Difficulties in daily life and the association with self-care ability in adults with type 1 diabetes mellitus in Japan: A cross-sectional study.

This was a cross-sectional survey, so it cannot show whether lower self-care agency causes more difficulty or whether more difficulty lowers self-care agency. All measures were self-reported, including A1C, so recall and reporting bias may affect the results. Only 321 of the 907 randomly selected patients were analysed, and 17 of 27 invited institutions participated, so the sample may not represent all adults with type 1 diabetes in Japan. The daily-life questionnaire was created and modified for this study, and some items were excluded because of ceiling or floor effects, so its use as a clinical measure is not established. The sample was 67.0% female and limited to ages 20 to 65 years, so findings may not apply to men or older adults. Some difficulties, such as health insurance ineligibility and confusion with type 2 diabetes, are tied to Japanese health and language context.

The authors declared no conflicts of interest. The supplied publication types list research support, non-U.S. Government, but no specific funder or funding statement appears in the article text.

Do not read the association between lower self-care agency and more daily-life difficulty as proof that teaching self-care will reduce difficulty. The study was cross-sectional and measured both by patient report, so it cannot show which way the relationship runs.