Background: Data from the United Kingdom Prospective Diabetes Study showed that poorly controlled diabetes mellitus are significantly associated with increased risk of cardiovascular diseases (CVDs). Exploring self-management experience of patients with poorly controlled type 2 diabetes would be valuable for developing patient-centered care so as to achieve an optimal glycemic control and reduce the risk of developing CVDs.
Methods: A qualitative enquiry was undertaken. Participants with poorly controlled type 2 diabetes were purposively selected, with the aim of including patients having a variety of characteristics and experiences concerning diabetes self-management. Content analysis was conducted with data from one-time interviews and field notes. Trustworthiness was supported through triangulation of data sources, recruitment of extreme cases, and the use of an audit trail.
Findings: A total of 30 participants were interviewed (age: 55.57 ±10.09 years old, 67% of participants were male, HbA1c: 8.97± 2.18 %). The qualitative data revealed that patients with poorly controlled type 2 diabetes were more likely to violate healthy eating principle and skip glucose testing. They described the experiences of managing diabetes as emotionally, physically, and socially challenging. Their engagement towards diabetes self-management, although varied, could be categorized into: autonomous, routine, collaborated, delegated, and burdensome activities. Participants with poor self-management performance experienced multiple impediments, including poor health literacy, lack of intrinsic motivation and purposive reflection, and psychological distress. Poor performance can affect their sense of self-efficacy and attitude towards active participation, initiating a vicious circle.
Conclusions: These findings add depth and complexity to interpretations of self-management activities from the perspective of patients with poorly controlled type 2 diabetes. Patient-centered intervention are needed to assist and motive patients to become effective partners in diabetes care and thereby reduce the risk of developing CVDs.