Learning What Works: Illness Coherence and Self-Monitoring of Blood Glucose in Type 2 Diabetes Management

Abstract

Self-monitoring of blood glucose (SMBG) can be a useful tool to provide more immediate feedback to type 2 diabetes patients, but has had mixed results for improving glycemic control in patients who are not prescribed insulin. To understand how patients with type 2 diabetes may learn to use SMBG and benefit from it, two studies were conducted. The theoretical construct of illness coherence, a component of the Common Sense Model, was used as a framework for understanding SMBG's role in diabetes self-management. Illness coherence is the sense of understanding that results from the alignment of patient's personal model of illness with experiential feedback. As a mode of medical feedback, SMBG holds promise for strengthening patients' illness coherence, which could lead to maintaining effective health behaviors. Two studies aimed to answer the following questions: 1) How does illness coherence develop? and 2) Can illness coherence predict improvements in diabetes self-care behaviors? In Study 1, semi-structured interviews with adults with well-controlled type 2 diabetes explored strategies they used to improve their glycemic control and develop illness coherence. Study 2 tested a new feedback-based method of assessing illness coherence and its relationship to diabetes self-care behaviors. Results from Study 1 demonstrate that patients with well-controlled type 2 diabetes approached SMBG with an experimental attitude, creating novel situations from which they could learn from their glucose meter readings and employing active problem solving. Participants also described engaging in open communication with providers. In Study 2, two facets of the illness coherence construct emerged: confidence in diabetes feedback, and diabetes-related confusion. While using feedback was positively correlated with engaging in more diabetes self-care behaviors, greater confusion about diabetes feedback was associated with greater distress and worse glycemic control. Recommendations are made for translating approaches utilized by successful diabetes self-managers into educational interventions for patients who are struggling with managing their illness and improving their glycemic control.