673-P: Food Insecurity and Intervention Opportunities for American Indians and Alaska Natives with Type 2 Diabetes: A Qualitative Analysis

American Indians and Alaska Natives (AI/ANs) bear a disproportionate burden of diabetes and associated long-term complications. Behavioral interventions play a vital role in promoting diabetes medical and psychological outcomes, yet the development of interventions for AI/AN communities has been limited. A systematic review was conducted of studies focused on the psychosocial and behavioral aspects of diagnosed diabetes among AI/ANs. Ovid and PubMed databases and published reference lists were searched for articles published between 1987 and 2014 that related to the psychosocial and behavioral aspects of type 1 or type 2 diabetes in the AI/AN population. Twenty studies were identified that met the inclusion criteria. Nineteen studies were observational and one study was intervention based. Two of the studies used community-based participatory research methodology. Of the 20 studies, 2 discussed cultural influences associated with diabetes self-management and 10 identified the specific tribes that participated in the study. Tribal affiliations among the studies were broad with the number of AI/AN participants in each study ranging from 30 to 23,529 participants. Emotional and behavioral topics found in the literature were adherence ( n = 2), depression ( n = 9), physical activity ( n = 3), psychosocial barriers ( n = 1), social support ( n = 3), and stress ( n = 2). Relatively few studies were identified using AI/AN populations over a 27-year period. This is in stark contrast to what is known about the prevalence and burden that type 1 and type 2 diabetes mellitus place on AI/AN communities. Future research should promote community engagement through the use of community-based participatory research methodologies, seek to further understand and describe the emotional and behavioral context for diabetes self-management in this population, and develop and test innovative interventions to promote the best possible diabetes outcomes.

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Youth-Onset Type 2 Diabetes Among American Indians and Alaska Natives

Journal of Public Health Management and Practice ◽

10.1097/phh.0b013e3181cbc4b5 ◽

2010 ◽

Vol 16 (5) ◽

pp. 388-393 ◽

Cited By ~ 5

Author(s):

Kelly Moore

Keyword(s):

Type 2 Diabetes ◽

American Indians ◽

Alaska Natives ◽

Onset Type

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Food choices and distress in reservation-based American Indians and Alaska Natives with type 2 diabetes

Public Health Nutrition ◽

10.1017/s1368980018000897 ◽

2018 ◽

Vol 21 (13) ◽

pp. 2367-2375

Author(s):

Nicolette I Teufel-Shone ◽

Luohua Jiang ◽

Jennifer Rockell ◽

Jennifer Chang ◽

Janette Beals ◽

...

Keyword(s):

Type 2 Diabetes ◽

American Indians ◽

Food Choice ◽

Alaska Natives ◽

Healthy Food ◽

Bivariate Analysis ◽

Unhealthy Food ◽

Linear Regression Models ◽

Distress Scale

AbstractObjectiveTo examine the association between food choice and distress in a large national sample of American Indians/Alaska Natives (AI/AN) with type 2 diabetes.DesignParticipants completed a sociodemographic survey, an FFQ and the Kessler-6 Distress Scale. Foods were identified as ‘healthy’ or ‘unhealthy’ using a classification grounded in the health education provided by the programme case managers; healthy and unhealthy food scores were calculated using reported intake frequencies. Pearson’s correlation coefficients for distress and food scores were calculated for all participants and by gender. Multiple linear regression models stratified by gender assessed the association between distress and food scores, controlling for sociodemographics and duration of type 2 diabetes.SettingRural AI reservations and AN villages.SubjectsAI/AN (n 2484) with type 2 diabetes.ResultsBoth males (34·9 %) and females (65·1 %) had higher healthy food scores than unhealthy scores. In bivariate analysis, distress level had a significant negative correlation with healthy food scores among female participants, but the association was not significant among males. Significant positive correlations between distress and unhealthy food scores were found in both genders. In the final multivariate models, healthy food scores were not significantly related to distress; however, unhealthy food scores showed significant positive relationships with distress for both genders (females: β=0·078, P=0·0007; males: β=0·139, P<0·0001).ConclusionsHealth professionals working with AI/AN diagnosed with type 2 diabetes should offer food choice strategies during difficult times and recognize that males may be more likely than females to select unhealthy foods when distressed.

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Food Insecurity and Associated Challenges to Healthy Eating Among American Indians and Alaska Natives With Type 2 Diabetes: Multiple Stakeholder Perspectives

Journal of Aging and Health ◽

10.1177/08982643211013232 ◽

2021 ◽

Vol 33 (7-8_suppl) ◽

pp. 31S-39S

Author(s):

Sarah Stotz ◽

Angela G. Brega ◽

J. Neil Henderson ◽

Steven Lockhart ◽

Kelly Moore ◽

...

Keyword(s):

Type 2 Diabetes ◽

Food Insecurity ◽

American Indians ◽

Healthy Eating ◽

Alaska Native ◽

Fruits And Vegetables ◽

Healthy Food ◽

Stakeholder Perspectives ◽

Healthcare Administrators

Objective: To examine stakeholder perspectives on food insecurity and associated challenges to healthy eating among American Indian and Alaska Native (AI/AN) adults with type 2 diabetes (T2D). Methods: Focus groups and interviews were conducted with purposively selected stakeholders: AI/ANs with T2D, their family members, healthcare administrators, nutrition and diabetes educators, and national content experts on AI/AN health. Two coders analyzed transcripts using the constant-comparison method. Results: Key themes included (1) rural- and urban-dwelling AI/ANs experience different primary food security and associated challenges; (2) factors contributing to food insecurity extend beyond cost of healthy food; and (3) barriers to consuming fresh, healthy food include cost, preparation time, limited cooking knowledge, and challenges with gardening. Discussion: Resources for AI/ANs with T2D who experience food insecurity and associated challenges to healthy eating should be tailored based on urban versus rural location and should address cost and other barriers to consumption of fresh fruits and vegetables.

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1715-P: Identifying Potentially Functional Variants in Regulatory Regions in KCNQ1 that Associate with Type 2 Diabetes in American Indians

Diabetes ◽

10.2337/db19-1715-p ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 1715-P

Author(s):

YUNHUA L. MULLER ◽

SAMANTHA E. DAY ◽

SAYUKO KOBES ◽

WILLIAM C. KNOWLER ◽

ROBERT L. HANSON ◽

...

Keyword(s):

Type 2 Diabetes ◽

American Indians ◽

Regulatory Regions ◽

Functional Variants

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1709-P: Assessing the Role of 211 “Established” Type 2 Diabetes Variants in American Indians

Diabetes ◽

10.2337/db19-1709-p ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 1709-P

Author(s):

ROBERT L. HANSON ◽

LAUREN E. WEDEKIND ◽

WEN-CHI HSUEH ◽

SAYUKO KOBES ◽

LESLIE J. BAIER ◽

...

Keyword(s):

Type 2 Diabetes ◽

American Indians

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2019-P: Gender Influence on Body Habitus for an Underserved Population with Type 2 Diabetes and Food Insecurity

Diabetes ◽

10.2337/db20-2019-p ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 2019-P

Author(s):

WENDY C. BEVIER ◽

NAMINO M. GLANTZ ◽

ARIANNA J. LAREZ ◽

MARY A. KUJAN ◽

CASEY CONNEELY ◽

...

Keyword(s):

Type 2 Diabetes ◽

Food Insecurity ◽

Underserved Population ◽

Body Habitus ◽

Gender Influence

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Caregiving Stress Among American Indians With Type 2 Diabetes: The Importance of Awareness of Connectedness and Family Support

Journal of Family Nursing ◽

10.1177/1074840718810550 ◽

2018 ◽

Vol 24 (4) ◽

pp. 621-639 ◽

Cited By ~ 2

Author(s):

Ashleigh Coser ◽

Kelley J. Sittner ◽

Melissa L. Walls ◽

Tina Handeland

Keyword(s):

Mental Health ◽

Type 2 Diabetes ◽

Physical Health ◽

Family Support ◽

American Indians ◽

Diabetes Management ◽

Cumulative Exposure ◽

Physical And Mental Health ◽

Community Connectedness

American Indian (AI) communities experience a disproportionate rate of Type 2 diabetes (T2D) and cumulative exposure to stress. Although this link is well researched among various populations, it has not been examined among AI communities. Path analysis was used to examine a multiple-mediator model to explain how caregiver stress influences self-reported mental and physical health among 100 AI participants with T2D. Caregiver stress was negatively associated with physical and mental health. Physical health was positively associated with family/community connectedness and mental health was positively associated with both family support and connectedness. The relationship between caregiver stress and mental health was partially mediated by family/community connectedness; caregiver stress had no indirect effects on physical health via either hypothesized mediator. Findings demonstrate the importance of integrating individuals’ connection to family and community and its influence on caregiver stress and mental health in intervention programs targeting diabetes management and care among AI communities.

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The Association of Food Insecurity, Inflammation, and Several Socioeconomic Factors with Type 2 Diabetes: A Case-Control Study

Journal of Nutrition and Food Security ◽

10.18502/jnfs.v5i1.2317 ◽

2020 ◽

Author(s):

Hamideh Janzadeh ◽

Hassan Mozaffari-Khosravi ◽

Maryam Javadi

Keyword(s):

Type 2 Diabetes ◽

Food Insecurity ◽

Case Control Study ◽

Economic Status ◽

Case Control ◽

Diabetic Patients ◽

Healthy Individuals ◽

Household Food ◽

Control Study

Background: Considering that food insecurity can be a precursor to health and nutrition problems, determining its associated factors seems necessary in any society. The purpose of this case-control study was to determine the food insecurity, c-reactive protein (CRP), and some socio-economic factors in type 2 diabetic patients. Methods: The present study was conducted on 200 people with type 2 diabetes mellitus (T2DM) and 200 healthy individuals within the age range of 30 to 59 years. Food security was assessed using the US Department of Agriculture Household Food Security questionnaire. Anthropometric index, physical activity, and biochemical factors were measured by questionnaire and blood test. Results: The prevalence of food insecurity was 71% within the diabetic patients, of which, 65.5% had food insecurity without hunger, 3.5% had food insecurity with moderate hunger, and 2% had food insecurity with severe hunger. In addition, 24.9% of the participants were healthy. The level of fasting blood glucose and inflammatory factors (CRP, WBC) were significantly higher in food insecure participants compared to the healthy individuals (P < 0.05). Multivariate logistic analysis showed that food insecurity, BMI > 25, occupational status, economic status, and education level were significantly correlated with T2DM (P < 0.001). Conclusion: As a result, health care providers should take measures to reduce the food insecurity in the community, specifically within T2DM patients. To this end, the individuals' economic status should be improved and the household food patterns should be modified.

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