Poorer glycaemic control in type 1 diabetes is associated with reduced self-management and poorer perceived health: A cross-sectional study Seyda Ozcan a, * , Stephanie A. Amiel b , Helen Rogers b , Pratik Choudhary b , Alison Cox b , Nicole de Zoysa c , David Hopkins d , Angus Forbes e a King’s College London Florence Nightingale School of Nursing and Midwifery and King’s College Hospital Koc ¸ University, School of Nursing, Istanbul, Turkey b Department of Diabetes, King’s College Hospital NHS Foundation Trust, London, United Kingdom c Diabetes and Cardiac Rehabilitation, King’s College Hospital NHS Foundation Trust, London, United Kingdom d Division of Ambulatory Care & Local Networks, King’s College Hospital NHS Foundation Trust, London, United Kingdom e Department of Primary and Intermediate Care, Florence Nightingale School of Nursing and Midwifery, King’s College London, London, United Kingdom d i a b e t e s r e s e a r c h a n d c l i n i c a l p r a c t i c e 1 0 6 ( 2 0 1 4 ) 3 5 – 4 1 a r t i c l e i n f o Article history: Received 17 December 2013 Received in revised form 29 April 2014 Accepted 20 July 2014 Available online 26 July 2014 Keywords: Type 1 diabetes Hypoglycaemia awareness Impaired hypoglycaemia awareness Hypoglycaemia unawareness Intensive insulin therapy Service development a b s t r a c t Aims: Many people with type 1 diabetes do not achieve optimal treatment targets despite high patient and professional input. To investigate the reasons underlying suboptimal control we have studied clinical characteristics and self-management behaviours in adults with type 1 diabetes attending a large treatment centre. Methods: A questionnaire-based enquiry into self-care behaviours of 380 patients with type 1 diabetes (mean age: 48 (15) years and mean duration of diabetes: 26 (15) years), linked with validated measures of impact of treatment on perceived health and hypoglycaemia recognition (Insulin Treatment Satisfaction Questionnaire; and EuroQoL EQ-5D, Gold score) and retrospective case note review of biomedical parameters. The data were analysed using chi- square test, ANOVA, ANCOVA and post-hoc procedures (Tukey’s-b) in SPSS-version 18. The minimum significance level was accepted as 0.05. Results: Sixty three percent of participants used multiple daily injections; 36% continuous subcutaneous insulin infusion. Mean HbA 1c was 7.7% (1.2) [61  10 mmol/mol]; 30% had impaired hypoglycaemia awareness (IHA). Factors significantly related to poor glycaemic control with IHA were longer duration of diabetes ( p = 0.01); less frequent glucose self- monitoring ( p = 0.05); and low level of patient-set glucose targets ( p < 0.001). Patients with IHA and poorer control had significantly lower insulin treatment satisfaction ( p < 0.001); and perceived health ( p < 0.001). Conclusions: Suboptimal biomedical outcomes in adults with type 1 diabetes attending a specialist intensified insulin therapy clinic are associated with longer duration of diabetes, fewer self-management behaviours and a trend towards poorer perceived health. These data suggest a need for greater emphasis on integration of psychological and self-manage- ment support with intensive medical management of type 1 diabetes. # 2014 Elsevier Ireland Ltd. All rights reserved. * Corresponding author. Tel.: +90 212 311 2665; fax: +90 212 311 2602. E-mail addresses: sozcan@ku.edu.tr, seyda_ozcan@hotmail.com (S. Ozcan). Contents available at ScienceDirect Diabetes Research and Clinical Practice journal homepage: www.elsevier.com/locate/diabres http://dx.doi.org/10.1016/j.diabres.2014.07.023 0168-8227/# 2014 Elsevier Ireland Ltd. All rights reserved.