Glycemic control among Latinos with type 2 diabetes: the role of social-environmental support resources

Abstract

Objective: Although active diabetes self-management is required to achieve glycemic control, adherence is poor among ethnic minorities, especially Latinos. Research shows that individuals who report greater social-environmental support resources for disease management manage their diabetes more effectively than those with fewer support resources.

Methods: Path analysis was conducted to investigate the value of a multiple-mediator model in explaining how support resources for disease management influence hemoglobin A1c (HbA1c) levels in a sample of 208 Latinos with Type 2 diabetes recruited from low-income serving community clinics in San Diego County. We hypothesized that the relationship between support resources for disease-management and HbA1c would be mediated by diabetes self-management and/or depression.

Results: Participants who perceived greater support resources for disease-management reported better diabetes self-management (β = .40, p < .001) and less depression (β = -.19, p < .01). In turn, better diabetes self-management and less depression were associated with tighter glycemic control (HbA1c; β = -.17, p < .05 and β = .15, p < .05, respectively). Once the indirect effects via diabetes self-management (95% CI [-.25; -.03]) and depression (95% CI [-.14; -.01]) were statistically controlled, the direct pathway from support resources to HbA1c was markedly reduced (p = .57).

Conclusions: These findings demonstrate the important connection that support resources for disease management can have with diabetes self-management, emotional well-being, and glycemic control among Latinos. Thus, programs targeting diabetes self-management and glycemic control in this population should consider culturally relevant, multilevel influences on health outcomes.

Figure 1

Multiple mediator model, including all possible indirect pathways from support resources for disease management to HbA1c. Arrow A depicts the direct pathway from support resources for disease management to HbA1c. Arrows B and C represent a potential indirect pathway from support resources for disease management to HbA1c via diabetes self-management. Arrows D and E show that depression may partially account for the relationship between support resources for disease management and HbA1c. Arrows B, F, and E represent a double-mediator pathway from support resources for disease management to HbA1c, via both diabetes self-management and depression.

Figure 2

Results of simple mediation models indicating diabetes self-management (a) and depression (b) as partial mediators of the relationship between support resources for disease management and HbA1c. c = direct relationship between support resources for disease management and HbA1c. c′ = direct relationship between support resources for disease management and HbA1c, after controlling for the proposed mediator. (c) Results of path analysis evaluating the revised model (pathway from depression to self-management removed). Age, gender, and educational attainment were included as covariates in all analyses. Standardized path coefficients are presented. *p < .05. **p < .01. *** p < .001.