title: Impact of neuropathy on the adherence to diabetes-related self-care activities: a cross-sectional study.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the impact of the presence and severity of neuropathy and depression on the patient's adherence to diabetes-related self-care activities (DRSCA) in a cohort of patients with type 2 diabetes mellitus (T2DM).
  
  
  METHODS
  In this cross-sectional, noninterventional study, 198 patients with T2DM were enrolled according to a population-based, consecutive-case enrollment principle. In all patients, the adherence to DRSCA was evaluated using the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire; a higher SDSCA score is associated with a better adherence. The presence and severity of neuropathy was assessed using the Michigan Neuropathy Screening Instrument (MNSI) and the severity of depression using the Patient Health Questionnaire-9 (PHQ-9).
  
  
  RESULTS
  The presence of neuropathy was associated with a decreased SDSCA score (26 points vs 37 points; P<0.001), an increased severe depression prevalence (24.7% vs 4.3%; P<0.001), and an increased PHQ-9 score (12 points vs 7 points; P<0.001). The MNSI score was reverse correlated with SDSCA score (r=-0.527; P<0.001) and positively correlated with PHQ-9 score (r=0.495; P<0.001). The reverse correlation between MNSI score and SDSCA score was present for all the subcomponents of SDSCA questionnaire (diet, exercise, glycemic monitoring, and foot care).
  
  
  CONCLUSIONS
  The presence of neuropathy is associated with decreases in the quality of adherence to DRSCA in patients with T2DM and with increases in the symptomatology of depression. The significant, negative association between the severity of T2DM and the quality of disease self-management points to a possible loop-type relationship between these two components, being possible a reciprocal augmentation with negative consequences on the global management of the disease.
authors.affiliation: Department of Functional Sciences.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Timar
authors.affiliation: Second Department of Internal Medicine.
authors.forename: Romulus
authors.initials: R
authors.lastname: Timar
authors.affiliation: Second Department of Internal Medicine.
authors.forename: Adalbert
authors.initials: A
authors.lastname: Schiller
authors.affiliation: Department of Infectious Diseases.
authors.forename: Cristian
authors.initials: C
authors.lastname: Oancea
authors.affiliation: Department of Functional Sciences.
authors.forename: Deiana
authors.initials: D
authors.lastname: Roman
authors.affiliation: Second Department of Internal Medicine.
authors.forename: Mihaela
authors.initials: M
authors.lastname: Vlad
authors.affiliation: Department of Microscopic Morphology.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Balinisteanu
authors.affiliation: First Department of Surgery, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
authors.forename: Octavian
authors.initials: O
authors.lastname: Mazilu
keywords: depression; diabetes self-care; diabetic neuropathy; type 2 diabetes mellitus