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Kuo HJ, García AA, Huang YC, Zuñiga JA, Benner AD, Cuevas H, Fan KC, Hsu CY. Impact of Fatigue and Its Influencing Factors on Diabetes Self-Management in Adults With Type 2 Diabetes: A Structural Equation Modeling Analysis. Sci Diabetes Self Manag Care 2023; 49:438-448. [PMID: 37873569 DOI: 10.1177/26350106231205029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
PURPOSE The purposes of this study were to (1) examine the relationships between fatigue, its influencing factors, and diabetes self-management and (2) test the mediation effects of fatigue on the link between the influencing factors and diabetes self-management in adults with type 2 diabetes. METHODS This cross-sectional, correlational study was guided by the theory of unpleasant symptoms. Data were collected using structured questionnaires. Fatigue was measured by the Fatigue Symptom Inventory and the Multidimensional Fatigue Inventory. Diabetes self-management was measured by the Summary of Diabetes Self-Care Activities. From March to July 2021, a convenience sample of 150 participants was recruited from 2 diabetes outpatient clinics of a regional hospital in Taiwan. Data were analyzed using structural equation modeling. RESULTS A more recent diagnosis of diabetes, more depressive symptoms, and lower sleep quality were related to higher fatigue. Higher fatigue correlated with less performance in diabetes self-management. Fatigue mediated the relationship between depressive symptoms, sleep quality, and diabetes self-management. CONCLUSIONS Fatigue had a mediating effect on the link between psychological influencing factors and diabetes self-management. Future development of fatigue interventions integrating depressive symptoms and sleep management will likely increase the performance of diabetes self-management and improve the health outcomes in adults with type 2 diabetes. The study tested the theory of unpleasant symptoms using empirical data and will assist in building theory-guided fatigue interventions to improve diabetes self-management in people with type 2 diabetes.
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Affiliation(s)
- Hsuan-Ju Kuo
- School of Nursing, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | | | - Ya-Ching Huang
- School of Nursing, Texas A&M University, College Station, Texas
| | - Julie A Zuñiga
- School of Nursing, The University of Texas at Austin, Austin, Texas
| | - Aprile D Benner
- Department of Human Development and Family Sciences, The University of Texas at Austin, Austin, Texas
| | - Heather Cuevas
- School of Nursing, The University of Texas at Austin, Austin, Texas
| | - Kang-Chih Fan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu City, Taiwan
| | - Chih-Yao Hsu
- Taipei City Hospital Renai Branch, Taipei City, Taiwan
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Terwee CB, Elders PJM, Blom MT, Beulens JW, Rolandsson O, Rogge AA, Rose M, Harman N, Williamson PR, Pouwer F, Mokkink LB, Rutters F. Patient-reported outcomes for people with diabetes: what and how to measure? A narrative review. Diabetologia 2023; 66:1357-1377. [PMID: 37222772 PMCID: PMC10317894 DOI: 10.1007/s00125-023-05926-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/03/2023] [Indexed: 05/25/2023]
Abstract
Patient-reported outcomes (PROs) are valuable for shared decision making and research. Patient-reported outcome measures (PROMs) are questionnaires used to measure PROs, such as health-related quality of life (HRQL). Although core outcome sets for trials and clinical practice have been developed separately, they, as well as other initiatives, recommend different PROs and PROMs. In research and clinical practice, different PROMs are used (some generic, some disease-specific), which measure many different things. This is a threat to the validity of research and clinical findings in the field of diabetes. In this narrative review, we aim to provide recommendations for the selection of relevant PROs and psychometrically sound PROMs for people with diabetes for use in clinical practice and research. Based on a general conceptual framework of PROs, we suggest that relevant PROs to measure in people with diabetes are: disease-specific symptoms (e.g. worries about hypoglycaemia and diabetes distress), general symptoms (e.g. fatigue and depression), functional status, general health perceptions and overall quality of life. Generic PROMs such as the 36-Item Short Form Health Survey (SF-36), WHO Disability Assessment Schedule (WHODAS 2.0), or Patient-Reported Outcomes Measurement Information System (PROMIS) measures could be considered to measure commonly relevant PROs, supplemented with disease-specific PROMs where needed. However, none of the existing diabetes-specific PROM scales has been sufficiently validated, although the Diabetes Symptom Self-Care Inventory (DSSCI) for measuring diabetes-specific symptoms and the Diabetes Distress Scale (DDS) and Problem Areas in Diabetes (PAID) for measuring distress showed sufficient content validity. Standardisation and use of relevant PROs and psychometrically sound PROMs can help inform people with diabetes about the expected course of disease and treatment, for shared decision making, to monitor outcomes and to improve healthcare. We recommend further validation studies of diabetes-specific PROMs that have sufficient content validity for measuring disease-specific symptoms and consider generic item banks developed based on item response theory for measuring commonly relevant PROs.
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Affiliation(s)
- Caroline B Terwee
- Amsterdam UMC, Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
- Amsterdam Public Health Research Institute, Methodology, Amsterdam, the Netherlands.
| | - Petra J M Elders
- Amsterdam Public Health Research Institute, Methodology, Amsterdam, the Netherlands
- Amsterdam UMC, Department of General Practice, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marieke T Blom
- Amsterdam Public Health Research Institute, Methodology, Amsterdam, the Netherlands
| | - Joline W Beulens
- Amsterdam UMC, Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Olaf Rolandsson
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Alize A Rogge
- Center for Patient-Centered Outcomes Research, Department of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Rose
- Center for Patient-Centered Outcomes Research, Department of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nicola Harman
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Paula R Williamson
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Frans Pouwer
- Steno Diabetes Center Odense, Odense, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Amsterdam UMC, Department of Medical Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Lidwine B Mokkink
- Amsterdam UMC, Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Methodology, Amsterdam, the Netherlands
| | - Femke Rutters
- Amsterdam UMC, Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Langendoen-Gort M, Groeneveld L, Prinsen CAC, Beulens JW, Elders PJM, Halperin I, Mukerji G, Terwee CB, Rutters F. Patient-reported outcome measures for assessing health-related quality of life in people with type 2 diabetes: A systematic review. Rev Endocr Metab Disord 2022; 23:931-977. [PMID: 35779199 PMCID: PMC9515038 DOI: 10.1007/s11154-022-09734-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2022] [Indexed: 11/26/2022]
Abstract
Patient-Reported Outcome Measures (PROMs) are important tools to assess outcomes relevant to patients, with Health-Related Quality Of Life (HRQOL) as an important construct to be measured. Many different HRQOL PROMs are used in the type 2 diabetes field, however a complete overview of these PROMs is currently lacking. We therefore aimed to systematically describe and classify the content of all PROMs that have specifically been developed or validated to measure (aspects of) HRQOL in people with type 2 diabetes. A literature search was performed in PubMed and EMBASE until 31 December 2021. Studies on the development or validation of a PROM measuring HRQOL, or aspects of HRQOL, in people with type 2 diabetes were included. Title and abstract and full-text screening were conducted by two independent researchers and data extraction was performed independently by one of the researchers. Data were extracted on language in which the PROM was developed, target population, construct(s) being measured, names of (sub)scales and number of items per (sub)scale. In addition, all PROMs and subscales were classified according to specific aspects of HRQOL based on the Wilson & Cleary model (symptom status, functional status, general health perceptions) to aid researchers in PROM selection. In total 220 studies were identified that developed or validated PROMs that measure (aspects of) HRQOL in people with type 2 diabetes. Of the 116 unique HRQOL PROMs, 91 (of the subscales) measured symptom status, 60 measured functional status and 26 measured general health perceptions. In addition, 16 of the PROMs (subscales) measured global quality of life. 61 of the 116 PROMs (subscales) also include characteristics of the individual (e.g. aspects of personality, coping) or environment (e.g. social or financial support) and patient-reported experience measures (PREMs, e.g. measure of a patient's perception of their personal experience of the healthcare they have received, e.g. treatment satisfaction), which are not part of the HRQOL construct. Only 9 of the 116 PROMs measure all aspects of HRQOL based on the Wilson & Cleary model. Finally, 8 of the 116 PROMs stating to measure HRQOL, measured no HRQOL construct. In conclusion, a large number of PROMs are available for people with type 2 diabetes, which intend to measure (aspects of) HRQOL. These PROMs measure a large variety of (sub)constructs, which are not all HRQOL constructs, with a small amount of PROMs not measuring HRQOL at all. There is a need for consensus on which aspects of HRQOL should be measured in people with type 2 diabetes and which PROMs to use in research and daily practice. PROSPERO: CRD42017071012. COMET database: http://www.comet-initiative.org/studies/details/956 .
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Affiliation(s)
- Marlous Langendoen-Gort
- General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
| | - Lenka Groeneveld
- Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
| | - Cecilia A C Prinsen
- Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
| | - Joline W Beulens
- Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Diabetes & Metabolism, Amsterdam, The Netherlands
| | - Petra J M Elders
- General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Diabetes & Metabolism, Amsterdam, The Netherlands
| | - Ilana Halperin
- Department of Medicine, Temerty Faculty of Medicine, Sunnybrook Health Sciences Center, King's College Circle, University of Toronto, Toronto, ON, Canada
| | - Geetha Mukerji
- Department of Medicine, Temerty Faculty of Medicine, Sunnybrook Health Sciences Center, King's College Circle, University of Toronto, Toronto, ON, Canada
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, Canada
| | - Caroline B Terwee
- Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
| | - Femke Rutters
- Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands.
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands.
- Amsterdam Cardiovascular Sciences, Diabetes & Metabolism, Amsterdam, The Netherlands.
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Terwee CB, Elders PJM, Langendoen-Gort M, Elsman EBM, Prinsen CAC, van der Heijden AA, de Wit M, Beulens JWJ, Mokkink LB, Rutters F. Content Validity of Patient-Reported Outcome Measures Developed for Assessing Health-Related Quality of Life in People with Type 2 Diabetes Mellitus: a Systematic Review. Curr Diab Rep 2022; 22:405-421. [PMID: 35819705 PMCID: PMC9355936 DOI: 10.1007/s11892-022-01482-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW We aimed to systematically evaluate the content validity of patient-reported outcome measures (PROMs) specifically developed to measure (aspects of) health-related quality of life (HRQOL) in people with type 2 diabetes. A systematic review was performed in PubMed and Embase of PROMs measuring perceived symptoms, physical function, mental function, social function/participation, and general health perceptions, and that were validated to at least some extent. Content validity (relevance, comprehensiveness, and comprehensibility) was evaluated using COSMIN methodology. RECENT FINDINGS We identified 54 (different versions of) PROMs, containing 150 subscales. We found evidence for sufficient content validity for only 41/150 (27%) (subscales of) PROMs. The quality of evidence was generally very low. We found 66 out of 150 (44%) (subscales of) PROMs with evidence for either insufficient relevance, insufficient comprehensiveness, or insufficient comprehensibility. For measuring diabetes-specific symptoms, physical function, mental function, social function/participation, and general health perceptions, we identified one to 11 (subscales of) PROMs with sufficient content validity, although quality of the evidence was generally low. For measuring depressive symptoms, no PROM with sufficient content validity was identified. For each aspect of HRQL, we found at least one PROM with sufficient content validity, except for depressive symptoms. The quality of the evidence was mostly very low.
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Affiliation(s)
- Caroline B Terwee
- Amsterdam UMC, Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
| | - Petra J M Elders
- Amsterdam UMC, Department of General Practice, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Marlous Langendoen-Gort
- Amsterdam UMC, Department of General Practice, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Ellen B M Elsman
- Amsterdam UMC, Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Cecilia A C Prinsen
- Amsterdam UMC, Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Amber A van der Heijden
- Amsterdam UMC, Department of General Practice, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Maartje de Wit
- Amsterdam UMC, Department of Medical Psychology, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Joline W J Beulens
- Amsterdam UMC, Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Lidwine B Mokkink
- Amsterdam UMC, Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Femke Rutters
- Amsterdam UMC, Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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García AA, Huang YC, Zuñiga JA. Illness Perceptions Mediate the Impact of Depressive Symptoms on Quality of Life Among Latinos with Type 2 Diabetes. J Immigr Minor Health 2022; 24:1517-1525. [PMID: 35195797 DOI: 10.1007/s10903-022-01338-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
Abstract
Latinos' type 2 diabetes (T2DM) and concurrent depression significantly lower quality of life (QoL). Patients' beliefs about their diabetes, called illness perceptions (IP), may account for the impact of depression on QoL. Using secondary data, we explored predictive and mediation relationships among IP, depression, and QoL among Mexican American adults with T2DM using hierarchical multiple regression and mediation analyses. Participants (n = 75) were predominately middle-aged, female, most scoring low on depressive-symptoms, who believed that diabetes was a chronic disease with serious consequences, controllable by treatment and personal self-management. Participants with higher acculturation and weak perceptions about negative consequences of diabetes reported better QoL. Depressive symptoms' impact on QoL were mediated by overall IP and perceptions about diabetes consequences, in particular. By eliciting patients' perceptions about disease consequences and teaching realistic ways to avoid them, clinicians may alleviate the impact of depression on QoL.
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Affiliation(s)
- Alexandra A García
- School of Nursing, The University of Texas at Austin, 1710 Red River Street, Austin, TX, 78712, USA.
| | - Ya-Ching Huang
- St. David's School of Nursing, Texas State University, 1555 University Drive, Round Rock, TX, 78665, USA
| | - Julie A Zuñiga
- School of Nursing, The University of Texas at Austin, 1710 Red River Street, Austin, TX, 78712, USA
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Wee PJL, Kwan YH, Loh DHF, Phang JK, Puar TH, Østbye T, Thumboo J, Yoon S, Low LL. Measurement Properties of Patient-Reported Outcome Measures for Diabetes: Systematic Review. J Med Internet Res 2021; 23:e25002. [PMID: 34397387 PMCID: PMC8398743 DOI: 10.2196/25002] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/18/2020] [Accepted: 06/14/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The management of diabetes is complex. There is growing recognition of the use of patient-reported outcome measures (PROMs) as a standardized method of obtaining an outlook on patients' functional status and well-being. However, no systematic reviews have summarized the studies that investigate the measurement properties of diabetes PROMs. OBJECTIVE Our aims were to conduct a systematic review of studies investigating the measurement properties of diabetes PROMs by evaluating the methodological quality and overall level of evidence of these PROMs and to categorize them based on the outcome measures assessed. METHODS This study was guided by the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Relevant articles were retrieved from the Embase, PubMed, and PsychINFO databases. The PROMs were evaluated with the COSMIN (COnsensus-based Standards for the selection of health Measurement Instruments) guidelines. RESULTS A total of 363 articles evaluating the measurement properties of PROMs for diabetes in the adult population were identified, of which 238 unique PROMs from 248 studies reported in 209 articles were validated in the type 2 diabetes population. PROMs with at least a moderate level of evidence for ≥5 of 9 measurement properties include the Chinese version of the Personal Diabetes Questionnaire (C-PDQ), Diabetes Self-Management Instrument Short Form (DSMI-20), and Insulin Treatment Appraisal Scale in Hong Kong primary care patients (C-ITAS-HK), of which the C-PDQ has a "sufficient (+)" rating for >4 measurement properties. A total of 43 PROMs meet the COSMIN guidelines for recommendation for use. CONCLUSIONS This study identified and synthesized evidence for the measurement properties of 238 unique PROMs for patients with type 2 diabetes and categorized the PROMs according to their outcome measures. These findings may assist clinicians and researchers in selecting appropriate high-quality PROMs for clinical practice and research. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42020180978; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020180978.
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Affiliation(s)
| | - Yu Heng Kwan
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | | | - Jie Kie Phang
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Troy H Puar
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Truls Østbye
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Julian Thumboo
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sungwon Yoon
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Lian Leng Low
- SingHealth Office of Regional Health, Singapore, Singapore
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
- Post Acute and Continuing Care, Outram Community Hospital, SingHealth Community Hospitals, Singapore, Singapore
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Kuo HJ, Huang YC, García AA. Fatigue, Pain, Sleep Difficulties, and Depressive Symptoms in Mexican Americans and Chinese Americans with Type 2 Diabetes. J Immigr Minor Health 2020; 22:895-902. [DOI: 10.1007/s10903-020-01001-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Morales J, Glantz N, Larez A, Bevier W, Conneely M, Fan L, Reed B, Alatorre C, Paczkowski R, Ahmed T, Mackenzie A, Duncan I, Kerr D. Understanding the impact of five major determinants of health (genetics, biology, behavior, psychology, society/environment) on type 2 diabetes in U.S. Hispanic/Latino families: Mil Familias - a cohort study. BMC Endocr Disord 2020; 20:4. [PMID: 31906923 PMCID: PMC6945604 DOI: 10.1186/s12902-019-0483-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 12/23/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In the United States (U.S.), the prevalence of both diagnosed and undiagnosed type 2 diabetes (T2D) is nearly twice as high among Mexican-origin Hispanic/Latino adults compared to non-Hispanic Whites. Rates of diabetes-related complications, e.g., acute stroke and end-stage renal disease, are also higher among Hispanic/Latino adults compared to their non-Hispanic/Latino White counterparts. Beyond genetic and biological factors, it is now recognized that sociocultural influences are also important factors in determining risk for T2D and the associated complications. These influences include ethnicity, acculturation, residence, education, and economic status. The primary objective of this study is to determine the influence of the 5 major determinants of human health (genetics, biology, behavior, psychology, society/environment) on the burden of T2D for Latino families. To achieve this objective, Mil Familias (www.milfamilias.sansum.org/) is establishing an observational cohort of 1000 Latino families, with at least one family member living with T2D. METHODS Specially trained, bilingual Latino/a community health workers (Especialistas) recruit participant families and conduct research activities. Each individual family member will contribute data annually on over 100 different variables relating to their genetics, biology, psychology, behavior, and society/environment, creating a Latino-focused biobank ("Living Information Bank"). This observational cohort study is cross-sectional and longitudinal. Participants are divided into 4 groups: adults age ≥ 18 years with and without T2D, and children age ≥ 7 and < 18 years with and without T2D. Study activities take place through encounters between families and their Especialista. Encounters include screening/enrollment, informed consent, health promotion assessment, laboratory tests, questionnaires, physical activity monitoring, and reflection. DISCUSSION By creating and providing the framework for the Cohort Establishment study, we intend to inform new approaches regarding equity and excellence in diabetes research and care. We will examine the complex set of factors that contribute to the burden of diabetes in Latino families and assess if cardio-metabolic disease risks go beyond the traditional biological and genetic factors. Breaking the code on the interplay of cardio-metabolic risk factors may help not only this fast growing segment of the U.S. population, but also other high-risk populations. TRIAL REGISTRATION Study retrospectively registered at ClinicalTrials.gov (NCT03830840), 2/5/2019 (enrollment began 2/1/2019).
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Affiliation(s)
- Jessikah Morales
- Sansum Diabetes Research Institute, 2219 Bath Street, Santa Barbara, CA 93105 USA
| | - Namino Glantz
- Sansum Diabetes Research Institute, 2219 Bath Street, Santa Barbara, CA 93105 USA
| | - Arianna Larez
- Sansum Diabetes Research Institute, 2219 Bath Street, Santa Barbara, CA 93105 USA
| | - Wendy Bevier
- Sansum Diabetes Research Institute, 2219 Bath Street, Santa Barbara, CA 93105 USA
| | - Mary Conneely
- Sansum Diabetes Research Institute, 2219 Bath Street, Santa Barbara, CA 93105 USA
| | - Ludi Fan
- Eli Lilly and Company, Indianapolis, IN USA
| | | | | | | | - Tamim Ahmed
- Santa Barbara Actuaries, Santa Barbara, CA USA
| | | | - Ian Duncan
- Santa Barbara Actuaries, Santa Barbara, CA USA
| | - David Kerr
- Sansum Diabetes Research Institute, 2219 Bath Street, Santa Barbara, CA 93105 USA
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Karakoç Kumsar A, Taşkın Yılmaz F, Gündoğdu S. Tip 2 diyabetli bireylerde algılanan semptom düzeyi ile HbA1c ilişkisi. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.551234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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García AA, Bose E, Zuñiga JA, Zhang W. Mexican Americans' diabetes symptom prevalence, burden, and clusters. Appl Nurs Res 2019; 46:37-42. [PMID: 30853074 DOI: 10.1016/j.apnr.2019.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 02/01/2019] [Accepted: 02/10/2019] [Indexed: 01/05/2023]
Abstract
AIMS Type 2 diabetes mellitus (T2DM), serious and increasingly prevalent among Mexican Americans, produces symptoms related to high and low glucose levels, medication side effects, and long-term complications. This secondary analysis explored symptom prevalence, differences among symptom burden levels, and how symptoms clustered. METHODS Clinical measurements and survey data (demographic, quality of life, and the symptom subscale of the Diabetes Symptom Self-Management Inventory) collected from Mexican American adults with T2DM (n = 71) were analyzed for symptom prevalence, differences across levels of symptom burden, and symptom clusters. Agglomerative hierarchical and k-means clustering analyses were performed on a Gower matrix. Internal validation methods and rank aggregation were used to identify the best clustering method of the two techniques and to identify symptoms that clustered together. RESULTS Participants reported mean = 14 symptoms; tiredness and trouble sleeping were most prevalent. People with high symptom burden had significantly lower quality of life and perceptions of worse diabetes severity. Hierarchical clustering produced three symptom clusters: cluster 1 = 9 symptoms (e.g. intense thirstiness, dry mouth); cluster 2 = 9 symptoms (e.g., itching skin, weight gain, noise or light sensitivity); cluster 3 = 13 symptoms (e.g., nervous, headache, trouble concentrating, and memory loss). CONCLUSION Mexican Americans with T2DM report several co-occurring symptoms. Quality of life is significantly worse for people with high symptom burden. Three distinct symptom clusters were identified. Studies with larger samples are needed to further diabetes symptom science. Clinicians should assess and address patients' co-occurring symptoms as a potential means of decreasing symptom burden and improving quality of life.
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Affiliation(s)
- Alexandra A García
- The University of Texas at Austin School of Nursing, Austin, TX, United States of America; The University of Texas at Austin Dell Medical School, Austin, TX, United States of America.
| | - Eliezer Bose
- The University of Texas at Austin School of Nursing, Austin, TX, United States of America
| | - Julie A Zuñiga
- The University of Texas at Austin School of Nursing, Austin, TX, United States of America
| | - Wenhui Zhang
- The University of Texas at Austin School of Nursing, Austin, TX, United States of America
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García AA, Zuñiga JA, Lagon C. A Personal Touch: The Most Important Strategy for Recruiting Latino Research Participants. J Transcult Nurs 2016; 28:342-347. [PMID: 27114390 DOI: 10.1177/1043659616644958] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
People from non-White racial groups and other underserved populations, including Latinos, are frequently reluctant to participate in research. Yet their participation into research is foundational to producing information that researchers and health care providers need to address health disparities. The purpose of this article is to describe challenges we have encountered along with culturally relevant strategies we used in five research studies to recruit Mexican American participants from community settings, some of whom were also of low socioeconomic status. We found that the most effective recruitment strategies reflect the common cultural values of personalismo, simpátia, confianza, respeto, and familismo.
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Hennink MM, Kaiser BN, Sekar S, Griswold EP, Ali MK. How are qualitative methods used in diabetes research? A 30-year systematic review. Glob Public Health 2016; 12:200-219. [DOI: 10.1080/17441692.2015.1120337] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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García AA, Brown SA, Horner SD, Zuñiga J, Arheart KL. Home-based diabetes symptom self-management education for Mexican Americans with type 2 diabetes. HEALTH EDUCATION RESEARCH 2015; 30:484-96. [PMID: 25953971 PMCID: PMC4434953 DOI: 10.1093/her/cyv018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 04/17/2015] [Indexed: 05/26/2023]
Abstract
This pilot study evaluated an innovative diabetes symptom awareness and self-management educational program for Mexican Americans, a fast growing minority population experiencing a diabetes epidemic. Patients with diabetes need assistance interpreting and managing symptoms, which are often annoying and potentially life-threatening. A repeated measures randomized controlled trial was conducted with 72 Mexican Americans aged 25-75 years with type 2 diabetes. Experimental condition participants received eight weekly, in-home, one-on-one educational and behavior modification sessions with a registered nurse focusing on symptom awareness, glucose self-testing and appropriate treatments, followed by eight biweekly support telephone sessions. Wait-listed control condition participants served as comparisons at three time points. Hierarchical linear modeling was used to evaluate the effects of the intervention between- and within groups on psychosocial, behavioral and clinical outcomes. Participants were predominantly female, middle-aged, moderately acculturated and in poor glycemic control. Experimental group participants (n = 39) significantly improved glycemic control, blood pressure, symptoms, knowledge, self-efficacy, empowerment and quality of life. Post intervention focus groups reported satisfaction with the symptom focus. Addressing symptoms led to clinical and psychosocial improvements. Symptoms seem to be an important motivator and a useful prompt to engage patients in diabetes self-management behaviors to relieve symptoms and prevent complications.
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Affiliation(s)
- Alexandra A García
- School of Nursing, The University of Texas at Austin, Austin, TX, USA, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA and Department of Public Health Sciences, Division of Biostatistics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sharon A Brown
- School of Nursing, The University of Texas at Austin, Austin, TX, USA, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA and Department of Public Health Sciences, Division of Biostatistics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sharon D Horner
- School of Nursing, The University of Texas at Austin, Austin, TX, USA, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA and Department of Public Health Sciences, Division of Biostatistics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Julie Zuñiga
- School of Nursing, The University of Texas at Austin, Austin, TX, USA, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA and Department of Public Health Sciences, Division of Biostatistics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kristopher L Arheart
- School of Nursing, The University of Texas at Austin, Austin, TX, USA, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA and Department of Public Health Sciences, Division of Biostatistics, University of Miami Miller School of Medicine, Miami, FL, USA
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