Putting Self-Management in the Context of Community-Dwelling American Indians Living With Type 2 Diabetes

Prioritizing Patient Experiences in the Management of Diabetes and Its Complications: An Endocrine Society Position Statement

Diabetes can be an arduous journey both for people with diabetes (PWD) and their caregivers. While the journey of every person with diabetes is unique, common themes emerge in managing this disease. To date, the experiences of PWD have not been fully considered to successfully implement the recommended standards of diabetes care in practice. It is critical for health-care providers (HCPs) to recognize perspectives of PWD to achieve optimal health outcomes. Further, existing tools are available to facilitate patient-centered care but are often underused. This statement summarizes findings from multistakeholder expert roundtable discussions hosted by the Endocrine Society that aimed to identify existing gaps in the management of diabetes and its complications and to identify tools needed to empower HCPs and PWD to address their many challenges. The roundtables included delegates from professional societies, governmental organizations, patient advocacy organizations, and social enterprises committed to making life better for PWD. Each section begins with a clinical scenario that serves as a framework to achieve desired health outcomes and includes a discussion of resources for HCPs to deliver patient-centered care in clinical practice. As diabetes management evolves, achieving this goal will also require the development of new tools to help guide HCPs in supporting PWD, as well as concrete strategies for the efficient uptake of these tools in clinical practice to minimize provider burden. Importantly, coordination among various stakeholders including PWD, HCPs, caregivers, policymakers, and payers is critical at all stages of the patient journey.

Social Support and Diabetes Management Among Older American Indians

Objective

Greater understanding how relationships that can facilitate or impede type 2 diabetes (T2D) management and control among older American Indian people is an overlooked, yet urgently needed strategy. Thus, we examined social support among older American Indian people in relation to their T2D management.

Methods

During the fall 2015, we conducted qualitative interviews with 28 participants aged ≥ 60 years who were members of a federally-recognized tribe. Drawing upon the buffering and direct effects theoretical models of how social support affects health, we examined transcribed audio recordings of the interviews with a systematic text analysis approach. We used a low-inference qualitative descriptive design to provide a situated understanding of participants' life experiences using their naturalistic expressions.

Results

The mean age of our participants was 73.0 ± 6.4 years with a mean HbA1c of 7.3 ± 1.5. Main social support sources were family, clinicians/formal services, community/culture, and spiritual/God. All four common social support types were represented, namely emotional, instrumental, informational, and appraisal support with most being instrumental in nature. A prominent gender difference was seen with respect to men receiving more instrumental support family/friends support than women.

Discussion

Value orientations among American Indian people often reflect extended social systems and interdependence. A deeper understanding is needed of how social relationships can be better leveraged to aid in effective T2D management among older American Indian people. The development and implementation of evidence-based social network interventions with an assets-based orientation that build upon the cultural value of reciprocity hold promise to improve T2D outcomes of older American Indian people.

"Together We Can Return to Balance"-Eastern Woodlands Native Perspectives and Type 2 Diabetes: A Qualitative Study

PURPOSE

To explore the perspectives of Eastern Woodlands Native people with type 2 diabetes (T2DM) in the context of health beliefs, T2DM disease self-management, and family and community connections.

METHODS

A qualitative descriptive method using face-to-face or telephonic semistructured interviews was employed with Native people ages 18 years or older who have a diagnosis of T2DM (N = 12) from an unidentified Eastern Woodlands tribe. The PEN-3 Cultural Model guided the study initially.

RESULTS

The overarching theme "together we can return to balance" corresponded to 5 subthemes: coming to know life paths with T2DM, acknowledging the imbalance, negotiating my way forward, making important connections, and sticking closer to Mother Earth. Dimensions within the subthemes suggest why Native people may not be reaching T2DM treatment goals. Reasons include incomplete diabetes knowledge, difficulty accessing resources, and contextual variations in adoption of conventional diabetes treatments.

CONCLUSION

This study identified themes from Native perspectives about T2DM self-management and about prospects that may mitigate incomplete knowledge and support. Integrating indigenous health and wellness knowledge with conventional principles of diabetes care presents several opportunities for nurses to advance diabetes self-management (DSM) education and support. Including Native health concepts when educating patients about DSM should be viewed as desirable for holistic family and community involvement that is central toward preventing disease progression.