"Have to Fight the Demon": Veteran Type 2 Diabetes Mellitus Behavioral Self-Management and Diabetes Specific Risk-Taking Behaviors.

Roman Jones J, Hart S, Crowley MJ, Bosworth HB, Shapiro AS, Eldridge MR, Whitfield CL, Howard T, Jeffreys AS, Coffman CJ, McConnell E, Barcinas S, Lewinski AA. "Have to Fight the Demon": Veteran Type 2 Diabetes Mellitus Behavioral Self-Management and Diabetes Specific Risk-Taking Behaviors. Journal of primary care & community health. 2025 Dec 23; 16:21501319251391012, DOI: 10.1177/21501319251391012.

Related HSR&D Project(s)

• RCS 08-027 – Research Career Scientist Award

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Abstract:

OBJECTIVES: Diabetes mellitus Type 2 (T2DM) requires a set of life-long, complex self-management strategies that affect both physical and psychosocial aspects of daily life. This study aimed to assess how Veterans with T2DM describe self-management behaviors and to explore whether a framework of diabetes-specificrisk-taking behaviors (originally applied to adolescents with T1DM) is applicable to Veterans with T2DM. METHODS: This study employed a secondary qualitative analysis of Veteran interviews (n  =  36) using a priori codes based on the Summary of Diabetes Self-Care Activities (SDSCA) and the Diabetes-Specific Risk-Taking Inventory (DSRI) to explore self-management behaviors and to assess the applicability of diabetes-specific risk-taking behaviors among Veterans. RESULTS: We identified themes aligned with each of the SDSCA a priori codes, along with an added code relating to medication, reflecting both self-management behaviors and diabetes-specific risk-taking behaviors: (1) diet: constant negotiation can involve purposeful risk-taking; (2) physical activity: intentional, but also avoided despite consequences; (3) blood-glucose monitoring: personal effort of monitoring can override risk-reduction; (4) foot care: preventing complications; (5) smoking: struggles and successes with quitting; and (6) medication: intent to adhere can be undercut by risk taking and lack of resources. CONCLUSION: Veterans described self-management behaviors that align with diabetes-specific risk-taking, suggesting that the DSRI framework has potential applicability to this population. Future work exploring diabetes-specific risk-taking behaviors will be critical to helping Veterans successfully manage their T2DM.