Glycemic Control Among Latinos With Type 2 Diabetes: The Role of Social-Environmental Support Resources
Glycemic Control Among Latinos With Type 2 Diabetes: The Role of Social-Environmental Support Resources
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DOI：
10.1037/a0022850
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发表时间：
2011-05-01
影响因子：
4.2
通讯作者：
Philis-Tsimikas, Athena
中科院分区：
文献类型：
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作者：
Fortmann, Addie L.;Gallo, Linda C.;Philis-Tsimikas, Athena
目的：虽然积极的糖尿病自我管理是实现血糖控制的必要条件，但少数民族，特别是拉丁美洲人的依从性较差。研究表明，在疾病管理方面拥有更多社会环境支持资源的个体比那些支持资源较少的个体更有效地管理他们的糖尿病。方法：通过通径分析，研究多中介模型在解释疾病管理支持资源如何影响圣地亚哥县低收入社区诊所招募的208名2型糖尿病拉美裔患者的血红蛋白A1c （HbA1c）水平方面的价值。我们假设疾病管理支持资源与HbA1c之间的关系可能是由糖尿病自我管理和/或抑郁介导的。结果：感知到更多疾病管理支持资源的参与者报告了更好的糖尿病自我管理（β = 0.40, p < 0.001）和更少的抑郁（β = - 0.19, p < 0.01）。反过来，更好的糖尿病自我管理和更少的抑郁与更严格的血糖控制相关（HbA1c; β = 0.17, p < 0.05和β = 0.15, p < 0.05）。一旦通过糖尿病自我管理（95% Cl[- 0.25; - 0.03]）和抑郁（95% CI[- 0.14; - 0.01]）的间接影响得到统计控制，从支持资源到HbA1c的直接途径显着降低（p = 0.57）。结论：这些发现表明疾病管理支持资源与拉丁美洲人糖尿病自我管理、情绪健康和血糖控制之间存在重要联系。因此，针对这一人群的糖尿病自我管理和血糖控制的项目应该考虑与文化相关的、对健康结果的多层次影响。
Objective: Although active diabetes self-management is required to achieve glycemic control, adherence is poor among ethnic minorities, especially Latinos. Research shows that individuals who report greater social-environmental support resources for disease management manage their diabetes more effectively than those with fewer support resources. Methods: Path analysis was conducted to investigate the value of a multiple-mediator model in explaining how support resources for disease management influence hemoglobin A1c (HbA1c) levels in a sample of 208 Latinos with Type 2 diabetes recruited from low-income serving community clinics in San Diego County. We hypothesized that the relationship between support resources for disease-management and HbA1c would be mediated by diabetes self-management and/or depression. Results: Participants who perceived greater support resources for disease-management reported better diabetes self-management (beta = .40, p < .001) and less depression (beta = -.19, p < .01). In turn, better diabetes self-management and less depression were associated with tighter glycemic control (HbA1c; beta = .17, p < .05 and beta = .15, p < .05, respectively). Once the indirect effects via diabetes self-management (95% Cl [-.25; -.03]) and depression (95% CI [-.14; -.01]) were statistically controlled, the direct pathway from support resources to HbA1c was markedly reduced (p = .57). Conclusions: These findings demonstrate the important connection that support resources for disease management can have with diabetes self-management, emotional well-being, and glycemic control among Latinos. Thus, programs targeting diabetes self-management and glycemic control in this population should consider culturally relevant, multilevel influences on health outcomes.