Interventions wanted to enhance high quality of life for underserved Black adults with diabetes

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Patient-centered interventions can help black adults with type 2 diabetes who live in city centers overcome various cultural and environmental barriers to care. This is evident from study results.

“African American patients with type 2 diabetes who live in distressed inner cities experience multidimensional adversity across various levels of influence that have significant implications for quality of life and clinical outcomes.” Leonard E. Egede, MD, MSHealio, professor of medicine, first chairman of the Milwaukee Community in Health Equity Research and director of general internal medicine at Medical College in Wisconsin, told Healio. “An important clinical implication of these results is the importance of patient-centered care and communication for quality of life and finding ways to improve it during patient consultations.”

Egede is a Professor of Medicine, First Chairman of the Milwaukee Community in Health Equity Research and Head of General Internal Medicine at the Medical College of Wisconsin.

Egede and colleagues conducted a cross-sectional study that examined the relationship between individual, community, and health factors and the physical and mental quality of life of black adults with type 2 diabetes who lived in city centers. The researchers recruited 241 black adults aged 21 and over who lived in Milwaukee in 2017 and 2018 (62% women; mean age 57 years). All participants had a clinical diagnosis of diabetes or an HbA1c score of 6.5% or greater and completed a paper-based SF-12 survey with physical and mental components to measure quality of life. The study cohort answered questions about sociodemographics, physical and psychosocial behavior, and barriers to health care and the community. Because of the large number of covariates, the researchers used four modeling strategies to identify significant factors: a sequential regression model with variables entered in blocks, a stepwise regression model with backward selection, a stepwise regression with forward selection, and all possible subset regressions.

The results were published in The Science of Diabetes Self-Management and Care.

82% of the study population said they were unemployed, and around two-thirds said they had between four and nine comorbidities.

In the analysis of the mental quality of life, an educational level of less than a high school graduate and severe depression were associated with poorer mental quality of life in all four modeling approaches. For physical quality of life, the results were similar in all four models. Employment and reporting of trauma were associated with better physical quality of life.

“Existing evidence shows that experiencing trauma has a dose-response relationship with physical functioning in national studies in the general population, but this has not really been studied in diabetic populations, and even less has been studied in downtown African Americans with diabetes . Said Egede. “We believe resilience, as seen in this study, as it is in other people with diabetes, may play a role. Hence, the observed relationship between trauma and the physical component of quality of life may occur indirectly through factors such as resilience, but we need to specifically study this. “

The researchers wrote that providers need to focus more on patient-centered care and develop programs that enable downtown populations to overcome the cultural and environmental barriers they face.

“A lot of work has been done to identify barriers at different levels of influence, and we are in the place where we need action, we need intervention, and there needs to be a focus on implementing evidence-based practices that are taken into account for the barriers identified throughout the evidence base, ”said Egede.

For more informations:

Leonard E. Egede, MD, MS, can be reached at legede@mcw.edu.

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Race and medicine

Race and medicine