Two investigators found that more than three hours a day would be required for an average type 2 diabetes patient to follow to the letter all home-care tasks recommended by the American Diabetes Association. The investigators from the Ohio University College of Osteopathic Medicine in Athens, arrived at their time estimates by compiling responses to questionnaires sent to certified diabetes educators. "The recommendations for diabetes mellitus self-care are likely too time intensive for most people to successfully complete," wrote Jay H. Shubrook, D.O., and Frank L. Schwartz, M.D., in a poster presented today at the American Diabetes Association Meeting here.
"To make the demands more realistic we will need to find ways to combine tasks, or, alternatively, develop a cultural change so that all adults can build self care into their daily lives," they added. More than half the daily time required by ADA recommendations would be devoted to meal planning, shopping and preparation, said the investigators, with the remainder taken up by glucose monitoring, record keeping, medication, exercise, and care of various body parts (feet and mouth, for example) that are affected by diabetes.
A previous study by researchers from Rutgers University in New Jersey and the University of Alabama at Birmingham found that patients with type 2 diabetes taking oral medications would need only 122 minutes every day to complete recommended tasks, whereas someone on insulin would need to carve an extra 144 minutes out of their day.
Building on those results, the Ohio researchers surveyed a large sample of diabetes educators from different geographical areas and diabetes education programs.
Participants were asked to complete a questionnaire administered to diabetes educators and dietitians, asking them to estimate the time required for a hypothetical adult with type 2 diabetes treated only with oral medication to complete all of the tasks recommended by the ADA. For those activities that did not require daily attention (such as shopping), the respondents were asked to estimate the weekly time required, and the results were averaged to arrive at a daily figure.
Based on a total of 30 responses, the investigators found that the time needed for the required elements as directed by the ADA was 202 minutes (three hours and 22 minutes). Of that time, 96 minutes were needed for home glucose monitoring, record keeping, medication management, oral care, foot care, problem solving, and exercise. Another 106 minutes per day would be taken up with meal planning, shopping and preparation.
The authors noted that there were substantial variations in the estimates of the time required, with the shortest possible routine (sum of all the shortest estimates) being just 50 minutes, and the longest estimated routine clocking in at a marathon 490 minutes (eight hours and 10 minutes).
"For example," they wrote, "estimates for the time needed to do glucose monitoring ranges from five to 45 minutes. Does the time really vary that much each time one checks their glucose, or is there a different expectation in the number of times per day that the person is to check their glucose?"
Office Pearls: Explain to interested patients that although time-consuming, self-care tasks are important for maintaining diabetes health and for preventing potentially serious complications in the future.
2006 American Diabetes Association Scientific Sessions: Shubrook JH and Schwartz FL. "Time Demands for Diabetes Self-Care." Presented June 10, 2006.
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