Knowledge about diabetes and its association with adherence to self-care and glycemic control in patients with type 1 diabetes in Southern Brazil

Foppa, Luciana; Nemetz, Betina; Matos, Rosimeri De; Schneiders, Josiane; Telo, Gabriela Heiden; Schaan, Beatriz D.

doi:10.20945/2359-3997000000648

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Original Article • Arch. Endocrinol. Metab. 67 (6) • 2023 • https://doi.org/10.20945/2359-3997000000648 copy

Knowledge about diabetes and its association with adherence to self-care and glycemic control in patients with type 1 diabetes in Southern Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To evaluate the association between knowledge about the disease, adherence to self-care, and glycemic control in people diagnosed with type 1 diabetes mellitus.

Subjects and methods:

A cross-sectional study of patients aged over 18 years diagnosed with type 1 diabetes mellitus, treated at an outpatient clinic of a Brazilian university hospital. Participants with other types of diabetes, cognitive impairment, pregnancy, and outpatient discharge were excluded. Data were collected from January to March 2021 (by telephone call), with questions about the participants’ profile, diabetes knowledge questionnaire (DKN-A), and self-care inventory revised (SCI-R) translated into and adapted for Brazilian Portuguese. Data analysis involved chi-square associations, Mann-Whitney U tests, and Poisson regression.

Results:

Among 198 adult participants, the mean age was 42 ± 12 years, 53.5% were women, the mean glycated hemoglobin was 8.6 ± 1.6%, 140 (70.8%) had satisfactory knowledge about diabetes, 65 (32.8%) had adherence to self-care, and 46 (23.2%) had adequate glycemic control. We found an association between knowledge and adherence to self-care (p < 0.001). Knowledge was not associated with glycemic control (p = 0.705).

Conclusion:

Knowledge about diabetes was associated with greater adherence to self-care in people with type 1 diabetes mellitus, but it did not reflect in better glycemic control.

Keywords
Type 1 diabetes mellitus; knowledge; self-care; glycemic control; health promotion

Feature^* * Continuous variables were described by mean and standard deviation and categorical variables by absolute number and percentile. Sensory neuropathy was considered present when recorded in the medical record by the attending physician. Satisfactory knowledge was considered 9 or more correct answers. Greater self-care was considered a score greater than or equal to 49.		n = 198
Age (years)		42.9 ± 12.4
Sex
	Female	106 (53.5)
	Male	92 (46.5)
Active smoking		21 (10.6)
Diagnosis time		22.5 ± 10.8
Glycated hemoglobin (%)		8.6 ± 1.6
	Adequate glycemic control	46 (23.2)
	Inadequate glycemic control	152 (76.8)
Comorbidities^† † More than one response to this variable was computed.
	Systemic arterial hypertension	61 (30.8)
	Psychiatric illnesses	62 (31.3)
	Dyslipidemia	46 (23.2)
	Cardiovascular diseases	21 (10.6)
	Retinopathy	107 (54)
	Diabetes kidney disease	44 (22.2)
	Sensory neuropathy	42 (21.2)
	Foot injuries	16 (8.1)
Schooling level
	Elementary school	78 (39.4)
	High school	78 (39.4)
	Higher education	42 (21.2)
Diabetes Knowledge Questionnaire (DKN-A)		9.5 ± 2.6
	Low knowledge	58 (29.2)
	Satisfactory knowledge	140 (70.8)
Self-care inventory revised (SCI-R)		44.6 ± 7.7
	Lesser self-care	133 (67.2)
	Greater self-care	65 (32.8)

Characteristic^* * Variables were described by absolute number and percentage. Satisfactory knowledge was considered 9 or more correct answers. Greater self-care considered a score greater than or equal to 49.		DKN-A Low knowledge	DKN-A Satisfactory knowledge	p-value
Sex				0.154^† † Yates continuity correction test.
	Female	26 (44.8)	80 (57.1)
	Male	32 (55.2)	60 (42.9)
Diagnosis time				0.366^‡ ‡ Pearson's chi-square test. DKN-A: Diabetes Knowledge Questionnaire.
	Less than 5 years	4 (6.9)	9 (6.4)
	Between 6 and 15 years	11 (18.9)	39 (27.9)
	Between 16 and 25 years old	19 (32.8)	31 (22.1)
	Over 26 years	24 (41.4)	61 (43.6)
Schooling level				0.003^‡ ‡ Pearson's chi-square test. DKN-A: Diabetes Knowledge Questionnaire.
	Elementary school	31 (53.5)	47 (33.5)
	High school	21 (36.2)	57 (40.8)
	Higher education	6 (10.3)	36 (25.7)
Self-care inventory revised (SCI-R)				<0.001^† † Yates continuity correction test.
	Lesser self-care	51 (87.9)	82 (58.6)
	Greater self-care	7 (12.1)	58 (41.4)
Glycemic Control				0.705^† † Yates continuity correction test.
	Adequate glycemic control	15 (25.9)	31 (22.2)
	Inadequate glycemic control	43 (74.1)	109 (77.8)

Characteristic^* * Variables described by absolute number and percentage; Greater self-care was considered a score greater than or equal to 49; SCI-R: Self-care inventory revised (SCI-R);		SCI-R Lesser self-care	SCI-R Greater self-care	p-value
Sex				0.928^† † Yates continuity correction test;
	Female	72 (54.1)	34 (52.3)
	Male	61 (45.9)	31 (47.7)
Schooling level				0.002^‡ ‡ Mann-Whitney U test.
	Elementary School	60 (45.1)	18 (27.7)
	High school	53 (39.8)	25 (38.5)
	Higher education	20 (15)	22 (33.8)
Diagnosis time				0.823^‡ ‡ Mann-Whitney U test.
	Less than 5 years	8 (6)	5 (7.7)
	Between 6 and 15 years	33 (24.8)	17 (26.2)
	Between 16 and 25 years old	35 (26.3)	15 (23.1)
	Over 26 years	57 (42.9)	28 (43.1)
Glycemic Control				0.390^† † Yates continuity correction test;
	Adequate glycemic control	28 (21.1)	18 (27.7)
	Inadequate glycemic control	105 (78.9)	47 (72.3)

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[1] Correspondence to: Luciana Foppa Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Enfermagem Ambulatorial Rua Ramiro Barcelos, 2.350 – 90035-003 – Porto Alegre, RS, Brasil lfoppa@hcpa.edu.br