Category: Home

Self-care tools for effective diabetes control

Self-care tools for effective diabetes control

Health Psychol10 1 :1—8. Am J Prev Effetive19 1 :9— Results of subgroup analysis by intervention feature in relation to reductions in hemoglobin A1c levels, systolic blood pressure, and diastolic blood pressure.

Self-care tools for effective diabetes control -

Keep insulin away from extreme heat or cold. Don't store it in the freezer or in direct sunlight. Tell your healthcare professional about any medicine problems. If your diabetes medicines cause your blood sugar level to drop too low, the dosage or timing may need to be changed.

Your healthcare professional also might adjust your medicine if your blood sugar stays too high. Be cautious with new medicines. Talk with your healthcare team or pharmacist before you try new medicines.

That includes medicines sold without a prescription and those prescribed for other medical conditions. Ask how the new medicine might affect your blood sugar levels and any diabetes medicines you take.

Sometimes a different medicine may be used to prevent dangerous side effects. Or a different medicine might be used to prevent your current medicine from mixing poorly with a new one. With diabetes, it's important to be prepared for times of illness.

When you're sick, your body makes stress-related hormones that help fight the illness. But those hormones also can raise your blood sugar.

Changes in your appetite and usual activity also may affect your blood sugar level. Plan ahead. Work with your healthcare team to make a plan for sick days. Include instructions on what medicines to take and how to adjust your medicines if needed. Also note how often to measure your blood sugar.

Ask your healthcare professional if you need to measure levels of acids in the urine called ketones. Your plan also should include what foods and drinks to have, and what cold or flu medicines you can take.

Know when to call your healthcare professional too. For example, it's important to call if you run a fever over degrees Fahrenheit Keep taking your diabetes medicine. But call your healthcare professional if you can't eat because of an upset stomach or vomiting. In these situations, you may need to change your insulin dose.

If you take rapid-acting or short-acting insulin or other diabetes medicine, you may need to lower the dose or stop taking it for a time. These medicines need to be carefully balanced with food to prevent low blood sugar.

But if you use long-acting insulin, do not stop taking it. During times of illness, it's also important to check your blood sugar often. Stick to your diabetes meal plan if you can. Eating as usual helps you control your blood sugar. Keep a supply of foods that are easy on your stomach.

These include gelatin, crackers, soups, instant pudding and applesauce. Drink lots of water or other fluids that don't add calories, such as tea, to make sure you stay hydrated. If you take insulin, you may need to sip sugary drinks such as juice or sports drinks.

These drinks can help keep your blood sugar from dropping too low. It's risky for some people with diabetes to drink alcohol. Alcohol can lead to low blood sugar shortly after you drink it and for hours afterward. The liver usually releases stored sugar to offset falling blood sugar levels.

But if your liver is processing alcohol, it may not give your blood sugar the needed boost. Get your healthcare professional's OK to drink alcohol. With diabetes, drinking too much alcohol sometimes can lead to health conditions such as nerve damage.

But if your diabetes is under control and your healthcare professional agrees, an occasional alcoholic drink is fine.

Women should have no more than one drink a day. Men should have no more than two drinks a day. One drink equals a ounce beer, 5 ounces of wine or 1. Don't drink alcohol on an empty stomach. If you take insulin or other diabetes medicines, eat before you drink alcohol. This helps prevent low blood sugar.

Or drink alcohol with a meal. Choose your drinks carefully. Light beer and dry wines have fewer calories and carbohydrates than do other alcoholic drinks. If you prefer mixed drinks, sugar-free mixers won't raise your blood sugar. Some examples of sugar-free mixers are diet soda, diet tonic, club soda and seltzer.

Add up calories from alcohol. If you count calories, include the calories from any alcohol you drink in your daily count. Ask your healthcare professional or a registered dietitian how to make calories and carbohydrates from alcoholic drinks part of your diet plan.

Check your blood sugar level before bed. Alcohol can lower blood sugar levels long after you've had your last drink. So check your blood sugar level before you go to sleep.

The snack can counter a drop in your blood sugar. Changes in hormone levels the week before and during periods can lead to swings in blood sugar levels. Look for patterns. Keep careful track of your blood sugar readings from month to month. You may be able to predict blood sugar changes related to your menstrual cycle.

Your healthcare professional may recommend changes in your meal plan, activity level or diabetes medicines.

These changes can make up for blood sugar swings. Check blood sugar more often. If you're likely nearing menopause or if you're in menopause, talk with your healthcare professional.

Ask whether you need to check your blood sugar more often. Also, be aware that menopause and low blood sugar have some symptoms in common, such as sweating and mood changes. So whenever you can, check your blood sugar before you treat your symptoms.

That way you can confirm whether your blood sugar is low. Most types of birth control are safe to use when you have diabetes. But combination birth control pills may raise blood sugar levels in some people.

It's very important to take charge of stress when you have diabetes. The hormones your body makes in response to prolonged stress may cause your blood sugar to rise. It also may be harder to closely follow your usual routine to manage diabetes if you're under a lot of extra pressure.

Take control. Once you know how stress affects your blood sugar level, make healthy changes. Learn relaxation techniques, rank tasks in order of importance and set limits. Whenever you can, stay away from things that cause stress for you.

Exercise often to help relieve stress and lower your blood sugar. Get help. Learn new ways to manage stress. You may find that working with a psychologist or clinical social worker can help.

These professionals can help you notice stressors, solve stressful problems and learn coping skills. The more you know about factors that have an effect on your blood sugar level, the better you can prepare to manage diabetes.

If you have trouble keeping your blood sugar in your target range, ask your diabetes healthcare team for help. There is a problem with information submitted for this request.

Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health. Click here for an email preview. Error Email field is required. Error Include a valid email address. To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you.

If you are a Mayo Clinic patient, this could include protected health information. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices.

You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox.

Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. This content does not have an English version. This content does not have an Arabic version.

Appointments at Mayo Clinic Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. Request Appointment. Diabetes management: How lifestyle, daily routine affect blood sugar. Products and services. Diabetes management: How lifestyle, daily routine affect blood sugar Diabetes management takes awareness.

By Mayo Clinic Staff. Thank you for subscribing! Sorry something went wrong with your subscription Please, try again in a couple of minutes Retry. Show references Facilitating behavior change and well-being to improve health outcomes. Standards of Medical Care in Diabetes — Diabetes Care.

Nutrition overview. American Diabetes Association. Accessed Dec. Diabetes and mental health. Centers for Disease Control and Prevention. Insulin, medicines, and other diabetes treatments. National Institute of Diabetes and Digestive and Kidney Diseases.

Insulin storage and syringe safety. Diabetes diet, eating, and physical activity. Type 2 diabetes mellitus adult. Mayo Clinic; Wexler DJ. Initial management of hyperglycemia in adults with type 2 diabetes mellitus. Diabetes and women. Planning for sick days. Diabetes: Managing sick days.

Castro MR expert opinion. Mayo Clinic. Hypoglycemia low blood glucose. Blood glucose and exercise. Riddell MC. Exercise guidance in adults with diabetes mellitus. Colberg SR, et al. Palermi S, et al. The complex relationship between physical activity and diabetes: An overview.

Journal of Basic and Clinical Physiology and Pharmacology. Take charge of your diabetes: Your medicines. Sick day management for adults with type 1 diabetes. Association of Diabetes Care and Education Specialists. Alcohol and diabetes. Diabetes and nerve damage. Roe AH, et al.

Combined estrogen-progestin contraception: Side effects and health concerns. Products and Services The Mayo Clinic Diet Online A Book: The Essential Diabetes Book.

See also Medication-free hypertension control A1C test Alcohol: Does it affect blood pressure? Alpha blockers Amputation and diabetes Angiotensin-converting enzyme ACE inhibitors Angiotensin II receptor blockers Anxiety: A cause of high blood pressure? Artificial sweeteners: Any effect on blood sugar?

Bariatric surgery Beta blockers Beta blockers: Do they cause weight gain? Beta blockers: How do they affect exercise? Blood glucose meters Blood glucose monitors Blood pressure: Can it be higher in one arm? Blood pressure chart Blood pressure cuff: Does size matter?

Blood pressure: Does it have a daily pattern? Blood pressure: Is it affected by cold weather? Blood pressure medication: Still necessary if I lose weight?

Blood pressure medications: Can they raise my triglycerides? Blood pressure readings: Why higher at home? Blood pressure tip: Get more potassium Blood sugar levels can fluctuate for many reasons Blood sugar testing: Why, when and how Bone and joint problems associated with diabetes Pancreas transplant animation Caffeine and hypertension Calcium channel blockers Calcium supplements: Do they interfere with blood pressure drugs?

Can whole-grain foods lower blood pressure? Central-acting agents Choosing blood pressure medicines COVID Who's at higher risk of serious symptoms? Diabetes Diabetes and depression: Coping with the two conditions Diabetes and exercise: When to monitor your blood sugar Diabetes and heat 10 ways to avoid diabetes complications Diabetes diet: Should I avoid sweet fruits?

Diabetes diet: Create your healthy-eating plan Diabetes foods: Can I substitute honey for sugar? Diabetes and liver Diabetes symptoms Diabetes treatment: Can cinnamon lower blood sugar?

Using insulin Diabetic Gastroparesis Diuretics Diuretics: A cause of low potassium? Diabetes self-care necessitates a high level of stress-coping skills as well as problem-solving ability.

Therefore, stress-coping behaviors are important for patients with type 2 diabetes. Even if stress management activity had a positive effect on diabetic self-care, over half of the patients in this study To enhance self-care behaviors and stress management, it is necessary to implement stress coping strategies and problem-solving skills.

The most common stress reduction measures used in this study were getting enough sleep, focusing on happy thoughts in bed, and relaxing daily after the activity. The adoption and implementation of different stress management approaches is a priority as stress management techniques improve self-care behaviors of diabetics [ 15 , 21 ].

In this current study, patients with good perceptions are more likely to practice diabetic self-care. One reason could be that when patients have good insight, it can help them understand their health status and avoid confusion when taking diabetes self-care measures.

In this study, patients with good family support were more likely to have self-management behavior. Diabetes self-management behavior can be significantly improved with increased family support.

Studies have shown that diabetes-specific supportive and family behaviors have a positive impact on individual self-management behaviors [ 31 , 32 , 33 ].

Therefore, to improve the health of adults with diabetes, it is important to support families who are committed to self-management of their diabetes. We need to build proper support and foster healthy relationships among all family members. The current study has some limitations, including the possibility that self-reported measures may be biased in response and overestimate behavioral performance.

This tool also needs more attention for accurate and reliable data. Practicing stress management and coping skills is the preferred strategy for improving diabetes management behavior.

This has been demonstrated in previous studies [ 15 , 21 , 22 , 24 ] and in this study. Since stress management behaviors and coping skills are associated with diabetes self-management, diabetes professionals should consider these aspects when discussing diabetes self-management. In addition, the results indicate that stress management programs may have significant clinical benefits for patients with type II diabetes.

Therefore, routine care and education programs should address diabetes self-care activities and coping skills that influence health-related behaviors and decision-making. In summary, the following key program areas attract the attention of policymakers and service providers; 1 As a routine therapeutic or therapeutic service, stress management strategies and coping skills should be integrated into existing systems.

The study results showed that stress management behavior significantly improved diabetes self-management behavior and had a positive association with it.

Patients with good stress management behaviors are more likely to engage in diabetes self-management activities. In addition, patients with good awareness and patients with family support were more likely to have diabetes self-care. All data generated in this study are included in the manuscript.

Datasets are available upon reasonable request from the corresponding author. World Health Organization. Diagnosis and management of type 2 diabetes HEARTS-D. Geneva]: World Health Organization; Licence: CC BY-NC-SA 3.

Google Scholar. International Diabetes Federation. IDF Diabetes Atlas, 9th Edition International Diabetes Federation, Bishu KG, Jenkins C, Yebyo HG, Atsbha M, Wubayehu T, Gebregziabher M. Diabetes in Ethiopia: a systematic review of prevalence, risk factors, complications, and cost.

Obes Med. Article Google Scholar. Ansari RM, Hosseinzadeh H, Harris M, Zwar N. Self-management experiences among middle-aged population of rural area of Pakistan with type 2 diabetes: a qualitative analysis. Clin Epidemiol Global Health. Ucik Ernawati TA, Wihastuti, Utami YW.

Effectiveness of diabetes self-management education DSME in type 2 diabetes mellitus T2DM patients: Systematic literature review. J Public Health Res ;10 2 Lin K, Park C, Li M, Wang X, Li X, Li W, Quinn L. Effects of depression, diabetes distress, diabetes self-efficacy, and diabetes self-management on glycemic control among Chinese population with type 2 diabetes mellitus.

Diabetes Res Clin Pract ;— Forouhi NG, Misra A, Mohan V, Taylor R, Yancy W. Dietary and nutritional approaches for prevention and management of type 2 diabetes.

Article PubMed PubMed Central Google Scholar. Evert AB, Boucher JL, Cypress M, Dunbar SA, Franz MJ, Mayer-Davis EJ, Neumiller JJ, Nwankwo R, Verdi CL, Urbanski P, et al.

Nutrition Therapy Recommendations for the management of adults with diabetes. Diabetes Care. Article CAS PubMed PubMed Central Google Scholar. Dagnew B, Debalkie Demissie G, Abebaw Angaw D. Systematic Review and Meta-Analysis of Good Self-Care Practice among People Living with Type 2 Diabetes Mellitus in Ethiopia: A National Call to Bolster Lifestyle Changes.

Habebo TT, Pooyan EJ, Mosadeghrad AM, Babore GO. BK D: Prevalence of Poor Diabetes Self-Management Behaviors among Ethiopian Diabetes Mellitus Patients: A Systematic Review and Meta-Analysis. Ethiop J Health Sci Jul 1;30 4 — PMID: ; PMCID: PMC, Nyklíček I, Kuijpers KF.

Effects of mindfulness-based stress reduction intervention on psychological well-being and quality of life: is increased mindfulness indeed the mechanism? Ann Behav Med Jun;35 3 — Epub Jun 6 PMID: ; PMCID: PMC Alzahrani F, Alshahrani NZ, Abu Sabah A, Zarbah A, Abu Sabah S, Mamun MA.

Prevalence and factors associated with mental health problems in saudi general population during the coronavirus disease pandemic: a systematic review and meta-analysis. Psych J. Epub Jan 5. PMID: Article PubMed Google Scholar. Alkhormi AH, Mahfouz MS, Alshahrani NZ, Hummadi A, Hakami WA, Alattas DH, Alhafaf HQ, Kardly LE, Mashhoor MA.

Psychological Health and Diabetes Self-Management among Patients with Type 2 Diabetes during COVID in the Southwest of Saudi Arabia. Medicina Kaunas ;58 5 PMID: ; PMCID: PMC Alonso-Morán E, Satylganova A, Orueta JF, Nuño-Solinis R.

Prevalence of depression in adults with type 2 diabetes in the Basque Country: relationship with glycaemic control and health care costs. BMC Public Health. Brannon L, Feist J, Updegraff JA.

Health psychology: an introduction to behavior and health. Cengage Learning; Psychological health and diabetes self-management among patients with type 2 diabetes during COVID in the Southwest of Saudi Arabia. Medicina , 58 5. Al-Ozairi A, Taghadom E, Irshad M. Association Between Depression, Diabetes Self-Care Activity and Glycemic Control in an Arab Population with Type 2 Diabetes.

Diabetes Metab Syndr Obes ;— Yu JS, Xu T. Relationship Between Diabetes, Stress, and Self-Management to Inform Chronic Disease Product Development: Retrospective Cross-Sectional Study.

JMIR Diabetes , 23;5 4 :e Kim EJ, Han KS. Factors related to self-care behaviours among patients with diabetic foot ulcers. J Clin Nurs ;29 9—10 — Epub Feb 25 PMID: Zamani-Alavijeh F, Araban M, Koohestani HR, Karimy M.

The effectiveness of stress management training on blood glucose control in patients with type 2 diabetes.

Diabetol Metab Syndr. Chew B, Khoo E, Chia Y. Social support and glycemic control in adult patients with type 2 diabetes mellitus.

Asia Pac J Public Health. Article CAS PubMed Google Scholar. Hapunda G. Coping strategies and their association with diabetes specific distress, depression and diabetes self-care among people living with diabetes in Zambia.

BMC Endocr Disorders. Ghasemi Bahraseman Z, Mangolian Shahrbabaki P, Nouhi E. The impact of stress management training on stress-related coping strategies and self-efficacy in hemodialysis patients: a randomized controlled clinical trial.

Kong S-Y, Cho M-K. Validity and reliability of the Korean Version of the self-care of diabetes inventory SCODI-K. Int J Environ Res Public Health. Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care activities measure: results from 7 studies and a revised scale.

KishHealth System Diabetes Education Center. Diabetes Questionnaire. Thomas JJ, Moring J, Bowen A, Rings JA, Emerson T, Lindt A. The influence of stress and coping on diabetes self-care activities among college students. J Am Coll Health ;—6. Epub ahead of print PMID: —6. Zhao FF, Suhonen R, Katajisto J, Leino-Kilpi H.

The association of diabetes-related self-care activities with perceived stress, anxiety, and fatigue: a cross-sectional study. Patient Prefer Adherence ;— Khymdeit E, Rao PA, Narayanan P, Mayya S.

Social support influencing diabetes self-management behaviors: a cross-sectional study in Udupi Taluk. Indian J Health Sci Biomedical Res KLEU. Garizábalo-Dávila CM, Rodríguez-Acelas AL, Mattiello R, Cañon-Montañez W.

Social Support intervention for self-management of type 2 diabetes Mellitus: study protocol for a Randomized Controlled Trial. Open Access Journal of Clinical Trials.

Mayberry LS, Osborn CY. Family support, medication adherence, and glycemic control among adults with type 2 diabetes. Pamungkas RA, Chamroonsawasdi K, Vatanasomboon P. A systematic review: Family Support Integrated with Diabetes Self-Management among uncontrolled type II diabetes Mellitus Patients.

Behav Sci , 7 3. Download references. We would like to extend our sincere gratitude to the research team members who contributed to the completion of this study. Finally, we would want to express our heartfelt gratitude to all participants, data collectors, and supervisors for their time and effort.

There are no specific grants for this research from funding agencies in the public, commercial, or non-profit sectors. Department of Public Health, Debre Berhan University, Debre Berhan, Ethiopia.

School of Medicine, Debre Berhan University, Debre Berhan, Ethiopia. School of Public Health, the University of Queensland, Brisbane, Australia. You can also search for this author in PubMed Google Scholar.

Conceptualization and formal analysis: Akine Eshete; Investigation and Methodology: Akine Eshete, Sadat Mohammed, Tilahun Deress, Tewodros Kifleyohans, Yibeltal Assefa. All authors contributed to the writing of the manuscript and approved the submitted version of the manuscript.

Correspondence to Akine Eshete. Ethical approval was obtained from the Asrat Woldeyes Health Science Campus, Debre Berhan University, and Institutional Review Board Approval No. All study methods were performed in accordance with Asrat Woldeyes Health Science Campus, Debre Berhan University, Institutional Review Board guidelines and regulations.

Necessary permission was secured from all concerned administrators. Written informed consent was obtained from each respondent before actual data collection. Issues of confidentiality were maintained by removing any identifiers from the questionnaire. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Open Access This article is licensed under a Creative Commons Attribution 4.

While diiabetes is no cure Embrace positivity daily diabetes, with treatment and self-management strategies, a person can Self-care tools for effective diabetes control a long and effecrive life. Self-care tips Self-care tools for effective diabetes control meal planning for nutrition, getting enough Slf-care exercise or physical activity, avoiding smoking, and more. Diabetes is a chronic disease that affects millions of people around the world. In the United States, 1. Diabetes also affects children and adolescents. Approximatelypeople younger than 20 in the country have diagnosed diabetes. The American Diabetes Association ADA note in guidelines that self-management and education are crucial aspects of diabetes care.

Self-care tools for effective diabetes control -

World health organization: Diabetes — Factsheet. Mohan D, Raj D, Shanthirani CS, Datta M, Unwin NC, Kapur A: Awareness and knowledge of diabetes in Chennai - The Chennai urban rural epidemiology study. J Assoc Physicians India , — Wild S, Roglic G, Green A, Sicree R, King H: Global prevalence of diabetes: Estimates for the year and projections for Diabetes Care , 27 5 — Article PubMed Google Scholar.

Pradeepa R, Mohan V: The changing scenario of the diabetes epidemic: Implications for India. Indian J Med Res , — CAS PubMed Google Scholar.

Katulanda P, Constantine GR, Mahesh JG, Sheriff R, Seneviratne RD, Wijeratne S: Prevalence and projections of diabetes and pre-diabetes in adults in Sri Lanka - Sri Lanka Diabetes, Cardiovascular Study SLDCS. Diabet Med , 25 9 — Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A: Improving chronic illness care: translating evidence into action.

Health Aff Millwood , 20 6 — UKPDS: Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes UKPDS Lancet , — Article Google Scholar. Ohkubo Y, Kishikawa H, Araki E, Miyata T, Isami S, Motoyoshi S: Intensive insulin therapy prevents the progression of diabetic micro-vascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study.

Diabetes Res Clin Pract , 28 2 — Shobana R, Augustine C, Ramachandran A, Vijay V: Improving psychosocial care: The Indian experience. Diabetes Voice , 50 1 — Chew LD: The impact of low health literacy on diabetes outcomes.

Diabetes Voice , 49 3 — Grey M, Thurber FW: Adaptation to chronic illness in childhood: diabetes mellitus. J Pediatr Nurs , 6 5 — Glasgow RE, Hiss RG, Anderson RM, Friedman NM, Hayward RA, Marrero DG: Report of the health care delivery work group: behavioral research related to the establishment of a chronic disease model for diabetes care.

Diabetes Care , 24 1 — BMJ , Health Educ Res , 18 2 — Paterson B, Thorne S: Developmental evolution of expertise in diabetes self management. Clin Nurs Res , 9 4 — Etzwiler DD: Diabetes translation: a blueprint for the future.

Diabetes Care , 17 Suppl. Bradley C: Handbook of Psychology and Diabetes. Chur, Switzerland: Harwood Academic; Johnson SB: Health behavior and health status: concepts, methods and applications. J Pediatr Psychol , 19 2 — McNabb WL: Adherence in diabetes: can we define it and can we measure it?

Diabetes Care , 20 2 — American Association of Diabetes Educators: AADE7 Self-Care Behaviors. Diabetes Educ , — Povey RC, Clark-Carter D: Diabetes and healthy eating: A systematic review of the literature.

Diabetes Educ , 33 6 — Boule NG, Haddad E, Kenny GP, Wells GA, Sigal RJ: Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: A meta-analysis of controlled clinical trials. JAMA , 10 — American Diabetes Association: Standards of Medical Care in Diabetes - Diabetes Care , 32 Suppl 1 :SS Article PubMed Central Google Scholar.

Odegard PS, Capoccia K: Medication taking and diabetes: A systematic review of the literature. Deakin T, McShane CE, Cade JE, Williams RD: Group based training for self management strategies in people with type 2 diabetes mellitus.

Cochrane Database Syst Rev , 2: CD Herschbach P, Duran G, Waadt S, Zettler A, Amch C: Psychometric properties of the questionnaire on stress in patients with diabetes-revised QSD-R. Health Psychol , 16 2 — J Assoc Physicians India , 47 12 — Poulsen P, Kyvik OK, Vag A, Nielsen-Beck H: Heritability of type II diabetes mellitus and abnormal glucose tolerance — a population-based twin study.

Diabetologia , 42 2 — American college of endocrinology: The American association of clinical endocrinologist guidelines for the management of diabetes mellitus: the AACE system of diabetes self-management. Endocr Pract , 8: SS Hendra JT, Sinclair AJ: Improving the care of elderly diabetic patients: the final report of the St.

Vincent joint task force. Age and Aging , 26 1 :3—6. Article CAS Google Scholar. Mensing C, Boucher J, Cypress M, Weinger K, Mulcahy K, Barta P: National standards for diabetes self-management education.

Diabetes Care , 29 Suppl 1 :SS Williams GC, Freedman ZR, Deci EL: Supporting autonomy to motivate patients with diabetes for glucose control. Diabetes Care , 21 10 — Norris SL, Lau J, Smith SJ, Schmid CH, Engelgau MM: Self-management education for adults with type-2 diabetes: a meta-analysis of the effect on glycemic control.

Diabetes Care , 25 7 — Glasgow RE, Strycker LA: Preventive care practices for diabetes management in two primary care samples. Am J Prev Med , 19 1 :9— Walker E: Characteristics of the adult learner. Diabetes Educ , 25 6 Suppl — American Diabetes Association: Standards of medical care in diabetes - Diabetes Care , 34 Suppl 1 :SS Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR: Exercise and type-2 diabetes.

Diabetes Care , 33 12 — Mora S, Lee IM, Buring JE, Ridker PM: Association of physical activity and body mass index with novel and traditional cardiovascular biomarkers in women. JAMA , 12 — Physical Activity Guidelines Advisory Committee: Physical Activity Guidelines Advisory Committee Report, Washington, DC, USA: US Department of Health and Human Services; United States Department of Health and Human Services : Physical Activity Guidelines for Americans; Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA: Physical activity and public health: updated recommendation for adults from the American college of sports medicine and the American heart association.

Med Sci Sports Exerc , 39 8 — Goodall TA, Halford WK: Self-management of diabetes mellitus: a critical review. Health Psychol , 10 1 :1—8. Marrero DG, Kako KS, Mayfield J, Wheeler ML, Fineberg N: Nutrition management of type-2 diabetes by primary care physicians.

J Gen Intern Med , 15 11 — Article CAS PubMed PubMed Central Google Scholar. Kotwani A, Ewen M, Dey D, Iyer S, Lakshmi PK, Patel A: Prices and availability of common medicines at six sites in India using a standard methodology.

Indian J Med Res , 25 5 — Toljamo M, Hentinen M: Adherence to self-care and glycemic control among people with insulin-dependent diabetes mellitus. J Adv Nurs , 34 6 — Wing RR, Goldstein MG, Kelly JA, Birch LL, Jakic JM, Sallis JF: Behavioral science research in diabetes.

Chronic Illn , 4 1 — Ramachandran A, Ramachandran S, Snehalatha C, Augustine C, Murugesan N, Viswanathan V: Increasing expenditure on health care incurred by diabetic subjects in a developing country: A study from India.

Diabetes Care , 30 2 — Debussche X, Debussche BM, Besançon S, Traore AS: Challenges to diabetes self-management in developing countries. Diabetes Voice , 12— Ciechanowski PS, Katon WJ, Russo JE, Walker EA: The patient-provider relationship: attachment theory and adherence to treatment in diabetes.

Am J Psychiatry , 1 — Grant RW, Devita NG, Singer DE, Meigs JB: Poly-pharmacy and medication adherence in patients with type 2 diabetes. Diabetes Care , 26 5 — Chin MH, Cook S, Jin L, Drum ML, Harrison JF, Koppert J: Barriers to providing diabetes care in community health center.

Diabetes Care , 24 2 — Nam S, Chesla C, Stotts NA, Kroon L, Janson SL: Barriers to diabetes management: patient and provider factors.

Diabetes Res Clin Pract , 93 1 :1—9. Preventative care practices among persons with diabetes - United States: — Morb Mortal Wkly Rep , 51 43 — Anderson RM: Patient empowerment and the traditional medical model: a case of irreconcilable differences?

Diabetes Care , 18 3 — Download references. You can also search for this author in PubMed Google Scholar. Correspondence to Saurabh RamBihariLal Shrivastava. SRS wrote the first draft of the article and performed intensive review of literature.

PSS edited the article continuously. JR read and approved the final manuscript. All authors read and approved the final manuscript.

This article is published under license to BioMed Central Ltd. Reprints and permissions. Shrivastava, S. Role of self-care in management of diabetes mellitus. J Diabetes Metab Disord 12 , 14 Download citation. Received : 22 January Accepted : 28 February Published : 05 March Anyone you share the following link with will be able to read this content:.

Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Download PDF. Abstract Diabetes mellitus DM is a chronic progressive metabolic disorder characterized by hyperglycemia mainly due to absolute Type 1 DM or relative Type 2 DM deficiency of insulin hormone.

Self-Management in Diabetes Chapter © Healthy Lifestyles for the Self-Management of Type 2 Diabetes Chapter © Use our pre-submission checklist Avoid common mistakes on your manuscript. Introduction Diabetes mellitus DM is a chronic progressive metabolic disorder characterized by hyperglycemia mainly due to absolute Type 1 DM or relative Type 2 DM deficiency of insulin hormone[ 1 ].

Addressing needs of diabetic patients One of the biggest challenges for health care providers today is addressing the continued needs and demands of individuals with chronic illnesses like diabetes[ 12 ].

Self-care in diabetes Self-care in diabetes has been defined as an evolutionary process of development of knowledge or awareness by learning to survive with the complex nature of the diabetes in a social context[ 20 , 21 ].

Diabetes self management education Though genetics play an important role in the development of diabetes, monozygotic twin studies have certainly shown the importance of environmental influences[ 34 ]. Diabetes self-care activities Diabetes education is important but it must be transferred to action or self-care activities to fully benefit the patient.

Compliance to self-care activities Treatment adherence in diabetes is an area of interest and concern to health professionals and clinical researchers even though a great deal of prior research has been done in the area.

The criteria were the SDSCA scales of self-care and the clinical outcomes BMI and HbA 1c. Patient characteristics such as sex, age, diabetes type, diabetes duration, type of medical therapy, and number of late complications were included in the analyses to examine possible associations in case of the dichotomous variables sex, diabetes type, and use of insulin point-biserial correlations were estimated.

Additionally, known groups validity was assessed by assorting the patients into three groups according to the HbA 1c value, which were then examined regarding self-care activities as assessed by the DSMQ. Patients with HbA 1c values up to 7. Between-groups differences were analysed using One-way Analyses of Variance.

If feasible according to the sample sizes , the explained analyses were additionally performed on the basis of the diabetes type 1 and 2 subsamples in order to test the applicability of the questionnaire in both diabetes types.

In order to perform the item selection, patients were assessed with the preliminary set of 37 items. The mean HbA 1c was 8. The relevant items assessed dealing with hypoglycaemic episodes, calculation of carbohydrates, alcohol consumption, carriage of needed therapy devices, and weight control.

In a second step, two items which were found to decrease the internal consistency of this item selection were removed. For the remaining 25 items an α coefficient of 0. In a third step, a principal component factor analysis was performed.

Varimax-rotated factor loadings were evaluated, and six items which did not show a loading of 0. In a fourth step, the factors were interpreted and the matching of items was rated. It was removed consequently. Secondly, one item which asks for the recording of blood glucose levels showed indeed a loading of 0.

Despite its bidimensionality and with a view to its correlation with HbA 1c of 0. In the final step, the remaining 18 items were analysed for contentual redundancy.

In each case, the item with the lower correlation with HbA 1c was removed. The psychometric properties of the final 16 item version of the DSMQ were assessed in patients.

The SDSCA served as comparison to assess the quality of our scale. The sample characteristics are presented in Table 2. Despite the slightly different proportions of diabetes types, rates of specific treatments, mean diabetes durations, and late complication statuses were highly similar as can be seen in Table 2.

Item analyses revealed a mean item difficulty of However, the indices of items 3, 4, and 7 were located in the peripheral zones of the distribution.

The mean inter-item-correlation or homogeneity was 0. The mean item-subscale-correlations were 0. Two items 14, 15 , however, showed item-total-correlations lower than 0.

Still, those were highly correlated with their corresponding subscales. With the exception of the items 8 and 15, both on physical activity, all correlations with HbA 1c were significant. A detailed overview of the above item characteristics is displayed in Table 3. If item and scale properties were assessed in the diabetes type subsamples separately, the analyses collectively revealed comparable results.

In type 1 diabetes patients, the mean inter-item-correlation was 0. The DSMQ subscales showed α coefficients of averagely 0. In type 2 patients, the mean inter-item-correlation was 0. However, in five cases items 8, 9, 11, 14, and 15 the correlations were insignificant.

This result was supported by the scree test. The varimax rotation converged in 6 iterations. Item 6, which asks for the recording of blood glucose levels, again as in the first study revealed a bidimensional structure with its additional loading on the diet factor.

The factor loadings are presented in Table 4. To test the observed factor structure, all items except item 16 were aggregated to four correlated factors as suggested by the EFA using CFA. These results indicate a very appropriate fit of the four factor model.

To evaluate the feasibility of integrating all items to a total scale, an additional single factor model all 16 items aggregated on one factor was tested. All results are shown in Table 5. If convergent correlations were assessed separately by diabetes type, the analyses of both subsamples revealed results which were highly comparable to those presented above.

The comparison between the DSMQ scales and their equivalent SDSCA scales regarding the correlations with HbA 1c and for the physical activity scales with BMI revealed the following results:. When these correlational analyses were performed separately by diabetes type, the results were in total clearly consistent with the ones described above.

Therefore, the finding of a higher association between the DSMQ subscale and HbA 1c — as observed in the total sample — could not be replicated. The purpose of this investigation was to describe the development of the DSMQ study 1 and evaluate its psychometric properties study 2.

The questionnaire was developed on a broad theoretical and empirical basis, and its evaluation indicates very good psychometric properties with adequate item characteristics, satisfactory reliability, and good validity.

According to the generally satisfactory item properties and good item validity coefficients regarding HbA 1c the overall item selection appears very satisfying. Since the items assess a number of different aspects of self-care, the total scale is rather heterogeneous, which is reflected by the mean inter-item-correlation of 0.

Against this background and with a view to the rather low number of items on each content, the internal consistency can be appraised as good based on the standard by Nunnally and Bernstein [ 59 ].

For a polydimensional construct a higher alpha coefficient might even be unfavourable, for it suggests high item redundancy in the scale, as pointed out by Streiner [ 60 ]. The slightly lower item-total-correlations in two cases should be interpreted with a view to this aspect as well.

The additional analyses of the subsamples revealed slightly better item properties and consistency in type 1 patients which can be partly attributed to the difference in sample size.

In sum, all coefficients were in the acceptable range and suggest general applicability. The EFA revealed a simple structure of four factors with high loadings of all items thereon. The factors were well interpretable and their contents clearly confirmed the designed scales.

But apart from that, the overall content structure is remarkably clear and indicates a good factorial validity. The EFA revealed a very good fit of the suggested four factor model, which also confirms the designed scales.

The criterion-related correlations between the DSMQ scales and the SDSCA scales indicate a good convergence between parallel measures suggesting validity. According to these results, higher sum scores as well as subscale scores of the DSMQ allow to infer better self-care activities in view of glycaemic control.

Notably, the DSMQ and SDSCA are equivalent in the way that both questionnaires assess self-care activities, which in most cases are clearly related, as reflected by the correlations between the parallel scales.

However, in spite of this commonality, self-care as assessed by the DSMQ is more strongly associated with glycated haemoglobin, which can be explained by the differently conceptualized functions [19; p.

In the course of the item selection only self-care activities which showed relevant associations with glycaemic control were kept. For this reason, several specific self-care activities which may be of interest in regards of diabetes care are not covered by the DSMQ.

The main limitation of the studies is based on the composition of the samples. Both samples were drawn from in-patients at a tertiary referral centre for diabetes, where patients are usually hospitalized because of relevant problems of diabetes treatment and glycaemic control reflected by the average HbA 1c values of 8.

Therefore, the study participants cannot be rated as representative of the general diabetic population, which limits the generalizability of results [ 61 ]. Furthermore, the majority of patients was treated with insulin, whereas only a small percentage used non-insulin medical treatments.

Thus, the pattern of correlations between the DSMQ scales and HbA 1c might differ when assessed in patients not treated with insulin or antidiabetic medication for example, dietary aspects and physical activity then might have a larger impact on glycaemic control.

Due to the generally short length of stay at the GDCM, the investigation was carried out cross-sectionally. In these regards additional analyses are needed. Nevertheless, the present results may be judged as promising. The strengths of this investigation, on the other hand, lie in the theoretical and empirical basis of the questionnaire contents on recent results from self-care research, which facilitates the integration of our findings and supports face validity.

The questionnaire development was performed through a highly formal process of item and test analysis study 1 , and its initial validation study 2 was based on a very appropriate sample size. Furthermore a high accuracy of HbA 1c analysis was achieved due to standardised analysis in a central laboratory , and the coincidence of blood sampling and psychometric assessment as well as the standardized data assessment ensure the internal validity of results.

Regarding its associations with HbA 1c, the DSMQ showed significant superiority to the German version of the SDSCA. In sum, in this initial study the DSMQ demonstrated very good psychometric properties.

The questionnaire presents itself as an efficient instrument which provides reliable and valid information on diabetes self-care, and assesses four well-defined specific self-care activities associated with glycaemic control. It was designed especially to enable scientific studies of psychosocial barriers to self-care and glycaemic control.

However, since good metabolic control can be regarded as the most important goal of diabetes treatment, the questionnaire appears also valuable for the clinical use as a screener or as diagnostic instrument to assess barriers of glycaemic control in individuals.

Thus, the DSMQ should benefit future research and also be of value in clinical settings. Spellman CW: Achieving glycemic control: cornerstone in the treatment of patients with multiple metabolic risk factors.

J Am Osteopath Assoc , Suppl 5 :8— Google Scholar. Stettler C, Allemann S, Jüni P, Cull CA, Holman RR, Egger M, Krähenbühl S, Diem P: Glycemic control and macrovascular disease in types 1 and 2 diabetes mellitus: Meta-analysis of randomized trials.

Am Heart J , 27— Article CAS PubMed Google Scholar. Akalin S, Berntorp K, Ceriello A, Das AK, Kilpatrick ES, Koblik T, Munichoodappa CS, Pan CY, Rosenthall W, Shestakova M, Wolnik B, Woo V, Yang WY, Yilmaz MT, Global Task Force on Glycaemic Control: Intensive glucose therapy and clinical implications of recent data: a consensus statement from the Global Task Force on Glycaemic Control.

Int J Clin Pract , — Johnson SB: Methodological issues in diabetes research. Measuring adherence. Diabetes Care , — Albisser AM, Harris RI, Albisser JB, Sperlich M: The impact of initiatives in education, self-management training, and computer-assisted self-care on outcomes in diabetes disease management.

Diabetes Technol Ther , 3: — Williams GC, McGregor HA, Zeldman A, Freedman ZR, Deci EL: Testing a Self-Determination Theory Process Model for Promoting Glycemic Control Through Diabetes Self-Management.

Health Psychol , 58— Article PubMed Google Scholar. Piette JD, Richardson C, Valenstein M: Addressing the needs of patients with multiple chronic illnesses: the case of diabetes and depression. Am J Manag Care , — PubMed Google Scholar.

Peyrot M, McMurry JF Jr, Kruger DF: A biopsychosocial model of glycemic control in diabetes: stress, coping and regimen adherence. J Health Soc Behav , — Gonzalez JS, Peyrot M, McCarl LA, Collins EM, Serpa L, Mimiaga MJ, Safren SA: Depression and diabetes treatment nonadherence: a meta-analysis.

Article PubMed Central PubMed Google Scholar. Gonzalez JS, Delahanty LM, Safren SA, Meigs JB, Grant RW: Differentiating symptoms of depression from diabetes-specific distress: relationships with self-care in type 2 diabetes. Diabetologia , — Article CAS PubMed Central PubMed Google Scholar. Aikens JE, Perkins DW, Lipton B, Piette JD: Longitudinal analysis of depressive symptoms and glycemic control in type 2 diabetes.

Fisher L, Glasgow RE, Strycker LA: The relationship between diabetes distress and clinical depression with glycemic control among patients with type 2 diabetes. Fisher L, Mullan JT, Arean P, Glasgow RE, Hessler D, Masharani U: Diabetes distress but not clinical depression or depressive symptoms is associated with glycemic control in both cross-sectional and longitudinal analyses.

Diabetes Care , 23— Lustman PJ, Anderson RJ, Freedland KE, de Groot M, Carney RM, Clouse RE: Depression and poor glycemic control: a meta-analytic review of the literature. Pibernik-Okanovic M, Grgurevic M, Begic D, Szabo S, Metelko Z: Interaction of depressive symptoms and diabetes-related distress with glycaemic control in Type 2 diabetic patients.

Diabet Med , — Baron RM, Kenny DA: The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol , — Lustman PJ, Clouse RE, Ciechanowski PS, Hirsch IB, Freedland KE: Depression-related hyperglycemia in type 1 diabetes: a mediational approach.

Psychosom Med , — Glasgow RE: Social-environmental factors in diabetes: Barriers to diabetes self-care. In Handbook of Psychology and Diabetes: a guide to psychological measurement in diabetes research and practice.

Edited by: Chur BC. Switzerland: Harwood Academic; — Toobert DJ, Glasgow RE: Assessing diabetes self-management: the summary of diabetes self-care activities questionnaire.

Wang RH, Lin LY, Cheng CP, Hsu MT, Kao CC: The psychometric testing of the diabetes health promotion self-care scale. J Nurs Res , — Lee NP, Fisher WP Jr: Evaluation of the Diabetes Self-Care Scale. J Appl Meas , 6: — Toobert DJ, Hampson SE, Glasgow RE: The summary of diabetes self-care activities measure: results from 7 studies and a revised scale.

Eigenmann CA, Colagiuri R, Skinner TC, Trevena L: Are current psychometric tools suitable for measuring outcomes of diabetes education? Bastos F, Severo M, Lopes C: Psychometric analysis of diabetes self-care scale translated and adapted to Portuguese.

Acta Med Port , 11— Choi EJ, Nam M, Kim SH, Park CG, Toobert DJ, Yoo JS, Chu SH: Psychometric properties of a Korean version of the summary of diabetes self-care activities measure. Int J Nurs Stud , — Michels MJ, Coral MH, Sakae TM, Damas TB, Furlanetto LM: Questionnaire of Diabetes Self-Care Activities: translation, cross-cultural adaptation and evaluation of psychometric properties.

Arq Bras Endocrinol Metabol , — Vincent D, McEwen MM, Pasvogel A: The validity and reliability of a Spanish version of the summary of diabetes self-care activities questionnaire.

Nurs Res , — Kav S, Akman A, Dogan N, Tarakci Z, Bulut Y, Hanoglu Z: Turkish validity and reliability of the summary of diabetes self-care activities measure for patients with type 2 diabetes mellitus. J Clin Nurs , — Morris AD, Boyle DI, McMahon AD, Greene SA, MacDonald TM, Newton RW: Adherence to insulin treatment, glycaemic control, and ketoacidosis in insulin-dependent diabetes mellitus.

Diabetes Audit and Research in Tayside Scotland. Medicines Monitoring Unit. Lancet , — QJM , — Lawrence DB, Ragucci KR, Long LB, Parris BS, Helfer LA: Relationship of oral antihyperglycemic sulfonylurea or metformin medication adherence and hemoglobin A1c goal attainment for HMO patients enrolled in a diabetes disease management program.

J Manag Care Pharm , — Krapek K, King K, Warren SS, George KG, Caputo DA, Mihelich K, Holst EM, Nichol MB, Shi SG, Livengood KB, Walden S, Lubowski TJ: Medication adherence and associated hemoglobin A1c in type 2 diabetes.

Ann Pharmacother , — Cohen HW, Shmukler C, Ullman R, Rivera CM, Walker EA: Measurements of medication adherence in diabetic patients with poorly controlled HbA 1c. Thomas D, Elliott EJ: Low glycaemic index, or low glycaemic load, diets for diabetes mellitus.

Cochrane Database Syst Rev Thomas DE, Elliott EJ: The use of low-glycaemic index diets in diabetes control. Br J Nutr , — Wikblad K, Montin K, Wibell L: Metabolic control, residual insulin secretion and self-care behaviours in a defined group of patients with type 1 diabetes.

Ups J Med Sci , 47— Schütt M, Kern W, Krause U, Busch P, Dapp A, Grziwotz R, Mayer I, Rosenbauer J, Wagner C, Zimmermann A, Kerner W, Holl RW, DPV Initiative: Is the frequency of self-monitoring of blood glucose related to long-term metabolic control?

Multicenter analysis including 24, patients from centers in Germany and Austria. Exp Clin Endocrinol Diabetes , — Malanda UL, Welschen LM, Riphagen II, Dekker JM, Nijpels G, Bot SD: Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin.

Poolsup N, Suksomboon N, Rattanasookchit S: Meta-analysis of the benefits of self-monitoring of blood glucose on glycemic control in type 2 diabetes patients: an update. Diabetes Technol Ther , — Allemann S, Houriet C, Diem P, Stettler C: Self-monitoring of blood glucose in non-insulin treated patients with type 2 diabetes: a systematic review and meta-analysis.

Curr Med Res Opin , — St John A, Davis WA, Price CP, Davis TM: The value of self-monitoring of blood glucose: a review of recent evidence. J Diabetes Complications , — Hirsch IB, Bode BW, Childs BP, Close KL, Fisher WA, Gavin JR, Ginsberg BH, Raine CH, Verderese CA: Self-Monitoring of Blood Glucose SMBG in insulin- and non-insulin-using adults with diabetes: consensus recommendations for improving SMBG accuracy, utilization, and research.

Polonsky WH, Fisher L: Self-monitoring of blood glucose in noninsulin-using type 2 diabetic patients: right answer, but wrong question: self-monitoring of blood glucose can be clinically valuable for noninsulin users.

Speight J, Browne JL, Furler J: Challenging evidence and assumptions: is there a role for self-monitoring of blood glucose in people with type 2 diabetes not using insulin?

Boulé NG, Haddad E, Kenny GP, Wells GA, Sigal RJ: Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials.

JAMA , — Thomas DE, Elliott EJ, Naughton GA: Exercise for type 2 diabetes mellitus. Tonoli C, Heyman E, Roelands B, Buyse L, Cheung SS, Berthoin S, Meeusen R: Effects of different types of acute and chronic training exercise on glycaemic control in type 1 diabetes mellitus: a meta-analysis.

Sports Med , — Parchman ML, Pugh JA, Noël PH, Larme AC: Continuity of care, self-management behaviors, and glucose control in patients with type 2 diabetes.

Med Care , — Sidorenkov G, Voorham J, Haaijer-Ruskamp FM, de Zeeuw D, Denig P: Association Between Performance Measures and Glycemic Control Among Patients With Diabetes in a Community-wide Primary Care Cohort.

Schectman JM, Schorling JB, Voss JD: Appointment adherence and disparities in outcomes among patients with diabetes. J Gen Intern Med , — Karter AJ, Parker MM, Moffet HH, Ahem AT, Ferrara A, Liu JY, Selby JV: Missed appointments and poor glycemic control: An opportunity to identify high-risk diabetic patients.

Nathan DM, Turgeon H, Regan S: Relationship between glycated haemoglobin levels and mean glucose levels over time. Nathan DM, Kuenen J, Borg R, Zheng H, Schoenfeld D, Heine RJ, the A1c-Derived Average Glucose ADAG Study Group: Translating the A1C assay into estimated average glucose values.

Bradley C: Translation of questionnaires for use in different languages and cultures.

Health Conditions Chevron. Self-care tools for effective diabetes control Health Chevron. Type 2 Diabetes Chevron. Contdol includes all the things you do to keep diabetss blood sugar levels as balanced as possible, which can play a vital role in your overall health and happiness. This term refers to the unique challenges and emotions that people with diabetes may experience, from the rigorous treatment regimen, to dealing with a complex medical system, to the daunting financial burden. Published on 4. Conyrol of this article:. Department of Effsctive and Selt-care Self-care tools for effective diabetes control Engineering, Antifungal essential oils of Hong Kong, Effectjve Kong, Hong Kong. Background: Mobile app-assisted self-care interventions are emerging promising tools to support self-care of patients with chronic diseases such as type 2 diabetes and hypertension. The effectiveness of such interventions requires further exploration for more supporting evidence. Methods: We followed the Cochrane Collaboration guidelines and searched MEDLINE, Cochrane Library, EMBASE, and CINAHL Plus for relevant studies published between January and January

Author: Sagor

4 thoughts on “Self-care tools for effective diabetes control

  1. Ich bin endlich, ich tue Abbitte, aber es kommt mir nicht ganz heran. Kann, es gibt noch die Varianten?

  2. Meiner Meinung nach ist das Thema sehr interessant. Ich biete Ihnen es an, hier oder in PM zu besprechen.

Leave a comment

Yours email will be published. Important fields a marked *

Design by