Confidence to Self-Manage in Diabetes: An All-Wales Cross-Sectional Population Study

Diabetes is a leading cause of morbidity and mortality in Wales, and concerningly, the prevalence of diabetes and the associated healthcare costs continue to rise. Effective self-management is essential in diabetes care to avoid poor outcomes; however, little is known about how confidence to self-manage impacts outcomes.

This study examines the association between confidence to self-manage and wellbeing and emergency and elective admissions in a large sample of people with diabetes surveyed in Wales over the age of 45 years (N = 2941). Where possible, multilevel regression modelling was used to account for patients being nested within GP practises; otherwise, logistic regression modelling was applied.

After controlling for various individual and situational factors, confidence to self-manage was found to be strongly associated with better wellbeing (B = 12.43; 95% CI: 11.19-13.67) and with reduced odds of having an emergency hospital admission (OR = 0.79; 95% CI: 0.65-0.95) but not an elective hospital admission (OR = 0.95; 95% CI: 0.81-1.13) in the year following survey completion. Other individual level factors such as being unable to work and having more chronic conditions were associated with poorer wellbeing and having an emergency admission.

These findings indicate that higher levels of confidence to self-manage were associated with better wellbeing and reduced odds of emergency hospital admission among diabetic people aged over 45 years in Wales. Therefore, healthcare providers, policymakers and patients should engage with and develop strategies to enhance confidence and self-management in diabetes.