An Assessment of Attitudes, Behaviors, and Outcomes of Patients with Type 2 Diabetes Self-efficacy, outcome expectations and self-care behaviour in people with type 2 diabetes in Taiwan. Effects of self-monitoring of glucose in non-insulin treated patients with type 2 diabetes: design of the IN CONTROL-trial The effectiveness of case management for comorbid diabetes type 2 patients; the CasCo study. Design of a randomized controlled trial Practice network-based care management for patients with type 2 diabetes and multiple comorbidities (GEDIMAplus): study protocol for a randomized controlled trial Designing and evaluating a web-based self-management site for patients with type 2 diabetes - systematic website development and study protocol Predicting self-care behaviours of patients with type 2 diabetes: the importance of beliefs about behaviour, not just beliefs about illness. The @RISK Study: Risk communication for patients with type 2 diabetes: design of a randomised controlled trial Adherence to self-care behavior and glycemic effects using structured education Addressing the needs of patients with multiple chronic illnesses: the case of diabetes and depression. Written emotional disclosure for adults with Type 2 diabetes: a primary care feasibility study. Educational disparities in health behaviors among patients with diabetes: the Translating Research Into Action for Diabetes (TRIAD) Study Promoting Health in Type 2 Diabetes: Nurse-Physician Collaboration in Primary Care Efficacy of self-monitoring blood glucose as a key component of a chronic care model versus usual care in type 2 diabetes patients treated with oral agents: results of a randomized trial Self-Efficacy, Depression, and Self-Care Activities in Adult Jordanians with Type 2 Diabetes: The Role of Illness Perception Illness representations among patients with type 2 diabetes and their partners: relationships with self-management behaviors. Depression, Self-Care, and Medication Adherence in Type 2 Diabetes
Objectives : Patient self-care behaviors , including taking medication , following a meal plan , exercising regularly , and testing blood glucose , influence diabetes control . The purpose of this research was to identify ( 1 ) which barriers to diabetes management are associated with problem behaviors and ( 2 ) which patient behaviors and barriers are associated with diabetes control . Methods : This was a cross-sectional study of linked medical record and self-reported information from patients with type 2 diabetes . A r and omly selected sample of 800 clinic patients was mailed an investigator-developed survey . The study sample consisted of 253 ( 55 % ) individuals who had measured glycosylated hemoglobin ( HbA1c ) within 3 months of the survey date . Results : The barriers to each diabetes self-care behavior differed . Cost was the most common barrier to the 4 self-care behaviors . In a multivariable regression model , the belief that type 2 diabetes is a serious problem and depression were strongly associated with higher HbA1c levels . Lower HbA1c levels were significantly associated with being married and greater self-reported adherence-satisfaction with taking medication and testing blood glucose . Conclusion : This study exp and ed earlier research by focusing on 4 specific self-care behaviors , their barriers , and their association with HbA1c . Barriers that were significantly associated with HbA1c were specific to the behavior and varied across behaviors AIMS To explore differences in self-care behaviour according to demographic and illness characteristics ; and relationships among self-care behaviour and demographic and illness characteristics , efficacy expectations and outcome expectations of people with type 2 diabetes in Taiwan . BACKGROUND Most people with diabetes do not control their disease appropriately in Taiwan . Enhanced self-efficacy towards managing diseases can be an effective way of improving disease control as proposed by the self-efficacy model which provides a useful framework for underst and ing adherence to self-care behaviours . DESIGN AND METHODS The sample comprised 145 patients with type 2 diabetes aged 30 years or more from diabetes outpatient clinics in Taipei . Data were collected using a self-administered question naire for this study . One-way anova , t-tests , Pearson product moment correlation and hierarchical regression were analysed for the study . RESULTS Significant differences were found : between self-care behaviour and complications ( t = -2.52 , p < 0.01 ) and patient education ( t = -1.96 , p < 0.05 ) . Self-care behaviour was significantly and positively correlated with duration of diabetes ( r = 0.36 , p < 0.01 ) , efficacy expectations ( r = 0.54 , p < 0.01 ) and outcome expectations ( r = 0.44 , p < 0.01 ) . A total of 39.1 % of variance in self-care behaviour can be explained by duration of diabetes , efficacy expectations and outcome expectations . CONCLUSIONS Findings support the use of the self-efficacy model as a framework for underst and ing adherence to self-care behaviour . RELEVANCE TO CLINICAL PRACTICE Using self-efficacy theory when design ing patient education interventions for people with type 2 diabetes will enhance self-management routines and assist in reducing major complications in the future Background Diabetes specific emotional problems interfere with the dem and ing daily management of living with type 2 diabetes mellitus ( T2DM ) . Possibly , offering direct feedback on diabetes management may diminish the presence of diabetes specific emotional problems and might enhance the patients ' belief they are able to manage their illness . It is hypothesized that self-monitoring of glucose in combination with an algorithm how and when to act will motivate T2DM patients to become more active participants in their own care leading to a decrease in diabetes related distress and an increased self-efficacy . Methods and design Six hundred patients with T2DM ( 45 ≤ 75 years ) who receive care in a structured diabetes care system , HbA1c ≥ 7.0 % , and not using insulin  will be recruited and r and omized into 3 groups ; Self-monitoring of Blood Glucose ( SMBG ) , Self-monitoring of Urine Glucose ( SMUG ) and usual care ( n = 200 per group ) . Participants are eligible if they have a known disease duration of over 1 year and have used SMBG or SMUG less than 3 times in the previous year . All 3 groups will receive st and ardized diabetes care . The intervention groups will receive additional instructions on how to perform self-monitoring of glucose and how to interpret the results . Main outcome measures are changes in diabetes specific emotional distress and self-efficacy . Secondary outcome measures include difference in HbA1c , patient satisfaction , occurrence of hypoglycaemia , physical activity , costs of direct and indirect healthcare and changes in illness beliefs . Discussion The IN CONTROL-trial is design ed to explore whether feedback from self-monitoring of glucose in T2DM patients who do not require insulin can affect diabetes specific emotional distress and increase self-efficacy . Based on the self-regulation model it is hypothesized that glucose self-monitoring feedback changes illness perceptions , guiding the patient to reduce emotional responses to experienced threats , and influences the patients ability to perform and maintain self-management skills . Trial registration Current Controlled Trials IS RCT Background More than half of the patients with type 2 diabetes ( T2DM ) patients are diagnosed with one or more comorbid disorders . They can participate in several single-disease oriented disease management programs , which may lead to fragmented care because these programs are not well prepared for coordinating care between programs . Comorbid patients are therefore at risk for suboptimal treatment , unsafe care , inefficient use of health care services and unnecessary costs . Case management is a possible model to counteract fragmented care for comorbid patients . It includes evidence -based optimal care , but is tailored to the individual patients ' preferences . The objective of this study is to examine the effectiveness of a  case management program , in addition to a diabetes management program , on the quality of care for comorbid T2DM patients . Methods / Design The study is a r and omized controlled trial among patients with T2DM and at least one comorbid chronic disease ( N = 230 ) , who already participate in a diabetes management program .  R and omization will take place at the level of the patients in general practice s. Trained practice nurses ( case managers ) will apply a case management program in addition to the diabetes management program . The case management intervention is based on the Guided Care model and includes six elements ; assessing health care needs , planning care , create access to other care providers and community re sources , monitoring , coordinating care and recording of all relevant information . Patients in the control group will continue their participation in the diabetes management program and receive care-as-usual from their general practitioner and other care providers . Discussion We expect that the case management program , which includes better structured care based on scientific evidence and adjusted to the patients ' needs and priorities , will improve the quality of care coordination from both the patients ' and caregivers ' perspective and will result in less consumption of health care services . Trial registration Netherl and s Trial Register ( NTR ) : Background Care management interventions in the German health-care system have been evaluated with promising results , but further research is necessary to explore their full potential in the context of multi-morbidity . Our aim in this trial is to assess the efficacy of a primary care practice network – based care management intervention in improving self-care behaviour among patients with type 2 diabetes mellitus and multiple co-occurring chronic conditions . Methods / Design The study is design ed as a prospect i ve , 18-month , multicentre , investigator-blinded , two-arm , open-label , individual-level , r and omized parallel-group superiority trial . We will enrol 582 patients with type 2 diabetes mellitus and at least two severe chronic conditions and one informal caregiver per patient . Data will be collected at baseline ( T0 ) , at the primary endpoint after 9 months ( T1 ) and at follow-up after 18 months ( T2 ) . The primary outcome will be the differences between the  intervention and control groups  in changes of diabetes-related self-care behaviours from baseline to T1 using a German version of the revised Summary of Diabetes Self-Care Activities ( SDSCA-G ) . The secondary outcomes will be the differences between the intervention and control groups in : changes in scores on the SDSCA-G subscales , glycosylated haemoglobin A level , health-related quality of life , self-efficacy , differences in ( severe ) symptomatic hypoglycaemia , cost-effectiveness and financial family burden . The intervention will be delivered by trained health-care assistants as an add-on to usual care and will consist of three main elements : ( 1 ) three home visits , including structured assessment of medical and social needs ; ( 2 ) 24 structured telephone monitoring contacts ; and ( 3 ) self-monitoring of blood glucose levels after T1 in 3-month intervals . The control group will receive usual care . The confirmatory primary analysis will be performed following the intention-to-treat ( ITT ) principle . The efficacy of the intervention will be quantified using two-level linear regression stratified by type of medical treatment adjusted for baseline values on the SDSCA-G. Secondary analyses will be performed according to the ITT principle . In health economic evaluations , we will estimate the incremental cost-effectiveness ratios . Discussion We hope that the results of this study will provide insights into the efficacy of practice network – based care management among patients with complex health-care needs . Trial registration Current Controlled Trials IS RCT N83908315 ( IS RCT N assigned 25 February 2014 ) Background Given that patients provide the majority of their own diabetes care , patient self-management training has increasingly become recognized as an important strategy with which to improve quality of care . However , participation in self management programs is low . In addition , the efficacy of current behavioural interventions wanes over time , reducing the impact of self-management interventions on patient health . Web-based interventions have the potential to bridge the gaps in diabetes care and self-management . Methods Our objective is to improve self-efficacy , quality of life , self-care , blood pressure , cholesterol and glycemic control and promote exercise in people with type 2 diabetes through the rigorous development and use of a web-based patient self-management intervention . This study consists of five phases : ( 1 ) intervention development ; ( 2 ) feasibility testing ; ( 3 ) usability testing ; ( 4 ) intervention refinement ; and ( 5 ) intervention evaluation using mixed methods . We will employ evidence -based strategies and tools , using a theoretical framework of self-efficacy , then elicit user feedback through focus groups and individual user testing sessions . Using iterative re design the intervention will be refined . Once finalized , the impact of the website on patient self-efficacy , quality of life , self-care , HbA1c , LDL-cholesterol , blood pressure and weight will be assessed through a non-r and omized observational cohort study using repeated measures modeling and individual interviews . Discussion Increasing use of the World Wide Web by consumers for health information and ongoing revolutions in social media are strong indicators that users are primed to welcome a new era of technology in health care . However , their full potential is hindered by limited knowledge regarding their effectiveness , poor usability , and high attrition rates . Our development and research agenda aims to address these limitations by improving usability , identifying characteristics associated with website use and attrition , and developing strategies to sustain patient use in order to maximize clinical outcomes OBJECTIVE There is evidence that perceptions of treatment may be more predictive than illness perceptions , e.g. medication adherence is often better predicted by beliefs about medication than by beliefs about illness . The present study aims to assess the generality of this finding , by comparing the extent to which self-care behaviours of patients with type 2 diabetes are predicted by patients ' beliefs about those behaviours , compared with their illness perceptions . METHODS This study is a one year prospect i ve cohort analysis of 453 patients recruited to a r and omised trial of blood glucose self-monitoring . Behaviour was assessed by the  medication adherence report scale ( MARS ) and diabetes self-care activities ( DSCA ) scales ; illness perceptions by IPQ-R ;  study -specific scales of beliefs about diet and physical activity were constructed by factor analysing items based on beliefs elicited in an earlier interview study involving patients with type 2 diabetes . RESULTS Past behaviour , trial group allocation , and clinical and demographic factors predicted between 16 % and 35 % variance in medication adherence , exercise , and diet scales . Illness perceptions added between 0.9 % and 4.5 % additional variance ; beliefs about behaviour added a further 1.1 % to 6.4 % additional variance . Beliefs regarding , respectively , the importance of exercise in controlling diabetes , the need to east less , and enjoyment from eating sweet or fatty food , added unique variance . CONCLUSION Beliefs about behaviour are at least as important as beliefs about illness in predicting several health-related behaviours . This suggests the possibility that behaviour change interventions with patient groups would be more effective by targeting beliefs about behaviour , rather than beliefs about illness Background Patients with type 2 diabetes mellitus ( T2DM ) have an increased risk to develop severe diabetes related complications , especially cardiovascular disease ( CVD ) . The risk to develop CVD can be estimated by means of risk formulas . However , patients have difficulties to underst and the outcomes of these formulas . As a result , they may not recognize the importance of changing lifestyle and taking medication in time . Therefore , it is important to develop risk communication methods , that will improve the patients ' underst and ing of risks associated with having diabetes , which enables them to make informed choices about their diabetes care . The aim of this study is to investigate the effects of an intervention focussed on the communication of the absolute 10-year risk to develop CVD on risk perception , attitude and intention to change lifestyle behaviour in patients with T2DM . The conceptual framework of the intervention is based on the Theory of Planned Behaviour and the Self-regulation Theory . Methods A r and omised controlled trial will be performed in the Diabetes Care System West-Friesl and ( DCS ) , a managed care system . Newly referred T2DM patients of the DCS , younger than 75 years will be eligible for the study . The intervention group will be exposed to risk communication on CVD , on top of st and ard managed care of the DCS . This intervention consists of a simple explanation on the causes and consequences of CVD , and possibilities for prevention . The probabilities of CVD in 10 year will be explained in natural frequencies and visualised by a population diagram . The control group will receive st and ard managed care . The primary outcome is appropriateness of risk perception . Secondary outcomes are attitude and intention to change lifestyle behaviour and illness perception . Differences between baseline and follow-up ( 2 and 12 weeks ) between groups will be analysed according to the intention-to-treat principle . The study was powered on 120 patients in each group . Discussion This innovative risk communication method based on two behavioural theories might improve patient 's appropriateness of risk perception and attitude concerning lifestyle change . With a better underst and ing of their CVD risk , patients will be able to make informed choices concerning diabetes care . Trail registration The trial is registered as NTR1556 in the Dutch Trial Register Aims / Introduction The purpose of the present study was to examine glycemic control in suboptimally controlled type 2 diabetes provided by a structured education group using the Diabetes Conversation Map ™ ( CM ™ ) vs usual care in a university-based hospital primary care clinic . Material s and Methods This was a r and omized , pragmatic clinical trial . Patients with type 2 diabetes were r and omly assigned to structured education or usual care groups . The primary outcome was the difference in the mean change of glycated hemoglobin ( HbA1c ) from baseline to 12 months . Secondary outcomes included the percentage achieving therapeutic HbA1c goal and self-behavioral changes . Results A total of 245 patients were r and omly assigned to two groups ( CM ™ group n = 121 ; usual care group , n = 116 ) . The absolute reduction of HbA1c was significantly greater in the CM ™ group at 3 and 6 months ( Δ = −0.59 % and Δ = −1.13 % , P < 0.01 ) , but the difference was no longer statistically significant at 9 and 12 months ( Δ = −0.43 % and Δ = −0.49 % ) , based on an intention-to-treat analysis . A per- protocol analysis showed the significant change was maintained at 12 months ( Δ = −0.67 % ) . In the intervention group , greater percentages of patients achieved their American Association of Diabetes Educators Self-Care Behaviours ™ framework ( AADE7 ) behavioral goals at 3 months , in particular being active , problem-solving , reducing risk and health coping . Conclusions In type 2 diabetic patients with suboptimally controlled glucose , there were greater improvements in glucose control and self-care behavioral goals in those who underwent the CM ™ education program compared with outcomes achieved in patients receiving usual care OBJECTIVES To review the literature on comorbid depression and diabetes ( DM/D ) and present a conceptual framework for integrating depression management with diabetes care in a managed care environment . STUDY DESIGN Literature review . RESULTS Depression affects diabetes management by 1 ) directly affecting patients ' health-related quality of life , 2 ) reducing physical activity levels , 3 ) limiting adherence to self-care regimens , and 4 ) impairing patients ' ability to communicate effectively with clinicians . Small r and omized trials suggest that both antidepressant medication and cognitive behavioral therapies ( CBTs ) or related approaches may improve not only DM/D patients ' depressive symptoms , but their physical health as well . CONCLUSIONS An effective DM/D management strategy should include the following elements : 1 ) systematic identification of DM/D patients and quality -of-care review s , 2 ) proactive patient monitoring between outpatient encounters , 3 ) intensive efforts to coordinate treatment across providers , 4 ) increased access to CBT or related therapies addressing patients ' depressive symptoms and diabetes self care , and 5 ) an emphasis on promoting physical activity to address both depressive symptoms and physiologic dysregulation . The conceptual framework developed for the care of DM/D patients offers general insights into the management of patients with multiple chronic medical AIM To test the feasibility of written emotional disclosure ( WED ) for UK primary care patients with Type 2 diabetes . BACKGROUND WED holds potential to address depressive symptoms in diabetes , yet its feasibility , and potential benefit , for primary care patients has not been established . METHOD Forty-one adults with Type 2 diabetes were r and omised to WED ( n=23 ) or neutral writing ( n=18 ) . Principal outcomes were feasibility of recruitment , compliance , acceptability and intervention fidelity . Potential benefit was assessed on between-group differences in depressive symptoms ( Centre for Epidemiological Studies Depression scale ) , diabetes distress ( Problem Areas in Diabetes scale ) , diabetes self-management behaviours ( Summary of Diabetes Self-care Activities question naire ) and perceived health status ( EQ-5D ) at three-month follow-up . FINDINGS Recruitment was modest ( 6 % ) , yet an unmet treatment need was identified . Fourteen intervention ( 61 % ) and 13(72 % ) control participants returned their writing , while 12 in each group ( 89 % ) then completed all sessions . Intervention fidelity was confirmed . Acceptability to patients was mixed . Exploratory effectiveness analyses suggested that relative to improvement in controls , WED is associated with a potentially clinical ly important worsening in depressive symptoms ( P=0.006 ) and a non-significant trend for a reduction in healthy dietary behaviour ( P=0.057 ) . There was no significant effect on other outcomes . The exploratory nature of the study , however , necessitates that the observed effects are interpreted with caution , and both the feasibility and effectiveness findings may be an artefact of the sample obtained . The evidence for the  feasibility of WED  in primary care diabetes was hence mixed , and in an unevaluated environment it may cause iatrogenic harm . On balance , WED is apparently not appropriate for use in this context in its current format . At most , further research with a more appropriate sample is required . The feasibility that was demonstrated and the unmet need identified suggest that this may be a worthy endeavour Background Our underst and ing of social disparities in diabetes-related health behaviors is incomplete . The purpose of this study was to determine if having less education is associated with poorer diabetes-related health behaviors . Methods This observational study was based on a cohort of 8,763 survey respondents drawn from ~180,000 patients with diabetes receiving care from 68 provider groups in ten managed care health plans across the United States .  Self-reported survey data included individual educational attainment ( " education " ) and five diabetes self-care behaviors among individuals for whom the behavior would clearly be indicated :  foot exams ( among those with symptoms of peripheral neuropathy or a history of foot ulcers ) ; self-monitoring of blood glucose ( SMBG ; among insulin users only ) ; smoking ; exercise ; and certain  diabetes-related health seeking behaviors ( use of diabetes health education , website , or support group in last 12 months ) . Predicted probabilities were modeled at each level of self-reported educational attainment using hierarchical logistic regression models with r and om effects for clustering within health plans . Results Patients with less education had significantly lower predicted probabilities of being a non-smoker and engaging in regular exercise and health-seeking behaviors , while SMBG and foot self-examination did not vary by education . Extensive adjustment for patient factors revealed no discernable confounding effect on the estimates or their significance , and most education-behavior relationships were similar across sex , race and other patient characteristics . The relationship between education and smoking varied significantly across age , with a strong inverse relationship in those aged 25–44 , modest for those ages 45–64 , but non-evident for those over 65 . Intensity of disease management by the health plan and provider communication did not alter the examined education-behavior relationships . Other measures of socioeconomic position yielded similar findings . Conclusion The relationship between educational attainment and health behaviors was modest in strength for most behaviors . Over the life course , the cumulative effect of reduced practice of multiple self-care behaviors among less educated patients may play an important part in shaping the social health gradient The purpose of this study is to examine effects of a nurse-physician collaborative approach to care of patients with type 2 diabetes and to determine possible effect sizes for use in computing sample sizes for a larger study . Forty patients from a family practice clinic with type 2 diabetes were r and omly assigned to control or experimental groups . The control group received st and ard care , whereas the experimental group received st and ard care plus home visits from a nurse , as well as consultation with an exercise specialist and /or nutritionist . Follow-up continued for 3 months . Clinical end points included st and ard measures of diabetes activity as well as quality -of-life indicators .  Focus group interviews were used to explore patients ’ responses to the program . Although findings were not statistically significant , a trend toward small to moderate positive effect sizes was found in glycosylated hemoglobin and blood pressure . Quality oflife measures also showed a trend toward small to moderate , but nonsignificant , improvements in physical functioning , bodily pain , vitality , social and global functioning , energy , impact of diabetes , and health distress . Focus group interviews indicated a very positive response from patients , who expressed feelings of empowerment . In this study , patients treated with  nurse-physician collaboration  demonstrated small , but nonsignificant , improvements in blood chemistry after only 3 months . Physical and social functioning , energy , and bodily pain also showed a small improvement . Changes in awareness of effects of diabetes on health and an expressed sense of self-efficacy suggest that effects could be sustainable over the longer term In recent years , patient-centered chronic care models ( CCMs ) have been widely recognized as the most effective approach for the management of chronic diseases including type 2 diabetes ( T2DM ) [ 1 ] ; however , their implementation in the real world is a dem and ing challenge [ 2 , 3 ] . In Italy , the SINERGIA CCM was developed in the diabetes outpatient clinic of Cusano Milanino [ 4 ] . In this model , self-monitoring blood glucose ( SMBG ) represents the key tool for patient engagement ; within the empowerment philosophy , patients undergo an educational process , which incorporates interactive teaching strategies design ed to involve patients in problem-solving and address their clinical , cultural and psychosocial needs [ 5 ] . Patients are actively involved in the discussion of their goals and instructed about the importance of glycemic control , lifestyle modifications , reduction in body weight and regular monitoring of diabetes complications and their risk factors . Organizational aspects , i.e. , training , skills and roles of each member of diabetes team , electronic data collection , and continuity of communication with the patients are also addressed by the model [ 4 ] . Following a preliminary evaluation of the SINERGIA impact in an observational cohort of over 1000 patients with T2DM cared for by the Cusano Milanino center [ 4 ] , the Self-Care Study was design ed as a multicenter , national , r and omized ( 1:1 ) , open-label , parallel group , controlled clinical trial of a duration of 12 months to compare SINERGIA models versus usual care . The primary end point was the change after 12 months from r and omization in HbA1c levels . Secondary end points were changes in body weight , waist circumference , blood pressure , lipid profile , specific quality -of-life scores , incidence of hypoglycemia and adverse events , and contacts between patient and center . After 24 months from r and omization , an additional analysis ( post-trial observational phase of the study ) assessed the long-term impact of SINERGIA versus  usual care . Inclusion criteria were : men or women aged ≥ 45 years with diagnosis of T2DM , at their first access at the diabetes clinic , with any diabetes duration , HbA1c > 7.0 and ≤ 9.0 % , treated or requiring the initiation of therapy with any oral oral hypoglycemic agent ( OHA ) , not using SMBG ( i.e. , frequency ≤ 1 test/week ) and signature of informed consent . Exclusion criteria were : treated or requiring the initiation of therapy with insulin , any condition that could render the subject unlikely or unable to comply with the protocol requirements ( full list of eligibility criteria available in https:// clinical trials.gov/ct2/show/NCT02082028?term= SINERGIA&cond = Diabetes+Mellitus%2C+Type+2&cntr y1=EU%3AIT&rank=1 ) . Patients were r and omized to two study arms :  patients allocated to the  experimental group received the SINERGIA diabetes educational model [ 4 ] and patients allocated to the control group received the st and ard diabetes education provided by the center , and SMBG ( any glucose meter ) was prescribed only if deemed appropriate based on physician ’s judgment . Patients in both groups were seen six times during the study period : 2 weeks before r and omization , at r and omization visit , 3 , 6 and 12 months after r and omization and 24 months after r and omization ( post-trial ) . Considering as clinical ly relevant a minimum betweengroup difference in HbA1c levels of 0.4 % after 12 months and assuming a st and ard deviation of HbA1c of 0.9 % and a Managed by Antonio Secchi Diabetes mellitus is reaching epidemic levels worldwide . In a developing country like Jordan , type 2 diabetes mellitus ( T2DM ) has reached a prevalence rate of 17.1 % . This cross-sectional study examined the relationship between  self-care activities  and : illness perception , depression , social support , religiosity and spiritual coping , and self-efficacy among patients with T2DM . A r and om sample of 220 patients with T2DM , who attended Jordan University Hospital in Jordan were enrolled . The data were collected through a structured interview and the medical files . The instruments consisted of a sociodemographic and clinical st and ardised question naires : Brief Illness Perception Question naire ,  Patients ’ Health Question naire-9 ; ENRICH Social Support Instrument ; Religious and Spiritual Coping Subscale ; Diabetes Management Self-Efficacy Scale ; and  Summary of Diabetes Self-Care Activities .  Bivariate analysis investigated the relationship between variables . Structure Equation Modelling ( SEM ) was performed to test the proposed conceptual model . The study found that approximately 70 % of the respondents suffered some form of depressive symptoms . The SEM showed a direct relationship between self-efficacy and self-care activities ( β = 0.40 ; p < 0.001 ) . Depression was indirectly related to self-care activities through self-efficacy ( β = –0.20 ; p = 0.003 ) ; nevertheless , it was directly related to perception of : treatment control , consequences , and emotional representations . Overall , the sequence between illness perception and self-efficacy was mediated by depression . Strategies to promote self-efficacy and illness perception are vital in customising a diabetes health plan to meet Arabic cultural expectations OBJECTIVE There is accumulating evidence to indicate that the illness representations of significant others are important for underst and ing patients ' responses to chronic disease . The aims of the present study were to ( a ) assess the illness representations of patients with type 2 diabetes and their partners , ( b ) determine the extent of agreement between patient and partner representations , and ( c ) examine whether partners ' representations mediate the relationships between patients ' representations and their prospect i ve self-management behaviors . METHODS Patients ' and partners ' representations of diabetes were assessed with the Revised Illness Perception Question naire [ Moss-Morris R , Weinman J , Petrie K , Horne R , Cameron LD , Buick , D. The revised illness perception question naire ( IPQ-R ) . Psychol Health 2002;17:116 ] at baseline ( n=164 ) . Self-management behaviors were assessed 12 months later with  self-report measures of physical activity , medication , and a food frequency question naire . RESULTS Patients scored lower on the illness coherence dimension , indicating that they reported a poorer underst and ing of the condition ( t=-2.66 , df=163 , P=.009 ) relative to their partners . Patients demonstrated higher scores for personal control than their partners ( t=2.01 , df=163 , P=.046 ) . Mediational analyses indicated that partners ' perceived timeline of diabetes partially mediated the relationship between patients ' representations and their self-management behaviors including physical activity and dietary intake . In addition , partners ' personal control representations partially mediated the relationship between patients ' representations and physical activity . CONCLUSION It was demonstrated that patient-partner dyads generally share similar representations of type 2 diabetes and perceived control over the condition . Furthermore , there was evidence that partners ' representations partially mediated the relationships between patients ' representations and their prospect i ve self-management behaviors OBJECTIVE —We examined the association between depression , measured as either a continuous symptom severity score or a clinical disorder variable , with self-care behaviors in type 2 diabetes . RESEARCH DESIGN AND METHODS —We surveyed 879 type 2 diabetic patients from two primary care clinics using the Harvard Department of Psychiatry/National Depression Screening Day Scale ( H AND S ) , the Summary of Diabetes Self-Care Activities , and self-reported medication adherence . RESULTS —Of the patients , 19 % met the criteria for probable major depression ( H AND S score ≥9 ) , and an additional 66.5 % reported at least some depressive symptoms . After controlling for covariates , patients with probable major depression reported significantly fewer days ' adherent to diet , exercise , and glucose self-monitoring regimens  ( P < 0.01 ) and 2.3-fold increased odds of missing medication doses in the previous week ( 95 % CI 1.5–3.6 , P < 0.001 ) compared with all other respondents . Continuous depressive symptom severity scores were better predictors of nonadherence to diet , exercise , and medications than categorically defined probable major depression . Major depression was a better predictor of glucose monitoring . Among the two-thirds of patients not meeting the criteria for major depression ( H AND S score < 9 , n = 709 ) , increasing H AND S scores were incrementally associated with poorer self-care behaviors ( P < 0.01 ) . CONCLUSIONS —These findings challenge the conceptualization of depression as a categorical risk factor for nonadherence and suggest that even low levels of depressive symptomatology are associated with nonadherence to important aspects of diabetes self-care . Interventions aim ed at alleviating depressive symptoms , which are quite common , could result in significant improvements in diabetes self-care
The most common concordant comorbidity was hypertension while depression was the most common discordant condition .
Adherence to medications was the most frequent diabetes self-care behavior reported and tended to be higher among concordant comorbidities .
The findings showed mixed results concerning the effect of some concordant comorbidities such as hypertension , hyperlipidemia , retinopathy , and heart failure on diabetes self-care behaviors .
But , there is agreement across studies that diabetes-discordant comorbidities have a more detrimental effect on self-care behaviors .
Conclusions : Concordant comorbidities may improve diabetes self-care , but the evidence is inconclusive .
Background : Most patients with Type 2 diabetes ( T2D ) have high number of comorbid chronic conditions that can affect their self-care abilities .
Guidelines for diabetes self-care behaviors are disease specific with little attention given to managing T2D with other comorbidities .
Identifying comorbidities that either improve or potentially diminish the individual 's capacity to perform effective self-care behaviors is essential to enhance clinical outcomes .
One such framework conceptualizes comorbidities as concordant or discordant with diabetes pathophysiological pathways and care goals .
Objective : The purpose of this systematic review was to examine the role of diabetes-concordant and discordant chronic conditions on the performance of self-care behaviors in adults with T2D .