Williams Myia S, Cigaran Edgardo, Martinez Sabrina, Marino Jose, Barbero Paulina, Myers Alyson K, DiClemente Ralph J, Goris Nicole, Gomez Valeria Correa, Granville Dilcia, Guzman Josephine, Harris Yael T, Kline Myriam, Lesser Martin L, Makaryus Amgad N, Murray Lawrence M, McFarlane Samy I, Patel Vidhi H, Polo Jennifer, Zeltser Roman, Pekmezaris Renee
Department of Medicine, Division of Health Services Research, Northwell Health, Manhasset, NY, United States.
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.
Front Clin Diabetes Healthc. 2023 Apr 28;4:1070547. doi: 10.3389/fcdhc.2023.1070547. eCollection 2023.
During the early stages of the COVID-19 pandemic, nationwide lockdowns caused disruption in the diets, physical activities, and lifestyles of patients with type 2 diabetes. Previous reports on the possible association between race/ethnicity, COVID-19, and mortality have shown that Hispanic/Latino patients with type 2 diabetes who are socioeconomically disadvantaged are disproportionately affected by this novel virus. The aim of this study was to explore stressors associated with changes in diabetes self-management behaviors. Our goal was to highlight the health disparities in these vulnerable racial/ethnic minority communities and underscore the need for effective interventions.
Participants were enrolled in part of a larger randomized controlled trial to compare diabetes telehealth management (DTM) with comprehensive outpatient management (COM) in terms of critical patient-centered outcomes among Hispanic/Latino patients with type 2 diabetes. We conducted a thematic analysis using patient notes collected from two research nurses between March 2020 and March 2021. Two authors read through the transcripts independently to identify overarching themes. Once the themes had been identified, both authors convened to compare themes and ensure that similar themes were identified within the transcripts. Any discrepancies were discussed by the larger study team until a consensus was reached.
Six themes emerged, each of which can be categorized as either a source or an outcome of stress. Sources of stress associated with the COVID-19 pandemic were (1) fear of contracting COVID-19, (2) disruptions from lockdowns, and (3) financial stressors (e.g., loss of income). Outcomes of COVID-19 stressors were (1) reduced diabetes management (e.g., reduced diabetes monitoring and physical activity), (2) suboptimal mental health outcomes (e.g., anxiety and depression), and (3) outcomes of financial stressors.
The findings indicated that underserved Hispanic/Latino patients with type 2 diabetes encountered a number of stressors that led to the deterioration of diabetes self-management behaviors during the pandemic.
在新冠疫情早期，全国范围的封锁导致2型糖尿病患者的饮食、身体活动及生活方式受到干扰。先前关于种族/民族、新冠疫情与死亡率之间可能存在的关联的报告显示，社会经济地位不利的西班牙裔/拉丁裔2型糖尿病患者受这种新型病毒的影响尤为严重。本研究的目的是探索与糖尿病自我管理行为变化相关的压力源。我们的目标是突出这些脆弱的种族/少数民族社区中的健康差异，并强调有效干预措施的必要性。
参与者是一项更大规模随机对照试验的一部分，该试验旨在比较糖尿病远程医疗管理（DTM）与综合门诊管理（COM）在以患者为中心的关键结局方面对西班牙裔/拉丁裔2型糖尿病患者的影响。我们使用2020年3月至2021年3月期间从两名研究护士收集的患者记录进行了主题分析。两位作者独立阅读转录本以确定总体主题。一旦确定了主题，两位作者就会召集会议比较主题，并确保在转录本中识别出相似的主题。任何差异都由更大的研究团队进行讨论，直到达成共识。
出现了六个主题，每个主题都可归类为压力的来源或结果。与新冠疫情相关的压力来源包括：（1）对感染新冠病毒的恐惧；（2）封锁造成的干扰；（3）经济压力源（如收入损失）。新冠疫情压力源的结果包括：（1）糖尿病管理减少（如糖尿病监测和身体活动减少）；（2）心理健康状况不佳（如焦虑和抑郁）；（3）经济压力源的结果。
研究结果表明，在疫情期间，服务不足的西班牙裔/拉丁裔2型糖尿病患者遇到了许多压力源，这些压力源导致了糖尿病自我管理行为的恶化。
