Successful self-management among non-insulin-treated adults with Type 2 diabetes: a self-regulation perspective

• Published in: Diabetic medicine 2015-11, Vol.32 (11), p.1504-1512
• Main Authors: Tanenbaum, M. L., Leventhal, H., Breland, J. Y., Yu, J., Walker, E. A., Gonzalez, J. S.
• Format: Article
• Language: English
• Subjects: Blood Glucose - analysis; Blood Glucose Self-Monitoring; Combined Modality Therapy; Diabetes; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - diet therapy; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - therapy; Diet, Diabetic; Exercise; Female; Glycated Hemoglobin A - analysis; Health Knowledge, Attitudes, Practice; Humans; Hyperglycemia - prevention & control; Hypoglycemic Agents - therapeutic use; Life Style; Male; Middle Aged; New Jersey; New York City; Patient Compliance; Patient Education as Topic; Retrospective Studies; Self Care; Sense of Coherence
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.12745

Aims To clarify the role of self‐monitoring of blood glucose (SMBG) in the self‐management of Type 2 diabetes from the patient's perspective, using in‐depth interviews with non‐insulin‐treated adults to investigate how they learned to manage their diabetes effectively and whether SMBG played a significant role in this process. Methods Individual interviews were conducted with 14 non‐insulin‐treated adults with Type 2 diabetes who had significantly improved their glycaemic control [64% women; 50% black; 21% Hispanic; mean age 60 years; mean HbA1c concentration 43 mmol/mol (6.1%)]. Interviews were transcribed and analysed by a coding team, applying the concept of illness coherence from the Common Sense Model of Self‐Regulation. Results The majority of participants relied on SMBG to evaluate their self‐management efforts. Key themes included: adopting an experimental approach; experiencing ‘a‐ha’ moments; provider‐assisted problem‐solving; using SMBG and other feedback to evaluate when their efforts were working; and normalizing diabetes‐specific behaviour changes as being healthy for everyone. Conclusions Our qualitative data are consistent with the argument that SMBG, if implemented appropriately with enough education and provider access, can be a powerful tool for non‐insulin‐treated adults with Type 2 diabetes to monitor their self‐management. Establishing sufficient conditions for illness coherence to develop while individuals are learning to use SMBG could increase their sense of personal control in managing a complex and demanding illness. What's new? This study explored the role of self‐monitoring of blood glucose (SMBG), among other relevant diabetes feedback sources, from a patient perspective, given the lack of consensus on the benefit of SMBG for non‐insulin‐treated adults with Type 2 diabetes mellitus. We interviewed patients who had successfully improved their glycaemic control through a combination of self‐management and oral diabetes medication. SMBG facilitated ‘a‐ha’ moments at critical points when participants were initiating behaviour change and learning to manage their illness. ‘A‐ha’ moments were motivational turning points for these successful participants.