Family and disease management in African-American patients with type 2 diabetes

Type 2 diabetes in urban black and rural white women

PURPOSE

The purpose of this secondary analysis was to describe and compare physiological, psychosocial, and self-management characteristics of urban black and rural white women with type 2 diabetes (T2D) in the northeast United States.

METHODS

A descriptive, cross-sectional secondary analysis was conducted with baseline data from 2 independent study samples: rural white women and urban black women.

RESULTS

Results revealed the sample were on average educated, working, low-income, mid-life women with poor glycemic and blood pressure control, despite having a usual source of primary care. When compared, black women were younger, had lower income levels, worked more, and were often single and/or divorced. They had worse glycemic control, significantly higher levels of diabetes-related emotional distress, and less support than white women.

CONCLUSION

Despite differences in geography and study findings, both groups had suboptimal physiological and psychosocial levels that impede self-management. These findings serve to aid in the understanding of health disparities, emphasizing the importance of developing and evaluating effective interventions of diabetes care for women with T2D.

Evaluating the reliability, validity and minimally important difference of the Taiwanese version of the diabetes quality of life (DQOL) measurement

Background

Few diabetes HRQOL instruments are available in Chinese language. We tested psychometric properties of a Diabetes Quality of Life (DQOL) in Chinese language for diabetes patients in Taiwan and estimated its minimally important differences (MIDs).

Methods

Data were collected from 337 patients treated in diabetes clinics of a Taiwan teaching hospital. Pearson's correlations among domain scores of the DQOL (satisfaction, impact, and worry), the D-39S (a diabetes-specific instrument, including domains of diabetes control, energy and mobility, social burden and anxiety and worry, and sexual functioning) and the RAND-12 (a generic instrument, including physical health composite (PHC) and mental health composite (MHC)) were estimated to determine convergent/discriminant validity. Known-groups validity was examined using 2-hour postprandial plasma glucose (2 h PPG), hemoglobin A1c (HbA1c)) and presence of complications (retinopathy, neuropathy, and diabetic foot complications rather than the known groups of cardiovascular and cerebrovascular complications). We used a combined anchor- and distribution-based approach to establish MIDs.

Results

The DQOL scores were more strongly correlated with the physical domains of the D-39S (diabetes control and energy and mobility) and RAND-12 PHC than psychological domains of the D-39S (social burden, anxiety and worry, and sexual functioning) and RAND-12 MHC. The DQOL showed satisfactory discriminative ability for the known groups of 2 h PPG and HbA1c (effect size (ES) ≥ 0.2) and retinopathy, neuropathy, and diabetic foot complications (ES ≥ 0.3), but less satisfactory for the known groups of cardiovascular and cerebrovascular complications. MIDs for the DQOL domains were 3–5 points for satisfaction, 4–5 points for impact, 6–8 points for worry, and 3–4 points for overall HRQOL.

Conclusion

We validated a DQOL in Chinese language for diabetes patients in Taiwan and provided MIDs to facilitate the measure of diabetes HRQOL.

Self-management in type 2 diabetes: the adolescent perspective

PURPOSE

The purpose of this study was to document barriers and facilitators of self-management as perceived by adolescents with type 2 diabetes.

METHODS

Focus groups were conducted with adolescents diagnosed with type 2 diabetes. Adolescents aged 13 to 19 years were recruited from an academic medical center diabetes clinic. Between 2003 and 2005, 6 focus groups were used to elicit responses from the adolescents related to self-management of their diabetes. Questions were asked by trained group facilitators. Transcripts were coded by 3 reviewers. Qualitative analyses were conducted using NVIVO software.

RESULTS

A total of 24 adolescents participated in 6 focus groups. Coding resulted in 4 common domains affecting self-management: adolescent psychosocial development; the role of others with diabetes; environmental influences; and adolescents' problem-solving/coping skills. Adolescents identified both barriers to and facilitators of self-management within each domain. Barriers often related to social situations, embarrassment, seeking acceptance or perceived normalcy, and balancing competing interests. Adolescents viewed having another family member with diabetes as both a positive and a negative influence. Environmental influences, including school and family situations, had a large impact on self-management behaviors. Making sensible food choices was a common challenge. Descriptions of problem-solving or coping skills were limited, but cognitive techniques, such as reframing, were described.

CONCLUSION

Adolescents with type 2 diabetes identified many barriers to self-management, particularly related to interpersonal interactions, the influence of others with diabetes, and environmental influences. Results suggest that improving self-management in adolescents may require multimodal interventions to address individual, family, and social processes.

Contextualizing the effects of yoga therapy on diabetes management: a review of the social determinants of physical activity

This article provides a review of literature both to identify the effects of yoga-based therapy on the management of type 2 diabetes mellitus and to examine the social context of physical activity. Findings from the review indicate that yoga has a positive short-term effect on multiple diabetes-related outcomes; however, long-term effects of yoga therapy on diabetes management remain unclear. The context of the social environment, including interpersonal relationships, community characteristics, and discrimination, influences the adoption and maintenance of health behaviors such as physical activity, including yoga practice. Further research is necessary to determine the extent of this influence.

Interventions for the family with diabetes

This article demonstrates that families can make a difference in diabetes outcomes and nurses can make a difference in how families organize and interact around the person with diabetes. Highlighted are key findings from the research on families and diabetes across different phases of the lifespan. Recommendations for general practice with families that might be adapted by nurses to different settings in which they care for families with diabetes are included.

Psychosocial and psychiatric challenges of diabetes mellitus

Diabetes mellitus is a chronic endocrine disorder that places considerable psychologic stress on individuals and their families. This article discusses psychosocial issues associated with diabetes and its management, and common psychiatric disorders in diabetes population. Psychosocial challenges and psychiatric disorders in people with diabetes can hinder patients' successful diabetes self-management and well-being. An understanding of mental health issues in diabetes is critical for all health care professionals who provide treatment to people with diabetes.

An altered oxidant defense system in red blood cells affects their ability to release nitric oxide-stimulating ATP

A novel microflow technique is used to demonstrate that a weakened oxidant defense system found in diabetic erythrocytes leads to decreased levels of deformation-induced release of adenosine triphosphate (ATP) from erythrocytes. Addition of an oxidant to rabbit erythrocytes resulted in a 63% decrease in deformation-induced ATP release before eventually recovering to a value that was statistically equivalent to the initial value. Inhibition of glucose-6-phosphate dehydrogenase prevents recovery from the oxidant attack. Finally, results indicated that the ATP release from the erythrocytes of type II diabetics (91 nM +/- 10 nM) was less than half of that measured from the erythrocytes of healthy controls (190 +/- 10 nM). These data suggest that the antioxidant status of erythrocytes is a critical determinant in the ability of these cells to release ATP, a known nitric oxide stimulus.