Abstract
An estimated 34.2 million people or 10.5% of the U.S. population have diabetes (Centers for Disease Control and Prevention, 2020). General classifications of diabetes include type 1 diabetes and type 2 diabetes. Type 1 diabetes is associated with autoimmune beta cell destruction and absolute insulin deficiency. Type 2 is diabetes is associated with loss of adequate beta cell insulin secretion and insulin resistance and accounts for 90%–95% of all diabetes cases (American Diabetes Association, 2020). Diabetes self-care is vital for effective glycemic control to avoid and/or reduce diabetes-related complications (e.g., peripheral neuropathy, blindness, stroke, and kidney disease) in people with diabetes and especially in those with comorbid conditions.
The AADE7 self-care behaviors® include healthy eating, being active, monitoring, taking medication, problem solving, reducing risks, and healthy coping (American Association of Diabetes Educators, 2020). However, people with diabetes face challenges adhering to their complex dietary, medication, physical activity, and blood glucose monitoring regimens. These challenges are complicated by financial constraints, perceived lack of self-control, fears associated with diabetes and self-care, and lack of social support. During today’s COVID-19 pandemic, it is even more important that we conduct future research to understand these challenges associated with diabetes self-care, especially among those diagnosed with the coronavirus. This understanding will assist health care providers in providing future resources to assist people with the AADE7 self-care behaviors®.
To add to the complexity of diabetes self-care, adults with diabetes often experience other chronic health conditions and comorbidities such as depression, anxiety, and stress. The relationship of depression to diabetes self-care is clearer than that of anxiety. The role of stress in both the development and self-care of diabetes has been an area of research focus. In a recent study, we found that depression, anxiety, and stress were not significantly associated with self-care behaviors in African American adults with type 2 diabetes; however, depression, anxiety, and stress were positively associated with glycated hemoglobin (Chlebowy et al., 2019). Clearly, there is a need to further examine the relationships of these psychological variables to diabetes self-care behaviors and glycemic control in people with diabetes.
Social support can have a positive impact on psychological outcomes such as depression, anxiety, and stress in people with diabetes. Al-Dwaikat et al. (2020) found that social support had a positive impact on psychological outcomes in adults with type 2 diabetes; those who reported higher levels of social support had less depression, anxiety, and stress when compared to their counterparts who reported lower levels of social support. Support from family, peers, and health care providers may positively influence adherence to diabetes self-care behaviors in adults with diabetes; however, it is important to understand that social support may not always be positive and may be problematic in some situations. Therefore, additional research studies are necessary to examine the impact of problematic social support on psychological outcomes and diabetes self-care behaviors in people with diabetes.
Moreover, it is important for us to understand the complexity of diabetes self-care and the daily challenges experienced by those with diabetes. Even the best evidence-based approaches cannot produce beneficial effects if these challenges are not clearly understood. Interprofessional research teams should further examine the relationships among depression, anxiety, and stress to diabetes self-care behaviors and the impact of problematic support on psychological outcomes in people with diabetes. In addition, it is vital that we further examine the diabetes self-care challenges in people experiencing health disparities. Understanding these challenges is important as we assist them to adhere to their complex self-care regimens to avoid and/or reduce diabetes-related complications.