Diabetes knowledge, self-efficacy and dietary, psychological and physical health barriers: Comparing young and usual-onset type 2 diabetes.

AIMS: Young-onset (21-39 years old) type 2 diabetes (YOD) is associated with high complication rates and glycaemic levels, and poor self-management plays a significant role. Knowledge, skills and barriers influence self-management behaviours considerably. Therefore, this study assessed diabetes knowledge, self-efficacy and barriers (situational dietary barriers, physical health, mental health and diabetes-related distress) between participants with young and usual-onset (40-59 years old) (UOD) diabetes. METHODOLOGY: A cross-sectional survey was conducted. Differences between YOD and UOD were analysed using bivariate analysis and effect sizes were estimated with Cohen's d. Differences were further adjusted by demographic factors (gender, ethnicity, marital status, educational level, income level) and diabetes duration. RESULTS: A total of 409 (97 YOD, 312 UOD) participants were recruited. Participants with YOD had lower self-efficacy levels (adjusted B = -0.19, CI -0.35 to -0.03) and higher dietary barriers (adjusted B = 3.6, CI 2.1-5.1), lower mental health scores (adjusted B = -3.5, CI -5.7 to -1.4) and higher diabetes-related distress levels (adjusted B = 0.2, CI 0.2-0.4). CONCLUSIONS: Our study found that participants with YOD faced more challenges with adapting to life with diabetes when compared with UOD. More effective self-management programmes are needed to support the multifaceted needs of adults with YOD.

Identifying barriers and facilitators to self care in young adults with type 2 diabetes.

AIMS: There is a rising trend of young-onset type 2 diabetes (YOD) occurring before the age of 40 years. Lower adherence to self care behaviours (diet, physical activity and taking medication) contributed to poorer glycaemic control and higher risk of complications. Young adults with YOD face unique challenges, and our study aimed to identify the main barriers and facilitators of self care behaviours in this population. METHODOLOGY: A qualitative study was conducted in the National Healthcare Group Polyclinics, Singapore, using in-depth semi-structured interviews. Maximal variation sampling was employed to include participants with YOD of varied age, ethnicity, educational levels and marital status. Thematic analysis was conducted, and barriers and facilitators were identified and mapped to domains of the theoretical domains framework. RESULTS: Twenty-one participants aged 22-39 years were interviewed. We found patterns of intentions, self care behaviours and mindsets that were associated with different barriers and facilitators. Four patterns were identified and were named according to mindsets: avoidant, indifferent, striving and activated. In addition, experience of stigma and self-blame from having type 2 diabetes in young adulthood was common across all mindsets, contributing to poorer self care behaviours and increased psychological burden. CONCLUSION: Our study identified key barriers and facilitators of diet, physical activity and medication adherence in young adults with type 2 diabetes. Understanding barriers and facilitators, as related to mindsets, intentions and behaviours, will support a more individualised care approach.