Interventions needed to improve quality of life for underserved Black adults with diabetes
Patient-centered interventions may help Black adults with type 2 diabetes living in inner cities overcome various cultural and environmental barriers to care, according to study findings.
“African American patients with type 2 diabetes living within distressed inner cities experience multidimensional adversity across levels of influence that have significant impact on quality of life and clinical outcomes,” Leonard E. Egede, MD, MS, professor of medicine, inaugural Milwaukee community chair in health equity research, and chief of the division of general internal medicine at the Medical College of Wisconsin, told Healio. “A major clinical implication of these findings is the importance of patient-centered care and communication on quality of life and finding ways of enhancing them during patient conversations.”
Egede and colleagues conducted a cross-sectional study examining the association of individual, community and health system factors with physical and mental quality of life for Black adults with type 2 diabetes who lived in inner-city areas. Researchers recruited 241 Black adults aged 21 years and older living in Milwaukee in 2017 and 2018 (62% women; mean age, 57 years). All participants had a clinical diabetes diagnosis or an HbA1c of 6.5% or higher and completed a paper-based SF-12 survey with physical and mental components to measure quality of life. The study cohort answered questions about sociodemographics, physical and psychosocial behavior, and barriers to health service and in the community. Due to the large number of covariates, researchers used four modeling strategies to identify significant factors: a sequential regression model with variables entered in blocks, a stepwise regression model with backward selection, stepwise regression with forward selection, and all possible subsets regression.
The findings were published in The Science of Diabetes Self-Management and Care.
Of the study population, 82% said they were unemployed and about two-thirds reported having between four and nine comorbidities.
In analysis of mental quality of life, having an education level of less than a high school graduate and having major depression were associated with a worse mental quality of life in all four modeling approaches. For physical quality of life, results were similar in all four models. Being employed and reporting trauma were associated with a better physical quality of life.
“Existing evidence shows that in national studies among the general population, experiencing trauma has a dose-response relationship with physical functioning, but this has not really been studied in diabetes populations and even less has been studied among inner-city African Americans with diabetes,” Egede said. “We believe that resilience, seen in this study as well as others in individuals with diabetes, may play a role. Therefore, the observed relationship between trauma and the physical component of quality of life may be occurring indirectly through factors such as resilience, but we need to examine this specifically.”
The researchers wrote that providers need to focus more on patient-centered care and create programs to allow inner-city populations to overcome the cultural and environmental barriers they face.
“A lot of work has been done to identify barriers across levels of influence, and we are at the place in the field where we need action, we need interventions, and there needs to be a focus on implementation of evidence-base practices that accounts for the barriers identified across the evidence base,” Egede said.
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Leonard E. Egede, MD, MS, can be reached at email@example.com.