Active self-care improves blood sugar control

NEW YORK (Reuters Health) - Adults with type 1 diabetes, sometimes referred to as "juvenile diabetes," who use an insulin pump, have better control over their blood sugar levels if they actively participate in self-care; have realistic expectations of pump performance; and have a clear recollection of how they felt when they were first diagnosed with diabetes, according to results of a new study.

Insulin pumps are devices about the size of a cell phone that are worn outside the body, continuously delivering insulin through a cannula implanted underneath the skin. Based on blood sugar monitoring, the device can be adjusted to deliver various amounts of insulin, removing the need for daily injections.

Dr. Katie Weinger, of Harvard Medical School, Boston, and colleagues recruited 30 adults with long-term type 1 diabetes who used an insulin pump to take part in focus groups that were loosely formed on the basis of the subjects' blood sugar level, also know as glucose or glycemic level.

Five focus groups were formed that included two groups with low average glucose levels, one with mild elevations in glucose and two more with high levels. From the discussions, the authors identified three major themes: the impact of the pump on diabetes self-care; emotional reactions to the insulin pump; and body image and social acceptance.

Subjects in the low glucose group described the pump as a tool to meet glycemic goals. These patients had a more active approach to diabetes. Patients who described the pump as a panacea had a more passive approach to self-care and had poorer glycemic control.

Patients in the low glucose groups reported emotional reactions to starting the insulin pump that reminded them of feelings they experienced when they were initially diagnosed with diabetes. However, those in the two high blood glucose groups did not report experiencing these feelings.

Participants with low blood glucose said the pump helped them better accept their diabetes and feel less ashamed and more able to speak about their condition with others, Weinger and colleagues report in their study, published in the March issue of Diabetes Care.

Conversely, those with poor blood glucose control "spoke of being 'tired' of the pump," the researchers note. "They described feeling discouraged and 'frustrated' that the pump did not 'fix everything' and that 'it's still a lot of work.'"

The researchers found women to be more concerned than men about body image and social acceptance with insulin pump use.

Ways to improve how diabetics manage the use of their pump "should include evaluation and discussion of active versus passive approaches to self-care, recall of diabetes diagnosis, expectations of the pump, and pump-related self-consciousness and body image concerns," Weinger's group concludes.

SOURCE: Diabetes Care, March 2007.