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Tang TS, Yip AKW, Klein G, Moore L, Hessler D, Polonsky WH, Fisher L. Training peers to deliver mental health support to adults with type 1 diabetes using the REACHOUT mobile app. Diabet Med 2024; 41:e15210. [PMID: 37634222 DOI: 10.1111/dme.15210] [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: 04/13/2023] [Revised: 08/19/2023] [Accepted: 08/22/2023] [Indexed: 08/29/2023]
Abstract
AIMS While peer support research is growing in the Type 1 diabetes (T1D) community, the peer supporter training (PST) process is rarely documented in detail. This study provides a comprehensive description of PST and evaluation for the REACHOUT mental health support intervention, and examines the feasibility and perceived utility of PST. METHODS Fifty-three adults with T1D were recruited to participate in a 6-hour, zoom-based PST program for mental health support. The program was structured in three parts: (1) internal motivation, resilience and empathy; (2) mindfulness, emotions and diabetes distress; and (3) active listening and deferring clinical questions to professionals. Candidates were evaluated based on eight pre-established competency criteria during a 5-day support trial with an assigned standardized T1D participant. Perceived usefulness of training skills was also assessed 3 months into the REACHOUT mental health support intervention. RESULTS Fifty-one of the fifty-three candidates who completed training achieved the criteria to graduate. Mean scores for the eight competency domains were: listens actively (4.55); asks open-ended questions (4.12); expresses empathy (4.42); avoids passing judgment (4.67); sits with strong emotions (4.44); refrains from giving advice (4.38); makes reflections (4.5); and defers medical questions (4.58). Of the skills learned during the PST, 95% rated interpreting and discussing diabetes distress profile and expressing empathy as moderately to extremely useful. CONCLUSIONS Findings demonstrate that it is feasible to recruit and graduate the number of trainees needed using a rigorous process. Only by making training protocols available can the PST be replicated and translated to other T1D populations (e.g. adolescents, parents of children with T1D).
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Affiliation(s)
- Tricia S Tang
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Annie K W Yip
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gerri Klein
- BCDiabetes, Vancouver, British Columbia, Canada
| | - Lauren Moore
- Lauren Moore Counseling, British Columbia, Canada
| | - Danielle Hessler
- Department of Family Medicine, University of California, San Francisco, USA
| | - William H Polonsky
- Behavioral Diabetes Institute, San Diego, California, USA
- University of California, San Diego, California, USA
| | - Lawrence Fisher
- Department of Family Medicine, University of California, San Francisco, USA
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Bruggeman BS, Walker AF, Peters AL, D’Avolio LW, Haller MJ. Blue Circle Health: A Novel Patient-Centered Model of Health Care Delivery for Low-Income Patients With Type 1 Diabetes. J Diabetes Sci Technol 2023; 17:925-934. [PMID: 36710449 PMCID: PMC10348005 DOI: 10.1177/19322968221149008] [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] [Indexed: 01/31/2023]
Abstract
Analog insulins, insulin pumps, and continuous glucose monitors (CGM) have revolutionized type 1 diabetes (T1D) treatment over the last 50 years. Nevertheless, less than 20% of patients in the United States reach guideline-based HbA1c targets. The dysfunctional delivery of U.S. health care has further worsened glycemic outcomes among structurally disadvantaged groups such as non-Hispanic Black and low-income populations. Administrative complexities resulting from mixed insurance coverage and delivery systems, incongruity between effective policies and reimbursement, structural racism, and implicit biases have led to high diabetes care-related costs, provider scarcity and burnout, and patient diabetes distress. The Extension for Community Healthcare Outcomes (ECHO) Diabetes tele-education outreach model was created to increase self-efficacy among primary care providers through a combination of weekly didactic sessions led by a team of diabetes experts and access to community-based peer coaches. As an evolution of ECHO Diabetes, Blue Circle Health has been established as a philanthropically funded health care delivery system, using a whole-person, individualized approach to T1D care for adults living in underserved communities. The program will provide direct-to-patient telehealth services, including diabetes education, management, and related psychological care regardless of ability to pay. Community-based diabetes support coaches will serve as the primary point of contact, or guide on the "Blue Circle Health Member Journey." Access to needed insulins, supplies, and CGMs will be provided at no cost to the individual. Through a continuous learning and improvement model, a person-centered, equitable, accessible, and effective health care delivery model will be built for people living with T1D.
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Affiliation(s)
| | - Ashby F. Walker
- College of Public Health & Health Professions, University of Florida, Gainesville, FL, USA
| | - Anne L. Peters
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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Illness perception and perceived benefits of illness among persons with type 1 diabetes. HEALTH PSYCHOLOGY REPORT 2022. [DOI: 10.5114/hpr/153999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
BackgroundIllness perception is assigned an increasing role in the control of chronic disease. This study examines illness perception and perceived benefits related to illness in persons with type 1 diabetes mellitus. We used quantitative and qualitative methods for a more in-depth analysis.Participants and procedureThe participants (N = 110; mean age: 31.52 years; 80.9% women) completed online questionnaires: the Brief Illness Percep-tion Questionnaire (B-IPQ), the perceived benefits subscale of the Illness Cognition Questionnaire (ICQ) and the Hospital Anxiety and Depression Scale (HADS). Interpretative phenomenological analysis (IPA) was used to analyze patients’ re-sponses to an open-ended question regarding perceived benefits.ResultsPerceived benefits score was positively correlated with personal (ρ = .20) and treatment control: life-style (ρ = .25) and co-herence (ρ = .22). Negative correlations were noted between B-IPQ total score (ρ = –.30), concern (ρ = –.30), depression (ρ = –.35), anxiety (ρ = –.32) and irritability (ρ = –.19). 52.7% of participants reported at least one benefit of having type 1 diabetes. Patients who reported at least one benefit had statistically significantly higher scores in the perceived benefits subscale (p < .001), personal control (p = .005) and treatment control (p = .030) and lower scores in consequences (p = .023), identity (p = .045), concern (p < .001), emotional response (p < .001), and illness perception total score (p < .001) than those who did not report any benefit. IPA revealed four main themes: personal benefits, health-related benefits, social contacts and economic benefits.ConclusionsThe study revealed that in patients with type 1 diabetes perceived disease benefits are closely related to more positive illness perception and lower levels of depression, anxiety and irritability. The findings suggest that addressing potential benefits related to illness may influence the emotional state.
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Messina R, Berry E, Golinelli D, Donetto S, Reno C, Moscatiello S, Laffi G, Sturt J. Tackling diabetes as a team: co-designing healthcare interventions to engage couples living with type 1 diabetes. Acta Diabetol 2022; 59:1053-1061. [PMID: 35624322 PMCID: PMC9242905 DOI: 10.1007/s00592-022-01900-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/25/2022] [Indexed: 11/24/2022]
Abstract
AIMS Couples living with Type 1 diabetes: co-designing interventions to support them. METHODS This is a qualitative study comprising two phases. Phase I represents the exploratory phase, consisting of semi-structured interviews with persons with Type 1 diabetes (N = 16) and partners (N = 6). In the second phase, co-design principles guided workshops with healthcare professionals, persons with Type 1 diabetes, and partners (N = 7) to facilitate discussion of the key themes identified and solutions to engage couples living with Type 1 diabetes in diabetes care. RESULT The key themes identified from phase I as priorities to target in future interventions were: (i) Emotional impact of diabetes and (ii) Partners' involvement. Priority (i) captures the impact the emotional burden of diabetes management produces within couples' relationship. Priority (ii) captures the request from partners to be more involved in diabetes management. Characteristics of the interventions suggested during the co-design phase II focused on engaging patients and partners via a counseling point in healthcare settings and tailored help for couples' psychological support needs. CONCLUSIONS Couples value pro-active intervention and support from their diabetes team or primary care for both the partners to live well with Type 1 diabetes.
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Affiliation(s)
- Rossella Messina
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Via San Giacomo, 12, 40126, Bologna, Italy.
| | - Emma Berry
- School of Psychology, Queen's University Belfast, Belfast, Ireland
| | - Davide Golinelli
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Via San Giacomo, 12, 40126, Bologna, Italy
| | - Sara Donetto
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Chiara Reno
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Via San Giacomo, 12, 40126, Bologna, Italy
| | - Simona Moscatiello
- Unit of Endocrinology and Prevention and Care of Diabetes, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Gilberto Laffi
- Unit of Endocrinology and Prevention and Care of Diabetes, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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Christensen MO, Berg AK, Rytter K, Hommel E, Thyssen JP, Svensson J, Nørgaard K. Skin Problems Due to Treatment with Technology Are Associated with Increased Disease Burden Among Adults with Type 1 Diabetes. Diabetes Technol Ther 2019; 21:215-221. [PMID: 30943072 DOI: 10.1089/dia.2019.0007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND In a 4-month follow-up survey, we examined whether treatment with continuous subcutaneous insulin infusion (CSII) and/or continuous glucose monitoring (CGM) in adults with type 1 diabetes was associated with sustained skin problems and whether skin problems were associated with diabetes-related emotional distress. RESEARCH DESIGN AND METHODS A total of 111 adult patients completed a follow-up questionnaire concerning skin problems as a result of CSII and/or CGM use. The questionnaire included a patient-reported outcome measure, the Problem Areas in Diabetes (PAID) scale. RESULTS Current visible skin problems caused by CSII or CGM use were reported by 51 (46.0%) participants, in 34 (66.7%) of whom skin problems had been reported more than 4 months earlier. Seventy-two (64.9%) participants reported skin problems as a result of CSII use, whereas 38 (74.5%) reported skin problems owing to CGM use at some time. Itching was the most prevalent complaint. CSII-related itching was associated with a mean PAID score >20 (P = 0.01), and patients with more than one skin problem had an increased PAID score compared with those with one or no skin problems (P = 0.006). CONCLUSIONS More than half patients treated with CSII, CGM, or both had experienced skin problems during 4 months of follow-up that were associated with increased diabetes burden. Skin problems represent a persistent health issue affecting diabetes-specific emotional distress.
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Affiliation(s)
- Maria O Christensen
- 1 University of Copenhagen, Copenhagen, Denmark
- 2 Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Anna K Berg
- 1 University of Copenhagen, Copenhagen, Denmark
- 3 Copenhagen Diabetes Research Center (CPH-DIRECT), Department of Pediatrics, Copenhagen University Hospital, Herlev, Denmark
| | - Karen Rytter
- 2 Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Eva Hommel
- 2 Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Jacob P Thyssen
- 4 Department of Dermatology and Allergy, Copenhagen University Hospital, Hellerup, Denmark
| | - Jannet Svensson
- 1 University of Copenhagen, Copenhagen, Denmark
- 3 Copenhagen Diabetes Research Center (CPH-DIRECT), Department of Pediatrics, Copenhagen University Hospital, Herlev, Denmark
| | - Kirsten Nørgaard
- 2 Steno Diabetes Center Copenhagen, Gentofte, Denmark
- 5 Department of Endocrinology, Copenhagen University Hospital, Hvidovre, Denmark
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Ju C, Shi R, Yao L, Ye X, Jia M, Han J, Yang T, Lu Q, Jin H, Cai X, Yuan S, Xie B, Yu X, Coufal MM, Fisher EB, Sun Z. Effect of peer support on diabetes distress: a cluster randomized controlled trial. Diabet Med 2018; 35:770-775. [PMID: 29574995 DOI: 10.1111/dme.13625] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2018] [Indexed: 01/19/2023]
Abstract
AIM To investigate whether peer support would reduce diabetes distress and improve glycaemic control when added to usual diabetes education among adults with Type 2 diabetes in China. METHODS We conducted a cluster randomized trial involving 400 adults with Type 2 diabetes from eight communities in Nanjing. All participants received usual education for an average of 2 h each month from physicians, certified diabetes educators, dieticians, psychologists and podiatric nurses. Peer support was led by trained peer leaders and included diabetes knowledge- and skills-sharing at least once a month, as well as peer-to-peer communication. The primary outcome was diabetes distress measured using the Diabetes Distress Scale at 12 months. Secondary outcomes included fasting plasma glucose, 2-h postprandial glucose and HbA1c concentration. Outcome data were collected from all participants at baseline, 6 months and 12 months. RESULTS From 2012 to 2013, there were 200 participants in each study arm at baseline. Compared with the usual education arm, the peer support with usual education arm had greater reductions in regimen-related distress (1.4 ± 0.6 vs 1.2 ± 0.4; P=0.004) and total distress (1.3 ± 0.4 vs 1.2 ± 0.3; P=0.038) at 6 months. At 12 months, the scores for emotional burden (1.2 ± 0.3 vs 1.4 ± 0.6; P=0.002), physician-related distress (1.1 ± 0.3 vs 1.3 ± 0.4; P=0.001) and total scores (1.2 ± 0.3 vs 1.3 ± 0.4; P=0.002) were significantly lower in the peer support with usual education arm than in the usual education arm. Fasting plasma glucose levels were lower in the peer support with usual education arm than in the usual education arm at 6 months (7.5 ± 1.95 vs 8.0 ± 2.2; P=0.044) and 12 months (7.0 ± 2.3 vs 7.6 ± 1.5; P=0.008). CONCLUSIONS Beyond the benefits of usual education, peer support was effective in reducing diabetes distress for Type 2 diabetes mellitus. (Clinical Trials Registry no: NCT02119572).
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Affiliation(s)
- C Ju
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Nanjing, Jiangsu, China
| | - R Shi
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Nanjing, Jiangsu, China
| | - L Yao
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Nanjing, Jiangsu, China
| | - X Ye
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Nanjing, Jiangsu, China
| | - M Jia
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Nanjing, Jiangsu, China
| | - J Han
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Nanjing, Jiangsu, China
| | - T Yang
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Nanjing, Jiangsu, China
| | - Q Lu
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Nanjing, Jiangsu, China
| | - H Jin
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Nanjing, Jiangsu, China
| | - X Cai
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Nanjing, Jiangsu, China
| | - S Yuan
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Nanjing, Jiangsu, China
| | - B Xie
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Nanjing, Jiangsu, China
| | - X Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - M M Coufal
- Asian Centre for Health Education, Plano, American Samoa
| | - E B Fisher
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Z Sun
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Nanjing, Jiangsu, China
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Ridderstråle M. Comparison Between Individually and Group-Based Insulin Pump Initiation by Time-Driven Activity-Based Costing. J Diabetes Sci Technol 2017; 11:759-765. [PMID: 28366085 PMCID: PMC5588822 DOI: 10.1177/1932296816684858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Depending on available resources, competencies, and pedagogic preference, initiation of insulin pump therapy can be performed on either an individual or a group basis. Here we compared the two models with respect to resources used. METHODS Time-driven activity-based costing (TDABC) was used to compare initiating insulin pump treatment in groups (GT) to individual treatment (IT). Activities and cost drivers were identified, timed, or estimated at location. Medical quality and patient satisfaction were assumed to be noninferior and were not measured. RESULTS GT was about 30% less time-consuming and 17% less cost driving per patient and activity compared to IT. As a batch driver (16 patients in one group) GT produced an upward jigsaw-shaped accumulative cost curve compared to the incremental increase incurred by IT. Taking the alternate cost for those not attending into account, and realizing the cost of opportunity gained, suggested that GT was cost neutral already when 5 of 16 patients attended, and that a second group could be initiated at no additional cost as the attendance rate reached 15:1. CONCLUSIONS We found TDABC to be effective in comparing treatment alternatives, improving cost control and decision making. Everything else being equal, if the setup is available, our data suggest that initiating insulin pump treatment in groups is far more cost effective than on an individual basis and that TDABC may be used to find the balance point.
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Affiliation(s)
- Martin Ridderstråle
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Martin Ridderstråle, MD, Department of Clinical Sciences, Lund University, Malmö S-205 02, Sweden.
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Tang TS, Yusuf FLA, Polonsky WH, Fisher L. Assessing quality of life in diabetes: II - Deconstructing measures into a simple framework. Diabetes Res Clin Pract 2017; 126:286-302. [PMID: 28190527 DOI: 10.1016/j.diabres.2016.10.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 10/13/2016] [Indexed: 12/19/2022]
Abstract
A growing number of instruments measuring diabetes-specific health-related quality of life (HRQOL) have been identified in previous systematic reviews, the most recent being published in 2008. The purpose of this paper is report on an updated systematic review of diabetes-specific HRQOL measures highlighting the time period 2006-2016; to deconstruct existing diabetes-specific HRQOL measures into a simple framework for evaluating the goodness-of-fit between specific research needs and instrument characteristics; and to present core characteristics of measures not yet reported in other reviews to further facilitate scale selection. Using the databases Medline, Pubmed, CINAHL, OVID Embase, and PsycINFO, we identified 20 diabetes-specific HRQOL measures that met our inclusion criteria. For each measure, we extracted eight core characteristics for our measurement selection framework. These characteristics include target population (type 1 vs. type 2), number and type of HRQOL dimensions measured and scored, type of score and calculation algorithm, sensitivity to change data reported in subsequent studies, number of survey items, approximate time length to complete, number of studies using the instrument in the past 10years, and specific languages instruments is translated. This report provides a way to compare and contrast existing diabetes-specific HRQOL measures to aid in appropriate scale selection and utilization.
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Affiliation(s)
| | | | - William H Polonsky
- Behavioral Diabetes Institute, San Diego, CA, USA; University of California, San Diego, CA, USA
| | - Lawrence Fisher
- University of California, San Francisco, San Francisco, CA, USA
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Umeh K. Are Ethnic Disparities in HbA1c Levels Explained by Mental Wellbeing? Analysis of Population-Based Data from the Health Survey for England. J Racial Ethn Health Disparities 2017; 5:86-95. [PMID: 28281176 PMCID: PMC5816119 DOI: 10.1007/s40615-017-0346-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/06/2017] [Accepted: 01/29/2017] [Indexed: 12/20/2022]
Abstract
Aims It is unclear how ethnic differences in HbA1c levels are affected by individual variations in mental wellbeing. Thus, the aim of this study was to assess the extent to which HbA1c disparities between Caucasian and South Asian adults are mediated by various aspects of positive psychological functioning. Methods Data from the 2014 Health Survey for England was analysed using bootstrapping methods. A total of 3894 UK residents with HbA1c data were eligible to participate. Mental wellbeing was assessed using the Warwick-Edinburgh Mental Well-being Scale. To reduce bias BMI, blood pressure, diabetes status, and other factors were treated as covariates. Results Ethnicity directly predicted blood sugar control (unadjusted coefficient −2.15; 95% CI −3.64, −0.67), with Caucasians generating lower average HbA1c levels (37.68 mmol/mol (5.6%)) compared to South Asians (39.87 mmol/mol (5.8%)). This association was mediated by positive mental wellbeing, specifically concerning perceived vigour (unadjusted effect 0.30; 95% CI 0.13, 0.58): South Asians felt more energetic than Caucasians (unadjusted coefficient −0.32; 95% CI −0.49, −0.16), and greater perceived energy predicted lower HbA1c levels (unadjusted coefficient −0.92; 95% CI −1.29, −0.55). This mediator effect accounted for just over 14% of the HbA1c variance and was negated after adjusting for BMI. Conclusions Caucasian experience better HbA1c levels compared with their South Asian counterparts. However, this association is partly confounded by individual differences in perceived energy levels, which is implicated in better glycaemic control, and appears to serve a protective function in South Asians.
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Affiliation(s)
- Kanayo Umeh
- School of Natural Sciences & Psychology, Liverpool John Moores University, Liverpool, L3 3AF, UK.
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