Self-management activities in diabetes care: A systematic review
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Self-management activities in diabetes care: A systematic review
Article in Australian health review: a publication of the Australian Hospital Association · September 2013
DOI: 10.1071/AH13060 · Source: PubMed
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Meaghan Coyle
RMIT University
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James Cook University
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Self-management activities in diabetes care: A systematic review
Article in Australian health review: a publication of the Australian Hospital Association · September 2013
DOI: 10.1071/AH13060 · Source: PubMed
CITATIONS
31
READS
1,705
3 authors:
Some of the authors of this publication are also working on these related projects:
Constructing a paper for Asian Development Bank View project
Chinese medicine for herpes zoster View project
Meaghan Coyle
RMIT University
39 PUBLICATIONS 470 CITATIONS
SEE PROFILE
Karen Francis
Australian Catholic University Ballarat Australia
188 PUBLICATIONS 2,575 CITATIONS
SEE PROFILE
Ysanne Chapman
James Cook University
142 PUBLICATIONS 1,306 CITATIONS
SEE PROFILE
All content following this page was uploaded by Ysanne Chapman on 02 June 2014.
The user has requested enhancement of the downloaded file.
Self-management activities in diabetes care: a systematic review
Meaghan E. Coyle 1,4 PhD, BHlthSc(Acup), Research Fellow
Karen Francis2 RN, PhD, BHSN, DHSN, Head of School
Ysanne Chapman3 RN, PhD, MSc (Hons), BEd(Nsg), GDE, DNE, DRM, MRCNA, Dean
1 RMIT University, Plenty Road, PO Box 71, Bundoora, Vic. 3083, Australia.
2 School Nursing, Midwifery and Indigenous Health, Charles Sturt University, Wagga Wagga Campus, Boorooma
Street, Locked Bag 588, Wagga Wagga, NSW 2678, Australia. Email: kfrancis@csu.edu.au
3 School of Nursing and Midwifery, CQ University, Mackay Campus, Boundary Road, PO Box 5606, Mackay MC,
Qld 4741, Australia. Email: y.chapman@cqu.edu.au
4 Corresponding author. Email: meaghan.coyle@rmit.edu.au
Abstract
Objective. To identify the range of self-management activities people diagnosed with diabetes engage in to manage
their disease, the frequency of use, and whether self-management practices change over time.
Methods. A systematic review of the literature was undertaken. Thirty-two studies identified through electronic
databases met the inclusion criteria and were included in the review.
Results. The study found that people living with diabetes undertake regular self-management activities and that
compliance with medication regimes is high. Adherence, however, varied with respect to blood glucose testing, diet, physical
activity and foot care. Levels of physical activity were not found to change over time. Evidence suggests that some people
with diabetes modify their self-management practices in response to factors such as holidays.
Conclusions. The review suggests that the majority of people with diabetes self-manage, although there is variation in
adherence to key self-management activities. How self-management practices change over time and whether this impacts on
health outcomes is an area for future research.
What is known about the topic? Self-management is key to diabetes control; however, many papers have described
adherence as variable. Although there is a growing body of knowledge on adherence to self-management strategies, the
question of whether self-management practices change over time has not been explored.
What does this paper add? This review found that adherence to medication regimes was highest of all self-management
strategies, whereas considerable variation exists for self-monitoring of blood glucose, dietary changes, physical activity and
foot care. The findings suggest that adherence varies under special circumstances; however, the question of whether self-
management practices change over time remains unanswered.
What are the implications for practitioners? Continued efforts are necessary to promote awareness of the importance of
diabetes self-management and adherence to regular self-care.
Received 20 March 2013, accepted 29 July 2013, published online6HSWHPEHU
Introduction
Chronic disease, including diabetes, it is argued will be the
greatest health challenge globally in the 21st century. 1,2 Globally,
the prevalence of diabetes was estimated to be 8.3% in the year
2012,3 with type 2 diabetes contributing to 90% of cases.2 People
with diabetes use healthcare resources at two and a half times
the rate of people without diabetes, 4 and the mean global cost
for diabetes-related expenditure per person is US$1270.04 per
annum. 3
In Australia, estimates for the year 2012 suggest that diabetes
affects 9.55% of the population, 3 with the majority of this
proportion living with type 2 diabetes. 5 The Australian Institute
for Health and Welfare indicates that diabetes is the eighth
leading cause of burden of disease in Australia,6 behind cancer,
cardiovascular disease and mental and neurological disorders,
placing a large burden on the healthcare system. Economic
costs associated with diabetes treatment for Australians are high
in comparison with global costs (the mean diabetes-related
expenditure per person in Australia is US$4643.21 (approximate-
ly A$4500), compared with the global mean cost of
US$1270.04).3 Self-management education and support are
seen as critical in improving outcomes for people with diabetes,
as well as reducing the human and economic burden of
diabetes. 7,8
Journal compilation Ó AHHA 2013 www.publish.csiro.au/journals/ahr
CSIRO PUBLISHING
Australian Health Review, 2013, 37, 513–522 Feature
http://dx.doi.org/10.1071/AH13060
MODELS OF CARE
Meaghan E. Coyle 1,4 PhD, BHlthSc(Acup), Research Fellow
Karen Francis2 RN, PhD, BHSN, DHSN, Head of School
Ysanne Chapman3 RN, PhD, MSc (Hons), BEd(Nsg), GDE, DNE, DRM, MRCNA, Dean
1 RMIT University, Plenty Road, PO Box 71, Bundoora, Vic. 3083, Australia.
2 School Nursing, Midwifery and Indigenous Health, Charles Sturt University, Wagga Wagga Campus, Boorooma
Street, Locked Bag 588, Wagga Wagga, NSW 2678, Australia. Email: kfrancis@csu.edu.au
3 School of Nursing and Midwifery, CQ University, Mackay Campus, Boundary Road, PO Box 5606, Mackay MC,
Qld 4741, Australia. Email: y.chapman@cqu.edu.au
4 Corresponding author. Email: meaghan.coyle@rmit.edu.au
Abstract
Objective. To identify the range of self-management activities people diagnosed with diabetes engage in to manage
their disease, the frequency of use, and whether self-management practices change over time.
Methods. A systematic review of the literature was undertaken. Thirty-two studies identified through electronic
databases met the inclusion criteria and were included in the review.
Results. The study found that people living with diabetes undertake regular self-management activities and that
compliance with medication regimes is high. Adherence, however, varied with respect to blood glucose testing, diet, physical
activity and foot care. Levels of physical activity were not found to change over time. Evidence suggests that some people
with diabetes modify their self-management practices in response to factors such as holidays.
Conclusions. The review suggests that the majority of people with diabetes self-manage, although there is variation in
adherence to key self-management activities. How self-management practices change over time and whether this impacts on
health outcomes is an area for future research.
What is known about the topic? Self-management is key to diabetes control; however, many papers have described
adherence as variable. Although there is a growing body of knowledge on adherence to self-management strategies, the
question of whether self-management practices change over time has not been explored.
What does this paper add? This review found that adherence to medication regimes was highest of all self-management
strategies, whereas considerable variation exists for self-monitoring of blood glucose, dietary changes, physical activity and
foot care. The findings suggest that adherence varies under special circumstances; however, the question of whether self-
management practices change over time remains unanswered.
What are the implications for practitioners? Continued efforts are necessary to promote awareness of the importance of
diabetes self-management and adherence to regular self-care.
Received 20 March 2013, accepted 29 July 2013, published online6HSWHPEHU
Introduction
Chronic disease, including diabetes, it is argued will be the
greatest health challenge globally in the 21st century. 1,2 Globally,
the prevalence of diabetes was estimated to be 8.3% in the year
2012,3 with type 2 diabetes contributing to 90% of cases.2 People
with diabetes use healthcare resources at two and a half times
the rate of people without diabetes, 4 and the mean global cost
for diabetes-related expenditure per person is US$1270.04 per
annum. 3
In Australia, estimates for the year 2012 suggest that diabetes
affects 9.55% of the population, 3 with the majority of this
proportion living with type 2 diabetes. 5 The Australian Institute
for Health and Welfare indicates that diabetes is the eighth
leading cause of burden of disease in Australia,6 behind cancer,
cardiovascular disease and mental and neurological disorders,
placing a large burden on the healthcare system. Economic
costs associated with diabetes treatment for Australians are high
in comparison with global costs (the mean diabetes-related
expenditure per person in Australia is US$4643.21 (approximate-
ly A$4500), compared with the global mean cost of
US$1270.04).3 Self-management education and support are
seen as critical in improving outcomes for people with diabetes,
as well as reducing the human and economic burden of
diabetes. 7,8
Journal compilation Ó AHHA 2013 www.publish.csiro.au/journals/ahr
CSIRO PUBLISHING
Australian Health Review, 2013, 37, 513–522 Feature
http://dx.doi.org/10.1071/AH13060
MODELS OF CARE
Self-management requires active involvement of the individ-
ual in their care, and is advocated by clinical practice guidelines
from the USA, UK and globally. 8–11 Effective self-management
requires that individuals be committed to understanding their
illness and treatment options, working with health professionals
in developing a plan of care, undertaking activities to protect and
promote health, monitoring and managing symptoms of the
condition, and managing the impact of the condition on physical
and emotional functioning and interpersonal relationships. 12 The
International Diabetes Foundation’s clinical practice guidelines
for type 2 diabetes extends this, stating that protocols for self-
monitoring blood glucose
. . . should only be made available to people with diabetes
when they have the knowledge, skills and willingness to use
the information obtained through testing to actively adjust
treatment, enhance understanding of diabetes, and assess
the effectiveness of the management plan on diabetes
control (p. 50). 9
Current evidence-based management of type 2 diabetes in
Australia involves a team approach where the patient is the central
member of the team and self-monitoring is promoted. 13 Once a
medical regimen is established (if required), the onus is on the
patient to manage their disease through blood glucose testing,
taking medication, and following a regular eating and exercise
plan. 14 Self-management, however, goes beyond simple perfor-
mance of these tasks. Effective self-management requires indi-
viduals to have the ability to integrate information and respond
accordingly, and adapt to problems as they arise. 15 Effectively,
patients become experts on their disease.
The American Association of Diabetes Educators advocate
seven self-care behaviours to promote healthy outcomes, includ-
ing healthy eating, physical activity, monitoring indicators of
diabetes control (including blood glucose and glycosylated hae-
moglobin), taking medication, problem solving and healthy
coping. 16 Self-care activities, also referred to as self-management
activities, include behaviours undertaken by people to manage
their disease. 17 Anecdotal evidence suggests that people with
diabetes undertake a range of activities for self-care, including
accessing services that are outside the mainstream healthcare
system and often independent of medical advice. There is a wealth
of research on interventions to improve diabetes self-manage-
ment, 18,19 and many papers now report on adherence to diabetes
self-management activities and the regularity with which they are
used. 20
The aim of the present paper was to undertake a systematic
review of the literature to examine the self-management activities
utilised by people with diabetes, how regularly self-management
activities are undertaken, and whether self-management practices
change over time as familiarity with self-management activities
increases and knowledge of self-care improves, or in response to
special conditions.
Methods
A literature search was undertaken in August 2012 to identify the
self-management activities used by people living with diabetes.
Search terms included diabetes, self-management, self-care,
activity, strategy, self-report and frequency. Online databases
searched included PubMed, Embase, CINAHL, and the Cochrane
Library (searched from inception to 29 August 2012). Papers
reporting self-management activities utilised by people with
diabetes were included if they were published in English, de-
scribed the rate, frequency or regularity with which self-care
activities are undertaken by people with type 1 or type 2 diabetes,
described the amount of time spent on self-care activities, and
were research, expert opinion, reviews or discussion papers
reporting original data on the above. Papers were not included
if they were related to gestational diabetes or if they reported on
interventions to improve diabetes self-management. Intervention
studies were excluded as one of the aims of this paper was to
explore changes in self-management practices over time in the
absence of interventions.
The literature search identified 513 references. After dupli-
cates were removed, 479 references were assessed for eligibility.
Titles and abstracts were reviewed against the inclusion criteria,
and 424 references were excluded. The full text was retrieved for
the remaining 55, resulting in 23 articles being excluded (see
Fig. 1). A total of 32 papers were included in the review. Two
authors (MC and KF) independently reviewed all retrieved
abstracts.
Results
Thirty-two papers met the inclusion criteria for this
review.14,21–51 The characteristics of included studies are de-
scribed in Table 1. Although most papers reported adherence to
undertaking the task (either as a percentage, on a Likert scale or
the mean number of times the activity was completed), others
described the amount of extra time spent undertaking the task on a
typical day, the mean number of days the activity was completed
in the previous week and month, and adherence to recommenda-
tions (either made by healthcare provider or compared with
national guidelines). Results are presented according to the five
Records identified through
database searching:
N = 513
Records screened:
N = 479
Full-text articles assessed
for eligibility:
Duplicates removed:
Records excluded:
Studies included in review:
Full text articles excluded:
Not reporting SM rates or
frequencies: 11
Association/government
reports: 7
Interventions: 2
Describes models: 3
N = 55
N = 32
N = 23
N = 424
N = 34
Fig. 1. Flow chart of review inclusions and exclusions.
514 Australian Health Review M. E. Coyle et al.
ual in their care, and is advocated by clinical practice guidelines
from the USA, UK and globally. 8–11 Effective self-management
requires that individuals be committed to understanding their
illness and treatment options, working with health professionals
in developing a plan of care, undertaking activities to protect and
promote health, monitoring and managing symptoms of the
condition, and managing the impact of the condition on physical
and emotional functioning and interpersonal relationships. 12 The
International Diabetes Foundation’s clinical practice guidelines
for type 2 diabetes extends this, stating that protocols for self-
monitoring blood glucose
. . . should only be made available to people with diabetes
when they have the knowledge, skills and willingness to use
the information obtained through testing to actively adjust
treatment, enhance understanding of diabetes, and assess
the effectiveness of the management plan on diabetes
control (p. 50). 9
Current evidence-based management of type 2 diabetes in
Australia involves a team approach where the patient is the central
member of the team and self-monitoring is promoted. 13 Once a
medical regimen is established (if required), the onus is on the
patient to manage their disease through blood glucose testing,
taking medication, and following a regular eating and exercise
plan. 14 Self-management, however, goes beyond simple perfor-
mance of these tasks. Effective self-management requires indi-
viduals to have the ability to integrate information and respond
accordingly, and adapt to problems as they arise. 15 Effectively,
patients become experts on their disease.
The American Association of Diabetes Educators advocate
seven self-care behaviours to promote healthy outcomes, includ-
ing healthy eating, physical activity, monitoring indicators of
diabetes control (including blood glucose and glycosylated hae-
moglobin), taking medication, problem solving and healthy
coping. 16 Self-care activities, also referred to as self-management
activities, include behaviours undertaken by people to manage
their disease. 17 Anecdotal evidence suggests that people with
diabetes undertake a range of activities for self-care, including
accessing services that are outside the mainstream healthcare
system and often independent of medical advice. There is a wealth
of research on interventions to improve diabetes self-manage-
ment, 18,19 and many papers now report on adherence to diabetes
self-management activities and the regularity with which they are
used. 20
The aim of the present paper was to undertake a systematic
review of the literature to examine the self-management activities
utilised by people with diabetes, how regularly self-management
activities are undertaken, and whether self-management practices
change over time as familiarity with self-management activities
increases and knowledge of self-care improves, or in response to
special conditions.
Methods
A literature search was undertaken in August 2012 to identify the
self-management activities used by people living with diabetes.
Search terms included diabetes, self-management, self-care,
activity, strategy, self-report and frequency. Online databases
searched included PubMed, Embase, CINAHL, and the Cochrane
Library (searched from inception to 29 August 2012). Papers
reporting self-management activities utilised by people with
diabetes were included if they were published in English, de-
scribed the rate, frequency or regularity with which self-care
activities are undertaken by people with type 1 or type 2 diabetes,
described the amount of time spent on self-care activities, and
were research, expert opinion, reviews or discussion papers
reporting original data on the above. Papers were not included
if they were related to gestational diabetes or if they reported on
interventions to improve diabetes self-management. Intervention
studies were excluded as one of the aims of this paper was to
explore changes in self-management practices over time in the
absence of interventions.
The literature search identified 513 references. After dupli-
cates were removed, 479 references were assessed for eligibility.
Titles and abstracts were reviewed against the inclusion criteria,
and 424 references were excluded. The full text was retrieved for
the remaining 55, resulting in 23 articles being excluded (see
Fig. 1). A total of 32 papers were included in the review. Two
authors (MC and KF) independently reviewed all retrieved
abstracts.
Results
Thirty-two papers met the inclusion criteria for this
review.14,21–51 The characteristics of included studies are de-
scribed in Table 1. Although most papers reported adherence to
undertaking the task (either as a percentage, on a Likert scale or
the mean number of times the activity was completed), others
described the amount of extra time spent undertaking the task on a
typical day, the mean number of days the activity was completed
in the previous week and month, and adherence to recommenda-
tions (either made by healthcare provider or compared with
national guidelines). Results are presented according to the five
Records identified through
database searching:
N = 513
Records screened:
N = 479
Full-text articles assessed
for eligibility:
Duplicates removed:
Records excluded:
Studies included in review:
Full text articles excluded:
Not reporting SM rates or
frequencies: 11
Association/government
reports: 7
Interventions: 2
Describes models: 3
N = 55
N = 32
N = 23
N = 424
N = 34
Fig. 1. Flow chart of review inclusions and exclusions.
514 Australian Health Review M. E. Coyle et al.
key self-care activities recommended for diabetes self-
management.
Medication regimen
Twenty papers reported on diabetes
medication. 14,21,22,24,25,28–33,36,37,42,46–51 The results are pre-
sented in Table 2. There was considerable variation in the
reporting and classification of adherence, including adherence
as prescribed or recommended, self-reported general adherence
and more specific adherence such as the number of days per week
(as described in the Summary of Diabetes Self-Care Activities),
and number of times per day.
Adherence to medication was highest of all self-management
activities, ranging from 70 36 to 99%. 22 Adherence to taking oral
diabetic medication and insulin as directed was similar (93 and
97%, respectively). 14 Daily medication use ranged from 51.3 49 to
85.4%,31 with several studies reporting use of oral medication on
more than 5 days per week. 30,33,46 Non-compliance with pur-
chasing diabetes medication was 20.4%. 28
Several studies reported medication use by different ethnic
groups, with 80% of African American women taking
Table 1. Characteristics of included studies
ASMMT, Adherence and Self-Management Monitoring Tool; BRFSS, Behavioural Risk Factor Surveillance Survey; DAS, Diabetes Attitude Scale; DCP,
Diabetes Care Profile; DES, Diabetes Empowerment Scale; DFBC, Diabetes Family Behaviour Checklist; DKB, Diabetes Knowledge and Behaviour
Questionnaire; EBAS, Environmental Barriers to Adherence Scale; EPAQ-2, EPIC Physical Activity Questionnaire; NHANES, National Health and
Nutrition Examination Survey; SDSCA, Summary of Diabetes Self-Care Activities; SED, Self-Efficacy Score for Diabetes Scale; SEPSMB, Self-Efficacy
to Perform Self-Management Behaviours
Study No. of
participants
Country of
origin
Location Type of
diabetes
Instrument used
Aljasem et al.21 309 USA Urban Type 2 SED
Anderson et al.22 1202 USA Urban Type 1 and 2 Revised DAS
Barakat et al.23 867 UK Not specified Type 2 EPAQ-2
Chang et al.24 764 Taiwan Both urban and rural Type 1 and 2 Data from national health interview
Daly et al.25 253 USA Not specified Type 2 Author developed (included
components from SDSCA, DCP,
DES, DAS, DFBC, EBAS,
SEPSMB, among others)
Ettner et al.26 11 927 USA Not specified Type 1 and 2 Author developed
Franciosi et al.27 2968 Italy Not specified Type 2 Author developed
Hanko et al. 28 142 Hungary Not specified Type 2 Author developed
Huang et al. 29 28 USA Urban Type 2 Interviews
Irvine30 69 USA Rural Type 1 and 2 Unclear
Jordan et al.31 192 USA Not specified Type 2 SDSCA Revised & Expanded version
Lin et al.32 4463 USA Not specified Type 1 and 2 SDSCA Revised version
McCann et al.33 213 UK Not specified Type 2 Unclear
McCulloch et al.34 2862 Australia Rural and remote Type 1 and 2 Focus groups
Miller et al.35 11 USA Not specified Type 2 Resistance to Treatment questionnaire
Mosnier-Pudar et al.36 1092 France Both urban and rural Type 2 Unclear
Nelson et al.37 717 USA Not specified Type 2 SDSCA
Nelson et al.38 1480 USA Both urban and rural Type 2 NHANES
Neville et al.39 35 025 Australia Both urban and rural Type 1 and 2 NSW Health Survey
Nwasuruba et al.40 21 459 USA Both urban and rural Type 1 and 2 BRFSS
Perez et al.41 136 Puerto Rico Urban Type 1 and 2 Interviews (Secondary analysis of data)
Rahim-Williams et al.42 25 USA Urban Type 2 Interviews + questionnaires
(Author developed combined
with some questions from the
BRFSS)
Ruggiero et al. 14 2056 USA Both urban and rural Type 1 and 2 SDSCA (modified)
Schunk et al.43 334 Germany Both urban and rural Type 2 Unclear
Shaw et al.44 208 USA Both urban and rural
(includes subsamples)
Type 1 and 2 SDSCA based
Simmons et al.45 97 Australia Rural Type 1 and 2 Questions from the DKB questionnaire
Tang et al.46 89 USA Urban Type 2 SDSCA
Vijan et al.47 197 USA Urban Type 2 Survey (self-report, author
developed) + interviews
Von Goeler et al.48 30 USA Urban Type 2 Author developed
Wabe et al.49 347 Ethiopia Not specified Type 2 ASMMT (interviews)
Xu et al.50 211 USA Urban Type 2 SDSCA
Yusuff et al.51 200 Nigeria Not specified Type 2 ASMMT (interviews)
Self-management activities in diabetes care Australian Health Review 515
management.
Medication regimen
Twenty papers reported on diabetes
medication. 14,21,22,24,25,28–33,36,37,42,46–51 The results are pre-
sented in Table 2. There was considerable variation in the
reporting and classification of adherence, including adherence
as prescribed or recommended, self-reported general adherence
and more specific adherence such as the number of days per week
(as described in the Summary of Diabetes Self-Care Activities),
and number of times per day.
Adherence to medication was highest of all self-management
activities, ranging from 70 36 to 99%. 22 Adherence to taking oral
diabetic medication and insulin as directed was similar (93 and
97%, respectively). 14 Daily medication use ranged from 51.3 49 to
85.4%,31 with several studies reporting use of oral medication on
more than 5 days per week. 30,33,46 Non-compliance with pur-
chasing diabetes medication was 20.4%. 28
Several studies reported medication use by different ethnic
groups, with 80% of African American women taking
Table 1. Characteristics of included studies
ASMMT, Adherence and Self-Management Monitoring Tool; BRFSS, Behavioural Risk Factor Surveillance Survey; DAS, Diabetes Attitude Scale; DCP,
Diabetes Care Profile; DES, Diabetes Empowerment Scale; DFBC, Diabetes Family Behaviour Checklist; DKB, Diabetes Knowledge and Behaviour
Questionnaire; EBAS, Environmental Barriers to Adherence Scale; EPAQ-2, EPIC Physical Activity Questionnaire; NHANES, National Health and
Nutrition Examination Survey; SDSCA, Summary of Diabetes Self-Care Activities; SED, Self-Efficacy Score for Diabetes Scale; SEPSMB, Self-Efficacy
to Perform Self-Management Behaviours
Study No. of
participants
Country of
origin
Location Type of
diabetes
Instrument used
Aljasem et al.21 309 USA Urban Type 2 SED
Anderson et al.22 1202 USA Urban Type 1 and 2 Revised DAS
Barakat et al.23 867 UK Not specified Type 2 EPAQ-2
Chang et al.24 764 Taiwan Both urban and rural Type 1 and 2 Data from national health interview
Daly et al.25 253 USA Not specified Type 2 Author developed (included
components from SDSCA, DCP,
DES, DAS, DFBC, EBAS,
SEPSMB, among others)
Ettner et al.26 11 927 USA Not specified Type 1 and 2 Author developed
Franciosi et al.27 2968 Italy Not specified Type 2 Author developed
Hanko et al. 28 142 Hungary Not specified Type 2 Author developed
Huang et al. 29 28 USA Urban Type 2 Interviews
Irvine30 69 USA Rural Type 1 and 2 Unclear
Jordan et al.31 192 USA Not specified Type 2 SDSCA Revised & Expanded version
Lin et al.32 4463 USA Not specified Type 1 and 2 SDSCA Revised version
McCann et al.33 213 UK Not specified Type 2 Unclear
McCulloch et al.34 2862 Australia Rural and remote Type 1 and 2 Focus groups
Miller et al.35 11 USA Not specified Type 2 Resistance to Treatment questionnaire
Mosnier-Pudar et al.36 1092 France Both urban and rural Type 2 Unclear
Nelson et al.37 717 USA Not specified Type 2 SDSCA
Nelson et al.38 1480 USA Both urban and rural Type 2 NHANES
Neville et al.39 35 025 Australia Both urban and rural Type 1 and 2 NSW Health Survey
Nwasuruba et al.40 21 459 USA Both urban and rural Type 1 and 2 BRFSS
Perez et al.41 136 Puerto Rico Urban Type 1 and 2 Interviews (Secondary analysis of data)
Rahim-Williams et al.42 25 USA Urban Type 2 Interviews + questionnaires
(Author developed combined
with some questions from the
BRFSS)
Ruggiero et al. 14 2056 USA Both urban and rural Type 1 and 2 SDSCA (modified)
Schunk et al.43 334 Germany Both urban and rural Type 2 Unclear
Shaw et al.44 208 USA Both urban and rural
(includes subsamples)
Type 1 and 2 SDSCA based
Simmons et al.45 97 Australia Rural Type 1 and 2 Questions from the DKB questionnaire
Tang et al.46 89 USA Urban Type 2 SDSCA
Vijan et al.47 197 USA Urban Type 2 Survey (self-report, author
developed) + interviews
Von Goeler et al.48 30 USA Urban Type 2 Author developed
Wabe et al.49 347 Ethiopia Not specified Type 2 ASMMT (interviews)
Xu et al.50 211 USA Urban Type 2 SDSCA
Yusuff et al.51 200 Nigeria Not specified Type 2 ASMMT (interviews)
Self-management activities in diabetes care Australian Health Review 515
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