The associations of illness perception with metabolic control (HbA1c) among type 2 diabetes mellitus patients in a district hospital

Illness perception, medication adherence and glycemic control among primary health-care patients with type 2 diabetes mellitus at Port Said City, Egypt

Aims

Despite the availability of a wide selection of antidiabetic treatments, many patients with type 2 diabetes mellitus (T2DM) still do not have controlled glucose levels. This study aimed to assess illness perception, medication adherence, and glycemic control among primary care attendees with T2DM.

Methods

A cross-sectional study was conducted between July 2019 and November 2020. A random sample of 265 Egyptian T2DM patients were enrolled from primary health-care settings in Port Said, Egypt. Data on socio-demographic characteristics, lifestyle habits, and diabetic medical history were collected using a semi-structured questionnaire. The Brief Illness Perception Questionnaire (B-IPQ) was used to assess diabetes perception, whereas the 8-item Morisky Medication Adherence Scale (MMAS-8) was used to investigate medication adherence.

Results

There was a significant difference in B-IPQ scores between different groups of the patients in terms of diabetic medications, complications, and glycemic control (p < 0.05). There was a significant difference in MMAS-8 score found between different groups of the patients in terms of disease duration, family history of T2DM, and glycemic control (p < 0.05). Further, there was a significant difference in HbA1c score found between different groups of patients in terms of disease duration, medications, complications, and family history of T2DM (p < 0.05). Higher BMI, a positive family history of T2DM, patients who take insulin, high illness perception, and poor medication adherence were the factors associated with higher HbA1c level.

Conclusion

Higher HbA1c levels were linked to a higher BMI, a positive family history of T2DM, insulin users, high illness perception, and poor medication adherence.

A systematic review of illness perception interventions in type 2 diabetes: Effects on glycaemic control and illness perceptions

AIMS

This systematic review sought to synthesize the evidence regarding the effectiveness of illness perception interventions compared with control conditions at changing illness perceptions and improving glycaemic control in individuals with type 2 diabetes.

METHODS

Seven electronic databases were searched between October 2018 and May 2020. Randomized controlled trials that tested interventions informed by the Common-Sense Model in adults with type 2 diabetes, and measured illness perceptions and glycaemic control at pre- and post-intervention were included. The Cochrane risk of bias tool was used to assess risk of bias.

RESULTS

A total of 4095 articles were identified, of which nine randomized control trials (2561 participants) across 12 publications were included in this review. Findings showed that all the illness perception domains were modified in at least one trial, with the exception of cyclical timeline perceptions. Coherence, personal control, treatment control and chronic timeline perceptions were the most frequently modified perceptions. Glycaemic control demonstrated an improvement in the intervention group compared to the control group at 3 and 6 months post-intervention in two trials. Risk of bias assessment showed high risk of bias especially for the blinding of participants and the personnel domain.

CONCLUSIONS

There is limited evidence that interventions informed by the Common-Sense Model can improve glycaemic control in individuals with type 2 diabetes through changing inaccurate illness perceptions. Recommendations for future research are to tailor intervention content based on baseline perceptions, measure the emotional and causal domains, and involve family members in the intervention. (PROSPERO registration: CRD42019114532).

Association between Diabetes Knowledge and Self-Efficacy in Patients with Type 2 Diabetes Mellitus in China: A Cross-Sectional Study

OBJECTIVE

This study aimed to explore the association between DM knowledge and self-efficacy in Chinese patients with T2DM. The influence factors for DM knowledge were explored, and evidence on interventions was provided to patients for information.

DESIGN

A cross-sectional survey was conducted in various hospitals in Hunan Province, China, from April 2017 to February 2019, by using multistage stratified randomized sampling. DM knowledge and self-efficacy were measured using the Audit of Diabetes Knowledge (ADKnowl) and the General Self-efficacy (GSE) Scale. The relationship between the ADKnowl and the GSE scores was analyzed using the Spearman correlation analysis. Differences in the ADKnowl and GES scores among groups with different sociodemographic characteristics were computed; significant variables and GES scores were input in the multiple stepwise linear regression model to predict the influencing factors of ADKnowl scores.

RESULTS

A total of 1,512 eligible patients with T2DM were included in this study, and their mean ADKnowl score was 59.04 ± 16.24. The top score of the eight dimensions in the ADKnowl scale was reducing the complication risk by 71.01%. The mean GSE score was 2.42 ± 0.59. The Spearman correlation analysis showed that the GSE score displayed a significantly positive correlation with DM knowledge at the ADKnowl scale (r = 0.172, P < 0.001). The best fit multivariable linear regression analysis revealed eight variables that explained 37.6% of the variance of ADKnowl scores. They were diabetes-learning experience, educational background, complication, therapy, waist-to-hip ratio, diabetes duration, marital status, and GSE (R ² = 0.376, F = 5.971, P=0.015).

CONCLUSIONS

In Chinese patients with T2DM, the self-efficacy in managing DM positively influenced DM knowledge. DM knowledge, as a protective factor, conversely improved the efficiency of self-management for T2DM. Some ignored influence factors in previous studies can be showed by investigating and analyzing from two scales. Health educators and promoters should help in developing DM knowledge and self-efficacy.

The relationship between patients' perception of type 2 diabetes and medication adherence: a cross-sectional study in Japan

BACKGROUND

The self-management of type 2 diabetes mellitus (T2DM), which involves adherence to medical instructions on diet and nutritional advice, physical activity, medication regimen, and weight and stress management, is necessary for the treatment of T2DM.In this study, we investigated the relationship between patients' perceptions of their disease and their adherence to their medications. And we attempted to determine whether distinct subphenotypes of behavioral change of medication adherence can be discerned based on a patients' perceptions.

METHOD

A cross-sectional study using a questionnaire was conducted among 157 patients with T2DM from October 2015 to September 2017. Questionnaires were administered to assess the participants' demographic and clinical characteristics, medication adherence, diabetes knowledge, and perception of being diabetic. Principal component analysis (PCA) and cluster analyses were performed to classify medication adherence patterns in the total cohort. Multiple regression analyses were performed to identify the determinant factors of medication adherence.

RESULTS

PCA showed the interpretable medication adherence of patients with diabetes by using component 1 ("accessibility to medical treatment") and component 2 ("status of taking medicines"). We identified four groups that show significantly different medication adherence by using cluster analysis on the basis of the two components. Multiple regression analysis showed that body mass index (BMI), family history of diabetes, one factor of patient's perception (living an orderly life), and diabetes knowledge were found to be significant predictors of medication adherence in patients with T2DM.

CONCLUSIONS

In patients with T2DM, the patient's diabetes perception of "living an orderly life" is associated with medication adherence. A poor adherence group may be able to change their adherence to diabetes treatment by developing the perception of "living an orderly life."

Illness perception of patients with pemphigus vulgaris

Objective

Little is known about illness perception in patients with pemphigus vulgaris (PV). We designed a cross-sectional study to clarify the beliefs about PV.

Methods

A total of 100 patients with PV (45 men, 55 women) completed the Illness Perception Questionnaire-Revised to assess beliefs about seven aspects of illness perception, including chronicity, recurrence, consequences, self and medicine role in controlling illness, coherence, and emotional representation. The relationship between illness perception and clinical and demographic variables was evaluated.

Results

Patients viewed PV as a chronic and cyclical disease with important impression on their life and emotions. Patients had a good understanding of the disease and supposed an acceptable role for themselves and medical treatment. Interestingly, the clinical subtype and severity of the disease did not influence any aspect of illness perception, but some differences on the basis of demographic data were demonstrated.

Conclusion

Our patients had a relatively good understanding of their illness and a correct perception about chronicity and the cyclical identity of illness. The patients believed that their life and emotions had been strongly influenced by the disease but were hopeful for a cure. Because correction of misconceptions about a disease may improve treatment outcomes, an assessment of patients' illness perception may be useful to try and modify perception.