"Have to Fight the Demon": Veteran Type 2 Diabetes Mellitus Behavioral Self-Management and Diabetes Specific Risk-Taking Behaviors.

Abstract

Diabetes mellitus Type 2 (T2DM) requires a set of life-long, complex self-management strategies that affect both physical and psychosocial aspects of daily life. This study aimed to assess how Veterans with T2DM describe self-management behaviors and to explore whether a framework of diabetes-specificrisk-taking behaviors (originally applied to adolescents with T1DM) is applicable to Veterans with T2DM. This study employed a secondary qualitative analysis of Veteran interviews (n = 36) using a priori codes based on the Summary of Diabetes Self-Care Activities (SDSCA) and the Diabetes-Specific Risk-Taking Inventory (DSRI) to explore self-management behaviors and to assess the applicability of diabetes-specific risk-taking behaviors among Veterans. We identified themes aligned with each of the SDSCA a priori codes, along with an added code relating to medication, reflecting both self-management behaviors and diabetes-specific risk-taking behaviors: (1) diet: constant negotiation can involve purposeful risk-taking; (2) physical activity: intentional, but also avoided despite consequences; (3) blood-glucose monitoring: personal effort of monitoring can override risk-reduction; (4) foot care: preventing complications; (5) smoking: struggles and successes with quitting; and (6) medication: intent to adhere can be undercut by risk taking and lack of resources. Veterans described self-management behaviors that align with diabetes-specific risk-taking, suggesting that the DSRI framework has potential applicability to this population. Future work exploring diabetes-specific risk-taking behaviors will be critical to helping Veterans successfully manage their T2DM.