Research Article: Enablers and barriers to effective diabetes self-management: A multi-national investigation

Date Published: June 5, 2019

Publisher: Public Library of Science

Author(s): Mary D. Adu, Usman H. Malabu, Aduli E. O. Malau-Aduli, Bunmi S. Malau-Aduli, Simone Rodda.


The study aimed to identify the common gaps in skills and self-efficacy for diabetes self-management and explore other factors which serve as enablers of, and barriers to, achieving optimal diabetes self-management. The information gathered could provide health professionals with valuable insights to achieving better health outcomes with self-management education and support for diabetes patients.

International online survey and telephone interviews were conducted on adults who have type 1 or type 2 diabetes. The survey inquired about their skills and self-efficacy in diabetes self-management, while the interviews assessed other enablers of, and barriers to, diabetes self-management. Surveys were analysed using descriptive and inferential statistics. Interviews were analysed using inductive thematic analysis.

Survey participants (N = 217) had type 1 diabetes (38.2%) or type 2 diabetes (61.8%), with a mean age of 44.56 SD 11.51 and were from 4 continents (Europe, Australia, Asia, America). Identified gaps in diabetes self-management skills included the ability to: recognize and manage the impact of stress on diabetes, exercise planning to avoid hypoglycemia and interpreting blood glucose pattern levels. Self-efficacy for healthy coping with stress and adjusting medications or food intake to reach ideal blood glucose levels were minimal. Sixteen participants were interviewed. Common enablers of diabetes self-management included: (i) the will to prevent the development of diabetes complications and (ii) the use of technological devices. Issues regarding: (i) frustration due to dynamic and chronic nature of diabetes (ii) financial constraints (iii) unrealistic expectations and (iv) work and environment-related factors limited patients’ effective self-management of diabetes.

Educational reinforcement using technological devices such as mobile application has been highlighted as an enabler of diabetes self-management and it could be employed as an intervention to alleviate identified gaps in diabetes self-management. Furthermore, improved approaches that address financial burden, work and environment-related factors as well as diabetes distress are essential for enhancing diabetes self-management.

Partial Text

Diabetes mellitus is a major public health problem with rapidly increasing prevalence. In 2017, the global prevalence of diabetes among people aged 20–79 years was 425 million, mainly comprising type 1 or type 2 [1]. Diabetes is one of the top 10 global causes of mortality. In 2015, it was responsible for 1.6 million deaths, indicating a 60% increase in 15 years from less than 1 million in 2000 [2]. International audits have found that regimen adherence is less than optimal in both types 1 and 2 diabetes patients [3]. As a consequence, the majority of these patients are at risk of serious health complications that endanger life [1, 4] and impose great economic burden on affected individuals and the health care system [1].

To the best of our knowledge, this is the first mixed methods study that has investigated enablers and barriers to general self-management among a multinational audience of people who have type 1 or type 2 diabetes. Most importantly, our findings emphasise the consequential impact of currency of exposure to DSME (within the previous 12 months), duration of diagnosis, level of educational qualification and use of technological devices on self-management skills and self-efficacy, regardless of geographical location or ethnicity. This implies that provision of ongoing self-management education/support through the use of mobile phones may help address the various difficulties (including time/financial constraint, diabetes distress, and limited access to care providers) encountered by patients and foster adherence to recommended self-management activities, which are necessary to prevent the risk of developing diabetes complications. Furthermore, this study presents an in-depth understanding of the experiences of diabetic patients and provides useful insights to health professionals and researchers on how to improve the frequency and quality of self-management support provided to diabetic patients to achieve better health outcomes.




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