Environmental influences on adherence to self-management behaviors and glycemic control in African American patients with type 2 diabetes mellitus

Abstract

Diabetes mellitus is a chronic illness effecting approximately 20.8 million individuals in the United States. Minorities are adversely affected, with age-adjusted prevalence 1.7 times higher in African Americans than Caucasians. Type 2 diabetes is significantly affected by behavioral and environmental risk factors, including the presence of co-occurring diseases (i.e., hypertension, hyperlipidemia), obesity, age, and lack of physical activity, and each of these risk factors is more prevalent among African Americans. The treatment of diabetes is largely self-managed, with patients and their families handling 95% of their own care. Adherence to the multi-component diabetic treatment regimen requires daily care, often occurring in more than one environment. While many studies have attempted to address the impact of social support on the self-management behavior of diabetics, few have tried to assess both intra-individual and environmental influences of support on the adherence. There is a paucity of research concerning the diabetic self-care treatment regimen and social support in an African American population, or addressing the disproportionate effect of environmental influences on African Americans. The current study sought to address this gap in the literature by using the Chronic Illness Resources Survey, a measure of multilevel support resources, to assess environmental influences of social support on African American patients’ adherence to self-management behaviors. The current study also sought to address common methodological concerns, including the addition of glycemic control (HbA1c) as an outcome measure and control for social desirability.