Ethnic differences in psychological outcomes among people with diabetes: USA results from the second Diabetes Attitudes, Wishes, and Needs (DAWN2) study

Abstract

Objective:

To assess differences in psychological outcomes as well as risk and protective factors for these outcomes among several USA ethnic groups and identify correlates of these psychological outcomes among adults with diabetes in the second Diabetes Attitudes, Wishes and Needs (DAWN2) study.

Research design and methods:

The core USA DAWN2 sample was supplemented by independent samples of specific ethnic minority groups, yielding a total of 447 White non-Hispanics, 241 African Americans, 194 Hispanics, and 173 Chinese Americans (n = 1055). Multivariate analysis examined ethnic differences in psychological outcomes and risk/protective factors (disease, demographic and socioeconomic factors, health status and healthcare access/utilization, subjective burden of diabetes and social support/burden). Separate analyses were performed on each group to determine whether risk/protective factors differed across ethnic groups.

Main outcome measures:

Psychological outcomes include well-being, quality of life, impact of diabetes on life domains, diabetes distress, and diabetes empowerment.

Clinical trial registration:

NCT01507116.

Results:

Ethnic minorities tended to have better psychological outcomes than White non-Hispanics, although their diabetes distress was higher. Levels of most risk and protective factors differed significantly across ethnic groups; adjustment for these factors reduced ethnic group differences in psychological outcomes. Health status and modifiable diabetes-specific risk/protective factors (healthcare access/utilization, subjective diabetes burden, social support/burden) had strong associations with psychological outcomes, especially diabetes distress and empowerment. Numerous interactions between ethnicity and other correlates of psychological outcomes suggest that ethnic groups are differentially sensitive to various risk/protective factors. Potential limitations are the sample sizes and representativeness.

Conclusions:

Ethnic groups differ in their psychological outcomes. The risk/protective factors for psychological outcomes differ across ethnic groups and different ethnic groups are more/less sensitive to their influence. These findings can aid the development of strategies to overcome the most prominent and influential psychosocial barriers to optimal diabetes care within each ethnic group.

Keywords::

• DAWN2
• Ethnic disparities
• Psychological outcomes
• Quality of life
• Well-being

Transparency

Declaration of funding

This study was funded by Novo Nordisk A/S, Bagsværd, Denmark.

M.P. and L.E.E. researched data and wrote, reviewed, edited and approved the manuscript. M.M.F. and L.M.S. contributed to the introduction and discussion and wrote, reviewed, edited and approved the manuscript. A.J.C., C.C., H.L.S., L.R. and W.C.H. contributed to discussion and wrote, reviewed, edited and approved the manuscript. All statistical analysis and writing was done by the named authors. Authors other than M.P. and L.E.E. are listed in alphabetical order in recognition of their equal participation as authors.

M.P. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Declaration of financial/other relationships

M.P. and L.E.E. have disclosed that they received funding for statistical analysis work on this paper. M.P. has disclosed that he received funding for his role as Principal Investigator of the DAWN2 study, and has recently received funding for research and/or consulting from: Bristol-Myers Squibb, Calibra, Genentech, Lilly, Novo Nordisk, and Tethys. He has received speaking honoraria and participated in advisory panels for Novo Nordisk. A.J.C., C.C. and W.C.H. have disclosed that they served on the Novo Nordisk Multicultural Advisory Board. A.J.C. has disclosed that he is also a member of a speaker’s bureau for Novo Nordisk, Merck, Janssen and Valeritas. C.C. has disclosed that he also serves as an advisory panel member for Eli Lilly, BMS/AZ and Janssen. M.M.F. has disclosed that she serves as an advisory panel member for Animas/Lifescan, Bayer Diagnostics, Bristol-Myers Squibb/AstraZeneca Diabetes, Eli Lilly, GlaxoSmithKline, Halozyne Therapeutics, Hygeia Inc., Johnson & Johnson and Omada Health. L.R. has disclosed that she is a consultant and faculty presenter for Johnson & Johnson Diabetes Institute (JJDI). L.M.S. and H.L.S. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.

CMRO peer reviewers on this manuscript have received an honorarium from CMRO for their review work. Peer reviewer 1 has disclosed that she has received sponsorship from Novo Nordisk for symposia attendance. Peer reviewer 2 has no relevant financial or other relationships to disclose.

Acknowledgments

The DAWN2 study is a global partnership of several organizations, including the International Diabetes Federation, the International Alliance of Patients’ Organizations, the Steno Diabetes Center, and Novo Nordisk. DAWN and DAWN2 are registered trademarks of Novo Nordisk. M.P. is the Principal Investigator for the DAWN2 study and for the USA DAWN2 study. The complete list of study collaborators is available at www.dawnstudy.com. For information about data access, contact [email protected].

Editorial and logistical support for the development of this manuscript was provided by Bioscript Medical, UK. Funding for this support was provided by Novo Nordisk Inc., Princeton, NJ, USA.

Notes

*DAWN2 is a registered trademark of Novo Nordisk