Ethnic differences in family member diabetes involvement and psychological outcomes: results from the second Diabetes Attitudes, Wishes and Needs (DAWN2) study in the USA

Abstract

Objective:

To assess differences among USA ethnic groups in psychological status of adult family members (FMs) and their involvement with the diabetes of another adult.

Research methods:

Data are from the FM survey of the USA DAWN2 study, including 105 White non-Hispanics, 47 African Americans, 46 Hispanic Americans and 40 Chinese Americans. All FMs lived with and cared for an adult with diabetes. Analysis of covariance controlled for respondent and patient characteristics to assess ethnic group differences (P < 0.05). Multiple regression analyses identified significant (P < 0.05) independent correlates of psychological outcomes.

Main outcome measures:

FM psychological outcomes measured include well-being, quality of life (QoL), impact of diabetes on life domains, diabetes distress, and burden.

Clinical trial registration:

NCT01507116.

Results:

White non-Hispanics reported less diabetes burden and distress, more negative life impact, and lower well-being than FMs from ethnic minority groups. African Americans reported the highest well-being and lowest negative life impact, Chinese Americans reported the most diabetes burden, Hispanic Americans reported the highest distress. There were no ethnic group differences in QoL. Ethnic minority FMs reported having more involvement with diabetes, greater support success, and more access to a diabetes support network than White non-Hispanics. Higher FM diabetes involvement was associated with negative psychological outcomes, while diabetes education, support success and diabetes support network size were associated with better psychological outcomes. Potential limitations are the sample sizes and representativeness.

Conclusions:

Minority ethnic FMs experienced both advantages and disadvantages in psychological outcomes relative to each other and to White non-Hispanics. Ethnic minority FMs had more involvement in diabetes care, support success and support from others, with the first associated with worse and the latter two with better psychological outcomes. Additional studies are needed with larger samples and broader representation of ethnic groups to better understand these associations and identify areas for intervention.

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. 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: AstraZeneca, Bristol-Myers Squibb, Calibra, and Novo Nordisk. He has received speaking honoraria and participated in advisory panels for Eli Lilly, GlaxoSmithKline, and Novo Nordisk. 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. W.C.H. has disclosed that he has served on the Novo Nordisk Multicultural Advisory Board. L.R. has disclosed that she is a 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 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.

Anthony Cannon of The Institute for Public Health and Education Research, New Braunfels, TX, USA; Carlos Campos of Sleep & Wellness Medical Associates, Hamilton, NJ, USA; Antonio Nicolucci of Consorzio Mario Negri Sud, Santa Maria Imbaro, Chieti, Italy; and Katharina Kovacs Burns of Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, Canada provided in-depth reviews of the manuscript.