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Diabetes self-management behaviors, goals differ by ethnicity

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March 13, 2018

White, African-American, Hispanic-American and Chinese-American adults with diabetes self-reported common goals for improving healthy eating and physical activity patterns; however, medications use, self-monitoring of blood glucose and foot self-exams vary by ethnic group, according to an analysis of the DAWN2 study.

“Given the disproportionate number of [people with diabetes] in ethnic minority populations and the disparities in health and health care access, utilization and outcomes for adults with type 2 diabetes in the U.S., understanding the relationship between ethnicity and self-management is important,” Mark Peyrot, PhD, a professor of sociology at Loyola University in Baltimore, and colleagues wrote in the study background. “There are few investigations that identify differences in self-management behaviors among non-Hispanic whites, African-Americans, Hispanic-Americans and Chinese-Americans, their determinants and potential solutions to disparities.”

Peyrot and colleagues analyzed data from 1,055 U.S. participants of the DAWN2 study initiated in 2011, including white (n = 447), African-American (n = 241), Hispanic-American (n = 194) and Chinese-American (n = 173) respondents (mean age, 57 years; 52.8% women). Participants completed the Summary of Diabetes Self-Care Activity, assessing medication adherence, frequency of SMBG, healthy eating, physical activity and frequency of foot self-exams. Separate medication scores were calculated for participants on insulin therapy and those taking oral antidiabetes medications only. Researchers used analysis of covariance to compare self-management levels and interest in improving self-management among ethnic groups, with additional analysis of covariance to examine the relationship between participant ethnicity and health care practitioner-identified need for improvement in glucose control.

Across all ethnic groups, researchers found that mean number of days per week that participants reported self-management behaviors were highest for medication use (mean, 6.31 for insulin and 6.34 for oral medication only), intermediate for healthy eating (mean, 4.79), foot checks (mean, 4.55) and SMBG (mean, 4.44), and lowest for physical activity (mean, 3.28). There were no between-group differences for adherence to health care practitioner recommendations for oral medication or SMBG.

Researchers also observed that white adults demonstrated greater adherence to insulin therapy vs. other ethnic groups, but exercised less, whereas African-American participants performed foot checks more regularly vs. white and Chinese-American adults. Chinese-Americans performed foot checks less often vs. all other ethnic groups; however, they reported healthier eating when compared with white participants, according to researchers.

Overall, non-medication self-management scores were highest among African-American and Hispanic-American adults, intermediate among Chinese-American adults and lowest among white adults.

Researchers also found that, across all ethnic groups, the desire to improve self-management was higher for healthy eating vs. physical activity (73% vs. 69%; P < .05), followed by oral medications and SMBG (46%, 45% and 46%, respectively). Chinese-Americans self-reported greater interest in healthy eating vs. white and African-American participants, whereas Hispanic-American adults reported more interest in improving physical activity vs. white adults. The overall score of non-medication items was higher in Hispanic-American and Chinese-American adults and lower in African-American and white adults.

Researchers observed no between-group differences for health care practitioner-identified need for HbA1c improvement.

“More research is needed to better understand ethnic differences in preferences regarding self-management goal setting, improvement of glycemic control and support of [people with diabetes],” the researchers wrote. “There is a growing literature examining diabetes self-management in African-American and Hispanic-American populations; however, continued study of these groups and others that are less well-studied is required to understand the drivers of self-management behaviors and interest in improving self-management.” – by Regina Schaffer

Disclosures: Novo Nordisk funded this study. Peyrot reports he has received funding, speaking and consultant fees from or served on advisory boards for Calibra, Eli Lilly, Novo Nordisk and Valeritas. Please see the study for the other authors’ relevant financial disclosures.