Facilitators and Barriers to Type 2 Diabetes Self-Management Among Rural African American Adults

Purpose: The purpose of this study was to identify facilitators and barriers to self-management of type 2 diabetes mellitus (T2DM) among African American adults living in rural communities. Research indicates that African Americans experience higher rates of T2DM and diabetes-related complications than other ethnic groups. In Kentucky, diabetes is now the fourth leading cause of death by disease among African Americans. Methods: Twenty-two African American adults with T2DM were recruited from three churches in rural communities in Kentucky. Three focus groups were conducted to identify factors that made managing diabetes easier (facilitators) and factors that made managing diabetes more difficult (barriers). Demographic data were collected using a 15-item survey, focused on the participants’ personal, social and medical history related to T2DM. Results: Support was the primary facilitator of self-management. Support from family, friends, and health care providers which encouraged them to seek information and adhere to diet and medications helped with management. Identified barriers to self-management included fear, perceived beliefs about their health status, and difficulty making lifestyle changes. Discussion and Conclusion: T2DM is a serious health problem in the African American population. Interventions should be designed that focus on providing support for African Americans with T2DM. Additionally, interventions should focus on overcoming the identified barriers to assist them in taking control and feeling empowered to effectively self-manage T2DM

Relationships of Sociodemographic Characteristics with Glycemic Control and Dietary Adherence in Adults with Type 2 Diabetes

Background: Previous studies supported that sociodemographic characteristics are significantly associated with dietary adherence and glycemic control in adults with T2D. The American Diabetes Association (ADA) recommends that individually designed nutritional plans consider the sociodemographic characteristics of the patients. Few studies were conducted to examine the impact of sociodemographic characteristics on adherence to the ADA dietary guidelines and A1C in adults with T2D. Aim: The study aimed to examine the relationships of sociodemographic characteristics with adherence to ADA dietary guidelines and glycated hemoglobin (A1C) in adults with type 2 diabetes (T2D). Methods: A cross-sectional study used data for 1,401 adults that were extracted from the National Health and Nutrition Examination Survey conducted between 2007 and 2012. Results: A large percentage of the sample was non-Hispanic White and female. Sex, race/ethnicity, marital status, education, and income were significantly related to A1C. Race/ethnicity and marital status were significantly related to adherence to ADA dietary guidelines. Single participants were at greater odds of being non-adherent compared to married participants. Furthermore, non-Hispanic Whites had much lower odds of non-adherence to ADA dietary guidelines compared to Hispanics. Conclusion: Individualizing patients’ nutritional plans based on sociodemographic characteristics is crucial for improving glycemic control and health outcomes in patients with T2D

Relationships of Depression, Anxiety, and Stress with Adherence to Self-Management Behaviors and Diabetes Measures in African American Adults with Type 2 Diabetes

This study examines the relationships of depression, anxiety, and stress with adherence to self-management behaviors and diabetes measures in 42 African American adults with type 2 diabetes (T2D). Participants were recruited from an outpatient clinic located in an urban area of a midsized city in the southeastern USA. The mean age of the sample was 54.9 years (SD = 9.9) and the majority of the participants were female (73.2%), high school graduates (55.3%), unemployed (70.7%), and publicly insured (77.8%). Each participant completed a demographic survey and the Depression, Anxiety and Stress Scale 21. Adherence to self-management behaviors (physical activity, diet, and medication use) was assessed using surveys and self-reports. Glycated hemoglobin (A1c) and body mass index (BMI) were obtained from participants’ medical records at the time of the participants’ clinic visits. Depression, anxiety, and stress were not significantly correlated with self-management behaviors. Depression (r = 0.38, p = 0.03), anxiety (r = 0.56, p = 0.001), and stress (r = 0.36, p = 0.04) were positively correlated with A1c. The greater the dietary risk assessment score, the higher the A1c (r = 0.34, p = 0.05). Anxiety was the strongest correlate of A1c followed by depression, stress, and dietary risk assessment. Future studies to confirm this study’s findings in a larger sample are warranted. Interventions to mitigate the effects of these correlates should be designed and tested to improve health outcomes in African American adults with T2D

Relationships of Depression, Anxiety, and Stress with Adherence to Self-Management Behaviors and Diabetes Measures in African American Adults with Type 2 Diabetes

This study examines the relationships of depression, anxiety, and stress with adherence to self-management behaviors and diabetes measures in 42 African American adults with type 2 diabetes (T2D). Participants were recruited from an outpatient clinic located in an urban area of a midsized city in the southeastern USA. The mean age of the sample was 54.9 years (SD = 9.9) and the majority of the participants were female (73.2%), high school graduates (55.3%), unemployed (70.7%), and publicly insured (77.8%). Each participant completed a demographic survey and the Depression, Anxiety and Stress Scale 21. Adherence to self-management behaviors (physical activity, diet, and medication use) was assessed using surveys and self-reports. Glycated hemoglobin (A1c) and body mass index (BMI) were obtained from participants’ medical records at the time of the participants’ clinic visits. Depression, anxiety, and stress were not significantly correlated with self-management behaviors. Depression (r = 0.38, p = 0.03), anxiety (r = 0.56, p = 0.001), and stress (r = 0.36, p = 0.04) were positively correlated with A1c. The greater the dietary risk assessment score, the higher the A1c (r = 0.34, p = 0.05). Anxiety was the strongest correlate of A1c followed by depression, stress, and dietary risk assessment. Future studies to confirm this study’s findings in a larger sample are warranted. Interventions to mitigate the effects of these correlates should be designed and tested to improve health outcomes in African American adults with T2D

Self-Management as a Mediator of the Relationship between Social Support Dimensions and Health Outcomes of African American Adults with Type 2 Diabetes

Social support promotes behavior change and self-management that leads to improved health outcomes. The purpose of this study was to evaluate the role of self-management in mediating the relationship between social support dimensions and health outcomes of African Americans with type 2 diabetes (T2D). Cross-sectional data were collected from 102 African Americans with T2D at an outpatient clinic. The majority of the participants were female, single, unemployed, and having low income. Functional support, the quality of the primary intimate relationship, and the number of support persons were negatively correlated with depression. Functional support and satisfaction with support explained a significant small amount of the variance in self-management. However, self-management did not mediate the relationships between social support dimensions and the health outcomes. The results of this study shed the light on the unique relationships of social support dimensions with health outcomes of African Americans with T2D

Self-Management as a Mediator of the Relationship between Social Support Dimensions and Health Outcomes of African American Adults with Type 2 Diabetes

Social support promotes behavior change and self-management that leads to improved health outcomes. The purpose of this study was to evaluate the role of self-management in mediating the relationship between social support dimensions and health outcomes of African Americans with type 2 diabetes (T2D). Cross-sectional data were collected from 102 African Americans with T2D at an outpatient clinic. The majority of the participants were female, single, unemployed, and having low income. Functional support, the quality of the primary intimate relationship, and the number of support persons were negatively correlated with depression. Functional support and satisfaction with support explained a significant small amount of the variance in self-management. However, self-management did not mediate the relationships between social support dimensions and the health outcomes. The results of this study shed the light on the unique relationships of social support dimensions with health outcomes of African Americans with T2D

Food Insecurity, Quality of Life, and Diabetes Biomarkers in Adults with Diabetes

Background: Food insecurity can negatively affect healthcare outcomes in individuals with diabetes. In addition, food insecurity can negatively impact the quality of life of this population. Few studies have examined the impact of food insecurity on quality of life and diabetes biomarkers in adults with diabetes. Purpose: The purpose of this pilot study is to examine food insecurity, quality of life, and diabetes biomarkers (glycated hemoglobin [A1c], body weight, body mass index [BMI]), and systolic blood pressure [SBP] and diastolic blood pressure [DBP]) in adults with diabetes. Method: A convenience sample (N = 16) was recruited at an outpatient clinic. Each participant completed a sociodemographic survey, Hunger Vital Signs Survey, and the Centers for Disease Control’s Quality of Life Questionnaire. Diabetes biomarkers and SBP and DBP were obtained through chart reviews. A descriptive analysis was performed and continuous variables displayed as means and standard deviations; frequencies and percentages described all categorical variables. Results: Based on preliminary data, the mean age was 57.2 (SD = 10.9), 50% male, 50% female, 44% divorced, 50% had a high school degree or less, 56% lived in a house, 68% unemployed, and 38% reported a monthly family income of $1,000 or less. In the past 12 months, 43.8% reported not having adequate finances to purchase food and 37.5% reported being worried about having finances to purchase food. Fifty percent reported having fair to poor general health. The mean A1c, body weight, BMI, SBP, and DBP results were 8.1 (SD = 2.2), 220.9 (SD = 65.1), 34.9 (SD = 8.8), 134.1 (SD = 15.1), 80.4 (SD = 9.3), respectively. Conclusions: The preliminary results emphasize the importance of addressing food insecurity in this population. Further analyses are vital to better understand the impact of food insecurity on quality of life and diabetes biomarkers in adults with diabetes