Diabetes Self-Management: Patient Cognition and the Development of Expertise

Expert decision making has been widely researched among professionals, but non-professionals make many equally complex decisions. This study uses the case of type II diabetes to explore complex decision making among non-professionals. It was hypothesized that three cognitive aspects of expertise, problem detection, functional relationships, and problem solving, would be linked with higher levels of self-management (higher adherence and lower glucose). Twenty participants with diabetes were interviewed concerning their knowledge and experiences with diabetes. Participants also completed a questionnaire concerning their self-management practices. Interviews were transcribed and thematically coded. Participants who displayed characteristics of expert cognition reported higher levels of adherence to prescribed treatments and higher glycemic control. Most participants identified the factors involved in glucose regulation; fewer understood the functional relationships among factors; and less than half were able to solve glucose imbalances. Participants knew more about diabetes self-management than they reported applying in their daily lives.