Self-management profiles and metabolic outcomes in type 2 diabetes

This paper reports a study whose aims were (1) to examine whether it is possible to determine participants' self-management profiles using three open-ended questions about their self-perceived role in diabetes management; and (2) to analyse whether such self-management profiles have any bearing on haemoglobin A(1c) levels.

The behavioural and educational aspects of self-management in type 2 diabetes have been the topic of a number of investigations. The individual's role in maintaining health and a satisfying everyday life with chronic conditions is increasingly becoming the focus of secondary prevention.

Participants (n = 259) were recruited from those attending a year-long health educational programme for people with type 2 diabetes at Swedish pharmacies. A questionnaire was distributed 24 months after baseline. The health outcome, haemoglobin A(1c) was measured on four occasions. Three open-ended questions were used to explore self-management profiles based on perceived role, goal, and need of support in treatment. Data were collected during the period 1997-2002.

The following profiles of participants emerged: Disease Manager, Compliant, and Disheartened, with no initial differences in metabolic control. However, during the programme Disease Managers achieved good glycaemic control and succeeded in maintaining the reduction in their blood glucose for a longer period than those in other categories: their haemoglobin A(1c) level was reduced by -0.35 at 6 months (P = 0.000), -0.30 at 12 months (P = 0.001), and -0.28 at 24 months (P = 0.001) after baseline. Compliant participants had a good everyday routine and a -0.18 reduction at 6 months (P = 0.028) but no statistically significant haemoglobin A(1c) level reduction later. A smaller group of people, the Disheartened, reported difficulties in living with diabetes and did not succeed in decreasing their haemoglobin A(1c) by statistically significant amounts.

Healthcare professionals could use our three open-ended questions to assist in understanding people's views of their role in disease management so that health promotion and education can be tailored to individual needs.