Illness-behaviour, attitude, and knowledge in newly diagnosed diabetics

Sixty-five consecutive patients with newly diagnosed type I diabetes, aged 15-52, were exposed to a systematic educational programme and followed up by three-monthly controls for two to four years. In order to identify psychic, social and behavioural factors associated with good metabolic control and appropriate adaptation to illness, they were clinically tested and filled in a questionnaire. The study shows that the illness and the therapeutic regime created few problems regarding practical circumstances of daily living, but there were a vast number of psychological problems: perceived disability, fatigue, fear, anger, strain, bad conscience, and perceived discrimination. The patients assessed the treatment regimen they had been taught as fair, but still the majority reported inadequate compliance and problems in relation to compliance, especially regarding dietary restrictions. The educational programme was evaluated by the patients as useful and satisfying. Actual illness-related knowledge, skills and compliance were not closely associated, suggesting that knowledge itself is an insufficient precondition to appropriate management of the illness. Social class and other social environment factors were not associated with illness-related behaviour and attitudes and neither was metabolic control. There were no psychological or social differences between the patients with good and those with poor control. A possible interpretation of these findings is that an increase of quality of life in diabetic patients requires separate efforts to increase metabolic control and to create appropriate psycho-social adjustment to the change in life situation.