Racial differences in diabetes-related psychosocial factors and glycemic control in patients with type 2 diabetes

Figures & data

Table 1 Summary of psychosocial measures

Variable	Description	Measurement tool	# of items	Possible range	Cronbach’s alpha
Access to illness-management resources	Support (eg, informational or emotional) for the management of chronic illness available from one’s physician/health care team, family/friends, personal actions, neighborhood, community, media/policy, community organizations, and workplace	CIRS^Citation65	64	1–5	0.91
Interference of diabetes with daily life	Interference caused by diabetes to daily activities, work, and social/recreational activities	MDQ Subscale^Citation45	9	0–6	0.93
Perceived severity of diabetes	Extent to which diabetes is a severe health problem and causes concern/worry	MDQ Subscale^Citation45	3	0–6	0.87
Perceived diabetes-related social support	Social support received from significant others, family, friends, and health professionals	MDQ Subscale^Citation45	4	0–6	0.74
Positive reinforcing behaviors	Reinforcement received from significant others for engaging in desirable self-management behaviors	MDQ Subscale^Citation45	8	0–6	0.91
Misguided support behaviors	Nonsupportive behaviors by significant others to encourage self-management behaviors (eg, nagging)	MDQ Subscale^Citation45	4	0–6	0.82
Self efficacy in diabetes self management	Confidence in ability to perform desirable self-management behaviors	MDQ Subscale^Citation45	7	0–100	0.91
Outcome expectancies for self-care behaviors	Perceptions of the effects of desirable self-management behaviors on metabolic control and prevention of complications	MDQ Subscale^Citation45	6	0–100	0.88
Diabetes-related emotional distress	Emotional responses to issues unique to living with diabetes	PAID^Citation66	20	0–100	0.94

Abbreviations: CIRS, Chronic Illness Resources Survey; MDQ, Multidimensional Diabetes Questionnaire; PAID, Problem Areas in Diabetes Scale.

Table 2 Demographic and clinical characteristics of white and African American adults with type 2 diabetes

	Non-hispanic white (n = 203)		African American (n = 79)		Pa
Age (mean ± SD)	57.3	± 11.1	51.1	±8.9	0.001
Years of formal education	15.0	± 3.0	13.4	±2.4	0.0001
Body mass index	34.6	±7.0	35.3	±9.5	0.55
Caloric expenditure/week	3354.8	± 2612.9	4228.3	±3175.5	0.03
Comorbidity disease index	3.9	± 2.1	3.3	±2.0	0.02
Beck’s depression index	0.5	± 0.4	0.6	±0.5	0.08
Women (n %)	126	62.7%	63	79.8%	0.006
Income					0.0001
Less than $20,000	38	19.5%	40	51.3%
$20,000–$50,000	87	44.6%	23	29.5%
Greater than $50,000	70	35.9%	15	19.2%
Employment status					0.34
Employed	122	60.7%	43	54.4%
Not employed	79	39.3%	36	45.6%
Health insurance status					0.91
Insured	190	94.5%	74	94.9%
Not insured	11	5.5%	4	5.1%
Medication regimen					0.28
Includes insulin	37	19.4%	19	25.3%
Does not include insulin	154	80.6%	56	74.7%

Notes:

a Comparisons between white and African American participants were made using t-tests (or non-parametric equivalent) for means and χ² tests for frequencies.

Table 3 Psychosocial characteristics (mean ± SD) of white and African American patients with type 2 diabetes

	Non-hispanic white		African American		Pa
Access to illness-management resources	2.5	± 0.5	2.8	± 0.6	0.0005
Interference of diabetes with daily life	1.3	± 1.3	1.7	± 1.4	0.01
Perceived severity of diabetes	3.3	± 1.7	3.8	± 1.8	0.04
Perceived diabetes-related social support	3.2	± 1.5	3.6	± 1.4	0.047
Positive reinforcing behaviors	2.1	± 1.6	2.5	± 1.9	0.16
Misguided support behaviors	1.9	± 1.7	2.4	± 2.0	0.17
Self-efficacy in diabetes self-management	40.7	± 20.0	38.1	± 19.5	0.35
Outcome expectancies for self-care behaviors	61.4	± 7.9	59.9	± 12.1	0.31
Diabetes-related emotional distress	33.4	± 20.8	40.1	± 22.9	0.02

Notes:

a Comparisons between white and African American participants were made using t-tests (or nonparametric equivalent).

Table 4 Multiple linear regression models examining the association of race with HbA_1c after adjusting for demographic, clinical, and diabetes-related psychosocial factors that differ by race

Variables	Model 1: race				Model 2: model 1 + demographic and clinical factors				Model 3: model 2 + diabetes-related psychosocial factors
	B	SE	Beta	P	B	SE	Beta	P	B	SE	Beta	P
African American	0.73	0.26	0.17	<0.01	0.69	0.30	0.15	0.02	0.82	0.31	0.18	<0.01
Age					−0.008	0.01	−0.05	0.50	0.005	0.01	0.03	0.68
Years of formal education					−0.0003	0.04	−0.0004	1.00	0.01	0.04	0.02	0.81
Caloric expenditure/week (Kcal)					−0.09	0.04	−0.13	0.04	−0.06	0.05	−0.08	0.22
Comorbidity disease index					−0.13	0.06	−0.14	0.04	−0.16	0.07	−0.17	<0.01
Beck’s depression index					0.67	0.30	0.15	0.03	0.13	0.35	0.03	0.71
Women					−0.19	0.27	−0.05	0.47	−0.22	0.28	−0.05	0.42
Income								0.45				0.54
$20,000–$50,000					0.41	0.31	0.10	0.19	0.31	0.31	0.07	0.32
Greater than $50,000					0.28	0.34	0.06	0.41	0.07	0.34	0.02	0.84
Access to illness-management resources									−0.95	0.30	−0.25	<0.01
Interference of diabetes with daily life									0.02	0.12	0.01	0.87
Perceived severity of diabetes									0.25	0.10	0.21	0.02
Perceived diabetes-related social support									0.08	0.10	0.06	0.44
Diabetes-related emotional distress									−0.0008	0.009	−0.008	0.93

Abbreviations: B, unstandardized regression coefficient; SE, standard error; Beta, standardized regression coefficient.

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