Impact of neuropathy on the adherence to diabetes-related self-care activities: a cross-sectional study
Received 2 March 2016
Accepted for publication 4 May 2016
Published 1 July 2016 Volume 2016:10 Pages 1169—1175
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 2
Editor who approved publication: Dr Johnny Chen
Bogdan Timar,1 Romulus Timar,2 Adalbert Schiller,2 Cristian Oancea,3 Deiana Roman,1 Mihaela Vlad,2 Bogdan Balinisteanu,4 Octavian Mazilu5
1Department of Functional Sciences, 2Second Department of Internal Medicine, 3Department of Infectious Diseases, 4Department of Microscopic Morphology, 5First Department of Surgery, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
Purpose: The purpose of this study was to evaluate the impact of the presence and severity of neuropathy and depression on the patient’s adherence to diabetes-related self-care activities (DRSCA) in a cohort of patients with type 2 diabetes mellitus (T2DM).
Patients and methods: In this cross-sectional, noninterventional study, 198 patients with T2DM were enrolled according to a population-based, consecutive-case enrollment principle. In all patients, the adherence to DRSCA was evaluated using the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire; a higher SDSCA score is associated with a better adherence. The presence and severity of neuropathy was assessed using the Michigan Neuropathy Screening Instrument (MNSI) and the severity of depression using the Patient Health Questionnaire-9 (PHQ-9).
Results: The presence of neuropathy was associated with a decreased SDSCA score (26 points vs 37 points; P<0.001), an increased severe depression prevalence (24.7% vs 4.3%; P<0.001), and an increased PHQ-9 score (12 points vs 7 points; P<0.001). The MNSI score was reverse correlated with SDSCA score (r=-0.527; P<0.001) and positively correlated with PHQ-9 score (r=0.495; P<0.001). The reverse correlation between MNSI score and SDSCA score was present for all the subcomponents of SDSCA questionnaire (diet, exercise, glycemic monitoring, and foot care).
Conclusion: The presence of neuropathy is associated with decreases in the quality of adherence to DRSCA in patients with T2DM and with increases in the symptomatology of depression. The significant, negative association between the severity of T2DM and the quality of disease self-management points to a possible loop-type relationship between these two components, being possible a reciprocal augmentation with negative consequences on the global management of the disease.
Keywords: type 2 diabetes mellitus, diabetes self-care, diabetic neuropathy, depression
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