title: Glycaemic control and self-management behaviours in Type 2 diabetes: results from a 1-year longitudinal cohort study.
abstract: OBJECTIVE
  To better understand the associations between changes in self-management behaviours and glycaemic control.
  
  
  METHODS
  We conducted a prospective observational study of 295 adult patients with Type 2 diabetes evaluated at baseline, 6 and 12 months. Four self-management behaviours were evaluated using the Summary of Diabetes Self-Care Activities instrument, which assesses healthy diet, physical activity, medication taking and self-monitoring of blood glucose. Using hierarchical linear regression models, we tested whether changes in self-management behaviours were associated with short-term (6-month) or long-term (12-month) changes in glycaemic control, after controlling for demographic and clinical characteristics.
  
  
  RESULTS
  Improved diet was associated with a decrease in HbA1c level, both at 6 and 12 months. Improved medication taking was associated with short-term improvement in glycaemic control, while increased self-monitoring of blood glucose frequency was associated with a 12-month improvement in HbA1c . Completely stopping exercise after being physically active at baseline was associated with a rise in HbA1c level at 6-month follow-up. Interaction analysis indicated that a healthy diet benefitted all participant subgroups, but that medication taking was associated with glycaemic control only for participants living in poverty and more strongly for those with lower educational levels. Finally, a higher self-monitoring of blood glucose frequency was associated with better glycaemic control only in insulin-treated participants.
  
  
  CONCLUSIONS
  Even after adjusting for potential confounders (including baseline HbA1c ), increased frequency of healthy diet, medication taking and self-monitoring of blood glucose were associated with improved HbA1c levels. These self-management behaviours should be regularly monitored to identify patients at risk of deterioration in glycaemic control. Barriers to optimum self-management should be removed, particularly among socio-economically disadvantaged populations.
authors.affiliation: Department of Psychology, Université du Québec à Montréal, Montréal, Quebec, Canada.|Centre de recherche du Centre hospitalier universitaire de l'Université de Montréal, Montréal, Quebec, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Houle
authors.affiliation: Centre de recherche du Centre hospitalier universitaire de l'Université de Montréal, Montréal, Quebec, Canada.|Department of Family and Emergency Medicine, Université de Montréal, Montréal, Quebec, Canada.
authors.forename: M-D
authors.initials: MD
authors.lastname: Beaulieu
authors.affiliation: Centre de recherche du Centre hospitalier universitaire de l'Université de Montréal, Montréal, Quebec, Canada.|Department of Medicine, Université de Montréal, Montréal, Quebec, Canada.
authors.forename: J-L
authors.initials: JL
authors.lastname: Chiasson
authors.affiliation: Centre de recherche du Centre hospitalier universitaire de l'Université de Montréal, Montréal, Quebec, Canada.|Department of Psychiatry, Université de Montréal, Montréal, Quebec, Canada.
authors.forename: F
authors.initials: F
authors.lastname: Lespérance
authors.affiliation: Centre de recherche du Centre hospitalier universitaire de l'Université de Montréal, Montréal, Quebec, Canada.|Faculty of Nursing, Université de Montréal, Montréal, Quebec, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Côté
authors.affiliation: Centre de recherche du Centre hospitalier universitaire de l'Université de Montréal, Montréal, Quebec, Canada.|Department of Nutrition, Université de Montréal, Montréal, Quebec, Canada.
authors.forename: I
authors.initials: I
authors.lastname: Strychar
authors.affiliation: PERFORM Centre, Concordia University, Montréal, Quebec, Canada.|Institut de Gériatrie de Montréal, Montréal, Quebec, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Bherer
authors.affiliation: Department of Psychology, Université du Québec à Montréal, Montréal, Quebec, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Meunier
authors.affiliation: Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, Quebec, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Lambert
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D004032:Diet; D005081:Exercise Therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011446:Prospective Studies; D040242:Risk Reduction Behavior; D012648:Self Care / Q000379:methods*; D012959:Socioeconomic Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin