Psychosocial Factors and Glycemic Control in Mexican Americans with Type 2 Diabetes
Isaac
1
Salvdivar
& Ranjita
2
Misra
1
Educational Psychology, Texas A & M University, College Station, TX
2 Kinesiology & Health Education, Texas A & M University , College Station, TX
Abstract
Results
Method
Correlation Table
A1c
The prevalence of obesity and overweight among Hispanics is on the rise in recent years. Yet
few studies have assessed how psychosocial variables among Hispanic may play a role in
health maintenance.
PURPOSE: The purpose of the study was to examine the association of psychosocial (i.e.
social barrier, social support, acceptance of diabetes, and depression) on glycemic control
(A1c) in Mexican Americans with type 2 diabetes mellitus (T2DM).
METHODS: A cross-sectional study design was used to collect information from T2DM
Mexican Americans in Bryan/College Station, McAllen, and Laredo Texas. A convenience
sampling method was used to recruit participants from local churches, clinics, and the
community. Depression was measured using the Center for Epidemiologic Studies
Depression Scale (CES-D). Social support, social barrier, and acceptance of diabetes were
measured by validated and reliable instruments. Nutrition and physical activity were
assessed by the subscales of the Pender’s Health Promotion Lifestyle Profile.
Subjects and Experimental Design
Demographics
A1c
The study used a cross-sectional design to collect
information from T2DM Mexican Americans in
Bryan/College Station, McAllen, and Laredo Texas.
Total of 108 Mexican American Men and Women
aged from 8 to 12 years participated in this study.
Subjects were recruited from local churches and
clinics in the community.
49.7
42.6
41.5
34.8
RESULTS: The sample comprised of 108 Mexican American (78% female, 22%male) with
mean age of 49.7 10.7 years. The mean A1c was 7.4±1.7; 42.7% of individuals had poor
glycemic control (A1c≥ 7). Depression was positively associated with A1c (r=.233, p< 0.05),
indicating depressed Mexican Americans had poor metabolic control as compared to those
who did not have depression. Depression also was associated with a lower confidence of
participants to manage their disease. Hierarchical regression analysis showed depressed
Mexican Americans had a lower acceptance of the disease, perceived to have social barriers,
and had poor glycemic control (R-square = 0.35; p<.001), after controlling for age, age of
onset, educational level, obesity, nutritional behavior, and physical activity. )
Depression
Social Social Nutritio
PA
suppor barrier
n
Behavio
t
behavior
r
Age of
onset
Highest
grade
level
1
.089
.111
1
-.043
.106
.082
1
.067
-.017
-.135
.223*
1
Social support
-.103
-.113
.037
.021
.078
1
Social barrier
.189
.465**
.140
.080 -.074
-.099
1
-.238*
-.079
-.0.47
.070 -.172
.294**
-.148
1
PA Behavior
-.122
.033
-.168
.111
.018
.214*
-.202*
.329**
1
Age of onset
-.094
.100 -.071
.077
.081
.052
-.117
1
Highest grade
level
-.066
.039
-.233*
-.142
.220*
.361**
Gender
BMI
DM
Onset
Gender BMI
1
Age
Age
Age
.233
Study Site
1. Laredo
2. College Station
3. McAllen
Depress
ion
BMI
%BF
Acceptance of Diabetes
Nutrition behavior
1.7
-.023 .801**
0.9
CONCLUSIONS: The findings indicate that psychosocial factors are associated with
glycemic control. Psychological interventions, especially those focusing on acceptance of
diabetes, can be incorporated into the counseling/clinical setting for Mexican Americans
with T2DM.
Supported Funded by a grant from Progroma de Investigacion de Migracion y Salud
(PIMSA), the Health Initiative o f the Americans, University of California, Berkeley
Nutritioin
PA
-.213* .315** -.293**
.131
Regression Analysis
Data Collection
Psychosocial Factors
Introduction
Hispanic-Americans comprise 14% of the US population.
Mexican Americans, the largest Hispanic population are
disproportionately burdened by diabetes and related mortality.
Data collection occurred in two phases: (1) Faceto-face interview by bilingual trained interviewers
and (2) clinical data – blood work,
anthropometric measurements, and body
composition, Three core labs in the US – St.
Joseph, Dr. Reichman's lab, and Diabetes
Diagnostic Laboratory.
Hierarchical regression analysis showed depressed Mexican Americans had a
lower acceptance of the disease, perceived to have social barriers, and had poor
glycemic control (R-square = 0.35; p<.001).
20
Control variables included age, age of onset, educational level, obesity,
nutritional behavior, and physical activity. )
16.4
15
Sample = 108 Mexican American (78% female, 22%male)
Mean age of 49.7 10.7 years.
10
The mean A1c was 7.4±1.7; 42.7% of individuals who had poor glycemic
control (A1c≥ 7).
5.7
5
2% of diabetes patients have depression that impedes on coping with
the disease and self-management behaviors.
A high prevalence of overweight among Hispanic children, especially
among elementary-school students, has been confirmed in Texas.
Evidence demonstrates that overweight children are more likely to
become overweight adults.
Rationale/Purpose
The purpose of this study was to examine the association between
psychosocial factors and self care management and glycemic
control (A1c) of Mexican Americans with type 2 diabetes mellitus
(T2DM).
Psychosocial Factors = social barrier, social support, acceptance of
diabetes, and depression
A1c: Glycostilated hemoglobin level was
measured at the Diabetes Diagnostic Lab in
Columbia Missouri. ADA indicates A1c < 7.0 as
good control and > 7.0 as poor control of
diabetes.
Measurements
2.1
0
Social
Support
Depression
Social
Barrier
Depression also associated with a lower confidence of participants to manage
their disease.
Conclusion
Clinical Parameters
Body Composition
• The Body Mass Index (BMI),
• Percent Body Fat (% Fat)
• Waist/hip ratio
This is one of few studies to examine psychosocial factors among Hispanics
with type 2 diabetes mellitus (T2DM).
0.58
0.65
The Center for Epidemiologic Studies Depression Scale
A1c >=7
The results indicate that psychosocial factors are associated with glycemic
control.
Psychological interventions, especially those focusing on acceptance of diabetes,
can be incorporated into the counseling/ clinical setting for Mexican Americans
with T2DM.
0.47
The Multidimensional Scale of Perceived Social Support
Acceptance of Diabetes - 3 subscales of acceptance:
outlook, confidence, and inhibitors.
Social Barrier -
Depression was positively associated with A1c (r=.233, p< 0.05)
SysBP
DysBP
Given that acceptance of diabetes may deter health regimen psychosocial
aspects need to be and importance part in intervention in maintaining positive
health behaviors in this ethnic group.
1