Brewer-Lowry and coworkers identified approaches to diabetes self-management that differentiate persons with well-controlled from poorly controlled diabetes In-depth qualitative interviews were conducted with 48 adults, drawn from a population-based sample aged 65 years or older with diabetes. The sample was stratified by sex and ethnic group (African American, American Indian, and White), and from the low (A1C <6%) and high (A1C >8%) extremes of the glycemic control distribution. Case-based text analysis was guided by a model that included six self-management domains and four resource types (self-care, informal support, formal services, and medical care). A "structured" approach to self-management differentiated respondents in good glycemic control from those in poor glycemic control. Those in good glycemic control were more likely to practice specific food behaviors to limit food consumption and practice regular blood glucose monitoring with specific target values. The approach was facilitated by a greater use of home aides to assist with diabetes care. Respondents in poor glycemic control demonstrated less structure, naming general food categories and checking blood glucose in reaction to symptoms.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that the results provide evidence that degree of structure differentiates self-management approaches of persons with good and poor glycemic control. The findings should provide a foundation for further research to develop effective self-management programs for older adults with diabetes.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: The study suggests that if you learn self-management skills and are motivated to use them in controlling diabetes, you are likely to be more consistent at working within a context that insures the skills will be effective in controlling diabetes.

AN Brewer-Lowry et al. Differentiating Approaches to Diabetes Self-Management of Multi-ethnic Rural Older Adults at the Extremes of Glycemic Control. Gerontologist, January 28, 2010.