San Diego State University/University of California, San Diego, CA 92123, USA.
Health Psychol. 2011 May;30(3):251-8. doi: 10.1037/a0022850.
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.
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.
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).
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.
尽管需要积极的糖尿病自我管理来实现血糖控制，但少数民族，尤其是拉丁裔人群的依从性较差。研究表明，报告疾病管理方面有更多社会环境支持资源的个体比支持资源较少的个体更有效地管理他们的糖尿病。
路径分析用于调查疾病管理支持资源对血红蛋白 A1c（HbA1c）水平的影响，该分析基于从圣地亚哥县服务于低收入人群的社区诊所招募的 208 名 2 型糖尿病拉丁裔患者样本。我们假设疾病管理支持资源与 HbA1c 之间的关系将通过糖尿病自我管理和/或抑郁来介导。
感知到更多疾病管理支持资源的参与者报告了更好的糖尿病自我管理（β=.40，p <.001）和更少的抑郁（β= -.19，p <.01）。反过来，更好的糖尿病自我管理和更少的抑郁与更严格的血糖控制相关（HbA1c；β= -.17，p <.05 和β=.15，p <.05）。一旦通过糖尿病自我管理（95%CI[-.25;-.03]）和抑郁（95%CI[-.14;-.01]）的间接效应在统计学上得到控制，支持资源与 HbA1c 之间的直接途径明显减少（p=.57）。
这些发现表明，疾病管理支持资源与拉丁裔人群的糖尿病自我管理、情绪健康和血糖控制之间存在重要联系。因此，针对该人群的糖尿病自我管理和血糖控制的项目应考虑与文化相关的、多层次的健康结果影响因素。
