Effects of Self-Management on Urologic Health among Female Patients with Diabetes

Taiwan’s national survey (n = 7,541) showed that only 4.1% individuals with diabetes had good disease control. Poor diabetes control may lead to many chronic complications including macrovascular/microvascular diseases and urologic dysfunctions/symptoms. More than 50% female with diabetes experienced urologic dysfunctions or symptoms. In Taiwan, more than 40% female with Type II diabetes experienced daytime urinary frequency (44.9%) and nighttime urinary frequency (62.6%), and about 20% of them experienced overactive bladder. Healthcare systems need to pay special attention to bladder dysfunctions and lower urinary tract symptoms (LUTS) experienced by individuals with diabetes because these problems are common among this group. Positive effects of self-management on improving disease control, lifestyle modification, self-efficacy, self-care, and health related quality of life (HRQL) among individuals with diabetes were reported. Utilization of inexpensive self-management strategy to improve urologic symptoms is recommended. Current evidence shows that conservative management (pelvic floor muscle training, lifestyle interventions, and scheduled voiding regimens) are effective ways to improve urologic symptoms. We plan to conduct this study because (1) positive effects of self-management on diabetes disease control were reported, (2) conservative management on improving urologic symptoms were confirmed, and (3) few intervention studies had been conducted to improve urologic health among individuals with diabetes. This study will be conducted among female individuals with diabetes and aims to (1) understand individuals’ self-management behaviors related to urologic healthcare, (2) identify possible individual factors associated with self-management, and (3) deliver and examine the effects of a conservative intervention incorporated self-management concept. Pelvic floor muscle training, lifestyle interventions, and scheduled voiding regimens will be delivered. Study results will contribute to knowledge about individuals’ self-management behaviors related to urologic healthcare among female individuals with diabetes. Identification of individual factors associated with self-management is essential on screening for individuals who are at risk, and on developing interventions to improve individuals’ urologic health. Study results will enrich clinical evidence about effects of utilizing conservative management among female individuals with diabetes. This 2-stage study will be conducted at two metabolism/endocrinology outpatient departments in two hospitals. The first stage study is a psychometric testing study. It is also a cross-sectional, correlational study. Female individuals (n = 215) who are 20 to 70 years of age, and have been diagnosed with diabetes > 3 months will be recruited. Research aims are to: (1) examine psychometric properties of two developed instruments: self-efficacy and self-management related urologic healthcare, (2) understand individuals’ self-management behaviors related to urologic healthcare, and (3) identify individual factors associated with self-management. Information related to participants’ individual characteristics, self-efficacy, self-management, bladder dysfunctions/LUTS, and HRQL will be collected. For showing our appreciations, all participants will be arranged to attain a 2-month initial education program related to diabetes care. The second stage study is an intervention study with repeated measures. Female individuals (n = 154) who are 20 to 70 years of age, have been diagnosed with diabetes > 3 months, have attained initial education program, and experience at least one type of LUTS will be recruited. Research aim is to examine the effects of a conservative intervention on participants’ urologic health, self-management behaviors, and HRQL. Participants will be randomly assigned to intervention or control group. Intervention group will receive a 1-year conservation intervention incorporated self-management concept. Control group will receive the intervention after they complete a 1-year data collection. Information related to participants’ individual characteristics, self-efficacy, self-management, bladder dysfunctions/LUTS, self-perceived improvements on bladder dysfunctions/LUTS, and HRQL will be collected at 5 time points. Additional information related to participants’ exercise/activity/diet/voiding logs and pelvic floor muscle strength will be collected. Descriptive statistics will be used to demonstrate the distributions of individual characteristics, self-efficacy, self-management, bladder dysfunctions/LUTS, and HRQL. Internal consistency, test-retest reliability, content validity, and construct validity of the developed instruments will be examined. Logistic regression will be used to identify individual factors associated with good self-management. Effects of the intervention will be examined by repeated Measures ANOVA/Generalized Estimating Equations model. Participants’ self-perceived improvements and information obtained from uroflowmetry and voiding logs will also be used to examine intervention effects on their urologic health.