Making sense of blood glucose data and self‐management in individuals with type 2 diabetes mellitus: A qualitative study

Abstract

Aims and objectives To describe individuals' with type 2 diabetes mellitus sense‐making of blood glucose data and other influences impacting self‐management behaviour. Background Type 2 diabetes mellitus prevalence is increasing globally. Adherence to effective diabetes self‐management regimens is an ongoing healthcare challenge. Examining individuals’ sense‐making processes can advance staff knowledge of and improve diabetes self‐management behaviour. Design A qualitative exploratory design examining how individuals make sense of blood glucose data and symptoms, and the influence on self‐management decisions. Methods Sixteen one‐on‐one interviews with adults diagnosed with type 2 diabetes mellitus using a semi‐structured interview guide were conducted from March–May 2018. An inductive–deductive thematic analysis of data using the Sensemaking Framework for Chronic Disease Self‐Management was used. The consolidated criteria for reporting qualitative research (COREQ) checklist were used in completing this paper. Results Three main themes described participants’ type 2 diabetes mellitus sense‐making and influences on self‐management decisions: classifying blood glucose data, building mental models and making self‐management decisions. Participants classified glucose levels based on prior personal experiences. Participants learned about diabetes from classes, personal experience, health information technology and their social network. Seven participants expressed a need for periodic refreshing of diabetes knowledge. Conclusion Individuals use self‐monitored glucose values and/or HbA1C values to evaluate glucose control. When using glucose values, they analyse the context in which the value was obtained through the lens of personal parameters and expectations. Understanding how individuals make sense of glycaemic data and influences on diabetes self‐management behaviour with periodic reassessment of this understanding can guide the healthcare team in optimising collaborative individualised care plans. Relevance to clinical practice Nurses must assess sense‐making processes in self‐management decisions. Periodic “refresher” diabetes education may be needed for individuals with type 2 diabetes mellitus.

Identifying Factors Which Enhance the Self-Management of Type 2 Diabetes: A Systematic Review with Thematic Analysis

“…To the best of our knowledge, this is the first systematic review to consider this topic, however, our findings draw heavily from a rich field of qualitative considerations of diabetes self-management (Adu et al, 2019;Alzubaidi et al, 2017;Aweko et al, 2018;Christensen et al, 2020;Despins & Wakefield, 2020;Elliott et al, 2013). Recent complementary publications support our findings and include a narrative review of meta-analyses on trends in diabetes self-management conducted by Hermanns et al (2020).…”

“…Conversely, medical information provided and communicated to patients involving the use of medical jargon, and medical terms without comprehensive explanations, caused patients to perceive less and understand little, creating confusion due to inconsistent information (Kindarara et al, 2017;Macido, 2019;Siminerio et al, 2013). As a result, patients followed "their own way" of managing their diabetes with limited engagement and communication with health professionals (Bezo et al, 2020;Despins & Wakefield, 2020;Jiang et al, 2019;Maneze et al, 2019;Ross et al, 2019;Siminerio et al, 2013;Weller et al, 2017). Financial constraints were also identified as a theme, with adults managing diabetes with limited financial resources described this experience as a game of balance and negotiation, whereby purchasing healthy foods and quality medications would be abandoned due to more pressing concerns and other priorities in their life (Masupe et al, 2018).…”

“…Three sub-themes emerged: access to health clinical settings, the need for adequate Health professionals and resources, and inadequate guidelines for diabetes management. There were a wide range of difficulties in accessing diabetes services including more current recommendations (Bech et al, 2019;Christensen et al, 2020;Fritz, 2017;Graves et al, 2019;Rendle et al, 2013), health education (Gunggu et al, 2016;Wu et al, 2019) and technologies (Alzubaidi et al, 2017;Despins & Wakefield, 2020) particularly in rural (Graves et al, 2019) or resource-constrained health care settings (Adu et al, 2019). It was also found that patients experienced dissatisfaction due to lengthy waiting times and the time wasted while at facilities (Aweko et al, 2018;Christensen et al, 2020;De Man et al, 2019;Elliott et al, 2013).…”

Patient Perspectives on Self-Monitoring of Blood Glucose When not Using Insulin: a Cross-sectional Survey

“…12 In a qualitative study, patients stated that use of SMBG helps manage their diabetes by enabling them to build mental models and make self-management decisions. 14 However, randomized trials of SMBG do not support that it improves patient satisfaction, quality of life, or well-being. 7,15 Use of SMBG has also been associated with increased levels of stress, worry, and depression.…”

Lived experience of having type 2 diabetes: A phenomenological research in three villages in rural Northern Saudi Arabia

“…It is also a long-term chronic disease. [ 1 ] Saudi Arabia as a developing country is not the only one that is suffering from this disease. [ 2 ] The reasons may be attributed to the increase of cardiovascular risk factors in the urban areas, because of a decrease in exercise or any activities that target the body fat.…”