Theoretical Framework

Type 2 Diabetes (T2DM) Self-Management

Nursing 8782Jennifer Bauman, RN, BA, PCCN

December 2, 2013

T2DM

• In the U.S., diabetes affects 25.8 million people, or 8.3% of the population. T2DM accounts for 90 to 95% of cases (CDC, 2011).

• Diabetes incidence has doubled every 20 years since 1945 (King et al., 1999).

• Cost of diabetes in 2012: $245 billion (ADA, 2013).• Poor glycemic control results in renal, vascular, and ophthalmic

complications (CDC, 2011). • Proper glycemic control can prevent or delay the micro- and

macro-vascular complications that lead to poor outcomes (DCCT, 1993; Stratton et al., 2000).

• Appropriate glycemic control can be achieved through adequate self-management.

Glass & McAtee (2006)

Grey, Knafl, & McCorkle (2006)Self-and family Management Framework

Ryan & Sawin (2009)Individual and Family Self-Management Theory

Udlis (2011)

• Concept Analysis

Audulv, et al. (2009)

• Grounded theory

Sousa & Zauszniewski (2005)Enhance-Behavior Performance Model

Sousa & Zauszniewski (2005)

Bauman (12.2.2013)

Outcomes: glycemic control, diabetes-related

complications, self-rated health, health

care utilization/$

Self-Managem

ent Behaviors

Influencing Factors

Self-efficacyDepressive symptomsPerception of illness

Trajecotry/severity of illness

Co-morbid conditionsGenetics

Demographics (age, race, ethnicity, sex,

gender)Stress (perceived, diabetes-related,

biological)

PolicyHealth care system

Insurance status

Social supportAutonomy

supportHealthcare provider-patient

relationshipAccess to care

SESNeighborhoo

dCharacteristic

s of family/friendsSocial norms

References• American Diabetes Association (ADA). (2013, March 6). American Diabetes Association Releases New Research Estimating Annual

Cost of Diabetes at $245 billion. Retrieved December 1, 2013, from http://www.diabetes.org/for-media/2013/annual-costs-of-diabetes-2013.html?loc=cost-of-diabetes.

• Audulv, A., Norbergh, K.G., Asplund, K., & Hornsten, A. (2009). An ongoing process of inner negotiation – a Grounded Theory study of self-management among people living with chronic illness. Journal of Nursing and Healthcare of Chronic Illness, 1, 283–293. doi: 10.1111/j.1752-9824.2009.01039.x.

• Centers for Disease Control and Prevention (CDC). (2011). National Diabetes Fact Sheet. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.

• Diabetes Control and Complications Trial Research Group (DCCT). (1993). The effect of intensive treatment of diabetes on the development and progression of long term complications in insulin-dependent diabetes mellitus. New England Journal of Medicine, 329, 977–986.

• Grey, M., Knafl, K., McCorkle, R. (2006). A framework for the study of self- and family management of chronic conditions. Nursing Outlook, 54, 278-286. doi:10.1016/j.outlook.2006.06.004

• King, P., Peacock, P., & Donnelly, R. (1999). The UK Prospective Diabetes Study (UKPDS): Clinical and therapeutic implications for type 2 diabetes. British Journal of Clinical Pharmacology, 48(5), 643-648.

• Ryan, P., & Sawin, K.J. (2009). The Individual and Family Self-Management Theory: Background and perspectives on context, process, and outcomes. Nursing Outlook, 57(4), 217-225.

• Sousa, V.D., & Zauszniewski, J.A. (2005). Toward a theory of diabetes self-care management. Journal of Theory Construction and Testing, 9, 61–67.

• Stratton, I.M., Adler, A.I., Andrew, H., Neil, W., Matthews, D.R., Manley, S.E., Cull, C.A., Hadden, D. , Turner, R.C., Holman, R.R. (on behalf of the U.K. Prospective Diabetes Study Group). (2000). Association of glycemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): Prospective observational study. British Medical Journal, 321, 405–412.

• Udlis, K.A. (2011). Self-management in chronic illness: Concept and dimensional analysis. Journal of Nursing and Healthcare of Chronic Illness, 3, 130-139. doi: 10.1111/j.1752-9824.2011.01085.x.

Bauman (2013)Theoretical Framework for T2DM Self-Management

Global

Macro

Meso/Mezzo

Micro