Diabetes self-care activities in a public health population

Background: Adequate diabetes management can reduce morbidity and mortality because proper blood glucose control forestalls the development of diabetic complications. Self-care activities are an important aspect of diabetes management because proper glucose control largely depends upon lifestyle modifications and adherence to medications. Objective: To explore the extent of diabetes self-care activities performed by an adult population treated for diabetes at a public health clinic. Methods: Telephone interviews were conducted with 23% (n=48) of all diabetics treated at an urban public health clinic in 2005. The 48 respondents were predominately African-American (85%), female (88%), obese (68%) with type II diabetes (89%); the average age was 58 and 42% had no form of health insurance. The questionnaire is based on the Summary of Diabetes Self-Care Activities (SDSCA) which assesses self-care activities in the past week. Questions were added about health status, insurance, barriers to self-care, and co-morbidities. Results: Most respondents have multiple diabetic complications. Adherence to medication was much higher than adherence to lifestyle modifications. Almost all the insulin users (100%) and oral medication users (92%) took the medication as prescribed. Adherence rates were lower for diet (43%), exercise (46%), testing blood sugar (40%) and footcare (50%). Barriers to adherence named include cost (of food and testing supplies), lack of motivation and other medical conditions that may interfere with exercise. Conclusions: Interventions are needed to educate diabetics about self-care and motivate the initiation and maintenance of self-care. Policy changes to allow the provision of testing supplies to clinic patients are also needed.