B., Maleki, A., Yousefy, S. and Momeni, Z. (2023) Diabetes Self-Care Activities among Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis. International Journal of Diabetes in Developing Countries, 44, 10-19. https://doi.org/10.1007/s13410-023-01214-3
[13]
Eva, J.J., Kassab, Y.W., Neoh, C.F., Ming, L.C., Wong, Y.Y., Abdul Hameed, M., et al. (2018) Self-Care and Self-Management among Adolescent T2DM Patients: A Review. Frontiers in Endocrinology, 9, Article 489. https://doi.org/10.3389/fendo.2018.00489
[14]
Maina, P.M., Pienaar, M. and Reid, M. (2023) Self-Management Practices for Preventing Complications of Type II Diabetes Mellitus in Low and Middle-Income Countries: A Scoping Review. International Journal of Nursing Studies Advances, 5, Article 100136. https://doi.org/10.1016/j.ijnsa.2023.100136
[15]
Young-Hyman, D., de Groot, M., Hill-Briggs, F., Gonzalez, J.S., Hood, K. and Peyrot, M. (2016) Psychosocial Care for People with Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care, 39, 2126-2140. https://doi.org/10.2337/dc16-2053
[16]
Toobert, D.J., Hampson, S.E. and Glasgow, R.E. (2000) The Summary of Diabetes Self-Care Activities Measure: Results from 7 Studies and a Revised Scale. Diabetes Care, 23, 943-950. https://doi.org/10.2337/diacare.23.7.943
[17]
Llera-Fábregas, A., Pérez-Ríos, N., Camacho-Monclova, D.M., Ramirez-Vick, M. and Andriankaja, O.M. (2022) Diabetes Self-Care Activities and Perception and Glycemic Control in Adult Puerto Rican Residents with Type 2 Diabetes: The LLIPDS Study. Journal of Public Health Research, 11, 1-12. https://doi.org/10.1177/22799036221125337
[18]
Lee, J., Lee, E., Chae, D. and Kim, C. (2020) Patient-Reported Outcome Measures for Diabetes Self-Care: A Systematic Review of Measurement Properties. International Journal of Nursing Studies, 105, Article 103498. https://doi.org/10.1016/j.ijnurstu.2019.103498
[19]
Chew, B., Vos, R.C., Pouwer, F. and Rutten, G.E.H.M. (2018) The Associations between Diabetes Distress and Self-Efficacy, Medication Adherence, Self-Care Activities and Disease Control Depend on the Way Diabetes Distress Is Measured: Comparing the DDS-17, DDS-2 and the Paid-5. Diabetes Research and Clinical Practice, 142, 74-84. https://doi.org/10.1016/j.diabres.2018.05.021
[20]
Pintaudi, B., Lucisano, G., Gentile, S., Bulotta, A., Skovlund, S.E., Vespasiani, G., et al. (2015) Correlates of Diabetes-Related Distress in Type 2 Diabetes: Findings from the Benchmarking Network for Clinical and Humanistic Outcomes in Diabetes (BENCH-D) Study. Journal of Psychosomatic Research, 79, 348-354. https://doi.org/10.1016/j.jpsychores.2015.08.010
[21]
Kim, S., Love, F., Quistberg, D.A. and Shea, J.A. (2004) Association of Health Literacy with Self-Management Behavior in Patients with Diabetes. Diabetes Care, 27, 2980-2982. https://doi.org/10.2337/diacare.27.12.2980
[22]
Bloomgarden, Z. and Gouller, A. (2004) Prevention of Microvascular Complications of Diabetes. In: Principles of Diabetes Mellitus, Springer, 619-638. https://doi.org/10.1007/978-1-4757-6260-0_33
[23]
Salmerón, J., Hu, F.B., Manson, J.E., Stampfer, M.J., Colditz, G.A., Rimm, E.B., et al. (2001) Dietary Fat Intake and Risk of Type 2 Diabetes in Women. The American Journal of Clinical Nutrition, 73, 1019-1026. https://doi.org/10.1093/ajcn/73.6.1019
[24]
Marshall, J.A. and Bessesen, D.H. (2002) Dietary Fat and the Development of Type 2 Diabetes. Diabetes Care, 25, 620-622. https://doi.org/10.2337/diacare.25.3.620
[25]
Glasgow, R.E. and Osteen, V.L. (1992) Evaluating Diabetes Education: Are We Measuring the Most Important Outcomes? Diabetes Care, 15, 1423-1432. https://doi.org/10.2337/diacare.15.10.1423
[26]
Glasgow, R.E., Fisher, E.B., Anderson, B.J., LaGreca, A., Marrero, D., Johnson, S.B., et al. (1999) Behavioral Science in Diabetes. Contributions and Opportunities. Diabetes Care, 22, 832-843. https://doi.org/10.2337/diacare.22.5.832
[27]
Govindarajan Venguidesvarane, A., Jasmine, A., Varadarajan, S., Shriraam, V., Muthuthandavan, A.R., Durai, V., et al. (2020) Prevalence of Vascular Complications among Type 2 Diabetic Patients in a Rural Health Center in South India. Journal of Primary Care & Community Health, 11, Article 2150132720959962. https://doi.org/10.1177/2150132720959962
[28]
Pelluri, R., Srikanth, K., Chimakurthy, J. and Nagasubramanian, V.R. (2021) Microvascular Complications and Their Associated Risk Factors among Rural Type 2 Diabetic Population: A Cross-Sectional Study. SN Comprehensive Clinical Medicine, 3, 625-631. https://doi.org/10.1007/s42399-021-00786-7
[29]
Yan, Z., Cai, M., Han, X., Chen, Q. and Lu, H. (2023) The Interaction between Age and Risk Factors for Diabetes and Prediabetes: A Community-Based Cross-Sectional Study. Diabetes, Metabolic Syndrome and Obesity, 16, 85-93. https://doi.org/10.2147/dmso.s390857
[30]
Singh, V.P., Bali, A., Singh, N. and Jaggi, A.S. (2014) Advanced Glycation End Products and Diabetic Complications. The Korean Journal of Physiology & Pharmacology, 18, Article No. 1. https://doi.org/10.4196/kjpp.2014.18.1.1
[31]
Garg, R., Chawla, S.S., Kaur, S., Bharti, A., Kaur, M., Soin, D., et al. (2019) Impact of Health Education on Knowledge, Attitude, Practices and Glycemic Control in Type 2 Diabetes Mellitus. Journal of Family Medicine and Primary Care, 8, 261-268. https://doi.org/10.4103/jfmpc.jfmpc_228_18
[32]
Hwang, Y., Lee, D. and Kim, Y.S. (2020) Educational Needs Associated with the Level of Complication and Comparative Risk Perceptions in People with Type 2 Diabetes. Osong Public Health and Research Perspectives, 11, 170-176. https://doi.org/10.24171/j.phrp.2020.11.4.05
[33]
Ghaemi, F., Firouzabadi, F.D., Moosaie, F., Shadnoush, M., Poopak, A., Kermanchi, J., et al. (2021) Effects of a Mediterranean Diet on the Development of Diabetic Complications: A Longitudinal Study from the Nationwide Diabetes Report of the National Program for Prevention and Control of Diabetes (NPPCD 2016-2020). Maturitas, 153, 61-67. https://doi.org/10.1016/j.maturitas.2021.08.003
[34]
Rydall, A.C., Rodin, G.M., Olmsted, M.P., Devenyi, R.G. and Daneman, D. (1997) Disordered Eating Behavior and Microvascular Complications in Young Women with Insulin-Dependent Diabetes Mellitus. New England Journal of Medicine, 336, 1849-1854. https://doi.org/10.1056/nejm199706263362601
[35]
Chudasama, Y.V. and Khunti, K. (2023) Healthy Lifestyle Choices and Microvascular Complications: New Insights into Diabetes Management. PLOS Medicine, 20, e1004152. https://doi.org/10.1371/journal.pmed.1004152
[36]
Zhu, X., Zhang, X., Zhou, C., Li, B., Huang, Y., Li, C., et al. (2023) Walking Pace and Microvascular Complications among Individuals with Type 2 Diabetes: A Cohort Study from the UK Biobank. Scandinavian Journal of Medicine & Science in Sports, 34, e14501. https://doi.org/10.1111/sms.14501
[37]
Makura, C.B., Nirantharakumar, K., Girling, A.J., Saravanan, P. and Narendran, P. (2013) Effects of Physical Activity on the Development and Progression of Microvascular Complications in Type 1 Diabetes: Retrospective Analysis of the DCCT Study. BMC Endocrine Disorders, 13, Article No. 37. https://doi.org/10.1186/1472-6823-13-37
[38]
Blomster, J.I., Chow, C.K., Zoungas, S., Woodward, M., Patel, A., Poulter, N.R., et al. (2013) The Influence of Physical Activity on Vascular Complications and Mortality in Patients with Type 2 Diabetes Mellitus. Diabetes, Obesity and Metabolism, 15, 1008-1012. https://doi.org/10.1111/dom.12122
[39]
Vithian, K. and Hurel, S. (2010) Microvascular Complications: Pathophysiology and Management. Clinical Medicine, 10, 505-509. https://doi.org/10.7861/clinmedicine.10-5-505
[40]
Mansour, A., Mousa, M., Abdelmannan, D., Tay, G., Hassoun, A. and Alsafar, H. (2023) Microvascular and Macrovascular Complications of Type 2 Diabetes Mellitus: Exome Wide Association Analyses. Frontiers in Endocrinology, 14, Article 1143067. https://doi.org/10.3389/fendo.2023.1143067
[41]
Tuomilehto, J., Schwarz, P. and Lindström, J. (2011) Long-Term Benefits from Lifestyle Interventions for Type 2 Diabetes Prevention. Diabetes Care, 34, S210-S214. https://doi.org/10.2337/dc11-s222
[42]
Geng, T., Zhu, K., Lu, Q., Wan, Z., Chen, X., Liu, L., et al. (2023) Healthy Lifestyle Behaviors, Mediating Biomarkers, and Risk of Microvascular Complications among Individuals with Type 2 Diabetes: A Cohort Study. PLOS Medicine, 20, e1004135. https://doi.org/10.1371/journal.pmed.1004135
[43]
Zhang, Y., Pan, X., Chen, J., Xia, L., Cao, A., Zhang, Y., et al. (2019) Combined Lifestyle Factors and Risk of Incident Type 2 Diabetes and Prognosis among Individuals with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. Diabetologia, 63, 21-33. https://doi.org/10.1007/s00125-019-04985-9
[44]
Turner, R. (1998) Intensive Blood-Glucose Control with Sulphonylureas or Insulin Compared with Conventional Treatment and Risk of Complications in Patients with Type 2 Diabetes (UKPDS 33). The Lancet, 352, 837-853.
[45]
Dahl-Jorgensen, K., Brinchmann-Hansen, O., Hanssen, K.F., Sandvik, L. and Aagenaes, O. (1985) Rapid Tightening of Blood Glucose Control Leads to Transient Deterioration of Retinopathy in Insulin Dependent Diabetes Mellitus: The Oslo Study. British Medical Journal, 290, 811-815. https://doi.org/10.1136/bmj.290.6471.811
[46]
Stratton, I.M. (2000) Association of Glycaemia with Macrovascular and Microvascular Complications of Type 2 Diabetes (UKPDS 35): Prospective Observational Study. British Medical Journal, 321, 405-412. https://doi.org/10.1136/bmj.321.7258.405
