Erhardt Erik, Murray-Krezan Cristina, Regino Lidia, Perez Daniel, Bearer Elaine L, Page-Reeves Janet
Department of Mathematics and Statistics, University of New Mexico, 1 University of New Mexico, Albuquerque, NM, 87131, USA.
Department of Internal Medicine, University of New Mexico, 1 University of New Mexico, Albuquerque, NM, 87131, USA; Department of Medicine, University of Pittsburgh, 200 Meyran Ave., Suite 300, Pittsburgh, PA, 15213, USA.
Soc Sci Med. 2023 Mar;320:115713. doi: 10.1016/j.socscimed.2023.115713. Epub 2023 Jan 21.
Depression and diabetes are co-occurring epidemics. This article explores the association between depression and diabetes in a cohort of Latinx patients with diabetes from low-income households. Data were gathered in Albuquerque, New Mexico (U.S.) between 2016 and 2020 as part of a patient-engaged comparative effectiveness trial comparing two culturally appropriate diabetes self-management programs-the Chronic Care Model (CCM) and the standard of care, Diabetes Self-Management Support Empowerment Model (DSMS). We proposed that the program most culturally and contextually situated in the life of the patient would have the greatest impact on diabetes self-management. Participants were enrolled as dyads-226 Latinx diabetes patient participants (PPs) from low-income households and 226 social support participants (SSPs). Data gathered at baseline, 3, 6, and 12 months included a measure of depression and A1c testing. Outcomes between programs were analyzed using longitudinal linear mixed modeling, adjusted for patient demographic characteristics and other potential confounding covariates. Patient A1c had an initial slight decrease at 3 months in both programs. At CCM, patients with a very high A1c (greater than 10%) demonstrated a clinically meaningful decrease in A1c over time. Patients at CCM experienced a large initial decrease in depression and continued to decrease throughout the study, while patients at DSMS showed a slight initial decrease through 6 months, but depression increased again by 12 months, nearly rebounding to baseline levels. A subgroup analysis revealed that a higher baseline A1c was associated with higher depression, and patients with higher A1c achieved greater reductions in depression at CCM than at DSMS. CCM scored higher on Consumer Assessment of Healthcare Providers and Systems cultural competence (CAHPS-CC). Interpretation of results suggests that the more culturally, contextually situated program, CCM, had better outcomes. This study demonstrates that culturally and contextually situating a diabetes intervention can deliver improved benefits for Latinx patients.
抑郁症和糖尿病是同时出现的流行病。本文探讨了来自低收入家庭的拉丁裔糖尿病患者队列中抑郁症与糖尿病之间的关联。2016年至2020年期间，在美国新墨西哥州阿尔伯克基收集了数据，作为一项患者参与的比较有效性试验的一部分，该试验比较了两种符合文化背景的糖尿病自我管理项目——慢性病护理模式（CCM）和护理标准糖尿病自我管理支持赋权模式（DSMS）。我们提出，在患者生活中文化和背景适应性最强的项目对糖尿病自我管理的影响最大。参与者以二元组形式招募——226名来自低收入家庭的拉丁裔糖尿病患者参与者（PPs）和226名社会支持参与者（SSPs）。在基线、3个月、6个月和12个月收集的数据包括抑郁症测量和糖化血红蛋白（A1c）检测。使用纵向线性混合模型分析项目之间的结果，并根据患者人口统计学特征和其他潜在混杂协变量进行调整。两个项目中患者的A1c在3个月时最初都略有下降。在CCM项目中，糖化血红蛋白水平非常高（大于10%）的患者随着时间推移糖化血红蛋白水平出现了具有临床意义的下降。CCM项目的患者在抑郁症方面最初有大幅下降，并在整个研究过程中持续下降，而DSMS项目的患者在6个月内最初略有下降，但到12个月时抑郁症再次上升，几乎反弹至基线水平。亚组分析显示，较高的基线糖化血红蛋白与较高的抑郁症相关，并且糖化血红蛋白水平较高的患者在CCM项目中抑郁症的降低幅度大于DSMS项目。CCM在医疗服务提供者和系统文化能力消费者评估（CAHPS-CC）方面得分更高。结果解释表明，文化和背景适应性更强的项目CCM有更好的效果。这项研究表明，在文化和背景方面对糖尿病干预进行定位可以为拉丁裔患者带来更好的益处。
