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Scholarly Works (8 results)

  • Thesis
  • Peer Reviewed
UC San Francisco Electronic Theses and Dissertations (2009)

Factors Associated with Insulin Reluctance in Individuals with Type 2 Diabetes

by

Soohyun Nam, RN, MSN, ANP

ABSTRACT

Background: There are many barriers to effective diabetes management for people with type 2 diabetes (T2D) and clinicians. Patients' reluctance to start insulin therapy is one of the barriers to effective management that may be influenced by patients' sociodemographic and psychosocial factors. Significant delay in starting insulin may increase complications and impair patients' quality of life. Little is known about insulin reluctance (IR) and its relationship with associated factors.

Purpose: 1) Summarize existing knowledge regarding various barriers to diabetes management from the perspectives of both patients and clinicians; 2) investigate the concept of IR, resistance to using insulin therapy, by describing patients' perceived barriers and their relationships with associated factors; and 3) examine the effectiveness of culturally competent diabetes education (CCDE) among ethnic minorities with T2D.

Methods: The first paper was a literature review regarding various barriers to diabetes management. The second study was a cross-sectional descriptive study. Data were collected from 178 people with T2D, who were 18 years or older, being treated with diabetic oral agents and able to speak English. The participants from general medicine practice clinics completed validated measures: Diabetes Attitude Scale, Diabetes Knowledge Test, Diabetes Self-efficacy Scale, Interpersonal processes of Care and Barriers to Insulin Treatment. Biomedical data were obtained from medical record reviews. The third study was a meta-analysis to evaluate the effectiveness of CCDE for ethnic minorities with T2D.

Findings: The first paper revealed that patients' adherence, attitude, knowledge about diabetes, culture, language capability, financial resources, comorbidity and social support may affect diabetes management. Clinician barriers to following treatment guidelines include beliefs, attitudes and knowledge, patient-clinician interaction and communication, and the health care system. The second study demonstrated that people with T2D had moderate IR. Fear of hypoglycemia was the strongest barrier to insulin treatment. Women were more reluctant to use insulin than men. Ethnic minorities had more psychological barriers to insulin treatment than whites. Greater diabetes self-efficacy scores predicted significantly less IR and better perceived interaction with the clinician may reduce IR. The third study showed that CCDE appears to be effective in improving glycemic control for ethnic minorities.

Word Count: 347

    Cover page: Factors Associated with Insulin Reluctance in Individuals with Type 2 Diabetes
    • Thesis
    • Peer Reviewed
    UC San Francisco Electronic Theses and Dissertations (2015)

    The Diabetes Prevention Program (DPP) trial demonstrated that lifestyle interventions could reduce the incidence of type 2 diabetes mellitus (T2DM) in adults at high-risk. Only a small percentage of adults at high-risk are aware of their T2DM risk status and implementation of lifestyle interventions modeled on the DPP intervention has not been achieved.

    The aims of the research presented in these three manuscripts address areas of needed action and research to speed up primary prevention efforts recommended by a Centers for Disease Control and Prevention, Division of Diabetes Translation advisory group: the need to effectively communicate T2DM risk, use mobile interactive technologies, and focus on vulnerable populations disproportionately impacted by T2DM.

    The first two manuscripts describe a 2-phase clinical research project in a sample of foreign-born Latino adults living in California and speaking predominately Spanish at home to describe risk perceptions of developing diabetes and associated risk factors. A new Spanish-language adaptation of a published risk perception questionnaire was developed and tested. The results supported validity and reliability of the instrument and validation of inferences in Latino, foreign-born, Spanish-speaking at-risk populations. Of the 135 participants with complete data, 31% had higher risk perceptions of developing diabetes. In univariate logistic regression analyses, 9 of 18 potential variables tested were significant predictors of risk perception of developing diabetes. In the multiple logistic regression model, 5 variables were significant predictors of risk perception: optimistic bias, worry, perceived personal disease risk, educational attainment of high school graduate, and history of gestational diabetes. The results contribute to knowledge of risk perception of developing T2DM in this at-risk population and suggest further need for culturally accessible T2DM primary prevention research.

    The final manuscript presents the results of a systematic review of DPP modeled T2DM preventive lifestyle interventions delivered via distance learning technologies. The evidence of efficacy is mixed and inconclusive due to heterogeneity of study designs, lack of targeted participant samples, variable intervention components, and inconsistent measures of weight loss outcome. Further, ethnic/racial minority groups were underrepresented in the samples. No trials tested Spanish-language interventions delivered via distance learning technologies and none tested mobile interventions.

      Cover page: Risk perception of developing diabetes among Spanish-speaking foreign-born Latinos
      • Thesis
      • Peer Reviewed
      UC San Francisco Electronic Theses and Dissertations (2009)

      Mexican Americans have a high prevalence of type 2 diabetes. Among the

      elderly, hearing loss is also a significant chronic condition. Understanding of the

      co-occurrence of these conditions is important for planning screening,

      intervention and support for a vulnerable population. Aims: The objective of this

      study was to test a model of predictors of hearing loss in type 2 diabetes. The

      model tested was developed through a process of answering several research

      questions in a two part analysis. Part 1 of the analysis explored the relationship

      between hearing loss and type 2 diabetes in an existing sample of Mexican

      Americans (N=990) from the greater Sacramento area of California. Additional

      analysis in Part 2 was focused on predictors of high frequency hearing loss in

      diabetes in the sub-cohort of participants with type 2 diabetes (n=405). Methods:

      A cross-sectional subset of data from the Sacramento Area Latino Study on

      Aging (SALSA) was analyzed to meet the study aims. Analysis included

      correlations, non-parametric testing, and logistic regression models. Results:

      High frequency hearing loss in the worse ear was significantly more prevalent in

      those with diabetes. In logistic regression modeling, age and gender were

      significant predictors of hearing loss but diabetes was only significantly related to

      hearing loss in the worse ear. This effect was found to be explained by females

      in the sample as it was not significant for males on gender-specific analysis.

      Analysis of participants with diabetes revealed that age, gender, and pesticides

      use predicted high frequency hearing loss in the worse ear while age, gender

      and two diabetes symptom factors relating to energy/fatigue and

      cardiac/pulmonary symptoms were predictors in the better ear. There was an

      interaction effect between diabetes and pesticides use that suggests a need for

      further study to determine if diabetes makes an individual more vulnerable to the

      negative effects of pesticides. The results provided partial support for the

      conceptual model developed for the study and suggested directions for future

      research on hearing loss in individuals with diabetes.

        Cover page: Type 2 diabetes, hearing loss, and contributors to hearing loss in older Mexican Americans
        • Article
        • Peer Reviewed
        UC San Francisco Previously Published Works (2017)

        Objective

        To compare leukocyte telomere length (LTL) by race and describe demographic, health, and psychosocial factors associated with LTL in postmenopausal women.

        Design

        Descriptive study with comparative analyses and correlations.

        Setting

        Data were collected at the University of California-San Francisco, San Francisco Clinical and Translational Science Institute.

        Participants

        Thirty-nine African American and White postmenopausal women between 58 and 65 years of age (mean age = 61.3 ± 1.83 years).

        Methods

        Measures included demographics, blood pressure, anthropometrics, scores on the Perceived Stress Scale and the Center for Epidemiologic Studies-Depression, and blood samples for LTL.

        Results

        African American women (n = 14) had greater PSS-10 and CES-D scores, greater blood pressure, and greater body mass index than White women (n = 25; p < .05), but LTL did not significantly differ between the two groups. Age was inversely related to LTL (r = -.355, p < .05). After age and race were controlled, fewer children (p = .005) and greater perceived stress (p = .036) were related to shorter LTL.

        Conclusion

        Findings from this small sample support the association between age and LTL. The association between perceived stress, number of children, and shorter LTL in postmenopausal women requires further research and replication of findings in a larger, more diverse sample.
          Cover page: Leukocyte Telomere Length in Postmenopausal Women
          • Article
          • Peer Reviewed
          UC San Francisco Previously Published Works (2016)

          Background and purpose

          Create a Spanish-language version of the Risk Perception Survey for Developing Diabetes (RPS-DD) and assess psychometric properties.

          Research design and methods

          The Spanish-language version was created through translation, harmonization, and presentation to the tool's original author. It was field tested in a foreignborn Latino sample and properties evaluated in principal components analysis.

          Results

          Personal Control, Optimistic Bias, and Worry multi-item Likert subscale responses did not cluster together. A clean solution was obtained after removing two Personal Control subscale items. Neither the Personal Disease Risk scale nor the Environmental Health Risk scale responses loaded onto single factors. Reliabilities ranged from .54 to .88. Test of knowledge performance varied by item.

          Conclusions

          This study contributes to evidence of validation of a Spanish-language RPS-DD in foreign-born Latinos.
            Cover page: A Spanish-Language Risk Perception Survey for Developing Diabetes: Translation Process and Assessment of Psychometric Properties.
            • Article
            • Peer Reviewed
            UC San Francisco Previously Published Works (2017)

            Context

            Patients with breast cancer receiving chemotherapy (CTX) experience multiple concurrent symptoms, but little is known about how symptoms change during and after treatment. Knowledge of the identity and trajectory of symptom clusters (SCs) would enhance measurement and management.

            Objectives

            We aimed to identify SCs and their change over time from baseline to completion of breast cancer CTX.

            Methods

            SCs were identified and assessed for change in 219 women from Nebraska at four times: baseline, during cycles #3 and #4 of CTX, and one month after finishing CTX. Ten symptoms were measured: two using the Hospital Anxiety and Depression Scale and eight using the Symptom Experience Scale. Exploratory factor analysis was conducted at each time point, then changes in SCs were evaluated at different times.

            Results

            Two SCs were identified before and after initiating CTX: gastrointestinal and treatment-related. The number and type of symptoms in each cluster differed over time. Clusters were dynamic during CTX with changes in the number and type of symptoms. Only one treatment-related SC, which consisted of fatigue, pain, and sleep disturbance, was identified after CTX completion.

            Conclusion

            SCs during CTX appear to be dynamic, changing over time from before until after CTX completion. Repeated assessments of SCs reveal symptoms that are present and when patients are most burdened and in need of additional support.
              Cover page: Symptom Clusters Change Over Time in Women Receiving Adjuvant Chemotherapy for Breast Cancer.
              • Article
              • Peer Reviewed
              UC San Francisco Previously Published Works (2015)
              The HITECH Act signed into law in 2009 requires hospitals to provide patients with electronic access to their health information through an electronic personal health record (ePHR) in order to receive Medicare/Medicaid incentive payments. Little is known about who uses these systems or the impact these systems will have on patient outcomes in HIV care. The health care empowerment model provides rationale for the hypothesis that knowledge from an electronic personal health record can lead to greater patient empowerment resulting in improved outcomes. The objective was to determine the patient characteristics and patient activation, empowerment, satisfaction, knowledge of their CD4, Viral Loads, and antiretroviral medication, and medication adherence outcomes associated with electronic personal health record use in Veterans living with HIV at the San Francisco VA Medical Center. The participants included HIV-Infected Veterans receiving care in a low volume HIV-clinic at the San Francisco VA Medical Center, divided into two groups of users and non-users of electronic personal health records. The research was conducted using in-person surveys either online or on paper and data abstraction from medical records for current anti-retroviral therapy (ART), CD4 count, and plasma HIV-1 viral load. The measures included the Patient Activation Measure, Health Care Empowerment Inventory, ART adherence, provider satisfaction, current CD4 count, current plasma viral load, knowledge of current ART, knowledge of CD4 counts, and knowledge of viral load. In all, 40 participants were recruited. The use of electronic personal health records was associated with significantly higher levels of patient activation and levels of patient satisfaction for getting timely appointments, care, and information. ePHR was also associated with greater proportions of undetectable plasma HIV-1 viral loads, of knowledge of current CD4 count, and of knowledge of current viral load. The two groups differed by race and computer access. There was no difference in the current CD4, provider satisfaction, Health Care Empowerment Inventory score, satisfaction with provider-patient communication, satisfaction with courteous and helpful staff, knowledge of ART, or ART adherence. The use of electronic personal health records is associated with positive clinical and behavioral characteristics. The use of these systems may play a role in improving the health of people with HIV. Larger studies are needed to further evaluate these associations.
                Cover page: A pilot study to evaluate the magnitude of association of the use of electronic personal health records with patient activation and empowerment in HIV-infected veterans
                • Article
                • Peer Reviewed
                UC San Francisco Previously Published Works (2016)

                Purpose

                The purpose of the study was to describe perception of risk for developing diabetes among foreign-born Spanish-speaking US Latinos.

                Methods

                Participants (N = 146), recruited at food-pantry distribution events and free clinics, were surveyed using the Risk Perception Survey for Developing Diabetes in Spanish. Type 2 diabetes risk factors measured included body mass index, physical activity, and A1C.

                Results

                Sample characteristics were mean (SD) age of 39.5 (9.9) years, 58% with less than a high school graduate-level education, and 65% with a family income less than $15,000/year. Prevalence of risk factors was 81% overweight or obese, 47% less than 150 minutes/week moderate/vigorous-intensity physical activity, and 12% A1C consistent with prediabetes. Of the 135 participants with complete data, 31% perceived a high/moderate risk for developing diabetes. In univariate logistic regression analyses, 9 of 18 potential variables were significant (P < .05) predictors of perception of risk. When these 9 variables were entered into a multiple logistic regression model, 5 were significant predictors of perception of risk: history of gestational diabetes, high school graduate or above, optimistic bias, worry, and perceived personal disease risk.

                Conclusions

                Use of the Spanish-language translation of the Risk Perception Survey for Developing Diabetes revealed factors influencing perception of risk for developing diabetes. Results can be used to promote culturally acceptable type 2 diabetes primary prevention strategies and provide a useful comparison to other populations.
                  Cover page: Perception of Risk for Developing Diabetes Among Foreign-Born Spanish-Speaking US Latinos.
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