Environmental influences on adherence to self-management behaviors and glycemic control in African American patients with type 2 diabetes mellitus

Diabetes mellitus is a chronic illness effecting approximately 20.8 million individuals in the United States. Minorities are adversely affected, with age-adjusted prevalence 1.7 times higher in African Americans than Caucasians. Type 2 diabetes is significantly affected by behavioral and environmental risk factors, including the presence of co-occurring diseases (i.e., hypertension, hyperlipidemia), obesity, age, and lack of physical activity, and each of these risk factors is more prevalent among African Americans. The treatment of diabetes is largely self-managed, with patients and their families handling 95% of their own care. Adherence to the multi-component diabetic treatment regimen requires daily care, often occurring in more than one environment. While many studies have attempted to address the impact of social support on the self-management behavior of diabetics, few have tried to assess both intra-individual and environmental influences of support on the adherence. There is a paucity of research concerning the diabetic self-care treatment regimen and social support in an African American population, or addressing the disproportionate effect of environmental influences on African Americans. The current study sought to address this gap in the literature by using the Chronic Illness Resources Survey, a measure of multilevel support resources, to assess environmental influences of social support on African American patients’ adherence to self-management behaviors. The current study also sought to address common methodological concerns, including the addition of glycemic control (HbA1c) as an outcome measure and control for social desirability

Promoting Physical Activity in Low Income African Americans: Project LAPS

Low income African Americans are at increased risk for physical inactivity and related chronic illnesses. Thus, effective interventions are needed to address these health disparities. The current study examined the efficacy of a home-based physical activity intervention among a low income African American sample with high rates of chronic illnesses (obesity, hypertension, diabetes, high cholesterol). Participants (n=214) were randomly assigned to either the home-based physical activity intervention (self-help print materials, five monthly newsletters, two telephone counseling sessions) or an attention control condition, which promoted healthy diet. Results indicated that the intervention did not produce significantly greater increases in physical activity from baseline to six months than the control group. Lessons learned from the current study include the importance of using proactive retention strategies with low income African American participants and taking into consideration the cultural relevance of the intervention

Medical and psychosocial outcomes of laparoscopic Roux-en-Y gastric bypass: cross-sectional findings at 4-year follow-up

BACKGROUND: In conjunction with the Louisiana Office of Group Benefits, the Louisiana State University School of Medicine conducted a study to examine 4-year medical and psychosocial outcomes of laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery in patients insured by a state-run managed care program. METHODS: Forty severely obese participants (body mass index \u3e40 and \u3c60 kg/m(2)) underwent LRYGB surgery. Four years later, self-reported data on weight, blood pressure, blood glucose, and cholesterol were collected from the participants via telephone, and chart reviews for most recent weight and laboratory measures available were requested from physicians of record. Participants also completed self-report measures of quality of life, depressive symptoms, binge eating, quality of eating style, and overall satisfaction with the surgery via telephone. RESULTS: Patients lost an average of 62% of excess weight. In addition, the sample showed favorable medical outcomes in terms of blood pressure, lipid profiles, and blood glucose. Patients reported low depression, good quality of life, high satisfaction with surgery, and no binge eating 4 years post-surgery. However, many participants reported concerns about eating habits as well as excessive intake of high-fat, high-calorie foods. CONCLUSIONS: Overall, these results suggest healthy levels of psychosocial and medical functioning 4 years after LRYGB and highlight the need for long-term dietary counseling and support post-surgery

Actual medical and pharmacy costs for bariatric surgery: 6-year follow-up

OBJECTIVE: To determine the change in total medical expenditures, total pharmacy expenditures, and subcategories of medical and pharmacy expenditures in obese individuals following weight loss surgery (WLS), and to compare these costs with expenditures in obese individuals not receiving WLS. METHODS: Louisiana Office of Group Benefits (OGB), the state-managed health insurer, invited members to be evaluated for insurance-covered WLS. Of 951 obese members who provided written consent to begin the WLS screening process, 40 were selected for surgery. Medical and pharmaceutical claims cost data of the 911 patients who did not have surgery and the 39 individuals who completed surgery were compared over a 2-year presurgical and 6-year postsurgical period. RESULTS: Total nonpharmacy medical costs were lower for WLS patients compared with non-WLS patients beginning 4 years postsurgery and lasting through 6 years postsurgery. No differences were found between WLS and non-WLS patients in expenditures for most medical subcategories examined, including emergency department, physical and occupational therapy, office visits, and laboratory/pathology; whereas sleep facility and all remaining medical expenditures not represented by a subcategory were lower for WLS patients during some postsurgery years. Total pharmacy costs were lower for WLS participants at 2 and 3 years postsurgery, but these lower costs were not maintained; however, costs remained lower for antidiabetic agents, antihypertensive agents, and dyslipidemic agents through all 6 postsurgery years under study. CONCLUSIONS: The cost of WLS may begin to be recouped within the first 4 years postsurgery with continued effects 6 years postsurgery