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Hoogendoorn CJ, Krause-Steinrauf H, Uschner D, Wen H, Presley CA, Legowski EA, Naik AD, Golden SH, Arends VL, Brown-Friday J, Krakoff JA, Suratt CE, Waltje AH, Cherrington AL, Gonzalez JS. Emotional Distress Predicts Reduced Type 2 Diabetes Treatment Adherence in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE). Diabetes Care 2024; 47:629-637. [PMID: 38227900 PMCID: PMC10973907 DOI: 10.2337/dc23-1401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/18/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE We examined longitudinal associations between emotional distress (specifically, depressive symptoms and diabetes distress) and medication adherence in Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE), a large randomized controlled trial comparing four glucose-lowering medications added to metformin in adults with relatively recent-onset type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS The Emotional Distress Substudy assessed medication adherence, depressive symptoms, and diabetes distress in 1,739 GRADE participants via self-completed questionnaires administered biannually up to 3 years. We examined baseline depressive symptoms and diabetes distress as predictors of medication adherence over 36 months. Bidirectional visit-to-visit relationships were also examined. Treatment satisfaction, beliefs about medication, diabetes care self-efficacy, and perceived control over diabetes were evaluated as mediators of longitudinal associations. RESULTS At baseline, mean ± SD age of participants (56% of whom were White, 17% Hispanic/Latino, 18% Black, and 66% male) was 58.0 ± 10.2 years, diabetes duration 4.2 ± 2.8 years, HbA1c 7.5% ± 0.5%, and medication adherence 89.9% ± 11.1%. Higher baseline depressive symptoms and diabetes distress were independently associated with lower adherence over 36 months (P < 0.001). Higher depressive symptoms and diabetes distress at one visit predicted lower adherence at the subsequent 6-month visit (P < 0.0001) but not vice versa. Treatment assignment did not moderate relationships. Patient-reported concerns about diabetes medications mediated the largest percentage (11.9%-15.5%) of the longitudinal link between emotional distress and adherence. CONCLUSIONS Depressive symptoms and diabetes distress both predict lower adherence to glucose-lowering medications over time among adults with T2DM. Addressing emotional distress and concerns about anticipated negative effects of taking these treatments may be important to support diabetes treatment adherence.
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Affiliation(s)
- Claire J. Hoogendoorn
- Endocrinology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
| | - Heidi Krause-Steinrauf
- Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Diane Uschner
- Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Hui Wen
- Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Caroline A. Presley
- General Internal and Preventive Medicine, Department of Medicine, University of Alabama, Birmingham, Birmingham, AL
| | - Elizabeth A. Legowski
- Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Aanand D. Naik
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX
- University of Texas Health Science Center (UTHealth) School of Public Health, Houston, TX
- Consortium on Aging, University of Texas Health Science Center (UTHealth), Houston, TX
| | - Sherita Hill Golden
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Valerie L. Arends
- Advanced Research and Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Janet Brown-Friday
- Endocrinology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Jonathan A. Krakoff
- Obesity and Diabetes Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - Colleen E. Suratt
- Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | | | - Andrea L. Cherrington
- General Internal and Preventive Medicine, Department of Medicine, University of Alabama, Birmingham, Birmingham, AL
| | - Jeffrey S. Gonzalez
- Endocrinology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
- New York-Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, NY
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Cherrington AL, Bebu I, Krause-Steinrauf H, Hoogendoorn CJ, Crespo-Ramos G, Presley C, Naik AD, Balasubramanyam A, Gramzinski MR, Killean T, Arends VL, Gonzalez JS. Does Emotional Distress Predict Worse Glycemic Control Over Time? Results From the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE). Diabetes Care 2024; 47:620-628. [PMID: 38252848 PMCID: PMC10973910 DOI: 10.2337/dc23-0642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 10/09/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To evaluate whether baseline levels of depressive symptoms and diabetes-specific distress are associated with glycemic control in Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE), a large randomized controlled trial comparing the metabolic effects of four common glucose-lowering medications when combined with metformin in individuals with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS The primary and secondary outcomes were defined as an HbA1c value ≥7%, subsequently confirmed, and an HbA1c value >7.5%, subsequently confirmed, respectively. Separate Cox proportional hazards models assessed the association between baseline levels of each exposure of interest (depressive symptoms measured with the eight-item Patient Health Questionnaire and diabetes distress measured with the Diabetes Distress Scale) and the subsequent risk of metabolic outcomes. RESULTS This substudy included 1,739 participants (56% of whom were non-Hispanic White, 18% non-Hispanic Black, 17% Hispanic, and 68% male; mean [SD] age 58.0 [10.2] years, diabetes duration 4.2 [2.8] years, and HbA1c 7.5% [0.48%]). A total of 1,157 participants reached the primary outcome, with time to event of 2.1 years on average, while 738 participants reached the secondary outcome at 3 years on average. With adjustment for sex, race/ethnicity, treatment group, baseline age, duration of T2DM, BMI, and HbA1c, there were no significant associations between the depressive symptoms or diabetes distress and the subsequent risk of the primary or secondary outcomes. CONCLUSIONS The current findings suggest that, at least for individuals with diabetes of relatively short duration, baseline levels of emotional distress are not associated with glycemic control over time.
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Affiliation(s)
- Andrea L. Cherrington
- General Internal and Preventive Medicine, Department of Medicine, University of Alabama, Birmingham, Birmingham, AL
| | - Ionut Bebu
- Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Heidi Krause-Steinrauf
- Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Claire J. Hoogendoorn
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
- Endocrinology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Gladys Crespo-Ramos
- Endocrinology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Caroline Presley
- Division of Preventative Medicine, University of Alabama, Birmingham, AL
| | - Aanand D. Naik
- University of Texas Health Science Center (UTHealth) School of Public Health, Houston, TX
| | - Ashok Balasubramanyam
- University of Texas Health Science Center (UTHealth) School of Public Health, Houston, TX
| | - Michaela R. Gramzinski
- Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Tina Killean
- Obesity and Diabetes Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - Valerie L. Arends
- Advanced Research and Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Jeffrey S. Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
- Endocrinology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
- New York-Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, NY
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Gonzalez JS, Bebu I, Krause-Steinrauf H, Hoogendoorn CJ, Crespo-Ramos G, Presley C, Naik AD, Kuo S, Johnson ML, Wexler D, Crandall JP, Bantle AE, Arends V, Cherrington AL. Differential Effects of Type 2 Diabetes Treatment Regimens on Diabetes Distress and Depressive Symptoms in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE). Diabetes Care 2024; 47:610-619. [PMID: 38416773 PMCID: PMC10973899 DOI: 10.2337/dc23-2459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/19/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE We evaluated whether adding basal insulin to metformin in adults with early type 2 diabetes mellitus (T2DM) would increase emotional distress relative to other treatments. RESEARCH DESIGN AND METHODS The Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) of adults with T2DM of <10 years' duration, HbA1c 6.8-8.5%, and taking metformin monotherapy randomly assigned participants to add insulin glargine U-100, sulfonylurea glimepiride, the glucagon-like peptide-1 receptor agonist liraglutide, or the dipeptidyl peptidase 4 inhibitor sitagliptin. The Emotional Distress Substudy enrolled 1,739 GRADE participants (mean [SD] age 58.0 [10.2] years, 32% female, 56% non-Hispanic White, 18% non-Hispanic Black, 17% Hispanic) and assessed diabetes distress and depressive symptoms every 6 months. Analyses examined differences at 1 year and over the 3-year follow-up. RESULTS Across treatments, diabetes distress (-0.24, P < 0.0001) and depressive symptoms (-0.67, P < 0.0001) decreased over 1 year. Diabetes distress was lower at 1 year for the glargine group than for the other groups combined (-0.10, P = 0.002). Diabetes distress was also lower for liraglutide than for glimepiride or sitagliptin (-0.10, P = 0.008). Over the 3-year follow-up, there were no significant group differences in total diabetes distress; interpersonal diabetes distress remained lower for those assigned to liraglutide. No significant differences were observed for depressive symptoms. CONCLUSIONS Contrary to expectations, this randomized trial found no evidence for a deleterious effect of basal insulin on emotional distress. Glargine lowered diabetes distress modestly at 1 year rather than increasing it. Liraglutide also reduced diabetes distress at 1 year. Results can inform treatment decisions for adults with early T2DM.
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Affiliation(s)
- Jeffrey S. Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
- Division of Endocrinology and Fleischer Institute for Diabetes and Metabolism, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY
- New York-Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, New York, NY
| | - Ionut Bebu
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Heidi Krause-Steinrauf
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Claire J. Hoogendoorn
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
- Division of Endocrinology and Fleischer Institute for Diabetes and Metabolism, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Gladys Crespo-Ramos
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
- Division of Endocrinology and Fleischer Institute for Diabetes and Metabolism, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Caroline Presley
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Aanand D. Naik
- School of Public Health, University of Texas Health Science Center, Houston, TX
| | - Shihchen Kuo
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | | | - Deborah Wexler
- Diabetes Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jill P. Crandall
- Division of Endocrinology and Fleischer Institute for Diabetes and Metabolism, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Anne E. Bantle
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Valerie Arends
- Advanced Research and Diagnostic Laboratory, Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Andrea L. Cherrington
- Department of Medicine (General Internal and Preventive Medicine), University of Alabama at Birmingham, Birmingham, AL
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Frias JP, Lee ML, Carter MM, Ebel ER, Lai RH, Rikse L, Washington ME, Sonnenburg JL, Damman CJ. A microbiome-targeting fibre-enriched nutritional formula is well tolerated and improves quality of life and haemoglobin A1c in type 2 diabetes: A double-blind, randomized, placebo-controlled trial. Diabetes Obes Metab 2023; 25:1203-1212. [PMID: 36594522 DOI: 10.1111/dom.14967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/19/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023]
Abstract
AIMS To investigate a prebiotic fibre-enriched nutritional formula on health-related quality of life and metabolic control in type 2 diabetes. MATERIALS AND METHODS This was a 12-week, double-blind, placebo-controlled study with an unblinded dietary advice only comparator arm. Participants were randomized 2:1:1 to a prebiotic fibre-enriched nutritional formula (Active), a placebo fibre-absent nutritional formula (Placebo), or non-blinded dietary advice alone (Diet). Primary endpoint was change in core Type 2 Diabetes Distress Assessment System (cT2-DDAS) at week 12. Glycated haemoglobin (HbA1c) change was a key secondary endpoint. RESULTS In total, 192 participants were randomized. Mean age was 54.3 years, HbA1c 7.8%, and body mass index 35.9 kg/m2 . At week 12, cT2-DDAS reduced significantly in Active versus Placebo (-0.4, p = .03), and HbA1c was reduced significantly in Active vs Placebo (-0.64%, p = .01). Gut microbiome sequencing revealed that the relative abundance of two species of butyrate-producing bacteria (Roseburia faecis and Anaerostipes hadrus) increased significantly in Active vs. Placebo. CONCLUSIONS A microbiome-targeting nutritional formula significantly improved cT2-DDAS and HbA1c, suggesting the potential for prebiotic fibre as a complement to lifestyle and/or pharmaceutical interventions for managing type 2 diabetes.
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Affiliation(s)
- Juan P Frias
- Velocity Clinical Research, Los Angeles, California, USA
| | - Martin L Lee
- UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Matthew M Carter
- Department of Microbiology and Immunology, Stanford University School Medicine, Palo Alto, California, USA
| | - Emily R Ebel
- Department of Microbiology and Immunology, Stanford University School Medicine, Palo Alto, California, USA
| | | | | | | | - Justin L Sonnenburg
- Department of Microbiology and Immunology, Stanford University School of Medicine, Chan Zuckerberg Biohub, San Francisco, California, USA
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Gonzalez JS, Krause-Steinrauf H, Bebu I, Crespo-Ramos G, Hoogendoorn CJ, Naik AD, Waltje A, Walker E, Ehrmann D, Brown-Friday J, Cherrington A. Emotional distress, self-management, and glycemic control among participants enrolled in the glycemia reduction approaches in diabetes: A comparative effectiveness (GRADE) study. Diabetes Res Clin Pract 2023; 196:110229. [PMID: 36549506 PMCID: PMC9974790 DOI: 10.1016/j.diabres.2022.110229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/08/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE We examined emotional distress in relation to metformin adherence, overall diabetes self-management, and glycemic control among adults with early type 2 diabetes (T2DM) enrolled in the GRADE study. METHODS Linear regression models examined cross-sectional associations of baseline depression symptoms and diabetes distress with adherence to metformin, self-management, and HbA1c, adjusting for covariates. Cognitive-affective (e.g., sadness) and somatic (e.g., sleep/appetite disturbance) depression symptoms and diabetes distress subscales were also examined. RESULTS This substudy of 1,739 GRADE participants (56 % Non-Hispanic White, 18 % Non-Hispanic Black, 17 % Hispanic, 68 % male, mean[SD] age = 57.96[10.22] years, diabetes duration = 4.21[2.81] years, and HbA1c = 7.51[0.48]) found that the prevalence of clinically significant depression and diabetes distress was 8.7 % and 25 %, respectively. Fully adjusted models showed that depression symptoms were associated with lower self-management (p < 0.0001); this effect was only significant for somatic symptoms. Diabetes distress was associated with lower adherence (p = 0.0001) and self-management (p < 0.0001); effects were significant for all subscales, except physician-related distress. No significant relationships of total depression symptom severity or diabetes distress with HbA1c were found. CONCLUSIONS Depression symptoms and diabetes distress were robustly associated with problematic diabetes self-management among participants in GRADE. These findings highlight the need for routine assessment of depression symptoms and diabetes distress early in T2DM care.
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Affiliation(s)
- Jeffrey S Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA; Department of Medicine (Endocrinology), Albert Einstein College of Medicine, Bronx, NY, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA; New York-Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Heidi Krause-Steinrauf
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD, USA
| | - Ionut Bebu
- The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD, USA
| | - Gladys Crespo-Ramos
- Department of Medicine (Endocrinology), Albert Einstein College of Medicine, Bronx, NY, USA
| | - Claire J Hoogendoorn
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA; Department of Medicine (Endocrinology), Albert Einstein College of Medicine, Bronx, NY, USA
| | - Aanand D Naik
- School of Public Health, University of Texas Health Science Center, Houston, TX, USA
| | | | - Elizabeth Walker
- Department of Medicine (Endocrinology), Albert Einstein College of Medicine, Bronx, NY, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA; New York-Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dominic Ehrmann
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
| | - Janet Brown-Friday
- Department of Medicine (Endocrinology), Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrea Cherrington
- Department of Medicine (General Internal and Preventive Medicine), University of Alabama, Birmingham, Birmingham, AL, USA
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Akbari M, Seydavi M, Rowhani NS, Nouri N. Psychological predictors of treatment adherence among patients with diabetes (types I and II): Modified information-motivation-behavioural skills model. Clin Psychol Psychother 2022; 29:1854-1866. [PMID: 35510374 DOI: 10.1002/cpp.2746] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/23/2022] [Accepted: 04/29/2022] [Indexed: 11/05/2022]
Abstract
Non-adherence to medical regimens among patients with diabetes is a well-recognized concern in health care. Modified information, motivation, behavioural skills (IMB) model by adding an emotion component to it was tested to explore predictors of treatment adherence among 1,125 Iranian patients with diabetes type I (T1D) and type II (T2D) and due to other medical conditions. The modified IMB model explained 35% of the treatment adherence with large effect-sizes f2 = 0.56 to 0.69. Self-compassion and interpersonal communication between staff and patients (ICSP) were significant predictors of treatment adherence among patients with T1D, T2D and diabetes due to other medical conditions, while both outperformed the other significant predictors of treatment adherence, i.e., illness perception and social support in all groups. Distress intolerance was a significant predictor of treatment adherence only in patients with T2D. In addition, patients, based on their type of diabetes, exhibited different patterns of illness perception in predicting treatment adherence. Among T2D patients and those with diabetes due to other medical conditions, gender (male; only in T2D) and being single were significant predictors of treatment adherence, while age and diabetes duration were not. Finally, the model demonstrated that above and beyond demographic features, self-compassion, interpersonal communication between patients and health care staff, distress intolerance, perceived social support and illness perception were significant predictors of treatment adherence among patients with diabetes.
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Affiliation(s)
- Mehdi Akbari
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Mohammad Seydavi
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Nayyereh S Rowhani
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Naemeh Nouri
- Department of Educational Psychology, Shiraz University, Shiraz, Iran
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Butler AM, Brown SD, Carreon SA, Smalls BL, Terry A. Equity in Psychosocial Outcomes and Care for Racial and Ethnic Minorities and Socioeconomically Disadvantaged People With Diabetes. Diabetes Spectr 2022; 35:276-283. [PMID: 36082019 PMCID: PMC9396713 DOI: 10.2337/dsi22-0006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The role of social determinants of health (SDOH) in promoting equity in diabetes prevalence, incidence, and outcomes continues to be documented in the literature. Less attention has focused on disparities in psychosocial aspects of living with diabetes and the role of SDOH in promoting equity in psychosocial outcomes and care. In this review, the authors describe racial/ethnic and socioeconomic disparities in psychosocial aspects of living with diabetes, discuss promising approaches to promote equity in psychosocial care, and provide future research directions.
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Affiliation(s)
- Ashley M. Butler
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Corresponding author: Ashley M. Butler,
| | - Susan D. Brown
- Department of Internal Medicine, School of Medicine, University of California, Davis, Sacramento, CA
| | | | - Brittany L. Smalls
- Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington, KY
| | - Amanda Terry
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
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