title: Poorer glycaemic control in type 1 diabetes is associated with reduced self-management and poorer perceived health: a cross-sectional study.
abstract: OBJECTIVE
  Many people with type 1 diabetes do not achieve optimal treatment targets despite high patient and professional input. To investigate the reasons underlying suboptimal control we have studied clinical characteristics and self-management behaviours in adults with type 1 diabetes attending a large treatment centre.
  
  
  METHODS
  A questionnaire-based enquiry into self-care behaviours of 380 patients with type 1 diabetes (mean age: 48 (±15) years and mean duration of diabetes: 26 (±15) years), linked with validated measures of impact of treatment on perceived health and hypoglycaemia recognition (Insulin Treatment Satisfaction Questionnaire; and EuroQoL EQ-5D, Gold score) and retrospective case note review of biomedical parameters. The data were analysed using chi-square test, ANOVA, ANCOVA and post-hoc procedures (Tukey's-b) in SPSS-version 18. The minimum significance level was accepted as 0.05.
  
  
  RESULTS
  Sixty three percent of participants used multiple daily injections; 36% continuous subcutaneous insulin infusion. Mean HbA1c was 7.7% (±1.2) [61±-10mmol/mol]; 30% had impaired hypoglycaemia awareness (IHA). Factors significantly related to poor glycaemic control with IHA were longer duration of diabetes (p=0.01); less frequent glucose self-monitoring (p=0.05); and low level of patient-set glucose targets (p<0.001). Patients with IHA and poorer control had significantly lower insulin treatment satisfaction (p<0.001); and perceived health (p<0.001).
  
  
  CONCLUSIONS
  Suboptimal biomedical outcomes in adults with type 1 diabetes attending a specialist intensified insulin therapy clinic are associated with longer duration of diabetes, fewer self-management behaviours and a trend towards poorer perceived health. These data suggest a need for greater emphasis on integration of psychological and self-management support with intensive medical management of type 1 diabetes.
authors.affiliation: King's College London Florence Nightingale School of Nursing and Midwifery and King's College Hospital Koç University, School of Nursing, Istanbul, Turkey. Electronic address: sozcan@ku.edu.tr.
authors.forename: Seyda
authors.initials: S
authors.lastname: Ozcan
authors.affiliation: Department of Diabetes, King's College Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Amiel
authors.affiliation: Department of Diabetes, King's College Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Rogers
authors.affiliation: Department of Diabetes, King's College Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Pratik
authors.initials: P
authors.lastname: Choudhary
authors.affiliation: Department of Diabetes, King's College Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Alison
authors.initials: A
authors.lastname: Cox
authors.affiliation: Diabetes and Cardiac Rehabilitation, King's College Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Nicole
authors.initials: N
authors.lastname: de Zoysa
authors.affiliation: Division of Ambulatory Care & Local Networks, King's College Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Hopkins
authors.affiliation: Department of Primary and Intermediate Care, Florence Nightingale School of Nursing and Midwifery, King's College London, London, United Kingdom.
authors.forename: Angus
authors.initials: A
authors.lastname: Forbes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control / Q000523:psychology*; D007003:Hypoglycemia / Q000517:prevention & control / Q000523:psychology*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010465:Perception; D012189:Retrospective Studies; D012648:Self Care; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Hypoglycaemia awareness; Hypoglycaemia unawareness; Impaired hypoglycaemia awareness; Intensive insulin therapy; Service development; Type 1 diabetes