Diabetes mellitus type 2: factors related to adherence to self-care

the adherence to self-care was greater when it comes to medications (M_d=7.0) and foot care (M_d= 6.0), but lower in regard to blood sugar testing (M_d=1.0), exercise (M_d=2,0), and diet (general) (M_d=4.0). The variables age group (p=0.007), educational level (p=0.015), body mass index (p=0.035), complications with diabetes (p=0.009), and nutritional follow-up (p=0.000) had associations with self-care activities.

Conclusions:

identifying the factors related to the adherence to self-care was found to be essential to strengthen the line of care in chronic diseases and to direct educational actions, aiming to improve the quality of life of people with diabetes.

Descriptors:
Type 2 Diabetes Mellitus; Self Care; Behavior; Nursing Care; Treatment Adherence and Compliance

Variables	n	%
Sex
Female	188	69.6
Male	82	30.4
Age group (years)
18-39	5	1.9
40-59	82	30.4
60-69	106	39.3
> 70	77	28.5
Marital Status
Married/Stable Union	127	47.0
Single	79	29.3
Widow/widower	53	19.6
Divorced/Separated	11	4.1
Years of formal education
Illiterate	25	9.3
Elementary school	156	57.8
High School	77	28.5
Higher education	12	4.4
Profession
Retired	136	50.4
Works at home	76	28.2
Active	45	16.7
Unemployed	13	4.8
Family income
Less than 1 minimum wage^* * Minimum wage of R$ 1,045.00 in 2020.	36	13.3
From 1 to 2 minimum wages	217	80.4
From 3 to 5 minimum wages	14	5.2
From 6 to 10 minimum wages	3	1.1

Self-care activities for diabetes	Frequency (No. of days of the week)		Median ± IQR^* * Median and interquartile range;
Self-care activities for diabetes	0 to 4 days n (%)	5 to 7 days n (%)	Median ± IQR^* * Median and interquartile range;
Diet (general)
Followed a healthful eating plan	137 (50.7)	133 (49.3)	4.0 ± 3.0
Followed your eating plan	156 (57.8)	114 (42.2)	4.0 ±4.8
Diet (specific)
Eat five or more servings of fruit and/or vegetables	114 (42.2)	156 (57.8)	5.0 ±4.0
eat high fat foods such as red meat or full-fat dairy products	202 (74.8)^ Results described before the values were inverted.	68 (25.2)^ Results described before the values were inverted.	1.0 ±1.8^ Results described before the values were inverted.
meals include sweets	245 (90.7)^ Results described before the values were inverted.	25 (9.3)^ Results described before the values were inverted.	0.0 ±1.0^ Results described before the values were inverted.
Exercise
At least 30 minutes of physical activity	209 (77.4)	61 (22.6)	2.0 ±4.0
Participated in a specific exercise session	222 (82.2)	48 (17.8)	0.0 ±3.0
Blood sugar testing
Tested blood sugar	235 (87)	35 (13.0)	1.0 ±2.0
Tested blood sugar the number of times recommended by your health care provider	236 (87.4)	34 (12.6)	1.0 ±2.0
Foot care
Checked the feet	88 (32.6)	182 (67.4)	5.0 ±3.8
Inspected the inside of shoes	110 (40.7)	160 (59.3)	5.0 ±3.0
Dried between toes after washing	70 (25.9)	200 (74.1)	6.0 ±3.0
Medications
Took recommended diabetes medication	23 (8.5)	247 (91.5)	7.0 ±0.0
Took recommended insulin injections	10 (15.6)	54 (84.4)	7.0 ±0.0
Took recommended number of diabetes pills	23 (9.4)	221 (90.6)	7.0 ±0.0

Variables	Diet (general)		Diet (specific) (fruits and/or vegetables)		Diet (specific) (sweets)
Variables	Median ± IQR^* * Median and interquartile range;	p value^ Mann-Whitney's and Kruskal-Wallis's tests.	Median ± IQR^* * Median and interquartile range;	p value^ Mann-Whitney's and Kruskal-Wallis's tests.	Median ± IQR^* * Median and interquartile range;	p value^ Mann-Whitney's and Kruskal-Wallis's tests.
Age group (years)		0.018		0.723		0.811
18-39	7.0 ± 7.0		7.0 ± 6.0		7.0 ± 1.0
40-59	4.0 ± 3.8		5.0 ± 4.0		7.0 ± 1.0
60-69	5.0 ± 3.0		5.0 ± 4.0		7.0 ± 1.0
> 70	3.5 ± 3.0		5.0 ± 3.0		7.0 ± 1.0
Years of formal education		0.110		0.015		0.138
Illiterate	3.5 ± 4.0		5.0 ± 3.0		7.0 ± 1.0
Elementary school	4.0 ± 3.0		5.0 ± 3.0		7.0 ± 1.0
High School	4.0 ± 3.0		5.0 ± 4.0		7.0 ± 1.0
Higher education	5.5 ± 3.0		6.0 ± 1.2		6.0 ± 2.0
Family income		0.926		0.117		0.033
Less than 1 minimum wage	4.5 ± 4.0		5.0 ± 4.0		7.0 ± 0.0
From 1 to 2 minimum wages	4.0 ± 3.5		5.0 ± 3.0		7.0 ± 1.0
From 3 to 5 minimum wages	4.0 ± 3.5		6.5 ± 1.8		6.0 ± 1.0
From 6 to 10 minimum wages	4.0 ± 1.8		4.0 ± 1.5		5.0 ± 3.0
Education group for diabetes		0.553		0.622		0.074
Yes	4.0 ± 3.5		5.0 ± 4.0		7.0 ± 1.0
No	4.0 ± 4.0		5.0 ± 3.0		7.0 ± 1.0
Body Mass Index		0.035		0.467		0.035
Underweight	2.0 ± 0.0		7.0 ± 0.0		5.0 ± 0.0
Normal	5.0 ± 4.0		5.0 ± 4.0		7.0 ± 0.2
Overweight	4.0 ± 4.0		5.0 ± 3.0		7.0 ± 1.0
Obesity	3.5 ± 3.0		5.0 ± 3.0		7.0 ± 1.0
Time of diagnoses		0.489		0.157		0.770
Less than 5 years	4.0 ± 4.0		5.0 ± 3.0		7.0 ± 1.0
5 to 10	4.0 ± 3.5		5.0 ± 4.0		7.0 ± 1.0
More than 10 years	4.0 ± 3.0		5.0 ± 4.0		7.0 ± 1.0
Nutritional follow up		0.000		0.000		0.276
Yes	5.0 ± 3.0		6.0 ± 3.0		7.0 ± 0.5
No	4.0 ± 3.0		5.0 ± 3.0		7.0 ± 1.0
Follow up with nurse		0.705		0.892		0.975
Yes	4.0 ± 2.0		5.0 ± 3.0		7.0 ± 1.0
No	4.0 ± 4.0		5.0 ± 4.0		7.0 ± 1.0

Variables	Exercise		Blood sugar testing
Variables	Median ± IQR^* * Median and interquartile range;	p value^ Mann-Whitney's and Kruskal-Wallis's tests.	Median ± IQR^* * Median and interquartile range;	p value^ Mann-Whitney's and Kruskal-Wallis's tests.
Age group (years)		0.007		0.545
18-39	0.0 ± 3.5		1.0 ± 7.0
40-59	1.5 ± 3.0		1.0 ± 1.0
60-69	2.0 ± 4.5		1.0 ± 2.0
> 70	0.0 ± 2.0		1.0 ± 1.0
Years of formal education		0.354		0.040
Illiterate	1.0 ± 5.0		0.0 ± 1.0
Elementary school	1.5 ± 4.0		1.0 ± 1.0
High School	1.5 ± 3.0		1.0 ± 2.0
Higher education	1.2 ± 2.0		3.5 ± 6.0
Education group for diabetes		0.111		0.164
Yes	2.0 ± 3.2		1.0 ± 2.0
No	1.0 ± 3.5		1.0 ± 1.0
Body Mass Index		0.086		0.045
Underweight	1.0 ± 0.0		7.0 ± 0.0
Normal	1.5 ± 3.5		1.0 ± 1.0
Overweight	1.5 ± 5.0		1.0 ± 1.0
Obesity	0.8 ± 2.6		1.0 ± 2.0
Time of diagnoses		0.149		0.056
Less than 5 years	1.5 ± 4.0		0.5 ± 1.0
5 to 10	2.0 ± 3.5		1.0 ± 2.0
More than 10 years	1.0 ± 3.0		1.0 ± 2.0
Medications		0.229		0.000
Only oral antidiabetic	1.5 ± 3.5		1.0 ± 1.0
Oral antidiabetic and insulin	1.0 ± 3.0		2.0 ± 6.5
Only insulin	0.5 ± 2.5		5.0 ± 6.2
Diabetes complications		0.009		0.045
Yes	0.8 ± 3.0		1.0 ± 2.0
No	2.0 ± 4.0		2.0 ± 1.0
Medical follow up		0.101		0.003
Yes	1.5 ± 3.5		1.0 ± 2.0
No	0.0 ± 1.2		0.0 ± 0.0
Follow up with nurse		0.413		0.144
Yes	2.0 ± 4.0		1.0 ± 2.0
No	1.0 ± 3.5		1.0 ± 1.0

Variables	Foot care (checking the feet)		Foot care (drying between toes)		Medications (taking medications)
Variables	Median ± IQR^* * Median and interquartile range;	p value^ Mann-Whitney's and Kruskal-Wallis's tests.	Median ± IQR^* * Median and interquartile range;	p value^ Mann-Whitney's and Kruskal-Wallis's tests.	Median ± IQR^* * Median and interquartile range;	p value^ Mann-Whitney's and Kruskal-Wallis's tests.
Age group (years)		0.048		0.123		0.930
18-39	7.0 ± 1.0		1.0 ± 5.0		7.0 ± 0.0
40-59	6.0 ± 3.8		6.0 ± 2.0		7.0 ± 0.0
60-69	5.0 ± 2.8		6.0 ± 1.0		7.0 ± 0.0
> 70	5.0 ± 3.0		5.0 ± 2.0		7.0 ± 0.0
Years of formal education		0.070		0.124		0.825
Illiterate	5.0 ± 5.0		5.0 ± 3.0		7.0 ± 0.0
Elementary school	5.0 ± 2.2		6.0 ± 1.0		7.0 ± 0.0
High School	6.0 ± 3.0		6.0 ± 2.0		7.0 ± 0.0
Higher education	5.5 ± 4.8		5.5 ± 6.2		7.0 ± 0.0
Education group for diabetes		0.078		0.288		0.235
Yes	6.0 ± 2.0		6.0 ± 2.0		7.0 ± 0.0
No	5.0 ± 4.0		5.0 ± 3.0		7.0 ± 0.0
Time of diagnoses		0.151		0.605		0.110
Less than 5 years	5.0 ± 3.0		5.0 ± 2.0		7.0 ± 0.0
5 to 10	6.0 ± 2.0		6.0 ± 3.0		7.0 ± 0.0
More than 10 years	5.0 ± 4.0		5.0 ± 2.8		7.0 ± 0.0
Diabetes complications		0.772		0.967		0.668
Yes	5.0 ± 4.0		5.0 ± 3.0		7.0 ± 0.0
No	5.0 ± 2.0		6.0 ± 1.0		7.0 ± 0.0
Medical follow up		0.817		0.675		0.098
Yes	5.0 ± 3.0		6.0 ± 2.0		7.0 ± 0.0
No	5.0 ± 4.0		5.0 ± 5.5		7.0 ± 0.5
Follow up with nurse		0.088		0.012		0.124
Yes	5.0 ± 3.0		5.0 ± 2.0		7.0 ± 0.0
No	5.0 ± 3.0		6.0 ± 2.0		7.0 ± 0.0

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[1] Corresponding author: Raquel de Aguiar Portela, E-mail: raquelportela23@hotmail.com