Introduction
Subjects, materials and methods
Design
Interviews
Subjects and setting
Interview guide
Data analyses
Survey
Subjects and setting
Questionnaire
Data analysis
Compliance with ethical standards
Results
Sex | |
Female | 10 |
Male | 6 |
Age group (years) | |
< 60 | 2 |
60–70 | 6 |
70–80 | 4 |
≥ 80 | 4 |
Level of education | |
Primary school | 2 |
Secondary school | 7 |
Vocational education | 4 |
Higher education | 3 |
Level of health literacy | |
Low | 2 |
Medium | 0 |
High | 14 |
Use of alcohol | |
Yes | 11 |
No | 5 |
Smoking | |
Yes | 1 |
No | 15 |
Diabetes duration (years) | |
< 1 | 0 |
1–5 | 3 |
5–10 | 0 |
> 10 | 13 |
Last hypoglycaemic event | |
< 1 week ago | 8 |
1–2 weeks ago | 1 |
2–4 weeks ago | 1 |
> 1 month ago | 6 |
Glucose lowering medication | |
Insulin | 4 |
Insulin + metformin | 7 |
Insulin + sulfonylurea | 1 |
Insulin + GLP-1 | 1 |
Insulin + sulfonylurea + metformin | 1 |
Sulfonylurea | 1 |
Sulfonylurea + metformin | 1 |
Glucose monitoring | |
Daily | 9 |
Weekly | 3 |
Rarely | 3 |
Never | 1 |
Respondents | |
---|---|
Number of respondents | 83 |
Age (years), mean (SD) | 66 (11) |
< 60 years, n (%) | 20 (24%) |
60–69 years, n (%) | 27 (33%) |
70–79 years, n (%) | 23 (28%) |
≥ 80 years, n (%) | 12 (14%) |
Missing, n (%) | 1 (1%) |
Female, n (%) | 53 (42%) |
Diabetes duration, n (%) | |
0–5 years | 9 (11%) |
6–10 years | 11 (13%) |
≥ 10 years | 63 (76%) |
Missing | 0 (0%) |
Diabetes related complication(s) | 49 (59%) |
Body weight, n (%) | |
Underweight | 0 (0%) |
Healthy Weight | 18 (22%) |
Overweight | 29 (35%) |
Obese | 34 (41%) |
Missing | 2 (2%) |
Alcohol use, n (%) | 49 (59%) |
Smoking, n (%) | 7 (8%) |
Physical activity > 30 min/day, n (%) | |
0 days | 5 (6%) |
1–3 days | 28 (34%) |
4–6 days | 28 (34%) |
7 days | 22 (27%) |
Missing | 0 (0%) |
Working, n (%) | 39 (47%) |
Working irregular hours, n (%) | 13 (16%) |
Marital status/household situation (%) | |
Married/living together | 55 (66%) |
Living independent | 27 (32%) |
Missing | 1 (1%) |
Education, n (%) | |
No/primary education | 13 (16%) |
Pre-vocational education | 24 (29%) |
Vocational education | 15 (18%) |
Pre-college/pre-university | 11 (13%) |
College/university | 18 (22%) |
Missing | 2 (2%) |
Number of medications | |
1–5 medication(s) | 32 (39%) |
6–10 medications | 38 (46%) |
> 10 medications | 11 (13%) |
Missing | 2 (2%) |
Insulin use | 54 (65%) |
Sulfonylurea use | 47 (57%) |
Statin use | 55 (66%) |
Antihypertensive use | 63 (76%) |
Glucose meter at home | 78 (94%) |
Severe hypoglycaemia | 15 (18%) |
Nocturnal hypoglycaemia | 31 (37%) |
Frequency hypoglycaemia | |
Daily | 1 (1%) |
Weekly | 4 (5%) |
Monthly | 21 (25%) |
Yearly or less | 57 (69%) |
Self-management issues
Nature of behaviour
Quotes | TDF | |
---|---|---|
[A] | “No, I do not have them very often [low blood sugar]. No, but then with my husband [he broke his hip due to a fall] ( …) But I just had to get used to it, to the new routine, until it was over.” (female, 70–80 years old) | Nature of behaviour |
[B] | “I should have prepared the warm meal earlier, but I am used to eating lunch at 12 o’clock. And I have the food ready at 12 o’clock, and I could not make that.” (female, 70–80 years old) | Nature of behaviour |
[C] | “I do not really know this very well yet ( …) It is not that easy for me to skip one tablet or to take one tablet extra the next day. That is my problem, because I don’t have a sufficiently regular daily schedule. I’m trying to change that.” (Female 60–70 years old) | Knowledge/ Nature of behaviour |
[D] | “So when it is low they say: ‘you need to inject more’, ok, how much more?” [Interviewer: “If it is low you need to inject more insulin?”] “Yes, so that it will go up again, as it were. [Interviewer: “Insulin lowers your sugar.”] “Yes, exactly. So I think, I will do it my way. I get a small bottle of soda or two biscuits with jelly and then it’s all fine again.” (Female ≥ 80 years old) | Knowledge |
[E] | “Yes, I have had days, that I think like, ( …) I want to finish my work, my assignment, but then a colleague said like: ‘leave it for a while, we will take it over and you just sit down for a while.” (Female < 60 years old) | Social influences and social/professional role and identity |
[F] | “I went to the gym for a while, ( …) and there I sometimes overestimated myself a little, and then I would get a hypo, because I would use a treadmill more than I could handle with my bad legs.” | Beliefs about capabilities |
[G] | “So, I injected 4 [units] ( …) But, sometimes, it is too much and then I think that I should inject only 3 units. ( …) But then again my glucose gets close to 10 and I really want my glucose to be as low as possible.” (Female 70–80 years old) | Motivation and goals |
[H] | “I love mashed potato stews; I allow myself this once in a while. I think I should be able to do that, otherwise life is not pleasant anymore.” (Female 60–70 years old) | Motivation and goals |
Knowledge
Yes I know how to do that | Yes, but I do not know how to do that | No, I do not know how to do that | No, I am not allowed to do so by my HCP | No that is not necessary | |
---|---|---|---|---|---|
I adjust my medication when I exercise more than usual (n = 80), (%) | 25.0 | 2.5 | 5.0 | 5.0 | 62.5 |
I adjust my medication when I exercise less than usual (n = 80), (%) | 21.3 | 1.3 | 5.0 | 5.0 | 67.5 |
I adjust my medication when I eat more than usual(n = 82), (%) | 34.2 | 1.2 | 4.9 | 9.8 | 50.0 |
I adjust my medication when I eat less than usual (n = 82), (%) | 30.5 | 0.0 | 4.9 | 8.5 | 56.1 |
I adjust my medication based on measured glucose levels (n = 78), (%) | 35.9 | 5.1 | 3.9 | 18.0 | 37.2 |
I adjust my medication when I am ill (n = 79), (%) | 24.1 | 0.0 | 12.7 | 3.8 | 59.5 |
I adjust my medication when I am on a diet (n = 35), (%) | 40.0 | 0.0 | 14.3 | 11.4 | 34.3 |
Emotion
Memory, attention and decision processes
Social influences and social/professional role and identity
Beliefs about capabilities and consequences
Motivation and goals
Environmental context and resources
Self-identified causes of hypoglycaemia
Medication (6 participants) |
Accidentally overdosing medication |
Forgetting adjustment made to the medication regimen |
Adjusting the wrong type of insulin |
Fluctuating glucose levels |
Physical activity (9 participants) |
Household chores |
Sports |
Physical leisure activities |
Sexual activity |
Nutrition (10 participants) |
Skipped, delayed, forgotten meals |
Low appetite/premature satiation |
Meals low on carbohydrates |
Fatty meals |
Alcohol consumption |
Low-carb diet |
Stress/emotion (4 participants) |
Stress |
Cognitive overload |
Grief |