Impact of Monthly A1C Values Obtained at Home on Glycemic Control in Patients With Type 2 Diabetes: A Randomized Clinical Trial.

The purpose of this randomized controlled clinical trial was to determine whether an A1C value obtained at home by participants followed by a phone discussion of the result with a clinician would lead to 1) a more rapid and significant decrease in A1C, 2) more effective advancement of diabetes treatment, and 3) improvement in diabetes self-care behaviors. The study included 307 participants with type 2 diabetes, most of whom were of Latino origin. All study participants experienced a statistically significant reduction in mean A1C (control subjects -0.3%, P = 0.04; intervention subjects -0.5%, P = 0.0002), but there was a statistically significant difference in the number of people who achieved a reduction of ≥0.5% by 6 months, favoring the intervention (33.6 vs. 46.7%, P = 0.05).

Association of Diabetic Retinopathy with Chronic Kidney Disease Progression in Latinos with Type 2 Diabetes.

Aims: Diabetes remains a leading cause of blindness and kidney failure in the United States. Latinos are at increased risk for type 2 diabetes, and microvascular complications such as diabetic retinopathy (DR) and chronic kidney disease (CKD). We evaluated the association of DR with decline in kidney function in Latinos with type 2 diabetes with or without CKD in a multispecialty clinic. Methods: This is a retrospective cohort study of 351 self-identified Latino individuals with type 2 diabetes enrolled in the Latino Diabetes Initiative at Joslin Diabetes Center. Baseline demographic factors including age, sex, comorbidities, and laboratory values such as A1c and albuminuria were evaluated as predictors of kidney outcomes. The annualized change in estimated glomerular filtration rate (eGFR) was evaluated with a linear regression model. We used logistic regression to evaluate whether DR was associated with development of rapid progressors (>3 mL/min/y eGFR loss) and 30% change in eGFR per year. Results: DR was present in 39.2% of the cohort with mild nonproliferative DR (NPDR) in 57.1%, moderate to severe NPDR in 27.8%, and proliferative DR in 15.0%. Those with DR had a longer duration of type 2 diabetes (P<.001), higher albuminuria (P=.003), and lower baseline eGFR (P=.001). We found that individuals with moderate to severe NPDR and proliferative DR had a significant decline in GFR (coefficient -6.32; 95% CI, -11.40 to -1.23) and -7.82 (-14.99 to -0.65), compared with individuals without DR. Conclusions: The presence of DR is a marker for increased eGFR loss, emphasizing the need for routine retinal examinations as part of comprehensive diabetes care. Individuals with DR should be considered at high risk for GFR loss.

Bodily aesthetic ideals among Latinas with type 2 diabetes: implications for treatment adherence, access, and outcomes.

PURPOSE: The purpose of this study was to examine how attitudes and practices related to bodily aesthetic ideals and self-care might inform the engagement of Latinas with type 2 diabetes (T2DM). METHODS: Focus groups were used to collect qualitative data concerning bodily aesthetic ideals and diabetes management, including help-seeking experiences, from Latina women with T2DM (n = 29) receiving care through Latino Diabetes Initiative at the Joslin Diabetes Center. Focus groups were conducted in Spanish, audiotaped, transcribed, and content analyzed. RESULTS: Four main themes emerged: (1) a preference among participants for a larger than average body size, although perceptions of attractiveness were more closely linked to grooming than body size; bodily dissatisfaction centered on diabetes-induced skin changes, virilization, and fatigue rather than weight; (2) diabetic complications, especially foot pain, as a major obstacle to exercise; (3) fatalistic attitudes regarding the inevitability of diabetes and reversal of its complications; and (4) social burdens, isolation, and financial stressors as contributing to disease exacerbation. CONCLUSIONS: Interventions that emphasize reduced body size may be less effective with Latinas who have T2DM than those that emphasize the benefits of exercise and weight loss for skin health, energy levels, and reduced virilization.

Food purchasing selection among low-income, Spanish-speaking Latinos.

BACKGROUND: In the U.S., poverty has been linked to both obesity and disease burden. Latinos in the U.S. are disproportionately affected by poverty, and over the past 10 years, the percentage of overweight U.S. Latino youth has approximately doubled. Buying low-cost food that is calorie-dense and filling has been linked to obesity. Low-income individuals tend to favor energy-dense foods because of their low cost, and economic decisions made during food purchasing have physiologic repercussions. Diets based on energy-dense foods tend to be high in processed staples, such as refined grains, added sugars, and added fats. These diets have been linked to a higher risk of obesity, type 2 diabetes, and cardiovascular disease. PURPOSE: This pilot study conducted ethnographic qualitative analyses combined with quantitative analyses to understand grocery shopping practices among 20 Spanish-speaking, low-income Latino families. The purpose was to analyze food selection practices in order to determine the effect of nutrition education on changes in shopping practices to later develop educational tools to promote selection of healthier food options. METHODS: Participants received tailored, interactive, nutrition education during three to five home visits and a supermarket tour. Grocery store receipts for grocery purchases collected at baseline and at the end of the project were analyzed for each family to extract nutritional content of purchased foods. Nutritional content was measured with these factors in mind: quantity, calories, fats, carbohydrates, fiber, protein, and percentage of sugary beverages and processed food. Data were collected in 2010-2011 and analyzed in 2011-2012. RESULTS: After receiving between three and five home-based nutrition education sessions and a supermarket tour over a 6-month period, many families adopted instructions on buying budget-friendly, healthier alternative foods. Findings indicate that participating families decreased the total number of calories and calories per dollar purchased from baseline to post-education (median total calories: baseline, 20,191; post-education, 15,991, p=0.008); median calories per dollar: baseline, 404; post-education, 320, p=0.008). The median grams of carbohydrates per dollar (baseline, 66, post-education, 45) and median calories from processed food (baseline, 11,000, post-education, 7845) were not reduced (p=0.06). CONCLUSIONS: This pilot study demonstrated that grocery shopping practices are an important factor to address in nutrition education among Spanish-speaking, low-income individuals, and that there may be ways to encourage low-income, Latino families to purchase healthier foods. Findings challenged arguments suggesting that such an approach is not possible because of the high cost of healthier foods.

Cultural approaches to diabetes self-management programs for the Latino community.

The issue of diabetes within the Latino population of the United States is of such magnitude that reviewing previously published studies on culturally oriented diabetes self-management interventions is imperative to further understanding and progress on this matter. The purpose of this revision is to illustrate what has been accomplished to date, analyze the lessons learned, and restate the importance of developing culturally relevant interventions for vulnerable populations.