Idiosyncratic Personal Explanations for Blood Glucose Events Are Associated With Poorer Self-Management and Glycemic Control in Adult Patients With Long-Standing Type 1 Diabetes

Abstract

OBJECTIVE -To examine whether spontaneous causal attributions for blood glucose events were associated with blood glucose control (HbA 1c [A1C]), self-management, and adjustment to diabetes. RESEARCH DESIGN AND METHODS-A total of 62 adults (31 female) with type 1 diabetes, recruited from a diabetes specialist clinic, with a mean age of 42.3 years and a mean illness duration of 19.6 years, were interviewed about the onset, history, course, and management of their diabetes. Spontaneous causal attributions for fluctuations in blood glucose level were extracted from the interviews and coded in accordance with the Leeds Attributional Coding System. Participants completed questionnaire measures of anxiety, depression, and appraisal of diabetes. Glycemic control (A1C) at the time of interview and 1 year later was extracted from notes.RESULTS -Participants who made proportionally more personal, or idiosyncratic, explanations for blood glucose fluctuations or events (such as hypoglycemic episodes) had higher A1C levels at time 1 and 1 year later and were judged to manage their diabetes less well. Furthermore, the association between personal attributions and A1C was partly accounted for by selfmanagement behavior. Participants who made personal and stable attributions appraised their diabetes more negatively.CONCLUSIONS -Clinicians should be sensitive to patients' causal explanations for blood glucose events. Helping patients consider alternative explanations may produce benefits in terms of better management and control of diabetes.

Prevalence and determinants of physical activity and fluid intake in kidney transplant recipients

“…The self‐regulation model posits that cognitive representations influence engagement in health‐related behaviors as individuals seek to limit the threat of graft failure, improve health, and cope with illness (31). Representations may include attributions of the cause of disease, perceived responsibility for care, and the value accorded to treatments for achieving a desired outcome (32).…”

Accountability for patient self-management of chronic conditions; ethical analysis and a proposal

“…It is important to note that the current assumption is that patient beliefs not blessed by scientific medicine must be modified; instead, there should be a forum where lay and medical knowledge are routinely assessed and critiqued. 22 Most critical to measure are elements necessary for competent practice of PSM, including knowledge, clinical judgement, self-efficacy, sometimes physical skills, persistence and attention to task, and their integration into daily management. Do these combinations of measures exist for major chronic diseases in areas in which PSM is appropriate?…”