1. Theoretical Framework Type 2 Diabetes (T2DM) Self-Management Nursing 8782 Jennifer Bauman, RN, BA, PCCN December 2, 2013

2. T2DM In the U.S., diabetes affects 25.8 million people, or 8.3% of the population. T2DM accounts for 90 to 95% of cases (CDC, 2011). Diabetes incidence has doubled every 20 years since 1945 (King et al., 1999). Cost of diabetes in 2012: $245 billion (ADA, 2013). Poor glycemic control results in renal, vascular, and ophthalmic complications (CDC, 2011). Proper glycemic control can prevent or delay the micro- and macro-vascular complications that lead to poor outcomes (DCCT, 1993; Stratton et al., 2000). Appropriate glycemic control can be achieved through adequate self-management.

3. Glass & McAtee (2006)

4. Grey, Knafl, & McCorkle (2006) Self-and family Management Framework

5. Ryan & Sawin (2009) Individual and Family Self-Management Theory

6. Udlis (2011) Concept Analysis

7. Audulv, et al. (2009) Grounded theory

8. Sousa & Zauszniewski (2005) Enhance-Behavior Performance Model

9. Sousa & Zauszniewski (2005)

10. Bauman (12.2.2013) Outcomes: glycemic control, diabetes- related complications, self-rated health, health care utilization/$ Self- Management Behaviors Influencing Factors Self-efficacy Depressive symptoms Perception of illness Trajecotry/severity of illness Co-morbid conditions Genetics Demographics (age, race, ethnicity, sex, gender) Stress (perceived, diabetes-related, biological) Policy Health care system Insurance status Social support Autonomy support Healthcare provider- patient relationship Access to care SES Neighborhoo d Characteristic s of family/friends Social norms

11. References American Diabetes Association (ADA). (2013, March 6). American Diabetes Association Releases New Research Estimating Annual Cost of Diabetes at $245 billion. Retrieved December 1, 2013, from http://www.diabetes.org/for-media/2013/annual-costs-of-diabetes-2013.html?loc=cost-of-diabetes. http://www.diabetes.org/for-media/2013/annual-costs-of-diabetes-2013.html?loc=cost-of-diabetes Audulv, A., Norbergh, K.G., Asplund, K., & Hornsten, A. (2009). An ongoing process of inner negotiation – a Grounded Theory study of self-management among people living with chronic illness. Journal of Nursing and Healthcare of Chronic Illness, 1, 283–293. doi: 10.1111/j.1752-9824.2009.01039.x. Centers for Disease Control and Prevention (CDC). (2011). National Diabetes Fact Sheet. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Diabetes Control and Complications Trial Research Group (DCCT). (1993). The effect of intensive treatment of diabetes on the development and progression of long term complications in insulin-dependent diabetes mellitus. New England Journal of Medicine, 329, 977–986. Grey, M., Knafl, K., McCorkle, R. (2006). A framework for the study of self- and family management of chronic conditions. Nursing Outlook, 54, 278-286. doi:10.1016/j.outlook.2006.06.004 King, P., Peacock, P., & Donnelly, R. (1999). The UK Prospective Diabetes Study (UKPDS): Clinical and therapeutic implications for type 2 diabetes. British Journal of Clinical Pharmacology, 48(5), 643-648. Ryan, P., & Sawin, K.J. (2009). The Individual and Family Self-Management Theory: Background and perspectives on context, process, and outcomes. Nursing Outlook, 57(4), 217-225. Sousa, V.D., & Zauszniewski, J.A. (2005). Toward a theory of diabetes self-care management. Journal of Theory Construction and Testing, 9, 61–67. Stratton, I.M., Adler, A.I., Andrew, H., Neil, W., Matthews, D.R., Manley, S.E., Cull, C.A., Hadden, D., Turner, R.C., Holman, R.R. (on behalf of the U.K. Prospective Diabetes Study Group). (2000). Association of glycemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): Prospective observational study. British Medical Journal, 321, 405–412. Udlis, K.A. (2011). Self-management in chronic illness: Concept and dimensional analysis. Journal of Nursing and Healthcare of Chronic Illness, 3, 130-139. doi: 10.1111/j.1752-9824.2011.01085.x.

12. Bauman (2013) Theoretical Framework for T2DM Self-Management Global Macro Meso/Mezzo Micro