The Science of Diabetes Self-Management and Care

Purpose

The purpose of this study was to evaluate how social support and race/ethnicity were associated with diabetes self-care behaviors and clinical outcomes.

Methods

Using the cross-sectional 2005-2006 National Health and Nutrition Examination Survey (NHANES), the authors examined white, black, and Latino respondents who self-reported a diabetes diagnosis (n = 450), estimating the associations of social support on diabetes outcomes. The primary exposure was a social support index (0-5), which assessed the number of sources of support in one’s life. Outcomes were self-care behaviors (controlling weight, exercising, controlling fat/caloric intake, checking feet, and self-monitoring blood glucose) and intermediate clinical outcomes (hemoglobin A1C, diastolic blood pressure, and low-density lipoprotein [LDL]).

Results

There were no differences in social support by race/ethnicity. The authors observed several significant race/ethnicity by social support interactions in adjusted models, controlling for age, gender, education, self-reported health, depression, functional disability, insurance status, and insulin use. Among blacks, social support was associated with controlling weight (odds ratio [OR] = 1.55, P = .03), exercising (OR = 1.38, P = .03), controlling fat/ calories (OR = 1.84, P = .03), and lower diastolic blood pressure (β = -3.07, P = .02). Among whites, social support was associated with lower LDL (β = -9.45, P = .01). No significant effects were noted for Latinos.

Conclusions

The relationship of social support with diabetes management differed by race/ethnicity, with the strongest findings among blacks. Social support may be influential for maintaining self-care behaviors among blacks and controlling lipid levels among whites.

Purpose

The purpose of this study is to investigate the impact of a 6-month Web-based intervention on the psychosocial well-being of older adults with diabetes.

Methods

This study was a randomized controlled trial (N = 62) comparing the effects of a 6-month Web-based intervention plus usual care with usual care alone among adults aged 60 years or older with diabetes. The outcomes included quality of life, depression, social support, and self-efficacy.

Results

The intervention group showed significant improvement, F(4.48) = 4.03 P = .007, when compared with the control group on measures of depression, quality of life, social support, and self-efficacy when controlling for all baseline outcome variables (age, gender, and number of years with diabetes).

Conclusions

These findings provide support for the conclusion that a Web-based intervention is effective in improving the psychosocial well-being of participants at a 6-month follow-up. Future research needs to investigate the long-term effectiveness of Web-based interventions for sustaining psychosocial well-being, including factors that may affect quality of life, such as diabetes-specific beliefs, attitudes, social support, and disease-specific coping skills.

Patients with human immunodeficiency virus (HIV) are an increasing subpopulation of patients seen in endocrine/ diabetes clinics. This article explores evidence-based treatment recommendations for patients with metabolic syndrome who are also positive for HIV. Patients infected with HIV may manifest metabolic abnormalities. They often present with low high-density lipoprotein (HDL-C), hypertension, visceral adiposity, and insulin resistance, among other symptoms consistent with features of the metabolic syndrome. The etiologies of the metabolic abnormalities are not completely understood. The role of highly active antiretroviral therapy (HAART) and the separate effect of HIV on patients who are surviving longer may contribute to the increased incidence of the development of the metabolic syndrome. The role of the health care team is to provide patient education to patients with HIV concerning lifestyle modification in order to prevent complications related to the metabolic syndrome.

Purpose

The purpose of this study was to determine the effects of a behavioral faith-based diabetes prevention program called the Fit Body and Soul program in a semi-urban African-American church using a community-based participatory approach.

Methods

The 12-session Fit Body and Soul program was modified from the group lifestyle balance intervention that was modified from the successful National Institute of Health (NIH) funded Diabetes Prevention Program. The Fit Body and Soul program was implemented in a semi-urban African-American church community. Based on the results of physical examinations and increased body mass index (BMI ≥ 25), 40 adult members of the church were identified as being at high risk for diabetes. Four church ministers, after receiving Fit Body and Soul program training for 2 days, served as study interventionists. The primary objective was weight loss of at least 5% by the end of the 12-session Fit Body and Soul intervention.

Results

Screening of church participants was conducted at the Gospel Water Branch Baptist Church in Augusta, Georgia. A total of 40 individuals having a BMI ≥ 25 were selected. Of the 40, a total of 35 (87.5%) attended at least 10 sessions and provided information required for the study. Of the 35, a total of 48% lost at least 5% of baseline weight, 26% lost 7% or more, and 14% lost >10% of baseline weight.

Conclusions

This pilot trial suggests that carrying out a larger Fit Body and Soul study in a faith-based setting, using behavioral lifestyle interventions, in the context of a diabetes prevention program for African American communities is feasible, as is the possibility that subjects in that larger study will achieve a clinically significant degree of weight loss.

Purpose

The purpose of this study was to determine the influence of having a family member who experienced an amputation on one’s own perceived risk and fear of experiencing a diabetes-related amputation.

Methods

This was a descriptive cross-sectional study using paper-and-pencil surveys by mail. Adults with type 2 diabetes and a family history of diabetes attending a self-management education program in the Metropolitan New York/ New Jersey area were recruited. Measures were completed about risk perception and fear of amputation, emotional representations of diabetes from the Illness Perception Questionnaire, and the foot self-care behavior component of the Summary of Diabetes Self-care Activities Survey. The authors estimated the variability in foot self-care that was accounted for by risk perception and fearful memories.

Results

In those who remembered a family member needing an amputation, high perceived risk and fear was associated with less routine foot self-care. For those without family history of amputation, fear was positively associated with foot self-care.

Conclusions

Motivation for foot self-care behavior may be driven by risk perception and emotional responses. The ways in which risk perception and fear influence motivation for preventive foot self-care behavior are influenced by whether one’s family member was affected by an amputation. Probing about the influence of the patient’s legacy of diabetes may be helpful when customizing education plans.

Purpose

The purpose of this study was to examine gender-based differences in cardiovascular risk factors and risk perception among individuals with diabetes.

Methods

The sample consisted of patients with an established history of diabetes who were enrolled in a telemedicine trial to reduce cardiovascular disease (CVD) risk. All subjects had a 10% or greater risk on the Framingham risk index. Assessments included blood pressure, A1C, lipid profile, medication history, and knowledge and risk perception surveys.

Results

Data were available for 211 individuals with type 2 diabetes (88 men and 123 women). The women and men did not differ in age, body mass index, or Framingham risk. Only 37.4% of women and 40.9% of men were at an A1C target of <7%. Total cholesterol levels were significantly higher among women, and fewer women were at low-density lipoprotein or blood pressure targets. Knowledge of CVD was similar between the 2 sexes. However, women perceived their risk for CVD to be significantly higher than did men.

Conclusion

Less favorable cardiovascular risk profiles are observed among women with diabetes as compared with their male counterparts. Multifaceted approaches to both diabetes management and education are needed to target CVD risk reduction among individuals with diabetes.

Purpose

The purpose of this study was to assess beliefs, perceived access to, and practices regarding contraception among adolescent women with type 1 diabetes.

Methods

Eighty-nine females with type 1 diabetes between the ages of 13 and 19 years, who were recruited from 2 endocrinology practices as part of a larger study, completed a battery of questionnaires designed to assess variables relevant to discussions of sexuality, preconception counseling, contraception, and pregnancy. In addition, items were designed to explore adolescents’ relationship with their health care provider and comfort requesting birth control. Baseline data were analyzed using descriptive statistics.

Results

Half of the sexually active adolescents in this sample reported having had sex without birth control at a time they were trying to avoid pregnancy. A third (36%) of subjects felt that women with diabetes have very limited choices of birth control, and 43% incorrectly believe that all birth control methods are less effective when used by women with diabetes. Less than half (47%) reported that they had discussed birth control with a health care professional, and 29% of subjects reported they had not received formal instruction on birth control in any setting. Perhaps of greatest concern, only 69% stated they would feel comfortable asking a professional for birth control.

Conclusion

Many adolescent women with diabetes are at risk of unintended pregnancy and do not feel comfortable asking a health professional for birth control. Diabetes educators who initiate preconception counseling at puberty and discuss contraceptive options with adolescent women with diabetes may improve pregnancy outcomes.

Purpose

The purpose of this study was to examine perceived barriers to physical activity among adults with and without abnormal glucose metabolism (AGM), and whether barriers varied according to physical activity status.

Methods

The 1999 to 2000 Australian Diabetes, Obesity, and Lifestyle Study (AusDiab) was a population-based cross-sectional study among adults aged ≥25 years. AGM was identified through an oral glucose tolerance test. The previous week’s physical activity and individual, social, and environmental barriers to physical activity were self-reported. Logistic regression analyses examined differences in barriers to physical activity between those with and without AGM, and for those with and without AGM who did and did not meet the minimum recommendation of 150 minutes/week of moderate-to-vigorous intensity physical activity.

Results

Of the 7088 participants (47.5 ± 12.7 years; 46% male), 18.5% had AGM. Approximately 47.5% of those with AGM met the physical activity recommendation, compared to 54.7% of those without AGM (P < .001). Key barriers to physical activity included lack of time, other priorities, and being tired. Following adjustment for sociodemographic and behavioral factors, there were few differences in barriers to physical activity between those with and without AGM, even after stratifying according to physical activity.

Conclusions

Adults with AGM report similar barriers to physical activity, as do those without AGM. Programs for those with AGM can therefore focus on the known generic adult-reported barriers to physical activity.