Social Support or Diabetes Distress—What Relates More Closely to Diabetes Self-Management in Hispanics?

Abstract

Adherence to recommended self-management behaviors is particularly poor among Hispanics with type 2 diabetes (T2D), which increases risk for developing serious complications. In addition to minority status, research has also shown diabetes distress to predict poorer diabetes self-management. In contrast, social-environmental support for disease management has emerged as a potential protective factor, given associations of greater support with better diabetes self-care. This study aimed to compare the relative associations of support [Chronic Illness Resource Survey] and diabetes distress [Diabetes Distress Scale] with diabetes self-management [Summary of Diabetes Self-Care Activities]. A cross-sectional baseline analysis of N=126 Hispanic adults with poorly controlled T2D (HbA1c ≥ 7.5%) at federally-qualified health centers in Southern California was performed. When examined separately, lower diabetes distress (rs = -.26 and -.18) and higher support (rs = .49 and .22) were both significantly associated with better diet and exercise, respectively (ps < .05). However, when entered in joint linear regression models, only support remained a statistically significant predictor of diet (β = 0.46) and exercise (β = 0.18), ps < .05. The associations of diabetes distress with self-management behaviors decreased in magnitude by 30-58% after control for support, and were no longer statistically significant. While diabetes distress certainly impacts self-management behaviors, these findings indicate that support may be a relatively stronger correlate in this population - perhaps due to the emphasis the Hispanic culture places on interpersonal relationships. Findings point to social-environmental support for disease management (not just distress) as an important target for diabetes self-management interventions. However, further longitudinal research is needed to fully disentangle the associations among distress, support, and self-management behaviors. Disclosure T. Clark: None. J.A. Euyoque: None. A. Philis-Tsimikas: Research Support; Self; Dexcom, Inc.. Advisory Panel; Self; Dexcom, Inc., Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk A/S, Sanofi. Research Support; Self; Novo Nordisk A/S, Sanofi, Mylan. Stock/Shareholder; Spouse/Partner; Novo Nordisk A/S. Employee; Spouse/Partner; Ionis Pharmaceuticals, Inc.. Stock/Shareholder; Spouse/Partner; Esperion Therapeutics, Ionis Pharmaceuticals, Inc.. Advisory Panel; Self; AstraZeneca. L. Gallo: None. A.L. Fortmann: None.