Contemporary models of care for patients with chronic diseases such as diabetes focus on preparing them for self-care. Patients diagnosed with type 1 diabetes should be aware that it is an incurable disease that requires continuous pharmacotherapy and insulin administration. Patients diagnosed with type 2 diabetes should be made aware that the course and progression of the disease, optimization of glycemia, and intensity of symptoms depend on their decisions and individual health behaviors [12, 14-16].
A diabetic patient prepared for self-care is a patient who has a certain amount of knowledge and specific skills. In terms of knowledge, it is necessary to understand the nature of the disease, its pathophysiology, metabolic changes, symptoms, state of hyper and hypoglycemia as well as pharmacological and non-pharmacological methods of treatment. A patient with diabetes should learn the skills of self-observing the symptoms, using a glucometer, administering insulin (pen, insulin pump), using a blood pressure measuring device, performing a urine strip test for ketone bodies and adjusting their menu to daily requirements .
Due to the course and duration of the disease as well as the impact of the patient's health behavior on the risk of late complications and treatment costs, the International Diabetes Federation has developed guidelines for patient care and prevention of diabetes , which are consistent with the position of the Polish Diabetes Society . It emphasizes that the preparation of the patient for self-care and self-management takes place through education that is individualized, focused on the patient, and taking into account their clinical condition, perceptual abilities and environmental conditions. Education of a diabetic patient should be comprehensive and carried out by a competent team. It should also be combined with behavioral therapy, which aims to correct health behaviors. An inseparable element of education is psychological support provided to the patient, focused on encouraging acceptance of a chronic disease, strengthening the motivation for optimal management in the therapy process, and shaping the patient's sense of influence on the course of the disease, while at the same time ensuring open communication with the therapeutic team. Education in the treatment of diabetic patients is of such importance that it is recommended that it involves not only diabetics themselves, but also their families and caregivers .
Referring to the description of a patient characterized as prepared for self-care, it is difficult to talk about full co-responsibility and active participation of the patient in the therapeutic process, since as many as 23.2% of patients included in the present study did not control their glucose levels at home with a glucometer, and every fifth respondent (21.1%) reported using the help of another person in taking this measurement. In this study, 64.7% of the respondents declared keeping a self-care diary. This result is consistent with the data presented in the report of the Coalition for Fighting Diabetes of 2017, where 58% of respondents managed a self-care diary .
In the present study, self-preparation and administration of oral hypoglycemic drugs or insulin was reported by 63.7% of patients. A potential lack of independence of a patient indicates the need to provide them with physical rehabilitation, to select medical equipment adapted to their psychophysical abilities, and – in many cases – to use the support of relatives.
For patients with a chronic disease such as diabetes, it is crucial to learn about their internal resources: the sense of agency, of being able to manage the disease, of independence, and of security. These translate into the patient's independence and the ability to manage self-care. Professional psychological help makes it easier for the patient to discover their individual internal resources [18, 19].
In the treatment of people with diabetes, it is recommended to strive for modification and transition from a sedentary to a more active lifestyle with the use of all forms of activity [5, 6]. Physical activity should be undertaken regularly. Before and after exercise, it is advisable to determine blood glucose levels corrected by taking an additional portion of carbohydrates [20,21]. Although regular physical activity for at least 30 minutes is conducive to reducing the risk of cardiovascular diseases and is an important aspect of non-pharmacological treatment of diabetes, the present study showed that 52.1% of the patients did not consider it as a permanent element in their lifestyle. Only three patients (1.6%) declared systematic physical activity of about 150 minutes a week. In the National Health Test of Poles in 2020, among 401,195 respondents, the largest group of people (39%) was engaged in physical activity for up to 30 minutes a day .
Chronically ill patients require systematic therapy, following indications and recommendations of their physician, as well as compliance with treatment procedures in order to minimize the effects of the disease. Failure to comply with the principles of long-term therapy reduces the effectiveness of treatment, which most often leads to the patient discontinuing the therapy and, consequently, causes a greater number of complications and increases mortality. Complications reduce the patient's quality of life and burden the health care system [3,23].
The standard for the management of diabetic patients adopted by the Polish Diabetes Society provides for comprehensive patient care and is based on the assumption that compliance with this standard prevents the progression of the disease and the development of serious complications. The standard defines the educational role of the nurse in preparing the patient for self-care. Nurses working at all levels of diabetes care can contribute to organizing and delivering high-quality care for patients with diabetes. Nurses play an important role in shaping and supporting the patient's responsibility for own health through face-to-face consultations, counseling, or the provision of structured diabetes education and self-control plans [8,24,25,26].