Connections Among Daily Occupational Participation, Diabetes Self-Management, and Quality of Life

Importance: Diabetes requires daily management activities, collectively called diabetes self-management (DSM). However, performing DSM while engaging in daily occupations can be challenging to sustain. Objective: To explore the relationships among participating in daily occupations, performing DSM, maintaining target glycemic levels, and health-related quality of life (HRQoL) and which daily occupations (domestic, leisure, caring for others, learning, sport, self-care, quiet, spiritual, work activities) explain variations in DSM levels. Design and Participants: This cross-sectional study included people with Type 2 diabetes mellitus (N = 99, M age = 65.61 yr, SD = 12.17; glycated hemoglobin [HbA1c] M = 7.98, SD = 1.89; 55.6% male) who received ongoing follow-up in a public health care diabetes clinic in Israel. Measures: Participants completed the DSM, Adult Subjective Assessment of Participation, 12-item Short-Form Health Survey, and demographic questionnaires. HbA1c, fasting glucose, and body mass index information were retrieved from medical charts. Results: Participation in recreation and leisure activities and total participation correlated with engaging in more physical activities as part of DSM and better mental and physical HRQoL. Domestic activities, caring for others, quiet activities, and work had ambivalent connections with DSM and HRQoL. Participants who engaged in more physical activities accomplished more DSM tasks; those who engaged in quiet activities (e.g., reading, watching TV) completed fewer tasks. Conclusions and Relevance: Occupational therapy treatment should be personalized to identify and address specific activities within an individual’s daily routine that support or hinder their DSM. Treatment should encourage clients to engage in fewer quiet activities and more physical activities to promote DSM. Plain-Language Summary: Diabetes is a common and complex health condition that requires daily management. Research shows that performing diabetes management activities, called diabetes self-management (DSM), can be challenging and difficult to sustain for many people with diabetes. Our study explored how engaging in daily activities affects DSM, including maintaining glycemic levels and health-related quality of life, for people living with Type 2 diabetes mellitus (T2DM), and which activities might help the most. We gathered information from medical records and questionnaires completed by 99 people with T2DM (55 men and 44 women who were, on average, 65 years old). Their average blood glucose levels were above the levels recommended by the American Diabetes Association. We found that participating in daily activities as a whole and engaging in specific activities, such as caring for others and active recreation, were associated with better health-related quality of life and increased engagement in the physical activity component of DSM. However, quieter activities, like reading or watching TV, were associated with decreased engagement in DSM activities. We recommend that occupational therapists work closely with people with T2DM to understand their daily routines and help them positively incorporate activities related to DSM.