Physical activity and self-care activities among type 2 diabetic patients: the role of insomnia impact and vital exhaustion

Objectives: Within an health protection framework, we examined in a group of diabetic type 2 patients how and to what extent the impact of insomnia and negative affect are associated with physical activity and with adherence to important self care activities (monitoring diet, blood glucose, feet, etc); having controlled the role of the perceived severity of diabetes and of the perceived interferences with daily activities. Methods: We interviewed 147 diabetic type 2 patients (63% male) on the following areas: (i) perceived severity of diabetes and its complications, and perceived interference of diabetes with daily activities, work, and social activities, measured through the Multidimensional Diabetes Questionnaire (Talbot et al., 1997), (ii) Vital Exhaustion measured by the Maastricht Questionnaire (Appels, et al., 1987), (iii) A score of insomnia impact calculated from the Sleep Disorder Questionnaire (Violani et al., 2004), (iv) A score of physical activity derived from the Physical Activity Scale for the Elderly (PASE; Washburn et al., 1993), (v) A global score of self care activities calculated on the basis of the Summary of Diabetes Self-Care Activities Measure (SDSCA, Toobert et al., 2000). We used a series of hierarchical regression analyses for each criterion variable (PASE and SDSCA). Firstly we controlled for interference and severity of diabetes. In the second block we entered: vital exhaustion and insomnia impact. Subsequently, in the third block, we considered the two ways interaction of vital exhaustion and impact insomnia. Results: Higher levels physical activity were associated with higher scores of perceived severity (Beta = 0.36; P < 0.000) and lower levels of interference of diabetes (Beta = -0.19; P < 0.05). Furthermore the interaction between vital exhaustion and insomnia impact was significant (Beta = 0.28; P < 0.05). Patients characterized by lower levels both of vital exhaustion and insomnia impact were more prone to declare to engage in physical activity. With regards to self care, lower scores of monitoring diet, feet and blood glucose were associated with higher scores of insomnia impact (Beta = -0.29; P < 0.05). Conclusion: Findings suggest that vital exhaustion and insomnia impact play an important role in the adherence to prescribed behaviors among type 2 patients. The process of disease management in diabetic type 2 patients should be integrated with counseling regarding sleep hygiene.