Review: Diabetes self-care management practices among insulin-taking patients

Although set in Jordan, this exploration of diabetes self-care management (DSCM) practices utilising the ‘40 Item Diabetes Self-Management Scale’ (Gharaibeh et al., 2017) emphasises to us that DSCM could be improved in all insulin-taking patients, wherever they are. I return to this point later. Furthermore, as well as the identified predictors of DSCM, such as education and training, age, etc., cultural barriers are also recognised as potentially being responsible for poorer levels of DSCM, particularly in the case of Jordanian females. This of course resonates with current knowledge that diabetes education and care need to be culturally appropriate in order to be effective in improving DSCM (Creamer et al., 2016).

The results from the authors’ research clearly indicated that in the sample group the patients with type 1 diabetes demonstrated a higher level of DSCM than those with type 2 diabetes and queried why this might be so, postulating that, since many of the type 2 diabetics were also on oral hypoglycaemic medication, the burden of diabetes might thus have been higher. However, it is also reported that two-thirds of the sample group were on both insulin and oral hypoglycaemics, so some of the type 1 diabetics were also on oral hypoglycaemics. This caused me to wonder whether this group of type 1s showed similar characteristics of DSCM to the type 2 patients. This is not made clear in the reviewed study, and could help clarify the distinction between DSCM in type 1 and 2 diabetics – that additional medication alters DSCM in type 1 and 2, or that it is just that type 2 diabetics have poorer levels of DSCM? This of course leads us to question just why this is so. Another area that could have been further explored regarding the differences between DSCM in type 1 and 2 diabetes concerns age. It is known that as patients age their DSCM declines, which the reviewed study also demonstrates. However, it would have been useful to compare patient ages between the two types of diabetes. Type 1 diabetes tends to occur earlier in life, whereas type 2 tends to occur later. This might help explain why the type 2 diabetics had reduced levels of DSCM, since as a group they would more likely be older, although this is not clear within the paper.

Returning to the influencing factors governing DSCM and the need to globally improve them, the authors acknowledge that levels of DSCM are complex and multi-factorial. The tool used to assess levels of DSCM aims to consider these factors, and the reviewed study thus identifies many of them as barriers to good DSCM, such as the lack locally of education programmes like ‘DESMOND’ and ‘DAFNE’, and ‘Certified Diabetes Educators’. One area that was thought provoking is that these programmes are identified with a more holistic approach, and one area that again could be of significance to the gap between DSCM in type 1 and 2 diabetics concerns psychological influences and motivation. It is well known that diabetes causes anxiety and depression (Jones et al., 2014), particularly when complications of the disease occur. Patients with type 2 diabetes are frequently only diagnosed when complications have begun to occur, so it could be that psychological affect has inhibited their DSCM (Bruce et al., 2018).

To conclude, the reviewed study is of value because it continues to highlight major weakness in the healthcare support for good DSCM, and causes us to consider what those individual influencing factors are and how we might begin to help patients overcome them.

Biography

Jonathan Clough is an educator and researcher in nursing, with a clinical background in critical care nursing. His interests include critical care, diabetes mellitus, chronic obstructive pulmonary disease (COPD) and clinical placement learning and teaching.