Compliant behaviour: relationship to attitudes and control in diabetic patients

A study was conducted to examine patient performance of certain safety measures in relation to 'attitude' and glycaemic control. One hundred and thirty consecutive routinely attending insulin-dependent diabetic patients (IDDM) were asked to show a source of sugar and diabetes identification (ID). An attitude scale, developed and psychometrically evaluated with intent to examine 'general attitude to diabetes', was used to study attitudes. Fifty-eight per cent of the IDDM patient sample carried both sugar and ID. The mean HbA1c of these patients (8.4%) was 2% lower (p less than 0.01) compared with patients carrying either ID only (24% of sample: mean HbA1c 10.4%), sugar only (6% of sample: mean HbA1c 10.3%) or neither item (12% of sample: mean HbA1c 10.7%). The general attitude score in these patients was significantly higher if sugar was carried (p less than 0.02) but there was no relationship with HbA1c (p greater than 0.1). A seven-item subcluster representing attitudes to diabetic management was more strongly related to sugar carriage (p less than 0.001) and was inversely correlated with HBA1c (r = 0.252: p less than 0.02). These findings indicate that attitudes to diabetes management may influence specific behavioural elements (i.e. compliance with advice always to carry sugar and ID). However, there was also a significant trend to higher carriage rates for sugar with a higher frequency of perceived hypoglycaemia (p less than 0.05) but no relationship between perceived hypoglycaemia and HbA1c. Absence of sugar of ID appears to represent a useful indicator of poor diabetic control and may assist in the definition of relevant attitudinal differences.