Characteristics of Low-Income African-American and Caucasian Adults That Are Important in Self-Management of Type 2 Diabetes (original) (raw)
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Ethnicity & Disease, 2016
Objective: Healthy People 2020 (HP2020) includes benchmarks for diabetes management. The objective of our study was to describe diabetes management among African American women, a patient group that carries a disproportionate diabetes burden.Design: Cross-sectional survey study.Participants: African American women with type 2 diabetes enrolled in dietary and weight management interventions.Main Outcome Measures: Self-report assessments of diabetes education, specialty care, self-care behaviors and advice. Associations between diabetes self-care behaviors and diabetes advice using Chi-square tests.Results: Among 96 participants (age = 53 ± 9.4; BMI = 37.9 ± 7.3 kg/m2), reported diabetes education and foot exams were lower than HP2020 benchmarks, 48.9% vs 62.5% and 35.1% vs 74.8%, respectively and higher for dilated eye exams (70.1% vs 58.7%). The most frequently reported dietary advice was to increase fruit/ vegetable intake (58%) and approximately 50% reported physical activity advi...
Psychosocial Impacts of Type 2 Diabetes Self-Management in a Rural African-American Population
Journal of Immigrant and Minority Health, 2012
This qualitative study explored the underlying psychosocial factors and conditions that may influence type 2 diabetes (T2D) self-management among adult T2Ddiagnosed African Americans in the Arkansas Delta. Listening to participants' narratives in their own voices provided meaningful insights in their real-life experiences of T2D-related psychological and emotional challenges in African American social cultural contexts. Self-determination theory was used to conceptualize the participants' motivations for making health behavior changes. Using purposive sampling, 31 participants total (16 women and 15 men) were interviewed. The study participants described their (1) concern over prescribed dietary and physical exercise guidelines as impractical and culturally not relevant to them; (2) doubts over the availability of social supports necessary to implement T2D self-management; and (3) fatalistic expectations of negative outcomes that undermined their self-motivation to follow self-management guidelines. Specific strategies for developing culturally competent T2D selfmanagement guidelines and community-based communication outreach initiatives are discussed.
Food and Nutrition Sciences, 2013
Adequate care of type 2 diabetes is reflected by the individual's adherence to dietary guidance; yet, few patients are engaged in diabetes self-care at the recommended level, regardless of race/ethnicity. Few studies on the effect of dietary medical advice on diabetes self-management (DSM) and glycemic control have been conducted on Haitian and African American adults with type 2 diabetes. These relationships were assessed in total of 254 Blacks with type 2 diabetes (Haitian Americans = 129; African Americans = 125) recruited from Miami-Dade and Broward Counties, Florida by community outreach methods. Although dietary advice received was not significantly different between the two Black ethnicities, given advice "to follow a diet" as a predictor of "using food groups" was significant for Haitian Americans, but not for African Americans. Haitian Americans who were advised to follow a diet were approximately 3 times more likely to sometimes or often use food groups (or exchange lists) in planning meals. Less than optimal glycemic control (A1C > 7.2) was inversely related to DSM for African Americans; but the relationship was not significant for Haitian Americans. A one unit increase in DSM score decreased the odds ratio point estimate of having less than optimal glycemic control (A1C > 7.2%) by a factor of 0.94 in African Americans. These results suggest that medical advice for diet plans may not be communicated effectively for DSM for some races/ethnicities. Research aimed at uncovering the enablers and barriers of diet management specific to Black ethnicities with type 2 diabetes is recommended.
Contemporary Clinical Trials, 2014
The Lifestyle Improvement through Food and Exercise (LIFE) study is a community-based randomized-controlled trial to measure the effectiveness of a lifestyle intervention to improve glycemic control among African Americans with type 2 diabetes attending safety net clinics. The study enrolled African American adults with a diagnosis of type 2 diabetes and HbA1c ≥ 7.0 who had attended specific safety net community clinics in the prior year. 210 patients will be enrolled and randomized to either the LIFE intervention or a standard of care control group, which consists of two dietitian-led diabetes self-management classes. The LIFE intervention was delivered in 30 group sessions over 12-months and focused on improving diet through dietitian-led culturallytailored nutrition education, increasing physical activity through self-monitoring using an accelerometer, increasing ability to manage blood sugar through modifications to lifestyle, and providing social support for behavior change. In addition to the group sessions, peer supporters made regular telephone calls to participants to monitor progress towards behavioral goals and provide social support. The 12-month intervention phase was followed by a six-month maintenance phase consisting of two group sessions. The primary outcome of the study is change in A1C from baseline to 12-months, and an additional follow-up will occur at 18-months. The hypothesis of the study is that the participants in the LIFE intervention will show a greater improvement in glycemic control over 12-months than participants in the control group.
Preventing Chronic Disease, 2014
Introduction The objective of this pilot 6-month randomized controlled trial was to determine the effectiveness of an intensive, community-based, group intervention that focused on diet, physical activity, and peer support for reducing weight among urban-dwelling African Americans with comorbid type 2 diabetes and hypertension. Methods Sixty-one participants were randomized into an intervention or control group. The 6-month intervention consisted of 18 group sessions led by a dietitian in a community setting and weekly telephone calls from a peer supporter. The intervention featured culturally tailored nutrition education, behavioral skills training, and social support focused on changes to diet and physical activity. The control group consisted of two 3-hour group sessions of diabetes selfmanagement education taught by a community health worker. Outcome measures were assessed at baseline and 6 months. The primary outcome was achievement of a 5% weight reduction at 6 months. A secondary outcome was achievement of a 0.5 percentage-point reduction in hemoglobin A1c (HbA1c). Results Groups did not differ in achievement of the weight-loss goal. Intervention participants lost a mean of 2.8 kg (P = .01); control participants did not lose a significant amount of weight. A greater proportion of intervention (50.0%) than control (21.4%) participants reduced HbA1c by 0.5 percentage points or more at 6 months (P = .03). Conclusion The intervention was more effective than usual care (short-term diabetes education) at improving glycemic control, but not weight, in low-income African Americans with comorbid diabetes and hypertension. A community-based 6month group class with culturally tailored education, behavioral skills training, and peer support can lead to a clinically significant reduction in HbA1c. control in African Americans with type 2 diabetes (5-9), but to our knowledge no study has tested an intervention designed for people with comorbid diabetes and hypertension. This study was a pilot randomized controlled trial of an intervention to improve diet and physical activity behavior in low-income African Americans with comorbid diabetes and hypertension to reduce levels of hemoglobin A1c (HbA1c) and ultimately, long-term health risks. Our hypothesis was that an intensive group-based intervention including culturally tailored nutrition education, behavioral skills training, and social support would be more effective than usual care at motivating African Americans with comorbid diabetes and hypertension to lose weight. A secondary hypothesis was that the intervention would also result in improved glycemic control. Methods Recruitment and eligibility For inclusion in the study, participants had to be African American, aged 18 or older, prescribed medication for type 2 diabetes and hypertension, have a body mass index (BMI [kg/m ]) from 25 to 45, and have no medical contraindications to participation. Patients were recruited through flyers distributed in a federally qualified health center in Chicago, Illinois. Potential participants were screened for eligibility by telephone before enrollment. Informed consent was obtained before enrollment. All procedures were approved by the Rush University Medical Center Institutional Review Board. Recruitment and follow-up took place from February 2009 through July 2010. Study design and intervention The study was a randomized controlled trial comparing 2 treatments: 1) the Lifestyle Improvement Through Food and Exercise (LIFE) intervention, which was an intensive, group-based diabetes self-management class; and 2) a control treatment consisting of 2 group classes on diabetes self-management.
Culturally Tailored Intervention for Rural African Americans With Type 2 Diabetes
The Diabetes Educator, 2008
Twenty-two participants were recruited and randomly assigned to either Group or Individual diabetes selfmanagement (DSME). Group DSME included storytelling, hands-on activities, and problem-solving exercises. Individual DSME sessions focused on goalsetting and problem-solving strategies. Sessions were offered in an accessible community center over a 10week period.
The Diabetes Educator, 2014
The purpose of this study is to test the feasibility of conducting a community-based randomized controlled trial evaluating a culturally tailored community-based group diabetes self-management education (DSME) program among rural African Americans. Methods Thirty-two African American rural adults with type 2 diabetes were recruited and 25 adults were retained and participated in an interventional study designed to test the effectiveness of the "Taking Care of Sugar" DSME program for the 2-year follow-up. Participants were selected from rural central Virginia. Primary outcomes variables included average blood sugar levels, cardiovascular risk factors, and general physical and mental health. These outcomes were assessed at baseline, 3 months, 6 months, and 12 months post baseline. Results From baseline to 3-month follow-up assessment, participants exhibited significant improvement on several physiological and behavioral measures. Given the small sample size, hypothesis testing was limited. Results show change from baseline over time, illustrating that the primary outcome of A1C decreased, although not significant. Additionally, participants reported more knowledge about diabetes self-management and personal care 520570T DEXXX10.