Disease-related emotional distress of Hispanic and non-Hispanic type 2 diabetes patients.

BACKGROUND: Diabetes is a serious chronic illness that disproportionately affects prevalence and comorbidity rates among Hispanic populations. Little comparative research has been conducted on the emotional distress experienced by Hispanic patients living with type 2 diabetes. PURPOSE: [corrected] To conduct a psychometric examination of an established measure of emotional distress specific to diabetes and to use this tool to examine levels and predictors of distress in a comparative study of Hispanic and non-Hispanic type 2 diabetes patients. METHOD: Psychometric analyses were conducted (skewness, kurtosis, differential item function (DIF), confirmatory factor analysis (CFA), internal consistency reliability) to examine the equivalence of U.S. English and U.S. Spanish language versions of a measure of diabetes-related distress (Problem Areas in Diabetes (PAID). Regression modeling was used to evaluate differences in distress by ethnic group, after adjusting for blood glucose control, sex, age, education, physical functioning, mental health functioning, and spirituality. Psychometric results showed that PAID had high reliability (alpha = 0.96). Skewness, kurtosis, and DIF were not present. CFA identified a large general factor, supporting use of the total PAID score. Univariate analyses found a significantly higher mean PAID score for Hispanic patients compared to non-Hispanic (45.9 +/- 28.5 vs. 35.9 +/- 26.4). A final regression model based on age, physical functioning, and mental functioning accounted for approximately 50% of PAID variance. CONCLUSION: Our findings supported the reliability and unidimensionality of the U.S. Spanish and U.S. English PAID versions for comparative research. Compared to non-Hispanic patients, Hispanic patients reported higher distress, which was substantially predicted from age and physical and mental functioning.

An internet-based diabetes management platform improves team care and outcomes in an urban Latino population.

OBJECTIVE: To compare usual diabetes care (UDC) to a comprehensive diabetes care intervention condition (IC) involving an Internet-based "diabetes dashboard" management tool used by clinicians. RESEARCH DESIGN AND METHODS: We used a parallel-group randomized design. Diabetes nurses, diabetes dietitians, and providers used the diabetes dashboard as a clinical decision support system to deliver a five-visit, 6-month intervention to 199 poorly controlled (HbA1c >7.5% [58 mmol/mol]) Latino type 2 diabetic (T2D) patients (mean age 55 years, 60% female) at urban community health centers. We compared this intervention to an established, in-house UDC program (n = 200) for its impact on blood glucose control and psychosocial outcomes. RESULTS: Recruitment and retention rates were 79.0 and 88.5%, respectively. Compared with UDC, more IC patients reached HbA1c targets of <7% (53 mmol/mol; 15.8 vs. 7.0%, respectively, P < 0.01) and <8% (64 mmol/mol; 45.2 vs. 25.3%, respectively, P < 0.001). In multiple linear regression adjusting for baseline HbA1c, adjusted mean ± SE HbA1c at follow-up was significantly lower in the IC compared with the UDC group (P < 0.001; IC 8.4 ± 0.10%; UDC 9.2 ± 0.10%). The results showed lower diabetes distress at follow-up for IC patients (40.4 ± 2.1) as compared with UDC patients (48.3 ± 2.0) (P < 0.01), and also lower social distress (32.2 ± 1.3 vs. 27.2 ± 1.4, P < 0.01). There was a similar, statistically significant (P < 0.01) improvement for both groups in the proportion of patients moving from depressed status at baseline to nondepressed at follow-up (41.8 vs. 40%; no significance between groups). CONCLUSIONS: The diabetes dashboard intervention significantly improved diabetes-related outcomes among Latinos with poorly controlled T2D compared with a similar diabetes team condition without access to the diabetes dashboard.