Adjusting insulin doses: from knowledge to decision

Abstract

The aim of this study was to analyze the absence of adjustment of insulin doses in type 1 diabetic patients with poorly controlled diabetes. Twenty-eight patients (HbA 1 c higher than 8.5% during the last 6 months, performing at least three capillary blood glucose determinations per day), completed a questionnaire on the degree of confidence in their own knowledge, the nature of their health beliefs, their fear of hypoglycemia, their own appreciation on how they adjust their insulin doses (subjective score). An analysis of their diabetes logbook provided an objective score of the adjustment of doses actually performed. The results show that the subjective and objective scores of adjustment were not significantly correlated. Further there was a significant negative correlation between the score of uncertainty on knowledge and the subjective score of adjustment of the insulin doses, but not with the objective score. There was a significant correlation between the score of positive health beliefs and the subjective score of adjustment of the insulin doses, but not with the objective score. No correlation was found between the score of fear of hypoglycemia and the subjective score of adjustment of the insulin doses. Correlation with the objective score was higher, but not significant. Actually, the fear of hypoglycemia was the most frequently given reason for not adjusting the insulin doses, when the question was asked to the patients with an open answer. This study illustrates the difference between thinking and doing. It also shows that the degree of confidence in one's own knowledge, the health beliefs, and the fear of hypoglycemia differently influence the perception that the patients have of their behavior, and what they really do.

Feeling of certainty: Uncovering a missing link between knowledge and acceptance of evolution

“…Although studies of FOC have not been conducted in educational settings, FOC measures have been implemented in several medical research projects (e.g., Bruttomesso et al, 2003, 2006; El Saadawi et al, 2010; Reach, Zerrouki, Leclercq, & d'Ivernois, 2005). Our FOC items were nearly identical to those used in this prior medical work.…”

“…After thinking carefully about your feelings please indicate your degree of certainty on the 11‐point scale below”). Although some studies of FOC have used Likert‐scale items or dichotomous‐scale items (e.g., Bruttomesso et al, 2006; El Saadawi et al, 2010; Reach et al, 2005), Hodge and Gillespie (2007) suggested that phrase completion scales (11‐point scales) are capable of measuring psychological states much more accurately than traditional Likert‐scale items. Moreover, Hodge and Gillespie's study indicated that phrase completion scales are more suited for studies employing structure equation modeling statistics than traditional Likert‐scale items.…”

Barriers to and enablers of insulin self‐titration in adults with Type 2 diabetes: a qualitative study

“…Not self-titrating was associated with increased blood glucose levels and ultimately serious, potentially life-changing complications, which encouraged people to titrate. As found in Type 1 diabetes, however, increasing the dose of insulin was linked to weight gain [14] and an increased likelihood of experiencing a hypoglycaemic episode [15], as well as developing a habit or addiction, as reported by others with Type 2 diabetes [9]. As a consequence, some people prioritized avoiding these outcomes rather than increasing their dose.…”

Évaluation préliminaire de l’impact d’un dispositif de formation aux gestes et soins d’urgence

“…La « connaissance erronée » peut effectivement se révéler plus dangereuse que l'« ignorance avouée ». La confiance ou le doute (justifié ou non) du stagiaire sur ses connaissances en gestes et soins d'urgence influencent grandement sa décision d'action ou une demande d'aide [17] . L'exploitation des degrés de certitude au cours d'évaluations formatives est encore peu développée [18] .…”