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Adherence to self-care among individuals with diabetes with and without diabetic foot complications: objective and self-report measures

Rachel Natovich*, Ilana Harman-Boehm, Daniella Margalit, Tali Cukierman-Yaffe & Talma Kushnir

Aim: Adherence to self-care recommendations is a key factor in ulcer healing and prevention. There is paucity of data regarding adherence in this high risk group. We compare self-care adherence levels among adults with diabetes, with and without the diabetic foot (DF) complication. Methods: Case-control study conducted among adults with diabetes. 99 individuals with (cases) and 95 without DF (control) were recruited. Groups were matched for gender and diabetes duration. Adherence was inferred from self-reported activities, using the Summary of Diabetes Self-Care Activity questionnaire and two objective measures of treatment efficiency: Body Mass Index, and glycated hemoglobin level (HbA1c). Results: DF adhered significantly (p<0.01) less than controls to physical activity, but more (p<0.5) to performing blood tests. HbA1c levels were significantly (p<0.001) higher in the DF group (x Ì… 8.8 vr. 7.3). Differences persisted in a multivariable analysis after adjusting for several confounding factors. Conclusions: our data show that individuals with DF had the same or lower levels of adherence in all domains, aside for better adherence to blood tests. Thus, the presence of DF does not seem to act as a "wake up call" and is not translated into better adherence.