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Obesity and type 2 diabetes disproportionately impact U.S. racial and ethnic minority communities and low-income populations. Improvements in implementing efficacious interventions to reduce the incidence of type 2 diabetes are underway (i.e., the National Diabetes Prevention Program), but challenges in effectively scaling-up successful interventions and reaching at-risk populations remain. In October 2017, the National Institutes of Health convened a workshop to understand how to (1) address socioeconomic and other environmental conditions that perpetuate disparities in the burden of obesity and type 2 diabetes; (2) design effective prevention and treatment strategies that are accessible, feasible, culturally relevant, and acceptable to diverse population groups; and (3) achieve sustainable health improvement approaches in communities with the greatest burden of these diseases. Common features of guiding frameworks to understand and address disparities and promote health equity were described. Promising research directions were identified in numerous areas, including study design, methodology, and core metrics; program implementation and scalability; the integration of medical care and social services; strategies to enhance patient empowerment; and understanding and addressing the impact of psychosocial stress on disease onset and progression in addition to factors that support resiliency and health.

ObjectiveLower health literacy is associated with higher rates of mortality and chronic disease. It remains unclear whether health literacy is associated with diabetes and/or hyperglycemia in older adults, and if this relationship differs by sex.Research design and methodsWe performed a cross-sectional analysis of 2510 older adults in the Health, Aging and Body Composition (Health ABC) Study who had both a Rapid Estimate of Adult Literacy in Medicine (REALM) measurement and diabetes status available. Sex-stratified logistic regression models were used to analyze the relationship of health literacy categories (low, medium, and high) to diabetes status, adjusting for key covariates. Secondary analyses examined the relationship of health literacy to glycemic markers (A1C, fasting blood glucose).ResultsAmong participants in the Health ABC cohort, 429 had diabetes. Mean age was 76years old and 45% were female. Men with diabetes more commonly had low health literacy levels than men without diabetes (10.1% versus 9.3%, p=0.02). Similar results were seen among women (14.7% versus 6.1%, p

To guide effective planning and decision-making regarding strategies to address adverse social determinants of health (SDOH) in diabetes, an understanding of upstream drivers and root causes is imperative. The World Health Organization SDOH framework includes socioeconomic and political systems and racism as upstream drivers of SDOH. These factors are not currently included in the Healthy People 2030 framework or other commonly used U.S. SDOH frameworks. This review gives an overview of the socioeconomic status SDOH and race and ethnicity in diabetes prevalence and incidence, discusses socioeconomic and political contexts and racism as upstream drivers and root causes of SDOH that necessitate attention in the U.S., illustrates the role of these drivers in the entrenched nature of SDOH within racial and ethnic minoritized and marginalized populations, and examines current and emerging actions within and beyond the health care sector to mitigate adverse SDOH. The incorporation of socioeconomic and political systems and racism as root causes and current drivers of adverse SDOH into U.S. SDOH frameworks enables an emphasis shift from primary individual- and neighborhood-level time-limited solutions to multisector and all-of-government initiatives that bring requisite policy change and permanent structural change. 6331876271112 dci230001video1 Video 1. Dr. Felicia Hill-Briggs, American Diabetes Association 83rd Scientific Sessions Diabetes Care Symposium–Social Determinants of Health: Impact on Diabetes Development and Care. [ABSTRACT FROM AUTHOR]

As endocrinologists we have focused on biological contributors to disparities in diabetes, obesity and other endocrine disorders. Given that diabetes is an exemplar health disparity condition, we, as a specialty, are also positioned to view the contributing factors and solutions more broadly. This will give us agency in contributing to health system, public health, and policy-level interventions to address the structural and institutional racism embedded in our medical and social systems. A history of unconsented medical and research experimentation on vulnerable groups and perpetuation of eugenics theory in the early 20th century have resulted in residual health care provider biases toward minority patients and patient distrust of medical systems, leading to poor quality of care. Historical discriminatory housing and lending policies resulted in racial residential segregation and neighborhoods with inadequate housing, healthy food access, and educational resources, setting the foundation for the social determinants of health (SDOH) contributing to present-day disparities. To reduce these disparities we need to ensure our health systems are implementing the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care to promote health equity. Because of racial biases inherent in our medical systems due to historical unethical practices in minority communities, health care provider training should incorporate awareness of unconscious bias, antiracism, and the value of diversity. Finally, we must also address poverty-related SDOH (eg, food and housing insecurity) by integrating social needs into medical care and using our voices to advocate for social policies that redress SDOH and restore environmental justice. [ABSTRACT FROM AUTHOR]

Objective: To assess whether an all-condition case management program can improve health care utilization and clinical outcomes in patients with diabetes.Research Design and Methods: 1342 patients with diabetes were enrolled in the Johns Hopkins Community Health Partnership (J-CHiP) Case Management program for high-risk patients with any chronic disease. We categorized participants into two intervention exposure categories based on the number of contacts with case manager (CM) and community health worker (CHW) per month: low contact (≤1 contact/month), and high contact (>1 contacts/month). The primary outcomes were rates of emergency department (ED) visits, hospitalizations, and 30-day hospital readmissions.Results: In analyses adjusted for age, sex, race, risk score, and baseline health utilization rate, Medicaid participants in the high contact group had 42% (rate ratio (RR): 1.42; 95% CI: 1.08-1.86) and 64% (RR: 1.64; 95% CI: 1.08-2.48) higher risks for hospital admission and readmission, respectively, than the low contact group. Similar increases were seen in the Medicare participants with 20% (RR: 1.20; 95% 1.02-1.42) and 42% (RR:1.42; 95% 1.09-1.84) higher risks for admission and readmission, respectively. The associations were not statistically significant for ED visits. Subsidiary analysis of a subset with HbA1c available (n = 545) revealed a statistically significant decrease in HbA1c among Medicare participants (mean (SD): -0.17% (1.50%)), with a larger decrease in the high contact group (mean (SD): -0.23% (1.59%)).Conclusion: In an all-condition case management program for high-risk patients, the higher intensity of contacts with CHW and CM was not associated with a reduced health care utilization in adults with diabetes. [ABSTRACT FROM AUTHOR]

Disparities in diabetes burden exist in large part because of the social determinants of health (SDOH). Translation research and practice addressing health equity in diabetes have generally focused on changing individual behavior or providing supportive approaches to compensate for, rather than directly target, SDOH. The purpose of this article is to propose a pathway for addressing SDOH as root causes of diabetes disparities and as an essential target for the next generation of interventions needed to achieve health equity in diabetes prevention and treatment. This review describes ( a) the current burden of diabetes disparities, ( b) the influence of SDOH on diabetes disparities, ( c) gaps in and implications of current translation research, and ( d) approaches to achieving health equity in the next generation of diabetes translation. [ABSTRACT FROM AUTHOR]

Purpose Of Review: The goal of this review is to describe diabetes within a population health improvement framework and to review the evidence for a diabetes population health continuum of intervention approaches, including diabetes prevention and chronic and acute diabetes management, to improve clinical and economic outcomes.Recent Findings: Recent studies have shown that compared to usual care, lifestyle interventions in prediabetes lower diabetes risk at the population-level and that group-based programs have low incremental medial cost effectiveness ratio for health systems. Effective outpatient interventions that improve diabetes control and process outcomes are multi-level, targeting the patient, provider, and healthcare system simultaneously and integrate community health workers as a liaison between the patient and community-based healthcare resources. A multi-faceted approach to diabetes management is also effective in the inpatient setting. Interventions shown to promote safe and effective glycemic control and use of evidence-based glucose management practices include provider reminder and clinical decision support systems, automated computer order entry, provider education, and organizational change. Future studies should examine the cost-effectiveness of multi-faceted outpatient and inpatient diabetes management programs to determine the best financial models for incorporating them into diabetes population health strategies. [ABSTRACT FROM AUTHOR]

Background: The republic of Trinidad and Tobago (T&T) is a middle income country with a comparatively high prevalence of diabetes mellitus (DM) compared to others in the Caribbean. To date, there have been no studies on health care professionals' (HCP) perspectives regarding the barriers to achieving optimal care of patients with DM in this country and few previous studies in the Caribbean, yet such perspectives are imperative to develop strategies that reduce the global burden of this disease.Methods: An electronic invitation was sent to prospective HCP in T&T inviting them to attend a symposium on DM and cardiovascular disease. A total of 198 HCP participants attended of whom approximately 100 participants completed an Audience Response Survey at the completion of the conference. The Audience Response Survey included questions regarding access to resources, need for prevention and education, and coordination of care for to diabetes care in T&T. Responses were analyzed in aggregate.Results: The 198 HCP participants attending the symposium included mostly nurses (40 %) and physicians (43 %). The most common specialty indicated by the 198 HCP participants was Internal and Family Medicine (28 %), followed by Anesthesiology (7 %), Emergency Medicine (6 %), Endocrinology and Diabetes (5 %) and Cardiology (3 %). Among the ~100 HCP who completed the Audience Response Survey, multiple barriers to achieving optimal care of patients with diabetes were reported such as: limited access to blood testing (75 %), ophthalmological evaluations (96 %), ECGs (69 %), and cardiac stress tests (92 %); inadequate time to screen and evaluate DM complications (95 %); poor access to consultants for referral of difficult cases (77 %); and lack of provider education regarding cardiovascular complications of DM (57 %). HCP agreed that nurses could potentially be considered to have a more active role in the care and prevention of cardiovascular disease and diabetes through leading patient education efforts (98 %), screening patients for complications (91 %), coordinating care efforts (99 %) and educating family members (98 %).Conclusions: The HCP in our study reported significant barriers to achieving optimal diabetes care in T&T. In the future, such barriers to care will need to be addressed in order to respond to the projected growth of diabetes in developing countries both within the Caribbean and globally. [ABSTRACT FROM AUTHOR]

Problem solving is an essential skill for effective diabetes self-management. Evidence suggests that problem-solving therapy (PST) approaches, used in the context of broader diabetes educational or lifestyle interventions, may be effective for mood and select diabetes outcomes. As a stand-alone treatment, formal PST adapted for diabetes self-management is a promising behavioral intervention for improving health-related problem-solving, diabetes self-care behaviors, and disease control. [ABSTRACT FROM AUTHOR]

Diabetes is associated with dementia in older adults, but it remains unclear whether nondemented adults with type 2 diabetes show subtle abnormalities across cognition, neuroanatomy, and everyday functioning. Using the Aging, Brain Imaging, and Cognition study sample of 301 community-dwelling, middle-aged and older adults, we conducted a secondary analysis on 28 participants with and 150 participants without diabetes. We analyzed brain magnetic resonance imaging data, cognitive test performance, and informant ratings of personal and instrumental activities of daily living (PADL/IADL). Relative to controls, participants with diabetes had lower brain-to-intracranial volume ratios (69.3 ± 4.5% vs. 71.7 ± 4.6%; p < .02), and performed more poorly on measures of working memory, processing speed, fluency, and crystallized intelligence (all p <.05). Decrements in working memory and processing speed were associated with IADL limitations (p < .01). Nondemented adults with diabetes exhibit neuroanatomic and cognitive abnormalities. Their cognitive deficits correlate with everyday functional limitations. [ABSTRACT FROM PUBLISHER]

The article presents a study on the role of nurse case manager (NCM) on the medical care of urban African Americans who suffer type two diabetes mellitus (DM). It notes that there are few randomized controlled trials done to test the appropriate interventions of DM care for African Americans adult. With this, assessment of the data on diabetic control which includes emergency department (ER) visits was done. The result shows a decrease in ER visits to African Americans with DM.

Background: Despite prevalent low literacy nationally, empirical research on the development and testing of literacy-adapted patient education remains limited.Objective: To describe procedures for developing and evaluating usability and acceptability of an adapted diabetes and CVD patient education.Design: Materials adaptation for literacy demand and behavioral activation criteria, and pre-/post-test intervention evaluation design.Participants: Pilot sample of 30 urban African-American adults with type 2 diabetes with Below Average literacy (n = 15) and Average literacy (n = 15).Measurements: Wide Range Achievement Test (WRAT-3, Reading), assessment of diabetes and CVD knowledge, and patient rating scale.Results: Reading grade levels were: > 12th, 30%; 10th-12th, 20%; 7th-9th, 10%; 4th-6th grade, 10%; and < or = 3rd grade or unable to complete WRAT-3, 30%. Education materials were modified to a reading level of < or = 4th grade. Knowledge improved for Below Average (2.7 to 4.7, p = 0.005) and Average (3.8 to 5.7, p = 0.002) literacy groups, with up to a ten-fold increase, at post-education, in the number of participants responding correctly to some content items. The print materials and class received maximum usability and acceptability ratings from patients.Conclusions: Development of patient education meeting very low literacy criteria was feasible, effective for knowledge acquisition, and highly acceptable irrespective of literacy level. [ABSTRACT FROM AUTHOR]

OBJECTIVE -- Populations with the lowest literacy and health literacy in the U.S. are also among those disproportionately burdened by diabetes and its complications. Yet, suitability of publicly available diabetes and cardiovascular (CVD) patient education materials for these patients is not clear. We evaluated selected American Diabetes Association (ADA) and American Heart Association (AHA) print education materials for accessibility and usability characteristics. RESEARCH DESIGN AND METHODS -- English-language, print patient education brochures addressing lifestyle/behavioral management of diabetes and CVD were obtained from the ADA (n = 21) and the AHA (n = 19). Materials were evaluated using 32 criteria, 23 addressing literacy demand and 9 addressing behavioral activation, compiled from authoritative sources on development of low-literacy consumer health information. RESULTS -- Of the 32 criteria identified by two or more sources, ADA materials consistently met 11 (34%) and AHA materials consistently met 8 (25%). Criteria most frequently achieved were text case, use of cues (e.g., bullets) to emphasize key points, design of graphics/illustrations, some provision of "how to" information, and positive depiction of cultural images. The least consistently achieved criteria were reading grade, word usage (e.g., scientific jargon), sentence length, font size, line length, white space, visual organization, limited scope, clear and specific (e.g., step-by-step) behavioral recommendations, and demonstration of audience relevance and cultural appropriateness. CONCLUSIONS -- Materials consistently met few criteria for usability by patients with low literacy, limited prior medical knowledge, and/or limited resource availability. Use of available criteria and methods for increasing reach of print education materials to these underserved patient populations is indicated. [ABSTRACT FROM AUTHOR]

Objective: Develop an accessible education module and test whether presence of diabetes complications and functional impairments differentially impacted intervention usability. Method: 30 African Americans with type 2 diabetes completed 1 of 4 (90-min) group education classes. Preintervention measures included medical history, Medical Outcomes Study Short Form-8, Telephone Interview for Cognitive Status, and Diabetes and Cardiovascular Disease Knowledge Test. For outcomes comparisons, patients were categorized according to functional impairment (physical; physical + cognitive or physical + visual; physical + cognitive + visual) and number of diabetes complications (0-1, 2-3, 4-6). Outcome measures were knowledge test change scores and patient ratings of satisfaction and accessibility of class and materials. Results: Education resulted in increased mean knowledge scores, from 6.6 to 11.3 (p < .001), with significant learning found for participants in all functional impairment categories and with 0-3 complications. Patient ratings of accessibility and satisfaction were high (42-43 of 45), with minor areas identified for improvement among persons with excess complications (4-6) and impairment (physical + cognitive + visual). Conclusion: The diabetes education module demonstrated accessibility and effectiveness. It may be particularly useful in treating high-risk, diabetic adults with existing complications, functional impairment, or disability. [ABSTRACT FROM AUTHOR]

Background: Patient problem solving and decision making are recognized as essential to effective self-management across multiple chronic diseases. However, a health-related problem-solving instrument that demonstrates sensitivity to disease control parameters in multiple diseases has not been established.Objectives: To determine, in two disease samples, internal consistency and associations with disease control of the Health Problem-Solving Scale (HPSS), a 50-item measure with 7 subscales assessing effective and ineffective problem-solving approaches, learning from past experiences, and motivation/orientation.Design: Cross-sectional study.Participants: Outpatients from university-affiliated medical center HIV (N = 111) and diabetes mellitus (DM, N = 78) clinics.Measurements: HPSS, CD4, hemoglobin A1c (HbA1c), and number of hospitalizations in the previous year and Emergency Department (ED) visits in the previous 6 months.Results: Administration time for the HPSS ranged from 5 to 10 minutes. Cronbach's alpha for the total HPSS was 0.86 and 0.89 for HIV and DM, respectively. Higher total scores (better problem solving) were associated with higher CD4 and fewer hospitalizations in HIV and lower HbA1c and fewer ED visits in DM. Health Problem-Solving Scale subscales representing negative problem-solving approaches were consistently associated with more hospitalizations (HIV, DM) and ED visits (DM).Conclusions: The HPSS may identify problem-solving difficulties with disease self-management and assess effectiveness of interventions targeting patient decision making in self-care. [ABSTRACT FROM AUTHOR]

In 181 urban African Americans with Type 2 diabetes, medication adherence was assessed using a measure designed specifically for an urban, impoverished sociodemographic population. Hemoglobin A1c, blood pressure and cholesterol levels, medication-related beliefs, and depression were assessed. Seventy-four percent of the sample reported adherence to diabetes medication. Adherence, adjusted for age, was associated with lower hemoglobin A1c. The specific behaviors associated with poorer diabetes control were forgetting to take medications and running out of medications. Knowledge of blood glucose goals differed for adherers and nonadherers. Blood pressure and cholesterol medication adherence rates were not associated with actual levels of blood pressure or lipids, respectively. These data suggest that specific medication-taking behaviors are important to diabetes control and constitute logical targets for interventions. [ABSTRACT FROM AUTHOR]

A correction notice is presented for the article "Psychosocial Care for People With Diabetes: A Position Statement of the American Diabetes Association."

Analyzes change in health-related quality of life (HRQOL), as assessed using the Medical Outcomes Study 36-item short form (SF-36), following a randomized controlled trial in urban African Americans with type 2 diabetes. Research design; Method used to compare SF-36 change scores for usual care and each intervention group; Conceptualizations of HRQOL.

Problem: Diabetes clinical practice recommendations call for assessment and intervention on diabetes self-management during inpatient hospitalization. Although diabetes is prevalent in inpatient rehabilitation settings, diabetes self-management has not traditionally been a focus of inpatient rehabilitation psychology care. This is because diabetes is often a secondary diagnosis when an individual is admitted to rehabilitation for an acute event. Objectives: The authors provide a rationale for a role for rehabilitation psychologists in assessing and intervening on the psychosocial, behavioral, and functional self-management needs of individuals with diabetes within the rehabilitation setting. The development of a rehabilitation psychology Inpatient Rehabilitation Diabetes Consultation Service is described. Theoretical and empirical bases for compilation of the assessment and intervention materials are provided. Format and implementation of the service on a university-affiliated inpatient rehabilitation unit is described, with special consideration given to professional issues faced by rehabilitation psychologists and teams. Results" A flexible consultation model was implemented using a guided diabetes psychosocial assessment with brief educational handouts addressing selected key topics (i.e., hyperglycemia, hypoglycemia, blood sugar monitoring, nutrition, physical activity, medication, and, A IC and average blood sugar). The consultation service was feasible and well-accepted by treated individuals and the rehabilitation team. Conclusions: Rehabilitation psychologists are uniquely positioned to address the functional, psychosocial, and behavioral needs of individuals with diabetes. With further research to assess clinical outcomes, this approach may further address practice recommendations for inpatient diabetes care. Moreover, such a diabetes consultation model may be useful on an outpatient rehabilitation basis as well. [ABSTRACT FROM AUTHOR]

Summary Objective Prior studies have shown a bidirectional association between depression and type 2 diabetes mellitus (T2DM); however, the prospective associations of anger and anxiety with T2DM have not been established. We hypothesized that trait anger and anxiety would predict incident T2DM, independently of depressive symptoms. Research design and methods In the Multi-ethnic Study of Atherosclerosis (MESA), we prospectively examined the association of trait anger and trait anxiety (assessed via the Spielberger Trait Anger and Anxiety Scales, respectively) with incident T2DM over 11.4 years in 5598 White, Black, Hispanic, and Chinese participants (53.2% women, mean age 61.6 years) at baseline without prevalent T2DM or cardiovascular disease. We used Cox proportional hazards models to calculate the hazard ratios (HR) of incident T2DM by previously defined anger category (low, moderate, high), and anxiety quartile, as there were no previously defined categories. Results High total trait anger was associated with incident T2DM (HR 1.50; 95% CI 1.08–2.07) relative to low total trait anger. The association was attenuated following adjustment for waist circumference (HR 1.32; 95% CI 0.94–1.86). Higher anger reaction was also associated with incident T2DM (HR = 1.07; 95% CI 1.03–1.11) that remained significant after adjusting for potential confounders/explanatory factors. In contrast, trait anxiety did not predict incident T2DM. Conclusions High total trait anger and anger reaction are potential modifiable risk factors for T2DM. Further research is needed to explore the mechanisms of the anger–diabetes relationship and to develop preventive interventions. [ABSTRACT FROM AUTHOR]

This paper aims to elucidate the need for counseling services among clients with diabetes, clarify common adjustment and diabetes self-care issues, and suggest counseling strategies for this population. We suggest that counselors increase their competencies in diabetes counseling, and strive to help traditional members of the diabetes care team (e.g., physicians) to recognize the benefits of routinely including counseling in diabetes care. This paper also explains the medical, psychosocial, and vocational aspects and implications of diabetes. [ABSTRACT FROM AUTHOR]