Self-Care Practices Among Adult Type 2 Diabetes Patients With and Without Peripheral Neuropathy: A Cross-Sectional Study at Tertiary Healthcare Settings in Ethiopia

Abstract

Background

Type 2 diabetes mellitus (T2D) has become a global health challenge. Diabetic peripheral neuropathy (DPN) is one of the common comorbidities of T2D that may affect the ability to perform diabetes self-care.

Purpose

To compare self-care practices between adult T2D patients with and without comorbid DPN and identify factors predicting self-care practices.

Methods

In this cross-sectional study, conducted at tertiary hospitals in Ethiopia, a total of 216 (108 with DNP and 108 without DNP) participants completed an interviewer-administered questionnaire including measures of diabetes self-care practices, self-evaluated peripheral neuropathy, self-efficacy, diabetes knowledge, and social support.

Results

Adult T2D patients with comorbid DPN had lower dietary (P< 0.001), exercise (P< 0.001), blood glucose testing (P = 0.001), and foot (P = 0.007) self-care practice than those without DPN. Social support is a significant predictor of dietary self-care in both groups while predicting foot self-care and blood glucose testing in those with comorbid DPN. Moreover, occupation, education, and having a glucometer are significant predictors of diabetes self-care practice in both groups.

Conclusion

This study found that adult T2D patients with comorbid DPN have poorer diabetes self-care practice than those without comorbid DPN. Interventions should focus on addressing social support and access to a glucometer in order to improve diabetes self-care practices in adult T2D patients with comorbid DPN.

Keywords

Diabetes self-care type 2 diabetes peripheral neuropathy comorbidity nursing

Get full access to this article

View all access options for this article.

References

AADE. (2008). AADE7 self-care behaviors. The Diabetes Educator, 34(3), 445–449.

Abdissa

Hamba

Kene

Bedane

D. A.

Etana

Muleta

Gerbi

(2020). Prevalence and determinants of peripheral neuropathy among type 2 adult diabetes patients attending Jimma University Medical Center, Southwest Ethiopia, 2019, an institutional-based cross-sectional study. Journal of Diabetes Research. Advance online publication. https://doi.org/10.1155/2020/9562920

Abebe

S. M.

Yemane

Worku

Assefa

(2014). Diabetes mellitus in North West Ethiopia: A community based study. BMC Public Health, 14(97). http://www.biomedcentral.com/1471-2458/1414/1497

ADA. (2021a). Glycemic targets: Standards of medical care in diabetes – 2021. Diabetes Care, 44(Suppl. 1), S73–S84. https://doi.org/10.2337/dc21-S006

ADA. (2021b). Improving care and promoting health in populations: Standards of medical care in diabetes d – 2021. Diabetes Care, 44(Suppl. 1), S7–S14. https://doi.org/10.2337/dc21-s001

Aguado

Moratalla-Navarro

Lopez-Simarro

Moreno

(2020). Morbinet: Multimorbidity networks in adult general population. Analysis of type 2 diabetes mellitus comorbidity. Scientific Reports, 10(2416). https://doi.org/10.1038/s41598-41020-59336-41591

AHEAD. (2017). Effects of a long-term lifestyle modification programme on peripheral neuropathy in overweight or obese adults with type 2 diabetes: The look AHEAD study. Diabetologia, 60, 980–988. https://doi.org/10.1007/s00125-017-4253-z

Ahrary

Khosravan

Alami

Nesheli

M. N.

(2020). The effects of a supportive educational intervention on women with type 2 diabetes and diabetic peripheral neuropathy: A randomized controlled trial. Clinical Rehabilitation, 34(6), 794–802. https://doi.org/10.1177/0269215520914

Amour

A. A.

Chamba

Kayandabila

Lyaruu

I. A.

Marieke

Shao

E. R.

Howlett

(2019). Prevalence, patterns, and factors associated with peripheral neuropathies among diabetic patients at tertiary hospital in the Kilimanjaro region: Descriptive cross-sectional study from North-Eastern Tanzania. International Journal of Endocrinology. https://doi.org/10.1155/2019/5404781.

10.

Ayana

D. A.

Bacha

Y. D.

Roba

K. T.

, Kebede

D. A.

(2015). Type 2 diabetes mellitus among government employees in Harar, Eastern Ethiopia: A cross-sectional study. Research and Reports in Endocrine Disorders, 5, 71–77

11.

Baltzis

Roustit

Grammatikopoulou

M. G.

Katsaboukas

Athanasiou

Iakovou

Veses

Manes

Trakatelli

M.-C.

(2016). Diabetic peripheral neuropathy as a predictor of asymptomatic myocardial ischemia in type 2 diabetes mellitus: A cross-sectional study. Advances in Therapy, 33(10), 1840–1847. https://doi.org/10.1007/s12325-016-0399-1

12.

Bandura

(1997). Self-Efficacy: The exercise of control. W.H. Freeman and Company.

13.

Bekele

Chelkeba

Fekadu

Bekele

(2020). Risk factors and outcomes of diabetic foot ulcer among diabetes mellitus patients admitted to Nekemte Referral Hospital, Western Ethiopia: Prospective observational study. Annals of Medicine and Surgery, 51, 17–23. https://doi.org/10.1016/j.amsu.2020.01.005

14.

Bekele

Fekadu

Bekele

Dugassa

(2019). Incidence of diabetic foot ulcer among diabetes mellitus patients admitted to Nekemte Referral Hospital, Western Ethiopia: Prospective observational study. Endocrinology & Metabolic Syndrome, 8(2), 1–5.

15.

Brown

S. J.

Handsaker

J. C.

Bowling

F. L.

Boulton

A. J. M.

Reeves

N. D.

(2015). Diabetic peripheral neuropathy compromises balance during daily activities. Diabetes Care, 38, 1116–1122. https://doi.org/10.2337/dc14-1982

16.

Chali

S. W.

Salih

M. H.

Abate

A. T.

(2018). Self-care practice and associated factors among Diabetes Mellitus patients on follow up in Benishangul Gumuz Regional State Public Hospitals, Western Ethiopia: A cross-sectional study. BMC Research Notes, 11(833). https://doi.org/10.1186/s13104-13018-13939-13108

17.

Chen

Pei

J.-H.

Kuang

Chen

H.-M.

Chen

Z.-W.

Yang

H.-Z.

(2015). Effect of lifestyle intervention in patients with type 2 diabetes: A meta-analysis. Metabolism, 64, 338–347. https://doi.org/10.1016/j.metabol.2014.10.018

18.

Chrvala

C. A.

Sherr

Lipman

R. D.

(2016). Diabetes self-management education for adults with type 2 diabetes mellitus: A systematic review of the effect on glycemic control. Patient Education and Counseling, 99(6), 926–943. https://doi.org/10.1016/j.pec.2015.11.003

19.

Denyes

M. J.

Orem

D. E.

Bekel

(2001). Self-care: A foundational science. Nursing Science Quarterly, 14(1), 48–54. https://doi.org/10.1177/089431840101400113

20.

Dessie

Wagnew

Henok

Belachew

Negesse

Kassa

G. M.

Habtewold

T. D.

Parchinski

(2020). Association between the level of reported good medication adherence and the geographic location of a patient’s residence and presence of a glucometer among adult patients with diabetes in Ethiopia: A systematic and meta-analysis. Current Therapeutic Research, 92, 100585. https://doi.org/10.1016/j.curtheres.2020.100585

21.

Egan

A. M.

Mahmmod

W. A. W.

Fenton

Redziniak

Tun

T. K.

Sreenan

Mcdermott

J. H.

(2013). Barriers to exercise in obese patients with type 2 diabetes. International Journal of Medicine, 106, 635–638. https://doi.org/10.1093/qjmed/hct075

22.

Ekoru

Doumatey

Bentley

A. R.

Chen

Zhou

Shriner

Fasanmade

Okafor

Eghan

Agyenim-Boateng

Adeleye

Balogun

Amoah

Acheampong

Johnson

Oli

Adebamowo

Collins

Dunston

Rotimi

(2019). Type 2 diabetes complications and comorbidity in Sub-Saharan Africans. EClinicalMedicine, 16, 30–41. https://doi.org/10.1016/j.eclinm.2019.09.001

23.

ENRICHD. (2000). Enhancing recovery in coronary heart disease patients (ENRICHD): Study design and methods. American Heart Journal, 139(1), 1–9.

24.

Faul

Erdfelder

Lang

A.-G.

Buchner

(2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175–191.

25.

Feldman

E. L.

Collaghan

B. C.

Pop-Busui

Zochodne

D. W.

Wright

D. E.

Bennett

D. L.

Bril

Russell

J. W.

Viswanathan

(2019). Diabetic neuropathy. Nature Reviews, 5(41), 1–18.

26.

Feldman

E. L.

Stevens

M. J.

Thomas

P. K.

Brown

M. B.

Canal

Greene

D. A.

(1994). A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of dianetic neuropathy. Diabetes Care, 17(11), 1281–1289.

27.

Fitzgerald

J. T.

Funnel

M. M.

Anderson

R. M.

Nwankwo

Stansfield

R. B.

Piatt

G. A.

(2016). Validation of the revised brief diabetes knowledge test (DKT2). The Diabetes Educator, 42(2), 178–187. https://doi.org/10.1177/0145721715624968

28.

Gao

Wnag

Zheng

Haardorfer

Kegler

Zhu

(2013). Effects of self-care, self-efficacy, social support on glycemic control in adults with type 2 diabetes. BMC Family Practice, 14(66). http://www.biomedcentral.com/1471-2296/1414/1466

29.

Gebreyes

Y. F.

Goshu

D. Y.

Geletew

T. K.

Argefa

T. G.

Zemedu

T. G.

Lemu

K. A.

Waka

F. C.

Mengesha

A. B.

Degefu

F. S.

Degheno

A. D.

Wubie

H. T.

Negeri

M. G.

Tesema

T. T.

Tessema

Y. G.

Regassa

M. G.

Eba

G. G.

Beyene

M. G.

Yesu

K. M.

Zeleke

G. T.

Belayneh

A. B.

(2018). Prevalence of high bloodpressure, hyperglycemia, dyslipidemia, metabolic syndrome and their determinants in Ethiopia: Evidences from the National NCDs STEPS Survey, 2015. PLoS One, 13(5), e0194819. https://doi.org/0194810.0191371/journal.pone.0194819.

30.

Herman

W. H.

Pop-Busui

Braffett

B. H.

Martin

C. L.

Cleary

P. A.

Albers

J. W.

Feldman

E. L.

Group

T. D. E. R.

(2012). Use of the Michigan Neuropathy Screening Instrument as a measure of distal symmetrical peripheral neuropathy in Type 1 diabetes: Results from the Diabetes Control and Complications Trial⁄Epidemiology of Diabetes Interventions and Complications. Diabetic Medicine, 29(7), 937–944. https://doi.org/10.1111/j.1464-5491

31.

Hicks

C. W.

Selvarajah

Mathioudakis

Sherman

R. L.

Hines

K. F.

Black

J. H. I.

Abularrage

C. J.

(2016). Burden of infected diabetic foot ulcers on hospital admissions and costs. Annals of Vascular Surgery, 33, 149–158. https://doi.org/10.1016/j.avsg.2015.11.025

32.

Hicks

C. W.

Selvin

(2019). Epidemiology of peripheral neuropathy and lower extremity disease in diabetes. Current Diabetes Reports, 19(10), 86. https://doi.org/10.1007/s11892-019-1212-8

33.

International Diabetes Federation. (2019). IDF diabetes atlas.

34.

Jember

Melsew

Y. A.

Fisseha

Sany

Gelaw

A. Y.

Janakiraman

(2017). Peripheral sensory neuropathy and associated factors among adult diabetes mellitus patients in Bahr Dar, Ethiopia. Journal of Diabetes & Metabolic Disorders. 16(16). https://doi.org/10.1186/s40200-40017-40295-40205

35.

Khawaja

Abu-Shennar

Saleh

Dahbour

S. S.

Khader

Y. S.

Ajlouni

K. M.

(2018). The prevalence and risk factors of peripheral neuropathy among patients with type 2 diabetes mellitus; the case of Jordan. Diabetology & Metabolic Syndrome, 10(8). https://doi.org/10.1186/s13098-13018-10309-13096

36.

Kim

H.-S.

Bowman

J. D.

Cho

N. H.

(2016). Comparing diabetic patient characteristics related to stated medication adherence in a rural vs. urban community in Korea. Journal of Clinical Pharmacy and Therapeutics, 41, 40–46. https://doi.org/10.1111/jcpt.12344

37.

Koetsenruijter

Eikelenboom

N. v.

Lieshout

J. v.

Vassilev

Lionis

Todorova

Portillo

M. C.

Foss

Gil

M. S.

Roukova

Angelaki

Mujika

Knutsen

I. R.

Rogers

Wensing

(2016). Social support and self-management capabilities in diabetes patients: An international observational study. Patient Education and Counseling, 99, 638–643. https://doi.org/10.1016/j.pec.2015.10.029

38.

Liddy

Blazkho

Mill

(2014). Challenges of self-management when living with multiple chronic conditions: Systematic review of the qualitative literature. Canadian Family Physician, 60, 1123–1133.

39.

Lin

Zhang

Gouo

Roberts

C. K.

McKenzie

W.-C.

Liu

Song

(2015). Effects of exercise training on cardiorespiratory fitness and biomarkers of cardiometabolic health: A systematic review and meta-analysis of randomized controlled trials. Journal of the American Heart Association, 4, 1–28. https://doi.org/10.1161/JAHA.115.002014

40.

Liu

Zeng

(2019). The risk factors for diabetic peripheral neuropathy: A metaanalysis. PLoS One, 14(2), e0212574. https://doi.org/0212510.0211371/journal.pone.0212574

41.

Mbanya

J. C. N.

Motala

A. A.

Sobngwi

Assah

F. K.

Enoru

S. T.

(2010). Diabetes in sub-Saharan Africa. Lancet, 375, 2254–2266.

42.

Mikhael

E. M.

Hassali

M. A.

Hussain

S. A.

(2020). Effectiveness of diabetes self-management educational programs for type 2 diabetes mellitus patients in Middle East countries: A systematic review. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 13, 117–138. https://doi.org/10.2147/DMSO.S232958

43.

Mogre

Johnson

N. A.

Tzelepis

Paul

(2019). Barriers to diabetic self‐care: A qualitative study of patients’ and healthcare providers’ perspectives. Journal of Clinical Nursing, 28, 2296–2308. https://doi.org/10.1111/jocn.14835

44.

Mohammad

M. T.

Muhaidat

Momani

M. S.

Al-Khlaifat

Okasheh

Qutishat

Al-Yahya

(2019). Translation and psychometric properties of the Arabic version of Michigan neuropathy screening instrument in type 2 diabetes. Journal of Diabetes Research. Advance online publication. https://doi.org/10.1155/2019/2673105

45.

Mutyambizi

Pavlova

Hongoro

Groot

(2020). Inequalities and factors associated with adherence to diabetes self-care practices amongst patients at two public hospitals in Gauteng, South Africa. BMC Endocrine Disorders, 20(15). https://doi.org/10.1186/s12902-12020-10492-y

46.

Nshisso

L. D.

Reese

Gelaye

Lemma

Berhane

Williams

M. A.

(2012). Prevalence of hypertension and diabetes among Ethiopian adults. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 6, 36–41. https://doi.org/10.1016/j.dsx.2012.05.005

47.

Nyomba

B. L. G.

Murphy

L. J.

(2004). Facilitating access to glucometer reagents increases blood glucose self-monitoring frequency and improves glycaemic control: a prospective study in insulin-treated diabetic patients. Diabetic Medicine, 21, 129–135. https//doi.org/10.1046/j.1464-5491.2330.01070x

48.

Paterson

Thorne

(2000). Developmental evolution of expertise in diabetes self-management. Clinical Nursing Research, 9(1), 402–419.

49.

Rutten

G. E. H.

Vugt

H. V.

Koning

E. D.

(2020). Person-centered diabetes care and patient activation in people with type 2 diabetes. BMJ Open Diabetes Research & Care, 8, e001926. https://doi.org/10.1136/bmjdrc-2020-001926

50.

Sachithananthan

Loha

Gose

(2013). Prevalence of diabetes mellitus, hypertension and lipodystrophy in HAART receiving HIV patients in Southern Ethiopia. International STD Research & Reviews, 1(1), 1–11.

51.

Sartor

C. D.

Oliveira

M. D.

Campos

Ferreira

J. S. S. P.

Sacco

I. C. N.

(2018). Cross-cultural adaptation and measurement properties of the Brazilian Version of the Michigan Neuropathy Screening Instrument. Brazilian Journal of Physical Therapy, 22(3), 222–230. https://doi.org/10.1016/j.bjpt.2017.10.004

52.

Schiotz

M. L.

Bogelund

Almdal

Jensen

B. B.

Willaing

(2012). Social support and self-management behaviour among patients with type 2 diabetes. Diabetic Medicine, 29, 654–661. https://doi.org/10.1111/j.1464-5491.2011.03485.x

53.

Shiferaw

W. S.

Akalu

T. Y.

Work

Aynalem

Y. A.

(2020). Prevalence of diabetic peripheral neuropathy in Africa: A systematic review and meta-analysis. BMC Endocrine Disorder, 20(49). https://doi.org/10.1186/s12902-12020-10534-12905

54.

Singh

Armstrong

D. G.

Lipsky

B. A.

(2005). Preventing foot ulcers in patients with diabetes. Journal of American Medical Association, 293(2), 217–228. https://doi.org/10.100/jama.293.2.217

55.

Sousa

V. D.

Zauszniewski

J. A.

(2005). Toward a theory of diabetes self-care management. Thefournal of Theory Construction & Testing, 9(2), 61–67.

56.

Timar

Gaita

Oancea

Levai

Lungeanu

(2016). The impact of diabetic neuropathy on balance and on the risk of falls in patients with type 2 diabetes mellitus: A crosssectional study. PLoS One, 11(4), e0154654. https://doi.org/0154610.0151371/journal.pone.0154654

57.

Timar

Schiller

Oancea

Roman

Vlad

Balinisteanu

Mazilu

(2016). impact of neuropathy on the adherence to diabetes-related self-care activities: A crosssectional study. Patient Preference and Adherence, 10, 1169–1175.

58.

Tolossa

Mengist

Mulisa

Fetensa

Turi

Abajobir

(2020). Prevalence and associated factors of foot ulcer among diabetic patients in Ethiopia: A systematic review and meta-analysis. BMC Public Health, 20(41). https://doi.org/10.1186/s12889-12019-18133-y

59.

Toobert

D. J.

Hampson

S. E.

Glasgow

R. E.

(2000). The summary of diabetes self-care activities measure: Results from 7 studies and a revised scale. Diabetes Care, 23, 943–950.

60.

Trief

P. M.

Himes

C. L.

Orendoref

Weinstock

R. S.

(2001). The marital relationship and psychosocial adaptation and glycemic control of individuals with diabetes. Diabetes Care, 24(8), 1384–1389.

61.

Trief

P. M.

Wade

M. J.

Britton

K. D.

Weinstock

R. S.

(2002). A prospective analysis of marital relationship factors and quality of life in diabetes. Diabetes Care, 25(7), 1154–1158.

62.

Vaglio

Conard

Poston

W. S.

O'Keefe

Haddock

House

Spertus

J. A.

(2004). Testing the performance of the ENRICHD Social Support Instrument in cardiac patients. Health and Quality of Life Outcomes, 2(24). http://www.hqlo.com/content/2/1/24

63.

Wallston

K. A.

Rothman

R. L.

Cherrington

(2007). Psychometric properties of the perceived diabetes self-management scale (PDSMS). Journal of Behavioral Medicine, 30, 395–401. https://doi.org/10.1007/s10865-007-9110-y

64.

Whittemore

Vilar-Compte

Cerda

S. D. L.

Marron

Conover

Delvy

Lozano-Marrufo

Perez-Escamilla

(2019). Challenges to diabetes self-management for adults with type 2 diabetes in lowresource settings in Mexico City: A qualitative descriptive study. International Journal for Equity in Health, 18(133). https://doi.org/10.1186/s12939-12019-11035-x

65.

Williams

J. S.

Walker

R. J.

Smalls

B. L.

Hill

Egede

L. E.

(2016). Patient-centered care, glycemic control, diabetes self-care, and quality of life in adults with type 2 diabetes. Diabetes Technology & Therapeutics, 18(10), 644–649.

66.

Wilson

A. L.

McNaughton

Meyer

S. B.

Ward

P. R.

(2017). Understanding the links between resilience and type-2 diabetes self-management: A qualitative study in South Australia. Archives of Public Health, 75(56). https://doi.org/10.1186/s13690-017-0222-8

67.

Zare

Tarignat-Esfanjani

Rafraf

Shaghaghi

Asghari-Jafarabadi

Shamshiri

(2020). The barriers and facilitators of self-management among adults with type 2 diabetes mellitus: A trans theoretical model (TTM)-based mixed method study in Iran. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 13, 2687–2699. https://doi.org/10.2147/DMSO.S230083

68.

Zhang

Jing

Tang

Zhu

(2017). Global epidemiology of diabetic foot ulceration: A systematic review and meta-analysis. Annals of Medicine, 49(2), 106–116. https://doi.org/10.1080/07853890.2016.1231932

69.

Zhu

Leung

S.-w.

(2016). Is selfmonitoring of blood glucose effective in improving glycaemic control in type 2 diabetes without insulin treatment: A meta-analysis of randomised controlled trials. BMJ Open, 6, e010524. doi:010510.011136/bmjopen-012015-010524.

70.

Zimmet

P. Z.

Magliano

D. J.

Herman

W. H.

Shaw

J. E.

(2014). Diabetes: A 21st century challenge. Lancet Diabetes and Endocrinology, 2, 56–64.