Chronic Disease

Cost and depression serve as barriers to performing self-care behaviors for people with diabetes

People living with diabetes juggle four self-care tasks to control their disease: taking medicine, testing their blood-glucose level, following a healthy diet, and exercising regularly. Yet significant barriers prevent individuals from performing these self-care tasks, reveals a new study. Arthur J. Hartz, M.D., Ph.D., of the University of Utah, and colleagues at the University of Iowa surveyed 253 people in the Midwest who had diabetes for an average of 10 years.

Compared with those who were married, individuals who were unmarried and young had higher HbA1c test results, indicating higher blood-sugar levels. Those who reported high satisfaction with taking their medications and following meal plans had lower HbA1c test results. This test gives a picture of the average blood-glucose control for the past 2 to 3 months and lets patients know how well their diabetes treatment plan is working.

Individuals with diabetes encountered the most difficulty with following a meal plan and monitoring their blood-glucose levels. High costs and depression were the main barriers affecting compliance with these self-care tasks, and these barriers resulted in higher HbA1c levels. Although cost is not a factor a medical team can control, the authors note that treating depression may improve patients' health and self care. They further suggest that providers offer plans that patients find realistic and understandable, because good physician communication was also found to be associated with lower HbA1c levels. This study was funded in part by the Agency for Healthcare Research and Quality (HS14410).

See "An assessment of attitudes, behaviors, and outcomes of patients with type 2 diabetes," by Jeanette M. Daly, R.N., Ph.D., Dr. Hartz, Yinghui Xu, M.S., and others in the May-June 2009 Journal of the American Board of Family Medicine, 22(3), pp. 280-290.

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