Impact of Distress Reduction on Behavioral Correlates and A1C in African American Women with Uncontrolled Type 2 Diabetes: Results from EMPOWER

Objective: Symptoms of emotional distress related to diabetes have been associated with inadequate self-care behaviors, medication non-adherence, and poor glycemic control that may predispose patients to premature death. African American women, in whom diabetes is more common and social support is often insufficient, may be at particularly high risk. The objective of this study was to examine the impact of lowering diabetes-related emotional distress on glycemic control and associated behavioral correlates in rural African American women with uncontrolled type 2 diabetes (T2D).Design: Post-hoc analysis of prospective, randomized, controlled trial.Setting: Rural communities in the southeastern United States.Patients: 129 rural middle-aged African American women with uncontrolled type 2 diabetes (T2D)(A1C ≥ 7.0).Primary Independent Variable: Diabetes-related distress.Main Outcome Measures: Changes from baseline to 12-month follow-up in diabetes-related distress, and associated changes in medication adherence, self-care activities, self-efficacy, and glycemic control (A1C).Results: Patients with a reduction in diabetes-related distress (n=79) had significantly greater improvement in A1C, medication adherence, self-care activities, and self-efficacy compared with those in whom diabetes distress worsened or was unchanged (n=50). Changes in distress were also significantly and inversely correlated with improvements in medication adherence, self-care activities, and self-efficacy.Conclusions: Among rural African American women, reductions in diabetes-related distress may be associated with lower A1C and improvements in self-efficacy, self-care behaviors, and medication adherence.Ethn Dis. 2017;27(2):155-160; doi:10.18865/ed.27.2.155.

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Regimen-Related Distress, Medication Adherence, and Glycemic Control in Rural African American Women With Type 2 Diabetes Mellitus

Annals of Pharmacotherapy ◽

10.1177/1060028014536532 ◽

2014 ◽

Vol 48 (8) ◽

pp. 970-977 ◽

Cited By ~ 23

Author(s):

Doyle M. Cummings ◽

Lesley Lutes ◽

Kerry Littlewood ◽

Emily DiNatale ◽

Bertha Hambidge ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

African American ◽

Medication Adherence ◽

Glycemic Control ◽

African American Women ◽

American Women

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Aspects Of The Sociocultural Context And Self-Care Practices In Older African American Women With Type 2 Diabetes

PsycEXTRA Dataset ◽

10.1037/e322352004-050 ◽

2002 ◽

Author(s):

Anne Skelly

Keyword(s):

Type 2 Diabetes ◽

African American ◽

African American Women ◽

Self Care ◽

Sociocultural Context ◽

American Women ◽

Older African American Women ◽

Care Practices

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A Diabetes Management Program for African American Women With Type 2 Diabetes

The Diabetes Educator ◽

10.1177/014572170002600508 ◽

2000 ◽

Vol 26 (5) ◽

pp. 796-805 ◽

Cited By ~ 41

Author(s):

Thomas C. Keyserllng ◽

Alice S. Ammerman ◽

Carmen D. Samuel-Hodge ◽

Allyson F. Ingram ◽

Anne H. Skelly ◽

...

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

African American ◽

Randomized Trial ◽

African American Women ◽

Diabetes Management ◽

Self Care ◽

American Women ◽

Phone Calls

PURPOSE this paper describes a clinic and community-based diabetes intervention program designed to improve dietary, physical activity, and self-care behaviors of older African American women with type 2 diabetes. It also describes the study to evaluate this program and baseline characteristics of participants. METHODS The New Leaf... Choices for Healthy Living With Diabetes program consists of 4 clinic-based health counselor visits, a community intervention with 12 monthly phone calls from peer counselors, and 3 group sessions. A randomized, controlled trial to evaluate the effectiveness of this intervention is described. RESULTS Seventeen focus groups of African American women were used to assessed the cultural relevance/acceptability of the intervention and measurement instruments. For the randomized trial, 200 African American women with type 2 diabetes were recruited from 7 practices in central North Carolina. Mean age was 59, mean diabetes duration was 10 years, and participants were markedly overweight and physically inactive. CONCLUSIONS Participants found this program to be culturally relevant and acceptable. Its effects on diet, physical activity, and self-care behaviors will be assessed in a randomized trial.

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Diabetes Self-Management Education and Self-Efficacy Among African American Women Living With Type 2 Diabetes in Rural Primary Care

Journal of Doctoral Nursing Practice ◽

10.1891/2380-9418.10.1.11 ◽

2017 ◽

Vol 10 (1) ◽

pp. 11-16

Author(s):

Cynthia Harrington ◽

Heather D. Carter-Templeton ◽

Susan J. Appel

Keyword(s):

Type 2 Diabetes ◽

African American ◽

African American Women ◽

Health Care Providers ◽

Self Efficacy ◽

Self Management ◽

Health Clinic ◽

Care Providers ◽

American Women

African American women suffer the highest prevalence of type 2 diabetes (T2D). Self-efficacy is important for optimal diabetes self-management (DSM). Purpose: To evaluate DSM by comparing pre- and postintervention responses to a diabetes self-efficacy scale. Design: Descriptive pilot study. Sample: Participants for this study were N = 15 African American women aged 25–65 years (M = 47.4 years) and recruited from a rural health clinic in the Southeastern United States, who received a 4-hr DSM class. Method: Data were collected using the Stanford Self-Efficacy for Diabetes (SED). Results: The increase in the pre- and posttest SED scores were statistically significant, (p < .001). Implications for Nursing: Health care providers should tailor a diabetes education program for these individuals living with T2D. Through a collaborative patient–provider relationship to care, individuals may ultimately experience increased self-efficacy leading to improved DSM.

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A Randomized Trial of an Intervention to Improve Self-Care Behaviors of African-American Women With Type 2 Diabetes: Impact on physical activity

Diabetes Care ◽

10.2337/diacare.25.9.1576 ◽

2002 ◽

Vol 25 (9) ◽

pp. 1576-1583 ◽

Cited By ~ 156

Author(s):

T. C. Keyserling ◽

C. D. Samuel-Hodge ◽

A. S. Ammerman ◽

B. E. Ainsworth ◽

C. F. Henriquez-Roldan ◽

...

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

African American ◽

Randomized Trial ◽

African American Women ◽

Self Care ◽

American Women

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Depressive Symptoms, Cardiovascular Risk, and Diabetes Self-Care Strategies in African American Women With Type 2 Diabetes

Archives of Psychiatric Nursing ◽

10.1016/j.apnu.2007.03.002 ◽

2007 ◽

Vol 21 (4) ◽

pp. 201-209 ◽

Cited By ~ 6

Author(s):

Jan Collins-McNeil ◽

Ezra C. Holston ◽

Christopher L. Edwards ◽

Judy Carbage-Martin ◽

Debra L. Benbow ◽

...

Keyword(s):

Type 2 Diabetes ◽

African American ◽

Depressive Symptoms ◽

Cardiovascular Risk ◽

African American Women ◽

Self Care ◽

American Women

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Admixture mapping and fine-mapping of type 2 diabetes susceptibility loci in African American women

Journal of Human Genetics ◽

10.1038/s10038-018-0503-2 ◽

2018 ◽

Vol 63 (11) ◽

pp. 1109-1117 ◽

Cited By ~ 3

Author(s):

José M. Uribe-Salazar ◽

Julie R. Palmer ◽

Stephen A. Haddad ◽

Lynn Rosenberg ◽

Edward A. Ruiz-Narváez

Keyword(s):

Type 2 Diabetes ◽

African American ◽

African American Women ◽

Fine Mapping ◽

Admixture Mapping ◽

Susceptibility Loci ◽

Diabetes Susceptibility ◽

American Women

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Effects of a tailored text messaging intervention among diverse adults with type 2 diabetes: Evidence from the 15-month REACH RCT

10.2337/figshare.13052981.v1 ◽

2020 ◽

Author(s):

Lyndsay A. Nelson ◽

Robert A. Greevy ◽

Andrew Spieker ◽

Kenneth A. Wallston ◽

Tom A. Elasy ◽

...

Keyword(s):

Type 2 Diabetes ◽

Medication Adherence ◽

Self Efficacy ◽

Text Messaging ◽

Self Care ◽

Baseline Hba1c ◽

Median Response ◽

Text Messaging Intervention

Objective: Text messaging interventions have high potential for scalability and to reduce health disparities; however, more rigorous, long-term trials are needed. We examined the long-term efficacy and mechanisms of a tailored text messaging intervention. Research Design and Methods: Adults with type 2 diabetes participated in a parallel-groups, 15-month randomized trial, assigned to receive REACH (Rapid Education/Encouragement and Communications for Health) for 12 months or control. REACH included interactive texts and tailored texts addressing medication adherence, and non-tailored texts supporting other self-care behaviors. Outcomes included HbA1c, diabetes medication adherence, self-care, and self-efficacy. Results: Participants (N=506) were approximately half racial/ethnic minority and half were underinsured, had annual household incomes <$35,000 USD and ≤ high school education; 11% were homeless. <a>Average baseline HbA1c was 8.6%±1.8%; 70.0±19.7 mmol/mol) with n=219 having HbA1c≥8.5% (69 mmol/mol)</a> and half were prescribed insulin. Retention was over 90%. Median response rate to interactive texts was 91% (interquartile range 75%, 97%). The treatment effect on HbA1c at 6 months (-0.31%; 95% CI [-0.61%, -0.02%]) was greater among those with baseline HbA1c≥8.5% (-0.74%; 95% CI [-1.26%, -0.23%]), and there was not evidence of effect modification by race/ethnicity or socioeconomic disadvantage. REACH improved medication adherence and diet through 12 months, and self-efficacy through 6 months. Treatment effects were not significant for any outcome at 15 months. REACH reduced barriers to adherence, but barrier reduction did not mediate outcome improvements. Conclusions: REACH engaged at-risk patients in diabetes self-management and improved short-term HbA1c. More than texts alone may be needed to sustain effects.

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