Clinical and socio-demographic determinants of inadequate self-care in adults with type 1 diabetes mellitus: the leading role of self-care confidence

Aims: To describe self-care maintenance, monitoring, and management behaviors in adults with type 1 diabetes (T1DM), and to identify clinical and socio-demographic determinants of inadequate self-care. Methods: A cross-sectional study was conducted in two diabetes outpatient clinics in Italy. Clinical and socio-demographic characteristics were collected from the medical records of 181 consecutively enrolled T1DM patients. The Self-Care of Diabetes Inventory was used to measure self-care maintenance, self-care monitoring, self-care management and self-care confidence. A standardized 0–100 score was used for each self-care dimension. A score < 70 was considered inadequate self-care. Three multiple logistic regression models were run to find determinants of inadequate self-care maintenance, monitoring, and management. Results: The majority of patients had adequate self-care maintenance (74%; n = 134), self-care monitoring (68.5%; n = 124) and self-care confidence (87.3%; n = 158), while self-care management was adequate for only a minority (34.8%; n = 63). The odds of inadequate self-care maintenance increased by 4.5 times when self-care confidence was inadequate (OR adjusted 4.589; 95% CI 1.611–13.071; p = 0.004). The odds of inadequate self-care monitoring increased four times when patients had inadequate self-care confidence (OR adjusted 4.116; 95% CI 1.457–11.628; p = 0.008). Inadequate self-care confidence increased the odds of performing inadequate self-care management more than five times (OR adjusted 5.313; 95% CI 1.143–24.686; p = 0.033). Conclusions: Self-care management is commonly inadequate in adults with T1DM. Self-care confidence is the most important determinant of self-care behaviors in this population. Educational interventions are recommended to improve self-care confidence in adults with T1DM.