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Validation of theoretical pathway between discrimination, diabetes self-care and glycemic control. J Diabetes Complications 2016 07;30(5):858-63

Date

04/14/2016

Pubmed ID

27068266

Pubmed Central ID

PMC7061439

DOI

10.1016/j.jdiacomp.2016.03.014

Scopus ID

2-s2.0-84962654751   8 Citations

Abstract

AIMS: This study examined the mechanisms through which discrimination influences diabetes self-care and glycemic control in patients with diabetes by using structured equation modeling.

METHODS: 615 patients were recruited from two adult primary care clinics in the southeastern United States. Measures were based on a theoretical model and included perceived discrimination, social support, social cohesion, and perceived stress. Structured equation modeling examined the relationship with diabetes self-care and glycemic control.

RESULTS: The final model (chi2(211)=328.82, p<0.0001, R(2)=0.99, RMSEA=0.03 and CFI=0.98) shows that higher stress is directly significantly related to a decreased self-care (r=-0.59, p <0.001) and increased HbA1c (r=0.27, p<0.05). There was no significant direct association between discrimination, social support or social cohesion, and glycemic control or self-care. There was, however, a direct significant association between increased discrimination (r=0.46, p<0.001), decreased social support (r=-0.34, p<0.001), increased social cohesion (r=0.14, p<0.05) and increased stress.

CONCLUSIONS: These results support the hypothesized pathway of discrimination on health outcomes, showing both a direct and indirect influence through stress on HbA1c in adults with diabetes. Understanding the pathways through which discrimination influences diabetes outcomes is important for providing more comprehensive and effective care. These results suggest future interventions targeting patients with diabetes should take discrimination-induced stress into account.

Author List

Dawson AZ, Walker RJ, Campbell JA, Egede LE

Authors

Jennifer Annette Campbell PhD, MPH Assistant Professor in the Medicine department at Medical College of Wisconsin
Aprill Z. Dawson PhD, MPH Assistant Professor in the Medicine department at Medical College of Wisconsin
Leonard E. Egede MD Center Director, Chief, Professor in the Medicine department at Medical College of Wisconsin
Rebekah Walker PhD Associate Professor in the Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Aged
Combined Modality Therapy
Cross-Sectional Studies
Diabetes Mellitus, Type 2
Female
Glycated Hemoglobin A
Humans
Hyperglycemia
Hypoglycemia
Interpersonal Relations
Male
Middle Aged
Models, Psychological
Patient Compliance
Primary Health Care
Self Care
Self Report
Social Support
South Carolina
Stress, Psychological