Our findings demonstrate that patients with diabetes, despite having long-standing disease and regular outpatient diabetes care, frequently hold beliefs regarding disease and medication that are inconsistent with a chronic disease model of diabetes. Insulin use and worse A1C levels were associated with higher rates of several of these beliefs, as were female sex, lower education levels, and oral medication use, suggesting a potential need for additional attention when treating diabetic patients with these characteristics. The newly observed misconceptions and related predictors may represent important opportunities for targeting barriers to successful diabetes management.
Furthermore, patients displayed unrealistic expectations of treatment, as exemplified by the finding that one-third expected their doctor to cure them of diabetes. Most of the patients were also unaware of the A1C test. Equally troubling is the fact that half of the patients thought that a glucose level up to ≤200 mg/dl is normal, and 42% stated that the glucose level up to ≤110 mg/dl is too low. These frequent misconceptions may be even more prevalent and have a greater effect in populations with more limited access to care and more poorly controlled A1C levels than those observed in this population.
Diabetes is a complex disease that involves monitoring of multiple indexes, assessment of risk factors, and, frequently, multiple medications. As noted in other studies, misconceptions and inadequate knowledge represent significant barriers to effective management (6
). However, there has been limited research examining how behavioral theory–driven assessments of patients' knowledge and beliefs about the disease and its treatment relate to successful diabetes management, particularly among inner-city adults with long-standing diabetes.
In summary, we found that disease and medication beliefs inconsistent with a chronic disease model of diabetes were common among urban minorities with diabetes despite long-standing disease and regular medical care. These misconceptions may be logical targets for interventions to improve diabetes self-management in lower-income, minority populations.