The purpose of this study was to describe sociodemographic, clinical, and psychosocial correlates of diabetes self-care behaviors in adults with type 2 diabetes mellitus (T2D) and comorbid heart failure (HF).
Method
Baseline data of 180 participants from a clinical trial that tested a 6-month integrated self-care intervention for persons with comorbid HF and T2D were analyzed. Correlational bivariate and multiple logistic regression analyses were performed to examine correlates of diabetes self-care behaviors.
Result
Participants had a mean age of 58 ± 11years; the majority were male (n = 118, 66%) and African American (n = 119, 66%). Number of comorbidities >2 (P < .001), having more than a high school education (P < .05), and African American ethnicity (P < .05) predicted better exercise, self-monitoring blood glucose (SMBG), and foot care behaviors, respectively. The use of an aldosterone inhibitor (P < .05) predicted worse exercise performance, higher Charlson Comorbidity Index scores (P < .01) predicted worse SMBG, and treatment with diet plus medication (P < .05) and dyslipidemia (P < .001) predicted worse foot care.
Conclusion
Findings from this study provide new insights into the complex self-care requirements for T2D patients with comorbid HF. Integrated self-care interventions are clearly warranted in persons living with multiple chronic conditions for optimal health outcomes and the prevention of complications. Our sample of predominately African American men showed they had better T2D self-care behaviors than whites than previously reported. Additional research is needed to determine racial and gender differences on health outcomes in persons with T2D and comorbid HF.
Get full access to this article
View all access options for this article.
References
1.
NCD-RisC. Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants. Lancet. 2016;387(10027):1513-1530.
2.
ChoNHShawJEKarurangaSet al. IDF diabetes atlas: global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018;138:271-281.
3.
HolmanNYoungBGadsbyR. Current prevalence of type 1 and type 2 diabetes in adults and children in the UK. Diabetic Med. 2015;32(9):1119-1120.
4.
XuGLiuBSunYet al. Prevalence of diagnosed type 1 and type 2 diabetes among US adults in 2016 and 2017: population based study. BMJ. 2018;361:k1497.
5.
LehrkeMMarxN. Diabetes mellitus and heart failure. Am J Med. 2017;130(6S):S40-S50.
6.
EinarsonTRAcsALudwigCPantonUH. Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientifc evidence from across the world in 2007-2017. Cardiovasc Diabetol. 2018;17(1):83.
7.
RogerVL. Epidemiology of heart failure. Circ Res. 2013;113(6): 646-659.
8.
NicholsGAGullionCMKoroCEEphrossSABrownJB. The incidence of congestive heart failure in type 2 diabetes. Diabetes Care. 2004;27(8):1879-1884.
9.
BauduceauBFlachJ-PLHalimiSVernyCDoucetiJ. Cardiovascular complications over 5 years and their association with survival in the GERODIAB cohort of elderly french patients with type 2 diabetes. Diabetes Care. 2018;41(1):156-162.
10.
WangYNegishiTNegishiKMarwickTH. Prediction of heart failure in patients with type 2 diabetes mellitus—a systematic review and meta-analysis. Diabetes Res Clin Pract. 2015;108(1):55-66.
11.
ThomasMC. Type 2 diabetes and heart failure: challenges and solutions. Curr Cardiol Rev. 2016;12(3):249-255.
12.
BasiSFeslerPMimranALewisJB. Microalbuminuria in type 2 diabetes and hypertension: a marker, treatment target, or innocent bystander?Diabetes Care. 2008;31(Suppl.2):S194-S201.
13.
OktayAAAkturkHKEsenbogaKJavedFPolinNMJahangirE. Pathophysiology and prevention of heart disease in diabetes mellitus. Curr Probl Cardiol. 2018;43(3):68-110.
14.
PatersonBThorneS. Developmental evolution of expertise in diabetes self-management. Clin Nurs Res. 2000;9(1):402-419.
15.
American Diabetes Association. Glycemic targets: standards of medical care in diabetes—2018. Diabetes Care. 2018;41(suppl 1):S55-S64.
16.
ElgartJFGonzalezLPrestesMRucciEGagliardinoJJ. Frequency of self-monitoring blood glucose and attainment of HbA1c target values. Acta Diabetologica. 2016;53(1):57-62.
17.
GaoLJiLSuQet al. Impact of structured self-monitoring of blood glucose on the quality of life of insulin-treated Chinese patients with type 2 diabetes mellitus: results from the COMPASS study. Diabetes Res Clin Pract. 2016;112:88-93.
18.
JiLSuQFengBet al. Structured self-monitoring of blood glucose regimens improve glycemic control in poorly controlled Chinese patients on insulin therapy: results from COMPASS. J Diabetes. 2017;9(5):495-501.
19.
BlevinsT. Value and utility of self-monitoring of blood glucose in non–insulin-treated patients with type 2 diabetes mellitus. Postgrad Med. 2013;125(3):191-204.
20.
BrelandJYMcAndrewLBurnsELeventhalEALeventhalH. Using the common sense model of self-regulation to review the effects of self-monitoring of blood glucose on glycemic control for non–insulin-treated adults with type 2 diabetes. Diabetes Educ. 2013;39(4):541-558.
21.
YoungLABuseJBWeaverMAet al. Glucose self-monitoring in non–insulin-treated patients with type 2 diabetes in primary care settings: a randomized trial. JAMA Intern Med. 2017;177(7):920-929.
22.
OngWMChuaSSNgCJ. Barriers and facilitators to self-monitoring of blood glucose in people with type 2 diabetes using insulin: a qualitative study. Patient Prefer Adherence. 2014;8:237-246.
23.
ZhangPLuJJingYTangSZhuDBiY. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Ann Med. 2017;49(2):106-116.
24.
MoxeyPWGogalniceanuPHinchlifeRJet al. Lower extremity amputations—a review of global variability in incidence. Diabet Med. 2011;28(10):1144-1153.
25.
BoykoEJSeelingADAhroniJH. Limb- and person-level risk factors for lower-limb amputation in the prospective seattle diabetic foot study. Diabetes Care. 2018;41(4):891-898.
26.
American Diabetes Association. Microvascular complications and foot care: standards of medical care in diabetes—2018. Diabetes Care. 2018;41(suppl 1):S105-S118.
27.
BonnerTFosterMSpears-LanoixE. Type 2 diabetesrelated foot care knowledge and foot self-care practice interventions in the United States: a systematic review of the literature. Diabet Foot Ankle. 2016;7:29758.
28.
van NettenJJPricePELaveryLAet al. Prevention of foot ulcers in the at-risk patient with diabetes: a systematic review. Diabetes Metab Res Rev. 2016;32(suppl. 1):84-98.
29.
LiRYuanLGuoX-Het al. The current status of foot self-care knowledge, behaviours, and analysis of influencing factors in patients with type 2 diabetes mellitus in China. Intern J Nurs Sci. 2014;1(3):266-271.
30.
NatovichRHarman-BoehmIMargalitDCukierman-YaffeTKushnirT. Adherence to self-care among individuals with diabetes with and without diabetic foot complications: objective and self-report measures. Diabetes Manag. 2017;7(2):234-239.
31.
D’SouzaMSRuppertSDParahooKet al. Foot care behaviors among adults with type 2 diabetes. Prim Care Diabetes. 2016;10(6):442-451.
32.
WendlingSBeadleV. The relationship between self-efficacy and diabetic foot self-care. J Clin Transl Endocrinol. 2015;2(1):37-41.
33.
LumbA. Diabetes and exercise. Clin Med. 2014;14(6):673-676.
34.
ColbergSRSigalRJFernhallBet al. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care. 2010;33(12):e147-e167.
35.
American Diabetes Association. Lifestyle management: standards of medical care in diabetes—2018. Diabetes Care. 2018;41(suppl. 1):S38-S50.
36.
HansenDPeetersSZwaenepoelBet al. Exercise assessment and prescription in patients with type 2 diabetes in the private and home care setting: clinical recommendations from AXXON (Belgian Physical Therapy Association). Phys Ther. 2013;93(5): 597-610.
37.
RydenLGrantPJAnkerSDet al. ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the task force on diabetes, pre diabetes, and cardiovascular diseases of the European Society of Cardiolog (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J. 2013;34(39):3035-3087.
38.
UmpierreDRiberiroPABKramerCKet al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analy. JAMA. 2011;305(17):1790-1799.
39.
GraceAChanEGiallauriaFGrahamPLSmartNA. Clinical outcomes and glycaemic responses to different aerobic exercise training intensities in type II diabetes: a systematic review and meta-analysis. Cardiovasc Diabetol. 2017;16(1):37.
40.
LiubaoerjijinYTeradaTFletcherKBouleNG. Effect of aerobic exercise intensity on glycemic control in type 2 diabetes: a meta-analysis of head-to-head randomized trials. Acta Diabetol. 2016;53(5):769-781.
41.
MendesRSousaNReisVMThemudo-BarataJL. Implementing low-cost, community-based exercise programs for middle-aged and older patients with type 2 diabetes: what are the benefits for glycemic control and cardiovascular risk?Int J Environ Res Public Health. 2017;14(9):E1057.
42.
PanBGeLXunYQet al. Exercise training modalities in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis. Int J Behav Nutr Phys Act. 2018;15(1):72.
43.
SchwingshacklLMissbachBDiasSKonigJHoffmannG. Impact of different training modalities on glycaemic control and blood lipids in patients with type 2 diabetes: a systematic review and network meta-analysis. Diabetologia. 2014;57(9):1789-1797.
44.
HalaliFMadaviRJafarabadiMAMobasseriMNamaziN. A cross-sectional study of barriers to physical activity among overweight and obese patients with type 2 diabetes in Iran. Health Soc Care Community. 2016;24(5):e92-e100.
45.
DunbarSBClarkPCQuinnCGaryRAKaslowNJ. Family influences on heart failure self-care and outcomes. J Cardiovasc Nurs. 2008;23(3):258-265.
46.
DunbarSBButtsBReillyCMet al. A pilot test of an integrated self-care intervention for persons with heart failure and concomitant diabetes. Nurs Outlook. 2014;62(2):97-111.
47.
DunbarSBReillyCMGaryRAet al. Randomized clinical trial of an integrated self-care intervention for persons with heart failure and diabetes: quality of life and physical functioning outcomes. J Card Fail. 2015;21(9):719-729.
48.
GreenSB. How many subjects does it take to do a regression analysis. Multivar Behav Anal. 1991;26(3):499-510.
49.
CohenJ. Statistical Power Analysis for the Behavioral Sciences. 2nd ed.Mahwah, NJ: Lawrence Erlbaum Associates, Publishers; 1988.
50.
CharlsonMEPompeiPAlesKLMacKenzieR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-383.
51.
ToobertDJHampsonSEGlasgowRE. The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care. 2000;23(7):943-950.
52.
AljohaniKAKendallGESinderPD. Psychometric evaluation of the summary of diabetes self-care activities–Arabic (SDSCA-Arabic): translation and analysis process. J Transcult Nurs. 2016;27(1):65-72.
53.
WallstonKARothmanRLCherringtonA. Psychometric properties of the perceived diabetes self-management scale (PDSMS). J Behav Med. 2007;30(5):395-401.
54.
Al-AboudSAAhmadSBidinMBLIsmailNE. Validation of Malaysian versions of perceived diabetes self-management scale (PDSMS), medication understanding and use selfeffcacy scale (MUSE) and 8-Morisky medication adherence scale (MMAS-8) using partial credit Rasch model. J Clin Diagn Res. 2016;10(11): LC01-LC05.
55.
FitzgeraldJTFunellMMAndersonRMNwankwoRStansfieldRBPiattGA. Validation of the revised brief diabetes knowledge test (DKT2). Diabetes Educ. 2016;42(2):178-187.
56.
KroenkeKSpitzerRLWilliamsJBW. The PHQ-9 validity of brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613.
57.
YaungAFungFYuS-Cet al. Validation of the Patient Health Questionnaire-9 for depression screening among Chinese Americans. Compr Psychiatry. 2008;49(2):211-217.
58.
The ENRICHD Investigators. Enhancing recovery in coronary heart disease patients (ENRICHD): study design and methods. Am Heart J. 2000;139
(1 Pt 1):1-9.
59.
VaglioJConardMPostonWSet al. Testing the performance of the ENRICHD Social Support Instrument in cardiac patients. Health Qual Life Outcomes. 2004;2(1):24.
60.
TriefPMIzquierdoREimickeJPet al. Adherence to diabetes self care for white, African-American and Hispanic American telemedicine participants: 5 year results from the IDEATel project. Ethnic Health. 2013;18(1):83-96.
61.
TangTSBrownMBFunnellMMAndersonRM. Social support, quality of life, and self-care behaviors among african americans with type 2 diabetes. Diabetes Educ. 2008;34(2):266-276.
62.
MaddenMHTomsikPTerchekJet al. Keys to successful diabetes self-management for uninsured patients: social support,observational learning, and turning points: a safety net providers’ strategic alliance study. J Natl Med Assoc. 2011;103(3):257-264.
63.
TrentoMPasseraPTomalinoMet al. Group visits improve metabolic control in type 2 diabetes. Diabetes Care. 2001;24(6):995-1000.
64.
RaoufiAMTangXJingZZhangXXuQZhouC. Blood glucose monitoring and its determinants in diabetic patients: a cross-sectional study in Shandong, China. Diabetes Ther. 2018;9(5):2055-2066.
65.
Bos-TouwenISchuurmansMMonninkhofEMet al. Patient and disease characteristics associated with activation for selfmanagement in patients with diabetes, chronic obstructive pulmonary disease, chronic heart failure and chronic renal disease: a cross-sectional survey study. PLoS One. 2015;10(5):e0126400.
66.
MillerWRRollnickS. Motivational Interviewing: Helping People Change. 3rd ed.New York: The Guilford Press; 2013.
67.
SemenkovichKBrownMESvrakicDMLustmanPJ. Depression in type 2 diabetes mellitus: prevalence, impact, and treatment. Drugs. 2015;75(6):577-587.
68.
American Diabetes Association. Comprehensive medical evaluation and assessment of comorbidities: standards of medical care in diabetes—2018. Diabetes Care. 2018;41(suppl 1):S28-S37.
69.
MedagamaAGalgomuwaM. Comorbidities and ethnocultural factors limit the physical activity of rural Sri Lankan patients with diabetes mellitus. J Diabetes Res. 2018;2018:4319604.
70.
BeverilyEAWrayLAChiuCJWeingerK. Perceived challenges and priorities in co-morbidity management of older patients with Type 2 diabetes. Diabet Med. 2011;28(7):781-784.
71.
CarrollJKFlockeSASandersMRLowensteinLFiscellaKEpsteinRM. Effectiveness of a clinician intervention to improve physical activity discussions in underserved adults. Fam Pract. 2016;33(5):488-491.
72.
AlharbiMStraitonNGallagherR. Harnessing the potential of wearable activity trackers for heart failure self-care. Curr Heart Fail Rep. 2017;14(1):23-29.
73.
MiyauchiMToyodaMKaneyamaNet al. Exercise therapy for management of type 2 diabetes mellitus: superior efficacy of activity monitors over pedometers. J Diabetes Res. 2016; 5043964.
74.
ButlerJEzekowitzJACollinsSPet al. Update on aldosterone antagonists use in heart failure with reduced left ventricular ejection fraction. Heart Failure Society of America Guidelines Committee. J Card Fail. 2012;18(4):265-281.
75.
EdelmannFWatchterRSchmidtAet al. Effect of spironolactone on diastolic function and exercise capacity in patients with heart failure with preserved ejection fraction: the Aldo-DHF randomized controlled trial. JAMA. 2013;309(8):781-791.
76.
VardenyOCavallariLHClaggettBet al. Race influences the safety and efficacy of spironolactone in severe heart failure. Circ Heart Fail. 2013;6(5):970-976.
77.
TaylorALZiescheSYancyCWet al. Early and sustained benefit on event-free survival and heart failure hospitalization from fixed-dose combination of isosorbide dinitrate/hydralazine consistency across subgroups in the African-American Heart Failure Trial. Circulation. 2007;115(13):1747-1753.
78.
IngleLReddyPClarkAIClelandJGF. Diabetes lowers six-minute walk test performance in heart failure. J Am Coll Cardiol. 2006;47(9):1904-1917.
79.
ZubairMMalikAAhmadJ. Incidence, risk factors for amputation among patients with diabetic foot ulcer in a North Indian tertiary care hospital. Foot. 2012;22:24-30.
80.
YangT-LLinL-YHuangC-Cet al. Association of statin use and reduced risk of lower-extremity amputation among patients with diabetes: a nationwide population-based cohort observation. Diabetes Care. 2016;39(4):e54-e55.
