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Perceived barriers to diabetes self-management tied to diabetic retinopathy risk

Roshini Claire Anthony
03 Jan 2018

Individuals who have a higher perception of barriers to diabetes self-management may be at an elevated risk for diabetic retinopathy (DR), according to findings of the Singapore Diabetes Management Project study.

“[A] greater level of perceived barriers to [diabetes self-management] in Asian patients with type 2 diabetes [T2D] was associated with higher odds of having any DR, mild to moderate DR, and severe DR,” said the researchers.

“More important, these findings were independent of the parameters of diabetes control [HbA1c, blood pressure, and lipid levels], suggesting that, aside from pharmaceutical management, measures to address these perceived barriers, including counselling, goal setting, and logistical support for access to health care, may help to prevent or delay the risks of DR,” they said.

In this cross-sectional, single-centre study, researchers used a 23-item Asian-validated questionnaire to gauge the level of perceived barriers to diabetes self-management of 361 Asian patients (mean age 57 years, 29.1 percent female) with T2D who were recruited at the Singapore National Eye Centre.

Results showed that individuals with a higher perception of barriers to diabetes self-management had an increased risk of DR (odds ratio [OR], 1.32, 95 percent confidence interval [CI], 1.06–1.66), regardless of whether it was mild to moderate (levels 20–43 on the Early Treatment Diabetic Retinopathy Study; OR, 1.30, 95 percent CI, 1.01–1.68) or severe DR (levels ≥53; OR, 1.36, 95 percent CI, 1.03–1.79). [JAMA Ophthal 2017;doi:10.1001/jamaophthalmol.2017.4888]

When compared with patients with the lowest perceived barriers to diabetes self-management, those with the highest perceived barriers had more than twice the risk of having mild to moderate (OR, 2.52, 95 percent CI, 1.30–4.89; p=0.006) or severe DR (OR, 2.41, 95 percent CI, 1.15–5.02; p=0.02).

“[B]arriers to diabetes self-management … is defined as a process in which the knowledge, skills, and abilities required for a patient to adequately manage his or her diabetes are facilitated,” said the researchers, citing these barriers as a major contributor to poor diabetes control.

“[C]ommunity and clinical health efforts to overcome patients’ perceived barriers to [diabetes self-management], including diabetes support groups and evaluation of individual patient perception toward diabetes with the goal of making realistic and specific recommendations for self-care activities, are warranted to combat the increasing incidence of diabetes and DR in Asia,” they said.

The researchers acknowledged that the mechanisms behind the association between barriers to self-management and DR were not assessed in this study, neither were the mental health and health literacy of the participants, thus limiting the understanding of the role these factors play in the association, and presents an avenue for future research, said the researchers.

The perceived barriers were also only assessed from the patients’ perspective, though previous research has highlighted that barriers to diabetes self-management from healthcare professionals also contribute towards poor diabetes management, the impact of which on DR requires further study, they said. 

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