DİYABET TEKNOLOJİLERİ İLE YAŞAM: UYUM VE UYUMSUZLUĞUN KÖKENLERİ VE KLİNİK SONUÇLARI

Abstract

Current national and international diabetes guidelines recommend insulin pumps as the gold standard treatment for type 1 diabetes. There are some barriers to the wider adoption of diabetes technologies. The aim of this study was to investigate the dimensions of adherence and non-adherence with diabetes technologies in type 1 diabetics, the clinical outcomes of such adherence and non-adherence, and the underlying psychological, social and environmental factors. This prospective case-control study included a control group (n:60) with type 1 diabetes on multiple daily injections and a case group (n:57) with type 1 diabetes who were active insulin pump users (n:45) and who had previously used an insulin pump and subsequently stopped using the pump (n:12). The clinical courses of patients evaluated. In this study, a hybrid method involving both quantitative and qualitative research approaches has been employed. In the neuropsychiatric evaluation of participants, the Diabetes Treatment Satisfaction Questionnaire (DTSQ), Hospital Anxiety and Depression Scale (HADS), Illness Perception Questionnaire-Revised (IPQ-R), Body Cathexis Scale (BCS), Rosenberg Self-Esteem Scale (RSES), Multidimensional Scale of Perceived Social Support (MSPSS), World Health Organization Quality of Life Scale-BREF (WHOQOL-BREF), Diabetes Distress Scale (DDS), Type 1 Diabetes Stigma Assessment Scale (DSAS-1), and Diabetes Eating Problem Survey-Revised (DEPS-R) were utilized. In-depth interviews were conducted with 20 participants who had experience using an insulin pump as part of a qualitative research method. It was observed that patients actively using insulin pumps had statistically significantly lower final HbA1c and glycemic variability values compared to those who administered multiple daily injections (p=0.002, p=0.000). According to DTSQ scores, it has been observed that patients using an active insulin pump have a statistically significantly higher treatment satisfaction (p=0.016). Based on BCS scores, patients using an active insulin pump were found to have lower satisfaction with their body parts and functions, but this difference was not statistically significant (p=0.077). According to DDS scores, it was determined that the case and control groups had similar levels of high diabetic distress (p=0.238). According to the DSAS-1 scores, it was observed that the perceived and/or experienced diabetes stigmatization in both groups was similar (p=0.464). In in-depth interviews, patients expressed their experiences regarding issues such as stigmatization due to insulin pump, negative body image due to the visibility of the pump, cost issues in diabetes technologies, telemedicine applications, and problems encountered with wired insulin pumps. As a result, while patients are satisfied with insulin pump usage, conventional insulin pumps prove insufficient in alleviating diabetic distress. In this thesis study, it is emphasized for the first time to this extent that the experiences of adults with type 1 diabetes that cannot be determined with quantitative scales can only be revealed through in-depth interviews. Therefore, conducting individual interviews and assessments with patients is important beyond quantitative scales.