The Science of Diabetes Self-Management and Care

Guided by the PEN-3 Cultural Model, the purpose of this study is to generate culturally framed insight into diabetes knowledge, management, and prevention among Haitians. Despite the disproportionate distribution of type II diabetes mellitus among US minorities, limited research explores outcomes within racial ethnic groups. It is particularly important to disaggregate the large racial-ethnic groups of black given the population growth among foreign-born blacks, such as Haitians, whose population has more than quadrupled in recent decades.

Focus group interviews were employed to understand diabetes knowledge, management, and prevention in the Haitian immigrant population in Philadelphia. Interviews were conducted in 2 groups: (1) people living with diabetes and (2) an at-risk sample for diabetes (defined as 30 and older with self-reported family history of diabetes). Interviews were recorded and transcribed verbatim in preparation for content analysis.

Of the 10 participants, who were recruited through a Philadelphia church-based population, ages ranged from 41 to 91, with an average of 65. Content analysis revealed 3 emergent themes across: (1) cultural identity, including person, extended family, and neighborhood; (2) relationships and expectations, including perceptions, enablers, and nurturers; and (3) cultural empowerment, including positive, existential, and negative.

Results may inform culturally appropriate diabetes interventions for Haitians. Future research should explore compliance with food recommendations as well as the cultural competency of health care professional’s information delivery.

The purpose of this pilot feasibility project was to examine the potential effectiveness of a digital storytelling intervention designed through a community-based participatory research (CBPR) approach for immigrants and refugees with type 2 diabetes mellitus (T2DM).

The intervention was a 12-minute culturally and linguistically tailored video consisting of an introduction, 4 stories, and a concluding educational message. A structured interview was used to assess the intervention for acceptability, interest level, and usefulness among 25 participants with T2DM (15 Latino, 10 Somali) across 5 primary care clinical sites. After watching the video, participants rated their confidence and motivation about managing T2DM as a result of the intervention. Baseline A1C and follow-up values (up to 6 months) were abstracted from medical records.

All participants reported that the intervention got their attention, was interesting, and was useful; 96% reported that they were more confident about managing their T2DM than before they watched the video, and 92% reported that the video motivated them to change a specific behavior related to T2DM self-management. The mean baseline A1C level for the intervention participants was 9.3% (78 mmol/mol). The change from baseline to first follow-up A1C level was −0.8% (−10 mmol/mol) (P < .05).

Implementation of a digital storytelling intervention for T2DM among immigrant populations in primary care settings is feasible and resulted in self-rated improvement in psychosocial constructs that are associated with healthy T2DM self-management behaviors, and there was some evidence of improvement in glycemic control. A large-scale efficacy trial of the intervention is warranted.

Diabetes affects more than 29 million people in the US and requires daily self-management in addition to knowledge of the disease. Three knowledge assessments used are the Michigan Brief Diabetes Knowledge Test (DKT), Starr County Diabetes Knowledge Questionnaire (DKQ), and Kaiser DISTANCE Survey (DISTANCE).

The purpose of the study was to test the discriminate validity of 3 diabetes knowledge scales and determine which is best associated with diabetes self-care and glycemic control.

Three hundred sixty-one adults with type 2 diabetes were recruited from primary care clinics. Four analyses were conducted to investigate the validity and relationships of the scale: alpha statistic to test internal validity, factor analysis to determine how much of the variance was explained, Pearson’s correlation between the 3 scales, and Pearson’s correlation between each scale, self-care, and outcomes.

The DKQ had an alpha of 0.75, the DKT had an alpha of 0.49, and DISTANCE had an alpha of 0.36. The DKQ was significantly correlated with glycemic control. The DKT scale was significantly associated with general diet, the DISTANCE survey was significantly associated with exercise, and both DKT and DISTANCE were significantly associated with foot care.

Correlations among the 3 scales were modest, suggesting the scales are not measuring the same underlying construct. These findings indicate that researchers should carefully select scales appropriate for study goals or to appropriately capture the information being sought to inform practice.

The purpose of this qualitative, focus group study was to further refine the Resilience-based Diabetes Self-management Education (RB-DSME) recruitment process and intervention, build greater trust in the community, and identify strategies to enhance its sustainability as a community-based intervention in African American church settings.

Six 2-hour focus groups (N = 55; 10 men and 45 women) were led by a trained moderator with a written guide to facilitate discussion. Two sessions were conducted with individuals diagnosed with type 2 diabetes mellitus (T2DM) who participated in previous RB-DSME pilot interventions and their family members, two sessions with local church leaders, and two sessions with community healthcare providers who care for patients with T2DM. Two independent reviewers performed content analysis to identify major themes using a grounded theory approach. The validity of core themes was enhanced by external review and subsequent discussions with two qualitative methods consultants.

There was expressed interest and acceptability of the RB-DSME program. Church connection and pastor support were noted as key factors in building trust and enhancing recruitment, retention, and sustainability of the program. Core themes across all groups included the value of incentives, the need for foundational knowledge shared with genuine concern, teaching with visuals, dealing with denial, balancing the reality of adverse consequences with hope, the importance of social support, and addressing healthcare delivery barriers.

Focus groups documented the feasibility and potential effectiveness of RB-DSME interventions to enhance diabetes care in the African American community. In clinical practice, inclusion of these core themes may enhance T2DM self-care and treatment outcomes.

The purpose of this study is to investigate the effect of volunteering at a diabetes camp on emerging adults with and without type 1 diabetes mellitus (T1DM).

Thirty counselors with and 22 without T1DM (19.07 ± 2.71 years old) volunteered at a 1-week T1DM camp in the northeastern United States. Counselors with T1DM had a range of self-reported A1C scores (5.8% or 39.9 mmol/mol to 14.0% or 129.5 mmol/mol). Self-report measures of quality of life, hope, and well-being were completed pre- and postcamp at 4 time points: 1 month before camp, arrival at camp, final day of camp, and 2 months postcamp. Open-ended questions regarding counselor experiences were analyzed to understand camp effect.

There were significant differences between counselors’ levels of trait hope in comparison to published norms. There were few clear differences in psychosocial outcomes pre- and postcamp; however, some increases in well-being were revealed in anticipation of camp. Major reasons for volunteering included assisting others and reciprocating or continuing a perceived positive experience as a camper.

No changes in psychosocial outcomes pre- to postcamp were observed. However, measures used in this study may be poorly defined for a counselor population. Further research on the characteristics of emerging adults who choose to be camp counselors is needed. By understanding the demographics of this population, health professionals can help target individuals to become camp counselors as well as enhance the camp experience to fit their developmental needs.

The purpose of this study was to determine if the use of both the Talking Circles (TCs) and diabetes self-management education (DSME) results in better adherence and outcomes for diabetes self-management than DSME alone in American Indians (AIs) with type 2 diabetes mellitus (T2DM).

A quasiexperimental, mixed-methods approach was used for AIs with uncontrolled T2DM, defined by an A1C > 7.0%. The experimental group (n = 20) participated in a TC and received DSME. The control group (n = 19) received only DSME. Talking Circles were audio-taped and analyzed qualitatively. Quantitative data were analyzed using the generalized estimating equation and Fisher exact test for all study participants every 3 months for 1 year.

Themes identified by TC participants were spirituality, gratitude, and sharing. Major topics of discussion were the experiences of living with T2DM, including challenges and coping. Evidence of positive trends for the experimental group who received the TC intervention included lower systolic blood pressure, lower A1C, lower weight over time, and increased adherence without incentives.

Talking Circles may have utility in improving adherence in AI adults with uncontrolled T2DM. Further studies are warranted, including extending the use of the TCs after completion of DSME sessions.

This meta-analysis examined relationships between social support and self-care in type 1 (T1DM) and 2 diabetes mellitus (T2DM).

We searched for published and unpublished studies using the following databases: PubMed, Embase, PsycINFO, the Cochrane Library, and Medline. MeSH search terms included “diabetes mellitus,” “social support,” “caregiver,” “self-care,” “self-management,” “self-care skills,” and “coping behavior.” Studies reporting correlations between social support and self-care were included.

Initially, 2 095 studies were extracted. After eliminating duplicate and irrelevant studies, 28 studies involving 5 242 patients with diabetes were included. Of these, 22 studies examined T2DM subjects. Social support was significantly associated with self-care (k = 28, r = .28, 95% CI: .21-.34, P < .001). Among the diabetes self-care types, the strongest effect was found for glucose monitoring (k = 6, r = .21, 95% CI: .08-.33). The relationship between social support and self-care was stronger in T2DM (k = 22, r = .30, 95% CI: .22-.37), relative to T1DM, samples (k = 5, r = .22, 95% CI: .02-.38).

It was concluded that the overall effect size for social support on self-care was moderate, and its strength differed by ethnic majority within the sample, type of social support measures, and publication status.