Frequency of Key Type 1 Diabetes Self-Care Behaviours Are Associated With Psychological Flexibility, Distress and Glycaemic Outcome.

introductionLiving with Type 1 diabetes (T1D) requires multiple daily self-care behaviours. Identifying important self-care behaviours associated with health and wellbeing has the potential to support a goal-focussed and person-centred consultation. We describe diabetes self-care behaviours and their associations with clinical outcomes including glycated haemoglobin (HbA1C) and diabetes distress, and characterise key behavioural measures associated with poorer outcomes that could be targeted via behavioural intervention.

methodsCross-sectional study involving 105 adults with T1D attending a tertiary diabetes outpatient clinic. Self-report questionnaires administered during routine appointments assessed diabetes self-care behaviours, measures of distress and psychological flexibility. Associations between behaviours, HbA1C and distress were examined. Cluster analysis identified subgroups of participants with similar profiles, providing insights into frequency of self-care behaviours, HbA1C and distress.

resultsHalf the participants reported lower frequencies of some key behaviours than generally considered necessary to manage day-to-day glucose variations. HbA1C less than 64 mmol/mol (< 8%) was associated with higher frequency of glucose checks, frequency of insulin administration, less prandial insulin omission, and days having hypoglycaemia treatment food available. Clinically significant distress was associated with less frequent insulin administration and less frequent glucose checks before administering insulin. Higher perceived attainment of diabetes self-care goals and psychological flexibility were associated with lower HbA1C and distress.

conclusionsA point of care self-reported questionnaire can identify the frequency of clinically meaningful self-care behaviours, particularly those most strongly associated with glycaemia and/or distress. This could inform targeted strategies to enhance health outcomes. A prospective study is necessary to test whether routine collection of behavioural information would enhance personalised approaches to diabetes care.